Community and Public Health Advisory Committees Meeting...2012/06/06 · Items were taken in the following order: 2.1, 3.1, 4.1, 5.1, Presentation on Whanau Ora, Presentation on Pharmac

Community and Public Health Advisory Committees Meeting

Wednesday, 06th June 2012

2.00pm

Venue

Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna

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.

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12 i

AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEES (CPHA C) MEETING

06th June 2012

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 2.00pm

COMMITTEE MEMBERS Lee Mathias - Committee Chair (ADHB Deputy Chair) Warren Flaunty - Committee Deputy Chair (WDHB Board member) Lester Levy - ADHB and WDHB Board Chair Max Abbott - WDHB Deputy Chair Jo Agnew - ADHB Board member Peter Aitken - ADHB Board member Judith Bassett – ADHB Board member Pat Booth - WDHB Board member Susan Buckland - ADHB Board member Chris Chambers - ADHB Board member Sandra Coney - WDHB Board member Rob Cooper - ADHB and WDHB Board member Robyn Northey - ADHB Board member Christine Rankin - WDHB Board member Allison Roe - WDHB Board member Gwen Tepania-Palmer – WDHB Board member Tim Jelleyman - Co-opted member Eru Lyndon - Co-opted member

MANAGEMENT Dale Bramley - WDHB, Chief Executive Margaret Wilsher - ADHB, Interim Joint Chief Executive Ngaire Buchanan – ADHB, Interim Joint Chief Executive Debbie Holdsworth - WDHB, Acting Chief Planning and Funding Officer Denis Jury - ADHB, Chief Planning and Funding Officer Margaret Dotchin - ADHB, Interim Executive Director of Nursing Hilda Fa’asalele - ADHB, General Manager, Pacific Health Paul Garbett - WDHB, Board Secretary Naida Glavish – ADHB and WDHB Chief Advisor, Tikanga Andrew Old - ADHB, Medical Advisor – Funding Division

Apologies: Gwen Tepania-Palmer

AGENDA

KARAKIA

DISCLOSURE OF INTERESTS • Does any member have an interest they have not previously disclosed? • Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda?

PART I – Items to be considered in public meeting All recommendations/resolutions are subject to approval of the ADHB and WDHB Boards.

2.00pm (please note agenda item times are estimates only) 1 AGENDA ORDER AND TIMING

2 CONFIRMATION OF MINUTES 2.00pm 2.1 Confirmation of Minutes of the Auckland and Waitemata DHBs’ Community and Public Health Advisory Committees Meeting held on 02/05/12 ....................................................................................... 1

3 DECISION ITEMS 2.05pm 3.1 Public Consultation and Engagement Policy Review ............................................................................... 13 2.15pm 3.2 Results of the Combined Community and Public Health Advisory Committees Meetings Review ........ 25

4 ITEMS FOR INFORMATION 2.45pm 4.1 Community/Consumer Engagement Update ............................................................................................ 43 2.55pm 4.2 Child Health Collaborative Planning Update............................................................................................ 45 3.15pm 4.3 Cervical Screening Update ....................................................................................................................... 49

5 STANDARD MONTHLY REPORTS 3.25pm 5.1 Primary Care Update ................................................................................................................................ 57 3.40pm 5.2 Planning and Funding Update................................................................................................................... 71

6 GENERAL BUSINESS

3.50pm 7 RESOLUTION TO EXCLUDE THE PUBLIC .................................................................................... 79

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12 ii

REGISTER OF INTERESTS

Committee Member

Involvements with other organisations

Last Updated

Lester Levy Professor of Leadership – University of Auckland Business School Chief Executive – New Zealand Leadership Institute Deputy Chair – Health Benefits Limited Independent Chairman – Tonkin & Taylor Chair – Auckland District Health Board Chair – Waitemata District Health Board

04/04/12

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

28/09/11

Jo Agnew Professional Teaching Fellow – University of Auckland Casual Staff Nurse – Auckland District Health Board

12/10/11

Peter Aitken Pharmacist Shareholder/Director, Consultant - Pharmacy Care Systems Ltd Shareholder – New Lynn Pharmacy

01/02/12

Judith Bassett Nil 09/12/10 Pat Booth Consulting Editor – Fairfax Suburban Papers in Auckland 24/06/09 Susan Buckland Self employed – Writing, editing and public relations services

Professional Conduct Committee member – Medical Council of New Zealand Professional Conduct Committee member – Occupational Therapy Board Member – Northern Regional Ethics Committee

12/10/11

Chris Chambers Employee – Auckland District Health Board (wife employed by Starship Trauma Service) Clinical Senior Lecturer – Anaesthesia Auckland Clinical School Associate – Epsom Anaesthetic Group Member – ASMS Shareholder – Ormiston Surgical

20/04/11

Sandra Coney Elected Member – Chair, Parks Committee, Auckland Council 02/05/11 Rob Cooper Board Member – Auckland District Health Board

Board Member – Waitemata District Health Board Chief Executive – Ngati Hine Health Trust Advisory Board Member – James Henare Research Centre, University of Auckland Member – National Health Board Chair – Whanau Ora Governance Group

19/01/11

Warren Flaunty Member of Henderson – Massey, Rodney and Upper Harbour Local Boards, Auckland Council Trustee - West Auckland Hospice Trustee - Waitakere Licensing Trust Shareholder - Metlifecare Shareholder - EBOS Group Shareholder – Pharmacy Brands Ltd Shareholder – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Trustee – Trusts Community Foundation Ltd Member – Health Practitioners Disciplinary Tribunal

09/11/11

Lee Mathias Managing Director – Lee Mathias Ltd Director – Midwifery and Maternity Providers Organisation Ltd Shareholder/Director – Pictor Ltd Director – John Seabrook Holdings Ltd Governance Advisor – AuPairlink Ltd Council member – NZ Council of Midwives Chair – Tamaki Transformation Transitional Board Chair – Health Promotion Agency Establishment Board

09/11/11

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12 iii

Register of Interests continued… Robyn Northey Project management, service review, planning etc. – Self employed Contractor

Board member – Hope Foundation Northern Region Member – University of Auckland Human Participants Ethics Committee

14/12/11

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

02/02/11

Allison Roe Shareholder – Optimisewellbeing.com Founding member – Breast Health Foundation Director – Spiritus NZ Trustee – Allison Roe Trust Founder – Takapuna 2020 Community Group Board member – North Shore Hospital Foundation

28/03/11

Gwen Tepania-Palmer

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

06/12/10

Co-opted Members Dr Tim Jelleyman

Clinical Director, Paediatrics (Child Health Service) Member, Active Clinical Network (ACN) for the Greater Auckland Integrated Health Network (GAIHN) Project

