BOARD MEETING · Advisory Committees with Public Excluded 08/06/16 That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result

BOARD MEETING

Wednesday 29th June 2016

9.45am

Note:

Public Excluded Session 9.45am to 12.15pm

Open meeting from 12.45pm

AGENDA

Items to be considered in public meeting

VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna

1

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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Waitemata District Health Board, Meeting of the Board 29/06/16

MEETING OF THE BOARD – 29th June 2016

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Tce, Takapuna Time: 09.45 am

WDHB BOARD MEMBERS Lester Levy - Chair Max Abbott - WDHB Board Member Kylie Clegg – WDHB Board Member Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Tony Norman - WDHB Deputy Chair Morris Pita - WDHB Board Member Christine Rankin - WDHB Board Member Allison Roe - WDHB Board Member Gwen Tepania-Palmer - WDHB Board Member

WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Chief Medical Officer Simon Bowen - Director Health Outcomes 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 - Board Secretary

APOLOGIES: James Le Fevre 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

TIME 09.45a.m (please note agenda item times are estimates only and that the public excluded session is from 09.45am-12noon) 12.45pm After Hours Care, West Auckland (John Tamihere, Chief Executive, Te Whanau o Waipareira Trust) 1. AGENDA ORDER AND TIMING

09.45am 2. RESOLUTION TO EXCLUDE THE PUBLIC ............................................................................................ 6 3. BOARD MINUTES 12.50pm 3.1 Confirmation of Minutes of the Meeting of the Board (25/05/16) ................................................. 12 Actions arising from previous meetings..................................................................................... 23

12.53pm 4. CHAIR’S REPORT.............................................................................................................................. 24

5. EXECUTIVE REPORTS 12.55pm 5.1 CEO’s Report.................................................................................................................................... 55 1.00pm 5.2 Health and Safety Report ................................................................................................................ 73 1.05pm 5.3 Communications Report .................................................................................................................. 90

6. DECISION PAPERS 1.10pm 6.1 Primary Birthing Facility Consultation Outcome ............................................................................. 96 1.25pm 6.2 2017 Board and Committee Meeting Schedule ............................................................................ 150

7. PERFORMANCE REPORT 1.30pm 7.1 Financial Performance ................................................................................................................... 153

8. COMMITTEE REPORTS 1.35pm 8.1 Hospital Advisory Committee Meeting (25/05/16) ....................................................................... 170 8.2 Auckland and Waitemata DHBs’ Community and Public Health Advisory Committees Meeting

(08/06/16) ..................................................................................................................................... 180

9. INFORMATION PAPERS 1.35pm 9.1 Health and Safety Markers Report ................................................................................................ 188 1.40pm 9.2 Bowel Screening Pilot Update ....................................................................................................... 205 1.45pm 9.3 Waitemata Healthy Food and Drink Policy ................................................................................... 214 1.50pm 9.4 Waitemata DHB and the Auckland Regional Tissue Bank ............................................................. 236

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Waitemata District Health Board

Board Member Attendance Schedule 2016

Apologies given *Attended part of the meeting only # Absent on Board business ^ Leave of Absence

NAME FEB APRIL MAY JULY AUG SEPT NOV DEC

Dr Lester Levy (Chair)

Max Abbott

Sandra Coney

Warren Flaunty

James Le Fevre

Anthony Norman (Deputy Chair)

Morris Pita

Christine Rankin *

Allison Roe *

Gwen Tepania-Palmer

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REGISTER OF INTERESTS

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy - Board Chairman

Chair – Auckland District Health Board Chairman – Auckland Transport Chairman – Health Research Council Independent Chairman – Tonkin & Taylor Chief Executive – New Zealand Leadership Institute Professor of Leadership – University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework

03/02/16

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

Kylie Clegg Board Member – Hockey New Zealand Trustee and Chairman – the Hockey Foundation Trustee and Beneficiary – Mickyla Trust Trustee and Beneficiary – M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Trustee and Beneficiary of M&K Investments Trust (owns 99% share in MC Capital Ltd, MC Securities Ltd and MC Acquisitions Ltd)

25/11/15

Sandra Coney Chair – Waitakere Ranges Local Board, Auckland Council 12/12/13

Warren Flaunty Member – Henderson - Massey and Rodney Local Boards, Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder – Green Cross Health Owner – Life Pharmacy North West Director – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Director - Trusts Community Foundation Ltd

25/11/15

James Le Fevre Emergency Physician – Auckland Adults Emergency Department Pre-hospital Physician – Auckland HEMS – ARHT/Auckland DHB Co-opted Member – Whanganui District Health Board Hospital Advisory Committee Trustee – Three Harbours Foundation Member – Association of Salaried Medical Specialists Shareholder – Pacific Edge Ltd James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine

12/08/15

Anthony Norman – Deputy Board

Chairman

Board Chair - Northland DHB Director - Health Alliance NZ Ltd Director - Health Alliance (FPSC) Ltd Trustee and Treasurer - Kerikeri International Piano Competition Trust Partner - Mill Bay Haven, Mangonui (accommodation provider)

05/11/14

Morris Pita Board Member – Auckland District Health Board Owner/operator – Shea Pita and Associates Limited Shareholder – Turuki Pharmacy Limited Wife is member of the Northland District Health Board

13/12/13

Christine Rankin Member - Upper Harbour Local Board, Auckland Council Director - The Transformational Leadership Company

15/07/15

Allison Roe Member – Devonport-Takapuna Local Board, Auckland Council Chairperson – Matakana Coast Trail Trust

02/07/14

Gwen Tepania-Palmer

Chairperson- Ngatihine Health Trust, Bay of Islands Life Member – National Council Maori Nurses Alumni – Massey University MBA Director – Manaia Health PHO, Whangarei Board Member – Auckland District Health Board Committee Member – Lottery Northland Community Committee

10/04/13

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2 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

Ground(s) under Clause 32 for passing this resolution

1. Minutes of the Meeting of the Board with Public Excluded 25/05/16

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.

2. Minutes of the Hospital Advisory Committee with Public Excluded 25/05/16





3. Minutes of the Audit and Finance Committee with Public Excluded 08/06/16



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)]

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4. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees with Public Excluded 08/06/16





5. Minutes of the Wilson Home Trust 08/04/16



Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:

i) would disclose a trade secret; or ii) would be likely to unreasonably

prejudice the commercial position of any person who supplied, or who is the subject of, such information.

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

6. Minutes of the Wilson Home Trust 22/04/16



Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:




7. Knee Replacement System



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)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:


prejudice the commercial position of any person who supplied, or

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who is the subject of, such information.


8. Colonoscopy and Gastroscopy



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)] Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:

iii) would disclose a trade secret; or iv) would be likely to unreasonably



9. Storage and Dispensing



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)]

10. Business Case 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.




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

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S.9 (2) (j)]




13. Primary and Community Services Plan




14. Capital Budget 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.




15. Long Term Investor Plan



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)]

16. Lease 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

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,

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section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


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.


17. Carparking 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.



18. Service Configuration



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)]

19. Migrant Health Contract





20. Funding Contracts That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the

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

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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.


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

21. Way-finding Upgrade




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3.1 Confirmation of Minutes of the Board meeting held on 25th May 2016 Recommendation: That the Minutes of the Board meeting held on 25th May 2016 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Wednesday 25 May 2016

held at Waitemata DHB, Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 9.36am

PART I – Items considered in public meeting BOARD MEMBERS PRESENT:

Lester Levy (Board Chair) Max Abbott Kylie Clegg Sandra Coney James Le Fevre Tony Norman (Deputy Board Chair) Morris Pita Gwen Tepania-Palmer ALSO PRESENT:

Andrew Brant (Acting Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Debbie Holdsworth (Director Funding) Simon Bowen (Director Health Outcomes) Cath Cronin (Director of Hospital Services) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director of Human Resources) Peta Molloy (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:

Lynda Williams (Auckland Womens Health Council) (present from 11.19am)

APOLOGIES:

Apologies were received and accepted from Warren Flaunty, Christine Rankin, Allison Roe and Dale Bramley, together with an apology for late arrival from Sandra Coney.

WELCOME

The Board Chair welcomed those present.

The Board Chair and Board acknowledged and thanked Paul Garbett for his work and support in his role as Board Secretary and wished him all the very best in his retirement.

DISCLOSURE OF INTERESTS

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

There were no declarations of interest relating to the open section of the agenda.

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1 AGENDA ORDER AND TIMING

Items were taken in same order as listed in the agenda.

The public excluded session was held first, from 9.42am to 11.19am

2 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 6-9)

Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer)






1. Minutes of the Meeting of the Board with Public Excluded 06/04/16





2. Minutes of the Hospital Advisory Committee with Public Excluded 06/04/16





3. Minutes of Manawa Ora with Public Excluded 20/04/16




4. Minutes of the Audit and Finance Committee with Public Excluded 27/04/16

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

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

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section 9 (2) (g) (i)) of the Official Information Act 1982.


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.


5. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees Meeting 27/04/16





6. Minutes of the ADHB-WDHB Collaboration Committee 24/02/16



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. Minutes of the Waitemata 2025 Special Committee of the Board


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

15







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

8. Minutes of the Waitemata 2025 Special Committee of the Board





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)]

9. Minutes of the Three Harbours Health Foundation



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.


10.Minutes of the Wilson Home Trust 26/02/16

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

Confidence

The disclosure of information would not be in the public interest because of the greater need to protect information

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exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


which if made available:

i) would disclose a trade secret; or

ii) would be likely to unreasonably prejudice the commercial position of any person who supplied, or who is the subject of, such information.


11. Leapfrog Programme 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.



12. Waitemata 2025 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.


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)] 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)]

13. Draft Annual Plan 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


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Information Act 1982.



14. Short Stay Ward, North Shore Hospital



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.


15. Draft Primary and Community Services Plan




16. Finance 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.






Carried

9.42am – 11.19am – public excluded session. 11.19am -12.10pm open session.

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3 BOARD MINUTES

3.1 Confirmation of Minutes of the Board Meeting held on 06th April 2016 (agenda pages 10-26) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg)

That the minutes of the Board meeting held on 06th April 2016 be approved.

Carried Actions arising from previous meetings (agenda page 27)

No issues were raised.

4 CHAIR’S REPORT

The Board Chair did not raise any matters at this point in the meeting.

5 EXECUTIVE REPORTS

5.1 Chief Executive’s Report (agenda pages 28-45)

Dr Andrew Brant (Acting Chief Executive) summarised the report, matters highlighted included:

That the Court of Appeal issued its decision in favour of the Waitemata DHBs Smokefree Policy. In response to a query about this matter later in the meeting, it was noted that it is the hospital sites that are smoke free and that people can leave the site and that this does occur.

There are a number of electronic clinical projects underway which are very innovative for the health sector. ePrescribing continues with 650 beds now covered.

Waitemata DHB showed improvements in the National Inpatient Survey.

The Friends and Family Test had a very pleasing 65% increase in response rate following roll out of the Friends and Family postcards. Reports continue to show that being welcoming and friendly is important to the patient experience.

The Board Chair noted that with regard to the Sky Bridge on the North Shore Hospital site and access by double decker buses that double decker buses will not travel on the hospital sites as they are only used for rapid transit and arterial routes. There is regulation around roads that double decker buses can travel on.

The Board Chair also noted the recent opening of the Department of Medicine and encouraged Board members to visit. The Department is a real exemplar of what can be done to provide appropriate facilities for people to retire to; the area is bright, light and spacious. Andrew Brant further noted that it is also a collaborative environment, connecting teams together.

A video of the Well Foundation was viewed.

The report was received.

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5.2 Health and Safety Performance Report – May 2016 (agenda pages 46-66)

Fiona McCarthy (Director, Human Resources) was present for this item.

The Auckland DHB and Waitemata DHB Health and Safety video was viewed. Fiona McCarthy thanked the Board Chair for his role in the video.

Fiona McCarthy summarised the report and matters highlighted and responses to questions included:

That a number of Health and Safety site visits were held in May, the Board Chair and Chief Executive completed visits of both the North Shore Hospital and Waitakere Hospital sites. The Board also undertook a visit on the 18th May around hazardous substances. Kylie Clegg expressed her thanks for the visit noting that it gave a real sense of size and scale of the work involved. Morris also acknowledged the opportunity to visit sites that are not normally seen; in particular he noted the hazardous substances safe room and concern that the DHB does not have a similar room at Waitakere Hospital. In response, Fiona noted that a business case for a dangerous good store at Waitakere Hospital is underway.

That the top three accident types (aggression; slips, trips and falls and patient handling) while not increasing are also not decreasing, more attention is being paid to these areas, robust targets set and identification of actions to meet those targets.

That in response to a question it was noted that the new Hazardous Substances Co-ordinator commenced on 2nd May. The Co-ordinator will recommence the auditing of the 33 high use areas and another 250 areas that use chemicals; the audits will occur over the next 18 months.

That in response to a question, Debbie Holdsworth noted that she had meant with John Rooney (Simpson Grierson) following his external review of the DHB’s plan regarding Funder contracts and an external review of the draft capability assessment. John Rooney has identified a number of areas which he considered low risk. The Board Chair noted the need to be prudent and include a clause in the DHBs contracts.

Fiona drew the Board’s attention to the recommendation for the Board to endorse version two of the notifiable event process.

The Board Chair noted the recent health and safety site visits he had undertaken at both the Waitemata and Auckland DHB hospital sites. A key issue highlighted is around staff identification of work that needs to be done to improve an area and the delay for the work to be completed. The Board Chair has requested that a process be put in place to fast track work required; this needs to be a facilitative process with perhaps two Board members and three executive members delegated to approve any health and safety improvement work of up to say $2million in cost. Fiona McCarthy and Robert Paine were requested to formalise this process.

Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg)

a) That the report be received.

b) That the notifiable event process is endorsed (Appendix 1).

Carried

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5.3 Communications (agenda pages 67-73)

Matt Rogers (Director of Communications) was present for this item. He noted that that there had been a cluster of adverse reports which were predominately around anti-natal care and featured in a number of media outlets. The report was received.

6 DECISION PAPERS

There were no decision papers. 7 PERFORMANCE REPORTS

7.1 Financial Performance (agenda pages 74-88)

Robert Paine (Chief Financial Officer) presented this item and responded to general questions, it was noted that a table will be provided to the Board demonstrating the long term asset management plan.

Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the following performance reports for the month and attachments be received:

1 Financial Overview of the 2015/16 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury

Carried

8 COMMITTEE REPORTS (agenda pages 89-139)

8.1 Auckland DHB and Waitemata DHB Disability Support Advisory Committees Meeting 09th March 2016 Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer)

That the draft minutes of the Disability Support Advisory Committee meeting held on 09th March 2016 be received.

Carried

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8.2 Hospital Advisory Committee Meeting held on 06th April 2016

Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer)

That the draft minutes of the Hospital Advisory Committee Meeting held on 06th April 2016 be received.

Carried

8.3 Auckland and Waitemata DHBs’ Community and Public Health Advisory

Committees Meeting held on 27th April 2016

Resolution (Moved James Le Fevre/Seconded Gwen Tepania-Palmer) That the draft minutes of the Community and Public Health Advisory Committee meeting held on 27th April 2016 be received.

Carried

9 INFORMATION PAPERS 9.1 Health and Safety Marker Report - Update April 2016 (agenda pages 140-155)

Fiona McCarthy noted that good progress is being made, with required actions continuing to be completed. The Board Chair noted the report as being very helpful. Resolution (Moved Tony Norman/Seconded Max Abbott) That the report be received.

Carried

The Chair thanked those present. The meeting concluded at 12.08 pm SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 25 MAY 2016 ________________________________CHAIR

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Actions Arising and Carried Forward from Previous Board Meetings as at 23 June 2016

Meeting Date

Agenda Ref

Topic Person Responsible

Expected Report back

Comment

24/02/16 9.1 Health and Safety Markers

- To check whether medical trials in hospitals come under the new Health and Safety legislation

Fiona McCarthy To be discussed with Worksafe and MoH in May. A verbal report may be available at the meeting.

- A more comprehensive update to be provided for the Board on asbestos risk in the DHB.

Fiona McCarthy Actioned - information on asbestos management including comment on the new regulations and our asbestos management plan went to the April Audit and Finance Committee meeting.

25/05/16 5.2 Health and Safety Performance Report

Health and Safety facilities group (x2 Board members x3 executive) with delegated authority to approve any health and safety improvement work.

Fiona McCarthy/

Robert Paine

20/07/16 Audit and Finance Committee

Verbal update to be provided at 29/06/16 Board meeting. Paper to be submitted to 20/07/16 Audit and Finance Committee meeting.

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26

The Controller and Auditor-General

Tumuaki o te Mana Arotake

Good Practice for Managing

Public Communications by

Local Authorities

April 2004

27

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ISBN 0-478-18117-5

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Foreword

We first published our Suggested Guidelines for Advertising and Publicity by Local Authorities in 1996. We published a revised version of those Guidelines in 1999.

Since 1999, a number of factors have contributed to significant change in the environment in which local authorities are involved in “advertising and publicity”. Probably the two major factors are the advances in communications technology and the rate of adoption of the new technology, and (more recently) the enhanced requirements for communication in the Local Government Act 2002. We saw as a consequence of that significant change the clear need to revisit the Guidelines to reassess their validity and determine what changes might be needed to preserve their usefulness. This publication reflects the fresh approach we have taken to the subject – still principles-based, but with an emphasis on the wider concept of “communication” rather than “advertising and publicity”.

As previously, this update represents what we believe is a code of good practice. The guidance it contains is no more authoritative than that. Further, the guidance is intended neither to be an operating manual nor to cover every conceivable situation. Local authorities will have to determine what practical application they make of our good practice guidance in particular situations. To do so, and to reflect the more open approach to disclosing how local government manages itself, we recommend that the adoption and application of the guidance in this publication be incorporated in a formal communications policy.

K B Brady Controller and Auditor-General 14 April 2004

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Contents Page 1 Introduction 7 The importance of Council communications 7 Why this guide? 7 The objects and scope of the guide 8 What is the status of the guide? 9 2 Scope – What are “Communications”? 10 3 Communications – Whose Responsibility? 12 4 Principles and Practice 14 Legitimacy and justification 14 Collective position 16 Standards of communication 17 Consultation and public debate 17 Communications by Members 19 Members’ personal profile 21 Communications in a pre-election period 22 5 Other Commonly Arising Issues 25 Use of surveys and market research 25 Joint ventures and sponsorship 25 Appendices – 1 Principles of the Local Electoral Act 2001 27 2 Statistics New Zealand Principles Applicable to the Production of Official Statistics 28

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1 Introduction

The importance of Council communications 1.1 Communication with the public is a major part of any Council’s activities. It

can consume large amounts of ratepayers’ money. 1.2 Some types of public communications are mandatory – for example,

notifying Council meetings, or issuing a statutory plan for consultation. Others are discretionary – for example, a Council-funded newsletter, a media release explaining a recent decision, or a pamphlet about disposal of household waste.

1.3 Councils communicate with the public by many different means. For any

communication, a Council has a broad range of choices – both as to the medium to be used (e.g. whether to pay for newspaper advertising or use the Council’s web site) and the degree of sophistication involved.

1.4 Choice introduces judgment and subjectivity. The dilemma of the

communicator is in reconciling the potentially conflicting criteria of:

• making the communication attractive so that the audience will give it their attention, absorb it, understand it, and (if that is what is expected) act on it;

• meeting acceptable standards of probity; and

• presenting accurate, complete, and fairly expressed information.

1.5 The skill required of the communicator is to observe the relevant principles

and apply the highest possible standards, and, importantly, to learn from experience.

Why this guide? 1.6 Communication of information at public expense or in an official capacity

always carries the risk of criticism. The commonest complaints (except for statutory notifications) are that a communication is unnecessary, unbalanced, or politically biased. The best defence to any complaint is that the communication meets acceptable standards.

1.7 The Auditor-General is often asked to express a view on whether a particular

communication is acceptable. Some requests come from the Council, before publication. Others come from members of the public afterwards, complaining about what has been done.

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1.8 Until 1996, there was no authoritative guidance as to what standards were acceptable in Council communications. Our suggested guidelines – first published in that year, and now updated for the second time – have aimed to fill that vacuum. Just as we bring an independent perspective to our job as the auditor of local authorities, we try to describe good practice that reflects not only the theory and practice of communications but also the expectations of the public.

1.9 We derive our guidance from:

• our knowledge of the kinds of official communications that may cause concern in both the central and the local government sectors;

• our experience, not only in giving help to communicators but also in

dealing with complaints from the public; and

• our consultations with a range of Council communications staff and advisers and with Local Government New Zealand.

1.10 The feedback we received from our consultations was that independent

guidance is a valuable and necessary aid, not only for Council Members but also for communications staff and advisers. Guidance can:

• provide a general framework for the conduct of a Council’s

communications activities;

• help with clarifying roles and responsibilities – especially as between Members and communications staff and advisers; and

• set benchmarks for particular types of communications – especially as to

what is acceptable in the political context and at critical times such as during a pre-election period.

The objects and scope of the guide

1.11 The statements of good practice in this guide are designed to meet three

objectives in relation to a Council’s communications practices:

• to ensure that Council communications resources are applied effectively and efficiently, and in a manner that produces good value for money;

• to ensure that those who are permitted to use Council communications

facilities do so for legitimate purposes; and

• to promote appropriate standards of conduct by those who consume Council communications resources, or use Council facilities, or otherwise communicate on behalf of the Council.

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1.12 This wide scope is consistent with our role as the auditor of local authorities, which includes examining the extent to which they, and their members and staff: • carry out activities effectively and efficiently, consistent with Council’s

own policies;

• comply with statutory obligations;

• avoid wasteful use of resources; and

• act with probity and financial prudence.1

1.13 The guide itself is produced under the authority of section 21 of the Public Audit Act, as a report on matters arising out of the performance and exercise of those functions.

What is the status of the guide? 1.14 Our guidance is not binding on Councils. Each Council is free to adopt its

own standards – which must of course be consistent with the relevant principles of the Local Government Act 2002 (LGA).2

1.15 We recommend that every Council consider adopting a formal

communications policy framed to suit its particular needs. The policy should:

• embrace these guidelines – or a variation of them (stricter or otherwise)

that the Council considers appropriate to its circumstances; and

• clearly direct Members and communications staff and advisers3 on how the policy is to be applied in particular cases.

1.16 Although this guide is not binding on Councils, they and the public should be

aware that it establishes the criteria that we will use in future in order to form a view on the appropriateness of a Council’s public communications.

1 Public Audit Act 2001, section 16. 2 Section 14 of the LGA. 3 Including those engaged as consultants.

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2 Scope – What are “Communications”? 2.1 Our guidance applies to any communication by a Council, or a Member or

employee or office holder of a Council, or a Member of a Community Board, where:

• the Council meets the cost (wholly or in part); or

• the person making the communication does so in an official capacity on

behalf of the Council or a Community Board. 2.2 We make no distinction between:

• mandatory and discretionary communications;

• communications in the Council’s own publications and the news media generally;

• Council-funded advertisements and other forms of publicity; or

• electronic (including web site or e-mail) and hard copy publication. The underlying principles are the same in each case.

2.3 Common examples of communications by Councils include:

• statutory documents – such as draft, final, and summary versions of the Long Term Council Community Plan or an Annual Report under the LGA;

• information on a web site, or in a poster or pamphlet, about Council

services available to the public, or the rights, entitlements, and responsibilities of people affected by a Council activity;

• newspapers and newsletters reporting Council news and activities;

• material explaining a particular proposal, decision, policy, or bylaw of

the Council;

• marketing material promoting the Council, its communities, or a regional brand;

• Council-funded advertising about a particular event, proposal, or Council

policy;

• educational material about issues affecting the community; and

• media releases initiating or responding to public comment about matters affecting the Council or its communities.

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2.4 In a different category are communications by Members using Council

resources or facilities. We address this type of communication in paragraphs 4.33-4.40 on pages 19-20.

2.5 The guide does not apply to:

• normal day-to-day correspondence between Members and their constituents on appropriate matters, except during a pre-election period when the content of the correspondence should not be inconsistent with Principle 12 on page 22; and

• communications by Members using their own resources.

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3 Communications – Whose Responsibility? 3.1 Corporate governance principles stress the different roles of the governing

body and the management of an organisation. For local authorities, section 39 of the LGA reflects these principles.

3.2 Members (i.e. the governing body) and management of a Council share

different elements of the communications function. In essence:

• Members are accountable to the community for the Council’s decisions and actions. What the Council says in its communications is, therefore, ultimately the Members’ responsibility.

• The mechanics of communications are operational activities, which form

part of the everyday business of the Council. Moreover, effective communication often requires professional input. Most Councils employ (or engage on contract) professional advice and assistance for some or all of their communications activities. The chief executive is responsible for the effective and efficient management of those people and their activities.

• Communications is also an area of risk. Those who are authorised to

communicate on behalf of a Council, and those who exercise editorial or quality control, need to have access to sources of professional advice when necessary (including legal and strategic communications advice). Obtaining that advice is also a management responsibility.

3.3 The communications function thus straddles the divide between governance

and management in the Council organisation. Each Council should allocate the respective roles and responsibilities according to its own size and needs. For example, in a small Council the Mayor might be the primary spokesperson on all issues, whereas in a larger Council the role might be shared between the Mayor and a communications manager.

3.4 The governance/management divide also affects the crucial elements of

policy development, quality control, and editorial supervision. We think these elements are best regarded as management functions, for which the chief executive is responsible.

3.5 The respective roles and responsibilities need to be well understood by all

concerned and put into practice effectively.4 This is especially important when the Council employs professional communications staff – who could, for example, feel undermined by Members intervening in editorial decisions.

4 See section 39(e) of the LGA. The local governance statement required by section 40 of

the LGA could be the appropriate place to record particulars of the division of roles and responsibilities.

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3.6 A useful approach is to regard the roles of Members and management as complementary, and to encourage everyone to work together in partnership for the good of the Council and the community.

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4 Principles and Practice 4.1 In this section we set out 13 principles that we believe should underpin a

Council’s policy and practice on communications. We supplement each of the principles with commentary.

4.2 We stress that the principles are intended as general statements, which are to

be applied in a flexible and common sense manner. Likewise, the commentary cannot expect to foresee all possible situations that might arise.

Legitimacy and justification

Principle 1 – A Council can lawfully, and should, spend money on communications to meet a community’s (or a section of a community’s) justifiable need for information about the Council’s role5 and activities.

4.3 Communications are a necessary and legitimate Council expense. Councils

are also justified in employing, or otherwise engaging, professional advice and assistance for their communications activities.

4.4 However, no communication should be undertaken without justification or

regard for the cost. 4.5 The main elements of justification are:

• establishment of an identifiable need for information on the part of a particular audience;

• the chosen method of communication should be one that is effective in

reaching those who have the need; and

• once the method has been identified, the communication should be made in the most cost-efficient manner.

4.6 Consideration should also be given to evaluating the effectiveness of the

communication. What is known to have been an effective communication supports the justification for that communication and can be a benchmark to support future communications.

5 The role of a local authority is to—

(a) give effect, in relation to its district or region, to the purpose of local government …; and

(b) perform the duties, and exercise the rights, conferred on it by or under this Act and any other enactment.

(LGA, section 11)

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4.7 A communication will be lawful when it:

• is authorised by a Council resolution or under a delegation; and

• complies with any specific legal requirements as to form, content6, timing, or method of publication7.

4.8 A Council can also exercise significant power over individuals and groups in

the community. Consequently, a Council has an obligation to ensure those people know how they are being affected by the Council’s actions, and what their rights and responsibilities are in relation to those actions.

4.9 Council communications are all the more important in the environment of the

LGA. Consultation with the community is fundamental to the working of the Act, and effective communication is vital to effective consultation.

Principle 2 – Communications should be consistent with the purpose of local government8 and in the collective interests of the communities the Council serves.

4.10 A Council is a corporate entity, with statutory role and purpose. The role and purpose include promoting the well-being of communities in its district or region. A Council may serve many communities, both in the geographical sense and in the sense of communities of interest. It should always act within the scope of its role and purpose, and in the collective interests of its communities.

4.11 Sometimes, a Council will need to communicate with only some of its

communities about a particular issue, or with part of a community. But it should always be able to justify any communication as being in the collective interests of them all.

6 Including the avoidance of defamatory comment, or misleading or deceptive conduct

under the Fair Trading Act 1986. 7 E.g. use of the special consultative procedure under the LGA. 8 The purpose of local government is—

(a) to enable democratic local decision-making and action by, and on behalf of, communities; and

(b) to promote the social, economic, environmental, and cultural well-being of communities, in the present and for the future.

(LGA, section 10)

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Principle 3 – Communications should comply with any applicable Council policies and guidelines as to process (including authorisation) and content.

4.12 We encourage all Councils to adopt a policy on communications: see

paragraph 1.15 on page 9. Collective position

Principle 4 – Communications on Council policies and decisions should reflect the collective position of the Council.

4.13 Wherever possible, the Council should “speak with one voice”, and its

communications should represent the corporate or collective position. 4.14 A communication by an authorised spokesperson appointed by the Council

(whether that person is a Member or an employee) should identify that person in his or her official capacity (for example, as a Committee chairperson). The purpose of the communication should always be to meet the Council’s, not the spokesperson’s, communications objectives. The person responsible should be careful to ensure that what is being said is portrayed as the Council’s position, not the personal views of the spokesperson.

4.15 Some Councils allow the Mayor to produce a regular “column” in a Council-

funded or other local publication, or to make regular broadcasts on local radio or television. The purpose of such communications should be to give voice to the Council’s corporate position on its activities, through the elected leader.

4.16 Communication of a Member’s personal perspective, views or opinions

(including in a regular “column”, broadcast, etc) should be the exception rather than the rule, and should be subject to Principles 9 to 11 (see pages 19-21).

Principle 5 – Communications on Council business should always be clearly attributed to the Council as the publisher.

4.17 A communication might, for example, identify the Council by reference to

the name of the Council or by use of its corporate logo. A communication designed to meet the Council’s statutory obligations (such as a draft annual plan) should not only say who authorised its publication (usually the chief executive officer) but also identify the statutory provision under which it is being published.

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4.18 For commentary about the identification of sponsors, see paragraphs 5.3-5.7 on pages 25-26.

Standards of communication

Principle 6 – Factual and explanatory information should be presented in a way that is accurate, complete, fairly expressed, and politically neutral.

4.19 Accurate means what it says. That which is held out to be true should be

founded on ascertainable facts, and be carefully and precisely expressed consistently with those facts. No claim or statement should be made that cannot be substantiated.

4.20 A communication will be complete when it consists of all the information

necessary for the audience to make a full and proper assessment of the subject matter.

4.21 Information will be fairly expressed when it is presented in an objective,

unbiased, and equitable way. In particular:

• the audience should always be able to distinguish facts from analysis, comment, or opinion; and

• when making a comparison, information should state fully and accurately

the nature of what is being compared, and inform the audience of the comparison in a way that does not mislead or exaggerate.

4.22 Information will be politically neutral when it presents the Council’s

collective position, or, where there is no collective position, sets out the issues in a manner that does not refer to the positions taken by any individual Member or political party or group of Members.

Consultation and public debate

Principle 7 – Communications about matters that are under consideration by the Council, or are otherwise a matter of public debate, should present the issues in an even-handed and non-partisan way.

4.23 Communications about matters that will be the subject of a future decision by

the Council should be distinctly different from those that follow a decision.

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4.24 In the “before” phase, all relevant facts and other considerations should be taken into account, and all significant points of view should be aired. The aim is to enable the Council to make itself aware of, and then to have regard to, the views of all its communities in relation to a particular decision9, while also meeting all its statutory obligations in respect of consultation10.

4.25 In particular, a “before” phase communication should:

• avoid the appearance and reality of bias or pre-determination – especially when summarising facts or arguments;

• present the issues in an objective manner, avoiding subjective opinion or

comment; and

• mention both the advantages and the disadvantages of particular options. 4.26 Mention of individual Members’ or political parties’ positions should always

be avoided. 4.27 In the “after” phase, the emphasis should be on what has been decided and its

implications for the Council and its communities. 4.28 This principle applies whether the purpose of the communication is to satisfy

LGA requirements, or otherwise.

Principle 8 – If engaging in public debate with an interest group or a section of the community, a Council should use the news media (rather than a Council funded publication) and designated spokespersons (rather than professional communications advisers) unless there is a particular justification for not doing so.

4.29 A Council may be justified in responding to publicity that is unfair,

unbalanced, or inaccurate. The object should be to put the record straight, including a measure of rebuttal.

4.30 But it is important to keep a balance and perspective. Council resources

should not be used merely to engage in a public argument. 4.31 The preferred approach in such cases should be to make use of the news

media, through release and publication of a written statement or making an authorised spokesperson available for interview. Use of Council-funded publications or professional advisers to engage in debate with interest groups could create the perception that Council resources are being used for the benefit of one section of the community against another, or in a way that results in an unequal public relations contest.

9 LGA, sections 14(1)(b) and 78. 10 LGA, sections 82-90.

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4.32 An example of where a Council-funded publication to engage with an interest group could be justified is when the group has issued public statements encouraging citizens to commit acts of civil disobedience or to actively break the law.

Communications by Members

Principle 9 – If the Council’s Communications Policy permits them, communications by Members of their personal perspective, views or opinions (as opposed to communication of Council matters in an official capacity) should: • be clearly identified as such; and

• be confined to matters that are relevant to the role of

local authorities11. 4.33 Members are collectively responsible for Council decisions. Communication

of Council business to the community often falls to a designated spokesperson. See Principle 4 and paragraphs 4.13-4.15 on page 16.

4.34 But Members are also individually responsible to the communities that

elected them. It is for the Council to decide whether and, if so, on what terms to make resources available to Members to communicate with constituents or the wider community in their capacity as individual Members.

4.35 An example of a communication that could involve a Member expressing

personal views is a “Members’ column” in a Council-funded newspaper or on a Council web site.

4.36 It is important that the Communications Policy, and the relevant part of the

communications budget, also sets out clearly the limits in relation to such communications. The policy should say:

• What types of communications are permitted and in what circumstances,

and the range of permitted subject matter. • Whether the material can or should be subject to editing and, if so, by

whom. • What procedures apply in respect of authorisation, attribution, and

editorial and quality control. These are for the Council to determine. However, whether or not material is edited, the Member must formally subscribe to what is being published.

11 Under sections 10 and 11 of the LGA – see footnotes 5 (page 14) and 8 (page 15).

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4.37 Note, however, that a Member’s freedom to talk about Council business is subject to confidentiality requirements (such as under Standing Orders) and the Council’s Code of Conduct – especially as regards Members’ conduct towards each other and their disclosure of Council information.12

4.38 Here are our views on some other examples of a Member communicating

personally:

• It is not appropriate for a Member to use a Council newsletter or web site to express views on a matter of central government responsibility (such as defence and foreign relations) that has no direct bearing on the Council’s activities.

• It may be appropriate (but only when the Council is undertaking no

formal consultation process) for a Member to use Council facilities to consult with the public on an issue under consideration by the Council, or to explain his or her position on a contentious decision, but not to seek political support on an issue that the Council has not considered. References to, or the use of a logo or slogan of, a political party or grouping are unacceptable.

• Members should not be permitted to use Council communications

facilities for political or re-election purposes. (See Principles 12 and 13 on pages 22-24 for more information on communications in the pre-election period.)

• Staff protocols on the use of the Internet, e-mail, and other

communications facilities for personal purposes should also apply to Members. The minimal cost of allowing use of such facilities can easily be outweighed by the perception that public resources are being misused.

Principle 10 – Politically motivated criticism of another Member is unacceptable in any Council-funded communication by a Member.

4.39 Neither the inherently adversarial nature of much Council politics nor the

right of free speech can justify Council communications resources being used to enable one Member to engage in political debate with, or to criticise, another Member. Preventing such misuse should be an objective of the Council’s policy on where editorial control and the power to authorise communications should lie.

4.40 Members are, of course, free to use their own resources for such purposes.

12 LGA, Schedule 7, clause 15.

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Members’ personal profile

Principle 11 – Care should be exercised in the use of Council resources for communications that are presented in such a way that they raise, or could have the effect of raising, a Member’s personal profile in the community (or a section of the community). In permitting the use of its resources for such communications, the Council should consider equitable treatment among all Members.

4.41 Two related objectives underlie this principle:

• It is important that the public know who their Councillors are. Councils are justified in using, or in some circumstances permitting Members to use, Council facilities for communications that have the objective of raising a Member’s personal profile.

• Giving a “human face” to a piece of information can be an effective

communications strategy to attract attention and make the information relevant and understandable to its audience.

4.42 It is acceptable for Councils to use photographs of Members, personal

quotes/attributions, and other standard journalistic techniques provided they are consistent with these objectives. However, Councils need to bear in mind the inherent risks of favouritism and unequal treatment of members.

4.43 For example, a “photo opportunity” shot, in a Council-funded publication, of

a Mayor or Committee Chairperson announcing a Council decision helps to draw the reader’s attention to the decision, and thereby improve the effectiveness of its communication, but could also have an unintended and beneficial spin-off effect for the Member’s personal or political profile in the community.

4.44 Allowing Members representing a particular Ward to issue their own

newsletter to constituents could have a similar effect. There is nothing wrong with such an idea in principle. However, the principle of equitable treatment makes it important that the same communications opportunity is available to Members representing other Wards. Matters such as editorial and quality control and attribution should also rest with the Council’s communications staff in accordance with Council policy.

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Communications in a pre-election period13

Principle 12 – A local authority must not promote, nor be perceived to promote, the re-election prospects of a sitting member. Therefore, the use of Council resources for re-election purposes is unacceptable and possibly unlawful.

4.45 Promoting the re-election prospects of a sitting Member, directly or

indirectly, wittingly or unwittingly, is not part of the proper role of a local authority.

4.46 A Council would be directly promoting a Member’s re-election prospects if

it allowed the member to use Council communications facilities (such as stationery, postage, internet, e-mail, or telephones) explicitly for campaign purposes.

4.47 Other uses of Council communications facilities during a pre-election period

may also be unacceptable. For example, allowing Members access to Council resources to communicate with constituents, even in their official capacities as members, could create a perception that the Council is helping sitting Members to promote their re-election prospects over other candidates.

4.48 For this reason, we recommend that mass communications facilities such as –

• Council-funded newsletters to constituents; and

• Mayoral or Members’ columns in Council publications –

be suspended during a pre-election period. 4.49 Promoting the re-election prospects of a sitting Member could also raise

issues under the Local Electoral Act 2001. For example:

• Local elections must be conducted in accordance with the principles set out in section 4 of the Local Electoral Act – see Appendix 1 on page 27. The principles apply to any decision made by a Council under that Act or any other Act, subject only to the limits of practicality. A breach of the principles can give rise to an “irregularity” which could result in an election result being overturned.14

13 By “pre-election period” we mean the three months before the close of polling day for the

purposes of calculating “electoral expenses”: see Local Electoral Act 2001, section 104. However, a Council may decide to apply restrictions over a longer period.

14 See Aukuso v Hutt City Council (District Court, Lower Hutt, MA 88/03, 17 December 2003).

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• The publication, issue, or distribution of information, and the use of electronic communications (including web site and e-mail communication), by a candidate are “electoral activities” to which the rules concerning disclosure of electoral expenses apply.

4.50 “Electoral expenses”15 include:

• the reasonable market value of any materials applied in respect of any electoral activity that are given to the candidate or that are provided to the candidate free of charge or below reasonable market value; and

• the cost of any printing or postage in respect of any electoral activity.

4.51 A Member’s use of Council resources for electoral purposes could therefore

be an “electoral expense” which the Member would have to declare – unless it could be shown that the communication also related to Council business and was made in the candidate’s capacity as a Member.

Principle 13 – A Council’s communications policy should also recognise the risk that communications by or about Members, in their capacities as spokespersons for Council, during a pre-election period could result in the Member achieving electoral advantage at ratepayers’ expense. The chief executive officer (or his or her delegate) should actively manage the risk in accordance with the relevant electoral law.

4.52 Curtailing all Council communications during a pre-election period is neither

practicable nor (as far as mandatory communications, such as those required under the LGA, are concerned) possible. Routine Council business must continue. In particular:

• Some Councils publish their annual reports during the months leading up

to an October election, which would include information (including photographs) about sitting Members.

• Council leaders and spokespersons need to continue to communicate

matters of Council business to the public.

15 Also defined in section 104.

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4.53 However, care must be taken to avoid the perception, and the consequent risk of electoral irregularity, referred to in the commentary to principle 12. Two examples are:

• journalistic use of photographic material or information (see paragraph

4.42 on page 21) that may raise the profile of a Member in the electorate should be discontinued during the pre-election period; and

• access to Council resources for Members to issue media releases, in their

capacities as official spokespersons, should be limited to what is strictly necessary to communicate Council business.

4.54 Even if the Council’s Communications Policy does not vest the power to

authorise Council communications solely in management at normal times, it should do so exclusively during the pre-election period.

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5 Other Commonly Arising Issues Use of surveys and market research 5.1 Councils should target their communications resources to best effect. In

appropriate cases, professional advice should be sought, and soundly obtained survey and market research information may be used.

5.2 Councils should meet acceptable standards in survey and market research

information. To assist Councils to meet those standards:

• we reproduce in Appendix 2 on page 28 the ten principles identified by Statistics New Zealand underpinning its Protocols for Official Statistics; and

• they can find useful guidance in the Statistics New Zealand publication A

Guide to good survey design16. Joint ventures and sponsorship 5.3 Many Councils seek to be involved with their communities, and may engage

in collaborative ventures with other public agencies and business and community groups.17 Communication (for example, to promote public education or changes in people’s behaviour) may be a feature of such ventures.

5.4 There is no reason in principle why a Council should not join with another

agency or group to publish information for the benefit of the community – provided the activity is consistent with the Council’s role and purpose. The use of private or community sponsorship for a Council communication may be a feature of such co-operation.

5.5 Examples of joint communication could include:

• a joint venture with the Police to issue information about individual and community safety in the Council’s district; and

• the use of business sponsorship for a Council advertisement of a

community event.

16 ISBN 0-477-06492-2; revised July 1995. Copies can be ordered through the Statistics

New Zealand web site at: www.stats.govt.nz/domino/external/web/prod_serv.nsf/htmldocs/A+Guide+to+Good+Survey+Design+(2nd+edition)

17 Section 14(1)(e), LGA.

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5.6 The Council’s Communications Policy should, if the Council wishes to involve a partner, address:

• the types of communications for which joint ventures or sponsorship are

appropriate; and

• the controls and procedures designed to manage the associated risks – such as perception of Council “capture” by a business or community group, actual or potential conflict of interest, and community attitude to the nature of the problem.

5.7 As a minimum, the Communications Policy should:

• require all mandatory communications to be funded solely by Council;

• require every communication joint venture or sponsorship proposal to be supported by a sound business case that is approved at an appropriate level within the Council organisation;

• set out the criteria for selecting a communication joint venture partner or

sponsor, in order to avoid conflict of interest and prevent a partner or sponsor from gaining (or being perceived to gain) inappropriate commercial or political advantage;

• require both the Council and the joint venture partner or sponsor to

adhere to the principles (including those in respect of editorial control) that it has adopted in the Communications Policy; and

• contain clear guidance as to the placement of logos, slogans, and other

sponsorship references.

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Appendix 1 Principles of the Local Electoral Act 2001

4 Principles (1) The principles that this Act is designed to implement are the following: (a) fair and effective representation for individuals and communities: (b) all qualified persons have a reasonable and equal opportunity to– (i) cast an informed vote: (ii) nominate 1 or more candidates: (iii) accept nomination as a candidate: (c) public confidence in, and public understanding of, local electoral processes through– (i) the provision of a regular election cycle: (ii) the provision of elections that are managed independently from the elected body: (iii) protection of the freedom of choice of voters and the secrecy of the vote: (iv) the provision of transparent electoral systems and voting methods and the adoption of procedures that produce certainty in electoral outcomes: (v) the provision of impartial mechanisms for resolving disputed elections and polls. (2) Local authorities, electoral officers, and other electoral officials must, in

making decisions under this Act or any other enactment, take into account those principles specified in subsection (1) that are applicable (if any), so far as is practicable in the circumstances.

(3) This section does not override any other provision in this Act or any other enactment.

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Appendix 2 Statistics New Zealand Principles Applicable to the Production of Official Statistics

1 The need for a survey must be justified and outweigh the costs and

respondent load for collecting the data. 2 A clear set of survey objectives and associated quality standards should

be developed, along with a plan for conducting the many stages of a survey to a timetable, budget and quality standards.

3 Legislative obligations governing the collection of data, confidentiality,

privacy and its release must be followed. 4 Sound statistical methodology should underpin the design of a survey. 5 Standard frameworks, questions and classifications should be used to

allow integration of the data with data from other sources and to minimise development costs.

6 Forms should be designed so that they are easy for respondents to

complete accurately and are efficient to process. 7 The reporting load on respondents should be kept to the minimum

practicable. 8 In analysing and reporting the results of a collection, objectivity and

professionalism must be maintained and the data impartially presented in ways which are easy to understand.

9 The main results of a collection should be easily accessible and equal

opportunity of access is enjoyed by all users. 10 Be open about methods used; documentation of methods and quality

measures should be easily available to users to allow them to determine if the data is fit for their use.

A full copy of Protocols for Official Statistics can be obtained by contacting Statistics New Zealand through its web site www.stats.govt.nz .

