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BOARD MEETING Wednesday 12 April 2017 09.45am AGENDA Items to be considered in public meeting VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna 1

BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

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Page 1: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

BOARD MEETING

Wednesday 12 April 2017

09.45am

AGENDA

Items to be considered in public meeting

VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna

1

Page 2: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

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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Page 3: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

MEETING OF THE BOARD

12 April 2017

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

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

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

APOLOGIES: Brian Neeson

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

9.45am 1. AGENDA ORDER AND TIMING

2. BOARD MINUTES

9.50am 2.1 Confirmation of Minutes of the Meeting of the Board (01/03/17) Actions arising from previous meetings

2.2 Confirmation of Minutes of the Executive Committee of the Board (24/2/17)

2.3 Circulated Resolution 17.03.17 - Proposed Amendment to the Constitution of New Zealand Health Partnerships

3. EXECUTIVE REPORTS

9.55am

10.05am

10.20am

3.1 Chief Executive Officer’s Report

3.2 Health and Safety Report

3.3 Communications Report

4. PERFORMANCE REPORT

10.25am 4.1 Financial Performance

5. COMMITTEE REPORTS

10.35am

5.1 Minutes of the Hospital Advisory Committee (22/03/17) 5.2 Recommendation from Community and Public Health Advisory Committee Meeting

(29/03/17)

6. INFORMATION PAPERS

10.40am

11.00am

6.1 Health and Safety Marker Report

6.2 North Shore Hospital site visit (no paper)

7. RESOLUTION TO EXCLUDE THE PUBLIC

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Page 4: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Waitemata District Health Board

Board Member Attendance Schedule 2017

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

NAME Mar Apr May Jul Aug Sep Nov Dec

Dr Lester Levy (Chair)

Max Abbott

Edward Benson Cooper

Kylie Clegg

Sandra Coney

Warren Flaunty

James Le Fevre

Matire Harwood

Brian Neeson

Morris Pita

Allison Roe

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Page 5: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 01/03/17

REGISTER OF INTERESTS

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy - Board Chairman

Chairman – Auckland District Health Board Chairman – Counties Manukau District Health Board Chairman – Regional Governance Group, northern region DHBs Chairman – Auckland Transport Chairman – Health Research Council Independent Chairman – Tonkin + Taylor Professor of Leadership – University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework

01/03/17

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

19/03/14

Edward Benson-Cooper Chiropractor – Milford, Auckland (with private practice commitments) 07/12/16

Kylie Clegg Board Member - Hockey New Zealand Trustee and Chair - 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 and a shareholding in Nextminute Holdings Ltd) Trustee and Beneficiary - M&K Investments Trust (owns 99% share in MC Capital Ltd and MC Securities Ltd and a minority shareholding in HSCP1 Ltd)

06/12/16

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

15/12/16

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

06/12/16

Dr Matire Harwood Senior Lecturer – Auckland University Board Director – Health Research Council Director – Ngarongoa Limited, which is contractor providing services to National Hauora Coalition. GP at Papakura Marae Health Clinic Advisory Committee Member – State Foundation NZ (Maori Health) Member Te Ora, Maori Medical Practitioners

09/12/16

James Le Fevre Deputy Chair – Auckland District Health Board Emergency Physician – Auckland Adults Emergency Department Pre-hospital Physician – Auckland HEMS – ARHT/Auckland DHB Trustee – Three Harbours Foundation Member – Association of Salaried Medical Specialists Member – Medical Protection Society Shareholder – Pacific Edge Ltd DHB Representative (Auckland and Waitemata DHBs) – Air Ambulance Codesign Procurement Governance Board. James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society

01/03/17

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Waitemata District Health Board, Meeting of the Board 01/03/17

Board/Committee Member

Involvements with other organisations

Last Updated

Brian Neeson Member – Upper Harbour Local Board Member – Human Rights Review Tribunal Member – Auckland District Licensing Committee Managing Director – BK & VS Neeson Limited Managing Director – Apollo Property Investments Limited Property Development Consultant

15/12/16

Morris Pita Owner/operator – Shea Pita and Associates Limited Shareholder – Turuki Pharmacy Limited Member - Eden Park Trust Board Morris’ wife is member of the Northland District Health Board Shareholder and Director of Healthcare Applications Limited

06/12/16

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

02/11/16

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Page 7: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

2.1 Confirmation of Minutes of the Board meeting held on 01 March 2017 Recommendation: That the Minutes of the Board meeting held on 01 March 2017 be approved.

2.1

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Page 8: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Minutes of the meeting of the Waitemata District Health Board

Wednesday 01 March 2017

held at Waitemata DHB, Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 9.53am

PART I – Items considered in public meeting

BOARD MEMBERS PRESENT:

Lester Levy (Board chair) Max Abbott Edward Benson-Cooper Kylie Clegg (Deputy Board chair) Sandra Coney James Le Fevre Warren Flaunty Matire Harwood Brian Neeson Morris Pita Allison Roe

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Andrew Brant (Chief Medical Officer) Jocelyn Peach (Director of Nursing and Midwifery, Emergency Systems Planner) Debbie Holdsworth (Director Funding) Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Fiona McCarthy (Director Human Resources) Matthew Rogers (Director Communications Roger Perkins (Executive Head, Chief Executive’s Office) Karen Bartholomew (Acting Director Health Outcomes) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

APOLOGIES:

There were no apologies received.

WELCOME

The Board Chair welcomed the Board members and all those present at the meeting.

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Waitemata District Health Board, Meeting of the Board 12/04/17

DISCLOSURE OF INTERESTS

The Board Chair advised that the New Zealand Leadership Institute could now be removed and that with regard to his registered interest ‘Lead Reviewer - State Services Commission, Performance Improvement Framework,’ reference to the review of MBIE can be removed. James Le Fevre advised that he was no longer a co-opted member of the Whanganui DHB Hospital Advisory Committee. He also advised tha the was now on the DHB Representative (Auckland and Waitemata DHBs) – Air Ambulance Codesign Procurement Governance Board. There were no declarations of interest relating to the open section of the agenda.

1 AGENDA ORDER AND TIMING

Items were taken in same order as listed in the agenda except that item 6.1 was considered after item 6.4. It was noted that the Board meeting would adjourn for morning tea between 10.30am and 11am and adjourn from 11.45am to 1.15pm. The Board Chair introduced Roger Perkins, Executive Head for the Waitemata DHB Chief Executive’s Office (0.5FTE) and for the Office of the Board Chair across the three metro-Auckland DHBs. The Chief Executive summarised the upcoming visit, along with the Board Chair and Chief Medical Officer, to China. Waitemata DHB has previously hosted three Chinese delegation visits, all of whom have requested reciprocal visits.

2 BOARD MINUTES

2.1 Minutes of the Meeting of the Board – 14/12/16 (agenda pages 7-18)

Resolution (Moved James Le Fevre /Seconded Matire Harwood) That the Minutes of the Board meeting held on 14 December 2016 be approved. Carried Actions arising from previous meetings (agenda pages 19)

There are no current actions.

2.2 Confirmation of Minutes of the Executive Committee of the Board - 14/2/17 (agenda pages

20-22) Resolution (Moved Max Abbott/Seconded Kylie Clegg) That the Minutes of the Executive Committee of the Board meeting held on 14 February 2017 be approved. Carried

2.1

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Page 10: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

3 EXECUTIVE REPORTS

3.1 Chief Executive’s Report (agenda pages 23-68)

The Chief Executive introduced and summarised the report. Additional matters highlighted and covered in discussion included:

That the DHB hosted the Minister of Health at the ‘Living with Diabetes Awards’ held on 22nd February 2017. New Zealand’s longest living person was presented with an award, with a further 20 awards given to people who had lived with diabetes for over 50 years.

Acknowledging Dr Jocelyn Peach for the work undertaken for the Health and Disability Service Standards certification audit of the Minister of Health. It was noted that the number of corrective actions was the lowest received to-date. The Board Chair also warmly acknowledged Dr Jocelyn Peach, noting her values, dedication and commitment to the organisation.

Noting that the Tanekaha Business Case (Mason Clinic) was presented before the Capital Investment Committee on 27th February 2017.

That in response to a question about the Leapfrog programme and engagement with external corporations around New Zealand, it was noted that that this does occur. Examples include interaction with Air New Zealand around the patient entertainment system and links with Vodafone. The precision medicine work also involves a number of external companies. In addition, in the engineering arena (robotics), an engineering fellow has commenced work at the DHB looking at system design processes and providing a different lens to progress.

The report was received. 3.2 Health and Safety Performance Report (agenda a pages 69-162)

Fiona McCarthy (Director of Human Resources) and Michael Field (General Manager, Occupational Health and Safety) were present for this item. Matters highlighted and response to questions included:

That with regard to section 7 of the report ‘Top Incident types that cause harm,’ it was noted that the further information is being provided regarding aggression incidents. In response to a question about the increased number of assault incidents reported, it was noted that specific work had been undertaken in this area. The level of focus has resulted in more accurate reporting; it is not believed that there is a higher level of actual incidents, but rather a culture change in the reporting incidents (including the area of verbal abuse).

That the development of the self-audit tool has been completed with implementation in April 2017. The tool will provide complete transparency of performance levels across the organisation. The audit tool is to be completed on an annual basis; re-audits can be undertaken after six months if areas of concern are identified. In response to a question, it was noted that the bow-tie tool had been considered and that an update would be provided to the Board on this tool.

That in response to a question about the need for contractors to report major incidents, it was noted that the Facilities Department now has a dedicated health and safety role appointed and that this will be an area they will address.

2.1

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Waitemata District Health Board, Meeting of the Board 12/04/17

Matire Harwood acknowledged the recent health and safety board member visit which had a focus on hazardous substances and new organisms. The report was received.

The meeting adjourned from 10.40am to 11.07am.

3.3 Communications Report (agenda pages 163-170)

Matthew Rogers (Director of Communications) introduced and summarised this item. He noted that over half of the requests under the Official Information Act were around mental health. Mr Rogers also noted that data on state sector performance showed that Waitemata DHB is ranked second of all DHBs nationally for Official Information Act requests received and responded to on time. The Board Chair acknowledged Mr Rogers on his commitment to the organisation. The report was received.

4 PERFORMANCE REPORTS

4.1 Financial Performance (agenda pages 171-186)

Robert Paine (Chief Financial Officer and Head of Corporate Services) summarised this item. In response to a question Robert Paine noted that there is a regional capital planning process to bring the regions capital requirements together and where possible find common ground to reduce overall costs. He further noted that the team is cognisant of any costs that go into capital planning. It was noted that under section 3.2 ‘Mental Health Services’ the figure reported should be $264k favourable for the six months ended 31 December 2016. Resolution (Moved James Le Fevre/Seconded Warren Flaunty)

That the Board:

a) Note the content of this report, with particular reference to the relative financial results in the Provider and Funder divisions and the plans to improve financial performance.

b) Receive the following reports:

1 Executive Summary and key themes 2 Financial Overview of the 2016/17 result 3 Financial Performance - DHB Arms 4 Financial Performance - Other Indicators / Trends 5 Capital Expenditure 6 Financial Position 7 Cash flow Position 8 Treasury

Carried

2.1

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Page 12: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

5 COMMITTEE REPORTS

5.1 Hospital Advisory Committee Meeting - 14/12/16 (agenda pages 187-193)

Resolution (Moved Edward Benson-Cooper/Seconded Max Abbott) That the draft minutes of the Health Advisory Committee meeting held on 14 December 2016 be received. Carried

5.1 Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Meeting - 23/11/16 (agenda pages 194-199)

Resolution (Moved Edward Benson-Cooper/Seconded Max Abbott) That the draft minutes of the Community and Public Health Advisory Committee meeting held on 23 November 2016 be received. Carried

6 INFORMATION PAPERS

6.1 Statement of Performance Expectation Reporting (agenda pages 200-206)

This item was considered after item 6.4. Wendy Bennett (Planning and Health Intelligence Manager) was present for this item. The report was received.

6.2 Health and Safety Marker Report - Update (agenda pages 207-220)

Fiona McCarthy (Director of Human Resources) presented this item. The Board Chair requested that the audit programme be shared with both Auckland DHB and Counties Manukau DHB. The report was noted.

6.3 Bowel Screening Pilot Final Evaluation Report (agenda pages 221-222)

Debbie Holdsworth (Director Funding) presented this item.

Matters highlighted and response to questions included:

Noting that the Waitemata DHB is assisting Wairarapa with its roll-out of the bowel screening programme.

That in response to a question about ensuring an equitable programme, it was noted that there has been a trial on offering community laboratory drop-off options. A copy of the publication which outlines the results of the trial will be forwarded to the Board. It was also noted that the rationale for community laboratory drop-offs as opposed to

2.1

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Waitemata District Health Board, Meeting of the Board 12/04/17

pharmacy drop-offs was that community laboratories have a process in place that connect to the testing laboratory.

A further update report will be provided to the Board at its meeting in May 2017. In response to a query about steps in place to reach national targets for Maori and Pacific women in both the cervical screening and breast screening programmes, Debbie Holdsworth noted that the information had been previously provided to the Board. The report was received.

6.4 Privacy Maturity Assessment Report (agenda pages 223-255)

This item was considered before item 6.1. Amanda Mark (General Counsel) presented this item. Resolution (Moved Matire Harwood/Seconded Kylie Clegg)

That the Board notes:

a) That the attached Privacy Maturity Assessment Report has been submitted to the Government Chief Privacy Officer.

b) The achievements against targets set for 2016/17. c) The targets which have been set for improving Waitemata DHB’s privacy maturity over

the next 12 months.

Carried

7 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 256-258)

It was noted that the decision regarding Board Committee membership will be brought into open meeting.

Resolution (Moved Warren Flaunty/Seconded James Le Fevre)

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 14/12/16

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.

2.1

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

2. Minutes of the Executive Committee of the Board with Public Excluded 14/02/17

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.

3. Minutes of the Hospital Advisory Committee with Public Excluded 14/12/16

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.

4. Minutes of the Audit & Finance Committee with Public Excluded 23/11/16

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)]

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)]

5. Waitemata DHB Committee Membership

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

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

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

6. Review of 2017/18 Annual Plan, Statement of Intent and Maori Health 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

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

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

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)]

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

7. Regional Intellectual Disability Services Service Procurement

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)]

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)]

8. Audit NZ Letter for Primary Health Organisations Audits

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)]

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. Update - Northern Region Long Term Investment 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 Information Act 1982.

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

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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Waitemata District Health Board, Meeting of the Board 12/04/17

RESOLUTION TRANSFERRED FROM THE CONFIDENTIAL AGENDA TO OPEN AGENDA The following item was considered as part of the confidential agenda (item 3.1) and the Board agreed that the following resolution be transferred to the open agenda.

Committee Membership

Resolution (Moved James Le Fevre/Seconded Matire Harwood) That the Board:

a) Approve changes to the terms of reference for Board committees to make it clear that any number of Board members may be appointed to a committee and that the number of externals who can be appointed (where a number is stated) is a ceiling not a fixed requirement.

b) Approve the appointment of chairs, deputy chairs and members of committees and groups, as set out in this paper.

c) Note that external appointees will be required in most areas.

d) Approve the areas of special interest for each Board member, as set out in this paper.

e) Approve the appointment of Anthony Norman as Independent Chair and Norman Wong as Independent Deputy Chair of the Audit and Finance Committee.

f) Approve Waitemata DHB Board representation on the Boards of Waitakere Health Link (Sandra Coney) and Health Link North (Edward Benson-Cooper and Allison Roe as alternate).

Carried

The Chair thanked those present. The open meeting concluded at 11.33am. SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 01 MARCH 2016 ________________________________CHAIR

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Waitemata District Health Board, Meeting of the Board 12/04/17

Actions Arising and Carried Forward from Previous Board Meetings as at 06 April 2017

Meeting Date

Agenda Ref

Topic Person Responsible

Expected Report back

Comment

01/03/17 3.2 Health and Safety Performance Report:

Provide comment to the Board on the bow-tie risk assessment tool

Fiona McCarthy

12/04/17 See item 3.2 Health and Safety Report.

01/03/17 6.2 Health and Safety Marker Report

That the audit programme be shared with both Auckland DHB and Counties Manukau DHBs.

Fiona McCarthy

Actioned.

01/03/17 6.3 Bowel Screening Pilot – Final Evaluation Report

That the publication outlining the results of the bowel screening pilot be forwarded to the Board.

That a further update report on the Bowel Screening Pilot be submitted to the Board in May 2017.

Debbie Holdsworth

24/05/17

Actioned.

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Waitemata District Health Board, Meeting of the Board 12/04/17

2.2 Confirmation of Minutes of the Executive Committee of the Board meeting held on 24 February 2017

Recommendation: That the Minutes of the Executive Committee of the Board meeting held on 24 February 2017 be approved.

2.2

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Waitemata District Health Board, Meeting of the Board 12/04/17

Minutes of the Meeting of the Waitemata DHB

Executive Committee

Wednesday 24 February 2017

held by teleconference commencing at 11.34am.

Part 1 - Items considered in public meeting COMMITTEE MEMBERS PRESENT:

Kylie Clegg (Deputy Board Chair) Max Abbott Warren Flaunty Morris Pita

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Peta Molloy (Board Secretary)

PUBLIC AND MEDIA REPRESENTATVES:

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

APOLOGIES:

An apology was received and accepted from Lester Levy.

DISCLOSURE OF INTERESTS:

There were no notifications of additions or amendments to interests that had been previously advised by members. There were no identified conflicts of interests for this agenda.

1 Resolution to Exclude the Public Resolution (Moved Warren Flaunty/Seconded Max Abbott) 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:

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

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)]

11.35am – 11.48 am - public excluded session The meeting concluded at 11.48am

SIGNED AS A CORRECT RECORD OF THE EXECUTIVE COMMITTEE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD HELD ON 24 FEBRUARY 2017

__________________________________DEPUTY CHAIR

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Waitemata District Health Board, Meeting of the Board 12/04/17

2.3 Circulated Resolution 17 March 2017 - Proposed Amendment to the Constitution of New Zealand Health Partnerships

Resolution passed 17 March 2017: That the Board approves an amendment to clause 9.3(b)(i) to the constitution of New Zealand Health Partnerships as follows: That the paragraph found at the end of clause 9.3(b)(i) of the constitution, which reads:

“The notice of appointment of each director must be signed by each DHB Shareholder jointly appointing that Director. Each Director must be a Chair or Chief Executive of one of the DHB Shareholders appointing the Director. The DHBs will endeavour to ensure that the composition of DHB Directors includes a mix of DHB Chairs and DHB Chief Executives.”

is altered by deleting the term “Chief Executive” and replacing it with the term “Deputy Chair”, and deleting the last sentence of that paragraph so that the altered paragraph now reads:

“The notice of appointment of each director must be signed by each DHB Shareholder jointly appointing that Director. Each Director must be a Chair or Deputy Chair of one of the DHB Shareholders appointing the Director.”