08/09/10

Eru Lyndon Ngati Whatua o Orakei Corporate Ltd Honorary Research Fellow – Auckland University Member – AUT Business School Industry Advisory Committee Te Mata a Maui Law

12/08/11

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12

Auckland and Waitemata District Health Boards

Community and Public Health Committees

Member Attendance Schedule 2012

NAME FEB MAR MAY JUNE JULY AUG OCT NOV

Lee Mathias (ADHB / WDHB combined Committees Chair and ADHB Deputy Chair)

� � �

Warren Flaunty (ADHB / WDHB combined Committees Deputy Chair)

� � �

Dr Lester Levy (ADHB and WDHB Chair) � � �

Max Abbott (WDHB Deputy Chair) � � �

Jo Agnew � � �

Peter Aitken � � �

Judith Bassett - � �

Pat Booth � � �

Susan Buckland � � �

Chris Chambers � � �

Sandra Coney � � �

Rob Cooper � � �

Robyn Northey � � �

Christine Rankin � � �

Allison Roe � � �

Gwen Tepania-Palmer - � � Co-opted members Dr Tim Jelleyman � � �

Eru Lyndon � � �

� absent ^ leave of absence

* attended part of the meeting only # absent on Board business

CONFIRMATION OF MINUTES

Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Meeting 06/06/12

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2.1 Confirmation of the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 02 May 2012

Recommendation: That the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 02 May 2012 be approved.


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Minutes of the meeting of the Auckland DHB and Waitemata DHB

Community & Public Health Advisory Committees

Wednesday 2 May 2012

held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 2.00p.m

PART I – Items considered in public meeting.

COMMITTEE MEMBERS PRESENT:

Lee Mathias (Committee Chair) (ADHB Deputy Chair) Warren Flaunty (Committee Deputy Chair) (WDHB Board Member) Lester Levy (ADHB and WDHB Board Chair) (present until 4.30p.m) Max Abbott (WDHB Deputy Chair) Jo Agnew (ADHB Board member) Peter Aitken (ADHB Board member) Judith Bassett (ADHB Board member) Pat Booth (WDHB Board member) (present until 4.55p.m) Susan Buckland (ADHB Board member) Chris Chambers (ADHB Board member) (present from 2.18p.m) Sandra Coney (WDHB Board member) Robyn Northey (ADHB Board member) Allison Roe (WDHB Board member) Gwen Tepania-Palmer (WDHB Board member) Tim Jelleyman (Co-opted member) (present from 2.22p.m)

Eru Lyndon (Co-opted member) (present until 4.50p.m) ALSO PRESENT: Dale Bramley (WDHB, Chief Executive) (present until 4.30p.m)

Margaret Wilsher (ADHB, Interim Joint Chief Executive) (present until 4.30p.m) Debbie Holdsworth (WDHB, Acting Chief Planning and Funding Officer) Denis Jury (ADHB, Chief Planning and Funding Officer) Andrew Coe (ADHB and WDHB, Group Manager Primary Care) Hilda Fa’asalele (ADHB, General Manager, Pacific Health) Paul Garbett (WDHB, Board Secretary) Naida Glavish (ADHB and WDHB, Chief Advisor, Tikanga) Stuart Jenkins (ADHB and WDHB, Clinical Director – Primary Care) Edith Mc Neill (WDHB, Maori Planning and Funding Manager) Tony O’Connor (ADHB, Engagement and Planning Manager) Andrew Old (ADHB and WDHB, Medical Advisor – Service Integration) Janine Pratt (WDHB, Group Planning Manager) Imelda Quilty-King (WDHB, Community Engagement Co-ordinator) Tim Wood (WDHB, Funding Manager) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

Tracy McIntyre, Waitakere Health Link Margaret Willoughby, Rodney Health Link Lynda Williams, Auckland Women’s Health Council Nicole Coupe, Hapai Te Hauora Tapui


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Lorelle George, Waitemata PHO Lance Norman, Deputy CEO, Waitemata PHO Ella Scanlan, Pacifica Integrated Healthcare Ltd Gayle Sharman, Healthwest Alistair Sullivan, White Cross Nick Swain, ProCare

APOLOGIES : Apologies were received and accepted from Rob Cooper, Christine Rankin and Margaret Dotchin, together with an apology for late arrival from Tim Jelleyman.

WELCOME The Committee Chair, Lee Mathias, welcomed those present. DISCLOSURE OF INTERESTS

There were no additions or amendments to the Interests Register.

With regard to the open agenda, it was noted that for the presentation on Whanau Ora, Eru Lyndon’s role with Ngati Whatua o Orakei Health Services involved a potential conflict of interest. As a presenter of this item, Eru did not participate in voting on the resolution that subsequently resulted.

With regard to the same item, Lee Mathias noted her position as Chair of the Interim Board, Tamaki Transformation Project.

Later in the meeting Warren Flaunty and Peter Aitken declared interests, as Pharmacists, relating to the Pharmac presentation on its proposal to change dispensing rules. With this item it was agreed that as it was a presentation only of a proposal that Pharmac is consulting on nationally, it would be appropriate and useful for them to participate in the discussion.

1. AGENDA ORDER AND TIMING

Items were taken in the following order: 2.1, 3.1, 4.1, 5.1, Presentation on Whanau Ora, Presentation on Pharmac Proposal to Change Dispensing Rules, Public Excluded Items 2.1 and 1.1, agenda item 4.2 (also considered with the public excluded) and lastly, General Business.

2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Auckland and Waitemata District Health Boards’

Community and Public Health Advisory Committees Meeting held on 14 March 2012 (agenda pages 1-12) It was noted that at the start of the minutes, the reference to Peter Aitken as “WDHB Board member”, requires correction to read “ADHB Board member”. Resolution (Moved Gwen Tepania - Palmer/Seconded Warren Flaunty) That with the correction noted at the meeting, the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 14 March 2012 be approved. Carried


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Matters Arising: In response to a question, Margaret Willoughby (Rodney Health Links) advised that the proposed merger between Rodney Health Links and North Shore Community Health Voice is still a work in progress. She would be willing to update CPHAC further at its next meeting. It was noted that the CPHAC Review Report, which had been e-mailed to Committee members for information, would be considered at the 6 June CPHAC Meeting. Tim Wood advised that with regard to the Oral Health items, an active dialogue is still underway with the Ministries of Health and Education.