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4.1 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:

The new Sky Bridge linking the main North Shore Hospital tower block with the Elective Surgery Centre (ESC) was officially opened by the Prime Minister, Rt Hon John Key, and the Minister of Health, Hon Dr Jonathan Coleman, on 21 June. The covered link between two of our major facilities is the latest major capital project completed by the DHB to meet the health care needs of the fastest-growing population in the country and is one of the key projects under our Waitemata 2025 10-year plan. Sky Bridge allows the DHB to perform a greater volume and complexity of surgeries at ESC as it allows for fast and direct patient transfers, with direct links to the high dependency and intensive care units in the main hospital. The project has come together very quickly, with works having only started in February. Sky Bridge promotes an integrated approach to patient care through faster patient transfers and an improved experience for those undergoing treatment in various hospital buildings. It also allows for increased staff transfers. Although the bridge is not available for general public access, whanau/family can accompany patients across the bridge during transfer. Sky Bridge follows the completion of other major construction projects, such as He Puna Waiora mental health inpatient facility, Hine Ora women’s ward, the new Department of Medicine and the Spiritual Centre. The next major project due for completion will be the Waitakere Hospital Emergency Department expansion, scheduled for August.

Prime Minister John Key and CEO Dr Dale Bramley officially opening the Sky Bridge

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During his visit to the North Shore Hospital campus, the Prime Minister also took the opportunity to communicate directly with Waitemata DHB staff. Mr Key’s CEO Lecture Series address outlined the Government’s policy direction for health care in New Zealand and how fast-growing populations like ours will access care into the future. More than 300 staff attended the lecture in-person and via video link to our Waitakere campus, making it one of the biggest audiences in the history of the series. The Prime Minister attended at my invitation and it was a wonderful opportunity for the Waitemata team to understand the Government’s ‘big picture’ vision for the health sector and how this would benefit the people it aimed to serve. Mr Key was very generous with his time and demonstrated a keen interest in our strategies for managing increasing demand for care while also demonstrating prudent fiscal management. The Chair and I also escorted the Prime Minister and the Minister of Health on a short tour of some of our recent major building developments as part of his official visit and he remarked on the patient-centred design of facilities such as ESC, He Puna Waiora and Hine Ora.

Prime Minister John Key delivering his CEO Lecture Series address

Our Mason Clinic campus marked an important milestone on 10 June, with the blessing of the re-built Te Miro unit. Te Miro is one of several buildings on the Regional Forensic Psychiatry Service site in Point Chevalier to have been affected by water damage. By mid-2021, a total of nine buildings on the site are set to have undergone major repair or replacement, with Te Miro being the first completed, along with the Kowhai administration block. This particular project began in mid-August 2015 and involved a total re-build from the existing concrete pad to the same design as the original structure due to the extent of building decay. Te Miro unit is not used to accommodate patients but provides Tangata whai iti ora and Pacifica service-users a place where they can participate in a range of cultural activities. The Te Miro redevelopment carried particular significance as it was the first

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location on the Mason Clinic site dedicated to the partnership of clinical and cultural practice.

The dawn blessing of the re-built Te Miro unit, Mason Clinic

Two respected members of the Waitemata health community who have both played influential roles in the delivery of care to our population were recognised in the Queen’s 90th Birthday Honours. Recently retired senior Waitemata DHB senior clinician Dr Pat Alley and community-based care leader Dianne Kidd were both made Members of the New Zealand Order of Merit (MNZM). Dr Alley was recognised for his services to health after specialising in gastro-intestinal, acute general and trauma surgery for the DHB for many years, also sharing his skills internationally as an exchange surgeon and lecturer. The award also recognised his dedication to improving palliative care by supporting education and training as well as his service as the Chair of Hospice North Shore for many years, establishing valuable links between palliative care providers. Mrs Kidd was recognised for her services to health administration for her work in the community over three decades. She was a founding Trustee of the Helensville District Health Trust in 1989 and has been its Chairman since 2009. Mrs Kidd was involved in the Trust’s establishment of one of New Zealand’s first birthing centres and helped raise the necessary funds for purpose-built premises for the Kaipara Medical Centre. Under her chairmanship, she established a new Board for the Helensville Women and Family Centre and oversaw the opening of satellite premises in Parakai for Iris Home Support Services and the Kaipara Medical Centre. Throughout 2012 and 2013 she oversaw the acquisition of the Medical Centre by the Trust from its corporate owners and was instrumental in the creation of an innovative partnership and ownership model for the Kaipara Medical Centre between the Health Trust, its senior doctors and Waitemata DHB. It is pleasing to see two people who have committed many years of their time to the service of others in our community recognised in this way. Congratulatory notes have been sent to both on behalf of the DHB.

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Construction of the new Waitemata Clinical Skills Centre began on 15 June, to be located on the lakefront at North Shore Hospital. This state-of-the-art, two-storey teaching facility is scheduled for completion in April 2017 and will create a new home for many of the academic activities taking place across the DHB. It will include an auditorium and clinical teaching spaces, ensuring Waitemata’s reputation as a place of learning and excellence continues well into the future. The centre will also have a dedicated clinical skills laboratory occupying most of the first floor and an AUT exercise-testing laboratory. The start of construction was a milestone for our DHB but it was of particular significance for Dr John Cullen, who has championed the development of such a facility for many years. It was a pleasure to join him on-site to see his dream taking shape. We owe John a debt of gratitude for his vision, energy and persistence in developing a teaching space that will benefit future generations.

L-R: Dr John Cullen and CEO Dr Dale Bramley on-site at the start of construction

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Exterior impression of the new Clinical Skills Centre from outside Lakeview Cardiology Unit

The auditorium is to be the showpiece of the centre

The DHB has undertaken paid newspaper advertising to give the people of the Waitemata district clear advice on how best to access the appropriate level of care for their needs. The easy-to-read design was prepared in-house and encourages people to prioritise the use of primary care options, Healthline and Healthpoint where possible while reserving our emergency departments for genuine emergencies. The adverts have been published twice in both the Western Leader and North Shore Times and the design is being made available as a poster to our primary care partners. We are also promoting the key messages of the

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campaign via social media. We will be evaluating the effectiveness of this campaign on presentations to our ED over the traditionally busy winter months. Our goal, as always, is to ensure patients get the right care at the right time in the right place and this is another tool to support this and enable us to provide rapid care to those patients who do genuinely need ED treatment.

At the time of drafting this report, the DHB was awaiting final Council approval to bring into service new staff car park spaces at Waitakere Hospital. These spaces were handed over to our Traffic team on 20 June, pending final Council sign-off. There are 79 new parking spaces in total on the former Te Atarau site, including two disability spaces. This will add convenience for staff working at our Waitakere campus and should free-up public parking capacity.

The inaugural Director of the Institute of Innovation and Improvement has been appointed. Dr Penny Andrew will lead our innovation and quality improvement programme with the aim of making Waitemata DHB a leader in these fields across the Asia Pacific region. Her focus will be on working jointly with our services and divisions to achieve the best possible health care outcomes for our patients/clients and their families. Over the last four years, Penny has been our Clinical Leader of Quality. She brings a wealth of experience to this new role with her deep understanding of innovation and improvement methods as well as her medical and legal background.

Creating a culture of appreciation A further 44 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 were:

- Toni Scott, Clerical Team Lead, Emergency Department WTH, nominated by Kate Allan and Marja Peters

- Samir Seleq, Medical Registrar, RMO Unit, nominated by Denise Smith - Raewyn Gale, Registered Nurse, NSH Gastroentology, nominated by Bonita Burton-Watt - Vickie Shakur, Recruitment Consultant, nominated by Shirley Campbell - Nicola Nell, Physiotherapist, Paediatrics WTH, nominated by Shirley Campbell - Helen Lipscombe, Registered Nurse, Ward 11 NSH, nominated by Dr Sidhesh Phaldessai - Felicity Mowbray, Registered Nurse, Ward 11 NSH, nominated by Dr Sidhesh Phaldessai - Meha Modi, Food Services Associate, Hospital Operations NSH, nominated by Elizabeth

Thompson - Angelina Sanders, Admin Clerk Clinical Team - SCBU West, nominated by Debbie Daniel - Angela Beddek, E-Radiology, nominated by Christine Hayes - Kevin Blair, Project Manager - E-Radiology, nominated by Christine Hayes - Jo Inivale, Specialty Nurse - Department of Anaesthesia - NSH, nominated by Margie

Mazciritis - Clair Turner, Associate Clinical Charge Midwife NSH, nominated by Sam Davenport - Marc Craddock, Desktop Technician, IT - Desktop Services, nominated by Lara Hopley - Nina Dunlop, Admin Clerk, General Medical NSH, nominated by Pat Henley - Sue Thornton, Registered Nurse, Outpatients NSH, nominated by Tess Ablanida - Bronwyn Menzies, Registered Nurse, Waitakere Day Surgery WTH Theatres, nominated

by Bede Saldanha

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- Dave Holder, Charge Nurse Manager, Kahikatea Unit- Carrington Hospital Site, nominated by Alison Nathan on behalf of Kahikatea team

- Leuila Stevenson, Dental Therapist, Dental South 3, nominated by Anishma Ram - Jeff Chung, Dental Therapist, Dental South 3, nominated by Anishma Ram - Tama Davis, Community Support Worker - Moko Services, nominated by Huia Cannon - Jacqui Johnston, Registered Nurse - He Puna Waiora, nominated by Jason Haitana - Caroline Larsen, Registered Nurse - He Puna Waiora, nominated by Jason Haitana - Antony Marunden, Cleaner, nominated by Penny Andrew - Anne McMahon, Health Educator, nominated by Mary Gill on behalf of the WDHB

Moving and Handling Educators - Dr David Burton, SMO - Anaesthesia, nominated by Karen George and Alynne Ledesma - Jenny Whitson, Registered Nurse - Ward 5, nominated by Lee Roberts - Michael Parker, Occupational Therapist - Ward 12, nominated by Yvonne Verner - Rose Smart, Research Support - Research & Knowledge Centre, nominated by Lorraine

Neave - Dr John D’Arcy, Medical Officer, nominated by Tracy Silva Garay - Sharyn Gruzelier, Quality Document Coordinator, nominated by Trina Robertson - Karen Moreno, Admin Clerk - Clinical Team, nominated by Jane Hamer - Leslie Ponen, Social Worker - Allied Health, nominated by Nikola Ncube - Paula Wood, Personal Assistant - Corporate, nominated by Umit Holland - Lorraine Ridgwell, Manager - Info Tec&Bus Analyst Staff, nominated by Umit Holland - Annette Murphy, Registered Nurse - Special Care Baby Unit, nominated by Vesna

Simovik - Dr Cameron Burton, Registrar - Paediatricians, nominated by William Shew - Kate Kim, Registered Nurse, nominated by Craig Wotten - Barbara Mankelow, Enrolled Nurse, Te Henga Ward, nominated by Rebecca Eade - Mike Gilbertson, Associate Clinical Charge Nurse - Radiology, nominated by Pauline

Bowden - Morag Thomson, Acute USS Booking Clerk - Radiology, nominated by Pauline Bowden - Stefanie Smith, Neonatal Nurse - SCBU West, nominated by Debbie Daniel - Christine Bethell, Admin Clerk - Security Services, nominated by Sharyn Gruzelier - Bridget Wilson, General Medical Registrar, nominated by Donna Riddell

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

Further progress on the next phase of ‘Our Values, Your Values’ activity.

Final stages of construction of the expanded Waitakere Hospital Emergency Department, scheduled to open in August.

Commencement of the Clinical Skills Centre at North Shore.

Ministerial visit to launch the new childhood obesity national health target.

Visit by the Capital Investment Committee to inspect Waitemata DHB facilities.

Continuation of works on the Community Health Building at North Shore Hospital.

Pacific Week from 11-15 July.

Continuation of the 2016 CEO Lecture Series.

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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 intended benefits are to move these projects along at a faster pace with top-level support for the significant changes required, giving greater visibility and attention to those projects identified as being important in achieving the DHB’s priorities and purpose as well as instilling the culture of improvement and innovation.

In a major development for the Leapfrog programme, the eVitals system is now live in the pilot ward (Anawhata) at Waitakere Hospital. The eVitals application is working as planned and the nurses are appreciating being able to access their patients’ observations and charts in one place and not having to spend time looking for paper charts. They are also enjoying using the mini-tablet computer for both ePrescribing and eVitals.

Kritika Lal and Donna Riddell from Anawhata ward, Waitakere Hospital, using the eVitals technology

The Community Allied Health Mobile project now has 83 clinicians fully mobile with the tablet computers.

The roll-out of ePrescribing at North Shore Hospital is proceeding extremely well under David Ryan’s guidance, with more than 850 beds covered. This includes all NSH general medical wards (2, 3, 5, 6, 10 and 11), Hine Ora, Short Stay and surgical wards 4 and 8. Orthopaedic wards were the next scheduled to roll-out at the time this report was prepared.

The eRadiology project is now complete, with more than 98 per cent of all radiology orders since 13 May placed in the new system. The old system still has future orders that will be transferred before

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it can be decommissioned by the end of July. eSign-off of all reports, facilitated by ongoing one-on-one training, will allow Radiology to cease all printing by the end of August.

The voice-to-text software implementation team are now working with Older Adults Services as the next service to use voice recognition for dictation. The Outpatient follow-up project is working with general surgery, orthopaedics and ORL on improving their systems with the ultimate aim of reducing the proportion of patients required to attend a hospital outpatient follow-up clinic. Procurement processes are underway for the Patient Experience Reporting System and the Mobile Enterprise Application Platform. Work on the Mobility Strategy and the implementation of a longer-term Enterprise Mobile Management platform continues at healthAlliance, with a new Digital Foundations Steering Group being established for the region.

4. Outcomes discussion

In late May, I was present at the WHO’s World Health Assembly in Geneva, which agreed on resolutions to tackle antimicrobial resistance. Below is a summary of the significant challenge this issue poses and the decisions taken by the Assembly.

Tackling antimicrobial drug resistance

The lack of discoveries of new antibiotics over recent decades combined with the rapidly escalating threat of antimicrobial resistance is a massive challenge for health care internationally.

England’s Chief Medical Officer has described this as a ‘catastrophic threat’ which could see routine operations posing much greater risk of death within 20 years due to ordinary infections which can no longer be treated with antibiotics.

The relatively recent discovery of a Teixobactin is the first new antibiotic product developed since the 1980s. In the meantime, existing antibiotics have been rendered less effective due to diseases evolving more quickly than the drugs historically used to treat them.

Considering that a new infectious disease has been discovered each year for the past 30 years, it is understandable that the international medical community is demanding action in the form of increased investment in innovation and development to address what has been described as a ‘discovery void’.

Below is a summary of the resolution passed by the World Health Assembly aimed at increasing activity in this critical area.

Delegates at the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug-resistance trend. Antimicrobial resistance is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine.

The plan sets out five objectives:

improve awareness and understanding of antimicrobial resistance;

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strengthen surveillance and research; reduce the incidence of infection; optimise the use of antimicrobial medicines; ensure sustainable investment in countering antimicrobial resistance.

The resolution urges Member States to put the plan into action, adapting it to their national priorities and specific contexts and mobilising additional resources for its implementation. Through adoption of the global plan, governments all committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan.

It needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans and will report progress to the Health Assembly in 2017.

Waitemata DHB will work closely with the Ministry of Health in developing and implementing a New Zealand-specific action plan to align with the global action plan.

Useful links:

https://www.racp.edu.au/fellows/resources/new-zealand-resources http://bsac.org.uk/antimicrobial-resistance-poses-catastrophic-threat-says-chief-medical-officer/ http://jac.oxfordjournals.org/content/70/10/2679.full http://www.nature.com/news/promising-antibiotic-discovered-in-microbial-dark-matter-1.16675

5. Board performance priorities The following provides a summary of the work underway to deliver on the DHB’s priorities: Relief of suffering Progress:

Patient and Whānau Centred Care Patient feedback

National Inpatient Survey The last national survey was carried out in February 2016. We received responses from 147

(37%) people. Overall results for four domains in February 2016:

In comparison to overall results in 2015, Waitemata DHB has made small gains in Communication and Partnership domains (increase 0.1 & 0.2 respectively) and a small decrease in Coordination and Needs (decrease 0.2 in each). The national inpatient survey

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https://www.racp.edu.au/fellows/resources/new-zealand-resources

http://bsac.org.uk/antimicrobial-resistance-poses-catastrophic-threat-says-chief-medical-officer/

http://jac.oxfordjournals.org/content/70/10/2679.full

http://www.nature.com/news/promising-antibiotic-discovered-in-microbial-dark-matter-1.16675


went out to a selection of discharged patients in May and responses from this survey are currently being collected and collated.

Friends and Family Test

During May, we received feedback from 1,252 people through the Friends and Family Test

(FFT). This is a five per cent increase from the preceding month, maintaining high levels of

responses since rolling out the FFT postcards from March 2016. The Net Promoter Score

(NPS) for May was 70, an improvement from 62 for the preceding two months and above

the DHB target of 65. Allied Health teams have been using FFT and this is the second report

where their feedback is available alongside the divisional data.

Patient Stories A total of 33 patient videos have been completed, including stories about dental services, mental health services, Asian health support services, thrombosis services, disability

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support, surgical services, SCBU, emergency admissions, upper GI cancer, ORL, discharge planning and end-of-life care. Three further stories are currently in production, including a delirium patient experience. The stories are used for staff training, public awareness (where consent allows) and to complement other patient experience data sources. Those that are able to be viewed publicly are available on the DHB website at: http://www.waitematadhb.govt.nz/Patients-visitors/Patient-stories. Patient Information

Patient Information booklet This booklet has been finalised and is awaiting printing, following approval of a

communication strategy and distribution process.

Continuous Quality Improvement Six ward priority projects

The Senior Management Team has agreed on six priority projects that all wards are expected

to implement.

o Welcoming and Friendly o Care Standards o Friends and Family Test o Bedside Handover o Protected Mealtimes o Discharge Calls

Many areas have already implemented these projects. Senior managers now meet regularly to maintain momentum and ensure timely implementation. Progress is reported monthly at divisional meetings and is noted on Quality Boards. Listening Week

A few ‘In Your Shoes’ events were facilitated in May by the patient experience team, including a focus on Maori Mental Health Services and Pacific Health Services. The patient feedback from these sessions will be used to support service-improvement focus and enhance patient outcomes. Recruitment

Director Patient Experience David Price commenced at Waitemata on 26 April. This role is the first of its kind in New Zealand and will be specifically dedicated to leading the development of our Waitemata experience programme, working with clinical teams to meet our DHB priorities of better outcomes and enhanced patient experience.

Facilities development Department of Medicine Occupation of the new facility is complete following the official opening on 3 May. Ward 3 Refurbishment Ward refurbishment is complete after the last of the patient rooms were handed back to the service on 13 May.

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http://www.waitematadhb.govt.nz/Patients-visitors/Patient-stories


Sky Bridge Practical completion was achieved on 10 June, followed by the official opening by the Prime Minister on 21 June (see News and Events summary). Short Stay Ward & Diagnostic Breast Service Options for a staged redevelopment and for full closure of this area to complete all works in one stage are being evaluated and a detailed business case will be presented to the Board in August 2016.

Community Building 5 Significant areas of rot have been found in structural wall and roofing elements of the building which has slowed progress and added cost. The impact is currently being assessed and the DHB is working with the contractor and the service to mitigate delays to this project and the impact on the dependent Short Stay Ward project. Surgical Pathology Office Relocation The project is progressing in accordance with the programme timeline, with detailed design completed and awaiting sign-off.

WTH ED New Build This project is tracking to programme with practical completion scheduled for 27 July 2016 and ‘Go Live’ scheduled 17 August 2016.

WTH Additional Beds – Wainamu and Muruwai Wards The project has been deferred until after winter due to the complexity of decanting requirements and unacceptable impact on patients. A scope change to include relocation of cardiology beds and a refit of the existing Assessment and Diagnostic Cardiology Unit is being considered to maximise benefit from this investment. A revised business case will be presented to the Board in September. Winter contingency beds will be available in the interim and recruitment of additional staff is progressing in time for the new schedule.

Better Outcomes Progress: On track Achieving the health targets – April 2016

Shorter waits in Emergency Departments – 94% (target 95%)

Improved Access to Elective Surgery – 102% (target 100%)

Increased immunisation – 93% (target 95%)

Better help for hospitalised smokers to quit – 98% (target 95%)

More heart and diabetes checks – 91% (target 90%)

Faster Cancer Treatment (FCT) – 74% (target 85%)*

* The FCT is a Ministry of Health priority and includes a cohort of patients who are referred to the

DHB with a high suspicion of cancer. The target is 85 per cent of this cohort of patients will receive cancer treatment, or other management, within 62 days from their referral-received date. This target is to be met by July 2016.

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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, MHoPS achieved an outstanding result of 99 per cent of falls risk assessments and Surgical and Ambulatory achieved 96 per cent on admission. Within eight hours of admission, MHoPS achieved 93 per cent while Surgical and Ambulatory achieved 88 per cent (against a target of 90 per cent). Hand Hygiene Waitemata DHB’s Hand Hygiene Audit result for May was a compliance rate of 82 per cent, exceeding the national target of 80 per cent. Healthcare-Associated Infections The CLAB insertion bundle was used in ICU on 96 per cent of occasions in May, again exceeding the national target of 90 per cent. Elective Surgery Centre (ESC) ESC discharges for April sat at 114 per cent of planned elective targets (104 per cent YTD). Elective WIES YTD is 90 per cent of planned target. Operationally, ESC continues with its efficient and productive service for its patients and clinicians, with a total of 436 patients operated on for the month. Patient satisfaction remains remarkably high, with a total of 88 satisfaction surveys completed for the month, 78 of which included positive comments. Māori Health Abdominal Aortic Aneurysm Screening Pilot for Māori On 10 June in Wellsford, the Waitemata Abdominal Aortic Aneurysm (AAA) screening pilot was officially launched with a hui jointly organised by Te Ha Oranga and Coast to Coast (one of the three participating practices). This pilot is exploring the feasibility of AAA screening by measuring the prevalence of this disease in Māori men aged 55-74 and Māori women aged 60-74. It is also testing a primary care-based delivery model for the screening. The pilot aims to screen approximately 500 eligible Māori enrolled with Coast to Coast, Waitakere Union Health Centre and Te Puna Hauora practices. Given the shortage of qualified sonographers in New Zealand, the project decided to train its own AAA ultrasound technician. As part of the training process, the AAA team is inviting Māori Waitemata DHB employees in the eligible age range to be screened when our trainee ultrasound technician is supported by a highly experienced vascular sonographer from Waikato DHB. This initial screening took place on 8-10 June and saw 85 per cent of invited people make an appointment for the ultrasound. Māori men and women appear to have a higher incidence of AAA than non-Māori and they develop this condition at a younger age (on average eight years earlier than non-Māori). In the past, screening programmes have been designed that do not work well for Māori. The AAA screening programme aims to serve as an example for other screening programmes by achieving unprecedented participation rates among Māori through detailed and innovative system design.

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Chief Executive Officer Dr Dale Bramley shows his support for the AAA Screening Pilot

Community Treatment Orders Work is underway to understand why Māori are over-represented on Community Treatment Orders (Section 29) of the Mental Health Act 1992.

Under the Act, a person can be put under a Compulsory Treatment Order which requires them to have treatment for their mental disorder. This treatment can be delivered within a hospital setting or within the community. When treatment is delivered within the community, it is called a Community Treatment Order (CTO). Under such an order, the patient must attend and accept treatment at their home or at some other place specified in the Order. The DHB has been consulting with Tangata Whai I Te Ora, their support workers and their whānau. As a result of running these hui, it is hoped a better understanding will emerge of the positive and negative experiences Māori have as a result of being on this type of compulsory treatment order.

The Māori Health team has also completed a data analysis which confirmed the following:

Māori have a higher burden of mental health illness, including schizophrenia (x2)

Māori do not have twice the antipsychotic medication use (1.5)

Māori have high mental health service utilisation, more hospitalisations (x2) for schizophrenia and higher readmissions (x2)

Schizophrenia drives the use of CTOs (>80%), and this is similar for Māori and non-Māori for hospitalised patients (1.1)

CTO use is higher for Māori (x3)

These findings will inform action to better understand the main drivers behind why Māori have such high rates of Schizophrenia, given this has been shown to be the main driver of CTO use within Māori population.

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Māori Health Plan The final draft of the Waitemata DHB 16/17 Māori Health Plan has been submitted to the Ministry of Health for consideration and feedback. The Ministry have approved the activities for 11 of the 12 indicator areas, with feedback on the last indicator delayed as the Ministry are awaiting further internal information prior to completing their review and feedback.

Pacific Health

Pacific Health was instrumental in coordinating the recent Auckland Pasefika older people’s/Matua consultation Fono for the development of the Ministry of Health older people’s strategy. A total of 75 Pacific peoples came from various networks supported by Vakatautua services, The Fono and Treasuring Older Adults. Participants broke off into the main Pacific ethnic groups - Samoa, Tonga, Fiji, Cook Island, Tuvalu and Niue, each facilitated in their languages.

The Samoa language group in progress

Pacific Week

Pacific Week events will roll-out across the DHB from 11-15 July, with a range of activities planned to

celebrate the contribution of our Pacific workforce and community. Highlights will include a ‘Colours

of the Pacific’ fashion competition, lunch time cultural entertainment sessions by Tuvaluan, Samoan

and Tongan groups, plus a range of clinical education events across the Waitakere and North Shore

campuses.

Pacific Best Practice

A major initiative to roll-out the Pacific Best Practice training course in the Waitemata DHB-run Auckland Regional Dental Services (ARDS) has led to a significant improvement in uptake levels, which are now well ahead of target as the table below demonstrates.

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CEO SCORECARD

Actual Target Trend Patient Experience Actual Target Trend

Better help for smokers to quit - hospitalised 98% 95% Complaint Average Response Time 14 days <14 days q

Better help for smokers to quit - primary care 90% 90% p

Improved Access to Elective Surgery - WDHB 102% 100% p

Shorter Waits in ED 94% 95% q Quality & Safety Trend

Faster cancer treatment (62 days) 74% 85% p Older patients assessed for falling risk 98% 90% p

Increased immunisation (8-month old) 93% 95% Occasions insertion bundle used 100% 95% p

More Heart & Diabetes Checks 91% 90% p Good hand hygiene practice 81% 80% p

Pressure injuries grade 3&4 1.00 0.00 q

ICU - CLAB rate per 1000 line days 0.90 <1 p

b. Antibiotic in the right time 98% 100% p

Waiting Times Actual Target Trend

ESPI Improving outcomes

ESPI 2 - % patients waiting > 4 months for FSA compliant Population coverage/Access Trend

ESPI 5 - % patients not treated within 4 months compliant g. Cervical Screening 76% 80% q

Diagnostics g. Breast screening 65% 70% q

% of CT scans done within 6 weeks 98% 90% pc. Bowel Screening Participation

% of MRI scans done within 6 weeks 91% 80% p - Round 1 57% 60%

- Round 2 54% 60% p

Urgent diagnostic colonoscopy (14 days) 91% 75% p

Diagnostic colonoscopy (42 days) 55% 65% q Treatment

Surveillance colonoscopy (84 days) 59% 65% pd. HSMR (Source: Health Round Tables) 75% <99% p

e. Surgical intervention rates (per 10,000 pop)

Patient Flow - Angioplasty 14.2 12.5 q

Elective Surgical Discharges (YTD) - Angiography 39.1 34.7 p

Elective Discharges - Total 15,601 15,244 p - Major joints 20.8 21 q

Elective Discharges - Provider Arm 10,707 10,446 p - Cataract 32.8 27 p

Elective Discharges - IDF Outflow 4,894 4,798 pf. # NOF patients to theatre (48 hours) 88% 95% p

Efficiency ST elevation MI receiving PCI (120 mins) 90% 80% p

Outpatient DNA rate (FSA + FUs) 9% <10% AT&R referrals assessed (2 working days) 94% 90% p

a. Average Length of Stay - Electives 1.39 days <1.77 days q

a. Average Length of Stay - Acutes 2.48 days <2.76 days p

Staff Experience Actual Target Trend Major Capital Programmes Time Budget Quality

Sick leave rate 8.5 days <7.5 days q Te Atarau car park (Sep 2015)

Turnover rate 11% 8-12% Department of Medicine (Mar 2016)

Lost time injury rate (avg hrs/100 FTE) 2.06 <3 q WTH Emergency Department redevelopment (Apr 2016)

Mason clinic - 15 Bed medium secure unit

Financial Result Trend Bridge ESC To Medical Tower (Jun 2016)

Net Surplus/Deficit (YTD) 31 k -625 k Lakefront (Dec 2016)

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

Waitemata DHB Monthly Performance Scorecard

Contact:

Victora Child - Reporting Analyst, Planning & Health Intelligence Team: [email protected]

Planning, Funding and Health Outcomes, Waitemata DHB

CEO ScorecardApril 2016

2015/16

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. 2015/16 new MoH Average length of stay definition.

b. Antibiotic at the right time - As at Sep Q1 2015/16 (latest data available).

c. Bowel Screening data - new overall figures as at Dec 2016, will be reported one quarter in arrears.

d. HSMR reported 3 months in arrears.

e. SI Rates reported one quarter in arrears -as at Dec Q2 2015/16.

f. Data one month in arrears - March 2016

g. As at March Q3 2015/16

Health Targets

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

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5.2 Health and Safety Performance Report – June 2016

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

1. Purpose of report

The purpose of the Health and Safety (H&S) report is to provide quarterly reporting of health and safety, performance including compliance, indicators, issues and risks to the Waitemata District Health Board.

2. Strategic Alignment

Emphasis and investment on both treatment and keeping people healthy

This report discusses the risks, actions and progress towards making Waitemata DHB a safe and healthy place for people to work, be educated, receive care and visit loved ones.

Service integration and/or consolidation

The report integrates cross department commentary on health and safety so it is consolidated in one place.

Intelligence and insight

A health and safety scorecard reports on health and safety data and provides insight into issues and trends.

Evidence informed decision making and practice

The report articulates actions that where possible will be informed by evidence or expert opinion.

Operational and financial sustainability

The evidence supports the undertaking of good health, safety and wellbeing practises leads to positive patient experience and outcomes and a sustainable business.

3. Highlights of the month

3.1 First Board Site Visit

The first Health and Safety Board site visit was held at North Shore Hospital to review Hazardous Substances. This visit included the laboratories, our medical waste holding area and our hazardous goods store. This review was extremely beneficial for the staff involved, as it provided us with an opportunity to outline the work to date, but also to receive specific feedback from the Board members in attendance, which was insightful. Actions from the visit are as follows:

Action/Question Accountability Response Timeframe Are there opportunities for workers to provide feedback/suggestions around health and safety to ensure the continual improvement mentality?

Michael Field It is a requirement of the new Act, but was in place under the previous legislation. Each area has a H&S Rep, who is responsible for H&S issues within their area. They discuss H&S at team meetings, collect and report information regarding hazards/risks and also act as a conduit for staff feedback/suggestions.

N/A

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Action/Question Accountability Response Timeframe Does the DHB take a lead role in disseminating information and learning’s around health and safety and hazardous substances to assist primary care?

Michael Field We have recently formed relationships with CMDHB, who we have been sharing information with, and will make similar connections in other Northern Region DHBs.

Mid-June

Area of concern - the keys in the waste compactor

Michael Field Although systems and processes were already in place, given the observation, it was decided that new systems were required. Keys to the compactor are now held in the Clinical Support Services office and any staff needing to use the compactor need to sign the key out from there and then return it after they have finished. This provides visibility that someone is using the compactor, who that person is and allows the staff stationed in this area to investigate if the key is not promptly returned. The Team Leader will follow up with any staff member who does not return the keys. Communications have been sent to all staff concerned, informing them of the new system, but also reiterating the hazard associated with not following it.

Completed

4. Actions from the last Board report

4.1 Ring-fenced Capex

Ring-fenced capex for Health and Safety purchases has been established under the Chief Financial Officer’s delegation. While a set of criteria is developed to enable access to the funds, the funds will be released on discussion with the Director Human Resources. Release of funds will be subject to normal procurement and business case processes if over $100,000. 4.2 Maintenance fast track process

At the last Board meeting the Auckland DHB fast track processes for maintenance jobs were discussed. Waitemata DHB also has a fast track process which involves the Building and Engineering Information Management System (BEIMS) administrator escalating maintenance requests that are health and safety related for review by the relevant Facilities and Development staff member. In the near future we hope to automate this process. Each request will be sent to Occupational Health and Safety for grading (from 1 to 10, with 1 being urgent), so that Facilities are able to prioritise the requests.

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5. Performance Scorecard Glossary for Monthly Performance Scorecard and Report

Lost Time Injury Rate Mathematical calculation that describes the number of lost time injuries per 100 fulltime employees at any given time frame.

Injury Severity Rate Mathematical calculation that describes the number of lost days experienced as compared to the number of incidents experienced.

Lost time injury Frequency Rate No of lost time Injuries per million hours worked. Lost time incidents Any injury claim resulting in lost time. Serious Harm (Currently Notifiable to Worksafe NZ and will in the new legislation be called “Notifiable Events” and have a wider criteria of reporting to include events not just injury)

The Health and Safety in Employment Act 1992 defines serious harm as: 1. Any of the following conditions that amounts to or results

in permanent loss of bodily function, or temporary severe loss of bodily function: respiratory disease, noise-induced hearing loss, neurological disease, cancer, dermatological disease, communicable disease, musculoskeletal disease, illness caused by exposure to infected material, decompression sickness, poisoning, vision impairment, chemical or hot-metal burn of eye, penetrating wound of eye, bone fracture, laceration, crushing.

2. Amputation of body part. 3. Burns requiring referral to a specialist registered medical

practitioner or specialist outpatient clinic. 4. Loss of consciousness from lack of oxygen. 5. Loss of consciousness, or acute illness requiring treatment

by a registered medical practitioner, from absorption, inhalation or ingestion of any substance.

6. Any harm that causes the person harmed to be hospitalised for a period of 48 hours or more commencing within seven days of the harm's occurrence.

Pre- Employment Health screening for new employees. Significant Hazard (Instead of a definition all hazards are risk rated to determine how serious they are in the new legislation)

A hazard with the potential to cause serious harm.

Psychosocial Risk Might be those aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm.

Patients who are away without leave (AWOLs)

Patients under the Mental Health (compulsory Assessment and Treatment) Act 1992, who leave DHB premises without prescribed or approved leave.

PCBU Person conducting business or undertaking.

Officer Person occupying the position of a director of a company or includes any other person occupying a position in relation to the business or undertaking that allows the person to exercise significant influence over the management of the business or undertaking.

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Worker An individual who carries out work in any capacity for the PCBU e.g. employee, contractor or sub-contractor, employee of the sub-contractor, employee of labour hire company, outworker, apprentice or trainee, person gaining work experience, volunteer.

Notifiable Injury/illness (a) Amputation of body part, serious head injury, serious eye injury, serious burn, separation of skin from underlying tissue, a spinal injury, loss of bodily function, serious lacerations. (b) any admission to hospital for immediate treatment (c) any injury /illness that requires medical treatment within 48 hours of exposure to a substance (d) any serious infection (including occupational zoonoses) to which carrying out of work is a significant factor, including any infection attributable to carrying out work with micro-organisms, that involves providing treatment or care to a person, that involves contact with human blood or bodily substances, involves contact with animals, that involves handling or contact with fish or marine mammals. (e) any other injury/illness declared by regulations to be notifiable.

Notifiable Incident An unplanned or uncontrolled incident in relation to a workplace that exposes a worker or any other person to a serious risk to that person’s health or safety arising from an immediate or imminent exposure to an escape, spillage or leakage of a substance; an implosion explosion or fire; an escape of gas or steam; an escape of a pressurised substance; an electric shock; a fall or release from height of any plant or substance; collapse or partial collapse of a structure; interruption of the main system of ventilation in an underground excavation or tunnel; collision between two vessels or capsize; or any other incident declared by regulations to be a notifiable incident.

Notifiable Event Death of a person, notifiable injury or illness or a notifiable incident.

Reasonably Practicable Means that which is or was at a particular time reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters.eg the likelihood of the hazard/risk occurring and the degree of harm resulting, what the person knows about hazard/risk and how to eliminate/ minimise the risk and the cost associated with elimination of the hazard/risk.

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Legend 20% variation – Green 21-50% variation – Amber Over 50% variation - Red The leading and lagging indicators in the above scorecard are indicative of Health and Safety performance across the organisation. Using trends and traffic light indicators will emphasise the areas where we are on or progressing towards our targets and when we need to improve. Some of our targets are staged to show improvement over time. Indicators in Red Issue Action Hazardous substances audits The new Hazardous substances

co-ordinator started on 2 May and audits are due to restart week commencing 6 June.

6. Key Health and Safety Risks

The table below outlines our key health and safety risks together with commentary on the current status/issues related to that risk and any actions to address issues. We have added residual risk (the portion of risk that is left after a risk assessment has been conducted) to this table. The actions reported each month are controls in progress and the residual risks from each of these identified risk areas will vary. The DHB has attempted to note the residual risk in the context of the original risk using a traffic light after each risk below.

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Legend increase in progress no change in progress decrease in progress

Risk Action Residual Risk Progress since last report

Aggression-physical and verbal

The Security Review project is moving ahead and a committee has been set up called the Community Alarms project. This group will look at the type of alarms required for our workers in the community. OH&S will be represented on this group. Terms of reference are currently being finalised. We have also arranged for a meeting to be held between OH&S, Legal and Mental Health, in order to identify the best way to escalate issues with clients who have assaulted staff. We are also arranging a similar meeting with WorkSafe NZ, so we are able to explain the residual risk that is unavoidable for staff working in Mental Health, to educate WorkSafe NZ in advance of an incident occurring.

Aggression remains the highest accident type.

Original Risk Residual Risk

Risk Actions Residual Risk Progress since last report

Blood and Body Fluid Incidents (BBFA)

The review is still pending the needleless system pilot.

Remains medium to high.

Needles are still the largest contributor.


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Risk Actions Residual Risk Progress since last

report

Hazardous Substances(HSNO)

A new hazardous substances and New Organisms (HSNO) co-ordinator has been recruited and started on 2nd May. He brings a wealth of knowledge to this position and the auditing will be re-commenced along with the introduction of health monitoring on exposure to hazards.

Audits are due to restart the week commencing 6th June.

A business case for a dangerous goods store for Waitakere is in progress.

HSNO audits and health monitoring positions will continue to reduce our risk further.

Changes have been made to some processes (i.e. handling, storage and disposal) and have reduced our risk.

Training of key staff about HSNO continues and is reducing the risk.



report Contractor and Procurement Management

The new Health, Safety and Environmental Advisor in Occupational Health and Safety has taken over the Facilities and Contractor Portfolio to oversee systems and processes and carry out training.

The asbestos management group has been set up with OH&SS representation.

Terms of reference have been finalised and work is currently underway reviewing our building portfolio. Additionally, an Asbestos Manager is currently being recruited to ensure day-to-day management of this activity and swift progress, with regular reporting to the committee.

Continuing to have minor incidents with contractors which indicate closer attention needs to be paid to our combined processes as PCBUs.


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Manual and Patient Handling

One of top three significant hazards

DHB’s all have different Moving and Handling Programmes and ACC/Worksafe are keen to adopt one model

A new model of engagement has been developed between occupational health and the moving and handling team to allow for quicker response to incidents and training requirements.

Facility design checklist now includes moving and handling requirements.

Risk remains until we see our actions result in a reduction in incidents



report

Health and Wellbeing (stress, fatigue, depression

The Healthy Workplaces Strategy is presently going through senior management review and is expected at the Board mid-year.

Residual risk remains until we put in place healthy workplace measures and can track progress.


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Physical environment (ventilation, lighting, equipment)

Ventilation, cooling and heating issues still being worked through by priority order, with OH&SS providing to support to facilities to triage these requests by risk.

Hazards and risks associated with the Helipad are being reviewed by a newly formed advisory committee.

A number of issues require business cases to be drafted for consideration of capex funding.

Although the DHB is working on every issue that comes up, the risk will stay moderate until issues are worked through and reducing.



Slips trips and Falls

All entrances now have ‘slippery when wet’ signage on doors and a review of entrance way flooring has been completed. We have also introduced umbrella bag stands at entry ways. The next steps are to develop additional signage to introduce the umbrella bag stands, encourage their use, and educate visitors on why this is important. During wet weather, entry ways will be checked regularly to ensure that any additional necessary signage is in place and that excess water is mopped up. Regular communications on slip, trip and fall risks are included in training and highlighted in the Waitemata Weekly and the Occupational Health website. Work is commencing with internal communications to develop posters to educate staff on this and raise awareness of what they can do to avoid incidents. As winter comes checks will be

Remains a high risk for numbers and claim costs.

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made in places like entrances, wards and communal areas for hazards associated with slips, trips and falls.


7. Funding, Planning and Outcomes

We have received Simpson Grierson’s written advice following the review of our health and safety plans in late May. Simpson Grierson confirms there are a number of areas where we can rely on the national contractual mechanisms in place for aged residential care and primary care. They have endorsed our capability assessment approach, however, have also identified a number of areas where further work is required before this can be implemented and recommended specialist input to provide more detailed advice. We are in the process of arranging a meeting to progress. 8. Staff Reported Incidents Glossary

CO - Corporate CWF - Child, Women and Family Services ESC - Elective Surgical Centre HO - Hospital Operations MEDHOP - Medical and Health of the Older Persons Service MH - Mental Health and Addictions Services OH&S - Occupational Health and Safety SA - Surgical and ambulatory services 8.1 Staff incidents

The number of reported incidents by staff during the month of April 2016 was 119. This is a decrease from 136 in March 2016 (last report states 134 - 2 were added after the month statistics were reported). Incident trends remain the same for this reporting period. The rate of staff incidents per discharged patients is 1.36% (based on inpatients only). The rate of staff incidents per FTE is 2.32% (134÷5,760x100).

Table 1: Number of reported staff incidents for April 2016 and prior 23 months

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Table 2: Staff incidents by type for April 2016

Table 3: Staff Incidents by Service

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9. Serious Harm Incidents The DHB noted no staff serious harm incidents in April 2016. 10. Top 3 Accident types that cause harm

The three main types of incidents and their management are as follows: 10.1 Aggression Aggression remains a high risk area, especially within the Mental Health Environment. As mentioned previously, collaborative work with health and safety, legal services, Police and Worksafe is now underway to gain a better understanding of aggression risk within that environment and agree controls and actions to reduce the consequence of these incident types. Mental Health Collaboration A number of meetings have been held with Mental Health Services with the aim of creating a collaborative environment for dealing with staff injuries and incidents. OH&SS are now working with Mental Health Services to identify controls and responses, specific to cases of aggression. This process seeks to identify all measures that could be put in place for consideration, including documenting these decisions. This work also focusses on how we can provide resources to ensure that any incidents of aggression are not able to escalate, seeking to avoid serious harm. This has included advice around the removal of objects from entry areas that could be used as projectiles such as small plant pots, width and placement of reception desks and the fixing of chairs to each other to ensure they cannot be thrown.

Table 4: Aggression Incidents by Service – April 2016

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Table 5: Physical assaults root cause April 2016

Table 6: Physical Assault outcomes April 2016

Table 7: Mental Health & MEHOP - Physical Assault (root cause Aggression) April 2016

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10.2 Slips, Trips and Falls Slips, trips and falls this month were caused by inattention (7), wet Floors (4) work practice (2) faulty equipment (3). Services have been sent a memo reminding people to be careful of slip, trip and fall hazards and to get any environmental hazards fixed as soon as they are identified.

Table 8: Slips trips and falls by service April 2016 10.3 Manual handling Moving and Handling injuries to staff since January have been recorded as follows:

January: 4

February: 7

March: 5 (6 reported 1 was no injury incurred)

April 2016

Number of

Incidents

Medicine & Health of Older People 2

Mental Health 1

Surgical & Ambulatory 4

TOTAL 7

Table 9: Patient handling incidents April 2016 Of the seven incidents recorded in April, five of these incidents resulted in sprain/strains to necks and backs. Two incidents were categorized as “near misses” in Surgical and Ambulatory.

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11. Health and Safety Activities

11.1 Board, Management and Staff Health and Safety Training A Health and safety training needs analysis is currently underway, with assistance being provided by the people capability team. This training needs analysis will be based on all staffing types and all managerial levels and seeks to identify specific health and safety training requirements. The final draft will be completed in July. 11.2 Recruitment Three new positions are in the process of being recruited to the Occupational Health and Safety team: 1. Health and Safety Advisor - this role will assist with the significant training that needs to be done

at all levels of the organisation. 2. Health and Safety Investigator/Auditor - this role is required to oversee the investigations and

corrective actions required to follow up on our more significant events and near misses as well as oversee the internal auditing that is required for the safety management systems.

3. An Analyst to replace the current HR Information and Financial Systems Analyst, who will also work in health and safety to improve statistical analysis and reporting.

A new Clinical Team Leader and the Hazardous Substances Co-Ordinator commenced work on the 2nd May and this has ensured that the clinical aspects of health and safety are managed and that the hazardous substances work already started has continued. 11.3 Influenza Vaccinations (UPDATE) To date the Flu vaccination campaign has now been completed with staff now presenting to Occupation Health and Safety for flu vaccinations. With the onset of the cooler weather there has been a slight increase in staff now requesting the flu vaccination. To date our records show over 3864 staff or 54 % have been vaccinated up to 20 June 2016. The breakdown by profession is as follows:

• Allied Health 794 (49.95%) • Doctors 315 (53.79%) • Nurses 1,428 (52.39%) • Midwives 49 (35.06%) • Others 579 (48.95%) this group includes HCA, Orderlies, Pharmacy etc.

In-team vaccinations have now finished though several areas have indicated that if there is a need for further clinics they are happy to perform this service.

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12. Health and Safety Prosecutions:

12.1 Builder ordered to pay over $63K after employee injured in ladder fall

Thursday 26 May 2016

A sentencing in the Wellington District Court yesterday has underlined the importance of managing fall from height workplace hazards after a construction worker fell from a ladder and sustained serious brain injuries.

Geordie Grieve, trading as Geordie Grieve Builders, was fined $15,000 and ordered to pay $48,592.43 in reparations to the injured employee after being found guilty of one charge under the Health and Safety in Employment Act 1992 for failing to take all practicable steps to keep a worker safe.