Prepared by: Peta Molloy (Board Secretary) The request to amend the constitution of New Zealand Health Partnerships following the most recent changes in DHB Board composition was considered and passed by circular resolution of the Board on 17

th March 2017.

The matter was considered under urgency to provide Board endorsement at the New Zealand Health Partnerships shareholders meeting on 20

th March 2017 (unanimous DHB approval of the resolution was

required) and to allow full DHB representation at the NZ Health Partnerships meeting scheduled to occur on 30

th March 2017.

The resolution is being submitted to the Board for endorsement.

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Waitemata District Health Board, Meeting of the Board 12/04/17

3.1 Chief Executive’s Report

Recommendation:

That the Chief Executive’s report be received.

Prepared by: Dr Dale Bramley (Chief Executive Officer)

1. News and events summary

A number of events of significance took place across the DHB over the past six weeks:

∑ On 1 March, the DHB hosted Prime Minister Bill English on a tour of the North Shore Hospital campus. It was Mr English’s first visit to Waitemata DHB as Prime Minister and presented an opportunity to demonstrate some of our recent major investments supporting enhanced patient care. Mr English, joined by Minister of Health Dr Jonathan Coleman and North Shore MP Maggie Barry, visited the Hine Ora women’s ward, inspected our Sky Bridge link and toured the Elective Surgery Centre. During the tour, the Prime Minister met several of our staff and patients and met our Chair, Dr Lester Levy, to discuss the future of healthcare delivery to our large and fast-growing population.

Chair Dr Lester Levy, PM Bill English and Chief Executive Officer Dr Dale Bramley during a tour of North Shore Hospital.

∑ Our inaugural awards recognising those who have successfully managed Type 1 Diabetes for long periods were held at Waitakere Hospital on 22 February. A total of 21 patients who have managed the disease for more than 50 years were recognised with flowers and certificates. Minister of Health, Dr Jonathan Coleman, was on-hand to present the HG Wells Award from

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Diabetes UK to 87-year-old New Lynn resident Winsome Johnston. The medal is presented to people who have successfully managed the condition for 80 years or more. Mrs Johnston is the first person in New Zealand to receive the award and is one of only three patients worldwide known to have survived beyond the age of 80. The awards also served to highlight the role our staff play in supporting Type 1 Diabetes patients to manage the disease and to live independent lives.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2017/WDHB-Diabetes-Awards.pdf

∑ The completion of a project to extend Huia ward at Waitakere Hospital was marked by a cultural blessing on 17 March. The extension is part of the Waitakere Additional Medical Capacity project which is due for completion in April and will make an additional 12 medical beds available to meet the health needs of West Aucklanders. It also includes two negative pressure isolation rooms for use in infection control. The investment is backed by 19 additional staffing positions, allowing more patients to be treated close to home. The Huia ward extension includes two patient bedrooms, a staff base and a clean utility/meds room as part of an area to be occupied by the Cardiology Service.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2017/WDHB-Additional-bed-capacity-project.pdf

Chaplain Sione Tu’ungafasi and Kaumata Frank Taipari at the Huia ward blessing.

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Waitemata District Health Board, Meeting of the Board 12/04/17

∑ After a decade in the role, Uaine Akari stepped down from her position as Executive Assistant to the Chief Executive Officer at the end of March. Uaine served both myself and the former Chief Executive Officer, the late Dave Davies, with distinction. People right across the organisation hold Uaine in tremendously high regard and I am grateful to her for the diligence, loyalty and commitment she has displayed in what is a very demanding role over such a long period. Thankfully, Uaine is not leaving the DHB and is transferring to a different role working as a member of our transcription team. This will allow her to spend more time with her first grandchild and on her creative interests. The role also means Uaine will be able to work from home on some days. We wish Uaine well and recognise her for the tremendous service she has given.

Chief Executive Officer Dr Dale Bramley with Executive Assistant Uaine Akari,who changed roles within the DHB at the end of March.

∑ On 28 March, the 2017 CEO Lecture Series kicked off with an address from the Chief Coroner, Judge Deborah Marshall. This was a well-attended event, attracting a live audience in excess of120 people, plus many who watched via telecast to Waitakere Hospital and other sites around our DHB, plus Tairawhiti DHB and, for the first time, Auckland DHB. Judge Marshall’s address was entitled ‘Reversing the stats: a clinician’s role in suicide prevention’. It was a thought-provoking and topical speech which clearly struck a chord with many of our staff. We are very grateful to Judge Marshall for giving so generously of her time and for sharing her insights on how different tiers of the state sector can work coherently together to support people who may be experiencing mental health challenges.

Chief Executive Officer Dr Dale Bramley with the Chief Coroner, Judge Deborah Marshall.

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Waitemata District Health Board, Meeting of the Board 12/04/17

∑ Years of planning came to fruition in March when new external signage was erected on our Waitakere Hospital campus. The signage follows international principles to help guide patients and visitors efficiently to where they need to go and is another step along the path of enhancing the experience of patients and whanau in our care. The new collateral replaces old, ad-hoc signage which was not always up-to-date and, on occasion, led to confusion for some visiting the site. Special mention for bringing this project to reality must go to our Director of Nursing, Dr Jocelyn Peach, who has chaired the DHB’s Wayfinding Committee, which has been responsible for investigating and commissioning this work. Waitakere Health Link has also played a role in this work and we thank them for their contribution. New signage will also soon be rolled-out at Mason Clinic and at North Shore Hospital.

Clear Signage for the public outside the Waitakere Hospital ED.

∑ Our role as a national leader in efforts to combat childhood obesity was recognised with the release of the latest quarterly results on national health target performance. Waitemata DHB was the first DHB in New Zealand to achieve 100 per cent in the Raising Healthy Kids target, which sees obese children identified in B4 School Checks offered a referral to a health professional for clinical assessment and potential interventions around family-based nutrition, physical activity and lifestyle. The DHB is committed to continuing to work closely with our B4 School Check provider, Plunket, and other primary care providers to ensure Waitemata children have the healthiest start to school life possible.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2017/DB-Waitemata-DHB-leads-in-efforts-to-combat-childhood-obesity-21-February-2017.pdf

∑ In mid-March, an analysis of 91 Crown entities across New Zealand saw Waitemata and Auckland DHBs ranked equal-first for compliance with ‘Good Employer’ principles for the second year. The review, by the Human Rights Commission, considers performance across a range of benchmarks, such as leadership and culture, recruitment, flexible work design, working conditions and harassment and bullying prevention.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2017/DB-Waitemata-and-Auckland-DHBs-continue-to-lead-the-way-as-Good-Employers-16Mar17.pdf

∑ Our new staff exercise room at Waitakere Hospital was officially opened by myself and Waitemata DHB Board member and former marathon champion Allison Roe on 24 March. It follows the opening of a similar facility on the North Shore campus and is aimed at supporting

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staff to look after their physical exercise needs to ensure own wellbeing and they are healthy to care for our patients. The new facility is aligned with the organisational value of ‘Everyone Matters – Staff’. It is located in an area previously used for non-clinical purposes and includes commercial quality treadmills, rowing machines, bikes, weights and other popular exercise equipment.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2017/WDHB-New-staff-exercise-room-at-Waitakere-Hospital.pdf

Board member Allison Roe and Chief Executive Officer Dr Dale Bramley at the staff exercise room opening.

Creating a culture of appreciation

A further 53 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 include:

∑ Deborah Clarke, Registered Nurse - MHSOP West, nominated by Bev Overington∑ Anne-Marie Bright, Registered Nurse - MHSOP West, nominated by Bev Overington∑ Rachel Hughes, Registered Nurse - MHSOP West, nominated by Bev Overington∑ Trudi Walker, Registered Nurse - MHSOP West, nominated by Bev Overington

“Truly dedicated and caring clinicians who really do make a difference for clients and colleagues alike.”

∑ Adrienne Reed, Charge Nurse Manager - Ward 15, nominated by Jo Bartlett“Adrienne is connected with staff and patients in the way that she listens and empathises with them and she demonstrates compassion with the wider hospital.”

∑ Kerry Turnpenny, Needs Assessment and Service Coordinator- NASC West, nominated by Liz Munt“Recently received two separate acknowledgements of the good work that Kerry is doing with her patients in the wards.”

∑ Beryl Turketo, Administration Clerk - Service Access System, nominated by Esther Linklater“Beryl helps to keep our service running as effectively as possible while supporting staff to be the best they can be.”

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Waitemata District Health Board, Meeting of the Board 12/04/17

∑ Rabin Burtun, Clinical Nurse Specialist - Diabetic Clinic, nominated by patient“Rab was the nurse who took over my care and I can say, without a doubt, that he gave me so much encouragement and support - his commitment to me was unbelievable.”

∑ Teresa Ferguson, Associate Clinical Charge Midwife - Waitakere Facility, nominated by RebeccaEade“Teresa works very hard to ensure our staff have a good roster which is pivotal to our work life balance and job satisfaction.”

∑ Charlie Aitken, Technical Support Coordinator - Learning and Development, nominated by Barbara Guthrie“Charlie is so calm and reassuring; he takes a lot of stress out of running workshops and trainings. What a gem!”

∑ Barbara Nicholson, Administration Clerk - Occupational Health, nominated by Jalinda van der Westhuizen“Barbara has been doing outstanding work in the past few months and has displayed all our values brilliantly by showing everyone matters.”

∑ Martin Olliff, Orderly - Clinical Support Service, nominated by Elspeth Pieterse“Martin is always friendly and helpful with a kind demeanour and gentle manner.”

∑ Sally Willis, Clinical Coding Administrator - Clinical Coding, nominated by Jacqui Knight“Sally always goes the extra mile to assist the Clinical Coding Team and visitors to the department.”

∑ Lorraine Emerson, Manager - Early Psychosis Intervention Team, nominated by Michelle Ball“Lorraine works tirelessly to ensure that families access the best possible care that her services can provide.”

∑ Taryn Broughten, Administrator - Community MHS West 1, nominated by staff at Waimarino∑ Liz Beresford, Administrator - Community MHS West 1, nominated by staff at

Waimarino∑ Cathryn Edmonds, Administrator - Recovery and Intensive, nominated by staff at

Waimarino∑ Andrea Bowman, Administrator - Recovery and Intensive, nominated by staff at

Waimarino∑ Lisa-Jane Applegate, Personal Assistant - Recovery and Intensive, nominated by staff at

Waimarino“Continue to provide a professional and friendly service to both our teams and the people who use our mental health service.”

∑ Debbie Hunt, Radiology Assistant - Radiology, nominated by Chantelle Berg“Debbie has supported and motivated me; she has shown me strength and given me value!”

∑ Ashley Kim, Audiologist - ORL and Audiology Services, nominated by David Grayson“Feedback from a patient and family: My wife and I have been overwhelmed by the professional, empathic and friendly concern and treatment shown toward us by Ashley.”

∑ Bernice Lidgard, Booking Clerk - Urology, nominated by Xu Cui“Bernice is very friendly and helpful. It has been a great pleasure working with her to achieve the best care for patients.”

∑ Amanda McClune, Clinical Receptionist - Outpatients North Shore Hospital, nominated by Xu Cui“Amanda is very friendly, caring and professional - she is always willing to help.”

∑ Brian Clark, Administration Clerk - Intensive Care Unit, nominated by Marcelle Mafi“Brian keeps us all in the loop, knows everything that is going on in the unit and is always willing to step in and help anybody.”

∑ Susan Naisbitt, Administration Clerk - Orthopaedics ICU Team, nominated by Jackie Turner“Susan helped an elderly lady who was lost on the lower ground floor and ensured she was guided back to the ward safely.”

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∑ Leslie Ponen, Social Worker - Inpatient North Therapies, nominated by Wendy Jessup“For his outstanding work with a non-resident patient and demonstrating the value of ‘everyone matters’.”

∑ Grainne Meany, Physiotherapist - Community West Therapies, nominated by Lindsay Collins“Grainne has been a wonderful addition to our small team.”

∑ Rosie Andricksen, Clinical Support Coordinator - Research and Knowledge Centre, nominated by Annette Murphy and Jenny Crawford“Rosie works tirelessly to ensure that CeDSS is up-to- date, broken links are quickly repaired, and makes changes in response to feedback.”

∑ Tahana Waipouri-Voykovic, Kaumatua/Community Support Worker - Moko Services/Maori Health, nominated by Piripi Daniels“Tahana is instrumental in the promotion of tikanga and values within our organisation, as well as the greater community.”

∑ Emily Sorby, Kaiatawhai - Maori Health Services, nominated by Riki Nia Nia“Emily has done a fantastic job bringing the team together and keeping the service operating while waiting for the appointment of a permanent Team Leader.”

∑ Jocelyn Peach, Director of Nursing and Midwifery, nominated by Riki Nia Nia“Jos deserves to be recognised as one of our clinical leaders who walks the talk and sets the standards by remodelling the sort of behaviour we expect to see from all our staff!”

∑ Louise Guy, Registered Nurse - Paediatrics, nominated by Sarah Timmis∑ Julieann Kumar, Health Care Assistant - Paediatrics, nominated by Sarah Timmis∑ Rhonda Butler, Administration Clerk - Paediatrics, nominated by Sarah Timmis∑ Katrina Salazar, Registered Nurse - Paediatrics, nominated by Sarah Timmis∑ Maria Breva, Registered Nurse - Paediatrics, nominated by Sarah Timmis

“For their enthusiasm and innovation regarding the decoration of the ward after Christmas. We are developing a more child friendly environment and these team members have been at the centre of this.”

∑ Dolly Alvares, Personal Assistant to General Manager - Facilities and Development, nominated by William van Ausdal“For exemplifying the DHB’s commitment to working together”

∑ Jenny Crawford, Pharmacist - Pharmacy, nominated by Dr Jerome Ng∑ Susan Lambers, Pharmacist - Pharmacy, nominated by Dr Jerome Ng

“These two demonstrate the true values of better, best, brilliant.”∑ Dr Phillip Tarrant, House Officer - General Medical Acute and Emergency Medicine, nominated

by Carole Oosterhof“Incorporates the values of compassion, everyone matters and connected; and exceeds expectations that normally go with being a junior doctor.”

∑ Dr Ronald Alexander, House Officer - General Medical Acute and Emergency Medicine, nominated by Karen Magorian“Dr Alexander demonstrates a highly professional approach, is extremely efficient and he has clearly demonstrated the DHB values of care and compassion.”

∑ Elly Richards, Nurse Educator - Inpatient Detox Unit/CADs, nominated by Astrid Smith“Elly is always keen, passionate and extremely knowledgeable about a range of medical issues.”

∑ Susanna Galea-Singer, Senior Medical Officer/linical Director - CADs, nominated by Cate Wallace“Susanna is extremely warm, engaging and works collaboratively to achieve consistently high quality services for people with addiction issues.”

∑ Robert Steenhuisen, General Manager - CADs, nominated by Cate Wallace“Robert has extensive knowledge, experience and skills as well as a high degree of pragmatism essential to the management of regional services.”

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∑ Toni Bowley, Manager - CADs, nominated by Cate Wallace“Toni is a highly skilled manager and her ability to provide very thorough, highly detailed data-rich evidence in a short space of time.”

∑ Polly Websdell, Group Coordinator - CADS, nominated by Keryn Wilson“Polly engages clients on a daily basis in the groups here at IPU – she is warm, friendly and empathetic to the client journey.”

∑ Joanne Inivale, Anaesthetic Nurse Specialist - Mental Health, nominated by Dave Burton“Joanne has great attention to detail and a genuine care for the patients. She reflects the DHB value of best care for everyone.”

∑ Geraldine Kirkwood, Charge Nurse Manager - Outpatients Waitakere, nominated by Margaret Rhind“Geraldine is consistently visible and available to all staff. She is approachable and looks for win/win solutions to some complex situations.”

∑ Tary Yin, Registrar - ORL and Audiology Services, nominated by Patient Feedback“Tary was welcoming, professional and communicated with my parents and myself with great consideration.”

∑ Heather Aplin, Registered Nurse - Outpatients North Shore, nominated by Patient Feedback“Heather was hilariously funny and connected immediately with my Dad, who has been feeling rather anxious and down about all his skin issues.”

∑ Brittany Hunt, Clerical Worker - Clinical Gastroenterology Department, nominated by Sue-Anne Bonhomme and Jenny Vitali“Brittney shows the DHB value of connected by supporting her patients and also her colleagues on the ward.”

∑ Nova Matthewson, Administration Clerk - Gastroenterology Department, nominated by Sue-Anne Bonhomme“Always displays enthusiasm for her work and provides an excellent service to the department.”

∑ Dr James Millar, House Officer - Special Medicine and HOAS, nominated by Joann Blomfield“Dr Millar impressed all of the Smartpage team and various RN’s around the hospital with his work ethic, compassion, friendliness, and his ability to cope under pressure.”

2. Upcoming events

Looking toward the upcoming months, we can expect to see:

∑ Progress on construction of Whenua Pupuke, the Clinical Skills Centre on the North ShoreHospital campus, with the official opening week planned for 9 June, followed by three days of events from 12-14 June.

∑ Opening of the refurbished Community Building 5 on the North Shore Hospital campus on 10 April to house outpatient clinics. The building has been gifted the name Kahui Manaaki ‘cluster of kindness’ by Chief Advisor Tikanga Naida Glavish.

∑ Full opening of stage 2 of Waitakere Hospital’s expanded Emergency Department scheduled for May 12.

∑ Opening of the new cardiology beds and negative pressure rooms at Waitakere Hospital in late April.

∑ Further progress on the new 15-bed unit at Mason Clinic, with the official opening in late July.∑ Patient Experience Week from April 24-28.∑ All-staff survey to enhance understanding and engagement in our workforce. ∑ Continuation of the 2017 CEO Lecture Series during the Clinical Skills Centre’s opening

celebrations.

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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.

Some of the first stage projects are now coming to an end and the benefits are being assessed. Evaluation of the mobile devices with community allied health staff has shown that, on average, each clinician saved 15 minutes per day on administration tasks and increased their patient visits by 1.5 per week.

Patient feedback about the use of the devices in consultations was overwhelmingly positive. eVitals has completed the first stage of rollout, finalised the nursing assessment forms and new developments include sepsis and glucose levels.

Further rollout is planned for paediatrics in early April and maternity. Voice-to-text has been rolled out to 100 authors, with the remainder planned over the next few months. The eLabs development is well underway, with the go-live planned for April with full deployment mid-year.

Phase two of Leapfrog is underway. Some projects have already commenced and some are in the scoping phase.

Local and regional work on Internal Referrals within the DHB is progressing. Under data discovery, the team is working on the implementation of the BI tool with clinical indicators for services. The Outpatient Follow-up project is working with hospital operations to rationalise the large amount of work being conducted related to the department.