3 DECISION ITEMS 3.1 An ‘Integrated Locality Approach’ for Health Service Planning (agenda pages 13-26)

Stuart Jenkins (Clinical Director – Primary Care, Auckland and Waitemata DHBs), Andrew Coe (Group Manager - Primary Care, Auckland and Waitemata DHBs), Janine Pratt (Group Planning Manager, Waitemata DHB), Tony O’Connor (Engagement and Planning Manager, Auckland DHB), Andrew Old (Medical Advisor - Service Integration, Auckland and Waitemata DHBs), and Imelda Quilty-King (Community Engagement Coordinator, Waitemata DHB) were present for this item. Stuart Jenkins introduced the paper, noting that key themes included:

• That to successfully integrate health services, a geographical framework needs to be adopted: Auckland Central, Auckland West and Auckland North. The link this provides with local government boundaries also provided the opportunity to engage with other sectors.

• The approach is about transformational change, clinically led but community focussed. It involves information gathering and information sharing to achieve quality improvement.

Matters covered in response to questions or in discussion included:

• Integrated Family Health Centres (IFHCs) – the Minister is encouraging their development nationally. While the general concept is well understood, no one has clearly articulated exactly what an IFHC is. It could be assumed that there will be variance community to community.

• Integrated Family Health Networks (IFHNs) – New Lynn provides a good example. Currently the New Lynn area covers 100,000 residents, with 15,000 in the new IFHC. In the District Health Board’s view, what is involved now is linking the other practices in the area in with the IFHC.

• It was agreed that the use of the word “family” in “Integrated Family Health Network” may convey to some members of the public a narrower view of an IFHN than what is envisaged.

• It was suggested that the engagement questions on patients’ experience of service delivery listed on page 16 of the agenda also needed to provide the opportunity for those fully satisfied with existing service delivery to express that.

• With regard to network privacy concerns, it was noted that checks and balances are in place, but that consumers would need to be reassured about privacy.

• Denis Jury noted that the concept is one of engagement of consumers and the community. That involved getting the right balance between involvement and understanding of what is possible.


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• The PHO role with IFHNs and IFHCs is a matter of current discussion with the PHOs. The Integration Steering Group has put forward some suggested roles, but these had not been finalised yet. The indication received to date from the PHOs is that they are comfortable with the District Health Boards taking the strategic role in determining the network, with PHO involvement being at the operational and implementation levels.

• As an example of how he saw Integrated Health Networks working in practice, Stuart Jenkins suggested clinicians meeting to discuss diabetes issues and being able to utilise a lot of primary care data that to date had been difficult for DHBs to access, providing an opportunity to discuss potential solutions.

• In response to concerns expressed by Nick Swain of ProCare that some of the concepts in the paper had not been discussed by the Steering Group, it was noted that the paper was seen as only a starting point for consultation.

• Eru Lyndon expressed concerns that the needs of high needs communities are missing from the paper and asked the team developing the approach to consider the needs of Maori and other high needs groups to be represented in the structure being set up.

• It was noted that the localities approach had been endorsed by the whole region. The Board Chair and the Committee Chair spoke of an iterative process, with different starting points but where all parties learned from each other as to what works.

• The importance of building on existing connections with local communities was emphasised.

• Requests were made for greater clarity of what is envisaged by the terms “patient centred”, “patient empowered”, “clinician led” and “partnerships” when the development of the integrated locality approach is next reported to CPHAC. Stuart Jenkins noted that “patient centred” and “patient empowered” were not that different to what should already be happening – informed discussion with patients.

Resolution (Moved Max Abbott/Seconded Robyn Northey) That the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees: 1. Note the background and progress made to date on developing a shared locality

approach. 2. Note the linkages across population health, primary care development and

community engagement activity, and the actions to align and coordinate across Auckland and Waitemata DHBs.

3. Endorse the integrated locality approach as outlined. Carried

4 INFORMATION ITEMS 4.1 Licence to Occupy Charges for Subsidised Aged Residential Care Residents (agenda

pages 27 - 30) Denis Jury introduced the report. It was noted that the relevant asset threshold for means testing is $210,000, not $180,000 as referred to in the example in the report. The report was received.


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5. STANDARD MONTHLY REPORTS 5.1 Primary Care Update – April 2012 (agenda pages 31- 44)

Andrew Coe (Group Manager Primary Care, Auckland and Waitemata DHBs) and Stuart Jenkins (Clinical Director Primary Care, Auckland and Waitemata DHBs) were present for this item. Andrew Coe introduced the report. With regard to the Regional After Hours Review he noted that this had not been able to be completed by the end of March, as planned. While a considerable amount of data was now available, there was not quite enough at detail level to make an informed decision. More information had been requested and it was intended to report back by the middle of May. The Committee Chair emphasised the importance of achieving this. Answers to questions included:

• The COPD (Chronic Obstructive Pulmonary Disease) Clinical Pathway (page 37 of the agenda) – work was taking place with GAIHN on how this will be rolled out and managed.

• With the pharmaceuticals optimal prescribing work stream (page 38 of the agenda), the complexity referred to in identifying realised savings from improved prescribing related to only Pharmac knowing dollar costs. This made it difficult to resolve the ongoing debate as to whether there should be rebates to PHOs because of improved prescribing.

Resolution (Moved Lee Mathias/Seconded Jo Agnew) That the report be received. Carried

Presentation – An Integrated Approach to Whanau Development and Maori Health Gains Providing this presentation by Ngati Whatua Orakei were Eru Lyndon, Puawai Rameka, Sharon Hawke, Sean Mahoney and Harry Burkhardt. Copies of the following documents were tabled at the meeting and distributed to CPHAC Members: Ngati Whatua o Orakei Programme of Action May 2011; Ngati Whatua o Orakei – Whanau Ora Service Review by Cranleigh Health (April 2011); Summary Paper re Whanau Ora Centre proposal; brochure - Mai Whanau; and copy of the power point presentation given at this meeting. Eru Lyndon introduced the presentation, advising that it would include some history concerning Ngati Whatua Orakei, Whanau Ora as policy, activities that Ngati Whatua Orakei had been engaged in, and their view of where Whanau Ora can proceed. Kaumatua, kuia and trustees were present to support the presentation. Kuia Puawai Rameka outlined the history of poor health and high mortality for Maori in Orakei and Glen Innes which had led to the establishment of the first Ngati Whatua Orakei Health Clinic, and the very positive impact the clinic had made. Sharon Hawke, a trustee of the Ngati Whatua o Orakei Trust Board, outlined the perspective of the Trust Board and its Strategic Plan, and its success as one of the few providers to lodge a


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successful Whanau Ora tender in the initial tender process. She described Whanau Ora as one of the keys to Tira Rangatiratanga (self determination). Eru Lyndon provided the power point presentation, emphasising key slides. Sean Mahoney outlined the need for a Whanau Ora Centre and the work to prepare a proposal that would be financially viable and led by Ngati Whatua. Eru Lyndon spoke of how Maori health providers have a lot of accountability for Maori health, but don’t have a lot of control. It is important not to perpetuate the marginalisation of Maori. Harry Burkhardt discussed the New Zealand Public Health and Disabilities Act 2000 and what he considered its unintended consequences including a fragmented delivery system for health. Iwi could offer an integrated long term approach, with (30 year) long term contracts and an appetite to deliver the highest quality of service. As Chairwoman of the Te Runanga o Ngati Whatua Board, Naida Glavish declared an interest in this matter. She said that she had a responsibility to support what was being proposed, and certainly did so. Answers to questions to the presenters included:

• The services provided by Ngati Whatua Orakei’s three health clinics are all open to all people living in the local communities, not just Ngati Whatua or Maori. There was also a mix of staff.