On 10 March 2015, the worker employed by Mr Grieve was using a ladder while dismantling a balcony 2.8m from the ground. As the worker attempted to get down from the ladder, the bottom of the ladder slipped forward and the worker fell, hitting his head on the ground.

As a result of the fall, the worker suffered skull fractures and complex head injuries.

A WorkSafe New Zealand investigation concluded that Mr Grieve failed to ensure that a fall from height hazard, a common cause of harm in the construction industry, was properly managed. It was revealed that the ladder’s rubber non-slip feet were worn out and therefore unable to keep the ladder steady – posing a major risk to anyone using it.

WorkSafe’s Construction Programme Manager Marcus Nalter says this incident could have been avoided if Mr Grieve had taken active steps to manage the hazard by making sure that the company’s ladders were fit for safe use, and any defective ladders were not used by workers until fixed or replaced. Non-slip feet for ladders cost approximately $14 per pair to replace.

“Working from height is a significant hazard, so appropriate steps must to be taken to ensure that any potential exposure to harm is minimised. Mr Grieve’s failure to identify and fix the ladder’s worn out feet heavily increased the chance of a fall from height occurring,” says Mr Nalter.

“Every employee has the right to expect to go home healthy and safe every day. In this case, basic hazard management failures put an employee in hospital for over two months with very serious injuries.”

12.2 Quarry operator ordered to pay over $150K after employee crushed to death


A South Canterbury-based quarry and transport operator has been ordered to pay reparations of $100,000 to the family of an employee who was crushed to death while working at its Gordon Valley limestone quarry.

Transport (Waimate) Limited pleaded guilty to two charges under the Health and Safety in Employment Act 1992 for failing to take all practicable steps to ensure the safety of Scott Baldwin and failing to ensure that Mr Baldwin held a current certificate of competence as a quarry manager.

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The company was also fined $54,000 at the sentencing in Timaru District Court yesterday.

On March 19 2015, Mr Baldwin, the quarry manager and sole regular employee on the quarry site, began work at the Gordon Valley quarry. He started two diesel motors at the plant used for processing limestone – one for the hammer mill and the other for the ancillary equipment – both located in an open store shed.

At approximately 7pm that evening, a person from a neighbouring property heard the motors at the site running at a high pitch and not under load. Upon investigating the noise, the neighbour entered the quarry shed and found Mr Baldwin’s severely injured body lying underneath rotating machinery.

A WorkSafe New Zealand investigation found that the company failed to identify and manage the clear hazard posed by the quarry machinery. There were no processes in place to stop maintenance on machinery being carried out while the machinery was running, and there were no effective controls for an operator to stop the top motor in an emergency.

Also the fact the company never ensured that Mr Baldwin held an appropriate qualification to manage the quarry was a significant failure.

WorkSafe Chief Inspector Keith Stewart says there were a number of steps that Transport (Waimate) could have taken to prevent such an incident occurring, including installing fixed guarding to make sure people could not reach into dangerous parts of machinery at all times, conducting regular audits for hazard identification, and making sure that Mr Baldwin was not left to work alone and unsupervised.

Mr Stewart says Mr Baldwin’s death is a reminder of the horrific things that can happen when adequate safety measures are not in place.

“Large machinery used on quarries poses an inherent danger to anyone that comes into close contact with it. Transport (Waimate) failed to protect its employee, and tragically, in this instance, Mr Baldwin has had to pay the ultimate price for the company’s failings,” Keith Stewart says.

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5.3 Communications 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:

Preparation for official opening of North Shore Hospital Sky Bridge

Communications support for start of construction of Clinical Skills Centre

Launch event for new childhood obesity national health target

Support to communicate new parking arrangements

Preparation for opening of expanded Waitakere Hospital ED

Communications support for Ministry of Social Development STEP initiatives

Liaison with the office of the Minister of Health on upcoming events

Assisting with Allied Health Awards presentation and content for the Speech Language Therapy Journal

Ongoing communications support for Maternity Collaboration

Communications advice for immunisation programme

Internal communications support around Bowel Screening Pilot roll-out

Development of ‘where should I go for healthcare?’ multi-channel campaign

Management of requests for assistance on university and school student assignments

Assistance with advertising placements for services

Oversight of the communications roll-out of the Our Health in Mind action plan

Coordination of 2016 CEO Lecture Series event by the Prime Minister

Preparation of May-June edition of Healthlines magazine

Liaison with Well Foundation Marketing and Communications

Liaison with Waitakere Health Link

Communications advice for Abdominal Aortic Aneurysm Screening Pilot

Ongoing out-of-hours media line cover and senior management communications support

Proof read leaflets, booklets and brochures for various departments

Ongoing management of Official Information Act requests and responses

Management of requests to film on DHB sites

Preparation of community update on major capital works projects

Ongoing social media strategy, activity and issues management

Responses to ‘Dear Dale’ email questions and comments from staff

Event photography

Fortnightly CEO recognition award communications

Drafting of correspondence from the corporate office

Review of copy for DHB website

Management of requests from external organisations to place collateral in the hospital foyers

Management of DHB general all-user screen saver content

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Publications The communications team published the following during the last six weeks:

May-June Healthlines, 12 pages

Fortnightly A note from the CEO message

Waitemata Weekly, emailed to all staff users

Weekly national health targets updated and communicated

Designed a number of publications including medical conference posters and patient-facing information leaflets for various services

Campaign: Healthcare…Where should I go?

Campaign for SCBU: If you need us, call us.

CADS booklet: Getting the facts

Health Careers booklet for Pacific Health

Private Radiology Service booklet

File: nurses portfolio 2016

Sky Bridge opening invitation

CEO Lecture Series invitation

Sleep Hospital Advice

Campaign: Te Hononga Oranga Māori Diabetes Service

Understanding CPR

Artwork for web WDHB online career hub Waitemata DHB, Careers and Awhina websites – Google Analytics Statistics

Waitemata DHB website

Number of visits May 2016 Total visits to this site 43,053 New Zealand 40,682 Australia 792 United Kingdom 314 United States 218

Top areas May 2016 Home page 15,911 Waitemata DHB staff page 18,454 North Shore Hospital 7,571 Waitakere Hospital 3,182 Contact us 2,895 Traffic sources May 2016 Search traffic 73% Direct traffic 19% Referral traffic 8%

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Careers website

Number of visits May 2016 Total visits to this site 16,499 New Zealand 14,337 United Kingdom 553

Australia 381

United States 292

Philippines 108

Awhina Health Campus website

Number of visits May 2016 Total visits to this site 1,906 New Zealand 1,651 United Kingdom 54 United States 42 Brazil 22 Australia 13

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Social media Waitemata DHB Facebook page likes – 1,825* Waitemata DHB Facebook star rating - 4.4/5 (164 reviews)* *As at 16 June 2016 OIAs received A total of 23 new OIA requests were received between 11 May and 13 June 2016:

R. Turner-Waugh (Transcriptionz) - Cost, accuracy and timeliness of medical transcription services.

A. McCulloch (scoop.co.nz) - Funding and services information for postnatal depression.

R. Bollard (Parliament library research) - Interpreter and translation service arrangements and spending.

A. Marett (Labour) - Number of physical assaults on staff in mental health units.

F. Payne (Iwi n Aus) - Number of medical operations and public health care expenditure on Australian citizens living in NZ.

A. Marett (Labour) - Lymphedema care provided to women who have undergone mastectomy.

A. Marett (Labour) - Details of any reviews of mental health service-delivery or funding in the last six months.

A. Marett (Labour) - Number of FTEs employed by Waitemata DHB waiting for police vetting.

N. Wilson - (FYI.org) - Amount paid to an external service-provider for strategy workshops and analysis.

A. Vailahi (NZ First) - Internal correspondence re MECAs and graduate nurses finding full-time employment by country.

A. Marett (Labour) - Neurologist numbers and services for MS patients.

N. Hanlon - Information relating to when a medical certificate should be issued.

S. McLennan (Hannover Medical School) - Policy for reporting and responding to health and disability service incidents.

C. Sziranyi (Radio NZ) - Total referral numbers for mental health services and comparison with previous five years.

A. Baird (Newshub) - Details of women declined for abortions.

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L. Hopkins (NZ First) - Acceptance criteria to access funded mental health support services.

P. Wakefield (NZ First) - Child tooth extractions under general anaesthetic.

K. Johnston (NZ Herald) - Copies of any Crimes of Torture Act reports 2010-16.

S. Wallace (NZ Aged Care Assn) – Details of age-related residential care entries.

J. Tamihere (Te Whanau O Waipareira Trust) - Number of patients, turnaround times, income flows etc for White Cross after-hours clinic.

A. Harris (FYI.org) - Number of mental health patients currently detained in seclusion units.

F. Thomas (NZ Doctor) - Funding information regarding palliative care.

A. Marett (Labour) - Financial impact of 2010/11 GST increase and ability to meet new Community Pharmaceutical Budget spending requirements.

Media Clippings - 9 May – 13 June 2016

Positive +

Neutral 0

Negative -

Channel Auckland

Well said - May +

Well said - June +

Dominion Post

Give priority to birthing centre 0

Red flag for bowel screening 0

Listener NZ

Land of hope 0

North Harbour News

New network 0

Dual-board members axed 0

Success for Waitemata DHB’s bowel screening programme +

North Shore Times

Donations call for life saving equipment +

Smoking ban sticks +

Better parenting programme +

Milestones +

Bus network 0

Success for Waitemata DHB’s bowel screen programme +

Dual-board roles going 0

More funding for DHB in 2016 budget +

Nor West News Brief

Donations call for life saving gear +

Warren Flaunty bill passes in Parliament 0

Queen’s birthday presents 0

NZ Doctor

Waitemata DHB defeats court bid to overthrow smoking ban +

Complaints about DHB’s jump more than 60 per cent in five years 0

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Peripheral oedema 0

Doubts that Budget will stretch to fit Govt’s great expectations 0

Door opens for bowel cancer screening to spread nationwide 0

NZ Herald/Herald on Sunday/NZherald.co.nz/Weekend Herald

I feel like road kill – not a hero 0

Pain threshold on increase as hundreds await ops -

The healthcare campaigner 0

Medical hub 0

Survivor lauds screening funding 0

From vineyard valley to ‘heart attack alley’ 0

We’re not free for everyone - hospital +

Rave – Waitakere hospital +

Rave – Big thanks +

Otago Daily Times

Why not begin where it is worst? 0

Bowel-screening plan rated ‘red’ 0

Pharmacy Today

Pharmacists should consider standing for DHB elections 0

Cost a barrier for pseudoephedrine 0

Orion Health plugs into data-driven healthcare 0

The Press/Weekend Press Christchurch

Canterbury misses out on health cash again 0

Red flag for bowel screening 0

Western Leader

Volunteers urgently wanted 0

Caring neighbours call ambulance 0

Donations call for life saving equipment +

Thanks to hospitals +

Court in support of hospital smoke ban +

What’s On – volunteers wanted 0

Dual-board members axed 0

More doctors +

Health boost +

Hospitals for an emergency only +

Volunteers wanted 0

TOTAL:

Positive + 20

Neutral 0 30

Negative - 1

Total items 51

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6.1 Primary Birthing Facility Consultation Outcome Recommendation: That the Board:

a) Note public consultation on potential primary birthing facilities elicited 1,162 completed survey responses and heard from over 450 people through community forums.

b) Note feedback from the community demonstrated strong support for either: i. A DHB owned/managed free-standing primary maternity unit in the

community, or ii. A DHB owned/managed free-standing primary maternity unit on the hospital

campus

c) Approve development of a detailed business case to establish a primary birthing unit in West Auckland.

d) Approve public release of the consultation report in full. Prepared by: Ruth Bijl (Funding and Development Manager, Child, Youth and Women), Linda Harun (former General Manager, Child Women and Family Service), Dr Peter Van De Weijer (Head of Division Medicine, Child Women and Family Services), Emma Farmer (Head of Division, Midwifery), Carol Hayward (Community Engagement Manager) and Wendy Devereux (Clinical Project Manager, Child Women and Family Services) Endorsed by: Aroha Haggie (Maori Health Gain Manager), Lita Foliaki (Pacific Health Gain Manager), Samantha Bennett (Asian, Refugee, New Migrant Health Gain Manager), Debbie Holdsworth (Director Funding) and Cath Cronin (Director Hospital Services)

Glossary

DHB - District Health Board LMC - Lead Maternity Carer (midwife or obstetrician) WDHB - Waitemata DHB 1. Executive Summary This paper reports the outcome of public consultation regarding development of potential primary birthing facilities. Evidence demonstrates that for women who are at low risk of complications, giving birth in a primary birthing unit reduces the use of medical interventions without compromising the health of the mother or infant. Currently only a small percentage of Waitemata women birth in the rural based primary birthing units. In October 2015, the Board approved a Maternity Plan. The Maternity Plan identified the intention to increase the number of primary birthing ‘beds’ across the Waitemata and Auckland districts to increase primary births. The Waitemata Board agreed to undertake public consultation on potential urban primary birthing facilities to complement the established secondary and rural primary units in Waitemata DHB. A robust consultation process has now been undertaken with independent analysis of results. The results demostrate strong support for development of an urban primary maternity facility in Waitemata. The preferred location is dependent on the respondent’s place of residence. As a result, it is recommended that, in the absence of information to the contrary, the previous

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recommendation to the Board to prioritise a facility in the West stands. Respondents first preference was for a DHB owned/managed free-standing primary maternity unit in the community. This was followed closely by a preference for a DHB owned/managed free-standing primary maternity unit on the hospital campus. The Board is requested to approve development of detailed business cases for all of the options to support their decision regarding progressing a development of an urban primary maternity facility in West Auckland. As previously indicated, the success of such a facility would inform further consideration of a potential unit on the North Shore.

2. Strategic Alignment Community, whanau and patient centred model of care

This consultation and engagement process was designed to better understand patients’ and families’ and whanau needs and expectations in relation to potential use of urban primary maternity facilities. Information obtained from the community including patients will be used to inform Board decision making and facility design.

3. Background As previously described, evidence demonstrates that for women who are at low risk of complications, giving birth in a primary birthing unit increases the chance of having a normal birth. For appropriately selected women, it is as safe to give birth in a primary birthing unit as a hospital for both mother and baby. For Maternity Services, an increase in the normal birth rate across the DHB is expected to contribute to preventing a predicted rise in the caesarean rate, increase community access to maternity care and help manage expected demand for hospital beds due to population growth over the next decade. In November 2015 the Auckland DHB and the Waitemata DHB, through the Women’s Health Collaboration, launched a plan for maternity services to 2025. Amongst the 22 detailed strategies are strategies to improve confidence in normal birth and increase primary birthing beds across the region. Currently Waitemata DHB has primary birthing units in Helensville, Warkworth and Wellsford. These rural units predominantly attract local women. Community groups, private maternity organisations and independent midwives have strongly advocated for the development of primary birthing units closer to urban centres in West Auckland and North Shore. We received a petition initiated by the Maternity Services Consumer Council signed by 827 people requesting that the Board establish a primary maternity facility in West Auckland. We have also received information from a private provider demonstrating a strong interest in developing a primary maternity facility in the North Shore (Albany). To gauge the level of support for primary birthing units, including which models would be most acceptable to the community, the Board approved undertaking community consultation. Consultation was undertaken around the following Board approved options:

a. Located in a hospital, next to or very close to the maternity unit, operated by the DHB b. Located on hospital grounds in a separate building, with its own entrance , operated by the DHB c. Located in the community, operated by the DHB d. Located in the community, operated by a private or community contractor (but still free).

The model of care described through consultation was one where women stay postnatally in the facility they birth.

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4. Community consultation

4.1. Methodology

Point Research was engaged to provide independent advice regarding planning and analysis of consultation feedback. Consultation with the community took place between 18 January and 7 March 2016. Participants were presented with information about primary birthing units to ensure that everyone had a similar understanding of the concept and terminology being used. Questions were designed to determine community views on the: • level of support for primary birthing units • potential use of a primary birthing unit • preferred locations • preferred delivery model of care (based on four defined options), and • key features of a primary birthing unit.

A mixed method was used including an online survey, community meetings and a series of small group forums focused specifically on hearing the views of Maori, Pacific, Asian and young parents. Completed responses to the online survey were received from 1,162 people. Over 450 people attended community meetings. This was a higher response than expected. Research and analysis was undertaken by an independent research and analysis firm, Point Research. Point Research has over 20 years experience in heath, local and central government research. The consultation report prepared by Point Research is attached in full in Appendix 1.

4.2. Findings

Respondents were positive about being asked their opinion on primary birthing units. Many responded they felt ‘heard’, ‘listened to’ and applauded the DHB for listening. The Board required that the consultation sought out the ‘quieter voices’ of women and their families who are generally less likely to participate in consultation. Participation by ethnicity was positive as shown in Table 1 below. Engagement with younger women was also positive with nearly a quarter (23.8%) of respondents aged under 30 years, as shown in Table 2 below. Over three quarters (77.6%) of respondents were hoping to have a baby in the future. Table 1: Participation by ethnicity (more than one ethnicity could be chosen) Ethnicity Percentage of Participants Maori 7.5% Pacific 10.5% Asian 9.9% MELAA 1.4% Other 4.8% European 77.2% Table 2: Participation by age Age group Percentage of Participants 19 years or less 1.3% 20 – 29 years 22.5% 30 – 39 years 41.6% 40 – 54 years 23.1% 55 years or more 10.9% Prefer not to say 0.7%

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4.2.1. Support for primary birthing units In response to the question, “Would you recommend a primary birthing unit to someone having a baby?,” nearly nine out of ten respondents (87% online, 88% meeting) indicated that they would be likely to recommend a primary birthing unit, with nearly three quarters (74%) indicating they were highly likely to do so. Some people expressed a desire to use a primary birthing unit for a postnatal stay only.

4.2.2. Potential use of a primary birthing unit In response to the question, “Would you choose to give birth in a primary birthing unit?” there was little difference based on where people lived, as shown in Figure 1. Figure 1: Would you choose to give birth in a primary birthing unit, by area (online)

Of those indicating they were hoping to have a baby in the future, 84% indicated they would consider giving birth in a primary birthing unit, with nearly two thirds (64%) indicating they would have a high likelihood of doing so. Current barriers to use of a primary birthing unit relate to travel time and convenience.

“I didn't go to the Helensville birthing facility because it would have meant my husband had to shuttle between our twins at home and me there, a 45 minute drive each way.“ “It's about location too. I don't want to drive to Warkworth to have a baby because depending on traffic it could take 2 hours.”

13 15 17

20 22 22

65 63 61

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

West Auckland North Shore Hibiscus Coast Rodney

0 to 4 5 to 7 8 to 10

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4.2.3. Preferred locations

Participants were asked to indicate their preferences in relation to whether it was more important for a unit to be closer to home, or closer to hospital and whether they had a preference on suburb/neighbourhood. Perhaps unsurprisingly people from the West preferred a facility in the West and those from North Shore preferred the Shore. Specifically, locations of Henderson, Ranui, New Lynn (West) or Takapuna or Northcote (North Shore) were identified. Some suggested Albany. Locations between their home and the hospital (or closer to the hospital) were preferred.

“I would prefer to have a more gentle birth away from hospitals but close enough if needed in an emergency. I love the idea of a more peaceful and respectful birth that is more inclusive of whanau needs.”

Access to transport links, shops, not far from hospital in an emergency and avoiding areas of congestion were factors mentioned by respondents in relation to location. It was essential that the location was easy to get to by car.

4.2.4. Preferred model We asked respondents to rank their preference against four options approved by the Board. Options and survey results are shown in the following graphic in the order of preference.

Located in the community,

operated by the DHB Located on hospital

grounds in a separate building, with its own

entrance, operated by the DHB

Located in the community, operated by a private or

community contractor (but still free)

Located in a hospital, next to or very close to the

maternity unit, operated by the DHB

Preferred option to: Online: 38.2% Groups: 43.2%

Preferred option to Online: 31.4% Groups: 32.5%



NB: preferences were randomised on online surveys to reduce the risk of bias. Differences are significant p < 0.05 Percentages may not add up to 100% as the options are drawn from four different survey variables. Overall, the preference was for a primary birthing unit operated by the DHB either located in the community or on hospital grounds in a separate building with its own entrance. Respondents cited reasons including alignment of policy, ensuring all services remain free and profit requirements potentially affecting services, as reasons for their preference for a DHB owned/operated model. While a privately operated unit did not receive widespread support from community or professional groups, just over half (51%) of the independent midwives who responded preferred this model. Pacific people preferred a community-based facility operated by a DHB. European and Māori consumers preferred this option, along with a facility based on hospital grounds in a separate building. Asian consumers favoured a primary birthing unit on the hospital grounds with a separate entrance or in the hospital near the maternity unit.

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4.2.5. Key features Participants were asked about features that were important in a birthing unit. Features considered essential varied according to the age, culture and ethnicity of those consulted though there were some common features with breastfeeding support/advice the highest ranking.

“Mothers today are suffering because not enough attention is paid to them during and after birthing a child. Birthing centres focus more on what individual mothers and babies need. Out of 12 people in my antenatal classes two of us spent time at Warkworth birthing centre and we are the only two who breastfed successfully due to the support of the midwives at Warkworth.”

Respondents wanted a warm, family-friendly environment with single rooms that can accommodate friends and family. A facility that is easy to get to by car, designed to allow support people in labour, and partners to stay overnight were identified as essential in any facility build.

“I feel it is so important to have partner stay. I had an awful birthing experience and not having my husband with me made me feel more isolated than I already did.” “Nearly all of my wahine [mainly Maori and Pacific Island] go home after the birth or the next day because of the above restrictions to whanau, thus missing out on the breastfeeding support that would benefit them”

A location easy to get to by car, with free car-parking were identified as essential. Providing tasty healthy food choices was a high priority for women, while group participants across ethnicities indicated the importance of the provision for families to provide and heat their own food for mothers. For the majority of Māori, Pacific and MELAA mothers, it was essential that rooms should have private ensuite bathrooms as well birthing pools.

“The main thing I think is necessary is a private bathroom-not shared with another patient!! For the afterbirth period, the last thing you want is to be sharing a bathroom.”

The significance of cultural and spiritual practices when bringing a baby into the world was important to many. A quiet or prayer space with spiritual support for mothers and their families was highlighted in particular through Maori, Pacific, Asian, refugee and migrant communities. 4.3. Conclusion and next steps

Previously, we recommended sequencing development of any facilities in the West first. The results of community consultation have not altered this advice. Consultation suggests that there is support for an urban primary birth unit and the community has expressed a preference for either a DHB operated unit in the community or a DHB operated unit on the hospital campus separate from the secondary maternity unit. We now seek the Board’s endorsement to proceed to a business case to invest in primary birthing unit. The team have come up with a preferred option and will provide an update to the Board on this option at the meeting. We would expect to complete a detailed business case in December 2016 with a view to progressing the Board’s decision in the 2017/18 financial year. We also seek the Board’s approval to release the consultation report publicly in July 2016.

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APPENDIX 1 - Preferred choice for type of a primary birthing unit (by ethnicity) Respondents were asked to rank the kind of primary birthing unit preferred from four options. Broken down by ethnicity to understand the quiet voices less likely to participate in consultation, in these are: European and Pacific peoples who responded to the survey had a preference for a community-based PBU operated by a DHB. Māori respondents favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance. Asian respondents were fairly equally in favour of all three DHB operated PBUs. Figure 5: Preferred primary birthing unit choice by ethnicity (online)

FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n=

European In community, DHB operated

38.8% (302)

On hospital grounds, in a

separate building

30.5% (235)

In community, privately operated

26.2% (199)

In hospital, near the

maternity unit

8.5% (64) 778

Māori In community, DHB operated

35.1% (26)


separate building

32.9% (25)


25.7% (19)


maternity unit

8.5% (6) 76

Pacific peoples

In community, DHB operated

48.9% (45)


separate building

28.1% (25)


maternity unit

26.6% (25)


11.4% (10) 94

Asian In community, DHB operated

31.5% (29)


separate building

31.2% (29)


maternity unit

29.5% (28)


13.0% (12) 95

Other In community, DHB operated

38.9% (21)


30.8% (16)


separate building

22.6% (12)


maternity unit

11.8% (6) 54

39 35

49

32 39

31 33 28 31 23 26 26 27

13

31

9 9 11

30

12 0

10

20

30

40

50

60

European Māori Pasifika Asian Other

Perc

ent

In community, DHB operated On hospital grounds, in a separate building

In community, privately operated In hospital, near the maternity unit

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Whilst Māori respondents online favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance, participants at forums with a Māori focus had a preference for community-based, DHB operated PBUs. Participants at forums with a refugee and new migrant focus showed a preference for a PBU on hospital grounds but with a separate entrance. Figure 6: Preferred primary birthing unit choice by ethnicity (groups)


Mixed groups


47.2% (25)


22.6% (12)


maternity unit

18.7% (10)


separate building

11.3% (6) 23


60.4% (32)


separate building

17.0% (9)

In community,

privately operated

13.2 (7)


maternity unit

9.4% (5) 53

Pacific peoples


maternity unit

34.3% (47)


31.4% (43)


separate building

27.0% (37)


7.3% (10) 56

Asian new

migrant


separate building

46.2% (24)


25.0% (13)


maternity unit

21.2% (11)


S* 52

* S - there were fewer than 5 people. Note that the percentages may not add up to 100% as the options are drawn from four different survey variables

47 60

31 25 11 17

27

46

23 13 7

19 9

34 21

0

10

20

30

40

50

60

70

80

Mixed Māori Pasifika Asian

Perc

ent



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APPENDIX 2 - Waitemata DHB: Primary Birthing Unit Consultation: Overview of community feedback 2016 (by Point Research)

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Waitemata DHB: Primary Birthing Unit

Consultation Overview of community feedback 2016

Alex Woodley Point Research Ltd, June 2016

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Contents Executive Summary .................................................................................................................................................... 3

Background ........................................................................................................................................................ 3

Aim ..................................................................................................................................................................... 3

Method ............................................................................................................................................................... 3

Findings .............................................................................................................................................................. 3

Waitemata DHB: Primary Birthing Unit Consultation ................................................................................................ 5

Background ............................................................................................................................................................ 5

Aim ......................................................................................................................................................................... 5

Methodology .......................................................................................................................................................... 5

Leadership .......................................................................................................................................................... 5

Consultation information and survey questions ................................................................................................ 5

Consultation plan ............................................................................................................................................... 6

Consultation process .......................................................................................................................................... 6

Consultation promotion ..................................................................................................................................... 7

Response ............................................................................................................................................................ 7

Findings ...................................................................................................................................................................... 8

Recommend a primary birthing unit (PBU) ............................................................................................................ 8

Would you recommend a primary birthing unit to someone having a baby? (Online) ..................................... 8

Using a primary birthing unit ........................................................................................................................... 10

If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit?

(Online)............................................................................................................................................................. 10

Preferred choice for type of a primary birthing unit ........................................................................................... 11

Respondent type .............................................................................................................................................. 13

Ethnicity ........................................................................................................................................................... 13

Consumers ....................................................................................................................................................... 15

Organisations, LMCs and other Health Professionals ...................................................................................... 16

Women under 30 years .................................................................................................................................... 17

Age Groups ....................................................................................................................................................... 18

Gender.............................................................................................................................................................. 19

Features of a primary birthing unit ...................................................................................................................... 20

Respondent type (online)................................................................................................................................. 20

Ethnicity (online) .............................................................................................................................................. 21

Feedback from community Hui and Fono and group meetings ...................................................................... 21

Other essential features of a PBU (Online) ...................................................................................................... 24

Proximity to home or hospital ............................................................................................................................. 25

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Location of birthing unit....................................................................................................................................... 26

Waitakere ......................................................................................................................................................... 26

North Shore ...................................................................................................................................................... 26

Rodney ............................................................................................................................................................. 26

Other comments .................................................................................................................................................. 26

Overall .................................................................................................................................................................. 26

Appendix 1: Tables ................................................................................................................................................... 27

Appendix table 1: Overall: Preferred choice for the Primary Birthing Unit ..................................................... 27

Appendix table 2: Preferred option for the primary birthing unit (group participants) .................................. 28

Appendix table 3: Features of primary birthing unit, rankings by ethnicity (online) ....................................... 29

Appendix table 4: Features of PBUs, rankings by gender (Online survey) ....................................................... 29

Appendix table 5: Features of the PBU identified as essential, by age group ................................................. 30

Appendix table 6: OVERALL - Proximity to home and hospital ........................................................................ 30

Appendix table 7: OVERALL - Would you recommend a primary birthing unit, by respondent type (online) 31

Appendix table 8: OVERALL - Would you choose to give birth in a primary birthing unit (online) ................. 31

Appendix table 9 - Respondent profile ............................................................................................................ 32

Appendix 2: Consultation Timeline .......................................................................................................................... 34

Appendix 3: Key partners and community networks .............................................................................................. 36

Appendix 4: People involved in consultation ........................................................................................................... 37

Appendix 5: References ........................................................................................................................................... 38

Appendix 6: Consultation survey ............................................................................................................................. 39

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Executive Summary Background

In November 2015 the Auckland DHB and Waitemata DHB collaboration maternity plan was launched. The plan

included a strategy to increase the number of primary birthing beds across the region. In order to understand

the needs of the community and the level of support for primary birthing units (PBUs) and to further understand

which delivery models would be most acceptable to the community, the Waitemata DHB Board agreed to

undertake broad community consultation to canvas their views.

The consultation process was a robust, multi-method approach that included a significant focus on ensuring

appropriate avenues and time to achieve high participation from key stakeholders and communities of interest.

There were 1162 responses to the survey and more than 450 people attending community events. This

substantive engagement provides confidence that the consultation process has canvassed diverse community

views to inform DHB decision making

Aim Community consultation sought to provide information to:

1. Determine the current level of support for primary birthing units in the community

2. Determine preferred locations for a primary birthing unit

3. Determine the preferred delivery model of care from four different options

4. Examine preferences on key features of a primary birthing unit

Consultation feedback is one part of the final information which the DHB board will use to inform their decision

making regarding potential primary birthing units in West Auckland and North Shore.

Method The community were provided with a range of opportunities, online and in person, to find out more and provide

detailed feedback including: an online survey, community forums and meetings. The data was collated and

analysed using SPSS. The results were significance tested.

For the purposes of this report, the Hibiscus area of Hibiscus and Bays Local Board has been included with North

Shore. Primary Birthing Units are already present in Northern and Western Rodney and are being analysed

separately.

Findings 1. Determine the current level of support for primary birthing units in the community

1.1. The majority of online respondents (87%) and those who attended groups (88%) indicated that

they would be likely to recommend a PBU to someone having a baby.

2. Determine the usage of the birthing unit

2.1. Most (64%) respondents hoping to have a baby in the future would consider choosing a birthing

unit, rating the likelihood as 8 or higher on a scale from 0 (definitely would not choose) to 10

(definitely would choose).

2.2. Those in West Auckland (65%) were slightly more likely to indicate that they would be likely to use

a PBU (rating it 8 or higher), than those in the North Shore and Hibiscus Coast area (63%) or Rodney

(61%).


3.1. Those who live in the Waitakere area would prefer the PBU to be located in Henderson, Ranui or

New Lynn. Asian groups suggested Blockhouse Bay or Titirangi as an option.

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3.2. Those from the North Shore indicated that they would like to see the PBU somewhere on the North

Shore, in Takapuna, or Northcote. Asian groups suggested Albany as a good location for a unit in

the community.

3.3. Respondents from Rodney favoured a PBU based at either the North Shore, Albany or West

Auckland. Some reiterated they would like to see it located close to a hospital.

3.4. Those in West Auckland and the North Shore and Hibiscus Coast area preferred the PBU to be

between home and hospital, or closer to hospital.


4.1. Overall online survey participants and those attending forums supported a community based

facility operated by a DHB or a PBU on hospital grounds, in a separate building.

4.2. Health providers other than LMC midwives preferred a community- based model operated by the

DHB.

4.3. LMC midwives preferred a community based PBU privately run. This model did not receive

widespread support from other demographic or professional groups.

4.4. There are no clear preferences by ethnicity between the community-based, DHB operated facilities, and a PBU based on hospital grounds in a separate building, as the online survey and forums supported different options.

4.5. It is noted, however, when respondents’ first two choices of model are combined, there is widespread support for a community based, DHB operated PBU.


5.1. Features considered essential to a PBU vary according to the age, culture and ethnicity of those

consulted. Nonetheless, there are some common features across the demographic groups.

Breastfeeding support/advice received the highest ranking and was seen as an essential service to

have as part of a PBU. Other essential features include ensuring that the PBU is a warm family-

friendly environment with single rooms which can accommodate friends and family. It must allow

partners to be able to stay overnight. Respondents need it to be easy to get to by car. Lower ranked

features included a children’s playground, a private garden area and access to food for visitors.

5.2. It is noted that many of those consulted said that they would like to continue to be involved in the ongoing development of a PBU.

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Waitemata DHB: Primary Birthing Unit Consultation Overview of primary birthing unit public consultation 2016

Background Since 2013, Auckland and Waitemata DHBs have been working together to develop a plan for maternity services

required over the next decade. In November 2015 the “Auckland DHB and Waitemata DHB collaboration

maternity plan was launched.” The plan detailed 22 strategies to strengthen services, based on the themes to

improve and enhance quality of care, build confidence, support parents and practitioners, and meet future

population needs; including a strategy to increase the number of primary birthing beds across the region.

Evidence from both New Zealand and the UK demonstrates that, for women who are at low risk of

complications, giving birth in a primary birthing unit increases the chance of having a normal birth. Feedback on

the maternity plan from stakeholders showed a strong support for increasing primary birthing options in the

Waitemata DHB area.

Currently Waitemata DHB has primary birthing units in Helensville, Warkworth and Wellsford; these are all rural

units and predominantly attract local women. The distances to these units are thought to be a barrier to uptake

for women giving birth. Community groups, private maternity organisations and LMC midwives have strongly

advocated for the development of primary birthing units closer to urban centres in West Auckland and North

Shore.

In order to understand the needs of the community and the level of support for primary birthing units and to

further understand which delivery models would be most acceptable to the community, the Waitemata DHB

board agreed to undertake broad community consultation to canvas their views.

Aim To allow the DHB board information to inform their decisions the following aims were agreed to gain the current

community views to:

1. Determine the current level of support for primary birthing units in the community




Consultation feedback is one part of the final information which the DHB board will use to inform their decision

making regarding potential primary birthing units in West Auckland and North Shore.

Methodology

Leadership A team was brought together including representation from: Māori, Pacific, Asian and migrant health, consumer

representatives, community engagement specialist, obstetrics, midwifery, Women’s health, and DHB planning

and funding. The team engaged Alex Woodley from Point Research to assist in planning and analysis of the

consultation feedback.

Consultation information and survey questions The participants were presented with some basic information about primary birthing units (see Appendix 2) to

ensure that everyone had a similar understanding of the concept and terminology used in this context.

The questions (see Appendix 3) were designed to gain insight into the current views on the following areas: key

features of a primary birthing unit, location, proximity to local hospital, preferred model of care (adjacent, on

hospital site, in the community, DHB or privately run), and support for primary birthing units.

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For the online consultation questions where multiple choices were given, options were randomly mixed to

reduce likelihood of any favouring of response. All questions were optional, except contact details.

Demographic information was requested from participants to help understand the team’s effectiveness in

reaching the diverse Waitemata community and to understand any differences in perspective. Tick-box options

were provided that represented key communities within Waitemata that matched both census data collection

approaches and how data is recorded within maternity services. This included:

Gender – while it was expected that more women would respond to the consultation, it was felt to be

important to ensure that the father’s voice was also heard and that other family members had an

opportunity to contribute.

Age group – options were designed to be able to identify the women who were more likely to be at an

appropriate birthing age for a new primary birthing unit should it go ahead.

Ethnicity – it was felt that it would be useful to be able to analyse any difference in perspective between

communities where possible so level 2 classification (e.g. Chinese as opposed to Asian which is level 1

classification) was used where appropriate.

In addition, people were asked if they were involved with a range of different types of organisation to help

understand the different perspectives of LMCs, other health professionals, community providers and

consumers.

Consultation plan The consultation was managed in a way that provided people with different ways of providing feedback:

through an online survey or through one of a series of small group forums or meetings aimed to focus

specifically on the views of Māori, Pacific, Asian and young parents. The consultation which targeted the

Waitemata DHB community took place between 18th January and 29th February 2016 (and later extended to 7

March 2016).

Consultation process The community were provided with a range of opportunities, online and in person, to find out more and provide

detailed feedback including:

1. Online consultation survey The Reo Ora Health Voice website (www.healthvoice.org.nz) was used as a platform for online feedback. The

site included a link to the consultation survey, some basic information about primary birthing units, overview of

consultation process and details of forums which participants could attend. An option was also given for anyone

to request a speaker for a group or network meeting.

Within the online survey, the only compulsory questions were name and email or postal address. These were

requested to ensure that feedback was genuine and to manage instances of people providing multiple

responses at events and / or online.

Questions on the kind of model of Primary Birthing Units and on the features people preferred were set up

within the online survey so that the order of options was randomised to reduce the risk of bias. The incentive of

a prize draw of one $50 supermarket voucher was offered for all those completing the consultation survey.

2. Community forums and meetings DHB-run forums (seven in total) took place on different dates and locations (including weekends and evenings).

These included targeted events for the Māori, Pacific and Asian community, as well as general community

events. Language support was provided where possible, and particularly within the Asian forums by the DHB’s

Asian Health Team and The Asian Network Incorporated. In addition, there were a number of small group

discussions that targeted key communities:

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http://www.healthvoice.org.nz/

7

Youth – Ohana Young Parents Unit

Refugee and migrant communities - Safari playgroup, De Paul House and WISE Collective Project

Pacific people - Enua Ola Health Committee, Matua Pasifika Wellness Group and Tongan Self-management education group

Maori - Incredible Years programme (Whānau House)

Positive parenting network

Ranui network meeting

Feedback was gathered in a slightly different format for these events to encourage and support participation.

Presenters were encouraged to keep within a structured format for presentations to reduce the risk of bias, but

to provide time for discussion throughout the forum to ensure that many of the participants at meetings had

the ability to be heard. This approach was felt to be more encouraging and supportive of participation for Māori,

Pacific and Asian communities in particular.

A project team member or community facilitator listened to the table discussion and noted key points of

feedback about the preferred features of primary birthing units and its preferred location. Attendees were then

asked to complete a short version of the feedback form which asked for individual responses to the type of

primary birthing unit preferred and whether or not the individual would recommend or use the unit.

This process was designed to encourage participation from communities who prefer to provide oral feedback or

who needed language support and may have found the long version of the feedback form off-putting.

Consultation promotion Consultation was promoted through the following areas:

Waitemata DHB website and social media accounts (facebook and twitter), and staff intranet (online link);

Reo Ora Health Voice website current members across Auckland & Waitemata DHB (email);

Auckland and Waitemata DHB Women’s Health Collaboration stakeholder networks (email), who were also encouraged to send out to their own networks;

Waitemata DHB Maternity staff and Lead Maternity Carer (LMC) who have access to practice in Waitemata DHB hospitals (email);

Posters distributed through DHB maternity units, libraries, community houses and parenting groups;

Media coverage – locally (picked up through national media via www.stuff.co.nz);

Waitemata DHB internal team meetings and weekly news;

Waitemata DHB Community Engagement Forum members and their networks;

Outreach also took place to support individual responses on paper surveys to the consultation from hard to reach communities.

The consultation was extended for an additional week to reach key groups who had not yet engaged and to give

them time to respond and provide feedback prior to the consultation closing on 7 March 2016.

Response The consultation was extensive and interest was high with around 1500 people participating in the consultation

process. In total, there were 1077 valid responses to the survey. Community meetings, hui and events were

attended by over 450 people at meetings filling in 348 questionnaires.

To strengthen the validity of the findings, the data was checked to minimise the risk of duplicate answers. It is

noted that 27 respondents were found to have answered the online questionnaire or attended a group more

than once. Those who responded in different capacities, for example both as an individual and on behalf of an

organisation, had both responses included in the analysis. Multiple responses from seven respondents were

excluded on the basis of apparent duplication.

112

8

Responses were analysed in further detail (where possible) by the following demographic variables to:

o Response method (online survey, group/community forum)* o Responder (provider type/organisation/consumer) o Ethnicity (Māori, NZ European, Pacific peoples, Asian, MELLA, Other) o Location (North Shore and Hibiscus Coast, West Auckland, Rodney) o Age groups (Under 19yrs, 20-29yrs, 30-39yrs, 40-54yrs, 55+ years) o Gender (Male, Female) o Potential future users of primary birthing unit development (women planning to have a baby in the

future, women aged 30 years or less)

Note that for the purposes of this report, the Hibiscus area of Hibiscus and Bays Local Board has been included

with North Shore. Primary Birthing Units are already present in Northern and Western Rodney and are being

analysed separately.

The results highlighted within the report were selected on the basis of prioritised categories considered by the

project team to be most relevant to the development of a primary birthing unit within Waitemata DHB. The

Appendices contain more detailed data tables, including a more detailed responder profile. It is noted that

respondents could select more than one ethnicity, and the ethnicity data Is non-prioritised. Data was analysed

using SPSS. Ninety-five percent confidence intervals have been used. The data was also significance tested using

t-tests. Small samples can affect the confidentiality of the results and individuals can be identified. Data has only

been presented when there are at least 5 people in the population group being analysed.

*Findings are shown as both ‘online’ and ‘group’ (community meeting) findings to reduce potential for multiple

responses and to indicate those who have attended a session which allowed for group table

participation/discussion. No limitation was placed on the number of events any member of the community

wished to attend.

Findings

Recommend a primary birthing unit (PBU) Respondents were asked how likely they would be to recommend a primary birthing unit to someone having a

baby, by rating their likelihood to recommend using a scale from 0 through to 10.

Would you recommend a primary birthing unit to someone having a baby? (Online)

Definitely not

recommend 0 10

Definitely would

recommend

Most of those consulted indicated that they would be likely to recommend a PBU to someone having a baby.

The majority of online respondents (87%) indicated that on balance, they would recommend the primary

birthing unit to someone having a baby, rating the likelihood of doing so as five or more. Three-quarters (74%)

indicated that they would be likely to recommend a PBU to someone having a baby, rating their likelihood of

doing so as eight or higher.

Similarly, most who attended groups (88%) indicated that on balance, they would recommend a PBU to

someone having a baby, rating it 5 or higher.

113

9

Although online respondents from West Auckland (86%) and North Shore and Hibiscus Coast (88%) indicated

that on balance they were likely to recommend a PBU to someone having a baby, those from Rodney were most

likely to do so (98%).

Whilst health professionals (93%) and LMC midwives (99%) in particular were likely to recommend a PBU the

majority of consumers (86%) too indicated they would recommend the unit to someone having a baby (rating

the likelihood five or higher).

Those from all ethnic groups indicated that they would recommend a PBU to someone having a baby. There

were no significant differences between potential birthing users such as those hoping to have a baby in the

future (86%), women under 30 years (87%), and other consumers.

It is noted that 2% of consumers would not recommend a PBU to someone having a baby, 12% of consumers did

not know whether they would or not.

Figure 1: Would you recommend a primary birthing unit, by respondent type (online)

WOULD NOT RECOMMEND

0 1 2 3 4 5 6 7 8 9 10 Don’t Know

WOULD RECOMMEND n=

Consumers 0.4%

2

0.0%

0

0.6%

3

0.6%

3

0.4%

2

4.0%

21

1.7%

9

6.9%

36

14.9%

78

8.4%

44

50.0%

262

12.2% 64

524

Organisations 0.0%

0

1.3%

1

0.0%

0

0.0%

0

0.0%

0

2.5%

2

2.5%

2

6.3%

5

15.0%

12

18.8%

15

45.0%

36

8.8% 7

80

Health Professionals

0.7%

1

1.4%

2

1.4%

2

2.1%

3

0.0%

0

6.3%

9

0.0%

0

2.8%

4

14.8%

21

12.7%

18

56.3%

80

1.4% 2

142

LMC Midwives

0.0%

0

0.0%

0

1.2%

1

0.0%

0

0.0%

0

2.4%

2

1.2%

1

1.2%

1

1.0%

1

8.5%

7

78.1%

64

0.0% 0

82

Differences are significant p < 0.05

2 1 6 1

13 11 9

5

73 79 84

94

12 9 1 0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Consumers Organisations Health Professionals LMC Midwives

0 to 4 5 to 7 8 to 10 Don’t Know

114

10

Using a primary birthing unit Respondents were asked if they were hoping to have a baby in the future, and if so whether they would choose

to give birth in a primary birthing unit, by rating their likelihood to recommend using a scale from 0 through to

10

If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit?

(Online)

Definitely not

choose 0 10

Definitely would

choose

Most (84%) of those hoping to have a baby in the future indicated, on balance, that they would consider

choosing a birth unit (rating the likelihood as 5 or higher). Two-thirds (64%) rating it as 8 or higher.

Those in West Auckland (65%) were slightly more likely to indicate that they would be likely to use a PBU (rating

it 8 or higher), than those on the North Shore and Hibiscus Coast (63%) or Rodney (61%).

It is noted most of those hoping to have a baby in the future would consider giving birth in a primary birthing

unit, irrespective of ethnicity or age.