Work streams relevant to reducing the need for in-person hospital visits will come into the Leapfrog project – including work that is progressing on collecting and visualising data on the reasons for follow-up and the size of the issue, and providing other means of follow-up such as Self-referral of Symptoms(SOS) clinics and remote consultations.

The next round of eOrders is in planning for mobility for collections (phlebotomy), eBloods and for clinicians taking their own samples. Business cases are being prepared for the board on kiosks and a patient engagement system.

4. Outcomes discussion

This month, I have asked Dr John Scott, Head of Division - Specialist Medicine and Health of Older People, to provide an update on efforts underway to provide enhanced stroke care to the Waitemata population. Clinical Director, Health Gain Dr Peter Sandiford has also included some observations on stroke rates and trends within the Waitemata district.

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ContextStroke is one of the most-common causes of death in New Zealand. Equally important, because most people with stroke do not die, the major burden from this illness is chronic disability. Stroke is, to a substantial degree, preventable, and we have increasingly effective treatments.

Due to better prevention (treatment of hypertension and diabetes, stopping smoking) rates of stroke in our lower risk populations are falling, though outcomes in higher risk groups are notably poorer.

Stroke rate per 105 population, by ethnicity, age adjusted, Auckland, 1981 – 2012.

Feigin VL, Krishnamurthi RV, Barker-Collo S, McPherson KM, Barber Personal Assistant, et al. (2015) 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies. PLOS ONE 10(8): e0134609. doi:10.1371/journal.pone.0134609

Overall, the stroke story is a very positive one, with dramatic declines in age-standardised mortality rates in Waitemata mirroring those seen nationally since the early 1980s. The mortality in Waitemata is lower than in the rest of New Zealand.

Stroke Mortality Rate – Waitemata DHB v New Zealand

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However, when looking at specific ethnic sub-groups and age groups, the picture is not so positive. Data from the Auckland Regional Stroke study spanning 30 years (ARCOS IV) shows that the incidence rate of stroke in the under 65 population has begun rising again (from 50 per 100,000 in 2002/03 to 55 per 100,000 in 2011/12).

This trend is strongest in females (in males it is almost static) and in the Pacific population where the rate in under 65s has risen from 74 per 100,000 to 126 per 100,000 over that same time period. Although this increase is observed in all ethnicities, it is growing at the fastest rate in Pacific and Asian ethnic groups.

This increase in stroke incidence has yet to be fully reflected in rising mortality rates, presumably because of improvements in stroke survival, although recent data for Waitemata show that the age-standardised mortality rate among Māori aged under 65 did rise between 2001-05 and 2009-13.

Age-Standardised Stroke Mortality Rate – Waitemata DHB under-65 by ethnicity 2001-05 v 2009-13

Age-Standardised Stroke Mortality Rate – Waitemata DHB over-65 by ethnicity 2001-05 v 2009-13

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With regard to treatment, the international evidence base is moving rapidly and it is clear we need to do more to give our population the best experience and the best outcomes.

Best Practice vs Current Services

Waitemata DHB has identified several areas where we can further improve our stroke outcomes. The two major areas are:

(1) Integrated stroke careCare of patients in a dedicated stroke unit, combining multi-disciplinary intervention and a programme of rehabilitation with expert medical care, is shown to significantly reduce mortality and to improve functional state at discharge.

At present, people from our district with an acute stroke are cared for in the stroke ward at North Shore, and Wainamu ward at Waitakere. Many are subsequently transferred to different wards for ongoing rehabilitation – the “AT&R” wards at North Shore and Waitakere, or the “Rehab Plus” facility at Point Chevalier for those aged under 65.

Current service configuration for acute and rehabilitation phases of stroke care could be improved further by development of a comprehensive combined stroke ward. On a number of national indicators, including the percentage of patients admitted to a stroke unit and the time taken to transfer to a rehabilitation service, there is opportunity for the DHB to improve.

(2) Regional Hyperacute pathwayThe last few years have seen major developments in the ability to provide so-called “hyperacute” interventions for persons with stroke.

There are two key technologies: thrombolysis, which involves the administration of powerful clot-dissolving drugs and “clot retrieval” whereby a catheter is introduced into the blood vessel that is blocked and the clot physically removed.

The two key constraints with hyperacute stroke therapies are the short timeframe in which benefit can be achieved and the requirement for expert assessment and intervention.

The brain has poor ability to survive without oxygen and within a few hours after the onset of a stroke, irreversible damage will have occurred. In addition, the diagnosis of acute stroke is not straightforward and requires advanced neuroimaging and trained clinical personnel.

Therefore, treatments to prevent damage from stroke can only be successfully applied in a health system that is configured to deploy complex clinical and technological interventions is a very short time window.

Thrombolysis was, early in its development, a controversial treatment as the harms from providing treatment incorrectly, or to the wrong people, are significant. Over time, international experience has refined the indications and clarified the parameters under which this treatment can be safely given. It is now the standard of care for most people with strokes as long as they (i) present early, and (ii) are able to have rapid expert assessment in order to confirm the diagnosis and rule out contraindications.

The proportion of people receiving thrombolysis is nationally recognised as a key performance indicator for stroke services. The current national target is 6% (1). Increasing this proportion requires improvements along the entire chain of care, from public education campaigns to encourage people

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to seek urgent attention, to improvements in ambulance/first responder assessment, to improving systems in our hospitals.

“Clot retrieval” is an approach which, while appealing in-principle, has required the development of sophisticated devices and imaging procedures to be successful.

High-quality data in support of the efficacy of this approach has only become available in the last two years. Provision of a clot retrieval service can only occur at centres where there is a team of qualified staff available 24/7, able to intervene within hours of symptom onset.

The cost and limited availability of this resource means that it is only viable to provide in three centres nationally. In the Auckland region, Auckland City Hospital will be the clot retrieval provider.

Nevertheless, when applied quickly and to the correct cohort of patients, the outcomes from clot retrieval are dramatic:

Number need to treat to see one person:

With a clinically meaningful reduction in disability 2.6

Alive and independent 5

Avoid long-term institutionalisation 6

ProposalWaitemata DHB is developing a business case to enable us to provide better stroke care to our population.

The key components of this are:

(i) a reconfiguration and enhancement of within-DHB stroke services to include:a. Combined acute and stroke care in an integrated unit. This will integrate services

currently provided in five locations (Ward 2, Wainamu ward, Muriwai ward, Ward 15, and “Rehab plus”) into one comprehensive unit.

b. Improved business-hours stroke services at Waitakere Hospital to further contribute to the ongoing development of services in the West.

(ii) Participation in a regional hyperacute stroke network, which will see all potentially eligible patients transferred emergently to Auckland City Hospital for rapid expert assessment and provision of clot retrieval indicated.

Outcome benefits

Implementation of these proposed changes should see Waitemata patients benefitting from the substantial gains in disability-free survival that the evidence shows these interventions can deliver.

There is an extensive set of performance indicators and outcome criteria developed. This, plus the fact that we have operated a stroke register for some years together with the fact that the Auckland region has some of the world’s best long-term incidence and outcomes research into stroke, will mean we are in an excellent position to measure the benefits of our interventions.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Figure 1: Hyperacute stroke performance measures

Performance Measures

Northern region hyperacute stroke care pathway success measure

'*' NRHP Stroke measure agreed by Stroke Network

**' Regional Stroke Indicators 2013/14 proposed by NZ Stroke KPI Working Group as minimum standards

Impact Measure

1. Better services for stroke patients * Thrombolysis rate for people with ischaemic stroke

2. Better services for stroke patients Thrombectomy rate for people who have been thrombolysed

3. Timely and efficient care“Symptom onset to needle” - Time from symptom onset to thrombolysis initiation (in hours, afterhours, minutes)

4. Timely and efficient care** “Door to needle” - Time from presentation to thrombolysis initiation (in hours, afterhours, minutes)

5. Timely and efficient care Hospital door to Acute Stroke Unit

6. Safer care % Protocol violations

7. Safer care Symptomatic intracerebral haemorrhage (sICH) rate

8. More independent stroke survivors ** % stroke patients with Rankin score of 0 to 2 at Day 90

9. Fewer stroke survivors requiring long term residential care

** % stroke patients with Rankin score of 4 to 5 at Day 90

10. Fewer deaths from stroke ** % stroke patients with Rankin score of 6 at Day 90

11. Shorter hospital stays Average length of stay (ALOS) – ICU

12. Shorter hospital stays Average length of stay (ALOS) – acute stroke unit

13. Shorter hospital stays Average length of stay (ALOS) – inpatient rehabilitation

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Waitemata District Health Board, Meeting of the Board 12/04/17

Process Measures

14. Number of self-presentations to HSC centre (by DHB of domicile)

15. Number of ambulance bypasses to HSC centre (from Waitemata DHB and Counties Manukau DHB)

16. Number of interhospital ambulance transfers to HSC centre (from Waitemata DHB andCounties Manukau DHB)

17. Interhospital transfer time to HSC centre (minutes)

18. Number of inappropriate ambulance bypasses to HSC centre (by DHB of domicile)

19. Number of ambulance bypasses/transfers where pre-notification was received by HSC team

20. **“Door to CT” - Time from presentation to CT (minutes)

21. Transfer time from HSC centre to DHB of domicile (hours)

22. Number of presentations which are mimics/not stroke

23. Number of presentations which did not receive treatment

24. Staff satisfaction. Measure/s to be confirmed.

25. Patient experience of care. Measure/s to be confirmed.

5. Board performance priorities

The following provides a summary of the work underway to deliver on the DHB’s priorities:

Relief of suffering

Progress a

Patient feedback

∑ National Inpatient SurveyThe first national survey for 2017 is currently being conducted; results will be available in the next Patient Experience Report.

∑ Friends and Family TestDuring January and February 2017, we received feedback from 2,000 people through the Friends and Family Test (FFT). The Net Promoter Score (NPS) for January was 72 and for February 70, above the DHB target of 65. Response rates for the FFT have started to rise in February in response to an increased awareness of how the FFT results are used within the organisation. Presentations to Frontline Focus (Charge Nurse meeting), Allied Health teams and other services were conducted in

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Waitemata District Health Board, Meeting of the Board 12/04/17

February and continue in March. Local ward-level work has also improved response rates for specific wards that have had consistently low response rates.

January Results

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Waitemata District Health Board, Meeting of the Board 12/04/17

February Results

Total Responses to Family and Friends Test across Waitemata DHB

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Page 39: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Patient Experience Activity Highlights∑ Always Event – Ward 6

In partnership with the Health Quality and Safety Commission, the Patient Experience Team and Ward 6 will pilot an Always Event based on the Picker Institute and Institute of Health Care Improvement (IHI) Always Event Toolkit. A researcher from Sapere Research Group Ltd will lead the pilot, which will be linked to the three lower scoring areas on the National Patient Experience Survey. Namely these are:

• Did the hospital staff include your family/whānau or someone close to you in discussions about your care?

• Do you feel you received enough information from the hospital on how to manage your condition after your discharge?

• Did a member of staff tell you about medication side effects to watch for when you went home?

In exploring these questions, staff, patients and family/carers/whānau will be interviewed, ward operations will be observed and a co-design type workshop will be conducted. This will be linked directly with our Waitemata DHB listening events strategy and identify key areas for improvement that the Patient Experience Team will support in partnership with Ward 6 staff and their patients.

∑ Volunteer Recruitment CampaignThe volunteer programme has started a recruitment campaign to increase volunteer numbers across the organisation. Many articles have been printed in the local newspapers celebrating the service many long-term volunteers have given, as well as targeted articles on social media for volunteer recruitment. To date, we have received 50 expressions of interest at Waitakere Hospital and 15 expressions of interest at North Shore Hospital. All of these people represent a variety of age groups and ethnicities and are currently progressing through a screening, on-boarding and orientation process. Following this, further recruitment campaigns will be conducted to increase numbers of volunteers available to wards and services.

∑ Patient Experience Week 2017The week for Patient Experience week celebrations has been confirmed – 24 to 28 April 2017. Promotion of Patient Experience initiatives and the staff value “with compassion” will take centre stage across the organisation during this week. This is in line with the international week of celebrations for Patient Experience. The timetable of events is below:

Event DescriptionMeet and greet ∑ Staff to meet and greet patients, whanau and other staff in areas of high foot

traffic, including the main entrance and outpatient’s reception. ∑ The purpose is for staff to be visible, understand and observe patient and

whānau experiences and concerns as they enter the hospital and to help our visitors reach their destination/appointment. Staff can also take time to talk to our volunteers and understand the crucial role that they play in our organisation to enhance patient experience.

You said, We did ∑ Following the success from 2016, Executive Leadership Team/Senior Management Team and Quality Leads will visit wards and talk to staff about how patient feedback is being used in their wards and the outcomes.

∑ The Patient Experience Team will ask wards and services to send examples of how the values and patient experience are influencing quality activity and their services.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Event DescriptionKids’ Drawing competition

∑ Children will draw what being a patient means to them.∑ Artwork will be displayed in the main entrance of North Shore Hospital and

Waitakere Hospital. Patients, whanau and staff will have the opportunity to vote and winners will be presented with a $25 Westfield voucher.

∑ Patients from Rangatira Ward, ED (North Shore Hospital and Waitakere Hospital) and Wilson Centre will participate.

Meal tray mats ∑ Meal tray mats with puzzles, health facts, contact us/have a say (reinforce that it’s safe to provide feedback, what we do with the feedback and changes we’ve made).

Fun facts and information ∑ Fun facts displayed across the hospital.∑ Fun facts on screensaver and TVs.∑ Facts to be based on Patient Experience i.e. in the world of Patient

Experience, the single-most-common thing patients tell us about are…∑ Other ideas include: how many people come through the hospital each day,

average age of the patient, how much energy do we use, alternative ways to travel to hospital i.e. bus, cycle, walk etc., our vision for the future, Waitemata DHB challenges, health facts i.e. improvements in technology have increased survival rates for breast cancer by x%.

Social Media/Communications

∑ Promote Patient Experience week on Social Media and through other communication channels.

∑ Promote patient stories through Facebook/Twitter – link to the website (the stories where patients have consented to being shown publicly).

Welcoming and friendly ∑ Continuation/refresh of what’s already happened in this space.∑ Smiling (Welcoming and Friendly toolkit). Still a significant thing that patients

and visitors talk about, something that really matters. We’ve become much better at it, let’s do it even better.

∑ Never Walk By (stop and ask if patients/visitors are OK).Empathy zone ∑ “Walk in our shoes” - Patients, whānau and staff have the opportunity to try

different medical equipment, including hand splints, fake plaster casts, wheel chairs, vision distortion glasses, crutches, stethoscopes, hospital gowns, blindfolds, sling, obesity suit etc and experience undertaking everyday tasks.

∑ Locations: hospital foyer at North Shore Hospital and Waitakere Hospital or North Shore Hospital corridor between outpatients and main reception.

∑ Ask participants to complete a short two-or-three-question survey about their experience.

∑ Other Patient Experience ActivityThere are a number of service improvement activities that the Patient Experience team are currently supporting:- Sleep Programme – developing a Sleep Champion Ward where sleep activities will be

piloted and tested.- E-learning patient experience training module.- Safe and Secure staff scripting – to support frontline staff with de-escalation of challenging

behaviours.- Orderlies and Cleaning Staff Education.- Allied Health Community Team Family and Friends Test development – to improve response

rates and data usage.- Larger Patients Training video – outlining current equipment and manual handling

challenges.

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Waitemata District Health Board, Meeting of the Board 12/04/17

- Patient Experience System rollout in conjunction with the Institute of Innovation andImprovement.

- Patient Information Booklet rollout across North Shore Hospital and development of WTK booklet.

- Values Programme – including events for opening of the Clinic Skills Centre.

Facilities

Major capital projects need strong regional support and alignment. The Northern Region is working on a Long Term Investment Plan (LTIP) to guide all significant future capital investments in the region. The Board will be regularly updated on this work going forward.

North Shore Hospital Sky BridgeMain project is complete, including bridge lighting donated by ECC Limited.

North Shore Hospital Community Building 5Construction will be completed on 5 April 2017. This will be followed by final fit-out of furniture and fittings and commissioning. Official opening is scheduled for 19 April and operational opening is planned for 24 April.

North Shore Hospital Surgical Pathology Offices RelocationThe offices opened in December as planned and Surgical Pathology has moved in.

Waitakere Hospital ED RedevelopmentThe facility is operating well. Some small changes to signage, window treatment and sound-proofing are required near reception to increase privacy.

Multi-phase refurbishment of the existing footprint is progressing and is proceeding well, with official opening scheduled for 12 May.

Waitakere Hospital Additional Beds – Wainamu and Muruwai WardsRCC healthcare are progressing construction works with disruptions to service generally as planned. To date, there have been no major issues and both patients and staff are coping well with the necessary disruption. Construction of final works is due for completion on 3 April, with FFE and commissioning following.

Special Care Baby Unit (SCBU) Waitakere Hospital and North Shore HospitalThe project variation to change the completion dates for Stage 1 – Extend and RefurbishWaitakere SCBU – July 2017 and for Stage 2 – Refurbish North Shore SCBU – January 2018 was agreed by the Board. Work is being progressed to meet the revised dates.

Elective Capacity and Inpatient Beds (ECIB) business case to Capital Investment Committee (CIC)The Capital Investment Committee (CIC) approved the progression to the business stage for the ECIB project. CIC also asked that a regional analysis over procedure rooms and theatre capacity be undertaken to inform development of a revised long list and regionally agreed options. This work is well underway through the regional Long term Investment Planning process.

Replacement Wards ProjectThe Risk Profile Assessment and Point of Entry documents were submitted to Treasury and Ministry of Health at the end of 2016. Work continued on the functional design briefs, models of care and accommodation schedules that will inform design. The regional LTIP process is informing the

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Waitemata District Health Board, Meeting of the Board 12/04/17

requirement for the replacement ward project and the next stage, guided by outcomes through the LTIP process, is to progress to Investment Logic Mapping and development of a Strategic Assessment.

Mason Clinic presentation to CIC for refurbishment of TanekahaThe Capital Investment Committee approved the Tanekaha business case at its meeting on 27 March subject to:

1) Agreeing the recycling of capital from the 44 Taharoto Road property.2) Submission of the post-implementation review of He Puna Waiora.3) Receiving a progress report on the 15-bed unit at Mason Clinic under construction.

Better Outcomes aProgress: On track

Achieving the health targets – as at February 2017

∑ Shorter waits in Emergency Departments – 96% (target 95%)∑ Improved Access to Elective Surgery – 106% (target 100%)∑ Increased immunisation – 91% (target 95%)∑ Better help for smokers to quit - maternity – 78% (target 90%) ∑ Raising healthy kids – 100% (target 80%) ∑ Faster Cancer Treatment (FCT – 62 days) – 92% (target 85%)

Health Quality and Safety Markers – February 2017

FallsFalls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, Acute and Emergency Medicine completed 89% of falls risk assessments, Specialist Medicine and Health of Older People completed 100% and Surgical andAmbulatory Services completed 96% on admission. Of those, Acute and Emergency Medicine completed 74%, Specialist Medicine and Health of Older People completed 86% and Surgical andAmbulatory Services completed 88% within eight hours of admission (against a target of 90%)

Hand Hygiene Waitemata DHB’s Hand Hygiene Audit results for February 2017 are a compliance rate of 87%,exceeding the national target of 80%.