• Some of the differences from the PHO Model are that this model is marae based, “our doors are always open”; the strategy to revitalise the community; the availability of traditional healing methods; the energy of wanting to do well for their people; and a model that gets away from arbitrage.

Ngati Whatua Orakei proposed a set of recommendations which were considered. It is noted that DHB management had not had the opportunity to review these recommendations. In discussing the recommendations, the Board Chair made it clear that while he was already on public record as being very supportive of Whanau Ora, he was concerned that these recommendations were very non-specific and when considered by the Board (as CPHAC can only recommend, they can not commit) the Board would need to know what the implications for resource were that would flow from these recommendations. The Board Chair suggested that it would be more useful if there was a more specific proposal with clearly understood resource implications. He also noted the District Health Boards were operating in constrained financial contexts and that in particular the Auckland District Health Board had some acute financial stress and that any new commitments would mean re-prioritising other expenditure (which was possible but challenging). Eru Lyndon advised that it was envisaged that something more detailed would emerge from the discussions with senior management proposed in the recommendations. Resolution (Moved Lee Mathias/Seconded Max Abbott) That the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees recommend to the Auckland District Health Board:

(a) That the Board support Ngati Whatua Orakei’s willingness to partner with the

District Health Board in the provision of health and wellbeing services in Auckland DHB District.


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(b) That the Board support the establishment of a Ngati Whatua led Whanau Ora centre in East Auckland as per Auckland District Health Board’s Maori Health Plan.

(c) That the Board commit senior management to actively work with Ngati Whatua Orakei senior management to identify specific areas where the Board and Ngati Whatua Orakei can work together to realise the bigger vision which both aspire to share for the population of Auckland.

Carried

The representatives of Ngati Whatua Orakei were thanked for their presentation. Presentation – Pharmac Proposal to Change Dispensing Rules

Rachel MacKay (Manager, Schedule and Contract, Pharmac), John Kristiansen (Pharmacy Programme Manager Waitemata DHB) and Tim Wood (Group Manager, Funder NGO, Waitemata DHB) were present for this item. As noted at the start of these minutes, Warren Flaunty and Peter Aitken declared interests in this item, as Pharmacists. The Committee agreed that as the item was a presentation only of a proposal that Pharmac is consulting on nationally, it would be appropriate and useful for them to participate in the discussion. Rachel Mackay acknowledged and thanked Sandra Coney for being instrumental in the establishment and running of Pharmac’s Advisory Committee for many years. Rachel provided a power point presentation on Pharmac’s proposed changes to dispensing rules. Matters covered in discussion and response to questions included:

• Pharmac’s Schedule and Contract Team included a member who is a community pharmacist.

• Rachel Mackay acknowledged that the system was very complex, with many rules, but hopefully they were on the right road to improving them.

• Rachel accepted with thanks an offer from Warren Flaunty to supply her with papers he had written and supplied to Pharmac eight years previously on Stat dispensing.

• With regard to the transactional cost of dispensing reviews, patient by patient, the pharmacist would be doing the assessment using a tool being developed. The assessment was expected to take between 10 and 20 minutes.

• A key objective of the changes was to give pharmacists the ability to focus on patients needing the most help.

Rachel Mackay was thanked for her presentation.

6. GENERAL BUSINESS

The Committee Chair advised of two matters that are being progressed with a view to future reports to CPHAC. Firstly, there is to be a focus on nutrition. There had been a first meeting on this and Lee had asked management to look at a couple of topics. The second issue that had been raised with the senior team was rehabilitation. Auckland DHB has a successful neuro-rehab model which may be worthwhile following for other District Health Boards. In answer to a question, Lee Mathias advised that a recommendation on the appointment of a Pacific Island representative to CPHAC was being considered by the Board Chair and herself,


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but it had been decided to delay this until the review of the Committee in June, in view of concerns over the size of the Committee. It was noted that an update information paper on Child Health Collaborative Planning had been prepared for this meeting but not included in the agenda because of the expected length of the meeting. It was agreed that this be circulated for general information rather than waiting for the June CPHAC meeting. Collaboration in this area is being progressed at Board level.

7. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved Warren Flaunty/Seconded Gwen Tepania-Palmer) 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 item, 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 the Minutes of the Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting with Public Excluded held on 14 March 2012

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 from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Pharmacy Dispensing 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.


Maintenance of the Law The disclosure of information would be likely to prejudice the maintenance of the law, including the prevention of, investigation of, and detection of offences, or prejudice the right to a fair trial.

[Official Information Act 1982 S.6 (c) ]

3. 2012/13 Draft Annual Plan That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official 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) 9ba)]

And that Rachel Mackay, Manager, Schedule and Contract, Pharmac, be permitted to remain in the meeting after the public have been excluded, for the consideration of the item on


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Pharmacy Dispensing, because of her knowledge and expertise in this area, which will be of benefit to the Committee’s consideration of that item.

Carried

The Committee Chair thanked members for their participation. The meeting concluded at 5.20p.m. SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS’ COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 2 MAY 2012 CHAIR


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Actions Arising and Carried Forward from Meetings of the Community & Public Health Advisory Committees as at 28 May 2012

Meeting Agenda Ref

Topic Person Responsible

Expected Report Back

Comment

CPHAC

10/8/11

3.1 CPHAC Terms of Reference – suggested improvements from Chris Chambers to be considered.

Denis Jury, Debbie Holdsworth

CPHAC

06/06/12

Will be included in review of CPHAC.

CPHAC

12/10/11

3.3 Oral Health

- issue of schools declining mobile oral health services to be discussed with the Ministries of Health and Education and reported back to CPHAC

- more detailed information to be obtained on number and type of mobile services visiting schools (primary and secondary).

Vicki Scott, Rachel Mattison

Vicki Scott, Rachel Mattison

CPHAC

06/06/12

CPHAC

06/06/12

Included in June CPHAC Planning and Funding Update.

Included in June CPHAC Planning and Funding Update.