Figure 2: Would you choose to give birth in a primary birthing unit, by area (online)

Definitely not 0 1 2 3 4 5 6 7 8 9 10 Definitely would n=

West Auckland

8.2%

(24)

2.1%

(6)

2.1%

(6)

2.1%

(6)

0.7%

(2)

6.2%

(18)

3.1%

(9)

11.0%

(32)

11.7%

(34)

9.6%

(28)

43.3%

(126) 291

North Shore

Hibiscus Coast

5.9%

(14)

2.5%

6)

1.3%

(3)

3.8%

(9)

1.3%

(3)

5.9%

(14)

5.1%

(12)

11.0%

(26)

13.1%

(31)

3.4%

(8)

46.6%

(110) 236

Rodney 10.0

%

(3)

6.7%

(2)

0.0%

(0)

0.0%

(0)

0.0%

(0)

10.0%

(3)

3.3%

(1)

3.3%

(1)

13.3%

(4)

10.0%

(3)

43.3%

(13) 30

13 15 17

20 22 22

65 63 61

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0 to 4 5 to 7 8 to 10

115

11

Preferred choice for type of a primary birthing unit Respondents were asked to rank the kind of primary birthing unit preferred from four options:

In a hospital, next to the maternity unit, located in a hospital, next to or very close to the maternity unit;

In the community, run by the DHB, located in the community, operated by the DHB;

On the hospital site in a freestanding building, located on hospital grounds in a separate building, with

its own entrance;

In the community run by a private provider, located in the community, operated by a private or

community contractor, but still free.

Overall, online survey participants preferred the PBU to be based in the community and operated by the DHB or on the hospital grounds in a separate building.

Figure 3: Preferred primary birthing unit choice (online)

FIRST CHOICE SECOND CHOICE THIRD CHOICE FORTH CHOICE n=

Overall online


38.2% (376)


separate building

31.4% (307)


23.4% (226)

In hospital, near the maternity

unit

12.5% (121)

985


Note that the percentages may not add up to 100% as the options are drawn from four different variables.

Similarly, those who attended the groups and open forums either selected a community-based facility operated

by the DHB, or a PBU on hospital grounds in a separate building as their first choices.

38

31

23

13

0

5

10

15

20

25

30

35

40

45

50

In community, DHBoperated

On hospital grounds, in aseparate building

In community, privatelyoperated

In hospital, near thematernity unit

Per

cen

t

Preferred option

116

12

Figure 2: Preferred primary birthing unit choice overall (open forums)


Overall groups


43.2% (114)


separate building

32.5% (76)


unit

28.7% (73)


14.9% (33)

264


Note that the percentages may not add up to 100% as the options are drawn from four different survey variables.

Those from West Auckland and Rodney favoured a community-based, DHB operated facility. Those in the North

Shore Hibiscus Coast area favoured a community-based DHB operated facility, or one on the hospital grounds in

a separate building.

Figure 3: Preferred primary birthing unit choice by area (online)


North Shore

Hibiscus Coast


37.2% (132)


separate building

33.0% (138)


24.5% (83)


unit

10.3% (35)

355

West Auckland


40.8 (172)


separate building

33.0% (138)


21% (86)


unit

11.2% (46)

422

43 33 29

15

0

10

20

30

40

50

60





Per

cen

t

Preferred option

37 41 42

33 33

20 25 21

33

10 11

0

10

20

30

40

50

North Shore Hibiscus Coast West Auckland Rodney

Per

cen

t



117

13

Rodney In community, DHB operated

42.0% (21)


32.7% (16)


separate building

20.4% (10)


unit S* 50

s* - there were fewer than 5 respondents

Note that the percentages may not add up to 100% as the options are drawn from four different survey variables.

Respondent type

The difference between consumers’ first and second choices, namely a community-based PBU operated by the

DHB or a PBU on hospital grounds with a separate entrance, were not significant.

Health providers too favoured a community-based, DHB operated facility.

LMC midwives, however, preferred a privately operated community-based facility.

It is noted that when respondents’ first and second choices were considered together, a community-based PBU,

run by the DHB was either the most popular or equally popular option across all the respondent types, including

LMC midwives.

Figure 4: Choice by Consumer, Health provider, LMC Midwives (Online survey)


Consumer In community, DHB operated

34.8% (175)


separate building

34.6% (140)


24.7% (121)


unit

9.0% (45)

503

Health providers


45.6% (57)


25.4% (33)


separate building

20.6% (26)


unit

12.2% (16)

131

LMC midwives


51.3% (40)


33.3% (26)


separate building

14.3% (11)


unit S* 78


Note that the percentages may not add up to 100% as the options are drawn from four different survey variables

Ethnicity European and Pacific peoples who responded to the survey had a preference for a community-based PBU operated by a DHB.

35 46

33 35

21 14

25 25

51

9 12 0

10

20

30

40

50

60

70

Consumer Health providers LMC midwives

Per

cen

t



118

14

Māori respondents favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance. Asian respondents were fairly equally in favour of all three DHB operated PBUs.

Figure 5: Preferred primary birthing unit choice by ethnicity (online)



38.8% (302)


separate building

30.5% (235)


26.2% (199)


unit

8.5% (64)

778


35.1% (26)


separate building

32.9% (25)


25.7% (19)


unit

8.5% (6)

76

Pacific peoples


48.9% (45)


separate building

28.1% (25)


unit

26.6% (25)


11.4% (10)

94


31.5% (29)


separate building

31.2% (29)


unit

29.5% (28)


13.0% (12)

95

Other In community, DHB operated

38.9% (21)


30.8% (16)


separate building

22.6% (12)


unit

11.8% (6)

54

Whilst Māori respondents online favoured either a community-based PBU run by a DHB or a PBU on hospital grounds with a separate entrance, participants at forums with a Māori focus had a preference for community-based, DHB operated PBUs. Participants at forums with a refugee and new migrant focus showed a preference for a PBU on hospital grounds but with a separate entrance.

39 35

49

32 39

31 33 28 31

23 26 26 27

13

31

9 9 11

30

12

0

10

20

30

40

50

60


Per

cen

t



119

15

Figure 6: Preferred primary birthing unit choice by ethnicity (groups)


Mixed groups


47.2% (25)


22.6% (12)


unit

18.7% (10)


separate building

11.3% (6)

23


60.4% (32)


separate building

17.0% (9)

In community,

privately

operated

13.2

(7)


unit

9.4% (5)

53

Pacific peoples


unit

34.3% (47)


31.4% (43)


separate building

27.0% (37)


7.3% (10)

56

Asian new migrant


separate building

46.2% (24)


25.0% (13)


unit

21.2% (11)


S* 52

* S - there were fewer than 5 people.


Consumers When examining the preferences of consumers separately from health providers, Pacific peoples and those

from other ethnicities preferred a community-based facility operated by a DHB. European and Māori consumers

too preferred this option, along with the facility based on hospital grounds in a separate building.

Asian consumers also favoured a PBU in the hospital near the maternity unit, along with a PBU in hospital near

the maternity unit.

47

60

31 25

11 17

27

46

23 13 7

19 9

34

21

0

10

20

30

40

50

60

70

80

Mixed Māori Pasifika Asian

Per

cen

t



120

16

Figure 7: Preferred primary birthing unit choice by ethnicity for consumers (online)

C FIRST CHOICE SECOND CHOICE THIRD CHOICE FOURTH CHOICE n=

European consumer


separate building

36.3% (140)


34.9% (135)


23.9% (89)


unit

8.1% (31)

387

Māori consumer


separate building

37.8% (14)


33.3% (12)


23.5% (8)


unit

2.0% (2)

37

Pacific consumer


47.4% (9)


separate building

33.3% (7)


S* In hospital, near

the maternity unit

S* 21

Asian consumer


separate building

37.9% (11)


unit

29.6% (8)


20.7% (6)


17.9% (5)

29

Other consumer


50.0% (11)


30.0% (6)


unit S*


separate building

S* 22



Organisations, LMCs and other Health Professionals Health professionals and respondents from organisations tended to favour a community-based DHB operated

facility as either first choice or first equal choice.

Pacific peoples who were staff had a clear preference for this model.

Whilst European and Māori staff preferred either this model or a community-based privately operated PBU,

Asian staff preferred either a community-based, DHB operated PBU or a hospital-based facility near the

maternity unit.

35 33

47

21

50

36 38 33

38

24 24 18

30

8 2

30

-10

0

10

20

30

40

50

60


Per

cen

t



121

17

Figure 8: Preferred primary birthing unit choice by ethnicity for organisations and health professionals (online)



42.3% (71)


37.4% (62)


separate building

16.4% (27)


unit

8.1% (13)

168

Māori


41.2% (7)


33.3% (5)


separate building


the maternity unit

S* 17

Pacific peoples


76.9% (9)


31.6% (6)


separate building


the maternity unit

S* 26

Asian


42.4% (14)


unit

32.4% (12)


separate building

17.1% (6)


S* 37

Other


47.1% (11)


29.4% (5)


unit S*


separate building

S* 17

* There were fewer than 5 respondents


Women under 30 years Women under 30 years ranked three different models similarly, namely a community-based PBU either DHB

operated or community run, or a PBU on hospital ground in a separate building. Few, however, favoured a

hospital-based PBU near the maternity unit.

42 33

77

42 29

16 17

37 41 32

47

8

32

-10

0

10

20

30

40

50

60

70

80

90


Per

cen

t



122

18

Figure 9: Preferred primary birthing unit choice of women under 30 years (online)


Women under 30

years


36.3% (78)


separate building

36.1% (67)


25.5% (54)


unit

9.0% (19)

215


Age Groups Whilst those aged between 20 years and 39 years ranked the community-based, DHB operated facility and a

PBU on hospital grounds in a separate building similarly, those aged 40 years or over had a clear preference for

a community-based DHB operated facility.

Figure 10: Preferred primary birthing unit choice by age group (online)


19 years or less


53.8% (7)


unit S*


separate building

S* In community,

privately operated

S* 13

20-29 years


separate building

35.4% (79)


33.2% (73)


25.1% (55)


unit

9.6% (21)

223

36 36

26

9

0

5

10

15

20

25

30

35

40

45





Per

cen

t

Preferred option

54

33 38 41 45

35 34 25

30 25 21

27 26

10 12 11 13

0

10

20

30

40

50

60

70

19 years or under 20-29 years 30-39 years 40-54 years 55+ years

Per

cen

t



123

19

30-39 years In community, DHB operated

37.6% (151)


separate building

33.9% (134)


21.3% (83)


unit

12.3% (48)

402


40.9% (88)

In community, run by private

provider

26.5% (58)


separate building

25.0% (54)


unit

10.6% (23)

219

55+ years In community, DHB operated

45.4% (44)


separate building

29.9% (29)


25.8% (24)


unit

13.0% (12)

97

* There were fewer than 5 respondents.


Gender There was no significant difference between either men’s or women’s first and second choices, namely a DHB-run PBU in the community or a PBU on hospital grounds with a separate entrance. However, when the first and second choices were combined, women had a clear preference for a PBU in the community, run by the DHB.

Figure 11: Preferred primary birthing unit option by gender (online)


Women In community, DHB operated

38.8% (341)


separate building

30.6% (266)


24.6% (212)


unit

10.7% (92)

878

Men


separate building

33.9% (19)


32.8% (19)


unit

20.7% (12)


17.5% (10)

58


39 33 31 34

25 18

11

21

0

5

10

15

20

25

30

35

40

45

Women Men

Per

cen

t



124

20

Features of a primary birthing unit Respondents were asked what would be important to them to have as part of a primary birthing unit. A list was

provided as a guide, and responders were asked to provide any other features important to them by ranking as:

essential, nice to have, not important or don’t know. Responses are represented as:

cells that are shaded blue had 75% or more respondents consider them to be an essential part of the

unit.

numbering represents the features ranking by order of importance.

Respondent type (online) Breastfeeding support/advice received the highest ranking as the most essential service to have as part of a PBU

by women planning to be pregnant, consumers, organisations, and health professionals. LMC midwives selected

the provision of a birthing pool as the most important service.

Lower ranked features included a children’s playground, a private garden area and access to food for visitors.

Table 12: Features of primary birthing unit, rankings by respondent type (online)

HOPING TO HAVE A BABY IN FUTURE*

WOMEN UNDER 30YRS

CONSUMER ORGANISATIONS HEALTH

PROFESSIONALS LMC MIDWIFE**

Breastfeeding support / advice 1 1 1 1 1 2

Family-friendly 2 2 2 2= 2 3=

Easy to get to by car 3 3 3 4 3 3=

Tasty healthy meals 4 5 4 11 5 6= Partners able to stay

overnight 5 4 5 7= 6 5

Birthing pool 6 6 6 13 4 1 Private ensuite

bathrooms 7 8 7 6 7 6=

Free car parking 8 7 8 9 9 9 Clinic rooms for

appointments 9 9 9 2= 10 12 Lounge area for

families 10 10 10 14 8 8 Pregnancy and

parenting classes 11 11 11 10 12 10 Easy to get to by public transport 12 13 12 7= 11 13

Language support 13 12 13 5 13 14

All day visiting 14 14 14 12 14 18 Other community

health services nearby 15 15 15 15 16 16

Private garden area 16 17 17 18 15 11 Access to food for

visitors 17 16 16 17 17 17

Children's playground 18 18 18 16 18 15

OVERALL n=511 n=223 n=457 n=85 n=147 n=54 *Women planning pregnancy included in all data groups

** Data shaded is where 75% or more of the group have considered the feature to be essential.

125

21

Ethnicity (online) The top ranked features that online respondents wanted to see in the PBUs were largely consistent across the

ethnic groups.

Breastfeeding support and advice was ranked as the most essential service by most (75% or more) respondents

across all ethnicities. A family-friendly service and a service easy to get to by car were also considered essential

by three-quarters or more of respondents from each ethnic group.

For those from ethnic groups other than European, having partners stay overnight and private bathrooms were

important to 75% or more of online respondents.

Tasty meals and a birthing pool were considered essential by Europeans, Māori and Pasfika, it was less likely to

be ranked highly by Asian or MELAA respondents.

Pacific peoples and Asian respondents favoured a `one stop shop’ ranking clinic rooms for appointments with

midwives, lactation consultants and physiotherapists as an essential service.

Features least likely to be considered essential were private garden areas, children’s playgrounds and access to

food for visitors, with respondents across each of the different ethnic groups giving these lower rankings.

Feedback from community Hui and Fono and group meetings

Māori

For those attending hui, participants ranked partners staying overnight, a lounge area for families and free

parking the most highly. The next highly ranked features included a birthing pool, breastfeeding support and

advice, language support and tasty healthy meals.

They also said they would like to see whānau centred care. This includes space for whānau, comfortable chairs,

and allowing partners and or support people to stay overnight. They would like rooms to be private, and to be

designed to enable new mothers to rest. It was suggested that a whānau room could be built alongside a

birthing room.

The importance of cultural support was emphasised. This included birthing facing the sun, enabling an elder to

offer the baby to the four winds, and ensuring the placenta could be taken home. It was felt that some staff are

unaware of the importance to Māori of these cultural practices.

Spirituality was also seen as important with participants considering the provision of a prayer and meditation

room, and chapel to be important features of PBUs.

The participants also wanted to see the PBU provide other services, such as childbirth classes, a lactation

consultant, and support for new mothers such as how to look after and care for babies.

For the participants of these groups, it was noted that small things can make a difference, such as toiletries and

hair dryers.

Participants also noted that trust needs to be built. For example, the death of a baby at a unit after a delay in

transfer reduced trust of such units. Work will need to be done to make PBUs an option as many women are not

given information about options other than hospitals.

It was felt there needed to be a grief team available to those who may need such support.

126

22

Pacific peoples

For those attending Pacific fono, breastfeeding advice, and a PBU which was easy to get to by car ranked most

highly. This was followed by features such as a birthing pool and clinic rooms for appointments. Attendees also

rated pregnancy and parenting classes, access to food for visitors, all day visiting, a private garden area, private

bathroom, a children’s playground and family-friendly facilities as essential.

Those attending fono noted that they would like to see the birthing unit closer to hospital in case of emergency.

They asked for the ambulance service to be free.

Fono attendees acknowledged the importance of cultural and spiritual values at the PBU. In addition to

interpreter services, participants said that faith support for families, through a chaplain service and other

spiritual supports such as a chapel, would be important to many Pacific peoples. One group asked for access to a

woman chaplain.

Other services they would like to see are free Wi-Fi services, access to computers and printers. Several groups

noted that they would like a support person, not necessarily a partner, to stay overnight.

In addition, they would like to see postnatal classes linked to community services, including counselling or

budgeting services.

In terms of the `feel’ of the unit, participants said the PBU would need to have a relaxed, family-friendly feel,

underpinned by cultural and faith based supports. One group pointed out that rooms needed to be large

enough to accommodate large Pacific families, with a children’s area where children too could be cared for and

stay overnight.

Asian, refugee and new migrant groups

Asian groups were most likely to rate having community health facilities nearby as essential to a PBU. This was

followed by ease to get to by car, access to food for visitors, a birthing pool, breastfeeding support and advice,

and clinic rooms for appointments. Other features which ranked highly included ease to access by public

transport, all day visiting, free car parking, family-friendly facilities and a lounge area for families.

Asian mothers, including Korean mothers, look after their daughters following birth, providing breastfeeding support and new parenting support. This is considered important for the wellbeing of the new mother, both physically and emotionally. Participants said that rooms would need to be of sufficient size to accommodate them. Some said that they found men on wards to be off-putting. Participants said that they would prefer single rather than shared rooms after delivery. This was a priority due to privacy reasons. Meals need to be culturally appropriate and nutritious. Cold food is considered inappropriate culturally. Food needs to be hot with vegan and vegetarian options. Korean women, for example, like to drink seaweed soup after birth to ward off postnatal depression. Similarly, special foods are important to Chinese women. It was suggested that a microwave could be provided so that clients could heat food up. The provision of a cooker, rice cooker and fridge to store food were also suggested, Like Pacific peoples, they would like to see a crèche for children. Participants said the birthing unit would need to be kept warm enough for mothers and their babies. It was suggested that the unit have underfloor heating. This is seen as very important. Participants said there was no need to provide outside space as new mothers and their babies need to be kept warm, rest and stay inside. Transport and parking were key concerns identified by those attending Asian group meetings. They said the unit would need to be accessible by public transport. Free parking was seen as important along with proximity to motorways and good roads.

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Support for new families was seen as critically important. It was suggested that staff be given permission to use their discretion and allow some families to stay longer, particularly where there is little family support. Some said that language support was needed, others felt that all day visiting would reduce the need for interpreter services.

Age Groups (online)

Again, breastfeeding support and advice was the PBU feature that ranked most highly across all the age groups.

Although the order varied, a family-friendly service, easy to get to by car and tasty healthy meals were selected

by 75% or more of those aged 20 years or over.

Three-quarters of those aged under 30 years wanted their partners to stay overnight.

Teen parents

A young mothers’ (teen) group said that they would like the PBU to provide an environment more akin to a

home than a hospital. They would like to see artwork on the walls, plants, and the comforts normally associated

with a home environment. They would like to see dim lighting, and comforts such as a couch or lazy boy chair.

They consider the soundproofing of walls to be essential as they said it was scary hearing others giving birth,

and frustrating hearing others give birth if their own labour is long. Young mothers also wanted a kitchen with

fruit or snacks. They were averse to the unit smelling like a hospital. The young mothers suggested additional

rooms in the PBU so that the unit could be a place where they could transfer to after birthing in hospital and be

supported. They were concerned that mothers could be transferred back to the unit if they had been

transferred from the unit to hospital, e.g. for pain relief.

Parenting groups

Parenting groups wanted the PBUs to have single rather than shared rooms as they were concerned about privacy. They wanted enough space for the father to be able to stay, and for both sets of grandparents to be able to visit. They emphasised the importance of the PBU being family-friendly, and dad friendly in particular. They would like double beds to be provided for dads to stay, and they felt it was important for PBUs to have less restrictive visiting hours. They would also like to be able to bring children in to see the new baby. They reiterated the importance of a warm and friendly environment as it can be hard for new mothers to ask for help or support. Participants in parenting groups suggested the PBU could become a hub for other services, such as antenatal services, and to provide information about home births. They would also like to see the PBU provide parenting advice and support to ensure that parents are well prepared before they go home. Other services which participants suggested included physiotherapy services, exercise classes and mental health support including information on warning signs. They would like the feel of the PBU to be homely. They are wary of private providers charging them for additional extras finding it elite and off-putting.

Gender (Online)

Both men and women had very similar ranked preferences. The only notable difference was the ranking of birthing pools, which was considered more important to women (ranked 5th) than men (ranked 13th).

For both men and women, breastfeeding support/advice was the highest ranked service to have as part of a PBU. The top four choices, namely breastfeeding support and advice, a family-friendly service, a PBU considered easy to get to by car, and a service which provided healthy, tasty meals were listed as essential by over 75% of the women surveyed. The top three services ranked by men, were considered to be essential by over 75% of male respondents.

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Lower ranked items for both men and women included access to food for visitors, and a private garden area, a children’s playground and nearby health services.

Other essential features of a PBU (Online) Respondents were asked if there were other essential services or features they would like to see in a PBU. More

than one in ten (13%) respondents said that they would like parenting or postnatal support or advice. One in ten

(10%) said that they would like the room to be comfortable, with the ability to play music, a double bed, or the

provision of arm chairs and lazy boys.

Some respondents (5%) noted that the Warkworth Birthing Centre was an excellent example of a PBU, and said

that they would like to see any new PBUs modelled on that.

It was noted that Muslim women need their own room away from men, but large enough to hold visitors. They

would prefer a kitchen to be available where they could make their own halal food. They would also like a space

where they can pray. Other requirements include no shoes to be worn. They would like lactation support

including an option to formula feed their babies.

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Proximity to home or hospital Respondents were asked whether they would prefer the Primary Birthing Unit to be closer to home or the

hospital. (See Appendix 1).

Those in West Auckland and on the North Shore and Hibiscus Coast area preferred the PBU to be between home

and hospital, or closer to hospital. Those in Rodney favoured a mid-point.

Those on the LMC midwives and other health professionals, were more likely to prefer the PBU to be located

between home and hospital. Consumers were divided in their preferences between it being located between

home and hospital, or nearer a hospital.

Consumers from ethnicities other than European were most likely to prefer the unit to be located closer to

hospital. Those attending Asian groups suggested that it needed be close enough to the hospital to get there if

there are complications so that families feel safe, however far enough away that the issues associated with

hospitals, such as parking, a lack of privacy and the risk of infection, are minimised.

Those aged under 30 years were slightly more likely to prefer the birthing unit sited between home and

hospital. Those aged 30-39 years were more likely to prefer it to be sited closer to the hospital.

Whilst women preferred a PBU to be located closer to hospital than home, or somewhere in between, men

were slightly more likely to prefer it to be sited closer to hospital.

Figure 13: Proximity to home and hospital, by area

CLOSER TO HOME

0 1 2 3 4 5 6 7 8 9 10 CLOSER TO HOSPITAL n=

West Auckland

1.1% (5)

3.2% (15)

3.0% (14)

2.8% (13)

1.7% (8)

23.4% (109)

5.2% (24)

13.7% (64)

16.7% (78)

6.0% (28)

23.2% (108)

466

North Shore

Hibiscus Coast

3.7% (14

3.5% (13)

3.2% (12)

3.2% (12)

3.5% (13)

20.9% (78)

4.5% (17)

12.6% (47)

17.6% (66)

7.8% (29)

19.5% (73)

374

Rodney 5.7% (3)

1.9% (1)

5.7% (3)

5.7% (3)

1.9% (1)

39.6% (21)

3.8% (2)

3.8% (2)

13.2% (7)

9.4% (5)

9.4% (5)

53

* Significant differences between highest and lowest values.

12 17

26

42 38 47 46 45

26

0

10

20

30

40

50

60


Per

cen

t

0 to 4 (closer to home) 5 to 7 8 to 10 (Closer to hospital)

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26

Location of birthing unit

Waitakere Those who live in the Waitakere area preferred the PBU to be located in Henderson, Ranui or New Lynn. Asian

groups suggested Blockhouse Bay or Titirangi in the trees as an option.

North Shore Those from the North Shore indicated that they would like to see the PBU somewhere on the North Shore, in

Takapuna, or Northcote. Asian groups suggested Albany as a good location, with staff able to cope with

emergencies as it is a distance from the hospital.

Rodney Online respondents from Rodney favoured a PBU based at either North Shore, Albany or West Auckland. Some

reiterated they would like to see it located close to a hospital.

Other comments In general respondents were supportive of a PBU, largely as they felt it was good to have birthing options. Key

concerns from consumers centred on how it would be run if privately operated. There were also questions

regarding the availability of land. Respondents commented that they would like on-going involvement and input

into the development of a PBU.

Overall Overall there is agreement that those consulted would be likely to recommend the PBU to others, and those hoping to have a baby in the future would be likely to use it. The Waitemata DHB: Primary Birthing Unit Consultation of online survey respondents and group participants has found support for a PBU to be based in the community and run by the DHB. Features considered essential to a PBU vary according to the age, culture and ethnicity of those consulted. Nonetheless, there are common features, such as breastfeeding support, a warm friendly environment with single rooms which can accommodate friends and family. It is noted that many of those consulted said that they would like to continue to be involved in the development of a PBU should these be progressed.

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Appendix 1: Tables Appendix table 1: Overall: Preferred choice for the Primary Birthing Unit

FIRST CHOICE

% n= SECOND CHOICE

% n= THIRD CHOICE

% n= FOURTH CHOICE

% n=

Gender

Overall In community, DHB operated

38.2% (376)


separate building

31.4% (307)


23.4% (226)


unit

12.5% (121)

Women In community, DHB operated

38.8% (341)


separate building

30.6% (266)


24.6% (212)


unit

10.7% (92)

Men


separate building

33.9% (19)


32.8% (19)


unit

20.7% (12)


17.5% (10)

Respondent type

Consumer In community, DHB operated

34.8% (175)


separate building

34.6% (140)


24.7% (121)


unit

9.0% (45)

Organisation In community, DHB operated

51.5% (34)


separate building

25.0% (16)


21.9% (14)


unit

19.1% (13)

Health Provider In community, DHB operated

45.6% (57)


25.4% (33)


separate building

20.6% (26)


unit

12.2% (16)

LMC midwives In community,

privately operated

51.3% (40)


33.3% (26)


separate building

14.3% (11)


unit 5.4% (4)

Other / Prefer not to say


42.9%* (72)


separate building

30.9% (53)


19.8% (34)


unit

12.9% (18)

Ethnicity


38.8% (302)


separate building

30.5% (235)


26.2% (199)


unit

8.5% (64)


35.1% (26)


separate building

32.9% (25)


25.7% (19)


unit 8.5% (6)

Pacific peoples In community, DHB operated

48.9% (45)


separate building

28.1% (25)


unit

26.6% (25)


11.4% (10)


31.5% (29)


separate building

31.2% (29)


unit

29.5% (28)


13.0% (12)

MELAA


separate building

50.0% (6)


27.3% (3)


unit

16.7% (2)


16.7% (2)



38.9% (21)


30.8% (16)


separate building

22.6% (12)


unit

11.8% (6)

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FIRST CHOICE

% n= SECOND CHOICE

% n= THIRD CHOICE

% n= FOURTH CHOICE

% n=

Age

19 years or less In community, DHB operated

53.8% (7)


unit

23.1% (3)


separate building

15.4% (2)


8.3% (1)

20-29 years


separate building

35.4% (79)


33.2% (73)


25.1% (55)


unit

9.6% (21)


37.6% (151)


separate building

33.9% (134)


21.3% (83)


unit

12.3% (48)


40.9% (88)

In community, run by private

provider

26.5% (58)


separate building

25.0% (54)


unit

10.6% (23)

55+ years In community, DHB operated

45.4% (44)


separate building

29.9% (29)


25.8% (24)


unit

13.0% (12)

Region

West Auckland In community, DHB operated

40.8% (172)


separate building

33.0% (138)


21.0% (86)


unit

11.2% (46)

North Shore Hibiscus Coast


37.2% (132)


separate building

33.0% (138)


24.5% (83)


unit

10.3% (35)

Rodney In community, DHB operated

42.0% (172)


21.0% (86)


separate building

20.4% (10)


unit s



38.7% (106)


28.0% (75)


separate building

25.1% (68)


unit

13.3% (35)

Potential future birthing population

Hoping to have a baby in the

future


35.6% (235)


separate building

29.5% (195)


23.2% (153)


unit

11.8% (78)

Women under 30 years In community,

DHB operated 36.3% (78)


separate building

36.1% (67)


25.5% (54)


unit

9.0% (19)


Appendix table 2: Preferred option for the primary birthing unit (group participants)

FIRST CHOICE

% n= SECOND CHOICE

% n= THIRD CHOICE

% n= FOURTH CHOICE

% n=

Open forums In community,

run by DHB 43.0% (113)

On hospital grounds, separate entrance

32.5% (76)


unit

28.7% (73)


14.9% (33)


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Appendix table 3: Features of primary birthing unit, rankings by ethnicity (online)

EUROPEAN MĀORI

PACIFIC PEOPLES ASIAN MELAA

OTHER / PREFER NOT

TO SAY


Family-friendly 2 2 4 2 2 2

Easy to get to by car 3 4 2 4 3 4

Tasty healthy meals 4 7 6 8 13 7

Birthing pool 5 6 9 14 14 6

Partners able to stay overnight 6 3 5 3 4 5

Private ensuite bathrooms 7 5 7 9 5 8

Free car parking 8 8 8 5 6 3

Lounge area for families 9 10 11 12 12 12 Clinic rooms for appointments (e.g. midwife,

lactation consultant, physiotherapist) 10 9 3 6 10 9

Easy to get to by public transport 11 12 10 7 8 11

Pregnancy and parenting classes 12 11 13 11 9 13


All day visiting 14 14 14 13 11 14

Other community health services nearby 15 15 15 15 16 16

Private garden area 16 17 18 18 18 17

Access to food for visitors 17 16 17 16 15 15


NB: Shaded cells denote that 75% or more respondents considered the feature to be an essential part of the

unit.

Appendix table 4: Features of PBUs, rankings by gender (Online survey)

FEMALE MALE

Breastfeeding support / advice 1 1

Family-friendly 2 3

Easy to get to by car 3 2

Tasty healthy meals 4 4=

Birthing pool 5 13

Partners able to stay overnight 6 4=

Private ensuite bathrooms 7 8

Free car parking 8 4= Clinic rooms for appointments (e.g. midwife, lactation

consultant, physiotherapist) 9 4=

Lounge area for families 10 9

Pregnancy and parenting classes 11 14

Easy to get to by public transport 12 10

Language support 13 11

All day visiting 14 12

Other community health services nearby 15 16=

Private garden area 16 18

Access to food for visitors 17 15

Children's playground 18 16=

OVERALL n=948 n=63

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* Other includes Gender Diverse & Prefer not to say. Gender diverse numbers were too small to provide robust analysis.


unit

Appendix table 5: Features of the PBU identified as essential, by age group

19 AND UNDER 20-29 30-39* 40-54 55+ PREFER NOT TO SAY


Family-friendly 4 2 2 2 3 3

Easy to get to by car 3 3 3 3 2 13

Tasty healthy meals 9 5 4 4 7 11

Partners able to stay overnight 6 4 5 7 11 9

Birthing pool 7 6 6 5 6 2

Private ensuite bathrooms 15 8 7 6 4 10

Free car parking 12 7 8 8 10 8

Lounge area for families 8 10 9 10 12 15 Clinic rooms for appointments (e.g.

midwife, lactation consultant, physiotherapist)

2 9 10 9 5 6

Pregnancy and parenting classes 5 13 11 12 9 5

Easy to get to by public transport 13 11 12 11 8 4


All day visiting 10 14 14 14 14 16

Other community health services nearby 16 15 15 16 15 12


Access to food for visitors 14 16 17 17 18 18

Private garden area 18 17 18 15 16 14

OVERALL n-13 n=233 n=431 n=239 n=113 n=7


unit

Appendix table 6: OVERALL - Proximity to home and hospital CLOSER TO

HOME 0 1 2 3 4 5 6 7 8 9 10

CLOSER TO HOSPITAL n=

Overall 2.6% 3.0% 3.3% 3.5% 2.5% 22.4% 4.4% 13.6% 16.6% 7.2% 20.8% 1034

Hoping to have a baby in

future 2.7% 3.4% 3.8% 3.3% 2.2% 22.6% 4.7% 13.0% 17.3% 6.5% 20.6%

875

Women under 30 years

2.7% 1.8% 0.9% 2.3% 3.6% 25.8% 6.3% 14.5% 17.2% 5.9% 19.0% 221

European 2.8% 2.8% 3.9% 3.5% 2.7% 24.0% 5.4% 14.5% 16.6% 6.0% 17.8% 820

Māori 1.3% 2.6% 3.8% 1.3% 1.3% 16.7% 3.8% 15.4% 12.8% 5.1% 35.9% 78

Pacific peoples

1.2% 6.0% 1.2% 0.0% 0.0% 19.0% 1.2% 11.9% 14.3% 10.7% 34.5% 84

Asian 3.9% 2.9% 1.9% 3.9% 0.0% 10.7% 1.0% 14.6% 22.3% 9.7% 29.1% 103

MELLA 7.7% 0.0% 0.0% 0.0% 0.0% 23.1% 0.0% 15.4% 15.4% 0.0% 38.5% 13

* *Significant difference between highest and lowest values.

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Appendix table 7: OVERALL - Would you recommend a primary birthing unit, by respondent type

(online)

0 1 2 3 4 5 6 7 8 9 10 Don’t Know

n=

Overall 0.4% 0.6% 0.8% 0.6% 0.5% 4.2% 2.0% 6.6% 13.4% 8.8% 52.1% 10.1% 1057


Hoping to have a baby

in future 0.5% 0.6% 0.6% 0.6% 0.6% 4.1% 2.2% 6.3% 13.3% 9.0% 51.3% 11.1% 875

Women under 30

years 0.5% 0.0% 0.5% 0.0% 0.5% 4.6% 2.7% 3.7% 13.2% 4.1% 58.4% 11.9% 219

Respondent type

Consumers 0.4% 0.0% 0.6% 0.6% 0.4% 4.0% 1.7% 6.9% 14.9% 8.4% 50.0% 12.2% 524

Organisations

0.0% 1.3% 0.0% 0.0% 0.0% 2.5% 2.5% 6.3% 15.0% 18.8% 45.0% 8.8% 80

Health professional

s 0.7% 1.4% 1.4% 2.1% 0.0% 6.3% 0.0% 2.8% 14.8% 12.7% 56.3% 1.4% 142

LMC Midwives

0.0% 0.0% 1.2% 0.0% 0.0% 2.4% 1.2% 1.2% 7.3% 8.5% 78.0% 0.0% 82

Other / Prefer not to

say 0.0% 1.5% 0.5% 0.0% 1.0% 2.5% 1.5% 10.1% 9.5% 8.5% 56.3% 8.5% 199

Ethnicity

European 0.4% 0.2% 0.7% 0.7% 0.6% 3.7% 1.6% 6.7% 13.9% 8.1% 53.4% 10.0% 819

Māori 1.3% 0.0% 3.8% 0.0% 1.3% 3.8% 1.3% 10.1% 12.7% 10.1% 49.4% 6.3% 79

Pacific peoples

0.0% 0.9% 1.9% 0.0% 0.0% 2.8% 2.8% 5.6% 8.4% 10.3% 60.7% 6.5% 186

Asian 0.0% 2.0% 0.0% 0.0% 0.0% 7.8% 3.9% 7.8% 14.7% 12.7% 38.2% 12.7% 102

MELLA 7.1% 7.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.1% 64.3% 14.3% 14

Other 0.0% 0.0% 0.0% 0.0% 0.0% 5.1% 1.7% 6.8% 20.3% 6.8% 52.5% 6.8% 59

* *Significant difference between highest and lowest values.

Appendix table 8: OVERALL - Would you choose to give birth in a primary birthing unit (online)

CLOSER TO HOME

0 1 2 3 4 5 6 7 8 9 10 CLOSER TO HOSPITAL

n=

Overall 7.8% 3.0% 2.1% 2.2% 1.0% 6.3% 3.3% 9.7% 12.7% 7.9% 44% 624

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Appendix table 9 - Respondent profile All respondents

n=1111 Percentages (%)

Overall

Online survey 1077 75.6% Open forums (forms) 348 24.4%

Mixed ethnicity hui participants 57 18.8% Māori hui participants 54 17.8%

Pacific fono participants 140 46.2% Asian, refugee, migrant forums 52 17.2%


Hoping to have a baby in future 682 77.6% Women under 30 years 225 22.0%

Gender

Female 952 93.3% Male 63 6.2%

Gender Diverse 3 0.3% Prefer not to say 2 0.2%

Age

19 years or less 13 1.3% 20-29 years 235 22.5% 30-39 years 432 41.6% 40-54 years 239 23.1%

55 years or more 113 10.9% Prefer not to say 7 0.7%

Ethnicity (Multiple response)

European 823 77.2% Māori 80 7.5%

Pacific peoples 118 10.5% Asian 105 9.9%

Middle Eastern, Latin American African

8 6

0.8% 0.6%

Other 51 4.8%

Respondent type

Consumers 527 58.9% Organisations 85 9.4%

Health Professionals 147 16.3% LMC Midwife 82 9.2%

Other / Prefer not to say 204 23%

Area

North Shore and Hibiscus Coast 387 37.1 West Auckland 485 46.5

Rodney 56 5.4 Auckland central 91 8.7

Other 25 2.4

KEY

Respondent type Consumers (Consumer, maternity service user); Organisations (Māori organisation, Pacific peoples organisation, Asian organisation, Youth organisation, Women’s health organisation); Health professionals (LMC Midwife*, LMC Obstetrician, DHB maternity clinical staff, Community health provider, Private health provider); Other (Government / Ministry of Health, Union, Other – please specify, Prefer not to say) * LMC midwife separated for analysis, as health professional providing advice on place of birth when in a primary birthing units

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Region Grouped by locality, based on local boards by Auckland Council: North Shore and Hibiscus (Devonport-Takapuna, Hibiscus and Bays, Kaipātiki, North Shore, Upper Harbour); West Auckland (Henderson-Massey, Waitākere Ranges, West Auckland, Whau); Rodney (Rodney, excluding Hibiscus and Bays) Auckland central (Auckland) Other (Counties Manukau, Outside Auckland Metro, Other/Unknown) Unspecified (unknown, prefer not to say)

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Appendix 2: Consultation Timeline

Date Meetings & activities

Mon, 18/Jan Start of public consultation period

Reo Ora Website Primary Birthing Unit consultation information and survey (live)

Press Release to Auckland & Waitemata press, and Womens Health Collaboration maternity

stakeholders advising of start of public consultation (with links to Reo Ora site)

Tue, 19/Jan Blog linking public to online consultation on Reo Ora site on Waitemata DHB facebook site

Banner linking public to online consultation on Reo Ora site on Waitemata DHB website

Banner linking staff to online consultation on Reo Ora site on Waitemata DHB intranet homepage

Tue, 02/Feb

to Fri, 05/Feb

Posters advertising online consultation and public meetings, put into community at Libraries,

Community Houses, Citizens Advice Bureau, and other places that families attend from Rodney:

Whangaparoa to Dairy Flat

North Shore: Browns Bay to Devonport

Waitakere: Whenuapai to New Lynn

Thu, 11/Feb 11am: Matua Pasifika Wellness Group, Henderson (Pacific Elderly Group)

Sat, 13/Feb 10-12: West Auckland Pacific Fono, Kelston Community Hall, (Pacific focused community meeting)

Wed, 17/Feb 10.30am: De Paul House Café Club, Onewa Road, Northcote (Migrant and displaced families)

Wed, 17/Feb 6-8pm: North Shore Pacific Fono, Maria Assumpta Church Hall, Beach Haven (Pacific focused

community meeting)

Thu, 18/Feb 7pm Enua Ola Health Committee, The Fono (West Auckland Pacific Health & Community providers)

Fri, 19/Feb 9.45am: Safari Playgroup, Henderson Baptist Church (Refugee & Migrant women)

Sat, 20/Feb 10-12: North Shore community meeting, Northcote Netball Centre (general community and

healthcare provider meeting)

Sat, 20/Feb 10-12: West Auckland Asian meeting, Kelston Community Centre (Asian focused community

meeting)

Mon, 22/Feb 11.30am - WISE women meeting, Henderson (women from diverse refugee backgrounds)

Mon, 22/Feb 1-3: North Shore Maori community hui, Birkdale Community Hall, Birkdale (Maori focused

community meeting)

Tue, 23/Feb 10-11am: Positive Parenting network meeting , Man Alive, 11 Edmonton road, Henderson

Tue, 23/Feb 12-1: Incredible Years education, Whanau House (Maori focussed parent education)

Tue, 23/Feb Ranui Community Action Network meeting, Ranui Baptist Church

Wed, 24/Feb 10-12am: TANI Network Meeting (75+ people), Western Springs

Wed, 24/Feb 10-12: West Auckland community meeting, Ranui Baptist Church (general community and

healthcare provider meeting)

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Date Meetings & activities

Wed, 24/Feb 12-1: Incredible Years education, Whanau House (Maori focussed parent education)

Thu, 25/Feb 8.30am: Waipareira Staff meeting, Whanau House, Henderson (Community health workers)

Sat, 27/Feb 10-12: North Shore Asian community meeting, St John Centre, Takapuna (Asian focused community

meeting)

Mon, 29/Feb Email to Auckland & Waitemata press and Women’s Health Collaboration maternity stakeholders

advising of additional week extension of public consultation (with links to Reo Ora site)

Extension update on Blog linking public to online consultation on Reo Ora site on Waitemata DHB

facebook site

Extension update on Banner linking public to online consultation on Reo Ora site on Waitemata DHB

website

Extension update on Banner linking staff to online consultation on Reo Ora site on Waitemata DHB

intranet homepage

Mon, 29/Feb 9-10: Te Puna Hauora Staff meeting, Northcote (Maori focused healthcare provider meeting)

Fri, 04/Mar Ohana teen parents group, West Auckland (Teen parent focussed meeting)

Fri, 04/Mar Tongan Self-Management Education group, New Lynn (older adult)

Mon, 07/Mar 7am Reo Ora Website Primary Birthing Unit consultation information and survey (closed)

End of public consultation period

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Appendix 3: Key partners and community networks

Group Outcome

Womens Health Stakeholder Network

Promoted to participants (approx. 150) Auckland DHB & Waitemata DHB Womens Health Collaboration stakeholders, who were encouraged to share with their networks across Health and Community organisations involved in Womens Health.

General community The two Health Links were a key partner for the two general community forums. They published information in their newsletters and actively promoted through their networks with particular encouragement to attend the events. Health links also helped to distribute posters through Plunket and childcare groups and enabled participation in networks eg in Ranui. The North Shore Community Co-ordinators also helped to spread the word through their networks and while there were opportunities to attend their community family days, the team was too stretched.

Maori community Worked in partnership with Te Runanga o Ngati Whatua to help encourage involvement and participation in the Maori community forum. Discussions also took place with Te Puna and with the Waipareira Trust.

Disability community Promoted through the disability networks and a sign language interpreter was offered for the two general community events but not required.

Asian community The Asian Network Incorporated (TANI) were a key partner and supported the two Asian community events in Kelston and Takapuna. TANI encouraged attendance at the events from people enrolled in their Healthy Babies Healthy Futures programme, promoted the consultation through their networks and social media and provided time at their network meeting to talk about the consultation and gather feedback. The Chinese New Settlers Services Trust also promoted through their networks through Chinese social media sites and attended the North Shore Asian community event. Cultural performers were arranged for both Asian community events which further encouraged participation from the Chinese and Korean communities.

Youth Promoted through Youthline, the Youth Health Hub and Youth Horizons Trust. Connections with Teen Parents, the Positive Parenting network and the Ohana Young Parents Unit

Pacific community Worked in partnership with the Fono to support attendance at the west Pacific community forum and to enable discussion with Enua Ola and other small Pacific group meetings. North Shore Pasefika forum were a partner in delivering the North Shore Pacific community forum and they helped to spread the word through local churches and through social media.

Refugee and migrant communities Gained support from the Auckland regional refugee migrant team to connect with key groups such as the WISE women’s collective and the Safari playgroup in West Auckland. Also met with De Paul House on the North Shore.

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Appendix 4: People involved in consultation

Waitemata DHB staff involved in consultation meetings and promotion:

Carol Hayward*

Wendy Devereux*

Linda Harun*

Peter van der Weijer*

Emma Farmer*

Ruth Bijl *

Lita Foliaki*

Leani Sandford*

Sangeeta Shah*

Wai Vercoe*

Aroha Haggie*

Galuafi (Galu) Lui

Grace Ryu

Samantha Dalwood

Bruce Levi

Christine Mellor

Sue Fitzgerald

Louise Elia - Kaumatua

Frank Taipari - Kaumatua

Jay O'Brien

Samantha Bennett

Lifeng Zhou

Sione Feki

Consumer and partner organisations involved in consultation meetings, support and promotion:

Jesse Solomon (Waitemata DHB Consumer Liaison)*

Isis McKay (Auckland DHB Consumer Liaison)*

The Fono: Hira Harema, Lingi Pulesea

North Shore Pasefika Forum: Gaylene Wilson, Maria Lafaele

Maria Assumpta Catholic Church: Fr Ikenasio Vitaliano (Parish Priest)

TANI: Samuel Cho, Vishal Rishi and Lily Xu

Te Runanga o Ngati Whatua: Te Hao Apaapa-Timu, Matua Heta Tobin

Youth Health Hub: Junior Tavai

Waipareira: Susan Van der Plas & Audrey Tinsley

Te Puna: John Marsden

Waitakere Health Link – Tracy McIntyre, David Lui, Farhana Buksh, Kay Lindley, Noelene Coppell, David Lui

Health Link North – Wiki Shepherd Sinclair, Lorelle George, Jennie Michel, Tanya Binzegger

Ohana Young Parent Unit: Kerry Leonard and Sam Molesworth

* Womens Health Collaboration - Primary Birthing Unit Consultation Project Team

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Appendix 5: References

Hollowell J, Puddicombe D, Rowe R, Linsell L, Hardy P, Stewart M, et al. (2011). The Birthplace

national prospective cohort study : perinatal and maternal outcomes by planned place of birth.