Healthcare-Associated InfectionsThe Central Line Associated Bacteraemia (CLAB )insertion bundle was used in ICU on 95% of occasions in February 2017. The insertion bundle compliance also exceeds the national target of 90%.

Elective Surgery Centre (ESC)As at the end of January, the Elective Surgery Centre had treated 3070 patients and was tracking at 97% of Ministry of Health target. The average theatre utilisation during this period sat at 80%.

Operationally, ESC continues to provide efficient and productive service to its patients, with patient satisfaction and feedback continuing to be excellent.

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Waitemata District Health Board, Meeting of the Board 12/04/17

ESC continues to plan the management of patient volumes directly alongside Surgical and Ambulatory Services to ensure all targets are met regarding Elective Services Patient Flow Indicator (ESPI) compliance and MOH volumes.

In summary, the patient and SMO feedback continues to remain extremely positive, with the processes and facility working very well. An excellent team spirit continues among the staff, who are extremely proud of the service they offer patients.

Māori Health

Maori Health PlanThe draft Waitemata 2017/18 Maori Health Plan was endorsed by the Community Public Health Advisory Committee to be submitted to the Ministry of Health.

The Ministry of Health no longer requires District Health Boards to produce standalone Annual Māori Health Plans. However, through the request and support of the Board to keep a focus on equitable Māori health outcomes, we are continuing to develop and present a Māori Health Plan.

The Waitemata District Health Board Annual Māori Health Plan will continue to be aligned with the Auckland District Health Board Annual Māori Health Plan. We are also working with Counties Manukau Health to align our Māori Health Plans and identify priority areas for regional collaboration.Engagement with key internal and external stakeholders has been undertaken and will continue to occur throughout the development process.

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CEO Scorecard

Actual Target Trend Patient Experience Actual Target TrendBetter help for smokers to quit - maternity 78% 90% ò q Complaint Average Response Time 13 days <14 days ò qBetter help for smokers to quit - primary care 88% 90% ò p Net Promoter Score FFT 70 65 ò qImproved Access to Elective Surgery - WDHB 106% 100% ò pShorter Waits in ED 96% 95% ò q Quality & Safety TrendFaster cancer treatment (62 days) 92% 85% ò p Older patients assessed for falling risk 98% 90% ò qIncreased immunisation (8-month old) 91% 95% ò q Occasions insertion bundle used 95% 95% ò qRaising Healthy kids 100% 80% ò ¨¨ a. Good hand hygiene practice 85% 80% ò q

Pressure injuries grade 3&4 0 0 ò ¨¨ICU - CLAB rate per 1000 line days 0.95 <1 ò p

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

Waiting Times Actual Target Trend Improving outcomesESPI Better help for smokers to quit - hospitalised 98% 95% ò q

a. ESPI 2 - % patients waiting > 4 months for FSA Compliant Population coverage/Access TrendESPI 5 - % patients not treated within 4 months Compliant Cervical Screening 76% 80% ò ¨¨Diagnostics Breast screening 67% 70% ò ¨¨

% of CT scans done within 6 weeks 96% 95% ò p c. Bowel Screening Participation% of MRI scans done within 6 weeks 83% 85% ò p - Round 2 55% 60% ò pUrgent diagnostic colonoscopy (14 days) 100% 85% ò p - Round 3 52% 60% ò qDiagnostic colonoscopy (42 days) 75% 70% ò pSurveillance colonoscopy (84 days) 73% 70% ò q Treatment

d. HSMR (Source: Health Round Tables) 1.01 <1.04 ò pPatient Flow e. Surgical intervention rates (per 10,000 pop)

Elective Surgical Discharges (YTD) - Angioplasty 14.6 12.5 ò p

Elective Discharges - Total 13,037 12,944 ò p - Angiography 42.4 34.7 ò pElective Discharges - Provider Arm 9,011 8,743 ò p - Major joints 27.6 21 ò pElective Discharges - IDF Outflow 4,026 4,201 ò p - Cataract 44.4 27 ò pEfficiency a. # NOF patients to theatre (48 hours) 90% 85% ò p

Outpatient DNA rate (FSA + FUs) 9% <10% ò p ST elevation MI receiving PCI (120 mins) 90% 80% ò pAverage Length of Stay - Electives 1.55 days <1.69 days ò q AT&R referrals assessed (2 working days) 97% 90% ò pAverage Length of Stay - Acutes 2.57 days <2.51 days ò p

Staff Experience Actual Target Trend Major Capital Programmes Time Budget QualitySick leave rate 3.2% <3.8% ò ¨¨ Te Atarau car park (mid 2016) - completed ò ò òTurnover rate 11% 8-12% ò ¨¨ WTH Emergency Department redevelopment (Apr 2016) ò ò ò

f. Lost time injury rate (per 100 00 hours worked) 1 <2 ò p Mason clinic - 15 Bed medium secure unit (May 2017) ò ò òNSH Building 5 Refurbishment (Mar 2017) ò ò ò

Financial Result Trend Clinical and Learning Skills Centre (Apr 2017) ò ò òNet Surplus/Deficit (YTD) 3,832 k 3,743 k ò Elective Capacity and Inpatient beds (TBC) ò ò ò

Bridge ESC to Medical Tower (Sep 16) ò ò ò

Performance indicators: Trend indicators:

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

ò Not Achieved but progress made ò 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 ScorecardFebruary 2017

2016/17

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. One month in arrears - as at Jan 2017 b. Sep Q1 2016/17 (latest draft HQSC data available).c. Bowel Screening Round 2 (closed) Jun Q4 2015/16 - Round 3 commenced (participation rate for invites Jan - Sep 2016).d. Reported quarterly - as at Dec 16 Q2 2016/17.e. As at Sep Q1 2016/17. f. New method of calculation and target June 2016 - Rate per 100 000 hours worked

Health Targets

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

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Waitemata District Health Board, Meeting of the Board 12/04/17

3.2 Health and Safety Performance Report – April 2017

Recommendation:

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

Glossary OH&SS - Occupational Health and Safety Services HSNO - Hazardous Substances and New Organisms M&H - Moving and Handling

1. Purpose of report

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

2. Strategic Alignment

Community, whanau and patient centred model of care

This report comments on issues and risks that impact on patient care and organisational culture.

Emphasis and investment on both treatment and keeping people healthy

This report comments on organisational health information via incidents, health monitoring, and leave information.

Intelligence and insight The report provides information and insight into workplace incidents and what the DHB is doing to respond to these and other workplace risks.

Evidence informed decision making and practice

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

Outward focus and flexible, service orientation

Health, safety and wellbeing risks and programmes are inherently focused on staff, patients, visitors, students and contractors. All strategic and operational work programmers and policy decisions are discussed with relevant services e.g. site visits, approaches to reduce risks (Section 6).

Operational and financial sustainability

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

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Waitemata District Health Board, Meeting of the Board 12/04/17

Trend highlights at a glance (rolling 12 months)

Staff incidents

Staff incident reporting now seems to

have stabilised, however it is expected

we will see a sharp increase following

the release of the Safe Way of

Working Audit, as this will act as a

reminder to staff to report all

incidents, including near misses.

Attendance at Health and Safety Orientation

Attendance at Health and Safety orientation remains reasonable stable over time, however a positive shift is required.

Pre-employment

Screening

Pre-employment screening prior to

commencement remains steady,

however this is expected to change

when we rollout out compulsory

screening process, which is currently

being piloted and evaluated.

Number of staff

injury claims

The number of staff injury claims

remains steady.

Health and Safety representative vacancies

Only two vacancies remain, which is a great result, so continued progress is being made.

Key

Increased performance

Steady performance

Decreased performance

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Waitemata District Health Board, Meeting of the Board 12/04/17

Performance Scorecard

Comment on variations

Indicator in amber Comment

Attendance at Health and Safety Orientation 65%

Occupational Health and Safety are following up with Learning and Development to better understand why we have seen a downward trend in this data set. A verbal update will be provided at the meeting.

In summary, for February Downward trend in number of staff reported incidents Only 1 contractor incident report Injury frequency Reduction in uptake of orientation Health and Safety rep training completed Steady levels of pre-employment screening prior to employment Increase in hand hygiene from last month (87% vs 85%)

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Waitemata District Health Board, Meeting of the Board 12/04/17

3. 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.

Risk: Aggression--physical and verbal

Previous Report Action Current Action

Community worker alarm tender evaluations complete and business case being drafted. Complete: 30%

Business case submitted for approval. Complete: 35%

Draft police complaints policy has been reviewed and feedback provided to Legal Services to complete policy. Complete: 50%

Awaiting final version from Legal Services. Complete: 50%

Red Beach Hazard Review: All actions implemented, awaiting final installation of reception desk ‘bar top’ and side screens. Complete: 80%

Desk has now been fully installed and all actions completed. Complete: 100%

He Puna Waiora hazard review : All actions now completed. Additional actions requested during follow-up site walkthrough, however not of significant risk. Complete: 95% (in light of new actions)

Complete: 100%

All Mental Health Unit reception area review actions almost completed and prioritisation of remaining actions is underway. Complete: 85%

Complete: 100%

Template for services to review their public reception areas planned and due to roll out March 2017. Complete: 0%

Template now completed, including all relevant questions to be answered. Rollout to commence early April. Complete: 80%

Residual Risk: As these projects are still underway, the residual risk has not changed. It is envisioned that the residual risk levels will reduce upon project delivery.

Original Risk Residual Risk

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Waitemata District Health Board, Meeting of the Board 12/04/17

Risk: Blood and Body Fluid Incidents (BBFA)

Previous Report Action Current Action

Needleless systems: Rollout continues to progress into other areas of Waitemata DHB. Deep dive audit scheduled for April 2017. Complete: 65%

Needleless systems: Progress continues and full implementation will be reported following deep-dive audit scheduled for April. Complete: 70%

Residual Risk: Nil change

Original Risk Residual Risk

Risk: Hazardous Substances and New Organisms (HSNO)

Previous Report Action Current Action

HSNO audits continue to progress on-target, with great progress being made in high use/volume areas that have undergone audit to date. Audits Complete: 18% The Waitakere Hospital Hazardous Goods Store is being retendered to end February. Complete: 10% New Action: Due to the time taken to complete the hazardous goods tender process, a short term option to house hazardous substances has been identified. A currently unused building on the Waitakere Hospital grounds has been assessed as meeting short-term requirements, provided we stay under set maximum volumes, otherwise the building would automatically be classed as a Hazardous Goods Store and would not be compliant. Complete: 30%

HSNO audits continue to progress on-target. Audits completed: 25% Tender evaluation is underway. Complete: 10%

Residual Risk: As the audit project and hazardous goods store progresses and each area becomes compliant, this residual level of risk will reduce.

Original Risk Residual Risk

Risk: Contractor and Procurement Management

Previous Report Action Current Action

Facilities are now working through the process of matching our own registers and information with the fields available within the Auckland DHB Asbestos Register, to ensure compatibility. Complete: 60% A Facilities and Development Health and Safety Manager has commenced work and OH&SS are collaborating closely with him to fast-track project and system implementation. Complete: 80%

This work is waiting on the employment of a dedicated Asbestos Coordinator. Recruitment is currently underway. Complete: 60% Collaborative work continues with processes and systems already being updated to ensure communication and tracking of requirements. Complete: 85%

Residual Risk: Nil change.

Original Risk Residual Risk

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Waitemata District Health Board, Meeting of the Board 12/04/17

Risk: Manual and Patient Handling

Previous Report Action Current Action

Manual handling incidents reducing so audit may not be needed, however each incident will continue to be reviewed. Complete: 10%

Joint meetings with managers to discuss moving and handling requirements, including training, has commenced, to provide support to services. Complete: 20%

Original Risk Residual Risk

Risk: Health and Wellbeing (stress, fatigue and depression)

Previous Report Action Current Action

Planning has commenced regarding project prioritisation. Work on the current projects:

Well at work expo

Summer events

Walking challenge

Diversity fund

Mindfulness and wellbeing sessions

Health assessments Complete: 20%

Progress continues across all identified projects. The Well@Work expo was at North Shore (28 March), Mason Clinic (28 March) and Waitakere (30 March). The Fitness Hub at Waitakere Hospital was launched on 24 March. Complete: 30%

Original Risk Residual Risk

Risk: Physical environment (ventilation, lighting and equipment)

Previous Report Action Current Action

All recommendations to improve the helipad have been accepted and a project manager is being allocated by Facilities and Development to arrange the required works. Complete: 60% Loading Docks: Awaiting final costs from Facilities and Development Project Manager. Complete: 40%

The project has been delayed due to questions about proximity to the Clinical Skills Centre and type of helicopter the pad should take. Questions are now resolved for the medium term and the project can now resume with agreement reached to allocate a Project Manager to quickly progress this work. Complete: 65% A new Project Manager has been allocated and progress is expected within the next month. Complete: 45%

Residual Risk: The residual risk remains the same at present until we complete some environmental projects and get regular environment reviews underway.

Original Risk Residual Risk

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Page 51: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Risk: Slips trips and Falls

Previous Report Action Current Action

Non-slip flooring: Replacement work continues. Complete: 90% Staff communications: ACC have notified us that their communications will not be ready until mid-next year, so we have begun developing our own strategy and will engage with Communications to assist us with this. Complete: 65%.

All entry way flooring has been replaced with non-slip in main Waitemata DHB owned facilities. Complete: 100% Staff communications: Slip, Trip and Fall posters have now been completed and are currently being rolled out across Waitemata DHB. A copy is attached as Appendix 2. Complete: 80%

Residual Risk: The residual risk has dropped for entryways, however this makes up a small proportion of overall slip, trip and fall events, requiring the residual risk to remain the same. As staff communications are developed and delivered, it is expected that this residual risk will fall.

Original Risk Residual Risk

4. Stakeholder feedback 4.1 Funding, Planning and Outcomes Nil to report this period 4.2 Regulatory Bodies Nil to report this period. 4.3 Health and Safety Impacts on Waitemata DHB stakeholders Contractor incident reporting We have communicated to other PCBU’s working at Waitemata DHB that they are to advise us of incidents occurring on our site. We appreciate it may take time for all PCBU’s to change their processes, and as such the number of incidents may not accurately reflect what is occurring, however we will be closely monitoring our expectations in conjunction with the relevant Contract Managers. Incident investigation Investigating incidents, whether those incidents result in injury or near misses, is an important contribution to keeping our staff, patients, visitors and others safe. Investigations allow us to understand root cause, suggest appropriate hazard and risk management controls, as well as applying learning in the service and across the DHB. Incident investigation follow-up has now been instigated for all relevant incident reports. This requires that all managers are given clear instructions on what type of investigation to carry out, a timeline for completion and that OH&SS are to receive a copy of all relevant investigation documentation and approve it before incident reports are closed. Our incident reporting system, RiskPro does not allow for a suitable investigation close off process, however we have added two additional fields to the incident form, which OH&SS staff fill out only when they are satisfied that all actions have been undertaken. We are able to run a weekly report on any incident reports closed without these fields having been completed. This allows us to proactively reopen incident reports and follow up with the relevant manager. Current timing requirements and escalation process are as follows:

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Page 52: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Non-urgent incident investigations are to be completed and submitted to OH&SS within 10 working days.

Urgent incident investigations, such as those resulting from a notifiable event, are to be completed and submitted to OH&SS within five working days.

If the deadline is missed by the manager, an additional three working days will be allowed and a copy sent to Group Manager, Occupational Health and Safety.

Should the second deadline be missed, the incident will be officially escalated to Group Manager, Occupational Health and Safety for direct follow-up and notification to relevant General Manager.

All new processes have been documented and we will monitor their effectiveness over the next few months.

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Page 53: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

5. Staff Reported Incidents

6. Notifiable Events

The DHB noted 0 notifiable events in February 2017.

Rolling year-on-year monthly

average comparison:

Previous 12 months – 117.75

Current 12 months – 134.83

Current Period:

The number of reported incidents

by staff during the month of

February 2017 was 102.

Rolling 12 month analysis:

The number of reported staff

incidents now seems to have

stabilised, with little notable change

over the last two reporting periods.

Factors that reassure us the number

of incidents themselves are not a

concern includes the indicators for

claims, injury frequency and injury

severity, which are heading down or

stable.

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Page 54: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

7. Top Incident types that cause harm

The main types of incidents that cause harm to our staff and their management are outlined in the following tables. 7.1 Aggression

Rolling 12 month trend analysis: Since August 2016, we have been experiencing a downward trend in aggression related incidents. Incidents for February In February we saw several incidents in the Medical and Mental Health and Addictions service. In the Medical services 1 patient generated several incidents over one week while needs an appropriate care plan created. In Mental Health and Addictions Services acuity remains high with several patients requiring high levels of 1:1, 2:1 and 3:1 care.

Rolling year-on-year monthly

average comparison:

Previous 12 months – 22.92

Current 12 months – 40.50

Actions:

Keeping patients and staff safe and ensuring patients receive appropriate clinical care is the key action to managing aggression incidents. Services use assessment, therapeutic and low sensory tools to support these care interventions. In addition, the DHB is continuing to work on the nine Security Review Project workstreams, and we encourage and appreciate staff continuing to report incidents for service review. A review of hospital based clinical reception areas is due in May.

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Page 55: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

7.2 Slips, Trips and Falls

Rolling 12 month trend analysis: Slips, trips and falls are very much driven by changes in weather, with wet period leading to higher incidents. A message for staff not to text and walk has been circulated as inattention is a high factor in falls. New posters to raise awareness of this risk have also been developed and are being distributed across Waitemata DHB.

Rolling year-on-year monthly

average comparison:

Previous 12 months – 15.58

Current 12 months – 14.50

Current period:

The 10 Slips, trips and falls in

February were categorized as

being caused by: environment

(3), polished/greasy surface (1),

inattention (5), and work

practice (1).

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Page 56: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

7.3 Moving and Handling

Rolling 12 month trend analysis: Moving and handling (M&H) related injuries to staff continue to be closely monitored and investigated. This month we have seen our lowest ever number of reported incidents over a two year reporting period. The combined efforts of the clinical and training teams are to be commended for these results. The systems approach used by the Waitemata DHB M&H team integrates risk assessment of the tasks and environments, patient presentations (needs and feedback) and incident investigation into training content and process planning. Collaborative work between OH&SS and M&H for staff injury and incident reporting allows for better investigation and potential solutions from the M&H team. As participation increases across the organisation, for example developing more M&H educators, we are likely to realise the optimal use of equipment and improve patient outcomes. Managers are encouraged to report incidents, especially near misses, so M&H and OH&SS can best support the reduction of risk in those areas. Patients requiring moving and handling assistance, special needs e.g. larger patients and those at risk of falls, will benefit from this decreasing trend in incidents and injuries.