CPHAC 14/12/11

01/02/12

14/03/12

5.1

Primary Care Updates – Information to be provided on: - Funding of Government’s new policy of free after hours visits for under 6’s, how policy will be implemented and funding implications for the regional after hours network. - What occurred with any unspent funds from Te Hononga PHO. - First data release from after hours

project (to be circulated to CPHAC members when ready). To include information on mix of trauma and medical cases if available.

- Report to be provided on outcome

of the Review of After Hours Service.

Andrew Coe Andrew Coe Andrew Coe Andrew Coe

CPHAC 06/06/12 CPHAC 06/06/12 CPHAC 06/06/12 CPHAC 06/06/12

Refer update in June CPHAC Primary Care report. Accounts still awaited - Refer May CPHAC Primary Care Update Refer June CPHAC Primary Care Update for progress on this. Refer June CPHAC Primary Care Update – review delayed but progressing.

CPHAC 02/05/12

1.1 Rodney Health Link and North Shore Community Health Voice – update on proposed merger

Margaret Willoughby / Imelda Quilty-King

CPHAC

06/06/12

Refer item 4.1 on the agenda.

CPHAC 02/05/12

6 Child Health Collaborative Planning – update progress report to be circulated by e-mail

Tim Jelleyman/Paul Garbett

Actioned. Emailed to members 7/5/12 see also report 4.2 on June CPHAC agenda.

DECISION ITEMS

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12 13

3.1 Public Consultation and Engagement Policy Review Recommendation That the Waitemata and Auckland District Health Boards’ Community and Public Health Advisory Committees recommend to the Auckland and Waitemata District Health Boards: That the Public Consultations and Engagement Policy be adopted. Prepared by: Denis Jury (Chief Planning and Funding Officer, Auckland DHB), Debbie Holdsworth (Acting Chief Planning and Funding Officer, Waitemata DHB), Julie Helean (Manager Planning and Service Development, Auckland DHB), Janine Pratt (Group Planning Manager, Waitemata DHB), Tony O’Connor (Engagement and Planning Manager, Auckland DHB) and Imelda Quilty-King (Community Engagement Co-ordinator, Waitemata DHB)

Glossary DHB - District Health Board HQSC - Health Quality and Safety Commission MOH - Ministry of Health

1. Summary An updated Public Consultation and Engagement Policy is presented for the CPHAC committees to recommend for adoption by the Waitemata and Auckland DHB Boards. Consultation is a critical ingredient to inclusive, transparent and robust decision-making. It is thus obligatory for ‘significant’ decisions within the public health sector. Both ‘consultation’ and ‘significant’ are defined in the policy. The policy includes additional criteria: that the DHBs will ‘engage’ their communities on ‘important’ decisions. Both ‘engagement and ‘important’ are defined in the policy. To date, Waitemata and Auckland DHBs have each had a public consultation and engagement policy. Both policies have been reviewed to bring them into line with new legislation and central government policy imperatives regarding both consultation and community engagement, such as the MOH’s Consultation Guidelines and a wide range of HQSC activity. The review has been undertaken collaboratively by Waitemata and Auckland DHBs’ staff..

2. Opportunities and Risks The need to update the Boards’ policies presents an opportunity to make a public commitment to engage our patients and populations on matters that may not be ‘significant’ enough to warrant consultation, but are ‘important’ enough to warrant community ‘engagement’ to ensure that our decision-makers are well informed of consumers’ and other stakeholders’ views. This approach supports the DHBs’ patient and community-centric approach. Legally, the policy may legitimately raise our patients and communities’ expectations for meaningful ‘engagement’ on ‘important’ service improvement and planning and funding activity.

Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting 06/06/12 14

3. Regional and National Implications

Both DHBs existing Public Consultation and Engagement Policies refer to legislation that was repealed in 2011. The existing policies do not refer to the “Service Change” process nor consultation obligations regarding the Northern Region Health Services Plan as outlined in the Operational Policy Framework. Both of these changes are addressed in the recommended policy. The revised policy now states that Auckland and Waitemata DHBs will take all practicable steps to engage and consult in a manner consistent with the other Northern Region DHBs (Counties-Manukau DHB and Northland DHB).

4. Budget Implications

There is an expectation that the costs associated with consulting and/or engaging patients and community representatives in service change and planning and funding proposals is met by project budgets. The policy now says the DHBs will engage in ways consistent with internationally recognised standards of best-practice. Therefore, there is likely to be development costs associated with ensuring best-practice patient and community engagement processes are embedded across our organisations. These costs will be met within operational budgets.

Auckland and Waitemata District GUIDING PRINCIPLES Board Health Boards (Section 2) Policy Manual

CONSULTATION & ENGAGEMENT POLICY

Section: Guiding Principles Issued by: Manager Engagement & Planning File: S 3.1 Attachment Public Consultation and Engagement Policy.doc Authorised by: A&WDHB Chief Executives Classification: PP01/PGP//nnn Date Issued: 26 May 2012

Public Consultation and Engagement Policy Page 1 of 10

Overview

This Document This policy describes principles and legislated responsibilities relating to

Auckland and Waitemata DHB’s engaging and consulting patients and other stakeholders about proposed changes to service funding, design and/or delivery and other DHB activities of public interest.

Topic See Page

Overview ............................................................................................... 1 Introduction ........................................................................................... 2 Associated Documents .......................................................................... 3 Definitions............................................................................................. 4 Consultation & Engagement Principles ................................................ 6 Policy Statements .................................................................................. 7 Central Government Requirements ....................................................... 8 Regional Alignment and Implementation ............................................. 9 Criteria to Assess Important and Significant ...................................... 10

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Board GUIDING PRINCIPLES Auckland District Policy Manual (Section 2) Health Board

PUBLIC CONSULTATION & ENGAGEMENT POLICY

Section: Guiding Principles Issued by: Manager Engagement and Planning File: S 3.1 Attachment Public Consultation and Engagement Policy.doc Authorised by: A&WDHB Chief Executives Classification: PP01/PGP//nnn Date Issued: 26 May 2012

Page: 2 of 10 Consultation & Engagement Policy

Introduction

Purpose To make a public statement about Auckland and Waitemata DHB’s

commitment to principles and legislated responsibilities to engage and/ or consult patients and other stakeholders about proposed changes to service funding, design and/or delivery and other DHB activities of community interest so that the DHBs can factor their views and preferences when developing proposals and/or making decisions. Consultation is a critical ingredient to inclusive, transparent and robust decision-making. It is thus obligatory for ‘significant’ decisions within the public health sector. Other decisions may be of an ‘important’ nature –whereby engagement will improve both the quality of the related decision and strengthen the DHBs’ patient-centric focus. This commitment is thus made in the interests of building relationships of trust with the public to facilitate dialogue about the ways the DHBs can improve health outcomes. In this policy, the Auckland and Waitemata DHBs are making a public commitment to engaging our communities on matters less significant than what is required by legislation.