Birthplace in England research programme. Final report part 4. United Kingdom.

Farry, A. (2015). A retrospective cohort study to evaluate the effect of ‘Place Presenting in Labour’

and ‘Model of Midwifery Care’ on maternal and neonatal outocomes for the low risk women

birthing in Counties Manukau District Health Board. Auckland University of Auckland Thesis

available online at May 9, 2016:

http://aut.researchgateway.ac.nz/bitstream/handle/10292/9467/FarryA.pdf?sequence=3

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http://aut.researchgateway.ac.nz/bitstream/handle/10292/9467/FarryA.pdf?sequence=3

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Appendix 6: Consultation survey 18 January to 7 March 2016

Primary Birthing Unit Consultation

Introduction Waitemata District Health Board (DHB) currently has primary birthing units in Helensville, Warkworth and Wellsford and is considering opening a new primary birthing unit in West Auckland, followed by one on the North Shore. Community support is a key factor in whether a unit is well used or not, so the DHB is holding a public consultation to hear what communities, individuals and health professionals think.

What is a primary birthing unit

Primary birthing units are places where healthy women with no complications can give birth, then stay for a day or two afterwards. They are staffed by midwives and have a relaxed homely feel. They are family friendly and partners are often able to stay overnight. Research says that giving birth in a primary birthing unit is safe for women with no complications. Primary birthing units have all the necessary equipment for normal birth. Women transfer to a hospital if they need epidurals or caesareans. Primary birthing units are free to all women eligible for publically funded healthcare (if the unit is public or has a contract with the DHB).

How to have your say

This consultation is important to help the DHB understand where a primary birthing unit should be located, what facilities should be there and how the unit should be managed. It will help us understand what would encourage the community to use the unit.

Consultation will begin on Monday 18 January and will close on Monday 7 March 2016. As part of the consultation, there will be community events, an online survey and information available in a wide range of places including online at www.healthvoice.org.nz . Where possible, the DHB will provide a speaker on request to talk with community groups or networks.

This survey can be completed by individuals, community organisations, health professionals or any interested persons. It will take 5-10 minutes to complete. You do not need to complete all questions but we do ask you to provide your name and email address so that we can keep you informed of the results and outcome of this consultation. Please let others know about the consultation so they can have a say too.

Everyone who provides feedback will be invited to enter into a prize draw for a $50 supermarket voucher.

Email [email protected] to register for events direct, if you have any queries or would like to request a speaker.

The consultation closes on Monday 29 February 2016.

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http://www.healthvoice.org.nz/

mailto:[email protected]

40

Your feedback Your contact details

As this is a public consultation your name and email or postal address are required to help us feel confident that the feedback we receive is genuine. Your name and email address will not be published.

We will not use your name and contact details for any purpose apart from entering you into a prize draw for a $50 supermarket voucher and providing you with feedback about this consultation.

1. Your name:______________________________________________________________________________

2. Your email address (or postal address if you prefer):_____________________________________________

3. What suburb/neighbourhood do you live in? This will be used to help us analyse the results of the consultation but is non-compulsory. ______________________________________________________________________________

4. What would be important to you to have as part of a primary birthing unit? Please indicate if you think the features listed are essential, nice to have or not important.

Features Essential Nice to have Not important Not sure

Access to food for visitors

All day visiting

Birthing pool

Breastfeeding support / advice

Children's playground

Clinic rooms for appointments (eg midwife, lactation consultant, physiotherapist)

Easy to get to by car

Easy to get to by public transport

Family friendly

Free car parking

Language support

Lounge area for families

Other community health services nearby

Partners able to stay overnight

Pregnancy & parenting classes

Private ensuite bathrooms

Private garden area

Tasty healthy meals

5. Do you have any other suggestions? ____________________________________________________________

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6. Is it more important for the primary birthing unit to be closer to home or closer to the hospital? Please indicate your preferred location using the scale of 0-10.

0 – closer to home

1 2 3 4 5 6 7 8 9 10 – closer to hospital

7. Do you have any preference on which suburb/neighbourhood it should be located? _____________________________ 8. Why do you think this? _____________________________________________________________________________ Primary Birthing Units come in a range of different designs to suit community needs. If a primary birthing unit is closer a hospital it is easier for a woman to transfer to hospital if needed. If the Primary birthing unit is located in the community there is a greater chance of a woman having a normal birth. For the baby, all options are equally safe. UK Birthplace study 2014. In the question below we have described the options that the Waitemata DHB is considering. Use the pictures below to rank the kind of primary birthing unit you would prefer - you can choose as many or as few as you like. 9. Please indicate your order of preference from 1st choice being your most preferred to 4th choice being your least preferred

Image Explanation 1st choice

2nd choice

3rd choice

4th choice

Located in a hospital, next to or very close to the maternity unit.

Located in the community, operated by the DHB.

Located on hospital grounds in a separate building, with its own entrance

Located in the community, operated by a private or community contractor, but still free.

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10. Would you recommend a primary birthing unit to someone having a baby? Please use the scale of 0-10 to identify your likelihood of recommending one.

0 – definitely not

1 2 3 4 5 6 7 8 9 10 – definitely would

Don’t know

11. If you are hoping to have a baby in the future, would you choose to give birth in a primary birthing unit? If you are not hoping to have a baby in the future, please go to the next question. Please use the scale to identify your likelihood of using one

0 – definitely not

1 2 3 4 5 6 7 8 9 10 – definitely would

Not relevant

12. Do you have any comments to help us understand your answers to the previous questions?_________________

__________________________________________________________________________________________ 13. Do you have any other comments or feedback?________________________________________________________ __________________________________________________________________________________________________

About you We would be grateful if you could answer a few questions about yourself to help us to understand how well we have reached our community. These questions will not be used to identify individuals but may help us to understand if there are different perspectives from different parts of the community. 14. Gender: Female / Male / Gender diverse / Prefer not to say 15. Age group:

19 years or less

20-29 years

30-39 years

40-54 years

55+

Prefer not to say

16. Which ethnic group do you belong to? Please select as many options that apply below.

New Zealand European Chinese

Other European Indian

Maori Japanese

Samoan Korean

Cook Islands Maori Other Asian

Tongan Middle Eastern

Niuean Latin American

Tokelauan African

Fijian Other please state

Other Pacific Peoples Prefer not to say

Filipino

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17. Are you submitting on behalf of an organisation or group? No / Yes – please specify_________________ 18. Do you align yourself with any of the following? Please select all that apply.

Consumer / maternity service user

Māori organisation

Pacific peoples organisation

Asian organisation

Youth organisation

Women’s health organisation

LMC Midwife

LMC Obstetrician

DHB maternity clinical staff

Community health provider

Private health provider

Government / Ministry of Health

Union

Other – please specify

Prefer not to say

19. If you are a Lead Maternity Carer which area or areas do you work in? Please select all that apply.

West Auckland

North Shore

Rodney

Auckland Central

Other – please specify

Prefer not to say

19. Would you like your name to be entered into the prize draw for a $50 supermarket voucher? Yes / No 20. Are you interested in being added to the mailing list to get involved in future maternity services improvements across Auckland and Waitemata DHBs? More information about the programme of work is at the following link . Note you will be able to unsubscribe at any time. Yes / No 21. Would you be interested in being added to the new Waitemata District Health Board Reo Ora Health Voice online community panel to have your say on other health matters? You will be sent links to other online surveys or occasional invitations to participate in community forums and focus groups. Note you will be able to unsubscribe at any time. Yes / No

Thank you for your feedback Thank-you for your feedback and having your say about primary birthing options for the Waitemata District Health Board.

What's next Feedback closes on Monday 7th March 2016 (extended deadline). Please also encourage your friends, families and networks to participate if you feel they would be interested.

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http://www.healthvoice.org.nz/auckland-dhb-and-waitemata-dhb-collaboration-maternity-plan-2015/

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All feedback provided through events and through this survey will be collated, analysed and provided to the Waitemata DHB Board to make a final decision on primary birthing unit options.

We will provide you with an update later this year on the results of the consultation, when decisions have been made and with other opportunities to get involved.

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6.2 2017 Board and Committee Meeting Schedule

Recommendation:

a) That the Board approves the attached meeting schedule for 2017, with meetings scheduled on a six weekly meeting cycle as follows:

i. The Waitemata DHB Board, Audit and Finance Committee and Hospital Advisory Committee meetings schedule follows the current basis for meetings to be on a six weekly meeting cycle.

ii. The combined Auckland DHB and Waitemata DHB Disability Support Advisory Committee and the Maori Health Gain Advisory Committee continue to meet four times per year on a six weekly meeting cycle.

iii. That the combined Auckland and Waitemata DHB Community and Public Health Advisory Committees will meet four times per year on a six weekly meeting cycle, bringing the Committee into alignment with the combined Auckland DHB and Waitemata DHB Disability Support Advisory Committees and the Maori Health Gain Advisory Committees meeting schedule.

b) That the Board approve an amendment to the Terms of Reference for the combined

Auckland and Waitemata DHB Community and Public Health Advisory Committees to meet in a combined forum four times per year, as noted in recommendation a) iii. above.

Prepared by: Peta Molloy (Board Secretary) Endorsed by: Dr Lester Levy (Chairman)

Note: the proposed Schedule has also been referred to the Auckland DHB Board for approval.

Glossary

ADHB - Auckland District Health Board CPHAC - Community and Public Health Advisory Committee DSAC - Disability Support Advisory Committee MHGAC - Manawa Ora (Maori Health Gain Advisory Committee) WDHB - Waitemata District Health Board

1. Summary

It is proposed that the 2017 Board, Audit and Finance Committee and Hospital Advisory Committee meetings schedule follows the current basis for meetings to be on a six weekly meeting cycle.

It is proposed that there be a change to the frequency of the combined ADHB and WDHB Community and Public Health Advisory Committees (CPHAC) meeting and that it be held four times per year. This will allow the Committee to better optimise its use of time and align the schedule with the current combined ADHB and WDHB DSAC and MHGAC meetings. These Committee meetings will continue to operate on a collaborative basis with ADHB within the six weekly meeting cycle.

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The proposed six weekly meeting cycle for 2017 follows below and the attached 2017 meeting schedule (attachment 1) designates the dates for each Board and Committee meeting and is coordinated with Auckland DHB’s cycle. The schedule allows for the week five meeting day to be dedicated to the Board meeting only (week five also includes the ADHB and WDHB Collaboration Committee).

Regular health and safety site visits will also be held on weeks three and six following any combined Committee meetings scheduled, timing and dates of the visits will be coordinated by the Board Secretaries at both ADHB and WDHB. In addition, Board members will be allocated lead roles in specific critical areas of activity: patient safety, patient experience, finance/budgets, health and safety, IT/innovation, facilities/equipment, primary care/NGOs/community care, care of elderly, mental health and risk. Board members will need to spend time on and develop particular knowledge around their lead role area.

The proposed cycle for 2017 follows the pattern (all meetings on Wednesdays):

Current Proposed

Week 1 – ADHB Audit and Finance

and DiSAC or Manawa Ora

Week 1 – ADHB Audit and Finance

and ADHB Hospital Advisory Committee

Week 2 – WDHB Audit and Finance

and CPHAC

Week 2 – WDHB Audit and Finance

and Hospital Advisory Committee

Week 3 – may be used at times for special meetings, workshops and the like

Week 3 – Manawa Ora/CPHAC and DiSAC (alternating) followed by a Health and Safety site visit *

Week 4 – ADHB HAC and ADHB Board Week 4 – ADHB Board

Week 5 – WDHB HAC and WDHB Board Week 5 – WDHB Board**

Week 6 – may be used at times for special meetings, workshops and the like

Week 6 – Health and Safety site visit (may also be used at times for special meetings, workshops and the like) ***

* Time can be assigned to lead roles on these days (weeks 3 and 6. ** The ADHB and WDHB Collaboration Committee will continue to be held on the WDHB Board meeting day.

The only variation to this is in December, because week 5 falls on Wednesday 20th December, it is proposed to hold the WDHB Board meeting on Thursday 14th December 2017.

The proposed cycle for the two Boards for 2017 commences on 01st February and concludes on 15th December.

Once both Boards have confirmed the schedule, a final schedule showing venues will be distributed to Board and Committee members, staff and interested parties and included on the DHB’s website.

Note: Elections 2016

Elections are due on Saturday 8th October 2016, with newly elected members coming into office on 5th December 2016. This means that (in addition to induction sessions) both ADHB and WDHB newly elected members will have one Board and HAC meeting day prior to the end of the calendar year.

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Proposed 2017 Waitemata DHB Meeting Schedule

Six weekly meeting cycle: Week 1: ADHB Audit and Finance and HAC; Week 2: WDHB Audit and Finance Committee and HAC; Week 3: MHAC or CPHAC and DiSAC*; Week 4: ADHB Board; Week 5: WDHB Board; Week 6: no regular scheduled meeting*

* Health and safety site visits will be schedule on weeks 3 and/or 6

COMMITTEE

TIME

JAN

FEB

MAR

APRIL

MAY

JUNE

JULY

AUG

SEPT

OCT

NOV

DEC

Audit and Finance Committee

8.30am 08/02 22/03 03/05 14/06 26/07 06/09 18/10 29/11

Hospital Advisory Committee

1.30pm

08/02 22/03 03/05 14/06 26/07 06/09 18/10 29/11

Maori Health Gain Advisory Committee (Manawa Ora) (MHGAC)

10.00am

15/02 10/05 02/08 25/10

Community and Public Health Advisory Committee (CPHAC)

10.00am

29/03 21/06 13/09 06/12

Disability Support Advisory Committee (DSAC)

1.30pm

29/03 21/06 13/09 06/12

Week 3: Health and Safety site visits

tba

15/02 29/03 10/05 21/06 02/08 13/09 25/10 06/12

BOARD

Board Only Time

Board meeting open following by confidential

Board HR Sub-Committee

9am

9.45am

tba

01/03 12/04 24/05 05/07 16/08 27/09 08/11 14/12

Week 6:Health and Safety site visits

08/03 19/04 31/05 12/07 23/08 04/10 15/11 n/a

Attachment 1

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7.1 Performance

Recommendation: That the following performance reports for the month and attachments be received:

1 Financial Overview of the 2015/16 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury

Prepared by: Rosemary Chung (Deputy Chief Financial Officer) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

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1 Financial Overview of the 2015/16 result

The planned 2015/16 financial result for Waitemata DHB is a surplus of $2.811m with $1.811m to be generated in the Funder Arm and $1m in the Provider Arm and breakeven result in the Governance Arm. For the month of April, the consolidated DHB result is a surplus of $969k against a budgeted surplus of $956k and is therefore $12k favourable to budget. The Provider arm is $3.571m unfavourable to budget, the Funder Arm is $3.580m favourable to budget. The Governance and Funding Arm is $4k favourable to budget. Year to date (YTD), the consolidated DHB result is a surplus of $31k against a budgeted deficit of $625k and is therefore $656k favourable to budget. The Provider Arm is $13.898m unfavourable to budget, the Funder arm is $14.350m favourable to budget and the Governance and Funding Admin Arm is $203k favourable to budget. The month end and the year to date result is consistent with the forecast for the year of a modest surplus. The financial result for the month of April 2016 compared to the budget is summarised in the table below.

WAITEMATA DISTRICT HEALTH BOARD

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE

($000's)

MONTH YEAR TO DATE

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUE

Crown 129,003 127,891 1,112 1,281,766 1,279,409 2,357 1,535,311 1,535,311 0

Other 2,348 2,290 58 21,774 22,274 (500) 28,149 28,149 0

131,351 130,182 1,170 1,303,540 1,301,683 1,857 1,563,460 1,563,460 0

EXPENDITURE

Personnel

- Medical 14,617 12,976 (1,641) 139,731 137,394 (2,337) 163,693 163,693 0

- Nursing 19,521 18,269 (1,252) 182,815 178,161 (4,654) 213,626 213,626 0

- All ied Health 9,766 8,726 (1,040) 88,722 88,179 (543) 106,005 106,005 0

- Support 1,443 1,231 (212) 12,919 13,108 189 15,858 15,858 0

- Management / Administration 5,888 5,195 (693) 57,236 56,935 (301) 67,467 67,467 0

Total Personnel 51,235 46,397 (4,838) 481,422 473,776 (7,646) 566,650 566,650 0

Other

Outsourced Services 6,986 5,556 (1,430) 60,907 55,667 (5,240) 67,023 67,023 0

Clinical Supplies 9,257 8,512 (745) 91,680 84,957 (6,723) 101,429 101,429 0

Infrastructure & Non-Clinical Supplies 9,199 7,788 (1,411) 86,037 78,187 (7,850) 93,882 93,882 0

Funder Provider Payments 53,706 60,972 7,267 583,463 609,722 26,259 731,666 731,666 0

79,148 82,828 3,680 822,088 828,533 6,445 994,000 994,000 0

Total Expenditure 130,383 129,225 (1,157) 1,303,510 1,302,309 (1,201) 1,560,649 1,560,649 0

NET RESULT 969 956 12 31 (625) 656 2,811 2,811 0

30 April 2016Reporting Date

FULL YEAR

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Comment on Major Variances Revenue Revenue is $1.857m YTD favourable to budget. ACC revenue is $549k favourable due to additional volumes in non acute rehab beds. Expenditure Overall expenditure was unfavourable to budget by $1.201m year to date. The key variances are summarised below: Personnel Costs ($7,646k unfavourable year to date) Variances in Personnel Cost categories were as follows:

Medical staff costs are unfavourable by $2,337k Year to date. This unfavourable variance was contributed to by Medical and Health of Older People Services of $1,916k, Surgical & Ambulatory Services $604k. Child Women and Family of $501k, largely due to leave balance expenses greater than expected, and having to cover shortfalls with higher qualified staff. This is offset in Mental Health and Corporate by $475k due to vacancies and use of contract staff and $670k in relation to unpaid day leave accrual reversals.

Nursing staff costs are unfavourable by $4,654 Year to date. This unfavourable variance is contributed to by higher than expected volumes and acuity resulting in additional individual patient observations (watches) on the wards and in the Mental Health in patient units (including Forensic Mental Health), the cost of statutory holiday adjustments and MECA holiday revaluations.

Allied Health staff costs were unfavourable to budget by $543k for the year to date mostly due to vacancies savings due to difficulties in recruitment.

Support staff costs are favourable by $189k mainly reflecting cleaners and orderly not incurred as support personnel as budgeted, with corresponding unbudgeted costs in the outsourced services cost category.

Management and Admin staff costs are unfavourable by $301k. This result is contributed to by under spends in corporate of $247k, partly offset by use of contractor costs incurred as part of outsourced services.

Outsourced Services Costs ($5,240k unfavourable for the year to date)

Overall, outsourced nurse bureau costs were adverse by $2,288k reflecting high external bureau for nursing cover. Agency costs for casual orderlies and cleaners are greater than budget by $1,110k. The total cost also includes savings targets.

Clinical Supplies Costs ($6,723k unfavourable for the year to date) Significant overspends in clinical supplies were incurred in:

Medicine and Health of Older People services unfavourable to budget by $486k. Mobility aids unfavourable at $284k continues to be the major contributor. Renal fluids are favourable to budget by $268k.

Hospital Operations is unfavourable to budget by $1,798k, due to increased volumes and centrally budgeted savings. Laboratory consumables and sendaway tests are unfavourable primarily due to a 7% increase in Microbiology testing for influenza and VRE screening. Blood product (Intragram) has increased 52% on last year.

Provider Management and Corporate Services is unfavourable to budget by $3,867k, due to actual depreciation greater than budget ($1,045k) and budgeted savings not being achieved on the same expense line of $2,005k.

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Infrastructure costs ($7,850k unfavourable for the year to date) The unfavourable variance relates in part to unbudgeted maintenance of $874k, fire levy price increase $159k and utility budget variances of $531k. The variance also includes $9,301k savings targets. Whilst some actual savings are included in relevant expense lines, overall savings are tracking behind budget. The Provider has a number of patient care/patient flow reviews are underway to identify opportunities for greater patient experience and efficiencies.

Funder Provider Payments ($26.259m favourable for the year to date) Funder Provider payments as reported in the Consolidated Statement of Financial Performance table are inclusive of Funder NGO payments and Funder IDF payments but do not include payments made to the Waitemata Provider Arm. The $26.26M favourable variance is gross of corresponding Provider Arm payments of $13.07M additional to budget that offset. Commentary on key drivers of the favourable Funder position are summarised under the Funder Financial Performance section that follows later in the report. Personnel Costs and Outsourced Service Costs Various measures are in place to get the unfavourable Personnel and Outsourced Service Costs variances back on track. These measures include constant monitoring of overtime hours taken, follow up with staff on sick leave taken, introduction of a pilot programme to more closely manage the use of watches. New HR reporting is being introduced to enable Managers to more closely manage Personnel expenditure. Clinical Supplies and Infrastructure Costs To get Clinical Supplies and Infrastructure costs back on track, management are continually working on procurement initiatives to identify savings. Savings have included successful price negotiations completed by healthAlliance, substitution of products to achieve greater value, increasing the number of products available on catalogue to take advantage negotiated prices, introduction of a Kanban stock system in some wards, which has reduced stock levels and creation of available space for alternative usage.

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2 Financial Performance - DHB Arms The financial performance for each of the DHB Arms for the month and the year is summarised in the table below, and the detailed statement of Financial Performance by DHB Arm is attached to this report (Attachment 1).

2.1. Provider Clinical Services

The Provider Clinical services result for the ten months ended 30 April 2016 is $10,410k unfavourable to budget. This is attributed to by an unfavourable performance in Child Women and Family services $2,177k, Medicine and Health of Older People services $6,898k, Surgical and Ambulatory Services $1,900k, Elective Surgery Centre $295k offset by a favourable performance in Mental Health services $859k. The key drivers for services financial performance are summarised below. Medicine and Health of Older People The service is $6,898k unfavourable for the ten months ended 30 April 2016. Medical and Health of Older People YTD result is driven by a significant increase in demand for constant observation (watch) shifts $985k unfavourable, as well as increased nursing demand, particularly in the two EDs. The service was also impacted by leave revaluations following the MECA uplift, this is compounded by a general problem of enabling staff to take all of their annual leave entitlement. Acute demand continues to exceed contracted levels with General Medicine WIES and ED presentations both running at 108% and 106% of YTD contract respectively, resulting in higher than anticipated demand for personnel and supply costs. Surgical & Ambulatory Services The Service is $1,900k unfavorable year to date. The financial result this month is unfavourable due to the costs of running additional sessions in order to catch up on elective orthopedic volumes while managing the sustained high level of acute volumes. The unfavorable result year to date is due to higher than planned service activity year to date, with acute volumes across SAS and ESC of 187 WIES above plan year to date April and Elective Discharges at ESC 144 above plan, against which anesthetist costs are incurred at SAS and recharged to ESC.Lower ACC revenues, unmet savings lines and unbudgeted nursing costs associated with running additional beds in the short stay ward. Cost containment initiatives have been partially successful in mitigating unbudgeted costs incurred this year, however, it is clear that a more proactive approach will be needed to secure financial sustainability in FY16/17. Operational planning is well underway to ensure a strong start to 2016/17. The new HR reporting series will afford better visibility of external agency and overtime hours, sick leave taken and the progress of active leave management plans for all staff. Cover models have been updated for all wards and theatres and coupled


FINANCIAL PERFORMANCE BY DHB ARM

($000's) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUEProvider Arm - Clinical Services 5,092 4,437 655 49,004 44,839 4,165 53,838 53,838 0 Provider Arm - Corporate & Support Services 67,808 63,624 4,184 644,986 635,637 9,348 762,493 762,493 0 Governance & Funding Admin Arm 1,015 998 17 10,229 9,976 252 11,972 11,972 0 Funder 124,063 123,534 529 1,236,504 1,235,339 1,166 1,482,406 1,482,406 0 Elimination (66,627) (62,411) (4,216) (637,182) (624,108) (13,074) (748,929) (748,929) 0 Consolidated 131,351 130,182 1,170 1,303,540 1,301,683 1,857 1,561,780 1,561,780 0

EXPENDITUREProvider Arm - Clinical Services 52,383 48,644 (3,739) 536,752 522,178 (14,574) 624,768 624,768 0 Provider Arm - Corporate & Support Services 23,283 18,612 (4,671) 173,269 160,433 (12,836) 190,563 190,563 0 Governance & Funding Administration 1,011 998 (13) 10,026 9,976 (49) 11,972 11,972 0 Funder 120,332 123,383 3,051 1,220,645 1,233,829 13,184 1,480,595 1,480,595 0 Elimination (66,627) (62,411) 4,216 (637,182) (624,108) 13,074 (748,929) (748,929) 0 Consolidated 130,383 129,225 (1,157) 1,303,510 1,302,309 (1,201) 1,558,969 1,558,969 0

NET RESULTProvider Arm - Clinical Services (47,291) (44,206) (3,084) (487,749) (477,339) (10,410) (570,930) (570,930) 0 Provider Arm - Corporate & Support Services 44,524 45,012 (487) 471,717 475,204 (3,488) 571,930 571,930 0 Governance & Funding Admin Arm 4 (0) 4 203 (0) 203 (0) (0) 0 Funder 3,731 151 3,580 15,859 1,509 14,350 1,811 1,811 0 Elimination 0 (0) 0 0 (0) 0 0 0 0 Consolidated 969 956 12 31 (625) 656 2,811 2,811 0

FULL YEAR

Reporting Date 30 April 2016

157


with the Bureau Booking system will afford better reporting and compliance of acuity cover and the standard hours rostered on the floor. The Procurement Management Team are seeing some good initiatives coming through and work is being done to secure better reporting for services in order to track savings realised within the new financial year. Other initiatives such as ERAS and OPIVA while not contributing direct savings will continue next year and do provide greater efficiencies through reduced lengths of stay and better patient outcomes, delaying the need for additional beds. Elective Service Centre The service is $295k unfavourable year to date due to higher than planned elective volumes, 5.3% above plan year to date. Costs associated with the number of discharges have offset savings that might otherwise have been realised through under delivery of more complex cases. The year end forecast is for an unfavourable financial result as the service is planning to over-deliver on budgeted volumes to ensure the overall surgical programme meets the Waitemata DHB Surgical health Target. Careful management of elective volumes between the SAS and ESC in the new year will limit over production (leading to budget overspends) while managing ESPI compliance.

Child Women & Family Services The service is $2,177k unfavourable to budget for year to date April 16. Revenue is $400k favourable year to date, driven by new service level agreements and several unplanned funding streams culminating to provide some relief against other unfavourable income and expenditure lines. Personnel costs are tracking $985k over budget and are attributed to a combination of high Medical allowances for covering registrar shortages, sick and sabbatical leave, cover for a regional shortfall in midwives, budget pricing issues within Allied Health staffing, unexpected back pay and several retirements. Personnel costs are being partially offset by under spending in other Allied Health and Management/Admin due to vacancies. Over spending in Outsourced costs $609k is being driven by a mixture of embedded savings $302k, nursing bureau $135k for sick and roster shortages, unbudgeted Anaesthetist costs and external postnatal services. Partially offsetting these costs are under spends in community radiology charging and lab send away tests. Embedded savings initiatives $165k per month remain a significant challenge. The service is looking to further build on the savings that are currently being realised through annual leave reduction, pricing benefits on community nursing continence supplies, specific dental and maternity products by exploring other areas such as community based logistics costs, telecommunications plans, cleaning and repairs and maintenance contracts to ensure that the services are getting value for money. Other group initiatives to support cost containment include the introduction of the Kanban stock management system across all inpatient wards and the creation of clinical supplies coordinator roles across North Shore and Waitakere Hospital to support this process by reducing potential over ordering and purchasing errors. A change in the model of care for Gynaecology patients is to be introduced in July 2016 resulting in a more cost effective, efficient and less invasive patient care. Mental Health Services Mental Health’s favourable YTD variance after April $859k is primarily the result of revenue from the new CADs contract for drug referrals from the Ministry of Justice $625k and also the impact of high YTD vacancies in nursing $1,277k. This is partially offset with high overtime in nursing $471k due to the combination of:

a) roster/sick cover particularly in the Adult and Forensic services

b) high acuity care in the Forensic inpatient units where 4 patients require dedicated 2-on-1 or 3-on-1 observations and

c) additional security in the Adult MHS, where staffing has been increased in Waiatarau and He Puna Waiora units to improve supervision of the courtyard areas as a result of security concerns earlier in the year.

Control of overtime remains a priority for the MHSG and introduction of better management tools has resulted in a 283 hour (23%) reduction per week in average Forensic overtime hours since July 2015. SMO

158


covering gaps in the registrar roster $292k in Adult and Forensic services follows an increased number of Registrar vacancies this year and excessive targeting of this account for budget savings in previous years. The Audit and Finance Committee have approved the business case for CAMHS increased service capacity in Rodney, with this service commencing from April. 2.2 Corporate and Support Services

The overall result for Provider Support is $3.488m unfavourable for the year to date.

Expenditure budget is overspent by $12.836m mainly due to unbudgeted repairs and maintenance $557k, outsourced colonoscopies $524k, unbudgeted gratuity and maternity leave payments $3.308m, overspends in additional cleaning and orderlies costs and clinical supplies in Hospital Operations due to increased volumes and centrally budgeted savings. Laboratory consumables and sendaway tests are unfavourable primarily due to an 8% increase in Microbiology testing. Blood product (Intragram) has increased 58% on last year. This is offset by additional revenue received of $9.347m received being $756k for outsourced colonoscopies (offset by unbudgeted outsourced costs), deficit support of $3.272m, additional funding for acute over delivery of $4.6m, additional revenue for outpatient pharmacy $373k and orthopaedic outsourcing $346k. 2.3 Financial Performance – Funder

The Funder position as reported in the Financial Performance by DHB Arm table represents the totality of the Funder and is inclusive of Funder Own Provider Arm Services, Funder NGO Services and Funder IDF Services. The Funder net result is $3.58M favorable to budget for the month and $14.35M favorable to budget for the year to date. The $14.35m favorable year to date variance is a net position that includes $4.17m of a budgeted $5.0M Inpatient IDF risk assessed as not needing to be accounted for. It also includes a favourable PHARMAC GST adjustment of $1.3M relating to 2014/15 as well as a favourable interim PHARMAC GST adjustment of $0.7M for the 2015/16 year. It further includes $4.9M of post budget favourable revision by PHARMAC of Drug rebates for 2015/16. It also includes various other prior year accrual releases of $1.5M and 2015/16 budgeted immunisation risk of $0.9M and a budgeted 2015/16 PHO IDF risk of $0.7M not being accounted for.

2.4 Financial Performance - Governance and Funding Administration Arm

The Governance and Funding Administration (GFA) represents the Waitemata DHB share of the Joint Planning Funding and Outcomes Arm and includes the Waitemata DHB share of the Northern Regional Alliance. The GFA Core Net Result is $203k favourable to budget for the year to date.

159


3 Financial Performance – Other Indicators/Trends

3.1 Net Result

The actual net result performance against the budget for the DHB tracked over time is illustrated in the graph below. The overall DHB result for the ten months to 30 April 2016 is $31k favourable which is $656k ahead of budget. The current full year forecast remains on budget at $2,811k.

3.2 Business Transformation Savings

The 2015/16 financial plan includes business transformation savings of $4.150M. The savings plan is on track as summarised in the table below:

-10,000,000

-8,000,000

-6,000,000

-4,000,000

-2,000,000

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

2014/15 2015/16

Waitemata DHB Surplus/(Deficit) By Month

Budget Actual

Waitemata DHBSummary of Key Actions that will impact Financial Performance

$000's

KEY ACTIONS - with brief description* Actual Plan Variance Commentary on / Explanation of Variance

Service Reconfigurations

Regional Dental Service Reconfiguration 510 0 468 (468) Invoicing arrangements are still being worked through for

services delivered year to date.

Standardisation of Clinical Supplies - Renal Fluids 540 495 495 0 Savings are on track year to date.

Standardisation of Clinical Supplies - Respiratory 50 46 46 0 Savings are on track year to date.

Standardisation of Clinical Supplies - Clinical Supplies Management 50 46 46 0 Savings are on track year to date.

Standardisation of Clinical Supplies - Food service contract 250 227 229 (2) The contract was delayed until August, savings are anticipated

for the remainder of the year.

Standardisation of Clinical Supplies - Gastro supplies 0 0 0 0 Savings are on track year to date.

Standardisation of Clinical Supplies - Gastro chemicals 30 0 28 (28) Savings are anticipated from Q2

Standardisation of Clinical Supplies - Dental Suppplies 130 96 119 (23) Savings are a little lower than anticipated due to some more

costly items being required.

Investment in Revenue Generation - Child Rehab - ACC Funding / Referrals 100 379 91 288 Additional ACC revenues have been realised year to date

within Child Rehab services.

Review and rationalisation of facilities - Rental space in Mental Health 166 152 152 0 Savings are on track year to date.

Review and rationalisation of facilities - Opthalmology facilities at Waitakere to

accomodate additional volumes

175 161 161 0 Savings are on track year to date.

Review of staffing rosters and models of care 50 44 46 (2) Savings are on track year to date.

Pharmaceuticals - Cost management 1,100 0 0 0 Savings are on track year to date.

Banking and finance - Treasury management 1,000 917 917 0 Savings are on track year to date.

Total 4,150 2,562 2,796 (233)

Full Year

Plan

FY14/15

Year to Date May-16

160


4 Capital Expenditure Capital expenditure planned for the 2015/16 year is $85.652M. The table below summarises performance against the capital expenditure budget for the month and for the year. The detailed capital expenditure statement is attached to this report (Attachment 2).

As at April 2016, capital expenditure is $14.728m below the plan. Underspend in Information Technology is due in part to resourcing issues.

Progress on implementation of major facilities capital projects is reported monthly to the Audit and Finance Committee via the Facilities and Development report. There are no significant departures from the plan; the under spend solely reflects the timing of the completion of projects.

5 Financial Position

The financial position as at 30 April 2016 is shown below. This indicates a strong balance sheet, with net worth of $304.829m including $110m in cash and deposits. The favourable equity position to budget was due to the increase in property valuation ($54m) in June 2015 following detailed valuations. The detailed Statement of Financial Position for the DHB Parent is provided as Attachment 3.

6 Cash flow Position

Summary of the cash flow statement as at 30 April 2016 is shown below. The detailed Cash flow statement is provided as Attachment 4. The DHB’s cash position in the HBL sweep as at 30 April 2016 is $82m (last month $84m).

The DHB also monitors performance in collecting amounts owed by other organisations; the total amount owed to the DHB as at 30 April 2016 was $14.0m (last month balance owed was $13.3m). 65% of this is

Actual Budget Variance Actual Budget Variance

Land 5,000 0 0 0 8,850 5,000 3,850

Buildings & Plant 48,954 4,631 5,320 (689) 41,254 43,801 (2,547)

Clinical Equipment 10,021 345 938 (593) 5,226 8,345 (3,119)

Other Equipment 3,850 426 321 105 1,718 3,211 (1,493)

Information Technology 12,819 668 1,240 (572) 3,133 10,331 (7,198)

Motor Vehicles 1,678 0 140 (140) 509 1,400 (891)

Purchase of softw are 3,330 0 0 0 0 3,330 (3,330)

Total Capital Expenditure 85,652 6,070 7,959 (1,889) 60,690 75,418 (14,728)

YTD (Apr-16)

$'000sFull Year

Budget

Month (Apr-16)

In $'000sOpening

30 Jun-15

Apr-16

Actual

Apr-16

Budget

Apr-16

Variance

Full Year

Budget

Crown Equity 304,723 304,829 238,897 65,932 238,897

Represented by :

Current Assets 185,552 165,976 111,137 54,839 104,177

Current Liabilities 267,128 294,202 253,108 (41,094) 252,051

Net Working Capital (81,576) (128,226) (141,971) 13,745 (147,874)

Fixed Assets 667,646 706,098 682,616 23,482 688,900

Term Liabilities 281,347 273,043 301,748 28,705 302,129

Total Employment of Capital 304,723 304,829 238,897 65,932 238,897

Month YTD


Opening cash 0 73,159 0 121,385

Operating 3,949 2,137 1,812 27,256 21,370 5,886

Investing (6,070) (7,959) 1,889 (88,690) (75,418) (13,272)

Financing 2,121 0 2,121 61,434 0 61,434

Closing cash 0 67,337 5,822 0 67,337 54,048

Closing Cash Balance in HBL Sw eep account 81,959 0 81,959 0

$'000s

161


within the 60 days period (46% of this relates to Ministry of Health and 21% to other DHBs). 35% is over 60 days and the majority of this is in the area most difficult to collect, i.e. non-residents income. An Accounts Receivables report and explanation for amounts overdue for more than 60 days is provided as Attachment 5.

7 Treasury 7.1 Financing Activity

Term debt drawn and average interest expense and rates are shown in the tables below.

$276.706m of Crown debt was fully drawn as at 30 April 2016. All loan facilities have been drawn down as at 30 April 2016. The average interest rates on the loan portfolio are provided in the table below:

MonthTerm Debt

($’000s)

CHFA Interest Expense

($’000s)

Jul-15 276,706 909

Aug-15 276,706 909

Sep-15 276,706 879

Oct-15 276,706 908

Nov-15 276,706 880

Dec-15 276,706 899

Jan-16 276,706 906

Feb-16 276,706 849

Mar-16 276,706 906

Apr-16 276,706 885

May-16

Jun-15

YTD 276,706 8,930

NZD

Available

Facilities

$000

Drawn Debt

Current

Month $000

Drawn Debt

Last Month

$000

Interest Rate

Current

Month

CHFA Fixed $272,996 $272,996 $272,996 3.8766%

CHFA Floating $3,710 $3,710 $3,710 3.1844%

Total Facilities $276,706 $276,706 $276,706 3.8673%

Monthly Weighted Average Interest Cost (Including Hedges & Margin) 3.8673%

162


7.2 Treasury Policy All Waitemata DHB debt shall be borrowed on either a fixed interest rate or floating interest rate basis, subject to the requirement that the overall percentage of fixed (fixed/floating master limit) in any time bucket must be in accordance with the following limits:

The fixed rate amount at month-end reporting dates must be within the following maturity bands (percentages calculated on the fixed rate amount at month end):

The interest rate re-pricing risk profile for the Waitemata DHB Crown debt is shown in the graph below:

7.3 Financial Covenants

Waitemata DHB’s performance against financial covenants (which are currently waived) is summarised below and compliance was achieved.

Financial Covenants Actual Budget Covenant Met

Shareholders’ Funds (=> $70 million) 305 m 239 m Yes

Net Total Debt / (Net Total Debt + SHF) < 65% 50% 56% Yes

ANZ Interest Cover EBITDA / Net Interest (> 1.5:1) 12 11 Yes

CHFA Interest Cover EBITDA / Net Interest (> 2.5:1) 8 8 Yes

163


ATTACHMENT 1

Attachment 1


STATEMENT OF FINANCIAL PERFORMANCE BY DHB SERVICE GROUP

MONTH Head Count

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual

Provider

Medical Services 1,030 971 59 18,494 16,934 (1,560) (17,464) (15,963) (1,501) (17,464) (15,963) (1,501) 2,018 1,874 (144) 2,374

Surgical Services 1,676 1,339 337 14,591 13,678 (913) (12,915) (12,339) (576) (12,915) (12,339) (576) 1,125 1,182 57 1,287

ESC 92 45 47 2,415 1,795 (619) (2,322) (1,750) (572) (2,322) (1,750) (572) 80 76 (4) 97

Child, Women & Family Services 1,175 1,088 87 6,993 6,551 (441) (5,818) (5,463) (355) (5,818) (5,463) (355) 931 924 (7) 1,168

Mental Health 1,120 994 126 9,891 9,685 (206) (8,771) (8,691) (80) (8,771) (8,691) (80) 1,269 1,283 13 1,391

Sub Total - Clinical Services 5,092 4,437 655 52,383 48,644 (3,739) (47,291) (44,206) (3,084) (47,291) (44,206) (3,084) 5,423 5,340 (84) 6,317

Hospital Operations 822 621 201 5,824 5,431 (393) (5,002) (4,809) (193) (5,002) (4,809) (193) 682 457 (225) 1,020

Facilities 562 51 511 2,710 2,310 (400) (2,149) (2,260) 111 (2,149) (2,260) 111 91 42 (49) 83

Provider Management 65,053 61,413 3,640 5,184 1,409 (3,775) 59,869 60,004 (135) 59,869 60,004 (135) 2 2

Corporate 1,371 1,539 (168) 9,564 9,462 (102) (8,194) (7,923) (270) (8,194) (7,923) (270) 256 358 101 301

Sub Total - Corporate & Support Services 67,808 63,624 4,184 23,283 18,612 (4,671) 44,524 45,012 (487) 44,524 45,012 (487) 1,029 859 (171) 1,404

Total Provider 72,900 68,061 4,839 75,666 67,255 (8,411) (2,766) 806 (3,572) (2,766) 806 (3,572) 6,453 6,198 (254) 7,721

Governance & Funding Administration 1,015 998 17 1,011 998 (13) 4 (0) 4 4 (0) 4 83 91 8 92

Funder Arm

Funder NGOs 35,015 38,702 (3,687) 31,280 38,551 7,271 3,736 151 3,585 3,736 151 3,585

Funder Inter District Flows 22,421 22,421 0 22,426 22,421 (5) (5) 0 (5) (5) 0 (5)

Total Funder Arm 57,436 61,123 (3,687) 53,706 60,972 7,267 3,731 151 3,580 3,731 151 3,580

Consolidated 131,351 130,182 1,170 130,383 129,225 (1,157) 969 956 12 969 956 12 6,536 6,290 (246) 7,813

YEAR TO DATE Full Year

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Budget

Provider

Medical Services 10,836 9,707 1,128 191,264 183,238 (8,026) (180,428) (173,530) (6,898) (180,428) (173,530) (6,898) 1,904 1,854 (50) 78,262

Surgical Services 14,921 13,639 1,282 147,821 144,639 (3,182) (132,900) (131,000) (1,900) (132,900) (131,000) (1,900) 1,069 1,182 114 (15,476)

ESC 638 454 184 19,356 18,877 (479) (18,717) (18,422) (295) (18,717) (18,422) (295) 76 76 0 4,960

Child, Women & Family Services 11,561 11,161 400 73,078 70,502 (2,576) (61,517) (59,340) (2,176) (61,517) (59,340) (2,176) 882 918 37 38,893

Mental Health 11,047 9,877 1,170 105,234 104,923 (311) (94,187) (95,046) 859 (94,187) (95,046) 859 1,224 1,282 58 33,803

Sub Total - Clinical Services 49,004 44,839 4,165 536,752 522,178 (14,574) (487,749) (477,339) (10,410) (487,749) (477,339) (10,410) 5,154 5,313 159 140,442

Hospital Operations 8,402 6,133 2,269 59,341 55,596 (3,745) (50,939) (49,462) (1,477) (50,939) (49,462) (1,477) 629 457 (172) (50,929)

Facilities 1,728 506 1,222 27,161 23,813 (3,347) (25,433) (23,307) (2,126) (25,433) (23,307) (2,126) 85 42 (44) (27,000)

Provider Management 625,044 614,132 10,912 (1,167) (16,052) (14,885) 626,210 630,184 (3,973) 626,210 630,184 (3,973) 2 2 (3,549)

Corporate 9,812 14,866 (5,054) 87,934 97,076 9,142 (78,122) (82,209) 4,088 (78,122) (82,209) 4,088 239 358 119 (58,964)

Sub Total - Corporate & Support Services 644,986 635,637 9,348 173,269 160,433 (12,836) 471,717 475,204 (3,488) 471,717 475,204 (3,488) 954 859 (94) (140,442)

Total Provider 693,989 680,476 13,513 710,021 682,611 (27,411) (16,032) (2,135) (13,897) (16,032) (2,135) (13,897) 6,108 6,172 64

Governance & Funding Administration 10,229 9,976 252 10,026 9,976 (49) 203 (0) 203 203 (0) 203 84 91 7

Funder Arm

Funder NGOs 375,009 387,019 (12,010) 358,214 385,510 27,296 16,795 1,509 15,286 16,795 1,509 15,286 1,811

Funder Inter District Flows 224,313 224,212 101 225,249 224,212 (1,037) (936) 0 (936) (936) 0 (936)

Total Funder Arm 599,322 611,231 (11,909) 583,463 609,722 26,259 15,859 1,509 14,350 15,859 1,509 14,350 1,811

Consolidated 1,303,540 1,301,683 1,857 1,303,510 1,302,309 (1,201) 31 (625) 656 31 (625) 656 6,192 6,264 72 1,811

FTE's

30 April 2016

Net Result FTE'sDirect Revenue Direct Expenditure Contribution

Direct Revenue Direct Expenditure Contribution Net Result

164


ATTACHMENT 2


STATEMENT OF CAPITAL EXPENDITURE

Month Ended 30 April 2016

Spend by Asset Category

Service Budget 2015/2016

Sum of Spent YTD Apr 2016

Balance (Budget Remaining)

Child, Women & Family

Clinical Equipment 1,442,909 400,300 1,042,608

Contingency 19,264 - 19,264

Information Technology 99,150 13,350 85,800

Building 20,781 18,101 2,680

Motor Vehicle 209,953 - 209,953

Other Equipment 172,501 93,050 79,451

Child, Women & Family Total 1,964,558 524,801 1,439,757

Corporate

Clinical Equipment 263,872 187,723 76,149

Contingency 8,960,465 - 8,960,465

Information Technology 6,029,720 1,021,082 5,008,638

Building 7,131,249 766,950 6,364,299

Other Equipment 583,358 975,101 (391,743)

Corporate Total 22,968,664 2,950,856 20,017,808

Decision Support

Contingency 2,094,081 - 2,094,081

Information Technology 7,746,005 753,953 6,992,052

Building (19,659) 2,150 (21,809)