Rolling year-on-year monthly

average comparison:

Previous 12 months – 9.50

Current 12 months – 6.75

Current period:

Both of the incidents recorded in

February were categorized as

sprain/strain.

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Page 57: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

8. Health, Safety and Wellbeing Activity

8.1 Occupational Health Influenza Vaccinations - 2017 The flu vaccination campaign began on Monday 20 March, a week earlier than previous years, to ensure as many staff are vaccinated prior to the Masters games in April and to capture staff before they go on annual leave during school holidays, which falls in the middle of the campaign. We are very fortunate to have started our flu campaign a week early this year. Increasing the timeframe of the campaign by an additional week means we have administered 1,100 vaccinations earlier into the flu season. We expect that the number of staff vaccinated will increase substantially over the next month, as in-team vaccinators become active. Additional staff communications are also being distributed to assist in creating a sense of urgency, especially in light of the fact that we have already seen our first influenza hospital admissions for the year. 8.2 Training Requirements We continue to work with Learning and Development training schedules for all staff. Dates for Board level are being confirmed and a verbal update will be provided at the Board meeting. Manager training is continuing, with all managers who have not attended so far being directly contacted to make them aware that the training is compulsory. 8.3 Bowtie Risk Assessment At a previous Board meeting, the DHB was asked to consider completion of a bowtie risk assessment. The bowtie risk assessment is an analysis of causal links, controls and consequence of a major risk or incident. Application of the bow tie approach for all DHB risks is not feasible, however, we will develop a systems based representation in the July Board report. 8.4 Health and Safety Representative Training Leading Indicator As requested in the previous meeting, we have taken a close look at the Health and Safety representative Training leading indicator provided within the scorecard, with the aim of understanding if an increase to 100% would be possible. The main challenge is that Health and Safety Representatives often turn-over very quickly, sometimes within a period of weeks, so ensuring they are trained within this short timeframe is not possible. It is suggested that a KPI of 100% would be achievable if we include a prerequisite time in role to qualify. From the June 2017 report a 100% target for this indicator will be set for all Health and Safety Representatives who have been in the position for five months, as this would ensure that those that stay only a very short time are excluded and only those that we physically have a chance to train are included. 8.5 Hazardous Substances and New Organisms (HSNO) Update Work has been progressing extremely well in this area and an update has been provided as part of the HSNO presentation which is also attached as Appendix 3. 8.6 Health and Safety Hero Award A new Health and Safety Hero Award process has now been implemented and included within the existing Chief Executive Officer Health Hero Award programme as a separate category. This award is to recognise outstanding contributions from staff and to raise awareness of Health and Safety across Waitemata DHB. All staff are eligible to apply for this award, either on behalf of themselves, or to nominate other staff members.

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Page 58: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Appendix 1

Glossary for Monthly Performance Scorecard and Report

Lost time incidents Any injury claim resulting in lost time.

Lost time injury Frequency Rate No of lost time Injuries per million hours worked.

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

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

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.

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

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Page 59: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

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.

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.

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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Page 60: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Slips, Trips and FallsFalling down the

stairs isn’t much fun, so make

sure you have one hand

on the rail

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Appendix 2
Page 61: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Slips, Trips and Falls

Don’t assume someone else

will take care of that wet floor,

make it safe yourself!

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Page 62: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Slips, Trips and Falls

Shoes that slip are

great for ice-skating, but

not so good for work.

Non-slip soles are much

better

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Page 63: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Slips, Trips and Falls

Reading messages on a mobile

phone is really convenient, just

not when you’re walking!

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Page 64: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Slips, Trips and Falls

The floor may be a

convenient place to leave

that box, but will the next

person walking along see it

before they trip over it?

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Page 65: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Introduction • What is HSNO?

– HSNO stands for Hazardous Substances and New Organisms Act 1996 – it is used in the industry to pertain to chemicals.

• HSNO Classification System

– System to identify the hazards of a particular chemical

– Controls set by the Environmental Protection Authority depending on classification

• HSNO Coordinator and Hazardous Substances Health Monitoring Advisor

– Working to provide guidance on the use, storage, and disposal of chemicals across the WDHB.

– Working in accordance with HSNO regulations and Health and Safety at Work Act.

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Page 66: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Hazardous Substances at WDHB

• Healthcare environments have among the highest number of hazardous substances of any industry segment

• Sample preservatives, disinfectants, solvents, agrichemicals, cleaning agents, laboratory reagents, fuel, cleaning , gardening products, pool chemicals, aerosols etc

• WDHB 33 High Risk Areas have been established and prioritise based on the

risks posed by the quantity and/or the type of hazardous substance and/or the nature of the work environment

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Manage hazardous substances across its lifecycle in the DHB (Procurement, Storage, Use, Disposal)

• HSNO Assessments/Audits and Task Observations

• WDHB Resources

– HSNO Staffnet – HSNO Database – Support, consultation, training – Developed additional tools (Inventory tool, Hazardous Substance Risk assessment tool, OHSS Hazardous Substance Assessment, Tracking Record, Training Record)

• Collaboration with Metro DHB

WDHB HSNO Management 3.2

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HSNO Assessment and Task Observation • HSNO Assessments for Regulatory Compliance

– Generally involves site reconnaissance, desktop review, and interviews

– Assess requirements such as: Notification, Hazardous substance location, Emergency Management, Approved Handler, Signage, Secondary containment, Hazardous atmosphere zone, Controlled zone, Tracking, Exposure Management, Disposal

– Uses audit criteria or compliance matrix to “quantify” compliance.

• Task Observation – Exposure and Health Monitoring assessment based on activity and potential to exceed

Workplace Exposure Standards (WES) or Short Term Exposure Limits (STEL) – Assessment on the chronic health effects of a substance i.e., effects that are not

instantaneous but develops overtime

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Page 69: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Hazardous Substances at WDHB

Woodford Garden ICU Wilson Centre Forensics

Outpatients Department Gastroenterology ARDS Surgical Pathology CSSD

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Page 70: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Hazardous Substances at WDHB

• HSNO Database Register up to 357 Chemicals to date: Ranging from sample preservatives, disinfectants, solvents, agrichemicals, cleaning agents, laboratory reagents, fuel, cleaning , gardening products, pool chemicals, aerosols

• Four (4) formal HSNO assessments (audits and reports issued) completed to date:

NSH Laboratory, NSH Renal Care Unit, NSH CSSD, WTH Gastroenterology

• Twenty four (24) sites visited for introduction of role, site reconnaissance, or provide support such as assisting with inventory, HSNO requirements, storage recommendations, and disposal advice.

• Tools developed and under review: Hazardous Substance Risk Assessment Tools Hazardous Substance Risk assessment tool, OHSS Hazardous Substance Assessment, Tracking Record, Training Record

• Thirteen (13) Products assessed and evaluated for use

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Page 71: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

HSNO Audit Results 3.2

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Page 72: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

In Summary • Hazardous substances are an integral part of the hospital operations and when managed

appropriately can minimise the risk posed to safety, human health, and the environment.

• The WDHB uses hazardous substances throughout various aspects of its operation. These substances include a wide range of products: from cleaning products; to sterilising agents; to petrol; and, to cytotoxic substances.

• HSNO Coordinator and Hazardous Substance Monitoring Advisor will continue to provide guidance (and identify opportunities for improvement) on the management of hazardous substances across their lifecycle through audits, assessments, and task observations among others.

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Page 73: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

3.3 Communications Report

Recommendation: That the report be received.

Prepared by: Matthew Rogers (Director, Communications)

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

Communications support for staff flu immunisation campaign

Input into front page design and navigation of new intranet site, including survey of satisfaction with the existing Staffnet platform

Waitakere Hospital Cardiology transition to Huia Ward

Blessing of new Waitakere Hospital Huia Ward extension

CEO Lecture Series presentation by Chief Coroner Judge Marshall

CEO Lecture sponsorship pitch to Johnson and Johnson and Janssen

Draft Living with asbestos general information document

Staff Safety in Community policies

Waitemata DHB Staff engagement survey

Draft Healthy Workplaces Communications Plan

Volunteers recruitment drive

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

Update of organisational charts

Communications support for the Primary Care and Community Services Launch

Communications support for AAA screening programme

Planning for opening of Whenua Pupuke -Waitemata Clinical and Learning Skills Centre

Review of General Surgery department communications

Communications support for Outpatients move to Outpatients -Kāhui Manaaki (Building 5)

Blessing/ opening of Outpatients -Kāhui Manaaki (Building 5)

Communications support for the lifting of toll bars on DHB phones

Communications for primary care to increase non-surgical procedures at ESC

Communications support for the Well @ Work Expo (March 2017)

Communications around the opening of exercise room at Waitakere Hospital (March 24)

Communications support for blessing of new Waitakere ED Paediatric Zone (February 23)

Communications support to Board as Wilson Home Trustee

Communications support for Pukekohe Intermediate Dental Clinic Public Health Notice

Media relations on quarterly national Health Target Performance

Auckland Metro DHBs’ media release on National Investor Confidence ratings

Communications support for the Prime Minister and Ministers’ visit to North Shore Hospital

Managing and chaperoning filming requests

Media relations on the DHB leading nationally in Good Employer criteria for the second year

Review of content for submission to health sector publications

Inaugural Diabetes Awards (February 22)

Support for paediatric outpatients relocation to North Shore Hospital tower block

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Waitemata District Health Board, Meeting of the Board 12/04/17

Communications support for Primary Care Portal project

Communications advice to Traffic Services

Drafting material for the 2016/17 Annual Plan

Planning for Patient Experience Week

Ongoing weekly internal communication via Staffnet and Waitemata Weekly

Liaison with Well Foundation Marketing and Communications

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

Proof-read leaflets, booklets and brochures for various departments

Ongoing social media strategy, activity and issues management

Event photography

Drafting of correspondence from the corporate office

CEO Board Report

Review of copy for DHB website

Management of DHB general all-user screen saver content

Approval for all-user staff emails

Weekly Board briefing

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

Booklet – Growing Stronger together

Booklet – Rangatira Ward

Booklet – Whanau Family Information

Campaign – Clean Hands

Campaign – ESBL

Campaign – ISBAR

Campaign – Patient experience week

Campaign – Slip trips and falls

Campaign – Well at Work expo

Campaign – Staff survey

Card – Mental Health Tell us what you think

Healthlines magazine –Issue 219 February March 2017

Invitation – CEO Lecture series 28 March 2017

Invitation – Waitakere Fitness Hub

Invitation – opening/blessing Whenua Pupuke

Invitation – Waitakere Hospital Paediatric Zone opening

Invitation – opening/blessing Building 5

Invitation – Dinner to meet Harry Burns

Leaflet – Low dose Aspirin

Logo – Whenua Pupuke

Logo – IP and C

Poster – Building Resilience

Poster – Clinical Outcomes

Poster – Clinical waste

Waitemata Weekly, emailed to all staff users

Fortnightly A Note From the CEO email to all staff

Weekly National Health Targets updated and communicated

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Waitemata District Health Board, Meeting of the Board 12/04/17

Waitemata DHB, Careers and Awhina websites – Google Analytics Statistics Waitemata DHB website

Number of visits February 2017 Total visits to this site 43,903 New Zealand 41,634 Australia 721 USA 277 United Kingdom 251

Top areas February 2017 Waitemata DHB staff page 20,750 Home page 14,159 North Shore Hospital 6,493 Waitakere Hospital 2,504 Contact us 2,247 Traffic sources February 2017 Search traffic 73% Direct traffic 22% Referral traffic 4%

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Page 76: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Careers website

Number of visits February 2017 Total visits to this site 14,892 New Zealand 13,057 United Kingdom 591

Australia 275

United States 210

South Korea 77

Awhina Health Campus website

Number of visits February 2017 Total visits to this site 1,176 New Zealand 1,073 Brazil 24 Australia 15 Philippines 15

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Page 77: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

Social media Waitemata DHB Facebook page likes – 2,425* Waitemata DHB Facebook star rating - 4.3/5 (197 reviews)* Twitter – 1,812 followers* *As at 27 March 2017

OIAs received A total of 25 new OIA requests were received between 14 February and 27 March 2017:

M. Taylor - A list and description of Official Information Act requests where a final response was provided for the month of January 2017.

R. Schumann - Funding to individual rest homes and whether amounts exclude funding by the MOH.

(Name withheld) - Information the DHB holds on the requester, including a report on a family member.

(Name withheld) - Copies of emails between a rest home and the DHB in relation to requester's relative.

A. Marett (Labour) - The average wait time to get an assessment by a psychiatrist for a service-user new to a crisis assessment team.

Y. Orton - Service and practice specific documents designed to guide allied health and occupational therapy practice.

A. Marett (Labour) - Patients assessed by a specialist but did not receive surgery.

J. McAllen - Details of devices manufactured in-house for use in surgery.

A. Vailahi (NZ First) - Number of staff employed to develop policy / deliver services to Maori and Pacifica peoples.

M. Atkin - Correspondence in relation to fluoridation since 1 January 2012.

T. Daniel - Information on whether the DHB intends to use a Glen Eden boarding house facility.

A. Vailahi (NZ First) - Details of top 12 suppliers of goods and services since 2014/15.

T. Rice-Edwards (St Thomas of Canterbury College) - Treatment, funding and accommodation of youth inpatients as part of research for the Youth Custody Index 2017.

K. Brown (Radio NZ) - External reports on physical assaults by mental health patients on staff over last two years.

Prof B. Swinburn (Auckland University) - Budget for population nutrition promotion over last three years.

M. Taylor - OIA requests responded to in the month of February 2017.

B. Saunders - Total DHB expenditure per financial year on clinical supplies 2006 – 2016.

K. Brown (Radio NZ) - Information regarding assaults at mental health units on staff and other patients for the past two years.

D. Fisher (NZ Herald) - Details of the provision of food by Compass to patients including reports, complaints and menu plan.

A. Marett (Labour) - Total amount of efficiencies achieved against budget in 2016/17.

G. Inwood - Information related to fees, expenses and payments to a named individual for last three years.

E. Penno (Otago University) - Public funding allocated to Waitemata DHB.

R. Lowik - Treatment injury and compensation details as part of a health law research project by international students.

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Waitemata District Health Board, Meeting of the Board 12/04/17

M. Rickerby / N. Woodhams (MS NZ) - Multiple Sclerosis information regarding number of staff, waiting times and specific appointments.

L. Hopkins (NZ First) - Number of non-clinical contractors employed, salary details and total budget spend per business unit since 2008/09.

Media Clippings - 13 February to 27 March 2017

Positive +

Neutral 0

Negative -

Devonport Flagstaff

Clean bill of health from the PM +

Dominion Post

Devil in details for bowel screening 0

Restraint use ‘cruel inhuman’ 0

End use of tie-down beds 0

Stuck in the middle 0

Mahurangi Matters

Local folk 0

Nor West News

Knitted fiddle mitts helping with delirium +

North Harbour News

Teen author’s continued quest 0

Help for obese kids +

More operations +

North Shore Times

Rent rises hit poorest hardest 0

Specialist assessments +

Inquest date set for teen’s death 0

What’s On – Woman’s health 0

PM tours North Shore +

NZ Doctor

Tamaki GPs brush up connections, share mental health load 0

Stop smoking services (SSSs) in New Zealand 0

Waitemata pilot, harsh lessons for national bowel screening planners -

General practice home for test of whanau-style diabetes care 0

Therapy time for Auckland PHOs 0

Six out of 20 join ‘national’ contract pursued under Ryall 0

Levy orders Auckland PHOs to shape up, or face ‘alternative’ future 0

Island marae opens doors, hearts to GPs on weekend of learning 0

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

His love is in our children 0

Agonising wait for surgery 0

Darkest days made brighter 0

Couple go on crime spree 0

Shortland Street casts net wide for new little star 0

Our boy is not going to die twice 0

Seven rob dairy 0

Devoy hits back at abusers of Asian kiwi 0

Freak mishap sidelines Adele fan 0

NZ Nursing

Professional Development 0

Patient handling – getting it right for both staff and patient 0

The nursing blues: are we caring enough for our carers 0

Otago Daily Times

Cancer diagnostic company burns shareholders’ cash 0

The Press Christchurch

Devil in details for bowel cancer screening 0

Bowel cancer screening 0

Suicide attempts increasing -

Treatment in prisons ‘inhuman’ 0

Waikato Times

Fiddle mitts produce a win/win +

Inmate restraints ‘inhuman’ 0

Hospital’s hands tied over dud recruiter 0

Western Leader

Knitted mitts a hit +

Million dollar mission 0

Open day 0

Emergency dental 0

Waitemata health services results +

Yes we care campaign 0

TOTAL:

Positive + 9

Neutral 0 38

Negative - 2

Total items 49

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Waitemata District Health Board, Meeting of the Board 12/04/17

4.1 Financial Performance

Recommendation:

That the Board:

a) Note the content of this report, with particular reference to the relative financial results in the Provider and Funder division, and the plans to improve financial performance.

b) Receive the following reports:

1 Executive Summary and key themes 2 Financial Overview of the 2016/17 result 3 Financial Performance - DHB Arms 4 Financial Performance - Other Indicators/Trends 5 Capital Expenditure 6 Financial Position 7 Cash flow Position 8 Treasury

Prepared by: Rosemary Chung (Deputy Chief Financial Officer - Corporate) and Simon Watts (Deputy Chief Financial Officer - Provider) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary

ACC - Accident Compensation Commission ADU - Assessment and Diagnostic Unit ARDS - Auckland Regional Dental Service CT - Computerised Tomography DHB - District Health Board hA FPSC - healthAlliance Finance, Procurement and Supply Chain GFA - Governance and Funding Administration RFP - Request for Proposal RMO - Registered Medical Officer SPAR - Specialist Paediatric and Adolescent Rehabilitation YTD - Year To Date

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Page 81: BOARD MEETING - waitematadhb.govt.nz · Lead Reviewer - State Services Commission, Performance Improvement Framework 01/03/17 Max Abbott Pro Vice-Chancellor (North Shore) and Dean

Waitemata District Health Board, Meeting of the Board 12/04/17

1. Executive Summary and key themes The DHB continues to operate within its financial budget and is on track to deliver a on budget result at year end (which is a surplus of $4.5m). The Provider, however, continues to operate in deficit with a YTD (February 2017) unfavourable variance to budget of $8.804m. The Funder is favourable to budget by $8.612m and, the Governance and Funding Arm is $281k favourable to budget. Overall the DHB is $90k favourable to budget. The key variables affecting the Provider result continues to be other direct costs including outsourced services, clinical supplies and infrastructure and non-clinical supplies that are costing more than the savings that are resulting from personnel vacancies. Efforts to manage high levels of overtime, sick leave and outsources personnel usage have had some success, but the unfavourable result will not be reversed by year end. Clinical supplies, utilities (water and power) and infrastructure maintenance (including the cost of diesel spill cleanup) continue to challenge the result. In addition to this savings targets booked into budgets more than explain YTD variances. The Provider Arm has work in progress currently to enable it to obtain financial sustainability. Work streams have been organised into key areas of focus and include tactical savings opportunities as identified by the services; benefits from procurement supply chain and capital projects and larger, multi-year strategic responses to the Provider Arm performance leveraging off work completed by Deloitte. Examples of these streams include:

Review of acute patient flow opportunities

Review of outpatient clinics and follow-up appointments

Review of the Radiology service production plans

Centralised roster systems implementation

Review of theatre service production plans

Within the services, management teams are also actively monitoring performance, and tight cost controls are in place in all key areas of expenditure that include:

Delegation being escalated to General Manager level as required.