Scope This policy is applicable to all Auckland and Waitemata DHBs’ Board

members and employees (full time, part time, casual and temporary) and contractors who are involved in any new or proposed change to a funding arrangement or service delivery, or any other matter that requires engagement or consultation. DHB Board members, employees and contractors will implement this policy when: • Consulting patients and other community stakeholders about a

proposed service change as required by the Minister (as per the Service Change - Rules Principles and Processes for DHBs)

• Engaging the wider public and/or key stakeholders about important decisions.

This policy does not apply to employment matters. This policy also applies to all of ADHB and WDHB and extends to their involvement on regional projects.

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Associated Documents

Associated Documents

The table below indicates other documents associated with this policy.

Type Document Titles

Board Policies • Bicultural Policy • Te Tiriti o Waitangi Policy (under development) • WDHB Translation Policy

Memorandum of Understanding

• MOU between the ADHB, WDHB and Te Runanga o Ngati Whatua

• MOU between WDHB and Te Whanau o Waipareira

Planning & Funding

• WDHB Consultation and Engagement Guidelines (available on the WDHB intranet)

• ADHB Consultation Engagement and Consultation Plan template

Legislation • New Zealand Public Health and Disability Act 2000

• Local Government Act 2002 Strategies • NZ Health Strategy 2000

• NZ Disability Strategy 2000 • He Korowai Oranga 2002

Ministry of Health • Operational Policy Framework • Service Change Rules, Principles and Processes for

District Health Boards • Consultation Guidelines for the Ministry of Health

and District Health Boards relating to the provision of health and disability services (2011).

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Definitions

Term Definition Community Community can be defined by place, identity and shared interest. For the

purposes of this policy, a community member is anyone who may be interested and/or affected by a health-related activity, proposal or decision to be made.

Consultation Consultation is identified as part of developing and implementing health and disability services and programmes in section 22 of the New Zealand Public Health and Disability Act 2000 and the Local Government Act 2002. The process includes soliciting public feedback on a proposal and decision-makers being able to demonstrate that they have taken that feedback into account when finalising a proposal. The objectives of District Health Boards under section 22 include:

… (f) to reduce, with a view to eliminating, health outcome disparities between various population groups within New Zealand by developing and implementing, in consultation with the groups concerned, services and programmes designed to raise their health outcomes to those of other New Zealanders: (g) to exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services: (h) to foster community participation in health improvement, and in planning for the provision of services and for significant changes to the provision of services: …

For Auckland and Waitemata DHBs, the term consultation also has a particular meaning with the context of the Treaty of Waitangi and the Memorandum of Understanding with Ngati Whatua. Waitemata DHB also has a particular obligation to consult under its Memorandum of Understanding with Te Whanau o Waipareira.

Engagement Engagement is not a legislated process. It can take many forms and serve many purposes that allow patients and other community stakeholders to inform and/or participate in decisions that affect their health and the development of services that they receive. Informing the community does not, in itself, constitute engagement. Engagement requires dialogue and building relationships.

Important A proposal’s importance is a matter of degree. It needs to be assessed on a case-by-case basis, taking into account the degree of impact and/or opportunity the proposal might have for a service or services, the DHB, its patients, service providers and wider community relative to other activity described for the year in the DHB’s Annual Plan. See the criteria used to assess a proposal’s importance in this policy’s “Implementation” section.

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Significant A proposal’s significance is also a matter of degree. In the community laboratories case, the Court of Appeal held that a proposal’s significance must be assessed in context and objectively, rather than on the fears of a particular group or groups within the DHB’s resident population that a service reduction may result. The Court also found that in the context of a fear of a reduction in service, the closure of a hospital in a particular locality is a matter likely to require consultation (item 327). See the criteria used to assess a proposal’s significance in this policy’s “Implementation” section.

Stakeholder A stakeholder is a person or collective that has something of value at stake that may be affected by a proposal or decision to be made. Who a proposal’s stakeholders are will depend on the subject-matter of the proposal and should therefore be identified accordingly.

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Consultation & Engagement Principles

Principles The principles of engagement and consultation are:

• Acknowledge our Treaty of Waitangi-based relationship with iwi and the MOU between the ADHB, WDHB and Te Runanga o Ngati Whatua

• Acknowledge the relationship between Waitemata DHB and Te Whanau o Waipareira under their MOU

• Assess the importance of the matter from the ADHB, WDHB and our patients, service providers and wider community stakeholders’ points of view

• The scale of engagement and consultation undertaken should correspond to: − The significance or importance of the matter, and − The amount of resources the DHB has available

• Have genuine intent and an open mind • Engage and consult as early as practicable • Engagement and consultation should be aligned to the decision-making

process • Because different communities communicate in different ways, engage and

consult stakeholders in a way that is focused on their needs for meaningful participation.

• Provide clear, comprehensive and balanced information. Use simple language and avoid jargon. We will provide translated material and interpreters and seek advice as to appropriate cultural practices in our consultation/engagement where needed.

• Allow sufficient time for stakeholders to consider the information required to make an informed response

• Close the loop by informing decision-makers and the people engaged and/or consulted about the engagement and/or consultation outcomes

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Policy Statements

Consultation and engagement

Consulting communities about and engaging them in decision-making is an overarching principle of a democratic system of government. Examples of DHBs’ democratic responsibility are included in the NZPHD Act (2000). This means that patients and other community stakeholders should be involved in or have their views factored into significant and other decisions of public interest. When consulting and engaging its patients and other community stakeholders, Auckland and Waitemata DHBs will adopt local and international standards of best practice1.

1 For example, Office for the Community and Voluntary Sector: www.goodpracticeparticipate.govt.nz/ and International Association for Public Participation: www.iap2.org

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Central Government Requirements

Central Government Requirements

This policy is consistent with imperatives established for DHB public engagement and consultation policy by: • New Zealand Public Health and Disability Act 2000 • NZ Health Strategy 2000 • NZ Disability Strategy 2000 • He Korowai Oranga 2002 • The Operational Policy Framework • Service Change Rules, Principles and Processes for District Health

Boards • Consultation Guidelines for the Ministry of Health and District Health

Boards relating to the provision of health and disability services (2011).

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Regional Alignment and Implementation

Regional Alignment ADHB and WDHB will take all practicable steps to engage and consult in a

manner consistent with the other Northern Region DHBs (Counties-Manukau DHB and Northland DHB), particularly with regard to changes to and the implementation of the Northern Region Health Services Plan.