Decision Support Total 9,820,427 756,103 9,064,324

ESC

Clinical Equipment 258,124 332,418 (74,294)


Information Technology 0 1,599 (1,599)

Building 4,938 9,699 (4,761)

ESC Total 297,000 343,716 (46,716)

Facilities

Clinical Equipment 3,682,733 389,415 3,293,318


Information Technology 94,674 - 94,674

Building 79,517,082 47,878,027 31,639,055

Other Equipment 3,076 2,796 280

Facilities Total 83,324,653 48,270,237 35,054,416

Hospital Operations

Clinical Equipment 1,500,907 656,191 844,716

Contingency 167,977 - 167,977

Information Technology 354,768 1,342,435 (987,667)

Building 1,465,212 1,168,951 296,261

Motor Vehicle 3,173,000 457,324 2,715,676

Other Equipment 795,897 475,790 320,107

Hospital Operations Total 7,457,761 4,100,691 3,357,070

Medical & Health of Older People



165


Information Technology 109,965 - 109,965

Building 21,530 18,716 2,814

Motor Vehicle 276,970 - 276,970

Other Equipment 22,717 21,320 1,397

Medical & Health of Older People Total 1,292,267 803,606 488,661

Mental Health



Building 381,474 240,282 141,192

Motor Vehicle 56,562 51,612 4,950

Other Equipment 81,665 146,529 (64,864)

Mental Health Total 596,631 469,818 126,813

Surgical & Ambulatory

Clinical Equipment 4,509,154 2,465,311 2,043,842


Other Equipment 5,493 4,123 1,371

Surgical & Ambulatory Total 4,525,542 2,469,434 2,056,108

Grand Total 132,247,503 60,689,263 71,558,240

166


ATTACHMENT 3

Attachment 3


STATEMENT OF FINANCIAL POSITION ($'000s)

30/06/2015 30/06/2016

Actual Actual Budget Budget

Crown Equity

103,015 Crown Equity 103,015 103,015 103,015

244,493 Revaluation Reserve 244,567 190,246 190,246

(44,872) Retained Earnings - Prior Years (42,785) (54,364) (54,364)

2,087 Retained Earnings - 2015/16 32

304,723 304,829 238,897 238,897

Represented by :

Current Assets

143,393 Bank and Short Term Deposits 109,959 70,637 63,677

35,454 Debtors 48,467 34,300 34,300

335 Prepayments 1,188 500 500

6,370 Inventory 6,362 5,700 5,700

Assets Held for Resale

185,552 165,976 111,137 104,177

Current Liabilities

Bank Overdraft

127,728 Creditors 126,818 127,388 125,930

46,983 Provisions and Accruals 63,994 47,690 47,690

66,368 Staff Related Liabilities - Current 77,341 74,050 74,464

26,049 Term Debt - Current Portion 26,049 3,980 3,967

267,128 294,202 253,108 252,051

(81,576) Net Working Capital (128,226) (141,971) (147,874)

Fixed Assets

567,288 Land, Buildings and Plant (net) 586,091 544,024 546,553

3,346 Leasehold Building Works (net) 3,751 3,337 3,337

43,109 Equipment (net) 39,597 44,029 45,242

95 Information Technology (net) 80 9,675 12,035

294 Intangible Software (net) 199 6,659 6,903

3,449 Vehicles (net) 2,910 5,813 6,075

19,390 Work in Progress 35,702 32,000 31,426

636,971 668,329 645,537 651,571

30,675 LT & Investments in Associates 37,768 37,079 37,329

30,675 37,768 37,079 37,329

Term Liabilities

29,064 Staff Related Liabilities- Term 21,040 20,000 21,500

435 Trust and Special Funds 435 8,503 8,503

251,848 Term Debt - External 251,568 273,245 272,126

281,347 273,043 301,748 302,129

304,723 304,829 238,897 238,897

Reporting Date 30 April 2016

167


Attachment 4

WAITEMATA DISTRICT HEALTH BOARD Reporting Date

CASHFLOW STATEMENT ($'000s)

Month YTD


Cash flows from operating activities:

Inflows

Crown 130,674 126,205 4,469 1,337,776 1,262,050 75,726

Interest Received 226 501 (275) 4,641 5,010 (369)

Other Revenue 4,637 2,665 1,972 39,100 26,650 12,450

Outflows

Staff 47,448 47,194 (254) 477,044 471,940 (5,104)

Suppliers 21,792 16,122 (5,670) 217,261 161,220 (56,041)

Other Providers 64,966 60,630 (4,336) 643,560 606,300 (37,260)

Capital Charge 0 1,583 1,583 12,138 15,830 3,692

Interest Paid 3,077 1,155 (1,922) 8,867 11,550 2,683

GST (net) (5,695) 550 6,245 (4,609) 5,500 10,109

Net cash from Operations 3,949 2,137 1,812 27,256 21,370 5,886

Cash flows from investing activities:

Inflows

Sale of Fixed Assets 0 0 0 0

Associates 0 0 0 0

Outflows

Capital Expenditure 6,070 7,959 1,889 60,690 75,418 14,728

Investments 0 0 0 28,000 0 (28,000)

Net cash from Investing (6,070) (7,959) 1,889 (88,690) (75,418) (13,272)

Cash flows from financing activities:

Inflows

Equity Injections 0 0 0 0 0 0

New Debt 0 0 0 0 0 0

Deposits Recovered 0 0 0 0 0 0

Outflows

Debt Repayments 0 0 0 0 0 0

Funds to Deposit (2,121) 0 2,121 (61,434) 0 61,434

Net cash from Financing 2,121 0 2,121 61,434 0 61,434

Net increase / (decrease) 0 (5,822) 0 (54,048)

Opening cash 0 73,159 0 121,385

Closing cash 0 67,337 0 67,337

Closing Cash Balance in HBL Sweep account 81,959 81,959

30 April 2016

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ATTACHMENT 5

WAITEMATA DISTRICT HEALTH BOARD Reporting Date 30 April 2016

STATEMENT OF ACCOUNTS RECEIVABLES

Ref As %

Total

Outstanding Current 1 - 30 D 31 - 60 D 61 - 90 D 91 Days + Prior Month

1 ACC 3.5% 486,434.48 454,341.67 14,766.73 9,107.11 1,922.60 6,296.37 495,724.89

2 Accredited Employers 0.0% 754.33 510.60 40.00 188.77 - 14.96 7,854.25

3 Commercial 4.6% 650,000.35 503,249.81 8,270.97 21,887.72 - 59.92 116,651.77 390,047.46

4 Crown (excluding MoH) 6.3% 882,472.32 566,185.29 267,029.91 8,681.10 14,650.45 25,925.57 1,022,954.18

5 DHBS' 22.2% 3,109,052.99 1,511,605.52 105,616.88 307,790.21 19,955.58 1,164,084.80 3,963,657.21

6 MOH 37.3% 5,220,542.46 3,785,333.11 345,391.77 49,829.91 251,250.13 788,737.54 4,002,552.44

7 Non Residents 25.6% 3,579,557.39 2,664.55 620,573.40 457,170.59 248,979.50 2,250,169.35 3,375,743.96

8 Overseas Govt 0.0% - - - - - -

9 Patient 0.4% 53,113.03 6,738.84 12,517.61 5,102.42 2,956.17 25,797.99 42,250.63

10 Staff 0.0% 1,485.83 81.85 104.43 - - 1,299.55 1,666.40

WDHB Total 13,983,413 6,830,711 1,374,312 859,758 539,655 4,378,978 13,302,451

49% 10% 6% 4% 31%

Total Less Nres 10,403,856 6,828,047 753,738 402,587 290,675 2,128,809

66% 7% 4% 3% 20%

Total 30+ 2,822,071

27%

REF

1 ACC As the aging ATB report indicates for ACC, the current oustanding represents 93.40% of the total oustanding.

3 Commercial There has been a decrease in the balance of the 91 days+ category down to $116,651.77.

4 Crown The balance of the 91+ category has decreased by $148,057.48 compared to the previous month. 95% is less than 60 days outstanding.

5 DHB's For 61+days overdue: CMDHB has $344K for the OPEX cost from 2013-2014. ADHB has $874K.

6 MOH 61+ days overdue: $439K as 3 invoices on-hold awaiting contract signing; $301K as 3 invoices in still in dispute

7 Non Residents $1,688,505 is on a current payment plan. This category of debtors is the most difficult to collect from.

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8.1 Hospital Advisory Committee Meeting held on 25th May 2016

Recommendation:

That the draft minutes of the Hospital Advisory Committee meeting held on 25th May 2016 be received.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee


held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 12.44p.m.

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Lester Levy (Board Chair) Kylie Clegg Sandra Coney (Deputy Committee Chair) Tony Norman (Deputy Board Chair) Morris Pita Gwen Tepania-Palmer Susanna Galea (co-opted member)

Willem Landman (co-opted member) Donna Riddell (co-opted member) David Ryan (co-opted member)

ALSO PRESENT Andrew Brant (Acting Chief Executive)

Robert Paine (Chief Financial Officer and Head of Corporate Services) Jocelyn Peach (Director of Nursing and Midwifery) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Debbie Eastwood (GM, Medicine and Health of Older People) Peter van de Weijer (HOD Medical, Child Women and Family Services) Emma Farmer (HOD Midwifery, Child, Women and Family Services) Stephanie Doe (Acting General Manager, Child, Women and Family) Ian MacKenzie (GM, Mental Health and Addiction Services) Jeremy Skipworth (Clinical Director, Forensic Services) Joanne Brown (Funding and Development Manager-Hospitals) (from 1.05pm) David Price (Director Patient Experience) Helen Wihongi (Acting Chief Advisor Tikanga) Peta Molloy (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 Lynda Williams (Auckland Womens Health Council) APOLOGIES Apologies were received and accepted from Max Abbott, Warren

Flaunty, Christine Rankin, Allison Roe and Dale Bramley and for early departure from Morris Pita.

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WELCOME The Committee Chair welcomed those present. The Committee Chair welcomed and introduced the new Director of Patient Experience, David Price. DISCLOSURE OF INTERESTS There were no additions or amendments to the interests register. There were no declarations of interest relating to the open section of the agenda. 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 06th April 2016 (agenda pages 7-32) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the minutes of the meeting of the Hospital Advisory Committee held on 24th February 2016 be approved. Carried Actions Arising (agenda page 33) No issues were raised.

3. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD There were no decision items.

4. PROVIDER ARM PERFORMANCE REPORT

4.1 Provider Arm Performance Report – March 2016 (agenda pages 34-95) Cath Cronin (Director of Hospital Services) introduced the report. Matters that she highlighted or updated included:

The letter of compliment (page 38 of the agenda) received was a pleasure to read and to share with the Committee.

That pathways and clinical improvements are progressing well with sustained change in practices being seen.

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The Shorter Stays in Emergency Departments target was achieved for the first quarter. The target was not reached in April, reaching the target in May and for the second quarter is a key focus.

That colonoscopy target performance is being closely managed with stabilising and improvement being seen, but not yet regular.

The Faster Cancer Treatment target is a priority to ensure the time to treat patients with cancer improves. The target rate has improved from 72% in the first quarter to 77.8% in the month of April with a goal of 85% by 30th June 2016.

With regard to the letter of compliment received, Morris Pita acknowledged the good work being undertaken in different parts of the organisation and the reflection on the organisations values. Human Resources Fiona McCarthy (Director Human Resources) briefly commented on this section of the report, noting in particular the impact of the work being undertaken within divisions around overtime and annual leave. She noted the overtime rate had seen a slight increase and as a result the strategies for using overtime are being investigated. Medicine and Health of Older Peoples Services Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services) presented this section of the report. Matters that she highlighted or updated included:

The value of the patient voice was noted in the design of the Waitemata DHB’s Stroke Service new model of care development, patients are being engaged with in the co-design. David Price will also be involved in supporting the co-design.

On 5th June 2016, the FAST [Face-Arms-Speech-Time] campaign rolls out nationally and encourages patients to present to ED helping to reduce the damage cause by stroke. The campaign will run for approximately ten weeks and include television, radio, digital and online adverts. There has been wide communication with staff about the campaign.

There are sustained allied health vacancies across services, recruitment strategies are being implemented including working with recruitment team leaders and setting in place advertising strategies. It was noted that the cost of living in Auckland was a consideration factor for overseas applicants.

Child, Women and Family Services Dr Peter van de Weijer (Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department Midwifery, Child, Women and Family Services) presented this section of the report. Dr Peter van de Weijer introduced Stephanie Doe who is Acting General Manager (Child, Women and Family Services) while Linda Harun is undertaking larger project work until October 2016.

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Matters that were highlighted included:

That work around improving transfer of domiciled neonates from the Neonatal Intensive Care Unit (NICU) at Auckland DHB back to the Waitemata DHB Special Care Baby Unit (SCBU) is underway. It is recognised that there is a high level of anxiety for the parents around transferring between the two services. Charge nurses from WDHB are now visiting NICU on a regular basis and also have a list of who is domiciled to Waitemata DHB and are gaining a better sense of when a transfer may occur. In response to a question it was noted that there is no data on staff time to visit NICU, however, it is a much more timely and proactive way for WDHB to be proactive and go and meet with NICU and patient families rather than reactively responding.

There are currently 11 midwifery vacancies at North Shore Hospital and that nurses have been recruited to fill midwife vacancies. It was noted that there is the opportunity to recruit new graduates annually during the month of May; of the graduate pool approximately fifty per cent opt for self-employment and the remaining take opportunities across the three metro-Auckland DHBs. In response to a question it was noted that the midwife FTE at North Shore Hospital was 47 and that there is a pool of casual staff that can be called in. Emma Farmer advised that whilst there is concern at the number of vacancies, she is confident a safe service is being provided. It was requested that the Committee be further updated on this matter.

In response to a question about the implementation of the Waitemata DHB induction of labour guidelines, it was noted that the guidelines are reviewed every three years. Two years ago a regional group reviewed the induction of labour guidelines and reached regional consensus and this was added to the local Waitemata DHB guidelines. Of interest, a new method of induction is the use of balloon catheters, allowing patients to go home rather than staying in hospital. In terms of reviewing the guidelines, particular steps are taken including a clinical review, review of new evidence, consultation with clinicians, LMCS and consumer representatives.

The gestational diabetes guidelines are national with implementation taking place in 2015, ahead of the required June 2016 date. The new guidelines require routine screening and with lower rangers than previous, more women are being diagnosed. In response to a question on whether women should be labelled as being pre-diabetic, it was noted that the testing was a national decision. It was also noted that the outcome of undetected and uncontrolled gestational diabetes on a baby can lead to a lifelong track of complications. The testing allows greater control of a baby’s birth rate leading to a better result as well as positive outcomes including lifestyle advice, such as seeing a dietician. Sandra Coney requested a copy of the national gestational diabetes guidelines.

In response to a question it was noted that the caesarean rates are decreasing. A report on caesarean rates is expected by the Committee every six months.

The Smokefree incentives programme for pregnant women has not been successful in a recent RFP and has now been stopped. The only referral process now available is Quitline, where historically there has been no success. It is an area of concern and the Funder has now included the matter on its risk register. It was noted that the smoking cessation programme may be an option as it is offered to outpatients and may therefore be available for pregnant women, this will be investigated.

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In response to a question from Kylie Clegg about the Gateway Assessment process and following the recent media story about a three year old boy, it was noted that the DHB is confident that all the necessary processes and systems are in place, along with working with CYF. Stephanie noted that a lot of work is being done with both CYF and the Police with regular meetings being held; the Gateway Co-ordinator will be attending the CYF operations meeting each month. Gwen Tepania-Palmer noted that 30 children waiting for over six weeks for a Gateway Assessment is a long time; in response it was noted that this wait time is of particular focus and it is anticipated the wait time will reduce. This matter will be reported back to the Committee.

1.20pm – the Board Chair briefly retired from the meeting.

Mental Health and Addiction Services Ian McKenzie (General Manager, Mental Health and Addictions Services), Dr Jeremy Skipworth (Clinical Director, Forensic Services) and Megan Jones (Quality and Improvement Lead, Mental Health Services Group) were present for this section of the report. Ian McKenzie noted that this was his last attendance at the Waitemata DHB Hospital Advisory Committee meeting as he has accepted a role as the General Manager of Mental Health at Northland DHB. He expressed his thanks to Waitemata DHB for is time at the DHB. The Committee Chair acknowledged and thanked Ian for his work at the DHB and with the Hospital Advisory Committee. 1.35pm – the Board Chair returned to the meeting.

Matters highlighted or updated on Mental Health included:

The acute service models for community mental health services have been running for two years now and are nearly completed. The main objective when the review commenced was to address what were clear problems and challenges of how the service was operating across the district, Rodney, North Shore and West. In listening to users and their families, steps have been put in place to ensure a better consistency for approach and referrals are handled efficiently. Service user feedback recently received expressed appreciation at the fast referral process. The Committee Chair noted the excellent work being undertaken.

Following an external review of security at the Mason Clinic, three different elements of security have been identified: physical, procedural and relational. Significant progress has been made with regard to the physical element, including better lighting and camera installation. The procedural element will see a better staff mix as historically clinical staff have been exclusively used and now there has been a shift of resource to include security staff onsite. The third important aspect was the relational element and ensuring the appropriate level of clinical and nursing staff with training support and supervision. Policy documents on all three security elements are being development, ensuring they are compliant with government security.

Susanna Galea noted that the submission on the proposed new Substance Addiction Bill had been submitted. The Committee Chair thanked Susanna for her work on the submission. Ian McKenzie noted that there would be a further

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report to the Committee at its next meeting on what it is thought the implications of the Bill will have on the DHB as a lead regional provider.

Surgical and Ambulatory Services Michael Rodgers (Chief of Surgery) was present for this item. He conveyed apologies from Michelle Sunderland (General Manager, Surgical and Ambulatory Services). Michael Rodgers highlighted the ‘clinically appropriate time to theatre’ improvement project and the effort to establish KIPs. A weekly report is now being produced on achieving the goals and will be reported to the Committee going forward. Another key issue highlighted is the faster cancer treatment times and that there is a drive to meet the targets set by the Ministry of Health and this is being closely monitored. Elective Surgery Centre Michael Rodgers noted that following the resignation of John Cullen he will continue as Chief of Surgery and that a clinical director will be appointed for the Elective Surgery Centre. Provider Arm Support Services Cath Cronin presented this section of the report, noting an area of concern was food service with more information to be provided to the Committee at its next meeting. Cath noted that the senior management team would be tasting food samples at its next meeting. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

5. CORPORATE REPORTS

5.1 Clinical Leaders’ Report (agenda pages 96-101)

Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery) and Tamzin Brott (Director of Allied Health) presented this report. Andrew Brant noted that the next Waitemata DHB Primary Care Connections Forum is scheduled in July 2016. The forum has moved towards a more educational component, connecting services and providing an opportunity to learn. In response to a question form the Committee Chair about the DHB’s emergency planning system, Jocelyn Peach advised that there were a number of programmes nationally and that Civil Defence were preparing a new Psychosocial support plan. Particular exercises noted included the: Orewa Tsunami Exercise that will take place on 14th June 2016, Hobsonville’s fuel fire explosion exercise and passengers taken ill on a cruise liner. The Board Chair noted the importance of good communications to ensure people have access to and know how to find information in an emergency. Jocelyn will

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report back further on emergency planning systems and advise what the region has in place and the expectations of other DHBs. Jocelyn further noted both the nurses week and nurses day celebrations along with the recognition of Georgina MacPherson (Nurse Practitioner, Womens Health Colposcopy Service) who was nominated as Waitemata DHB’s Nursing Review Nursing Hero and Graham Zinsli who received the Red Cross Florence Nightingale Award for International Humanitarian Service. Tamzin Brott noted that the National Allied Health, Scientific and Technical Conference was hosted in Auckland and that Waitemata DHB received the overarching host prize. Tamzin also noted that the Interdisciplinary Fun Feeding Group has been re-established, which is having a positive impact on the children who need assistance and their families. With regard to the implementation of the community Allied Health mobile device project (page 101 of the agenda) it is anticipated that 80 iPads will be operational by the end of August 2016. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

5.2 Human Resources (agenda pages 102-109)

Fiona McCarthy (Director Human Resources) presented this report and noted that average time to hire is steadily increasing; this is a combination of both the measure in time to recruit and the time it takes for a key professional to commence. Fiona also noted that a new candidate survey was undertaken in February 2016 to gain feedback on how the DHB can improve the candidate experience. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

6.1 Winter Plan 2016 (agenda pages 110-111)

Cath Cronin (Director of Hospital Services) presented this report. In response to a question from the Committee Chair, Cath noted that she regularly meets with Auckland DHB and is will share the Waitemata DHB Winter Plan 2016 with Auckland DHB. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the Committee notes the content and intent of the Winter Plan. Carried

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7. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 112)

Resolution (Moved Kylie Clegg /Seconded David Ryan)






1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 06/04/16




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.

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)]

3. HR Update 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.




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.


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4. Education Programme 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 2.15pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 25 May2016 COMMITTEE CHAIR

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8.2 Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Meeting 08th June 2016

Recommendation:

That the draft minutes of the Community and Public Health Advisory Committee meeting held on 08th June 2016 be received.

180


Minutes of the meeting of the Auckland DHB and Waitemata DHB

Community and Public Health Advisory Committees

Wednesday 08 June 2016

held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 2.00p.m.

Part I - Items considered in Public Meeting COMMITTEE MEMBERS PRESENT:

Gwen Tepania-Palmer (Committee Chair) (ADHB and WDHB Board member) Lester Levy (ADHB and WDHB Board Chairman (present from 2.22pm) Max Abbott (WDHB Board member) (present from 2.08pm) Jo Agnew (ADHB Board member) Peter Aitken (ADHB Board member) Judith Bassett (ADHB Board member) Chris Chambers (ADHB Board member) Sandra Coney (WDHB Board member) Warren Flaunty (Committee Deputy Chair) (WDHB Board member) Robyn Northey (ADHB Board member) (present from 2.15p.m) Christine Rankin (WDHB Board member) Allison Roe (WDHB Board member) Tim Jelleyman (Co-opted member) Elsie Ho (Co-opted member) ALSO PRESENT: Dale Bramley (WDHB Chief Executive Officer) Ailsa Claire (ADHB Chief Executive Officer) Debbie Holdsworth (ADHB and WDHB, Director Funding) Simon Bowen (ADHB and WDHB, Director Health Outcomes) Andrew Old (Chief of Strategy, Participation & Improvement) Tim Wood (ADHB and WDHB, Funding and Development Manager, Primary Care) Peta Molloy (WDHB, 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:

Lynda Williams, Auckland Womens Health Council Tracy McIntyre, Waitakere Health Link Wiki Shepherd-Sinclair, Health Link North

WELCOME: The Committee Chair gave a warm welcome to all those present.

KARAKIA: The Committee Chair led the meeting in the Karakia.

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APOLOGIES: That apologies be received and accepted from Lee Mathias and Rev Featunai Liuaana, together with an apology for late arrival from Lester Levy.

DISCLOSURE OF INTERESTS

There were no additions or amendments to the Interests Register. There were no declarations of interests relating to the agenda. 1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed on the agenda except for agenda item 5.2 which was discussed before item 5.1.

2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Auckland and Waitemata District Health

Boards’ Community and Public Health Advisory Committees Meeting held on 27th April 2016 (agenda pages 7-16) Resolution (Moved Jo Agnew/Seconded Judith Bassett) That the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 27th April 2016 be approved. Carried Matters Arising The Committee Chair summarised the matters arising. It was requested that the website link with regard to Breast Cancer Screening be emailed to CPHAC members.

3 DECISION ITEMS There were no decision items.

4 INFORMATION ITEMS There were no decision items.

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5. STANDARD REPORTS 5.2 Planning, Funding and Outcomes Update (agenda pages 31-47)

Simon Bowen (Director, Health Outcomes) introduced the report. He noted that both the ADHB and WDHB Annual Plans along with the Maori Health Plans had been submitted to the Ministry of Health. Feedback from the Ministry of Health is expected in June. He also noted that the draft Waitemata DHB Primary and Community Services Plan was submitted to the Waitemata DHB Board in May and work continues on the plan. Simon also noted the update on Auckland Regional Public Health Services (page 9 of the agenda). Ruth Bijl (Funding and Development Manager - Child, Youth and Women’s Health) and Dr Karen Bartholomew (Public Health Physician) presented the Child, Youth and Women’s Health section of the report. Matters included in discussion and responses to questions included:

Despite all the hard work towards meeting the immunisation health target, it unfortunately will not be met at either Auckland DHB or Waitemata DHB. There have been a number of factors in not reaching the target, including the flu season and negative publicity in general towards immunisation. There is a strategic focus on ensuring the message is received earlier (when pregnant). Work is underway with general practices to support practitioners in having discussions with couples who are finding the decision to immunise difficult to make.

The work being undertaken on prioritising child health was noted and highlighted in a diagram (page 33 of the agenda) representing the DHBs universal services and additional priorities.

In response to a question about the regional business case for the National Child Health Information Platform, it was noted that the business case is a few months away yet. It was also noted that a plan is in place in the Waikato/Midlands region.

In response to a question from Sandra Coney about the Ministry of Health’s Bowel Screening Programme roll-out and the implications on the Waitemata DHB Bowel Screening pilot programme, it was noted that:

The Waitemata DHB pilot was extended to now conclude December 2017. The pilot was extended on the basis of the results meeting outcomes as anticipated.

The Waitemata DHB has consistently reported results and external evaluations have been undertaken on the pilot.

There is a reduction in the age range (to be from 60 to 74 years) for the Ministry of Health’s programme roll out.

The Waitemata DHB would seek information from the Ministry of Health on the business case to roll-out the Bowel Screening programme and the impact it may have on Waitemata DHB’s pilot programme. This information will be reported back to the Waitemata DHB.

In response to a question from Allison Roe about a recent news story on the HP vaccine for boys, it was noted that the Ministry of Health had recently advised of its

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decision to extend the vaccination programme to boys and that this was in line with advice around the forms of tongue, throat and lip cancer. The Immunisation Governance Group is supportive of this decision. It was also noted that there will be a shift from three doses to two doses, this results from studies demonstrating that two doses are sufficient. Further information on the HPV vaccination for boys will be provided at the next Committee meeting. Tim Jelleyman noted the update from the Auckland Regional Public Health Service (ARPHS) who advised that the BCG vaccine supply expired on 31st May 2016 with a new supply of vaccine unlikely to be available until 2017. It was requested that ARPHS provide an update on the risk associated with this. Debbie Holdsworth introduced Trish Palmer who has commenced in her role as the Funding and Development Manager for Mental Health and Addiction Services. Trish has joined the DHBs from Northland DHB.

Trish Palmer was present for the Mental Health and Addictions section of the report. Matters included in discussion and responses to questions included:

The information requested from the April 2016 CPHAC meeting regarding Aged Related Residential Care and the mix of beds in each DHB was noted.

With regard to the pilot of an on-line training tool ‘QPR’ (question, persuade, refer) for screening, the Ministry of Health has allocated 400 licences to access the online training tool. It was noted that the ADHB and WDHB completion rate was high. The Committee requested that it receive an evaluation of this training tool in due course.

Following a recent media story about seclusion within mental health facilities, Robyn Northey queried the matter of seclusion in the Auckland region. It was noted that people cannot be held under the mental health act for non-specific reasons, it is not a clinical decision, but a judicial one and care needs to be taken with what is projected in the news media and actual. It was noted that matters regarding the mental health services for both Auckland DHB and Waitemata DHB are reported to the Hospital Advisory Committee. Further information will be requested on the matter of seclusion within the Auckland DHB and Waitemata DHBs mental health facilities (including dementia patients within the hospital wards) and the Auckland region; this information will be reported back to each Hospital Advisory Committee respectively.

The Committee Chair welcomed Trish Palmer to the DHBs and the CPHAC meeting. Debbie Holdsworth noted the work underway with regard to the Maori Health Plan and the Pacific Health Action Plan. She also noted the work underway with Asian students and the campaign being run to educate students about the New Zealand Health system. Elsie Ho requested a copy of the Asian International Benchmarking Report, Simon Bowen advised that the report is in the process of being drafted and when completed will be presented to the Committee. With regard to the Maori Health Gain update and the ‘Healthy Babies Healthy Futures’ programme, Chris Chambers requested information on how the targets are

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set and enrolments required for a lasting impact. Aroha Haggie will provide Chris with the information directly. In response to a query from Chris Chambers about the Building Pools Amendment Act, Simon noted that the report included a summary of the DHB-ARPHS issues and recommendations and the revised bill (page 44 of the agenda). Chris then queried whether the information was shared with groups like the Child, Youth and Mental Health Review Committee, coroners, the Commissioner of Children and the like, Simon Bowen will advise on the distribution directly to Chris. The Committee Chair thanked those that presented the report for their contribution and work.

Resolution (Moved Max Abbott/Seconded Peter Aitken)

That the report be received.

Carried

5.1 Primary Care Update (pages 17-30)

Debbie Holdsworth introduced Jagpal Benipal (Senior Programme Manager, Primary Care) and Daniel Tsai (Programme Manager, Community Pharmacy) to the Committee, who were present for this item. Daniel Tsai updated the Committee on the community pharmacy influenza services. Matters highlighted and responses to questions included:

That this service is being trialled at 15 community pharmacies and is a fully subsidised service for eligible people aged 65 and over.

The service is funded from a portion of the quality improvement fund.

The overall aim of the pilot is to improve access and uptake. To date 60 people have been immunised since March 2016. In response to a question about whether the uptake was low, it was noted that this is an initial pilot and there was no comparison of data. An evaluation will be completed at the end of the pilot.

In response to a question from Warren Flaunty about funding for the community pharmacy influenza services, Daniel Tsai noted that the portion of funding for quality improvement based on a population based funding formula was approximately 10 per cent for each DHB. With 15 pharmacies in the pilot each received a small portion of approximately $500 for that pharmacy individually.

Tim Jelleyman queried whether the population are aware of their local pharmacy as a place to receive immunisation (he noted the uptake for rheumatic fever was very low in pharmacies as well). In response Daniel noted that as part of the pilot they will review this and look at options for promoting this service at pharmacies. The Board chair noted the importance of strong change management processes and robust pilots in order for services like this to be successful; the community need to be aware of the service. Appropriate support needs to be given to the pharmacies to ensure this promotion occurs.

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It was noted that historically the lack of privacy in pharmacies was an issue for people; this matter has been addressed as each of the pharmacies participating all have a consultation room. The option of a consultation room was provided as part of the innovation funding, a number of the participating pharmacies utilised this option.

Jagpal Benipal summarised other key points in the report, responses to questions included that:

The Ministry had recently streamlined its contract around pharmacies and the quit smoking programme. Both Auckland DHB and Waitemata DHB submitted an RFP, which were unfortunately not successful.

There have been some issues with the data provided when reporting diabetes checks. This matter is being investigated with healthAlliance and the outcome of that will be reported back to the Committee.

An explanation was given on the definition of quintile 5, noting that it is the most deprived population group (approximately 20 per cent of the population).

The Committee Chair thanked Jagpal and Daniel for their attendance. Resolution: (Moved Robyn Northey/Seconded Judith Bassett) That the report be received. Carried

6. GENERAL BUSINESS

No matters were raised. 7 RESOLUTION TO EXCLUDE THE PUBLIC 3.13pm - Tim Jelleyman and Elsie Ho retired from the meeting.

Resolution: (Moved Jo Agnew/Seconded Peter Aitken)


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




1. Minutes of the ADHB and WDHB Community and Public Health Advisory Committees Meeting with Public Excluded 27/04/16




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2. Co-opted member appointments



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)]

Carried 3.13pm – 3.14pm: public excluded session The Committee Chair thanked those present for their participation in the meeting. The meeting concluded at 3.14pm. SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS’ COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 08 JUNE 2016 CHAIR

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9.1 Health and Safety Marker Report – update June 2016

Recommendation:

That the report be received.

Prepared by: Fiona McCarthy (Director Human Resources)

Purpose of report

The purpose of this report is to provide an update on progress towards meeting the expectations of the Health and Safety at Work Act 2015, which came into effect on 4 April 2016.

1. Executive Summary

The new Health and Safety and Work Act 2015 came into force on 4 April 2016. The new legislation is the result of work from the health and safety taskforce established in 2012 to evaluate whether the workplace and safety system in New Zealand was fit for purpose and to recommend practical strategies for reducing the high rate of workplace fatalities and serious injuries by 2020. From taskforce recommendations made in 2013, WorkSafe NZ was established with one goal – to reduce workplace deaths and injuries by 25% by 2020. The most significant changes are as follows:

Move from a relationship between employers and employees to one where a Person Conducting a Business or Undertaking (PCBU) has a primary duty of care for ensuring the health and safety of a worker on or near the business or undertaking.

Provides for personal liability for officers of a PCBU to exercise due diligence in relation to a PCBU’s health and safety obligations.

Provides that suppliers, who supply, install and/or manufacture plant, fixtures, fittings, substances do so to ensure they are fit for purpose and do not pose any risk to any person. This includes any calculation, testing, analysing or examining that is required to comply with the Act, as well as guidance on safe use, handling and storage.

Move from hazard management to risk management, which enables a broader view of health and safety.

A change from serious harm reporting to notifiable injuries, illnesses and incidents. We are now required to report incidents that could have caused harm but may not have.

Clarification of employee participation, selection and training obligations. A separate set of regulations to govern health and safety representatives is currently in consultation. The new legislation extends powers of health and safety representatives to provide improvement and compliance notices.

New obligations to set up a Health and Safety Committee if requested.

Additional penalties and fines with officers being exposed to higher remedies than workers. Details on how the DHB complies with the new legislation is outlined in Appendix 1, however, you will read that some processes are in place or pending, with further health and safety assurance and compliance audits to be undertaken over 2016 and 2017 and ongoing. The DHB has a number of completed and outstanding actions to meet and exceed the requirements of the Health and Safety at Work Act 2015 as outlined in Section 2.

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This report discusses the risks, actions and progress towards making Waitemata DHB a safe and healthy place for people to work, be educated, receive care and visit loved ones.


The report integrates cross department commentary on health and safety so it is consolidated in one place.

Intelligence and insight

A health and safety scorecard reports on health and safety data and provides insight into issues and trends.


The report articulates actions that where possible will be informed by evidence or expert opinion.


The evidence supports the undertaking of good health, safety and wellbeing practises leads to positive patient experience and outcomes and a sustainable business.

3. Completed and outstanding actions

The following actions are complete or outstanding as at 17 June 2016. 3.1 Completed or partially completed actions

Action Who Completed

Health and Safety representative transition training

Occupational Health and Safety Yes

Communication on impact meetings and H&S as regular agenda items

Director HR Yes

Complete audit training for Facilities Project Managers

Facilities and Development H&S Manager

Yes

Managers to be advised that all infrastructure, maintenance and environmental contractors are to be engaged via Facilities and Development

Director Hospital Services and Chief Financial Officer

Yes

Notifiable incident process to be developed and approved by the Board

Occupational Health and Safety and Facilities and Development

Yes Notifiable event process approved at 25 May Board meeting.

Put in place pre start safety meetings for build projects

Facilities and Development H&S Manager and Programme Manager W2025

Yes

Update obligations in Position Descriptions

Group Manager, HR Yes

Board site visit schedule Director HR Yes Draft visit schedule endorsed at the 6 April Board meeting. First hospital campus visits by Chair and CEO completed on

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Action Who Completed

2/3 May. First Board visit on hazardous substances completed 18 May.

Complete building project sign off process for health and safety

Facilities and Development H&S Manager, Occupational Health and Safety Manager and Programme Manager W2025

Yes

Put in place a health monitoring resource and plan across all hazard groups

Occupational Health and Safety Partially A 2 year fixed term resource has been assigned and the plan will be developed progressively from May 2016 to April 2018.

Ventilation, heating and cooling issues to be resolved

District Facilities Manager Ongoing and prioritised according to risk.

Complete write up of resource review recommendations

Director HR Partially Recommendations have been sent to SMT to review. The report will be finalised for the August Board meeting.

3.2 Outstanding actions

Action Who By when

Board and SMT session on due diligence obligations

Director HR Simpson Grierson

June A session plan has been developed and is being validated with Simpson Grierson. Training is likely to take place in July.

Develop an Officer orientation programme

Director HR and Occupational Health and Safety

Mid June

Review of ongoing training needs and other new expectations under the new Worker Engagement, Participation and Representation Regulations 2016

Group Manager, Occupational Health and Safety

Special project review - April to June 2016

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Action Who By when

Review of participation partnership agreement with Unions. Agreement on worker participation arrangements from the new Regulations to form part of this agreement.

Occupational Health and Safety and partner unions and Regional DHBs

Review due July 2016

Complete review of all work sites to assess hazardous substances and health monitoring needs

Sustainability Development Manager

HSNO coordinator starts 2 May and site reviews of hazardous substances will re commence.

Regular meetings with onsite contractors

General Manager Facilities and Development and Group Manager Occupational Health and Safety

Implement a phased approach: End May– Facilities to commence regular meetings with large contractors End September– regular meeting with other selected contractors

Review healthAlliance procurement systems

Collaborative work with hA and ADHB, CMDHB and WDHB

Underway with first process flow draft.

Review healthAlliance contracting systems

Collaborative work with hA and ADHB, CMDHB and WDHB

Underway with first process flow draft.

Put in place preferred supplier process for all maintenance contractors

District Facilities Manager and Facilities and Development H&S Manager

November 2016

Contractor orientation material to be reviewed


End September 2016. We expect to have an on line orientation system available in May/June.

Review asbestos management plan in line with new regulations and update register

General Manager, Facilities and Development

December 2016

Review sign off process for maintenance work

District Facilities Manager and Facilities and Development H&S Manager

Draft process in place and trialled end July and finalised end October 2016.

Do a stocktake on departmental orientation H&S practices and review how departmental orientation is recorded and provide for a recording mechanism

Occupation Health and Safety A process to review and centrally record orientation is being scoped. Estimated completion date is late 2016

Complete pre-employment screening implementation

Director HR and Group Manager, Occupational Health and Safety

October 2016

Review orientation processes for students and volunteers

Occupation Health and Safety Director of Patient Experience

A process to review and centrally record orientation is being scoped. Estimated completion date is late 2016

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Action Who By when

Safe Way of Working KPIs need to be devolved to Divisional meetings and GM KPIs

Chair, Waitemata DHB Health, Safety and Wellbeing Committee

July 2016

Complete Business case and RFP for community worker alarms

Chair, community workers alarms steering group

Draft Plan and Business case due November 2016

Security Training framework Project Manager, Security Review

August 2016

Complete roll out of root cause analysis and investigation model


End September 2016

Put in place process to review on site audit findings with Occupational Health and Safety team

Facilities and Development H&S Manager and Occupational Health and Safety Manager

Draft process in place end May and finalised end July 2016.

Revise Leading Indicators

Group Manager, Occupational Health and Safety

Each element of the safe way of working will be reviewed progressively from April 2016 to April 2017, starting with HSNO

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Glossary PCBU – person conducting a building or undertaking, and has a primary duty of care to ensure the health and safety of workers. The DHB is the PCBU. Officers - Includes Board Directors and the Senior Management team who make governance decisions that significantly affect the business. Officers have a duty of due diligence to ensure their business complies with its health and safety obligations. Officers may be found guilty of an offence under the Act, in addition to the PCBU. Due Diligence – taking steps to acquire and keep up to date knowledge of health and safety matters; gain an understanding of the business and hazards and risk associated with that business; ensure PCBU has available and uses appropriate resources and processes to manage risk; ensure PCBU has appropriate processes for considering incidents, hazard and risks in a timely way; ensure PCBU implements processes for complying with obligations under the Act; validates the provision and use of resources and processes to comply with obligations under the Act. Workers - Workers have a duty to take reasonable care for their own safety and that their own actions do not adversely affect the safety of others. They need to comply with reasonable health and safety instructions from the PCBU and co-operate with health and safety policies and procedure. Workers are people who work at the DHB and include employees, contractors, sub- contractors or their employees, apprentices, trainees, persons gaining work experience, employees of a labour hire company and volunteers. Other people - People who come to the workplace such as visitors or customers also have duties to comply with health and safety processes. Our patients and visitors are in this group. Notifiable injury or illness – an injury or illness that requires immediate treatment (i.e. amputation, serious burn, serious head injury or burn); admission to hospital; serious infection; medical treatment within 48 hours of exposure. All notifiable injuries or illnesses are to be reported to WorkSafe NZ. A notifiable incident is an incident that is an unplanned or uncontrolled incident in a workplace and that exposes a worker or other person to a serious risk to health and safety. Notifiable incidents include events such as: a spillage or leak of a substance; explosion or fire; escape of gas or steam; falls; electric shocks; structural collapses; in rush of water, gas or mud; interruption of underground ventilation. All notifiable instances are to be reported to WorkSafe NZ. Health and Safety Representative is a person elected to represent the workers in relation to health and safety matters. The representative has specific functions and roles under Schedule 2 of the Act.

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Appendix 1 Progress towards implementing the Health and Safety at Work Act 2015

Policy All of our health, safety and wellbeing policy requires an update to ensure change of terminology and focus to the new legislation. The February Board meeting endorsed the updated Health, Safety and Wellbeing Policy and our Safe Way of Working system (SWOW) document. The April Board meeting endorsed the remaining Health, Safety and Wellbeing policies and the Board health and safety visit schedule. Worker engagement, participation, and representation

What the Act says

A PCBU must:

Initiate election of health and safety representatives on request of workers.

Agree the work groups that are represented by a health and safety representative.

Consult about matters related to health and safety.

Provide information as requested with due consideration to the Privacy Act.

Allow a health and safety representative time to discharge their powers under the Act.

New regulations on worker engagement, participation and representation were introduced in February 2016 and outline the functions, number, training, powers and participation expectations of health and safety representatives.

How do we comply?

We have 260 health and safety representatives throughout the business, most of whom have baseline health and safety representative training, as endorsed by WorkSafe as well as divisional health and safety committees in place to provide ways to participate in local issues. In addition, the annual update of hazards is reviewed by representatives and representatives participate in the self-assessed six-monthly departmental health and safety audit. From a recent hazard event review, new expectations on participation in health and safety matters have been introduced and include ensuring work impact meetings are held for each building project and that health and safety is a regular item on team meeting agendas. Seven health and safety representatives sit on our health, safety and wellbeing committee. Transition training for all the representatives has been completed and modules for foundation health and safety training are available on line.

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What is outstanding?

Review of participation agreement with Unions.

Ongoing training needs (as part of the new Worker Engagement, Participation and Representation Regulations) will be assessed as part of a special project lead by Margaret Kamphuis, Group Manager, Occupational Health and Safety.

We need to review the number of health and safety representatives as part of the worker participation agreement with unions.

We still need to determine the process for on-site contractors to establish health and safety representatives and discuss health and safety matters together.

Consequences

There are fines for not having appropriate employee participation processes in place.

Notifiable events

What the Act says

A PCBU must

report on notifiable injury, illness and incidents as soon as possible after being made aware of them.

Secure a site if a notifiable event has occurred.

Keep a record of notifiable events

How do we comply?

We currently have notifiable event reporting and recording processes in place.


Nil

Consequences

There are fines for not notifying workplace injury or illness as soon as possible after being made aware of them.

Health and Safety Committee

What the Act says

A PCBU must:

Put in place a health and safety committee if requested by a worker.

Establish a health and safety committee within two months of this request.

Consult about health and safety matters with the committee.

Allow time for members to attend and carry out functions as a member of the committee.

Provide information to the committee

Within a reasonable time, adopt recommendations made by the committee.

A PCBU can also establish a Health and Safety Committee on its own initiative.

How do we comply?

The first meeting of the Health, Safety and Wellbeing Committee took place on 19 April 2016.

What is outstanding? There are no outstanding actions.

Consequences

There are fines for not setting up a Health and Safety Committee if requested, and if a PCBU does not: allow time for members to attend committee meetings/consider matters raised at the committee; or if a PCBU does not implement recommendations from the committee.

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Orientation

What the Act says

Orientation to a workplace is an important part of complying with the duty of care to ensure the provision and maintenance of a workplace that does not give rise to health and safety risks.

How do we comply?

Pre commencement orientation and a “safety first’ video are now in use for orientation, training and general health and safety messaging. A departmental health and safety induction checklist is sent to recruiting managers.


We need to ensure all new staff complete departmental orientation in health and safety, and that this is recorded centrally for easy access. We also need to put an Officer orientation programme in place. We need to check orientation processes for students and volunteers.

Consequences

There are fines and criminal punishments of imprisonment for reckless conduct in respect to duty of care and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

Risk Management

What the Act says

PCBUs have a duty of care to ensure the health and safety of another person is not put at risk from work carried out as part of the conduct of the business or undertaking. Risks must be eliminated or minimised so that a PCBU can, in so far is reasonably practicable:

Provide a workplace without risk

Provide and maintain safe systems, plant and structures

Ensure the safe handling, storage and use of plants, substances and structures

Provide training or supervise to protect persons from risk

Maintain accommodation so a worker is not exposed to risk

How do we comply?

We have an on line hazard management system where hazards are identified and controls recorded. We have started to move from the language of hazards to risk management, but in such a way as to align with rather than clash with the health sector concept of risk management and risk registers which consider organisational wide risks. Hazards/Risks are reviewed every 12 months by the divisional lead manager and Health and Safety Representatives. W2025 impact meetings are occurring. Processes to monitor and maintain operational compliance are in place, i.e. fire management plan, training, exercises, maintaining clear egress, etc., and are part of a current process improvement review.

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No outstanding actions.

Consequences

There are fines and punishments of imprisonment for reckless conduct in respect to duty of care and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

Contractors (Facilities, Health Alliance and Information Technology)

What the Act says

The PCBU, as well as ensuring the health and safety of its employees (workers), is also required to ensure the health and safety of other workers, as well as ensuring that plant, fixtures and fittings are without risks to health and safety to any person. There are new asbestos regulations that require a change in how PCBU’s currently manage and remove asbestos.