External Bureau and all overtime requests being reviewed by the General Manager as required.

Fortnightly reviews of financial performance against plan by Director of Hospital Services, General Manager, Deputy Chief Financial Officer and Clinical leads.

Within the Corporate Service, DHB wide initiatives are being agreed, which include:

Procurement Savings initiatives

Inventory rationalisation and process efficiency

Utility efficiency programme

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Waitemata District Health Board, Meeting of the Board 12/04/17

2. Financial Overview of the 2016/17 result For the month of February, the DHB result is a surplus of $3.016m against a budgeted surplus of $3.008m and is, therefore, $7k favourable to budget. For the month, the Provider Arm is $2.965m unfavourable to budget, the Funder Arm is $2.749m favourable to budget and the Governance and Funding Arm is $223k favourable to budget. For the month the Provider Arm unfavourable variance is driven by Facility and Development infrastructure and non-clinical expenditure. Cost pressures in Acute and Emergency Medicine as a result of acute demand and pricing variation was also a contributing factor. The financial result for the month of, and year to February 2017 compared to the budget is summarised in the table below.

Comment on Major Variances Revenue Revenue is $2.201m unfavourable to budget YTD. The unfavourable YTD variance includes interest revenue $1.9m less than budget which is reflective of a combination of the cash balance and the continuing low interest rates, drug trial and donation revenue of $1.3m which are expected to be recovered in the latter part of the year. This is offset against by a favourable variance for MoH and other DHB funding of $1.5m.

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 132,962 133,316 (353) 1,068,355 1,066,815 1,540 1,600,414 1,600,414 0

Other 3,435 3,314 121 22,465 26,206 (3,741) 39,611 39,611 0

136,397 136,629 (232) 1,090,820 1,093,020 (2,201) 1,640,025 1,640,025 0

EXPENDITURE

Personnel

- Medical 14,287 14,369 82 114,883 117,174 2,291 177,355 177,355 0

- Nursing 19,242 18,670 (572) 152,840 153,823 983 230,930 230,930 0

- All ied Health 8,573 8,669 96 71,088 71,976 888 109,048 109,048 0

- Support 1,422 1,529 107 11,866 12,313 448 18,548 18,548 0

- Management / Administration 5,808 5,886 78 46,424 48,350 1,926 73,480 73,480 0

Total Personnel 49,332 49,123 (209) 397,100 403,635 6,536 609,361 609,361 0

Other

Outsourced Services 6,009 5,482 (527) 50,009 44,459 (5,550) 66,590 66,590 0

Clinical Supplies 9,342 8,702 (640) 76,298 73,184 (3,115) 110,938 110,938 0

Infrastructure & Non-Clinical Supplies 9,798 7,030 (2,768) 73,615 61,727 (11,888) 89,228 89,228 0

Funder Provider Payments 58,900 63,284 4,384 489,965 506,272 16,307 759,408 759,408 0

84,049 84,498 448 689,887 685,642 (4,245) 1,026,164 1,026,164 0

Total Expenditure 133,382 133,621 239 1,086,987 1,089,278 2,290 1,635,525 1,635,525 0

NET RESULT 3,016 3,008 7 3,832 3,743 90 4,500 4,500 0

28 February 2017Reporting Date

FULL YEAR

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Waitemata District Health Board, Meeting of the Board 12/04/17

Expenditure Overall expenditure is favourable to budget by $2.29m YTD. The key variances are summarised below: Personnel Costs ($6.536m favourable YTD) A significant contributor to the favourable variance is vacancies due to positions budgeted in the new financial year that have yet to be appointed. Variances in Personnel Cost categories were as follows: Medical ($2.291m favourable YTD) This favourable variance is primarily driven by staff vacancies.

Nursing ($983k favourable YTD) The Provider services have continued to have a strong drive on monitoring overtime hours which has been a positive contributor to the variance. The favourable variance is offset by unfavourable outsourced bureau costs to cover un-recruited vacancies, watch cover and sick leave which are being actively monitored to ensure appropriate usage. Allied Health ($888k favourable, YTD) This was largely due to vacancies in the Sub Speciality and Child Women and Family services.

Support ($448k favourable,YTD) Management and Administration ($1.926m favourable,YTD) The favourable variance is offset in part by outsourced costs due to contractors currently in place. The variance also includes un-recruited positions and savings. The replacement of contractors with permanent staff is being actively pursued.

Other Costs ($4.245m unfavourable YTD) Outsourced Services Costs ($5.55m unfavourable,YTD) The variance relates to positions to be recruited and vacancies which are covered by outsourced resources. This includes nursing bureau costs largely due to the requirement for unplanned watches. The variance also includes savings targets which have been met in other cost lines.

Clinical Supplies Costs ($3.115m unfavourable,YTD) The YTD variance is driven by unfavourable variances in Hospital operations $1.1m, surgical and ambulatory services $1.2m and Children Woman and Families $408k. Favourable variances have been incurred by medicine and mental health. The favourable variances are offset against planned savings targets.

Infrastructure costs ($11.888m unfavourable,YTD) The YTD unfavourable variance is largely due to saving targets recorded in infrastructure, where the savings are offset in other expense lines.

Funder Provider Payments ($16.307m favourable,YTD) Funder Provider payments for February are $4.384m favourable for the month and $16.307m favourable for the YTD. Funder Provider payments as reported in the Consolidated Statement of Financial Performance table are for all Funder payments to third party providers and includes payments to NGO Providers as well as payments to other DHBs through Inter District Flow expenditure. It does not include payments made to the Waitemata DHB Provider Arm. Commentary

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Waitemata District Health Board, Meeting of the Board 12/04/17

on key drivers of the favourable Funder position is summarised under the Funder Financial Performance section that follows later in the report.

3. 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).

3.1. Provider Clinical Services The Provider Clinical Services result for the month ended February 2017 is $834k unfavourable to budget and YTD is $6,325k unfavourable to budget. The key drivers of the services financial performance are summarised below. Medicine Acute and Emergency Medicine The division is $2.6m unfavourable for the eight months ended February 2017. The volume of dedicated patient watches was favourable to budget for the month; however, on a YTD basis, patient watches have generated an unfavourable variance of $656k. Nursing costs are unfavourable to budget by $738k YTD with acute demand and pricing variations being the significant factors. Registrars and House Officers are unfavourable by $782k YTD, with both over allocations and category variations driving the adverse position. Sub Specialty Medicine The division is $0.3m favourable for the eight months ended February 2017. The favourable result is driven predominantly from vacancies within the Allied Health Service. Surgical and Ambulatory Services The Service is $3.7m unfavourable for the eight months ended February 2017. The unfavourable result is driven primarily by RMO run category increases and over allocations, one-off repairs and maintenance, CT service contracts (Waitakere Hospital) and unmet savings obligations. The service has prepared and is currently executing a recovery plan. The management team is closely monitoring surgical health targets on a weekly basis, and tight cost controls are in place in all key areas of

WAITEMATA DISTRICT HEALTH BOARD

FINANCIAL PERFORMANCE BY DHB ARM

($000's) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUEProvider Arm - Clinical Services 4,183 3,933 249 32,269 31,395 875 47,196 47,196 0 Provider Arm - Corporate & Support Services 68,883 67,956 927 548,478 543,708 4,770 815,952 815,952 0 Governance & Funding Admin Arm 1,306 1,081 225 8,495 8,646 (151) 12,969 12,969 0 Funder 128,871 128,824 47 1,031,843 1,030,593 1,250 762,280 762,280 0 Elimination (66,846) (65,165) (1,681) (530,265) (521,321) (8,945) 0 0 0 Consolidated 136,397 136,629 (232) 1,090,820 1,093,020 (2,201) 1,638,397 1,638,397 0

EXPENDITUREProvider Arm - Clinical Services 50,965 50,131 (834) 416,591 410,266 (6,325) 633,382 633,382 0 Provider Arm - Corporate & Support Services 22,433 19,125 (3,308) 172,218 164,094 (8,124) 229,766 229,766 0 Governance & Funding Administration 1,084 1,081 (3) 8,213 8,646 433 12,969 12,969 0 Funder 125,747 128,449 2,702 1,020,231 1,027,593 7,362 757,780 757,780 0 Elimination (66,846) (65,165) 1,681 (530,265) (521,321) 8,945 0 Consolidated 133,382 133,621 239 1,086,987 1,089,278 2,291 1,633,897 1,633,897 0

NET RESULTProvider Arm - Clinical Services (46,782) (46,198) (584) (384,322) (378,872) (5,450) (586,186) (586,186) 0 Provider Arm - Corporate & Support Services 46,451 48,831 (2,380) 376,260 379,614 (3,354) 586,186 586,186 0 Governance & Funding Admin Arm 223 0 223 281 0 281 0 0 0 Funder 3,124 375 2,749 11,612 3,000 8,612 4,500 4,500 0 Elimination 0 (0) 0 0 (0) 0 0 0 0 Consolidated 3,016 3,008 7 3,832 3,743 90 4,500 4,500 0

FULL YEAR

Reporting Date 28 February 2017

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expenditure with regular reviews by members of the senior management team. Delegations have been escalated to General Manager level, external bureau and all overtime requests are now approved by the General Manager. Elective Service Centre The service is $0.5m unfavourable for the eight months ended February 2017. This financial position has been adjusted to reflect the additional costs anticipated in order to achieve the Surgical Health Target. Work is ongoing to investigate any savings opportunities through procurement arrangements and potential efficiencies in service delivery models. The management team is closely monitoring surgical health targets on a weekly basis, and tight cost controls are in place in all key areas of expenditure with regular reviews by members of the senior management team. Child Women and Family Services The service reported a $154k favourable financial result for the month of February 2017. This favourable position was driven primarily by a new service level agreement with Auckland District Health Board Final sign off of this new Specialist Paediatric and Adolescent Rehabilitation service (SPAR) agreement has enabled the service to make a $187k quarterly funding provision in February. Service activity remains positive overall with Neonatal Inpatients tracking at 76% (February 2017) 96% ,YTD of targeted case weighted discharge, Gynecology electives at 121% (February 2017) and 98% ,YTD and Gynecology acute 100% (February 2017) and 100% (YTD) of target, Maternity Inpatient acute 110% and 114% with Pediatric Inpatient acute 73% and 101% respectively. Mental Health Services The service is $1.352m favourable for the eight months ended 28 February 2017. This is primarily driven by favorable variances in personnel and other direct costs. The personnel variance of $954k YTD is driven by a large number of vacancies in nursing offset by casual staff and overtime cover. There are also vacancies in medical. Other direct costs are favourable by $122k YTD driven by clinical supplies and infrastructure. Clinical supply variance is due to the flexifund for patient’s healthcare and wellbeing in community homes and infrastructure is primarily due to rent. 3.2 Corporate and Support Services The overall YTD result for Provider Support is $2.150m unfavourable. The Corporate and Support Services includes centrally budgeted savings which is the major contributor to the unfavourable variance. The overall result for Hospital Operations is $421k unfavourable for the YTD to February 2017. This is primarily due to unfavourable activity related non-pay costs. This includes the cost of pharmaceuticals and patient meal costs which are unfavourable due to a 1% increase in price for indexation per the terms of the contract plus a further 5.5% uplift in price due to lower than anticipated number of DHBs participating in the national Food Services Agreement. 3.3 Financial Performance – Funder The Funder net result for February is $2.75m favourable for the month and $8.61m favourable YTD. This result represents the totality of the Funder across all its divisions and is inclusive of Funder Provider Arm Services, Funder NGO Services and Funder IDF Services. The net favourable position is mostly a consequence of upsides within the Funder NGO Services. It results from a range of contributing factors which includes budgeted service initiatives not yet fully committed, lower than budget utilisation across the major community demand service categories and one off upsides relating to prior year adjustments. The Funder net position also includes the adverse impact of additional revenue allocations to the Provider Arm which are accounted for within the Funder as additional Funder expenditure and reported accordingly.

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Waitemata District Health Board, Meeting of the Board 12/04/17

3.4 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 0.22m favourable to budget for the month and $0.28m favourable to the budget YTD.

4. Financial Performance – Other Indicators/Trends 4.1 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 eight months to February 2017 is a surplus of $3.832m which is $90k favourable to budget.

4.2 Savings Targets and Initiatives The Savings Initiatives which have currently been identified are summarised as:

Savings Category $000s

Annual Leave Review and Management 700

Overtime reviews 1,000

Other Personnel Initiatives 2,075

Elective Surgery 400

Elective theatre efficiency 320

Waitemata Central 1,100

Revenue Generation 500

Fleet Strategy 500

Procurement 2,000

Supply Chain 1,000

Other Non-Personnel Initiatives 7,787

To be allocated 4,334

TOTAL 21,716

Predicted savings achieved to 28 February 2017 are estimated at $5.171m.

-4,000,000

-3,000,000

-2,000,000

-1,000,000

0

1,000,000

2,000,000

3,000,000

4,000,000

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

2016/17

Waitemata DHB Surplus/(Deficit) By Month

Budget Actual

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Waitemata District Health Board, Meeting of the Board 12/04/17

In this report, a summary of the key initiative being undertaken by the Acute Medicine and Sub Specialty Medicine divisions is included below: The Medicine divisions have made good progress in reducing expenditure on outsourced personnel (specifically Nursing Bureau) in the second half of 2016/17. The key drivers of this performance include the establishment of a dedicated patient watch project team lead by the Head of Nursing, Medicine. The objectives of this project team are to review, analyse, report and take analysis based management actions to ensure the appropriate services/wards have the right bureau resource while maintaining both patient experience and health outcomes. A reporting pack (dashboards) has enabled the relevant multidisciplinary teams (Clinical, Finance, Operations) to identify areas of opportunity and make considerable gains over a short period (expenditure avoidance forecasted to be $0.5-$1.0m in the six months to June 2017). This project is currently being extended to both ED and ADU teams in March 2017, and further benefits are expected to result in the coming months. Supply Chain Initiatives As part of the Northern Region Supply Chain Transformation Project, Waitemata DHB has developed a strategy for the management of inventory across DHB sites. The strategy has classified stock locations by a number of factors including the average unit value of inventory held and the criticality of the service. The DHB intends to use three inventory models – Inventory managed, Inventory Lite (KanBan + scanning) and Iproc. This will assist with standardisation of delivery and stock management approaches. Having developed the strategy, the DHB is now in the process of developing an implementation plan for adoption of the strategy. It is anticipated that savings will be made from stock rationalisation, faster ordering processes, less wastage, and stock outs. For the stock locations where InventoryLite has been implemented, savings have been realised. Procurement Initiatives There are a large number of procurement initiatives in the pipeline which forecast savings. These activities include: Identifying areas for high spend where contracts are required or require renegotiation: Negative pressure wound therapy is a category where there were two contracts with multiple price structures on offer. We approached a panel supplier and negotiated a favourable rent-to-own model. Summary of the clinical evaluation went well, and a business case is being finalised for sign off. The benefits from changing to competing supplier would be $1.31m over five years. Mobility Aids – Rental Equipment: A draft proposal has been presented to the steering group, which has endorsed a centralised management solution proposed. Proposed Price Increases: There was a price increase proposed by a supplier which we have re-negotiated providing an annualised benefit (avoided cost increase) of $100k and have a short-term agreement put in place to secure the pricing.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Requests for Proposals to Market: The team with the Services is working well with hA FPSC to prepare sourcing briefs to put out into the market. Two of the current projects:

Drinking water solutions: Waitemata DHB has awarded a supplier the contract and are currently undertaking an audit on our drinking water solutions throughout the DHB. We discovered financial opportunity from rationalizing and standardizing. We are currently looking at rent vs. purchase models.

ARDS cleaning contracts: Waitemata DHB currently has a number of expired cleaning contracts. Analysis has been undertaken on the current suppliers to understand time in clinic, and effectiveness of the service. An RFP has gone to market and we are due to have responses by the end of March.

Pharmac Wound Care Introduction: Pharmac have recently concluded a market share agreement within the Wound care category. The team has implemented the opportunities under the new contract with an expected annualised savings in excess of $100k. Pharmac surgical gloves reductions and rationalisation: Pharmac have recently concluded panel agreements within the category. This is estimated to provide $85K annualised savings.

5. Capital Expenditure Capital expenditure planned for the 2016/17 year is $74.926m. The table below summarises performance against the capital expenditure budget for the month and for the year.

Note: The Full Year Budget is based last filed DAP. As at February 2017, capital expenditure YTD is $7.376m below the plan. The majority of spend has been incurred on three large facilities capital projects. These are Community Building 5 refurbishment, the Learning Centre, and Mason Clinic 15 Medium Secure Units.

6. Financial Position The financial position as at February 2017 is shown below. This indicates a strong balance sheet, with net worth of $616.439m including $58m in cash. During February 2017 Crown Loans of $276,706,000 was converted to Crown Equity under the Government agreed initiative. The detailed Statement of Financial Position for the DHB Parent is provided as Attachment 2.

Actual Budget Variance Actual Budget Variance

Land 0 0 0 0 0 0 0

Buildings & Plant 46,133 3,774 3,833 59 30,767 30,024 (743)

Clinical Equipment 8,664 921 677 (244) 5,037 5,793 756

Other Equipment 4,288 16 237 221 230 3,255 3,025

Information Technology 6,514 1,298 272 (1,026) 3,787 3,954 167

Purchase of softw are 7,240 0 92 92 0 3,412 3,412

Motor Vehicles 2,087 29 165 136 658 1,417 759

Total Capital Expenditure 74,926 6,038 5,276 (762) 40,479 47,855 7,376

YTD (Feb-17)

$'000sFull Year

Budget

Month (Feb-17)

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Waitemata District Health Board, Meeting of the Board 12/04/17

7. Cash flow Position Summary of the cash flow statement as at February 2017 is shown below. The detailed Cash flow statement is provided as Attachment 3.