Implementation With regard to consultation, a brief about how patients and other

community stakeholders will be consulted about an important or significant proposal will be presented to the relevant Board Committee for approval before it is implemented. At ADHB, contact the Manager Engagement and Planning in the Planning and Funding group. At WDHB contact the Group Manager, Planning if you have questions about this policy or how to implement it.

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Criteria to Assess Important and Significant

Criteria used to assess “important” and “significant”

If a proposal is assessed as medium (or high) in one or more criteria by the Project Owner’s 2 then stakeholders should be engaged. If the assessment is high in one or more criteria, the National Health Board should also be informed as part of the ‘Service Change” process. The NHB may advise that public consultation is required.

Criteria High Medium Low

If the proposal diverges from strategic direction (district / regional / national), to what extent is it diverging?

What is the likely level of financial impact / benefit (on the DHB and on other DHBs)?

What is the likely level of impact on/ benefit to consumers and care givers?

What is the likely level of impact on/ benefit to service providers?

What is the current and/ or likely level of public interest in the matter?

Guidance Assessing of a project as important or significant should be made within the context of activity for the year in the DHB’s Annual Plan. For instance, an opportunity to make major changes to a high profile service is likely to be more important than proposing an improvement to a low profile service. If a proposed change or opportunity to rethink how a service should be delivered is likely to receive a high degree of interest amongst a range of stakeholders then it is likely to be important enough to require engagement. Also see the NHB’s “Service Change Rules, Principles and Processes for District Health Boards” section titled “Explanation of Terms” as a guide for interpreting whether a proposed change is significant or not.

2 The “Project Owner’s” assessment should be relative to activity in the year’s Annual Plan and informed by the views of the relevant GM/s, Clinical Director/s and the DHB’s owner of this policy.

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Auckland and Waitemata DHB Community and Public Health Advisory Committees Meeting 06/06/12

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3.2 Results of the Combined Community and Public Health Advisory Committees Meetings Review Recommendation That the Committee:

1. Discuss the results

2. Identify key areas to be addressed in a work plan.

__________________________________________________________________________________ Prepared by: Dr Tony O’Connor (Engagement and Planning Manager, Auckland DHB) Endorsed by: Dr Debbie Holdsworth (Acting Chief Planning and Funding Officer, Waitemata DHB) and Dr Denis Jury (Chief Planning & Funding Officer, Auckland DHB)

Glossary

CPHAC - Community and Public Health Advisory Committees DHB - District Health Board

1. Executive Summary The combined meetings format of the Waitemata and Auckland DHBs’ CPHAC committees has been reviewed. 53% of the people who were invited to participate in the survey responded. In summary, the survey feedback shows that, according to the respondents, the range of roles and functions that CPHAC has include: • An expert/ advisory responsibility to the Board and a democratic responsibility to the

communities the members represent, which can be difficult • Obligations to both the Board and Government as defined by statute, policy and strategy,

some of which are difficult to meet simultaneously • Existing as a forum for members to be informed, monitor, debate, formulate

recommendations, and/or make decisions on behalf of the Board and/ or the communities they represent, which can again be difficult to satisfy simultaneously

A response, if any is warranted, would be best determined after, if the Committees consider it necessary: 1. Clarifying what the Committees’ core purpose is, given that the respondents see multiple

demands in terms of their most important roles and functions; 2. Re-considering and/or fine-tuning the Committees’ Terms of Reference.

The Committees’ meeting arrangements, the topics they consider and the kinds of information management provides to them and how management does that could then be tailored/ fine-tuned, if and as required.


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2. Introduction/ Background This paper discusses the feedback received to a review of the combined meetings of the Waitemata and Auckland DHBs’ CPHAC committees. The purpose was to Review the function and benefits of the combined advisory committees [and] should consider the topics discussed compared with other Board committees, the style and form of the papers provided, the key performance information provided and opportunities for streamlining the approach to the committees1.

3. Approach to the review 3.1 Survey Process/ Approval

On 14 March 2012, the combined meeting of the Waitemata and Auckland CPHAC Committees endorsed, with some amendments, a process for reviewing the Committees’ meeting arrangements and effectiveness. As requested by the Committees, a revised draft questionnaire was circulated to the Chairs of the Committees and Boards for approval before the review began. The review process was approved by the Committees on the basis that the questionnaire have fewer questions and that the questions be re-phrased to be more solution-focused and returned to the Board and Committee Chairs for approval. The Committee Chair approved the survey questions. A Committee paper development and approval process question was added at the last minute. 3.2 Online survey, email and interview

The Committee members and managers who regularly engage with the Committees were sent an email (see appendix) explaining the purpose of the review, asking that they complete the online questionnaire, providing a paper explaining the rationale for combining the Committees, and the Committees’ Terms of Reference. A link to the questionnaire was embedded in the email. A follow-up email was sent to the Board and Committee Chairs, CEOs, and CPFOs offering that they could be interviewed, should they prefer. The interview option was limited to those respondents in the interests of clawing-back some time lost finalising and getting approval of the questionnaire. The survey questions were used to structure the interviews.

4. Analysis The purpose of the analysis was to find 1) the most common points made in response to survey questions and; 2) the range of opinions expressed within those points and 3) what the overall messages are and 4) how the Committee could make use of that information. The number of respondents was low which precluded any need for statistical analysis. However, the number of respondents who replied strongly in favour or against some questions gives a strong message that there is an expectation that improvements can be made in some areas and are unlikely to be realised in others. The number of respondents in each type of role (governance or management or joint appointment at Auckland and/or Waitemata DHB) was assessed to see if there was any notable clustering of response by role type and DHB affiliation.

1 Proposed Approach To The Combined Auckland DHB And Waitemata DHB Community And Public Health Advisory Committee Meetings, 10/08/11


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The comment data was analysed by identifying the points most commonly made and the diversity of opinion within those points (i.e. the themes and their sub-themes). The themes and sub-themes are aggregations of the respondents’ explanations as to why they answered yes, no or maybe/I’m not sure. The feedback quoted was selected on the basis that it illustrates what a theme and its sub-themes means. After working through the feedback to the survey questions, the overall messages and the implications of the feedback are offered as points the Committees may find useful to consider when determining, what, if any, action should be taken in response to the review.

5. Response

5.1 Respondents

The table shows how many people in governance or management roles across the two DHBs were invited to respond and how many did respond.

Invited and actual respondents

Role Invited Responded Response rate

(%) Joint A & WDHB Governance

4 2 50

WDHB Governance

7 3 43

ADHB Governance

8 4 50

WDHB Management

8 6 75

ADHB Management

8 5 63

Joint A & WDHB Management

3 0 0

Total n=38 n=20 53%

Most, but not all respondents responded to every question hence the number of respondents to each question varies.