How do we comply?

Selection of Contractors: The DHB has moved to a process of selecting a panel of preferred contractors who can tender for DHB construction and refurbishment work as it arises. Each contactor has to first qualify to be a part of the panel by satisfactorily completing contractor health and safety questionnaire which allows the organisation to demonstrate their performance against 12 health and safety criteria. Maintenance contractors do not have a preferred supplier arrangement in place as yet but contracts are in place and current for main contractors. Supplier Contracts and RFP processes: DHB contracts provide a standardised health and safety statement for minor or individual contracts. This clause will be confirmed that it satisfies the Act. Health Alliance procurement processes: Documentation is not adequate for the new Act. Orientation: Construction contractor induction is in place and completed prior to gaining access to the relevant site. Site access: All building contractors must report to Facilities before commencing their work and all Health Alliance (hA) staff (IT) will report to security. In addition,

New projects must be agreed and coordinated with Facilities prior to commencing

New contractors must complete induction prior to starting work

A contractor carrying out an agreed task e.g. for call out does not need to report to Facilities prior – they do need to report to area supervisor prior to and post work.

All contractors must have a WDHB photo ID which will only be issued after completing induction)

All healthAlliance staff and contractors are required to have the hA issued photo id on them at all times and visible. Usually if they are based on a particular site on a regular basis (i.e. not just visiting) then we will request a security access card with photo ID for that staff member from the site. Facilities: Once inducted contractors working for Facilities are issued with a Waitemata DHB ID card with a photo. Proof of identification (passport/ drivers licence) is require to obtain this ID. The duration of the ID card can be set to cover the estimated time of the project.

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On the job: Toolbox meetings occur each day. There is active management and collaboration with architects and designers to meet design expectations and requirements. Work impact meetings to assess risk occur regularly and ensure contractor health and safety plans are implemented. All Project managers, including the 2025 team are Site Safe certified. Asbestos: Asbestos register in place but the register needs to be updated in line with new regulations. This work is now underway via the WDHB Asbestos Management Group. Incidents and Accidents: Reporting of incidents and accidents follow the DHB process. Contractors experiencing any accident or incident are required to notify the DHB, investigate and report back any findings. On site audits: Regular external audits are conducted for construction site work. Project managers also undertake audits of their projects. Maintenance work review and sign off: For IT project work related to moves and new fit-outs, the desktop team work closely with the Waitemata DHB PM who reviews and signs-off that the work is complete. Building project health and safety management and sign off: A performance review is done mid-way through each major building project. Health and Safety design sign off and pre occupation processes are complete. The building sign off process follow the relevant policy. Post Implementation Reviews (PIRs): PIRs are done for each facility build project and results provided to the contractor selection panel.


Selection of contractors: The DHB is moving to the same preferred supplier process for maintenance contractors as noted above for large construction contractors. This process will be in place by November. WDHB maintenance team requires contractors to provide suitable prequalification material by a certain date. If not met the contractor will be removed from the approved contractor list. Health Alliance procurement processes: The DHB is working work with CMDHB, ADHB and Health Alliance to map processes that require additional health and safety documentation. Orientation: Induction material is being reviewed. On the job: A pre start safety meeting process is in development for all build projects, as well as ensuring work impact meetings occur regularly during the project. Safety in design guidance is in development. Asbestos: To review asbestos management plan in line with new regulations. Accidents and Incidents: Facilities intend to adopt an ICAM concept of investigation that will identify why things went wrong and what actions are required to ensure compliance and keep workers safe. All of evidence gained through incident reviews, audits and investigations is saved as confirmation of active management by the DHB in its role as the PCBU. Evidence folders and process will be discussed during audit training.

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Maintenance work review and sign off: The DHB is currently sharing learning from ADHB on a task planning and sign off process for maintenance work, ensuring competent review and management oversight. Building project health and safety management and sign off: Complete implementation of project sign off documentation.

Consequences

There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

Hazardous substances What the Act says

A PCBU has a primary duty of care to provide for staff use, handling and storage of substances. The DHB is also required to comply with the Hazardous Substances and New Organisms Act 1996 which requires the DHB to prevent and manage adverse effects of hazardous substances and new organisms.

How do we comply?

The DHB has focused on the 33 areas with high volume use of hazardous substances, with over 315 substances identified and added to the online register of substances available on StaffNet. A new and comprehensive HSNO policy has also been developed and published on the intranet, with a strong focus on roles and responsibilities. The Intranet HSNO site now contains hot links to information covering:

Policy document

Full HSNO database of all hazardous substances identified, including constituents, product state, UN number, CAS number, identified hazards, exposure limits, HSNO class and PPE specific to each substance. It is worth noting that, on average, we are identifying an additional 15 new chemicals per month, which are then added to the database.

Master Material Safety Data Sheets (MSDS) repository

Wastewater Disposal Guidelines

Training resources, including introductory PowerPoint

List of all Approved Handlers and their locations

Emergency response requirements

Specific spill kit contents list

Managers responsibilities

Key contacts for staff Approved handler training has been delivered for high risk areas. Work has also concluded with healthAlliance, to ensure that Material Safety data Sheets are supplied for all new chemicals being procured.


We have another estimated 350 areas to review and we have

employed a hazardous substances co-ordinator to complete this

work.

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The business case for the construction of a Hazardous Substances

Store for Waitakere Hospital is almost complete. The construction of

this store will greatly reduce the risk associated with the bulk storage

and disposal of hazardous substances at Waitakere Hospital.

Consequences

There are fines and punishments of imprisonment for reckless

conduct in respect to duty of care, and fines for failing to comply with

risks that expose individuals to death or serious injury/illness. It is

worth noting that hazardous substances are covered under three sets

of national legislation, as well as local bylaws (Health and Safety at

Work Act 2015, Hazardous Substances and New Organisms (HSNO)

Act 1996, Resource Management Act 1991 and Auckland Council’s

‘Water Supply and Wastewater Bylaw’), under all of which fines can

be payable.

Health of workers

What the Act says

A PCBU must ensure that the health of workers and conditions of the workplace are monitored for the purpose of preventing injury or illness. The PCBU must, as far as is reasonably practicable, maintain accommodation so that the worker is not exposed to risks to health and safety.

How do we comply?

The DHB has pre-employment screening in place but a number of staff still commence work pending their results. Planning is underway to put a process in place to ensure that staff cannot start until the health screening process is complete, results known, vaccinations or other actions are complete and the potential employee is fit for work or an offer is withdrawn if they are not fit to work. We undertake occupational health monitoring via our Occupational Physician health clinics however we wish to extend this to monitoring exposure to noisy areas (facilities), hazardous substances, laser care, and other risk areas. Monitoring for exposure for radiation (Radiology, Cardiac Catheter Lab) occurs externally. We provide free influenza and other vaccinations. A stocktake of issues with workplace heating, ventilation and cooling was completed in May 2015 and is being implemented in priority order. We have an asbestos register, and require contractors to review this prior to starting any work. Areas with friable asbestos require additional security clearance to gain access. Containers for sharps, hazardous materials and substances are provided on each site.

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Staff are provided with personal protective equipment (PPE) to wear. PPE requirements are outlined in various policies including the hazardous substances register, use of lasers, gloves, etc. Infection control processes are in place to manage any disease outbreaks and exposure. Installation of signage close to potential slip, trip and fall hazards has occurred and cleaner are asked to regularly monitor wet areas. Regular communication on hazards is issued.


Complete implementation of pre-employment screening. Health monitoring programmes should be in place across all relevant risk areas. An audit on use of PPE will be planned as part of the health monitoring programme to validate the application of various policies and risk controls. A resource to regularly inspect patient communal areas, wards and entrance ways is currently in recruitment.

Consequences


Equipment

What the Act says

A PCBU must provide and maintain a work environment that is without risk to health and safety.

How do we comply?

Equipment that is broken is escalated for capital replacement as relevant. A register of capital assets is in place and being added to, to ensure that equipment is budgeted for replacement according to the life span of that equipment. All bio-medical equipment is maintained by the Bio-Engineering team.


Alert systems for community workers are being trialled as part of the review of security.

Consequences


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Training

What the Act says

A PCBU must provide any information, training, instruction and supervision necessary to protect all persons from risks to health and safety arising from work carried out by the DHB.

How do we comply?

Orientation training is provided to staff within the first 4 weeks of their employment, however we are looking to introduce pre-employment orientation education for health and safety as noted in the orientation section above. Health and Safety representatives are provided with two days of training (Four half day modules) by the Occupational Health and Safety Service covering an introduction to health and safety management, hazard and emergency management, accidents and occupational rehabilitation, safe working procedure, health and wellbeing and the new legislation. All staff are required to complete the annual health and safety update on line. Training is provided on departmental specific instances such as moving and handling in patient areas, crisis intervention in areas where aggressive clients may be experienced, calming and restraint in mental health services, laser care in theatre, handling sharps by infection prevention and control. As already noted, approved handler training is in place for hazardous substances. Training is provided on how to access our incident management, risk register and hazard register systems. Training for notifiable events is complete. Emergency Response Training occurs regularly

Fire Response and Evacuation Training occurs for all new staff and annually on-line and face to face in key areas

Fire Evacuation Training occurs across all DHB areas 6 monthly which means each week there are activities in order to cover all areas

Warden Training occurs on all sites annually for all wardens and deputy wardens. This is for all areas so requires multiple sessions annually

Duty Nurse Manager training occurs for all new staff and three times a year

Incident Management Team training occurs quarterly

Key staff are required to attend Health CIMS2 training – which is available monthly and is done as a regional programme with the other DHBs. This is open to all health settings including PHO’s Accident and Medical centres and Residential Aged Care key staff

Key staff attend CIMS4 training quarterly

The DHB runs particular Health CIMS4 training with a provide provider twice a year for key areas that have identified a need.

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The training framework for security is currently being reviewed and due for completion in June 2016. A DHB wide training framework is being developed to enable officers and workers to increase awareness and knowledge of health and safety systems and processes.

Consequences


Audits

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB.

How do we comply?

Recently we have completed a number of readiness audits to access compliance with the new health and safety legislation and to assess new or different resources needed. Going forward the Northern region has agreed to undertake 2 audits during 2015-2017 which includes community workers and contractor management. Internal audit are currently conducting a policy assurance audit and policy assurance audits will be in place from 2017. Regular external audits of contractor sites are in place. A governance audit has just been completed and is due for report back in July.


There are no outstanding actions.

Consequences


Reporting

What the Act says

An Officer of a PCBU must ensure they acquire and keep up to date on health and safety matters.

How do we comply?

Monthly reports on health and safety matters are provided to the Board meeting and the Audit and Finance Committee meeting. In time reporting will incorporate feedback from the organisational health, safety and wellbeing committee.


As a result of the resource review, the DHB will revise its leading indicators and revise the Board committee reporting formats. The DHB will update the Board reporting format later in 2016.

Consequences


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Resources

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB.

How do we comply?

A resource review was completed last year. The report is having portions amended and added and a set of recommendations and actions will be presented to SMT in June and to the Board in August. On review of the report we have already implemented the following new resource:

0.4 training FTE to an existing H&S adviser role

Hazardous substances co-coordinator (1 FTE)

Health monitoring nurse specialist (1FTE fixed term for 2 years) And the following are in recruitment

H&S advisor (1FTE) so we can spread training across the advisory team and allow advisors to have service portfolios for in service outreach, advice, training and assistance

Investigator / auditor (1FTE)

Analyst and reporting specialist (1FTE)


Complete recommendations from the resource review.

Consequences


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9.2 Bowel Screening Pilot Update

Recommendation:

That the Board receives this report.

Prepared by: Dr Debbie Holdsworth (Director Funding)

Endorsed by: Dr Dale Bramley (Chief Executive)

Glossary

BSP - Bowel Screening Pilot, ‘the pilot’ iFOBT - Immuno-Faecal Occult Blood Test GP - General Practitioner PHO - Primary Health Organisation MOH - Ministry of Health, ‘the Ministry’

1. Introduction

As announced in Budget 2016, $39.3 million over four years has been provided to begin a progressive rollout of a national bowel screening programme from mid-2017 (see Appendix One). This paper provides an update on the announcement and what it means for Waitemata DHB and the Bowel Screening Pilot (BSP).

2. Background

International evidence supports the introduction of a national bowel screening programme by saving lives through early diagnosis and intervention. People who are diagnosed with bowel cancer and receive it at an early stage have a greater than 90% chance of surviving five years. After five years they have the same survival rate as someone who has never had bowel cancer. Most countries in Europe have implemented an organised bowel screening programme. As at 2015, Australia, the United Kingdom, Finland, France and Slovenia had completed the roll-out of organised screening programmes. Roll-out was underway in Belgium, the Netherlands, Denmark, Ireland, Italy, Poland, Malta and Spain. Pilot screening programmes were underway in Norway, Portugal and Sweden. Waitemata was selected as the pilot site to determine whether organised bowel screening could be introduced in New Zealand in a way that is: effective, safe and acceptable for participants, equitable and economically efficient. The pilot objectives are summarised in Appendix Two.

3. Pilot Progress

On 31 December 2015, the original two screening rounds of the pilot were completed. Budget 2015 provided funded for the pilot to run for a third two year cycle while the results of the original pilot were evaluated to inform a decision regarding a national roll out. We have requested a copy of the

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business case supporting the national rollout for the Board’s information, however, as this is yet to go to cabinet it is not yet able to be released publically. The Ministry have advised the Budget 2016 provides funding for the design, planning and set-up phases. Additional funding has been set aside for work on the national IT system and infrastructure needed for a national programme. Ongoing funding will be subject to Budget 2017 decisions. It would cover the ongoing operational costs of the programme, including screening colonoscopies. Surveillance colonoscopies that follow from screening would also be funded. 3.1 Results to date A substantive update on the Bowel Screening Pilot (BSP) was provided to the Board in April 2016 which included results up to September 2015. There have been no further results reported publically and the key aspects of this previous paper are summarised below. The previous paper can be viewed in the Diligent Boardbooks resource centre. The Ministry has released the final results for the first round (January 2012 to December 2013) and for the first twenty-one months of the second round (January 2014 – September 2015). The key challenges for the Pilot at the end of round one were to increase coverage, increase equity of participation and develop the register so that it is fit for purpose in the event of either the Waitemata DHB programme continuing or a national roll-out occur. 3.2 Participation For round one, a total of 121,798 people were invited to take part and 69,176 people returned a kit which could be tested by the laboratory. Participation for the total population was 56.8%. This result falls short of the 60% target but is higher than the internationally accepted minimum participation rate of 45% for first rounds. The experience of other countries is that participation in the second round will not reach the level of participation achieved in the first round. Our pilot is proving no exception. Overall participation for the first 21 months of the second round is 53.4%. The Ministry reports round two participation overall and also broken down into three subgroups:

Participants for whom this was their first invitation to participate i.e. they had ‘aged in’ or moved into the area

Participants who had been invited in round one but who did not respond or successfully complete a kit which could be tested

Participants who were successfully screened in round one and who participated again in round two.

Round one compared with round two broken down into these three subgroups is shown on the following table.

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Table 4: Participation in the BSP by ethnicity showing those invited from 1/01/12 to 30/09/15

An 83% overall response rate for those invited for a second round is considered to be extremely good when compared with other overseas programmes and provides a measure of patient satisfaction of their experience. Bowel Screening programmes in other countries have consistently reported a lower participation rate achieved during the second round and this has been the case for the Waitemata DHB pilot to date. For the BSP the difference in the overall participation rate between rounds is not as large as anticipated. Given that participation increases for several months after the end of the reporting period, there is a chance that the second round participation will continue to rise and the difference between the two rounds will decrease. 3.2 Fair access Round one participation rates for Maori (46%) and Pacific (30.4%) were of concern. Round two has seen a strong focus on strategies designed to increase equity. Despite a reduction in overall participation between rounds (from 56.8% to 53.4%) it is pleasing to report that Maori (48%) and Pacific (38%) participation has increased during the first 21 months of round two that is, the equity gap has reduced. In comparing both Maori and Pacific against European/Other, the equity gap for Maori has reduced from 13.7% in round one to 5% in round two and for Pacific, from 29.3% to 15.3% which is a great achievement in a short space of time. When looking at the participation rates for round two in those that participated in round one, the gap between Maori and Pacific compared with European/Other is 1.2% and 4.3% respectively. It is extremely encouraging the equity gap is almost eliminated for those who participated in the first round and who participated again in the second round. A number of strategies to increase equity in participation were implemented during the second round and the equity gaps have reduced. The extension of the pilot has provided the opportunity to also trial a pay for performance model as a further strategy to increase equity.

0%10%20%30%40%50%60%70%80%90%

100%

Rd1 Rd 2 overall averageof the three Rd 2

sub-groups

Rd 2 was firstscreen (ageing or

moving in)

Rd 2 was firstscreen (spoilt or didnot respond to Rd 1

invite)

Rd 2 was secondscreen (successful in

Rd 1 and invitedagain)

Total Population Maori Pacific Asian European or Other

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3.3 Screening effectiveness A total of 269 cancers were identified in the first two rounds of the pilot. Fewer cancers were identified in the second screening round than in round one. The cancer detection rate has also reduced from 2.8 per 1,000 in round one to 1.4 per 1,000 in round two (to 30 September 2015) as would be expected in a second screening round. Higher cancer detection rates for Maori have occurred in the second round.

Table 2: Colorectal cancers detected during round one and round two*

Ethnicity Round 1 # Round 1 % Ethnicity Round 2 # Round 2%

European 142 85 European 80 78

Chinese 11 7 Chinese 6 6

Asian 7 4 Maori 6 4

Pacific 4 2 Asian 4 3

Maori 2 1 Pacific 3 6

Other 1 1 Other 3 3

*BSP data

A significant percentage of the cancers (68.5% in round one and 65% in round two) are identified at stage 1 and 2 when treatment is more effective. This compares favourably with approximately 40% identified (anecdotally) at stage 1 and 2 in symptomatic services.

Table 3: Colorectal cancer stage at diagnosis (including polyp cancers)*

Stage Round 1% Round 2%

1 44.4 49

2 24.1 16

3 22.3 28

4 9.3 7

*BSP data

3.4 Cost effectiveness The BSP provided detailed costing data to inform the interim evaluation report which was published in late 2014. The final evaluation report is due for publication in mid-2016 and the BSP has provided updated information to the evaluation team.

4. Implications of National Rollout for Waitemata DHB

The programme will be progressively rolled out across the country beginning in mid-2017, with all DHBs expected to have started screening by the end of 2019. Hutt Valley and Wairarapa DHBs begin screening the eligible 60 to 74 year age group from mid-2017, with all other DHBs following in stages. The MOH have advised a number of factors contributed to the decision to start with these two DHBs, including their history of working together and their willingness to build a closer working relationship. The DHBs are able to begin screening in 2017 and their small size will enable them to adapt more easily to the complex requirements of an evolving programme. This will also mean they can trial new systems and processes for the wider roll-out. The DHBs also have a unique population mix that includes a rural component. The order in which other DHBs will join the roll-out will be finalised after DHBs confirm their readiness.

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Bowel screening will continue to be offered at Waitemata DHB, which will transition from the Pilot to the national bowel screening model over the course of the roll-out. The current contract is for the pilot to undertake a third two year cycle of screening which concludes December 2017. There are a number of implications: 4.1 Pilot Coordination Centre During the first stage of the roll-out in 2017, the Waitemata Bowel Screening Pilot (BSP) Coordination Centre will manage and send screening invitations, coordinate the processing, analysis and management of completed tests and results for the Pilot and also for bowel screening at Hutt Valley and Wairarapa DHBs. It is expected that a National Coordination Centre (NCC) will be established by 2018 to take over this role and the selection of the NCC will be subject to a competitive process. The role of the NCC is different to what the current pilot coordination centre undertakes as the functions are split between the NCC and four Bowel Screening Regional Centres (BSRCs). The NCC would send letters to participants following a negative result and notify GPs electronically of all results. It would also advise the four Bowel Screening Regional Centres of all results. The BSRCs would then be responsible for ensuring a colonoscopy or other appropriate bowel investigation is offered to people with a positive result. The BSRCs would also receive funding for awareness-raising activities at a regional and local level that drive equitable participation. One consideration for Waitemata DHB is whether it wishes to bid to be the National Coordination Centre. If Waitemata DHB chooses not to undertake this function or is not successful in a bid to be the NCC, then following the implementation support of the Hutt Valley and Wairarapa DHBs, the Pilot coordination centre will transition to the new NCC provider in early 2018. The selection of the four BSRCs is not expected to be a formal procurement process. The Ministry intends to engage with DHBs, Alliance Groups, Regional Cancer Networks and private providers in each region before calling for Expressions of Interest for delivery of each regional centre. It is envisaged that all DHBs in a region would endorse a joint solution. 4.2 Age Range The current pilot age range is 50 to 74, however, the national programme rollout will start with a narrower eligible age range, 60 to 74. The MOH have advised the reason for the change in eligible age is that more than 80 percent of cancers detected through the Waitemata DHB pilot have been in people aged 60 to 74 years. This also aligns with the approach used in other countries when establishing a national bowel screening programme. For Waitemata DHB the age range change will mean that eligible people aged 50 years and over, who are living in the Waitemata DHB area, will continue to be invited for screening until the Pilot ends in December 2017. People in the 50 to 74 year age group who have received an invitation through the Pilot will continue to be invited to complete a bowel screening test every two years. People living in the Waitemata DHB area who have not turned 50 years by the end of the Pilot and have not been invited to participate in the Pilot will now have to wait to be screened until they turn 60 and become eligible for screening as part of the National Bowel Screening Programme. The impact of this change will mean more cancers detected with fewer colonoscopies and will release physical colonoscopy capacity from early 2018 which could be made available for symptomatic cases.

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4.3 Screening Test Sensitivity Another potential change could be the positivity threshold for the iFOBT test. The MOH have advised, in line with other international bowel screening programmes, the amount of blood needed to trigger a positive result (positivity threshold) will be set at a level where there is a greater likelihood of a cancer being found in participants undergoing colonoscopy. The chosen positivity threshold will also minimise the number of participants who undergo a colonoscopy where serious problems are not found. If there is to be a change to this threshold, then this change would be implemented for the rollout of the first two DHBs and would be a change for the Waitemata pilot at the same time which would be early to mid-2017. The impact of this would be a further reduction in colonoscopy capacity required from mid-2017 onwards and as above would be available to be commissioned for the symptomatic service.

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Hon Dr Jonathan Coleman

Minister of Health

26 May 2016

Bowel screening programme roll-out

The roll-out of a national bowel screening programme is on track to begin in 2017, Health Minister Dr Jonathan Coleman says.

Budget 2016 invests $39.3 million over four years for national bowel screening – starting with Hutt Valley and Wairarapa DHBs. This will be followed by a progressive roll-out across the country.

Additional funding has also been set aside in contingency to enable the IT support needed for a national screening programme.

“Once fully implemented, the programme is expected to screen over 700,000 people every two years. We know that bowel screening saves lives by detecting cancers at an early stage when they can more easily be treated.

“Around 3,000 New Zealanders are diagnosed with bowel cancer each year. The Government is committed to better access to early detection and treatment.

“We have been working towards a national screening programme for some time. This investment builds on the successful Waitemata DHB bowel screening pilot, which has been running since 2012.

“The Government has also invested $15 million since 2013 to deliver more colonoscopies and reduce colonoscopy waiting times across the country. This has also helped to build capacity within the system,” Dr Coleman says.

A business case for the bowel screening roll-out will go to Cabinet shortly.

Once in place, DHBs will offer people aged 60 to 74 a bowel screening test every two years. More than 80 per cent of cancers found through the pilot were in those aged 60 to 74. Screening in this range will maximise the number of cancers found while minimising the cases where problems are not found.

In line with international best practice for adoption of screening programmes, a staged approach is planned. Information from the pilot and discussions with the sector have confirmed there will be a sufficient clinical workforce to deliver the additional colonoscopies required for a staged roll-out of a national programme.

Contact: Kirsty Taylor-Doig 021 838 372

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Appendix 2 - Pilot objectives

The overall goal for the BSP is to determine whether organised bowel screening could be introduced in New Zealand in a way that is effective, safe and acceptable for participants, equitable and economically efficient. The Pilot addresses four key aims:

1. Effectiveness: Is a national bowel screening programme likely to achieve the mortality reduction from bowel cancer for all population groups seen in international randomised controlled trials?

2. Safety and acceptability: Can a national bowel screening programme be delivered in a manner that is safe and acceptable?

3. Equity: Can a national bowel screening programme be delivered in a manner that eliminates

(or does not increase) current inequalities between population groups?

4. Economic efficiency: Can a national bowel screening programme be delivered in an economically efficient manner?

Ten objectives have been determined, to address the four aims: 1. Programme design - to pilot the use of a population register, closely linked with primary

health care services to invite the target population, along with a coordination centre and associated information system to manage the screening pathway

2. Screening effectiveness - to assess the early indicators of the effectiveness of bowel screening, including the number and stage of cancers detected, the number and size of adenomas detected, and colonoscopy completion rates

3. FOBT experience - to assess the performance and acceptability of the chosen FOBT in the New Zealand context including the positivity rates in New Zealand, positive predictive values for adenomas and cancers, technical repeat rates and false positive rates

4. Participation and coverage - to determine the level of participation and coverage for the eligible and invited populations, including sub-populations (defined by sex, age, ethnicity, socioeconomic status and rural representation)

5. Quality - to pilot the agreed quality standards and monitoring requirements along the Screening Pathway and assess the implications for a national programme; in particular to pilot the acceptability and safety of the standards and screening to providers and for different population groups

6. Service delivery and workforce capacity - to monitor the effect, including resource implications of screening activities, on primary care, community health services, laboratory, and secondary and tertiary services and the implications of this for a national programme

7. Fair access for all New Zealanders - to determine whether a bowel screening programme can be delivered in a way that provides fair access for all New Zealanders. In particular, to evaluate the process of adopting a focus in leadership, decision making processes and implementation of the pilot to provide fair access to all eligible people

8. Cost effectiveness - to determine the costs of all services along the Screening Pathway to determine the cost effectiveness of a bowel screening programme. To compare this, where possible, with other preventative programmes in New Zealand and bowel screening trials internationally

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9. Acceptability to the target population - to pilot provision of information and support to the target population to facilitate informed participation and evaluate the knowledge, attitudes and satisfaction of groups of participants (defined by sex, age, ethnicity, socioeconomic status and geographical residence) in the screening pilot, including identifying factors associated with non-participation

10. Acceptability to providers - to evaluate the knowledge and attitudes and acceptability to health professionals and health care providers based in community, primary care and hospital settings.

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Waitemata DHB Meeting of the Board 29/06/16

9.3 Waitemata Healthy Food and Drink Policy Recommendation That the Board notes that the Waitemata DHB Healthy Food and Drink Policy is being updated in line with the national policy subject to agreement with the National Resident Doctors Association and the National Bipartite Action Group for the wider health workforce. Prepared by: Rebecca McLean (Public Health Dietitian) and Roslyn Norrie (Food Service Manager) Endorsed by: Simon Bowen (Director Health Outcomes) Glossary

DHB - District Health Board ELT - Executive Leadership Team MOH - Ministry of Health HSR - Health Star Rating 1. Executive Summary

Waitemata DHB has had a Healthy Food and Drink policy in place for some time. This is being updated in line with the National Healthy Food and Drink Policy. The purpose of the policy is to ensure that healthy foods and beverages are the predominant options available on DHB premises, and provided by contracted providers. The policy is a response to initiative 21 ‘DHB Healthy Food Policies’ in the Ministry of Health’s (MOH) Childhood Obesity Plan. It has been developed in accordance with the New Zealand Eating and Activity Guidelines.

Ensuring an environment where healthy food and drink choices are the easiest choices is a mainstay in the prevention and reduction of overweight and obesity. The National Healthy Food and Drink Policy will provide an opportunity for Waitemata DHB to:

• Role model environments that promote healthy food and drink choices • Normalise healthy choices and smaller servings in health settings • Influence other community settings to review their food and drink environments • Signal desired changes to the food industry with one consistent set of food and drink criteria

across all DHBs The policy applies to all DHB facilities/sites, contractors and staff. It does not apply to inpatient meal services or meals on wheels. It is intended that the policy will be implemented by all DHBs and the MOH over a two-year period. It will be reviewed in 2019. Negotiations are taking place with the National Resident Doctors Association as required by law to reach common ground. The policy is also being discussed with the National Bipartite Action Group for the wider health workforce.

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Obesity is one of the leading modifiable risk factors in Waitemata. Implementation of a healthy food and drink policy is one of a number of measures the DHB is taking to address obesity. The benefits from healthier Waitemata DHB food environments include improvements to health and wellbeing for staff, visitors, family/whanau of patients and the general public, being a leader and role model to the community, and demonstrating alignment with the MOH and other DHBs across the country.


The DHB has worked with DHBs regionally and nationally as well as the MOH to develop the policy


The policy is based on best available evidence and have been developed by a network of dietitians and public health physicians


Obesity is a major risk factor for many chronic diseases including cancer, diabetes and CVD which have significant costs to the DHB. Reducing obesity therefore is an important population health goal and an important strategy to support the DHBs operational and financial sustainability

3. Background

An existing Healthy Food and Beverage Environments Policy is currently in operation at Waitemata DHB. On 20 August 2015 the Director-General of Health (MOH) wrote to all DHBs requiring they no longer sell sugar-sweetened beverages on their premises. This letter also required that DHB healthy food policies be made available on DHB websites – originally by 30 December 2015 and then extended to 1 July 2016. District Health Boards around the country were at varying stages of policy development and implementation, working with a range of different food and drink criteria. A National DHB Food and Drink Environments Network (the Network), which included the MOH, was established in August 2015 to agree a nationally consistent Healthy Food and Drink Policy for use across all DHBs and potentially other settings. The Network received support and advice from the Heart Foundation, Agencies for Nutrition Action, Ministry for Primary Industries, NZ Beverage Guidance Panel, and the University of Auckland in the development of the policy. In principle support was also provided from national agencies, including the NZ Medical Association, NZ Nurses Organisation, Allied Health Aotearoa NZ, Dietitians NZ, and the Royal Australasian College of Physicians. Healthy Food and Drink Environments are those where all indoor and outdoor areas a person sees, enters, is near to, or uses support healthy eating and drinking as a social norm and the easiest choice. One in four adults in the Waitemata district are obese, with disproportionately high rates for Māori (43%) and Pacific (65%) populations. Addressing obesity requires a multipronged approach and includes remodelling environments to become supportive of healthy lifestyles. The benefits from healthier Waitemata DHB food environments include improvements to health and wellbeing for staff, visitors, family/whanau of patients and the general public, being a leader and role model to the community, and demonstrating alignment with the MOH and other DHBs across the country.

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4. Changes to Existing Policy

The Auckland DHB Healthy Food and Beverage Environments Policy (Aug 2015), which is very similar to the Waitemata DHB Healthy Food and Beverage Environments Policy (Dec 2015), was used as a starting document for the National Healthy Food and Drink Policy. While there have been a number of changes, the purpose and scope of the policy is very similar to the Waitemata DHB policy.

Key changes from the 2015 Waitemata DHB Healthy Food and Beverage Policy include: • No confectionery will be sold on Waitemata DHB premises • Green category foods are required to dominate, making up at least 55% and Amber category

foods will make up less than 45% of food and drinks available. • All pre-packaged foods (excluding drinks) will meet the recently established Health Star Rating

(HSR) nutrient criteria of at least 3.5 stars. Additional criteria (such as portion sizes) may apply to some categories.

• Green category (cold) drinks have been restricted to water and milk only. Amber category options will include ‘no added sugar’ juices (≤200mls) and artificially sweetened drinks (≤300mls). Flavoured milks, liquid breakfasts and (caffeinated) energy drinks – including artificially sweetened varieties – are all classified as red.

5. Costs

Complying with the National Healthy Food and Drink Policy may impact on DHB revenue through commissions and leases. The DHB will continue to work collaboratively with retailers to progressively implement the Policy over a two-year period. It is possible that some of the retailers at Waitemata DHB may choose not to sign leases due to the Policy restrictions. If retailers who provide the DHB with a commission on revenue were to choose not to sign (or renew) contracts, and no other retailers took the lease, this would result in a reduction in total revenue for the DHB. The Healthy Food and Beverage Policy applies to any external party that provides catering ‘on site at any DHB facility, and off site where the DHB organises and/or hosts a function for staff, visitors and/or the general public’. The approved catering suppliers for Waitemata DHB are restricted to Archers Sushi, Subway or Medirest. Currently, in order to provide enough food within the $5 per person catering budget, staff often buy groceries from the supermarket, make up sandwiches and fruit platters, and then later submit an expense claim. 6. Consultation

6.1 Consultation already undertaken Internally, consultation has been undertaken with members of the senior management team, Auckland DHB dietitians, and Auckland DHB and Waitemata DHB food service managers. In April 2016 Waitemata DHB retailers and volunteer service providers affected by this policy were given the opportunity to comment on the draft Policy. Comments were received from the Red Cross. Nationally, the following agencies were invited to provide comment on the draft Policy: • Allied Health Aotearoa NZ • Association of Professional and Executive Employees (APEX) • Association of Salaried Medical Specialists (ASMS) • Compass • Dietitians NZ

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• E Tu • Food and Grocery Council • Health Partnerships Limited • NZ Medical Association • NZ Nurses Organisation • Public Services Association (PSA) • Resident Doctors’ Association • Royal Australasian College of Physicians • Spotless

In principle support was also provided from the NZ Medical Association, NZ Nurses Organisation, Allied Health Aotearoa NZ, Dietitians NZ and the Royal Australasian College of Physicians. Note that no comments were received from the PSA, E Tu, APEX or ASMS. Discussions are taking place with the Resident Doctors Association. Negotiations are taking place with the National Resident Doctors Association as required by law to reach common ground. The policy is also being discussed with the National Bipartite Action Group for the wider health workforce. 6.2 Clinical endorsement The guidelines have been endorsed by dieticians and public health physicians from the Network. 7. Implementation

The DHB will continue to work collaboratively with retailers to explain the new policy and guidelines, and to support retailers to work towards achieving the guidelines in progressive steps over a two-year period. A communication plan will be developed for staff, visitors and commercial and other stakeholders with key messages developed. A key theme in the agreement of this Policy is that we need to take our staff and the general public on a journey to better understand healthy food and drink choices. Issues are likely to be raised are around affordability, quality, choice and commercial viability. 8. Conclusion

The National Healthy Food and Drink Policy provides a powerful opportunity to role-model environments that promote healthy food and drink choices across all New Zealand DHBs. It is a step in normalising healthy choices and smaller servings in health settings, with potential to influence other community settings. Agreement with this policy will also assist the food and drink industry by having one set of food and drink provision criteria for all DHBs. Ensuring a healthy food and beverage environment within areas of DHB influence is essential to supporting healthy food and beverage choices for staff, visitors and users of contracted provider services. Ensuring an environment where healthy food and beverage choices are the easiest choices is a mainstay in the prevention and reduction of overweight and obesity. References

1. Ministry for Primary Industries. 2014. Health Star Rating. URL http://www.foodsafety.govt.nz/industry/general/labelling-composition/health-star-rating/ 2. QST. 2011. Is Healthy Food Really Profitable: URL http://www.qsrmagazine.com/health/healthy-food-really-profitable

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http://www.foodsafety.govt.nz/industry/general/labelling-composition/health-star-rating/

http://www.qsrmagazine.com/health/healthy-food-really-profitable

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Last updated 10 May 2016

National Healthy

Food and Drink

Policy Creating a healthier food and drink environment for staff,

visitors and the general public in District Health Boards

and the Ministry of Health

Developed by the

National District Health Board Food and Drink Environments Network

May 2016

Please note: The content of this policy is final, although the document is yet to be fully prepared for publication ie grammatically edited and formatted. The fully edited and formatted version will be available in June 2016.

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Table of Contents

1. Introduction ................................................................................................................................................ 3

2. Overview .................................................................................................................................................... 3

2.1 Purpose .............................................................................................................................................. 3

2.2 Scope ................................................................................................................................................. 4

3. Healthy Food and Drink Policy .................................................................................................................. 5

3.1 Healthy Food and Drink Environments .............................................................................................. 5

3.2 Healthy Food and Drink Policy Principles .......................................................................................... 5

3.3 Promotion of Healthy Options ............................................................................................................ 6

4. Staff Facilities ............................................................................................................................................ 6

4.1 Facilities for Storing Own Meals ........................................................................................................ 6

4.2 Drinking Water ................................................................................................................................... 6

4.3 Breastfeeding in the Workplace ......................................................................................................... 6

5. Healthy Food and Drink Environments Criteria ......................................................................................... 7

5.1 Food and Drink Categories ............................................................................................................... 7

5.2 Food and Drink Availability ............................................................................................................... 7

5.3 Additional Requirements .................................................................................................................... 8

6. Healthy Food and Drink Environments Nutrient Criteria Table ................................................................. 9

6.1 Vegetables and Fruit .......................................................................................................................... 9

6.2 Grain Foods ....................................................................................................................................... 9

6.3 Milk and Milk Products ..................................................................................................................... 10

6.4 Legumes, Nuts, Seeds, Fish and other Seafood, Eggs, Poultry (e.g. Chicken), and Red Meat ..... 10

6.5 Mixed Meals / Ready to Heat & Eat Meals ...................................................................................... 11

6.6 Fats and Oils, Spreads, Sauces, Dressings and Condiments ......................................................... 12

6.7 Packaged Snack Foods ................................................................................................................... 13

6.8 Bakery Items .................................................................................................................................... 13

6.9 Drinks ............................................................................................................................................... 14

7. Monitoring and Evaluation ....................................................................................................................... 15

8. Associated Documents ............................................................................................................................ 15

Appendix 1: Process ........................................................................................................................................ 16

Appendix 2: Network members and representatives of agencies supporting the development of the National

Policy ............................................................................................................................................................... 17

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3


1. Introduction

Healthy eating is essential for good health and wellbeing. With increasing rates of obesity and the

subsequent rise of associated poor health outcomes including type 2 diabetes and cardiovascular

disease, it is essential that District Health Boards (DHBs) and the Ministry of Health (the Ministry)

show leadership by providing healthy eating environments for their staff, visitors and the general

public. The development of DHB Healthy Food Policies is an action in the Ministry of Health’s

Childhood Obesity Plan (Ministry of Health 2015a).

The DHB Healthy Food and Drink Environments Network (the Network) was established in 2015 to

develop a nationally consistent Healthy Food and Drink Policy (the Policy) for use across all DHBs

and potentially other settings. The Network received support and advice from the Heart Foundation,

Agencies for Nutrition Action, Ministry for Primary Industries, New Zealand Beverage Guidance

Panel, and the University of Auckland in the development of the policy. For more information on the

process used to develop this policy see Appendix 1.

The Policy will be implemented in DHBs and the Ministry over a two-year period. It is the intention

that the Network will continue to support DHBs and the Ministry during this period and undertake a

review of the Policy in 2019.

2. Overview

2.1 Purpose

The purpose of this policy is to support DHBs and the Ministry to:

demonstrate commitment to the health and wellbeing of staff, visitors, and the general

public by providing healthy food and drink options, which support a balanced diet in

accordance with the New Zealand Eating and Activity Guidelines

act as a role model to the community by providing an environment that supports and

promotes healthy food and drink choices

assist the food and drink industry by having one set of food and drink provision criteria for all DHBs.

Important considerations

In providing healthy food and drink environments, DHBs take into consideration:

the needs of different cultures, religious groups and those with special dietary needs, and

accommodate these on request, where possible and practicable

ecologically sound, sustainable, and socially responsible practices in purchasing and using

food and drinks. Encourage procurement of seasonal and locally grown and manufactured

(regional and national) food and drinks where possible and practical.

the importance of discouraging association with products and brands inconsistent with a

healthy food and drink environment as defined by this Policy.

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http://www.health.govt.nz/our-work/eating-and-activity-guidelines

4


2.2 Scope

This policy applies to all DHB facilities/sites, contractors, and staff including:

all food and drink provided or able to be purchased from any retailer, caterer, vending

machine, or volunteer service on the DHB’s premises for consumption by staff, visitors,

and the general public1

any gifts, rewards, and incentives offered to staff, guest speakers and/or formal visitors on

behalf of the DHB if containing food and/or drinks

any fundraisers organised by either internal or external groups where food and drinks are

sold or intended for consumption on DHB premises. Fundraisers associated with groups

outside the DHB which do not meet this policy should not be promoted on DHB premises

or through DHB communications (e.g. chocolate fundraisers). Alternative healthy

fundraising and catering ideas are encouraged [link to be inserted]

all health service providers contracted by the DHB that have a food and drink environment

clause in their contract with the DHB

any external party that provides food or catering:

o on site at any DHB facility (e.g. recruitment agencies, drug companies), and

o off site where the DHB organises and/or hosts a function for staff, visitors and/or

the general public (e.g. conferences, training).

While the provision and consumption of healthy food and drink options is strongly encouraged, this

policy excludes:

food and drink brought to work by staff for their own consumption

gifts from families / whānau of patients / clients to staff

self-catered staff shared meals both on and off site (e.g. food brought for special occasions,

off-site self-funded Christmas parties or similar celebrations)

gifts, rewards, and incentives that are self-funded

inpatient meal services and meals on wheels. Separate standards exist for inpatients and

Meals on Wheels which reflect food and drink requirements in both health and illness and

for various age groups. The majority of inpatients are admitted because they are unwell

and therefore require food and drink that is appropriate at that time, for their clinical care

and treatment

food and drink provided by clients / patients and their families and visitors for their own use

(families and visitors are encouraged to check with healthcare staff before bringing in food

for inpatients)

alcohol-related recommendations (please refer to your DHBs position on alcohol).

1 Includes foods and drink available for purchase by patients

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3. Healthy Food and Drink Policy

3.1 Healthy Food and Drink Environments

The intent of this policy is to ensure that the DHB and its contracted health service providers (with a

healthy food and drink contract clause) role model an environment that consistently offers and

promotes healthy food and drink options. Section five of this policy provides Healthy Food and Drink

Criteria to provide greater clarity on how the policy can be implemented.

Consistent with the Eating and Activity Guidelines for New Zealand Adults (Ministry of Health 2015b),

messages and practices relating to food and drinks in the DHB will reflect the following principles:

3.2 Healthy Food and Drink Policy Principles

A variety of foods from the four food groups need to be available

Plenty of vegetables and fruit.

Grain foods, mostly whole grain and those naturally high in fibre.

Some milk and milk products, mostly low and reduced fat.

Some legumes, nuts, seeds, fish and other seafood, eggs, poultry (e.g. chicken)

and/or red meat with the fat removed.

Mostly prepared with or contain minimal saturated fat, salt (sodium) and added

sugar, and that are mostly whole and less processed.

Some foods containing moderate amounts of saturated fat, salt and / or

added sugar may be available in small portions (e.g. some baked or frozen

goods).

No deep fried foods.

No or limited confectionery (e.g. sweets and chocolate)2.

Water and unflavoured milk will be the predominant cold drink options.

Availability and portion sizes of drinks containing ‘intense’ sweeteners3, and

no added sugar juices are limited.

No sugar sweetened drinks4.

2 The National District Health Board Food and Drink Environments Network have chosen to adopt a no confectionery policy within

DHBs and the Ministry. Confectionery will be phased out over a two year period.

3 Intense sweeteners (also known as artificial sweeteners) are a type of food additive that provides little of no energy (kilojoules).

Intense sweeteners permitted for use in New Zealand include aspartame, sucralose and stevia.

4 Any drink that contains added caloric sweetener usually sugar. The main categories of sugary drinks include soft-drinks/fizzy-drinks,

sachet mixes, fruit drinks, cordials, flavoured milks, flavoured waters, iced teas/coffees, and energy/sports drinks.

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Healthy food and drink choices, including vegetarian and some vegan items, appropriate to a wide

variety of people should be available, with consideration given to cultural preferences, religious

beliefs and special dietary requirements such as gluten free.

Breastfeeding is supported in all DHB settings as the optimum infant and young child feeding

practice.

3.3 Promotion of Healthy Options

It is important that the DHB and its staff are role models for the community in obesity and disease

prevention and advocate for healthy nutrition in the workplace and other settings as appropriate. The

policy itself is a health promotion tool. Providing a healthy eating environment is a health and safety

issue which should be supported by all levels of the organisation. The DHB will actively promote

healthy food and drink options with staff, visitors, and the general public. Healthy options (‘Green

category’ foods and drinks – refer Section 5) should be the most prominently displayed items by

retailers, and should be readily available, in sufficient quantities, competitively priced and promoted

to encourage selection of these options. The DHB will promote healthy eating behaviours to staff,

visitors, and the general public through the provision of consistent evidence-based nutrition

messages.

Partnerships, fundraisers, associations, and promotions involving products and brands that are

inconsistent with a healthy food and drink environment as defined by this policy are discouraged.

4. Staff Facilities

4.1 Facilities for Storing Own Meals

Staff should be provided with reasonable access to food storage facilities, such as fridges, lockers

or cupboards. Wherever possible this would also include reasonable access to a microwave oven.

4.2 Drinking Water

The DHB will provide reasonable access to drinking water for all staff, visitors, and the general public

on site. Wherever possible this should be tap water and/or water fountains, with staff encouraged to

bring their own water bottle. Where water coolers are provided, each service must ensure that they

are replenished, cleaned and serviced on a regular basis. Consider environmentally friendly and

recyclable options when purchasing cups for water dispensing.

4.3 Breastfeeding in the Workplace

The DHB will promote and support breastfeeding by:

encouraging and supporting breastfeeding within the workplace

providing suitable areas that may be used for breastfeeding and for expressing and storing

breast milk

providing suitable breaks for staff who wish to breastfeed during work, where it is

reasonable and practicable.

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Refer to your DHB’s own specific breastfeeding policy for more detailed information.