The DHB’s cash position in the NZ Health Partnerships Limited sweep as at February 2017 is $52.2m (Last month $58.3m). During the month, the DHB repaid its Crown borrowing in exchange for Crown Equity, as approved by the Board. At the repayment date, accrued interest on the outstanding debt was paid. The cash flow budget set at the beginning of the year assumed no such early repayment and accordingly, a net cash negative variance occurred in the month. The DHB also monitors performance in collecting amounts owed by other organisations; the total amount owed to the DHB as at February 2017 was $15.7m (last month balance owed was $17.1m). 58% of this is within the 60 days period (45% of this relates to Ministry of Health and 25% to other DHBs). 42% 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 4.

8. Treasury All Crown Debt was converted to Equity on 15 February 2017. Accordingly, future financial reports will report by exception matters relating to Financing activity, Treasury Policy or financial covenants. Instead, this will be replaced by commentary on forecast cash flow positions, including capital forecasts, health alliance capital position, Crown Funding and asset management. For completeness, the following sections have been completed on the pre-conversion to equity basis.

In $'000sOpening

30 Jun-16

Feb-17

Actual

Feb-17

Budget

Feb-17

Variance

Full Year

Budget

Crown Equity 335,969 616,439 342,445 273,994 342,854

Represented by :

Current Assets 137,311 114,731 116,112 (1,381) 100,487

Current Liabilities 268,032 236,051 253,534 17,483 255,459

Net Working Capital (130,721) (121,320) (137,422) 16,102 (154,972)

Fixed Assets 748,469 768,650 782,270 (13,620) 800,229

Term Liabilities 281,779 30,891 302,403 271,512 302,403

Total Employment of Capital 335,969 616,439 342,445 273,994 342,854

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Waitemata District Health Board, Meeting of the Board 12/04/17

8.1 Financing Activity Term debt drawn and average interest expense and rates are shown in the tables below.

$276.706m of Crown debt was converted to Crown Equity on 15 February 2017. The average interest rates on the loan portfolio are provided in the table below:

All Crown Debt was converted to Equity on 15 February 2017. 8.2 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):

All Crown Debt was converted to Equity on 15 February 2017

MonthTerm Debt

($’000s)

CHFA Interest Expense

($’000s)

Jul-16 276,706 887

Aug-16 276,706 887

Sep-16 276,706 857

Oct-16 276,706 884

Nov-16 276,706 852

Dec-16 276,706 883

Jan-17 276,706 883

Feb-17 0 398

YTD 0 6,531

NZD

Available

Facilities

$000

Drawn

Debt

Current

Drawn

Debt Last

Month $000

Interest

Rate

Current

Interest

Rate

Last

CHFA Fixed $250,996 $250,996 $272,996 3.9324% 3.9324%

CHFA Floating $25,710 $25,710 $3,710 2.2229% 2.2229%

Total Facilities $276,706 $276,706 $276,706 3.7735% 3.7735%

Monthly Weighted Average Interest Cost (Including Hedges & Margin) 3.7735% 3.7735%

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Waitemata District Health Board, Meeting of the Board 12/04/17

8.3 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) 616m 342m Yes

Net Total Debt/(Net Total Debt + SHF) < 65% 5% 49% Yes

ANZ Interest Cover EBITDA/Net Interest (> 1.5:1) 9 11 Yes

CHFA Interest Cover EBITDA/Net Interest (> 2.5:1) 5 7 Yes

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Waitemata District Health Board, Meeting of the Board 12/04/17

ATTACHMENT 1

WAITEMATA DISTRICT HEALTH BOARD

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

Provider

Medical Services 861 972 (111) 18,598 18,033 (565) (17,738) (17,062) (676) 4,203 3,975 (228) 2,432

Surgical Services 892 689 204 13,146 12,677 (469) (12,253) (11,988) (265) 1,197 934 (263) 1,315

ESC (137) (137) 2,154 2,138 (16) (2,292) (2,138) (153) 100 76 (23) 111

Child, Women & Family Services 1,249 1,091 157 6,984 6,981 (3) (5,736) (5,890) 154 937 941 4 1,162

Mental Health 1,319 1,182 137 10,082 10,302 219 (8,764) (9,120) 356 1,263 1,324 61 1,384

Sub Total - Clinical Services 4,183 3,933 249 50,965 50,131 (834) (46,782) (46,198) (584) 7,699 7,251 (449) 6,404

Director of Hospital Services 766 697 69 2,086 1,703 (383) (1,320) (1,006) (314) 937 941 4 4

Hospital Operations 462 349 113 6,112 5,979 (133) (5,650) (5,630) (20) 560 537 (24) 1,037

Facilities 53 51 3 4,234 2,507 (1,727) (4,181) (2,457) (1,724) 94 45 (49) 94

Provider Management 66,446 65,030 1,415 819 (1,418) (2,236) 65,627 66,448 (821) 0 0

Corporate 1,157 1,829 (672) 9,182 10,353 1,171 (8,025) (8,524) 499 385 379 (7) 315

Sub Total - Corporate & Support Services 68,883 67,956 927 22,433 19,125 (3,308) 46,451 48,831 (2,380) 1,977 1,902 (75) 1,450

Total Provider 73,066 71,889 1,177 73,398 69,256 (4,142) (331) 2,633 (2,965) 9,677 9,153 (524) 7,854

Governance & Funding Administration 1,306 1,081 225 1,084 1,081 (3) 223 0 223 95 96 2 100

Funder Arm

Funder NGOs 38,627 40,318 (1,691) 35,307 39,943 4,636 3,320 375 2,945

Funder Inter District Flows 23,397 23,341 57 23,593 23,341 (253) (196) (196)

Total Funder Arm 62,024 63,659 (1,635) 58,900 63,284 4,384 3,124 375 2,749

Consolidated 136,397 136,629 (233) 133,382 133,621 239 3,015 3,008 7 9,771 9,249 (522) 7,954

YEAR TO DATE Full Year

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Budget

Provider

Medical Services 9,275 7,922 1,352 151,996 148,332 (3,664) (142,721) (140,409) (2,312) 1,981 1,988 7 (218,746)

Surgical Services 5,297 5,508 (211) 106,386 102,879 (3,508) (101,090) (97,370) (3,719) 1,115 1,032 (83) (154,205)

ESC (963) (0) (963) 17,445 17,867 423 (18,408) (17,867) (540) 91 86 (5) (25,287)

Child, Women & Family Services 9,163 8,742 421 58,347 57,694 (652) (49,183) (48,952) (231) 886 920 34 (74,966)

Mental Health 9,497 9,222 275 82,418 83,494 1,076 (72,920) (74,272) 1,352 1,230 1,312 83 (112,982)

Sub Total - Clinical Services 32,269 31,395 875 416,591 410,266 (6,325) (384,322) (378,872) (5,450) 5,302 5,338 36 (586,186)

Director of Hospital Services 6,198 5,576 622 17,232 15,212 (2,019) (11,034) (9,637) (1,397) (2,543)

Hospital Operations 3,961 2,795 1,166 50,139 48,552 (1,587) (46,178) (45,757) (421) 552 537 (16) (70,824)

Facilities 2,537 405 2,132 24,448 20,158 (4,290) (21,912) (19,753) (2,158) 87 45 (42) (29,745)

Provider Management 526,346 520,241 6,105 6,268 (4,395) (10,663) 520,078 524,636 (4,558) 0 0 784,049

Corporate 9,436 14,691 (5,255) 74,131 84,567 10,435 (64,695) (69,875) 5,180 354 378 24 (94,751)

Sub Total - Corporate & Support Services 548,478 543,708 4,770 172,218 164,094 (8,124) 376,260 379,614 (3,354) 993 960 (34) 586,186

Total Provider 580,747 575,103 5,645 588,809 574,360 (14,449) (8,061) 743 (8,804) 6,295 6,298 3

Governance & Funding Administration 8,495 8,646 (151) 8,213 8,646 433 281 0 281 86 96 11

Funder Arm

Funder NGOs 314,558 322,547 (7,989) 302,384 319,547 17,163 12,174 3,000 9,174 4,500

Funder Inter District Flows 187,019 186,725 294 187,581 186,725 (856) (562) (562)

Total Funder Arm 501,578 509,272 (7,694) 489,965 506,272 16,307 11,612 3,000 8,612 4,500

Consolidated 1,090,820 1,093,020 (2,201) 1,086,987 1,089,278 2,290 3,833 3,743 90 6,381 6,394 13 4,500

FTE's

28 February 2017

Net Result FTE'sDirect Revenue Direct Expenditure

Direct Revenue Direct Expenditure Net Result

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Waitemata District Health Board, Meeting of the Board 12/04/17

ATTACHMENT 2

Attachment 2

WAITEMATA DISTRICT HEALTH BOARD

STATEMENT OF FINANCIAL POSITION ($'000s)

30/06/2016 30/06/2017

Actual Actual Budget Budget

Crown Equity

103,015 Crown Equity 379,721 103,015 103,015

273,890 Revaluation Reserve 273,821 273,813 273,813

(42,785) Retained Earnings - Prior Years (40,936) (38,474) (38,474)

1,849 Retained Earnings - 2016/17 3,833 4,091 4,500

335,969 616,439 342,445 342,854

Represented by :

Current Assets

81,631 Bank and Short Term Deposits 52,211 60,182 42,959

47,953 Debtors 54,250 48,200 49,713

1,113 Prepayments 1,553 1,115 1,115

6,614 Inventory 6,718 6,615 6,700

Assets Held for Resale

137,311 114,731 116,112 100,487

Current Liabilities

Bank Overdraft

116,440 Creditors 128,553 117,884 119,620

46,645 Provisions and Accruals 704 620 620

78,898 Staff Related Liabilities - Current 106,538 108,981 109,170

26,049 Term Debt - Current Portion 256 26,049 26,049

268,032 236,051 253,534 255,459

(130,721) Net Working Capital (121,320) (137,422) (154,972)

Fined Assets

612,730 Land, Buildings and Plant (net) 601,239 600,833 594,877

3,660 Leasehold Building Works (net) 3,423 3,751 3,751

39,963 Equipment (net) 34,796 35,426 33,174

76 Information Technology (net) 57 (69) (69)

192 Intangible Software (net) 96 54 (14)

2,784 Vehicles (net) 2,328 2,097 1,813

50,975 Work in Progress 88,621 94,859 121,378

710,380 730,561 736,951 754,910

38,089 LT & Investments in Associates 38,089 45,319 45,319

38,089 38,089 45,319 45,319

Term Liabilities

29,825 Staff Related Liabilities- Term 30,029 42,400 42,400

435 Trust and Special Funds 435 10,435 10,435

251,519 Term Debt - External 427 249,568 249,568

281,779 30,891 302,403 302,403

335,969 616,439 342,445 342,854

Reporting Date 28 February 2017

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Waitemata District Health Board, Meeting of the Board 12/04/17

ATTACHMENT 3

WAITEMATA DISTRICT HEALTH BOARD Reporting Date

CASHFLOW STATEMENT ($'000s)

Month YTD

Actual Budget Variance Actual Budget Variance

Cash flows from operating activities:

Inflows

Crown 139,430 134,805 4,625 1,107,048 1,074,286 32,762

Interest Received 155 155 4,141 4,008 133

Other Revenue 3,515 1,331 2,184 28,278 10,401 17,877

Outflows

Staff 50,325 49,126 (1,199) 397,095 403,294 6,199

Suppliers 17,816 18,987 1,171 169,472 149,300 (20,172)

Other Providers 71,621 62,233 (9,388) 540,535 497,852 (42,683)

Capital Charge 0 0 0 11,692 12,264 572

GST (net) 245 0 (245) 1,264 0 (1,264)

Net cash from Operations 3,093 5,790 (2,697) 19,409 25,985 (6,576)

Cash flows from investing activities:

Inflows

Sale of Fixed Assets 0 0 0 0 0 0

Associates 0 0 0 0 0 0

Outflows

Capital Expenditure 6,038 4,775 (1,263) 40,479 43,847 3,368

Investments 0 0 0 0 0 0

Net cash from Investing (6,038) (4,775) (1,263) (40,479) (43,847) 3,368

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 0

Interest Paid 3,187 928 2,259 8,350 8,424 74

Funds to Deposit 0 0 0 0 0 0

Net cash from Financing (3,187) (928) 2,259 (8,350) (8,424) 74

Net increase / (decrease) (6,132) 87 (6,219) (29,420) (26,286) (3,134)

Opening cash 58,343 57,309 1,034 81,631 83,682 (2,051)

Closing cash 52,211 57,396 (5,185) 52,211 57,396 (5,185)

Closing Cash Balance in HBL Sweep account 52,211 52,211

28 February 2017

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Waitemata District Health Board, Meeting of the Board 12/04/17

ATTACHMENT 4

WAITEMATA DISTRICT HEALTH BOARD Reporting Date

STATEMENT OF ACCOUNTS RECEIVABLES

Ref As % Total Outstanding Current 1 - 30 D 31 - 60 D 61 - 90 D 91 Days + Prior Month

1 ACC 2.1% 336,637.00 308,082.67 7,836.72 3,014.82 2,133.52 15,569.27 928,542.22

2 Accredited Employers 0.0% 4,003.57 3,006.12 0.00 -17.39 20.00 994.84 1,493.96

3 Commercial 1.0% 157,342.24 65,186.91 50,454.05 24,737.72 1,938.87 15,024.69 604,780.73

4 Crown (excluding MoH) 10.5% 1,650,583.82 825,588.96 452,885.54 121,463.00 249,502.74 1,143.58 1,455,631.50

5 DHBS' 33.9% 5,316,400.83 1,408,546.01 704,902.98 183,775.67 86,439.49 2,932,736.68 4,715,394.84

6 MOH 31.3% 4,914,974.55 3,267,588.23 415,184.68 396,680.74 0.00 835,520.90 6,334,960.96

7 Non Residents 21.0% 3,295,490.88 97,970.96 522,233.30 263,635.94 170,745.42 2,240,905.26 3,026,243.96

8 Overseas Govt 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00

9 Patient 0.1% 22,088.22 6,167.68 270.00 1,620.78 0.00 14,029.76 31,190.92

10 Staff 0.0% 1,148.39 0.00 358.80 0.00 0.00 789.59 904.59

WDHB Total 15,698,669.50 5,982,138 2,154,126 994,911 510,780 6,056,715 17,099,143.68

38% 14% 6% 3% 39%

Total Less Nres 12,403,179 5,884,167 1,631,893 731,275 340,035 3,815,809

47% 13% 6% 3% 31%

Total 30+ 4,887,119

39%

28 February 2017

1 ACC 91+ category decreased significantly by 77% due to low invoicing in the month of Feb 17. Consequently,

the total outstanding figure is also significantly lower. A huge portion of the current category will be paid early March 17.3 Commercial $13,275 in the 360+ category is being disputed by Fuji Xerox Ltd.

4 Crown The unallocated payments in the 91+ days are for investigation and checking

5 DHB's For 91+days overdue: CMDHB $344K OPEX cost from 2013-2014 which is waiting resolution. ADHB $2.6M for 61+days -

escalated unpaid invoices to ADHB Finance to pass to the relevant services

6 MOH 31+ days overdue - $1.2M - down by 30% from last month

7 Non Residents $1,602,382 is on a current payment plan. This category of debtors is the most difficult to collection from.

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Waitemata District Health Board, Meeting of the Board 12/04/17

5.1 Minutes of the Hospital Advisory Committee Meeting held on 22 March 2017

Recommendation:

That the minutes of the Hospital Advisory Committee meeting held on 22 March 2017 be received.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 22 March 2017

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 1.35pm

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Max Abbott Kylie Clegg Sandra Coney (Committee Deputy Chair) Brian Neeson Allison Roe

ALSO PRESENT

Dale Bramley (Chief Executive Officer) Andrew Brant (Chief Medical Officer) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Jocelyn Peach (Director of Nursing and Midwifery) Joanne Brown (Funding and Development Manager-Hospitals) David Price (Director of Patient Experience) 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) Sue Claridge (Auckland Womens Health Council) Molly Neilson (Maternity Services Consumer Council)

WELCOME The Committee Chair welcomed those present. He thanked the co-

opted members whose terms had now concluded for their commitment and input to the Committee. The Committee will be looking to integrate internally and externally with stakeholders and the Chairs of the Board Committees will be reporting directly to the Board.

The Committee Chair also thanked the report writers as the quality of

the reporting is superb with a lot of information covered. There has been a move from being a reactive to proactive organisation.

APOLOGIES An apology was received and accepted from Morris Pita.

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Waitemata District Health Board, Meeting of the Board 12/04/17

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 14 December 2016 (agenda pages 5 to 11) Resolution (Moved Sandra Coney/Seconded Kylie Clegg) That the Minutes of the Hospital Advisory Committee meeting held on 14 December 2016 be approved. Carried Actions Arising (agenda page 12 ) There are currently no actions arising.

3. PROVIDER ARM PERFORMANCE REPORT 3.1 Provider Arm Performance Report – June 2016 (agenda pages 13 to 79)

Cath Cronin (Director Hospital Services) and Robert Paine (Chief Financial Officer Head of Corporate Services) introduced the report. Matters highlighted and response to questions included:

Noting that the Faster Cancer Treatment times have been met. It was also noted that the DHB does share what it is doing regionally.

That there are some financial pressures for the Provider Arm, reporting on this matter will be provided to the Committee.

That the ESPI 5 indicator was not achieved in January due to the RDA strike.

That in response to a question about DNA reporting, a further breakdown of data by ethnicity, will be provided to the Committee at its next meeting.

Noting that the ED 6 hour health target results are sustained; contributing to this is a specific related project and the team’s ability to respond.

Noting that with regard to unplanned/unbudgeted maintenance and repairs there had been a number of one-off situations such as the diesel spill at North Shore Hospital.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Human Resources (agenda page 13)

Fiona McCarthy (Director, Human Resources) summarised this section of the report. She noted that overall indicators are within the DHB’s expected parameters and that a deep dive looking at turnover figures has been commissioned to identify indicators and relationship depth. Acute and Emergency Medicine Division (agenda page 33)

Dr Gerard De Jong (Division Head Acute and Emergency Medicine) and Alex Boersma, (General Manager, Acute and Emergency Medicine) presented this section of the report. Matters covered in discussion and response to questions included:

Noting that the Acute Speciality Assessment Pathway clinic in the Assessment and Diagnostic Unit is going well and that it is planned to roll-out the clinic at Waitakere Hospital.

That the Division had achieved the ESPI targets during the RDA strike, which had a significant impact.

Noting that the turnover for the medical wards is impacted by new graduates training and that the medical wards and ED could be reported separately.

That in response to a question about reporting, it was noted that more clinical parameters were being developed with a focus on the quality aspect rather than management.

Dale Bramley (Chief Executive) noted that each Division is developing a set of metrics, which will be reported to the Committee. Frequency of the metrics reporting to the Committee (being quarterly or to each meeting) is to be decided. Specialty Medicine and Health of Older Persons (agenda page 39)

Debbie Eastwood (General Manager, Medicine and Health of Older People Services) and John Scott (Head of Division, Speciality Medicine and Health of Older People Services) presented this section of the report. Matters covered in discussion and response to questions included:

Noting an in-depth review will be undertaken on sick leave within the service. Results of the review will be reported to the Committee.

That with regard to safety and security incidents, education was need to ensure people are selecting the actual category for an incident instead of ‘other’.

That vacancies for the service has reduced from 27 to 16. John Scott summarised the TORU project (page 39 of the agenda). He noted that Dianna MacGregor (Maori Geriatric Nurse Specialist) identified a gap in care and engagement for older Maori residents in rest homes and in linking with Kelston Girls’ College developed an NCEA programme. Maori students from the College now visit Maori residents and earn NCEA credits for spending time with them and supporting them culturally. The Committee acknowledged the work undertaken by Dianna MacGregor and requested a presentation to the Board on the TORU Project.

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Waitemata District Health Board, Meeting of the Board 12/04/17

Further matters covered in discussion included:

That the DHB is funding a significant piece of work, the CARE project with is a programme based in primary care.

That with regards to the Needs Assessment Service, resource has been put in place to address any issues with service delays. The Committee will be provided information on time to assessment.

That regarding Acute Stroke to Rehab, a substantial piece of work is underway within stroke services at Waitemata DHB and regionally. The work will identify treatment changes and evidence around rehabilitation and models of care. A business case will be submitted to the Board later in the year on this matter.

Child Women and Family (agenda page 46)

Meia Schmidt-Uili (Acting Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department, Midwifery) presented this section of the report. Matters covered in discussion and response to questions included:

Noting the Good Start in Life Project - the DHB was pleased to be chosen for the pilot, which is being led by the Minister of Education in collaboration with the Ministry of Health.

Noting that the Gateway Assessment Service has maintained a low number of children waiting.

That in response to a question about the dental incident at Pukekohe Intermediate School, it was noted approximately 2,000 children had been contacted with relatively good uptake for testing. Some parents had declined testing and there were 20 families still to be contacted. The work has been led by Counties Manukau DHB. To clarify dental services, it was noted that Auckland Region Dental Service is a school service for children and Waitemata DHB delivers the service for the region. The facilities are owned by the specific DHB and Waitemata DHB provides the service within those facilities. It was noted that a report will be provided to the Board on this matter.

Mental Health and Addiction (agenda page 53)

Susanna Galea (Acting General Manager, Mental Health) and Alex Craig (Associate Director of Nursing, Mental Health) presented this section of the report. Susanna Galea thanked the Committee following her term as a co-opted member, she noted that she had gained a lot and hoped that she had contributed. The Committee Chair thanked Susanna and noted that the Committee very much appreciated the insights of the four co-opted members during their terms. Matters covered in discussion and response to questions included:

Noting the update on seclusion rates and that the DHB has the lowest seclusion rates in the country.

That an initiative regarding bed planning to 2025 will be reported to the Committee at a future meeting.

Noting that Substance Addiction – compulsory assessment and treatment is now an Act. Work is underway with Funding and Planning around delivery of this Act.

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Waitemata District Health Board, Meeting of the Board 12/04/17

That courtyard work for Adult Inpatient Units is underway and the courtyards are opened. The fencing of the courtyards has been reviewed to ensure people feel contained and safe, whilst reducing the ability to climb over the fences to leave the hospital site.

Susanna Galea introduced the reported special interest highlight ‘prescription and over-the-counter drug misuse: A focus on Codeine.’ Warren acknowledge the report and noted referred to an Australian press release dated 20th December 2016 reporting that the Australian Government Therapeutic Goods Administration had confirmed all medicines containing codeine being classified as prescription. In response to a request, the Committee agreed to pass a resolution for a report to the Board on the implications of moving to codeine being a prescription medicine. Resolution (Moved Sandra Coney/Seconded Max Abbott) That the Board be presented with a paper on the options and implications of moving to codeine being a prescription medicine. Carried

Surgical and Ambulatory Services/Elective Surgical Centre (agenda page 62) Michelle Sunderland (General Manager, Surgical and Ambulatory Services) and Michael Rodgers (Chief of Surgery) presented this section of the report. Michael Rodgers acknowledged and thanked Michelle Sunderland who had resigned from the DHB. Matters covered in discussion and response to questions included:

Noting that the Clinical Excellence metrics reported will be further developed overtime, additional commentary will be provided for context.

Noting that there has been an improvement in measuring the Utilisation of Theatre at Waitakere Hospital.

Provider Arm Support Services (agenda page 74) Robert Paine summarised this section of the report. In response to a question about the food service quality improvement plan, it was noted that the DHB is focussed on improving the service being provided. Resolution (Moved Kylie Clegg/Seconded Max Abbott) That the report be received. Carried

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4. CORPORATE REPORTS

4.1.1 Clinical Leaders’ Report (agenda pages 80 to 87 ) Dr Andrew Brant (Chief Medical Officer) and Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) presented this item. An apology was received from Tamzin Brott (Director of Allied Health).

Andrew Brant summarised the Medical staff section of the report, noting:

The resignation of Dr Peter van de Weijer and steps being taken to fill the vacancies.

That a RACMA (The Royal Australasian College of Medical Administrators) fellow will be assisting to seek the Registered Medical Officer’s perspective and involvement with organisational clinical government activities.

Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) summarised the Nursing and Midwifery; Emergency Planning Systems section of the report. Matters highlighted and response to questions included:

That in May there will be an intake of new nursing graduates with a particular focus on increasing Maori and Pacific graduates.

That work continues on the Care standards with improvements being made.

That planning is underway to cope with the impact of the 2017 World Master Games event commencing at the end of April 2017. It was noted that there will be over 25,000 participants, most of which will attend with one or more family members. Both Allison Roe and Kylie Clegg advised that they could connect Jocelyn Peach with the event management Board to ensure appropriate systems and planning is in place from a DHB perspective.

Resolution (Moved Max Abbott/Seconded Sandra Coney)

That the report be received.

Carried

4.2 Human Resources (agenda pages 88 to 95)

Fiona McCarthy (Director of Human Resources) introduced this report.

In response to question about senior doctor recruitment, it was noted that there had been an unusually low period of time to recruit and that this can be cyclical.

In response to a question about the scholarship programme and a student not completing the programme due to hardship, it was noted that the DHB offers all the assistance it can to support students who may have to defer participation in the programme due to personal circumstances/hardships. Placement on the programme remains open for the student to return if their circumstances change. Resolution (Moved Kylie Clegg/Seconded Max Abbott)

That the report be received.

Carried

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5. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 96 ) Resolution (Moved Kylie Clegg/Seconded Brian Neeson)

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. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 14/12/16

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 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.

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

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

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

3. Human Resources 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.

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

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

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)]

Carried The open session of the meeting concluded at 3.24pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 22 MARCH 2016

COMMITTEE CHAIR

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5.2 Recommendation from the Community and Public Health Advisory Committee Meeting held on 29 March 2017

These minutes were yet to be finalised when the Board agenda was being prepared and will be included in the May 2017 Board agenda.

Recommendation:

That the following recommendation from the Community and Public Health Advisory Committee meeting held on 29 March 2017 be approved:

Ref. Item/Recommendation

3.1 Equally Well Consensus Position Paper

That the Board endorses the Equally Well consensus position paper.

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6.1 Health and Safety Marker Report – update April 2017

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 at 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 DHB has been working on key aspects of the legislation specifically those around employee participation and engagement and work with PCBUs where we share accountability and procurement processes. While updating key policy and work methods, the DHB continues to have an active programme in place to measure and mitigate any resulting or residual risks. To monitor our compliance a number of deep dive audits are scheduled for 2016/17, as well as the roll out of the safe way of working self-audit tool. A summary of our compliance with the Act is outlined below and details are outlined in Appendix 1.

Key

High complies substantially or fully with Act

Good some actions to be completed

Low significant or some key actions to be completed

Topic Level of performance Outstanding actions

1. Policy High Overarching and community worker security policies in final consultation and due to Board in May 2017.

2. Worker engagement, participation, and representation

Good Region work participation agreement still in discussion. Final training framework being finalised.

3. Notifiable events

High

4. Health and Safety Committee

High

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5. Orientation

Good Orientation systems for contractors, volunteers and students being updated or reviewed.

6. Risk Management High

Investigation processes currently being reviewed. Health and Safety IT systems evaluation commissioned in March.

7. Contractors (Facilities, Health Alliance and Information Technology)

Low Work across a number of topics is underway (see Section 7 and 10)

8. Hazardous substances

Low High use areas accounting for 80% of chemicals currently under audit however over 300 sites still to be completed. This is a three year piece of work.

9. Health of workers

Low Comprehensive health monitoring plan in development.

10. Equipment and Maintenance

Interim assessment - Low

Deep dive audit on essential services and infrastructure maintenance underway.

11. Training

Good Health and safety training in place with key components being reviewed.

12. Audits

High Safe way of working self-audit currently is rolled out across the DHB. Audits for hazardous substances underway. Deep dive audits scheduled for 2016/17:

Health and safety incident investigation (audit complete)

Essential services and maintenance of equipment, machinery and infrastructure (audit underway)

Review of approach and controls in relation to the Waitemata DHB high accident types. The high accident types are: o Aggression o Moving and handling o Slips, trips and falls

Community services risk and controls 13. Reporting

Good A health and safety scorecard to allow access to regular reporting is in development.

14. Resources

Good One clinical team leader role still in recruitment. Additional resources in place for the flu vaccination programme.

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2. 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 and medical treatment within 48 hours of exposure. All notifiable injuries or illnesses are to be reported to WorkSafe NZ. Notifiable incident - 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 - 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 implementing the Health and Safety at Work Act 2015

1. Policy The DHB policies have been reviewed and are aligned to the new legislation. Changes and updates to policy will occur over the next few years as new regulations, audits and experimental learnings lead to new processes. Significant policy changes will be endorsed by the Board. 2. 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 307 health and safety representatives throughout the business, most of whom have baseline health and safety representative training, as endorsed by WorkSafe NZ 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 departmental health and safety audit. Representatives also undertake DHB wide health and safety activity such as flushing low use water outlets. Seven health and safety representatives sit on our health, safety and wellbeing committee. Transition training for representatives has been provided and foundation health and safety training is available online.

What is outstanding?

The regional employee participation agreement between the Northern Region DHBs and unions has not yet been signed by the Unions. We are working with the national bipartite group on an agreed way to include other PCBUs (e.g. Compass and healthAlliance) in the agreement.

Ongoing training needs (as part of the new Worker Engagement, Participation and Representation Regulations) are being assessed following the completion of a special project led by Margaret Kamphuis, Specialist Health and Safety Advisor. We are currently working with the metro DHBs to look at region wide representative structures and

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training.

Meeting with on-site contractors to establish health and safety representatives and discuss health and safety matters together are commencing.

Consequences

There are fines for not having appropriate employee participation processes in place.

3. 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.

What is outstanding? There are no outstanding actions, although we note that some of the actions in point 6 will benefit the notifiable event review process.

Consequences

There are fines for not notifying workplace injury or illness as soon as possible after being made aware of them.

4. 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 DHB has an organisation wide Health, Safety and Wellbeing Committee. 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.

5. 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.

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A departmental health and safety induction checklist is sent to recruiting managers.

What is outstanding?

We need to put an Officer orientation programme in place – due May. We need to check orientation processes for students and volunteers and a review of DHB health and safety training (inclusive of students and volunteers) is almost complete and orientation needs will be reviewed as part of the current scoping to put DHB orientation resources on line.

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.

6. 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 online hazard management system where hazards are identified and controls recorded. This is complemented by a corporate risk register where service, division and organisation wide health and safety risks are also recorded, controlled and regularly reviewed. Hazards/Risks are reviewed every 12 months by the divisional lead manager and Health and Safety Representatives. Waitemata2025 design and works 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. Entrance ways have signage to indicate they may be slippery when wet. On wet days, additional signage is displayed to alert patients, staff, visitors, contractors to potential slip, trip and fall hazards. This expectation is audited. CCTVs are active in appropriate places on and around our sites. A hazard and security risk assessment tool is being piloted in Community and inpatient Mental Health settings. Asbestos surveys are ongoing. Regular on site campus audit criteria is drafted and in process of being validated. Resource will then be assigned to start the audits.

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What is outstanding? Confirmation of investigation methodology – due December. Following our first deep dive audit on incident investigations, an investigation method, process and training is being developed and is due for release in March.

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.

7. 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 of 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 main contractor 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 is confirmed as satisfying 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 that does not need to be reported to Facilities prior – they do need to report to area supervisor prior to and post work.

All contractors must have a Waitemata DHB photo ID which will only be issued after completing induction)

All healthAlliance staff and contractors are required to have healthAlliance issued photo identification 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.

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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 required to obtain this ID. The duration of the ID card can be set to cover the estimated time of the project. On the job: Toolbox meetings occur on a scheduled basis. 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. Regular meeting with construction contractors are occurring. Asbestos: Asbestos register is in place and is updated as new surveys are completed. Corrective actions are being implemented to mitigate identified hazards. Asbestos management plans are being developed and implemented. This work is being led by the Waitemata DHB 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. Orientation: Induction material is in place. 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. Accidents and Incidents: Facilities adopted an ICAM concept of investigation that will identify why things went wrong and what actions are required to ensure compliance and keep workers safe. Records gained through incident reviews, audits and investigations are saved as confirmation of active management by the DHB in its role as the PCBU. 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 Project Manager 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. ‘

What is outstanding?

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 June 2017. Waitemata DHB 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. healthAlliance processes: The DHB is working with health Alliance about site orientation, safety and procurement processes. Asbestos: To complete the development of asbestos management plan in line with new regulations.

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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. Meetings: Put in place regular meetings with maintenance contractors

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.

8. 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 340 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.

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.

What is outstanding?

We have another estimated 350 areas to review but a comprehensive audit of the 33 high risk areas are underway. The business case for the construction of a Hazardous Substances Store for Waitakere Hospital is now out for tender. 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

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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.

9. 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 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 however a number of staff still commence work pending their results. A pilot is underway to trial a process 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 and have now extended 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. We provided and maintain workplace heating, ventilation and cooling. Areas with friable asbestos require additional security clearance to gain access. Containers for sharps, hazardous materials and substances are provided on each site. 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. Influenza planning for 2017 is well underway with over 1,200 staff vaccinated. The safe way of working audit tool has completed its pilot at Mason and the audit tool is now being rolled out across the DHB.

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What is outstanding?

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 – due June 2018.

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.

10. Equipment and Maintenance 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 A fast track process is in place to approve maintenance triggered for health and safety reasons. A Board approved funding pool for major Health and Safety purchases has been accrued for activation by the Chief Financial Officer as relevant. Work on updating the helipad area (i.e. safety zone painting, visual and audio alarms and pedestrian crossing) and implementing loading dock safety measures (e.g. safe walkways and barriers) will commence in April on appointment on a project manager. New for April 2017 Work on upgrading the loading dock will commence in April on appointment on a project manager.

What is outstanding?

Alert systems for community workers have completed their RFP and applications are being reviewed.

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.

11. 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 pre commencement and within the first four weeks of their employment. 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

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Waitemata District Health Board, Meeting of the Board 12/04/17

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 online. 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 online and face to face in key areas

Fire Evacuation Training occurs across all DHB areas six 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 provider twice a year for key areas that have identified a need.

Board and Senior Management training on health, safety and wellbeing is due in May.

A DHB wide health and safety training stocktake is complete and we are reviewing training gaps for recommendation to the Senior Management team in 2017. The first analysis of the security training framework has been reviewed and accepted and a detail business case is currently underway.

What is outstanding?

The training framework for security is currently being reviewed. 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

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.

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Waitemata District Health Board, Meeting of the Board 12/04/17

12. 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?

Since early 2015 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 two audits during 2015-2017 which includes community workers and contractor management. Regular external audits of contractor sites are in place. A governance audit is completed annually. An audit programme for 2016/17 has been agreed with Internal audit and includes deep dive audits on essential service maintenance, investigation processes and feedback loops, contractor management, community safety, governance assurance, efficacy of works to improve our three top accident types, and environmental controls. The safe way of working audit tool is currently being rolled out.

What is outstanding? There are 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.

13. 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 and the Audit and Finance Committee. In time reporting will incorporate feedback from the organisational Health, Safety and Wellbeing committee. A new Board Health and Safety Reporting format has been in place since November 2016. New for April 2017 The DHB has commenced commentary on trend drivers in Board reporting to give Board members a view on what impacts our health, safety and wellbeing performance. Board reports now also comment on health and safety impacts on stakeholders including contractors, patients and visitors.

What is outstanding? There are 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.

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Waitemata District Health Board, Meeting of the Board 12/04/17

14. 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. Recommended actions were tabled 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 Health and Safety advisor role

Hazardous substances co-coordinator (1FTE)

Health monitoring nurse specialist (1FTE fixed term for two years)

Health and Safety 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

Health and Safety Manager has been employed by Facilities and Development (1FTE)

Investigator/Auditor (1FTE)

Analyst and reporting specialist (1FTE) What is outstanding?

Complete recommendations from the resource review- first progress report due June 2017.

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.

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Waitemata District Health Board, Meeting of the Board 12/04/17

7 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 Meeting of the Board - Public Excluded (01/03/17)

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 Executive Committee of the Board with public excluded (24/02/17)

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.

3. Minute of a circular resolution of the Board - contract

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)]

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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Waitemata District Health Board, Meeting of the Board 12/04/17

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

4. Minutes of the Hospital Advisory Committee - Public Excluded (22/03/17)

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.

5. Minutes of Audit and Finance Committee – Public Excluded (22/03/17)

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)]

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)]

6. Our Health in Mind 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.

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

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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Waitemata District Health Board, Meeting of the Board 12/04/17

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

7. Waitakere CT 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.

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

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)]

8. Variation and Extension of Contract

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)]

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)]

9. Infusion Pump 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)]

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)]

10. 2017/18 Northern Region Health Plan – Preliminary Draft

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.

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)]

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

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

11. Shared Commercial Banking Arrangements

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)]

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)]

12. Food and Beverage Licence

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)]

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)]

13. Recycling of Capital Invested

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)]

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)]

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

14. Renewal and variation of licence to occupy

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)]

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)]

15. Lease Renewal 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)]

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)]

16. Lease Renewal 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)]

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)]

17. Lease Renewal 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)]

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)]

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

18. Lease Renewal 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)]

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)]

19. Lease Renewal 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)]

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)]

20. Update – Northern Region Long Term Investment 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 Information Act 1982.

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

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)]

21. Leapfrog Programme: Second Phase Update

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

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

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)]

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Waitemata District Health Board, Meeting of the Board 12/04/17

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

22. Board Decisions Implementation 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.

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

As per the resolutions from the open section of minutes of the relevant meetings as they relate to particular items in terms of NZPH&D Act 2000

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