5. Healthy Food and Drink Environments Criteria

5.1 Food and Drink Categories

The purpose of the food and drink categories is to provide a practical way for food service providers

to categorise foods. Foods will not be labelled with the colours or promoted using a traffic light

labelling system.

Foods and drinks are placed into three categories:

Green: These foods and drinks are part of a healthy diet. They are consistent with the Healthy Food

and Drink Policy Principles reflecting a variety of foods from the four food groups including:

plenty of vegetables and fruit

grain foods, mostly whole grain and those naturally high in fibre

some milk and milk products, mostly low and reduced fat

some legumes, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red

meat with the fat removed;

and are low in saturated fats, added sugar and added salt, and mostly whole and less processed.

Green category products must consist only of green category foods, drinks, and ingredients.

Amber: These foods and drinks are not considered part of an everyday diet, but may have some

nutritive value. Foods and drinks in this category can contribute to consuming excess energy, and

are often more processed. The amber category contains a wide variety of foods and drinks, some

healthier than others. Where possible provide the healthier options within this category e.g. a potato

top pie instead of a standard pie.

Amber category products can contain a mixture of green and / or amber foods, drinks, and ingredients.

Red: These foods and drinks are of poor nutritional value and high in saturated fat, added sugar,

and / or added salt and energy. They can easily contribute to consuming excess energy. These are

often highly processed foods and drinks.

5.2 Food and Drink Availability

Healthy food and drinks should be the easy choice. Within a food service (e.g. cafeteria, catered

event, shop, or vending machine), green category foods and drinks should predominate. This means

that they should make up at least 55% of food and drinks available for consumption. Over time,

organisations should aim to increase the proportion of green healthy foods and drinks (over and

above the minimum 55%).

Green category items:

dominate the food and drinks available (at least 55% of choices available)

are displayed prominently on shelves, benches, cabinets and vending machines

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are always available in sufficient quantities to be the predominant option.

Amber category items:

make up less than 45% of choices available

should be small portion sizes (as per specific criteria)

are not prominently displayed at the expense of green category items.

Red category items:

are not permitted (refer to section 2.2 for the scope of the policy)

should be phased out over time in accordance with each individual DHB’s Policy

implementation plan if these products are currently available within the DHB..

5.3 Additional Requirements

In addition to complying with the criterion within the Nutrient Criteria Table (refer Section 6):

all unpackaged / prepared on-site foods and drinks should be consistent with the

overarching policy principles.

all pre-packaged foods (excluding drinks) must meet set nutrient criteria standards (e.g.

Health Star Rating (HSR) of at least 3.5 stars5). Additional criteria (such as portion sizes)

may apply to some categories. For packaged foods without a Health Star Rating,

manufacturers6 can calculate a rating using the tool here.

it is acknowledged that specialty items such as gluten and dairy free items may not be able

to comply with all criteria, however products are still required to reflect the overarching

policy principles and relevant criteria where practical.

5 Technical Report: Alignment of NSW Healthy Food Provision Policy with the Health Star Rating System:

http://www.health.nsw.gov.au/heal/Pages/health-star-rating-system.aspx

6 It is up to the packaged food provider / manufacturer to calculate and provide the HSR of their product(s) to the DHB if their product

does not hold a HSR. DHB food service staff can contact the manufacturer / provider to seek this information prior to purchasing.

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http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/Calculator

http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/online-calculator


National DHB Food and Drink Environments Guidelines Feedback – 10/05/16

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6. Healthy Food and Drink Environments Nutrient Criteria Table7

CATEGORY GREEN

≥ 55% of products must fit within this category

AMBER

< 45% of products must fit within this category

RED

Products within this category are not permitted

6.1 Vegetables and Fruit

Vegetables All fresh, frozen, canned, and dried plain vegetables

Opt for no / minimal added unsaturated fat / salt varieties

Fruit All fresh, frozen, and canned fruit

Opt for no / minimal added sugar varieties

Dried fruit ≤30g serving size as an ingredient or part of a fruit and nut mix

Dried fruit >30g serving size as an ingredient or part of a fruit and nut mix or dried fruit on its own

6.2 Grain Foods

Breads and crackers

All wholegrain, multigrain, wheatmeal, and wholemeal breads and crackers with a ≥3.5 Health Star Rating (HSR)

All wholegrain, multigrain, wheatmeal, and wholemeal breads and crackers with a <3.5 HSR

All white breads and crackers with a ≥3.5 HSR

All white breads and crackers with a <3.5 HSR

Breakfast cereals Wholegrain breakfast cereals with a ≥3.5 HSR and ≤15g / 100g sugar

Breakfast cereals with a ≥3.5 HSR All breakfast cereals that do not meet the green / amber criteria

Cereal foods

Wholegrain and high fibre varieties

e.g. wholegrain rice, wholemeal pasta and couscous, quinoa, polenta, buckwheat, bulgur wheat, oats, pearl barley, spelt, rye

Refined grains and white varieties

e.g. rice, plain pasta, unflavoured noodles, polenta (degermed), couscous

7 Criteria within packaged / unpackaged food and drink items may not necessarily align.

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6.3 Milk and Milk Products

Milk and milk products

See section 6.9 Drinks

Reduced or low-fat (with a ≥3.5 HSR):

- milks and calcium enriched soy milk

- yoghurt / dairy food (≤150mls portion)

- custard (≤150mls portion)

- cheese (≤40g portion)

Calcium enriched milk alternatives (e.g. rice/almond/oat)

Full-fat (with a ≥3.5 HSR):

- milks and calcium enriched soy milk

- yoghurt / dairy food (≤150mls portion)

- custard (≤150mls portion)

- cheese (≤40g portion)

Reduced or low-fat varieties of the above (with a ≥3.5 HSR) with portion sizes greater than those stipulated in green category

Lite varieties of cream, sour cream and cream cheese

Frozen desserts (e.g. yoghurt, ice cream) with a ≥3.5 HSR and ≤100g portion

Full-fat (with a <3.5 HSR):

- yoghurt / dairy food (>150mls portion)

- custard (>150mls portion)

- cheese (>40g portion)

Standard varieties of cream, sour cream, and cream cheese

Frozen desserts with a <3.5 HSR or >100g portion

All sugar sweetened milk drinks

6.4 Legumes, Nuts, Seeds, Fish and other Seafood, Eggs, Poultry (e.g. Chicken), and Red Meat

Legumes

Dried and canned beans and peas

e.g. Baked beans, red kidney beans, soy beans, mung beans, lentils, chickpeas, split peas, bean curd & tofu

Use reduced salt/sodium varieties where applicable.

Nuts and seeds

All unsalted nuts and seeds with no added sugar All salted nuts and seeds ≤50g portion (with no added sugar)

All nuts and seeds with dried fruit ≤50g portion

All salted nuts and seeds >50g / portion

All sugared, candied, coated nuts and seeds

Nuts and seeds with confectionery10

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Fish and other seafood, eggs, poultry (e.g. chicken), and red meat

See section 6.6. for suitable cooking oils and cooking methods.

All fresh, frozen fish, seafood, skinless poultry e.g. chicken or turkey and lean meat. Eggs. Premium or prime mince (≥95% visual lean meats / ≥90% chemical lean)

Canned and packaged fish, chicken and meat with a ≥3.5 HSR

Meat with small amounts of visible fat only. Standard mince (≥90% visual lean meats/≥85% chemical lean) cooked and fat drained off. Chicken drumsticks

Processed fish, chicken (e.g. smoked)and meat:8

- ≤50g in sandwiches, rolls, salads

- ≤120g as a main meal

- ≤150g Sausages per meal

- Dried meat products e.g. jerky, biltong ≥3.5 HSR and ≤800kj per packet

Canned or packaged fish, chicken, and meat with a <3.5 HSR

All meat where fat is clearly visible

Poultry with visible fat and skin remaining (other than drumsticks)

Standard mince (where the fat is not drained off)

All processed fish, chicken and meat products that do not meet amber serving size

6.5 Mixed Meals / Ready to Heat & Eat Meals

Mixed meals (2 or more items/ ingredients from different food groups) and ready to eat / heat meals

Unpackaged: ≥50% of meal is *vegetables and/or fruit and prepared with green category items / ingredients only

Packaged: ≥3.5 HSR and meet the above criteria

*A variety of coloured vegetables/fruit are recommended

Unpackaged: Meal includes *vegetables and / or fruit and prepared with at least 50% green category items / ingredients

Packaged: ≥3.5 HSR and meet the above criteria

*A variety of coloured vegetables/fruit are recommended

Unpackaged: Meal includes no vegetables or fruit and is prepared with less than 50% green category items / ingredients

Packaged: <3.5 HSR

Sandwiches Prepared with green category items only Prepared with ≥50% green category items Prepared with ≤50% green category items

Sushi Prepared with green category items only

All other sushi. Excludes sushi containing deep fried ingredients Containing deep fried items / ingredients

- Milk based Smoothies prepared onsite

No added sugar, reduced fat milk based smoothies made with fresh/frozen and no sugar added canned fruit ≤ 300mls

Prepared with concentrate, fruit juice, or added sugar

8 Examples of processed meats include: fresh sausages; cooked comminuted meat products (e.g. luncheon, bologna, cooked sausages); uncooked comminuted fermented meat products (UCFM) (e.g. salami,

pepperoni); cooked cured meat products (e.g. ham, corned beef, pastrami); cooked uncured meat products (e.g. roast beef); bacon; dry-cured meat products (e.g. prosciutto); meat patties.

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6.6 Fats and Oils, Spreads, Sauces, Dressings and Condiments

Fats and oils, spreads, sauces and dressings, and condiments

Fats and oils, and spreads:

- Low salt mono- or poly-unsaturated spreads e.g. margarine, peanut butter

- Oil sprays and vegetable oils e.g. canola, olive, rice bran, sunflower, soya bean, flaxseed, peanut or sesame

Sauces and dressings:

- Reduced fat/sugar/salt varieties of salad dressings, mayonnaise, tomato sauce

Use in small amounts/ Serve on the side.

Condiments:

If available, opt for reduced fat/sugar/salt varieties of: sauces (chilli, soy, fish etc.), pastes (tomato), relishes, stocks, yeast and vegetable extracts (Marmite, Vegemite) or if using standard items don’t add salt.

Mustards

Herbs and spices

If using salt, use iodised salt

Fats and oils, and spreads

- Single serve butter( ≤10g PCU) - make margarine the default option for single serve spreads.

Sauces and dressings:

- Standard salad dressings, mayonnaise, tomato sauce

Use in small amounts / Serve on the side

Lite varieties of: coconut milk or coconut cream, or dilute coconut cream with water

Refer milk and milk products section for cream, sour cream and cream cheese

Fats and oils, and spreads

- Saturated fats and oils e.g. butter (excluding single serve ≤10g PCU butter), lard, palm oil, coconut cream, coconut oil and cream.

Standard varieties of: coconut milk and coconut cream

Refer milk and milk products section for cream, sour cream and cream cheese

Deep fried foods Where applicable, use healthier cooking methods i.e. braise, bake, steam, grill, pan fry, or poach

Where applicable, use healthier cooking methods i.e. braise, bake, steam, grill, pan fry, or poach

No deep fried foods

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6.7 Packaged Snack Foods

Packaged snack9 foods

≥3.5 HSR and ≤800kj per packet >3.5 HSR and / or >800kj per packet

Confectionery10 All confectionery

6.8 Bakery Items

Bakery items

Unpackaged and packaged bakery items:

- More than half of the selection of baked products offered must contain some wholemeal flour, wholegrains (e.g. oats, bran, seeds) and/or fruit / vegetables (e.g. fresh, frozen or dried)

- No or minimal icing (e.g. water icing)

- Use less fat, salt and sugar

- No confectionary10 within products

- (Pies only) Follow the Better Pies Guidelines

Portion sizes

- Scones, cake or dessert ≤120g

- Loaf, muffins ≤100g

- Slices, friands ≤80g

- Biscuits, muesli bars, pikelets ≤40g

- Pies and quiches ≤180g

- Small pastries ≤65g

- Sausage rolls ≤100g

All products that do not meet the amber criteria

9 Packaged Foods criteria applies to packaged foods not covered by other categories (e.g. bakery items). Generally single serve portions in vending machines and cafeterias. Where shops are onsite, multi-serve

packaged foods that meet the HSR of greater than or equal to 3.5 and any other criteria that applies per serving are able to be sold e.g. crackers, cereal, biscuits, canned or packaged soups, plain popcorn.

10 Confectionery definition: confectionary includes a range of sugar-based products, including boiled sweets (hard glasses), fatty emulsions (toffees and caramels), soft crystalline products (fudges), fully crystalline

products (fondants), gels (gums, pastilles, and jellies), and chocolate. (Heart Foundation Food and Beverage Classification System) Also includes fruit leathers, enrobed (e.g. yoghurt covered items), candied

fruit/nuts, and compound chocolate.

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6.9 Drinks

Cold Drinks

Plain, unflavoured, water and reduced fat milk/

calcium enriched milk alternatives e.g. reduced fat soy milk, almond milk

- Plain full-fat milk and calcium enriched milk alternatives e.g. soy milk, almond milk

- Carbonated water

- Still/carbonated drinks and milk drinks that are sweetened with ‘intense’ sweeteners11 ≤ 300mls

- Diluted no added sugar fruit or vegetable juices with total sugar content < 20g12 and ≤ 300mls

- 100% fruit and/or vegetable juices (or ice blocks) with no added sugar (including unflavoured coconut water) and ≤ 200mls

- Drinks containing added sugars13

- Sugar sweetened drinks

- Milk based drinks with added sugar e.g. milkshakes and liquid breakfasts

- Still/carbonated drinks that are sweetened with intense sweeteners > 300mls

- Diluted no added sugar fruit or vegetable juices with total sugar content ≥ 20g and/or > 300mls

Hot Drinks No criteria developed for hot drinks at this stage. Try to minimise added saturated fat, salt and sugar. Make reduced fat milk the default option.

11 ‘Intense’ sweeteners (also known as artificial sweeteners) are a type of food additive that provides little of no energy (kilojoules). Intense sweeteners permitted for use in New Zealand include aspartame, sucralose

and stevia.

12 This will be equivalent sugar content to 200mls of 100% fruit juice

13 Any drink that contains added caloric sweetener usually sugar. The main categories of sugary drinks include soft-drinks/fizzy-drinks, sachet mixes, fruit drinks, cordials, flavoured milks, flavoured waters, cold

teas/coffees, and energy/sports drinks.

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7. Monitoring and Evaluation

The processes of Monitoring / Reporting the policy will be part of each DHB's Implementation Plan and will be aligned

to the agreed expectations of the national DHB Food and Drink network and the Ministry of Health.

8. Associated Documents

Ministry of Health. 2015a. Childhood Obesity Plan. URL: www.health.govt.nz/our-work/diseases-and-

conditions/obesity/childhood-obesity-plan (accessed on 17 March 2016).

Ministry of Health. 2015b. Eating and Activity Guidelines for New Zealand Adults. URL:

www.health.govt.nz/our-work/diseases-and-conditions/obesity/childhood-obesity-plan (accessed on 17

March 2016).

Ministry of Health. 2013. Guidance on supporting breastfeeding mothers returning to work. URL:

www.health.govt.nz/your-health/healthy-living/food-and-physical-activity/guidance-nutrition-and-physical-

activity-workplaces/guidance-supporting-breastfeeding-mothers-returning-work (accessed on 18 March

2016).

Ministry of Health. 2015c. National District Health Board and Ministry of Health Healthy Food and Drink

Environments Policy Principles. URL: www.health.govt.nz/our-work/preventative-health-

wellness/nutrition/national-district-health-boards-and-ministry-health-healthy-food-and-drink-environments-

policy (accessed on 17 March 2016).

Heart Foundation NZ. 2015. Guidelines for Providing Healthier Cafeteria Food. URL:

www.heartfoundation.org.nz/uploads/HF_MenuGuidelines_2015_FINAL.pdf (accessed on 17 March 2016).

New Zealand Beverage Guidance Panel. 2014. New Zealand Drink Guidance Panel Policy Brief: Options to

Reduce Sugar Sweetened Drink (SSB) Consumption in New Zealand. URL:

www.fizz.org.nz/sites/fizz.org.nz/files/A4%20Policy%20Update%20Office%20print.pdf (accessed on 17

March 2016).

Dunford, E., Cobcroft, M., Thomas, M., & Wu, J.H. 2015. Technical Report: Alignment of NSW Healthy

Food Provision Policy with the Health Star Rating System. Sydney, NSW: NSW Ministry of Health. URL:

www.health.nsw.gov.au/heal/Pages/health-star-rating-system.aspx (accessed on 17 March 2016).

Ministry for Primary Industries. 2014. Health Star Rating. URL:

www.foodsafety.govt.nz/industry/general/labelling-composition/health-star-rating/ (accessed on 17 March

2016).

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http://www.health.govt.nz/your-health/healthy-living/food-and-physical-activity/guidance-nutrition-and-physical-activity-workplaces/guidance-supporting-breastfeeding-mothers-returning-work

http://www.health.govt.nz/your-health/healthy-living/food-and-physical-activity/guidance-nutrition-and-physical-activity-workplaces/guidance-supporting-breastfeeding-mothers-returning-work

http://www.fizz.org.nz/sites/fizz.org.nz/files/A4%20Policy%20Update%20Office%20print.pdf


http://www.foodsafety.govt.nz/industry/general/labelling-composition/health-star-rating/


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Appendix 1: Process

Following regular teleconferences, a face-to-face meeting, and review of national and international Healthy

Food policies, overarching Healthy Food and Drink Policy Principles were agreed in December 2015.

The Auckland region DHBs nutrient criteria were used as the initial basis for the development of more detailed

nutrient criteria. A sub-group of the Network developed draft nutrient criteria for the national policy following

a face-to-face workshop and regular teleconferences. This resulted in a draft policy which included both the

principles and the detailed criteria which was further refined through input from the Network. Subsequently a

revised draft policy was circulated more broadly for input, particularly in relation to issues to consider for

implementation, before being finalised into this Policy.

The Policy has been informed primarily by the following documents:

Eating and Activity Guidelines for New Zealand Adults (Ministry of Health, 2015b) – the Principles are

based on these; recommendations for healthy eating for children and young people were also

considered.

Health Star Rating (HSR) for packaged goods – using 3.5 stars as an indicator of a healthier food

based on a New South Wales Ministry of Health study (Dunford et al, 2015)

Heart Foundation NZ’s Healthier Cafeteria Guidelines (Heart Foundation NZ, 2015) and checklist.

World Health Organization’s Guideline: Sugars intake for adults and children (2015)

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Appendix 2: Network members and representatives of agencies

supporting the development of the National Policy

District Health Board and Ministry of Health Network Members

Auckland DHB Julie Carter (Dietitian) – Community Liaison Dietitian

Auckland Regional Public Health Service Jacqui Yip (Dietitian) - Public Health Dietitian

Canterbury DHB Holly Hearsey - Team Leader, Communities Team

Canterbury DHB Janne Pasco – Community Nutrition Advisor

Canterbury DHB Kerry Marshall – Manager, Communities Team

Canterbury DHB Nicky Moore (Dietitian) – Service Manager, Food and Beverages

Counties Manukau Health Doone Winnard (Public Health Physician)

Counties Manukau Health Stella Welsh (Dietitian) – Manager, Food Service

Hauora Tairawhiti DHB Nicki Mathieson (Dietitian) – Nutrition and Physical Activity Advisor

Hawkes Bay DHB Deborah Chettleburgh (Dietitian) – Nutrition and Food Service

Hawkes Bay DHB Kim Williams – Population Health Advisor

Hawkes Bay DHB Tracy Ashworth - Population Health Advisor

Mid Central Health Nigel Fitzpatrick – Health Promotion Advisor

Ministry of Health Anna Jackson (Dietitian) – Advisor, Nutrition

Ministry of Health Harriette Carr (Public Health Physician) – Principal Advisor, Public Health

Ministry of Health Louise McIntyre (Dietitian) – Senior Advisor, Nutrition

Nelson-Marlborough DHB Rob Beaglehole (Dentist) – Principal Dental Officer

Northland DHB Edith Bennett (Dietitian) – Public Health Nutrition and Physical Activity Advisor r

Regional Public Health Jane Wyllie (Dietitian)

Regional Public Health Vicki Robinson (Dietitian) – Public Health Dietitian

South Canterbury Syd Horgan – Healthy Lifestyle Manager

Southern DHB Janice Burton, Professional Leader, Health Promotion

Taranaki DHB Jill Nicholls (Dietitian) – Health Promoter

Toi Te Ora - Public Health Service Mel Arnold (MPH, Reg. Nutritionist) - Health Improvement Advisor

Waikato DHB Wendy Dodunski (Dietitian) - Manager Nutrition and Food Services

Waitemata DHB Rebecca McLean (Dietitian) – Public Health Dietitian

Waitemata DHB Roslyn Norrie (Dietitian) – Foodservices Manager

West Coast DHB Claire Robertson - Team Leader, Community and Public Health

West Coast DHB Rosie McGrath - Health Promoter, Community and Public Health

Whanganui DHB Marama Cameron – Health Promotion Manager

The following representatives and organisations also provided valuable support

Agencies for Nutrition Action Annaleise Goble (Reg. Nutritionist) – National Project Manager

Heart Foundation Andrea Bidois (Reg. Nutritionist) – Manager, Food Services and Hospitality

Ministry for Primary Industries Michelle Gibbs – Senior Adviser, Food Science

University of Auckland Cliona Ni Mhurchu (PhD) - Professor

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9.4 Waitemata District Health Board and the Auckland Regional Tissue Bank

Recommendation:

That the Board:

a) Note the progress of the Waitemata District Health Board (DHB) Breast Cancer Tissue Bank.

b) Note that a memorandum of understanding between Waitemata District Health Board and the University of Auckland or the Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank will be brought back to the Board.

Prepared by: Dr Paul Muir (Medical Administration Registrar to CMO), Dr Karen Bartholomew (Public Health Physician), Dr Helen Wihongi (Research Advisor – Māori, Auckland and Waitemata DHBs), Dr Matt Rogers (Clinical Director – WDHB Laboratories), Dr Reena Ramsaroop (Clinical Director – WDHB Pathology), Phill Shepherd (Manager – Auckland Regional Tissue Bank), Lee-Ann Weiss (Operations Manager – WDHB Laboratory) & Amanda Mark (Legal Adviser – WDHB) Endorsed by: Dr Andrew Brant (Chief Medical Officer)

Glossary

AAHA - Auckland Academic Health Alliance – a formal collaborative arrangement between the University of Auckland and Auckland DHB relating to research, clinical delivery and teaching

ADHB - Auckland District Health Board ARTB - Auckland Regional Tissue Bank Biobank - A type of biorespiratory that stores biological samples for use in research. It also

includes health data relating to an individual stored in a data warehouse. Further information is located in the Appendix.

FMHS - Faculty of Medicine and Health Science, University of Auckland. GAB - Governance Advisory Board (of Auckland Regional Tissue Bank) HRC - Health Research Council SAB - Scientific Advisory Board (of Auckland Regional Tissue Bank) Tissue Bank - A subset of a biobank usually referring to tumour tissue. ToR - Terms of reference WDHB - Waitemata District Health Board WDHB TOG - The Waitemata DHB Tissue Banking Operations Group that provides local level

governance relating to tissue collections

1. Executive Summary

In December 2014 the Board approved the establishment of a Breast Cancer Tissue Bank located at North Shore Hospital with a request to return to Board on progress. The Breast Cancer Tissue Bank has now been established, blessed and received very positive feedback from consumers.

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There is a governance structure in place with the Auckland Regional Tissue Bank (ARTB) which includes a Governance Advisory Board, Scientific Advisory Board, Core Management Group and local Waitemata DHB Tissue Banking Group. The Breast Cancer Tissue Bank is now sitting as a collection under the Auckland Regional Tissue Bank (ARTB), and Waitemata District Health Board (DHB) as an operational site (in a hub and spoke model) under the ARTB. The advisory boards and management groups now meet on a regular basis and all include strong representation of Waitemata DHB and Māori.

Benefits of the ARTB include better protection and integrity of tissue samples and greater transparency of approval processes for establishment of new collections. The ARTB has been recognised nationally as a best practice model by the Health and Disability Ethics Committee and through its commitment to consumers and Māori at all levels, informed by the Te Mata Ira framework and local DHB and mana whenua involvement.

A memorandum of understanding between Waitemata District Health Board and the University of Auckland or Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank will be brought back to the Board.

2. Introduction/Background

In 2014, two papers were presented to the Board for a proposal to establish a Biobank1 at Waitemata DHB. The first paper presented in April 2014 provided a background to Biobanking including issues for Māori, ethical issues, financial implication and sustainability. This was followed by a workshop session with Board members for further discussion. The second paper presented in December 2014 provided further information to specifically establish a Breast Cancer Tissue Bank located at North Shore Hospital. The Breast Cancer Tissue Bank was approved by the Board at this meeting, with a request to return to the Board with progress on the move to establishment of the collection under an umbrella regional tissue bank including any changes made as a result. Specific recommendations relating to the development of the overarching regional framework from the Board paper of December 2014 are outlined below:

1. That the Waitemata DHB Breast Cancer Tissue Bank be approved (in the same way that other biobank proposals within the region have been) under the current institutional and ethical approvals, on the condition that when the overarching framework (of the Auckland Regional Tissue Bank) is finalised the Waitemata DHB Breast Cancer Tissue Bank agree to make any necessary changes (to align with the agreed regional framework)

2. That mana whenua and the Auckland Academic Health Alliance continue to develop the overarching policy framework for the Auckland Regional Tissue Bank.

3. That development of the framework includes consumer perspectives.

4. That the framework includes governance structures (with mana whenua and consumer representation), scientific advice, community involvement, data access and laboratory processes.

1 A biobank refers to a collection of sample and health information available for future research.

Comparatively, a tissue bank is a subset of a biobank usually referring to tumour tissue. A flow diagram with further information is included in Appendix 1.

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5. That the framework also includes explicit decision points (clear policy statements) on a range of issues of interest to the DHB, Māori and consumers (for example return of results, incidental findings, and the ability to be recontacted).

6. That development of the framework includes consultation with consumers, clinicians, researchers, laboratory staff, DHB management and relevant people at the Ministry of Health or other government departments.

7. That the resulting agreed framework is brought to the Waitemata and Auckland DHB Boards to inform progress.

Progress of the Waitemata DHB Breast Cancer Tissue Bank

The regional approach was progressed, and when established the Breast Cancer Tissue Bank at Waitemata DHB became the second biobank in the Auckland region to come under the auspices of the Auckland Regional Tissue Bank (ARTB). At the time of establishment the Breast Cancer Tissue Bank retained its current institutional and ethical approvals. Following Board approval and karakia, the breast cancer tissue bank at WDHB accepted the first patient’s samples on 18 June 2015. The protocol is now well-established and is proceeding. As of 17 June 2016, 130 patients with newly diagnosed invasive breast cancer have samples stored at North Shore Hospital. The samples total 1438 vials. All standard processing protocols for the tissue banking are followed. No retrieval of tissue has been approved until the memorandum of understanding between Waitemata DHB and the ARTB has been finalised. Feedback from the patients is very positive and I quote from one of the breast care nurses: “We, as CNS – Breast Cancer, are very pleased to play a role in gaining consent to obtain breast cancer tumour samples for Auckland Regional Tissue Bank. In fact, patients are only too pleased to do so as they feel they have contributed in one small way to finding a reason why they have this dreaded diagnosis.”

Progress of Auckland Regional Tissue Bank Governance Structure

Since December 2014 the ARTB has consolidated and formalised its regional governance and accountability framework and conducted a range of improvements for biobanking in the Auckland region. These include the following:

Establishment of a Governance Advisory Board, Scientific Advisory Board, Core Management Group and individual DHB Tissue Banking Operations groups to provide strong governance at a regional and local level (Appendix 1).

The governance structure includes representation of both mana whenua and healthcare consumers.

Terms of Reference for the Governance Advisory Board and Scientific Advisory Board have been formulated and are available for the Board (Appendix 2).

A Vision and Goals statement which includes strategic direction for the Auckland Regional Tissue Bank.

The setting of Key Performance Indicators for the Auckland Regional Tissue Bank (Appendix 3).

The preparation and use of a new detailed Participant Information Sheet and Consent Form (including multi-lingual components) specifically for healthcare consumers who wish to

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donate to the Auckland Regional Tissue Bank. This will standardise consent processes across the region which is a significant step forward and as an approach this is endorsed by the Health and Disability Ethics Committee.

Better protection and integrity of samples through a significantly improved electronic database administered by the ARTB for tracking and coding. This approach is supported by prominent Māori academics as critical to the necessity to accurately track and protecting Māori tissue in a hub-and-spoke model.

Greater transparency of approval processes for establishment of new tissue collections. ARTB provides transparent policies and procedures that establish high quality collections for research, robust protections for consumers and Māori and strong oversight and management of data access. Work is continuing on development of standard operating procedures for some aspects of the ARTB.

A website is under development that will be freely accessible to the public and provide consumer information and advice on the Auckland Regional Tissue Bank.

3. Alignment to Auckland Regional Tissue Bank Governance structures

Waitemata DHB is now an Operational Site under the ARTB umbrella. The Waitemata DHB Breast Cancer Tissue Bank approved by the Board in December 2014 is now a collection under the ARTB, held at Waitemata DHB as the local Operational Site. As noted above Waitemata DHB and Māori are well represented at all structural levels of the ARTB with well-established local Operational Site governance. This provides confidence in the robustness of the biobank including future sustainability.

There are several tissue bank streams currently stored at the Waitemata DHB laboratory which have

locality authorisation and relevant ethical approvals. These and future tissue bank streams approved

through ARTB governance will move under the ARTB governance framework.

Waitemata DHB would need to enter into a memorandum of understanding setting out the foundation for our participation in the regional tissue bank. At this stage it appears likely that the memorandum of understanding would be with either the University of Auckland or with the Auckland Academic Health Alliance in which the University and Auckland DHB are partners. The memorandum of understanding will be provided to the Board for approval before it is signed.

4. Broader context

The broader national and international context of biobanking has also progressed since December 2014. The former National Health Committee (now a unit in the Ministry of Health called the Strategic Technology Prioritisation and Innovation team) is leading the International Policy Working Group on genomics and related technologies, and a national consultation process (including broad general public consultation).2 This work involves a national stocktake of biobanks with a view to standardisation and best practice, as represented by the ARTB processes.

The National Health Committee, and the ARTB establishment, has been informed by the large three year project on Māori views on biobanking, Te Mata Ira. This project was led by Maui Hudson who presented to the Board with the December 2014 paper. Te Mata Ira has produced a framework for

2 Link: http://www.health.govt.nz/publication/introduction-fit-purpose-omics-based-technologies-think-piece

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http://www.health.govt.nz/publication/introduction-fit-purpose-omics-based-technologies-think-piece


biobanking similar to the Te Ara Tika health research framework for Māori which has been very well received by clinicians, researchers and the Health and Disability Ethics Committee. The Te Mata Ira Project included an extensive series of hui across the country seeking consumer and Māori views on biobanking.

The Health and Disability Ethics Committee also endorse the ARTB processes, particularly the commitment to high quality informed consent processes, strong governance and data access arrangements and recognition of Māori views.

5. Conclusion

The continuing collaborative work between the Auckland Academic Health Alliance, mana whenua, local clinicians and researchers during 2015 has resulted in a robust and high quality framework of governance structures and processes for tissue banking in the metropolitan Auckland region. The approach is recognised as best practice nationally, and recognised for promoting transparency and setting high standards of involvement and protections for Māori and consumers. There are appropriate regional and local governance structures which include Māori, consumer and Waitemata DHB representation. Additional benefits from the ARTB approach include resource for improved tracking and coding of samples. The recommended approach is to further strengthen the Waitemata DHB position through a formal memorandum of understanding with the University of Auckland or Auckland Academic Health Alliance in relation to the Auckland Regional Tissue Bank which will be brought back to the Board.

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Appendix

Appendix 1: Auckland Regional Tissue Bank Governance Structure and Schematic

ADHB Tissue Banking

Operations Group

Clinical Lab Manager *Pathologist 1 Pathologist 2

Surgeon 1 Surgeon 2

Haematologist Med Lab Scientist 1 Med Lab Scientist 2

Senior Nurse 1 Senior Nurse 2

ARTB Technician Research Advisor - Maori

Governance Advisory Board

Dean FMHS

Chief Advisor Tikanga (ADHB) CMDHB Chief Medical Officer ADHB Chief Medical Officer WDHB Chief Medical Officer

Tissue Banking Expert Consumer/Lay Representatives Mana Whenua Representative

Ethics Expert

Ex Officio Clinical Director ARTB

ARTB Manager

Strategic Engagement manager

Group Services Manager (SMS)

Scientific Advisory Board

Senior Clinician/scientist (Chair)

FMHS Tumuaki Mana Whenua Representative

Maori Ethics Expert ADHB Representative*

CMDHB Representative* WDHB Representative*

Research Advisor - Maori Lay Representative

UOA Scientist 1 UOA Scientist 2 UOA Scientist 3

DHB Clinician/Scientist Ethics Expert

WDHB Awhina representative

Ex Officio

Clinical Director ARTB ARTB Manager

Strategic Engagement Manager

CMDHB Tissue Banking

Operations Group

Clinical Lab Manager *Pathologist 1 Pathologist 2

Surgeon 1 Surgeon 2

Haematologist Med Lab Scientist 1 Med Lab Scientist 2

Senior Nurse 1 Senior Nurse 2

ARTB Technician Research Advisor - Maori

Core Management Group

Clinical Director –ARTB

Strategic Engagement Manager - AAHA Group Services Manager (SMS)

Chair of the SAB ARTB Manager

WDHB Tissue Banking

Operations Group*

Regional Tissue Bank Manager

Pathology/Laboratory staff

including:

Clinical director – laboratories Clinical Director - Pathology Operations Manager – Lab

Special Assays Scientist – Lab

Awhina Staff including: Research and Innovation

Manager All lead research nurses

All lead research clinicians

Research Advisor – Maori

*(As defined by WDHB TOG ToR)

Dean (FMHS)

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The Auckland Regional Tissue Bank (ARTB) now has a robust governance structure comprising of a Governance Advisory Board (GAB), Scientific Advisory Board (SAB), Core Management Group (CMG) and individual Auckland DHBs Tissue Banking Operations Groups (TOG). Mana whenua and Waitemata DHB have representation on both the GAB and SAB.

Governance Advisory Board (GAB)

The Governance Advisory Board has overall guidance, fiscal and guardianship responsibilities. The Governance Advisory Board (GAB) membership comprises the following:

Dean – Faculty of Medicine and Health Sciences, University of Auckland

Chief Advisor tikanga (ADHB & WDHB)

CMDHB Chief Medical Officer (or representative)

ADHB Chief Medical Officer (or representative)

WDHB Chief Medical Officer (or representative)

Tissue Banking Expert

Consumer/Lay Representative

Mana T Whenua Representative

Ex-officio

Clinical Director ARTB

ARTB Manager


Scientific Advisory Committee (SAB)

The Scientific Advisory Board (SAB) provides the Auckland Regional Tissue Bank (ARTB) with scientific leadership, strategic advice and review of applications for biospecimen use.

The Scientific Advisory Board is responsible for the following:

Assess whether scientifically valid, appropriate and useful research is being proposed by researchers through a standardised application process.

Review all applications for tissue use within the Auckland Regional Tissue Bank.

Direct the Auckland Regional Tissue Bank in the procurement of relevant tissue streams to ensure the greatest benefit to all stakeholders.

Provide the GAB with recommendations on biospecimen collection scope, future expansion and collaboration with research groups and other tissue banks both nationally and internationally including horizon scanning for new technologies that may impact on the ARTB.

The SAB membership comprises the following:

Chair (a senior clinician or medically trained scientist)

Three Maori representatives (A tikanga advisor, the FMHS Tumuaki, and an external representative with broad knowledge of tissue banking and related issues)

Health research academia (4 scientists)

Clinical representatives reflecting the biospecimen collection (1 from each DHB)

Lay representation (suitably informed person)

WDHB Awhina Representative

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Ex-officio

Clinical director - ARTB

ARTB Manager


Chief Advisor tikanga

Core Management Group (CMG)

The Core Management Group leads and ensures the implementation and execution of advice from both the Governance Advisory Board and Scientific Advisory Board. The Core Management Group is also responsible for the following:

Ensure that both the GAB and SAB are updated at regular intervals that all components of the tissue bank are operating as directed.

The Core Management group is comprised of the following:

Director- ARTB


Group Services Manager (SMS)

Chair of the SAB

ARTB Manager

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Appendix 2: Terms of Reference for ARTB Governance Advisory Board (GAB) and ARTB Scientific Advisory Board (SAB)

AUCKLAND REGIONAL TISSUE BANK ADVISORY BOARD

Terms of Reference

Purpose

The Auckland Regional Tissue Bank will be led by the Core Management Group, comprising the

Tissue Bank Clinical Director and other key stakeholders, who will advise the Manager of the Bank in

the overall direction of the facility and its regional tissue banking activities. The Core Management

Group will be supported by the Advisory Board that will provide oversight, guidance and strategic

advice.

Advisory Board

The Board will advise and monitor the activities of the Auckland Regional Tissue Bank in accordance

with the University of Auckland policy on Units, Centres and Institutes and tikanga o Mana whenua,

thereby assisting the Management Group in ensuring the tissue banking activities are of the highest

standard, and meet the expectations of the funders and relevant stakeholders. Given the regional

focus of the Auckland Tissue Bank it will have representation from mana whenua, the contributing

institutions, and the community.

Terms of Reference

Provide strategic and business advice to the Tissue Bank Management Group;

Provide oversight of the ethical conduct of the Tissue Bank in accordance with the requirements; of the National Ethics Committee approvals, institutional practices and community expectations;

Oversight of cultural practices and partnership including maintaining the partnership with Mana Whenua;

Review and approve plans, reports and budgets;

Assist in raising the profile and reputation of the Regional Tissue bank and its activities;

Assist in developing community engagement;

Ensure funding decisions follow transparent processes and align with the purpose, vision and objectives of the Tissue Bank;

Resolve disputes not able to be resolved by the Management Group, as required;

Report annually to the Dean and all Partner Institutions regarding the performance of the Tissue Bank, making recommendations for change as required.

Board membership

The Advisory Board membership will reflect the following stakeholders:

Mana Whenua

University of Auckland

District Health Boards

Charitable Funding Sponsors

Community

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Other Maori , Pacific

External academic

Ethical/legal

The Chair and Vice Chair will be appointed by the Dean of the Faculty of Medical and Health

Sciences. Representation of mana whenua shall be that of a suitably informed representative, with

broad knowledge of tissue banking and related issues.

Operating Guidelines for the Advisory Board

Quorum Business will only be conducted if the meeting is quorate. The Advisory Board will be quorate with

one half of the voting members, including representation from mana whenua and the Chair or Vice

Chair, being present.

Attendance by Members The Chair of the Advisory Board will use his/her best endeavours to attend 100% of the meetings. If the Chair is unable to attend then he/she will nominate an acting chair for that meeting. Other committee members should attend a minimum of 50% of all meeting. Attendance by Others Others may be invited to attend as necessary to present papers, but shall have no vote. Accountability and Reporting Arrangements

Members will be required to declare any interests they might have in any issues arising at the meeting that might conflict with the business of the Auckland Regional Tissue Bank.

The Governance Committee will review the minutes of the Scientific Advisory and Tissue Bank Management Committees.

Frequency

Meetings will be held quarterly.

Additional meetings may be arranged when required to support the effective functioning of the Tissue Bank.

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AUCKLAND REGIONAL TISSUE BANK SCIENTIFIC ADVISORY BOARD

Terms of Reference

Governance and Purpose

The Scientific Advisory Board (SAB) has been established to provide the Auckland Regional Tissue

Bank (ARTB) with scientific leadership, strategic advice and review of applications for biospecimen

use. It will ensure incorporation tikanga Māori in acknowledgement of the Treaty of Waitangi and

will ensure that the tissue banking activities are of the highest standard, and meet the expectations

of the funders and relevant stakeholders. It will lead development of tissue banking practice and will

have an ultimate focus on long term benefit to patients. Given the regional focus of the ARTB it will

have representation from mana whenua, the contributing institutions, and the community, with

strong clinical/scientific input from academia. It will report to the Governance Advisor Board (GAB)

and will support the Core Management Group (CMG) and Tissue Bank Manager.

Terms of Reference

Application Review: The SAB will review applications for biospecimen use, making decisions

about the release of specimens for research based on research project ethical approval

status, governance issues, scientific and strategic value. The SAB will also advise researchers

about preparation and revision of applications for biospecimen use.

Ethical Conduct: (i) As part of their review of research applications for biospecimen use, the

SAB will ensure that biospecimens released will not be vulnerable to unethical use and will

be used in accordance with the requirements of Ethics Committee approval and ARTB

policies. (ii) As part of their Strategic Leadership, the SAB will regularly review ARTB ethical

approvals to ensure they remain in step with evolving ethical understanding, research and

clinical activity, as well as informing and protecting patients and communities.

Legal and Financial: The SAB will observe the legal processes established by the GAB to

ensure appropriate custodianship of biospecimens. Members will be required to register

any potential conflicts of interests related to ARTB business. The SAB will consider financial

implications when approving applications and making recommendations to the GAB

regarding changes to the biospecimen collection. The SAB will observe policies and

procedures established by the GAB that ensure security and access to the biospecimens held

by the ARTB.

Operational Processes: The SAB will be responsible for the development and regular revision of processes for effective and efficient collection of scientifically relevant tissue.

Resources and budget to operate the SAB will be the responsibility of the CMG.

Strategic Leadership: The ARTB is expected to lead development of future tissue banking practices including incorporation of tikanga Māori, emerging ethical protocols appropriate for the changing research environment. The SAB will provide recommendations to the GAB on biospecimen collection scope, future expansion and collaboration with research groups and other tissue banks both nationally and internationally, including horizon scanning for new technologies and initiatives that may impact on the ARTB.

The minutes of the SAB meeting will be formally recorded and available to the GAB.

The planning of the meetings is the responsibility of the Chair who, together with the CMG,

will establish a schedule of meetings each year.

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The SAB may from time to time need to obtain independent advice and/or to co-opt outsiders with relevant experience to its meetings. Any costs associated with this will be approved by the CMG.

The SAB will produce an annual report to the GAB which sets out how the SAB has met its

Terms of Reference during the preceding year.

The SAB will review its Terms of Reference and work programme on an annual basis.

Treaty of Waitangi and Partnership: In acknowledgement of the Treaty of Waitangi the

Tissue Bank will incorporate tikanga Māori and seek appropriate clinical and cultural input to

ensure the ‘value and suitability’ of its tissue collections and the research they support, for

the ultimate benefit of all New Zealanders.

Board membership

The SAB membership will reflect the following stakeholders:

Chair (a senior clinician or medically trained scientist)

Three Māori representatives (A tikanga advisor, the FMHS Tumuaki, and an external

representative with broad knowledge of tissue banking and related issues)

Health research academia (4 scientists)

Clinical representatives reflecting the biospecimen collection (1 from each DHB)

Lay representation (suitably informed person)

Ex-officio:

Clinical Director

Tissue Bank Manager


Operating Guidelines

Accountability and Reporting Arrangements: Members will be required to declare any interests they might have in any issues arising at the meeting that might conflict with the business of the Auckland Regional Tissue Bank. The Governance Board will review the minutes of the Scientific Advisory Board meetings.

Attendance by Members: The Chair of the Advisory Board will use his/her best endeavours

to attend 100% of the meetings. If the Chair is unable to attend then he/she will nominate

an acting chair for that meeting. Other Board members should attend a minimum of 50% of

all meetings.

Frequency: Meetings will in general be held quarterly, preferably just prior to the GAB

meeting. Additional meetings will be arranged when required to support the effective

functioning of the Tissue Bank. Meetings may be either in person or by telephone or other

electronic means of communication.

Quorum: Business will only be conducted if the meeting is quorate. The Advisory Board will be quorate with one half of the members, including the Chair or nominated acting chair, being present.

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Appendix 3: Auckland Regional Tissue Bank Key Performance Indicators

Auckland Regional Tissue Bank Key Performance Indicators – first 12 months

The Auckland Regional Tissue Bank has established governance and advisory structures and operating processes that incorporate tikanga Māori and fully comply with New Zealand’s ethical and regulatory requirements. These will include a Governance Advisory Board, Operations Committee and a Scientific Advisory Committee.

HDEC ethical approvals, locality approvals and agreements with institutions to provide space, staff and other resources will be in place.

Four targeted tissue collection initiatives will be underway, each of which will support specific research projects within the Auckland Academic Health Alliance while being equally balanced with tikanga Māori and the principles of the Treaty of Waitangi. These projects will be high profile projects and be likely to achieve high impact research outputs.

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Appendix 4: Schematic overview of a generic biobank

Figure 1. Schematic overview of a generic biobank

Table 1. Examples of New Zealand biobanks

Research biobanks

Cancer society tissue bank in Christchurch

Middlemore tissue bank

Pancreatic cancer bank North Shore Hospital

Colorectal cancer tissue bank Dunedin

Cardiovascular sample bank Dunedin

Brain bank Auckland

Arthritis sample bank Dunedin

Glioblastoma and Wilms tumour banks Dunedin

NZORD (rare diseases) bank Dunedin

Melanoma tissue banks being established in several centres around New Zealand

Neuroendocrine Tumour (NET) collection Auckland and national

Transplant biobanks

Cord blood bank (private)

Fertility tissue banks (private and public)

Placenta bank Dunedin

Eye bank Auckland

Other

Guthrie card (newborn heel prick test) long term repository (National Screening Unit, Ministry of Health)

Banked samples from longitudinal studies samples (eg Christchurch and Dunedin studies, and Growing Up in New Zealand)

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