6. Results The survey feedback is discussed under each of the survey’s questions.

6.1 Meeting arrangements

Would changing the meeting arrangements (e.g.: frequency/ length of meeting) help the Committees perform their functions more efficiently and effectively?

Role Yes Maybe/

Not sure No

Joint A & WDHB Governance 2 WDHB Governance 1 ADHB Governance 1 3 WDHB Management 1 5 ADHB Management 3 1 2 Total 3 3 13


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Overall, there is a general sense of agreement that the current arrangements are working well but there are also some points where change could deliver additional benefits.

No – changing the meeting arrangements will not deliver benefits

Timing Several members and managers said that the frequency and regularity is, as a member put it “about right”. A manager said that meeting 6 weekly as opposed to monthly is good/ preferable because it gives senior staff more time to get on with their regular jobs, although another manager notes that more frequent meetings do help keep members in touch with what is a rapidly changing and complex environment.

Focus A CPHAC member said that “the length of time of the meeting should be a discipline to keep discussion focused”. “Focus”, said another member “depends on the ability of the Chair to keep the meeting on track and to ensure members of the committee interact and contribute”.

Yes – changing the meeting arrangements will deliver benefits

Committee’s role/ purpose What the ideal arrangements for the Committee are, depends on what the role or purpose of the Committee is, said a manager. The role/ purpose will determine when meetings are scheduled in the DHB calendar and if any other extraordinary meeting are required of the Committee e.g. for strategic planning.

Flexibility Several members qualified there approval of the current arrangements and several managers said that there should be flexibility so that the Committees can meet when their attention to a matter is most needed. For instance, “The governance role could be more flexible to support management deadlines e.g. signing off the Annual Plan. The meeting schedule is driving the sign-off process rather than the meetings supporting this.”

Regional vis-à-vis Local A couple of members questioned the combined approach. One said that while “[the] present meeting arrangements under the combined committees is suitable as we discuss topics of regional importance … we are not addressing local issues that were previously discussed by this committee … we were elected by the population … to represent them and … this has been somewhat lost”.

Another member said that “It seems to me the format is simply a Clayton's stage along the way towards a single board - and administrative framework”.

Unsure if changing the meeting arrangements will deliver benefits

Frequency A manager noted that “meetings need to be frequent enough to ensure matters for discussion have currency and relevance”.

Papers CPHAC’s efficiency and effectiveness is more determined by the quality of papers prepared for the Committees, replied a manager.


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6.2 Membership

Would changing the Committees' membership (i.e. their size and composition) help the Committees perform their functions more efficiently and effectively?” Role Yes Maybe/

Not sure No

Joint A & WDHB Governance 2

WDHB Governance 3

ADHB Governance 3

WDHB Management 2 3

ADHB Management 5 1

Total 15 0 4

All the members who responded agreed that change would deliver benefits, however it is noticeable that management is somewhat divided as to whether change would deliver benefits.

Yes – changing the Committees’ membership will deliver benefits

Role and responsibilities Several members and managers said that the Committees’ membership could be more purposefully comprised with regard to the role and responsibilities of the Committees. This member noted that the committees should have a more focussed and smaller membership as true advisory committee[s] of the Board. Members should be selected to focus on the statutory requirements of the Committee[s] and [their] Terms of Reference.

Skill-set Several respondents commented on the perspective and skill-set necessary for governance. A manager said that “Must concentrate on governance role and not elevate personal interests. Healthcare is anchored in the scientific paradigm and committee members must understand value of evidence based decision making supported by economic analyses and validated qualitative measurements of sociological impacts”.

Diversity Several respondents, members and managers, noted that representing diversity is a core function of the Committees. A member noted that “One of the absent critical elements in my opinion is the Operational Policy Framework Relationships with Maori. This is the foundation for enabling a common understanding of putting policy into practice within the context of DHBs and Governance”.

In relation to other functions with regard to diversity, a manager suggested that the disabled community could be better represented and that a possible solution was to bring DiSAC into the fold. Another manager said “It’s important to have Pacific representation so that input can be available and given appropriately within the discussion or to perform functions required of the committee”.

Size Many respondents said that there are too many people at the meetings of the Committees. A member noted “that at the last meeting, he counted 22 members and officers around the table. This is too large for good governance”.


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Another member said that “The combined meetings are too big and anyone who understands business knows that this creates bad decision making”.

In addition to decision-making, a member notes that “The effect is to exclude those appointed members who may have special skills.” A manager who thinks there are too many people at the meetings also said that it is “important that authors attend and speak to their papers as required. This makes for tighter accountability”. Not every member or manager who agrees that there are too many people in attendance is sure what a suitable solution is, or if there even is one. A manager said “18 is an excessive number for any Committee meeting - however as the meetings deal with some key areas for both Boards, that may just be a price to be paid for ensuring acceptance of the combined arrangements by both Boards.”

No – changing the Committees’ membership will not deliver benefits

Size A manager who was somewhat circumspect in saying the membership of the committee needs to change: “You are answerable to a large group because there are two DHBs each with conscientious members who feel they need to know about the whole picture and a statute that seems to favour committees of the whole for the 'big' DHB functions. The committees need, primarily, to be effective but they also have a role as sounding boards, especially because of their community responsibility”.

Maybe – unsure if changing the Committees’ membership will deliver benefits

Trade-off A manager who has some misgivings about the number of meetings attendees says that “the benefit of reducing the number of members needs to be weighed up against the loss of capability. A smaller committee maybe easier to run from a chairing perspective. However, size needs to balanced by knowledge and skills of the committee”.

6.3 Topics

The respondents across all role types were split as to whether changing the topics discussed would be beneficial. However, those who replied ‘no’ and ‘maybe’ to this question also suggested improvements. Would changing the topics discussed (regular items include Primary Care Update, Planning and Funding update, KPIs) help the Committees perform their functions more efficiently and effectively?

Role Yes Maybe/ Not sure

No

Joint A & WDHB Governance 2

WDHB Governance 1

ADHB Governance 2 2

WDHB Management 2 2 2

ADHB Management 3 1 2

Total 8 5 6


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There was not a great deal of comment in response to this question, but that is not to say the comment that was made is of any less importance. Some of the open-ended responses to this question sit better amongst the responses to other questions (e.g. style and format of papers) so have been moved accordingly.

Yes – changing the Committees’ topics will deliver benefits

Purpose A manager said that the range of topics and how information is prepared about those topics should be determined in relation to the Committees’ purpose: “The range of suitable topics ties into the Committees’ role. They need to be kept informed to fulfil both their strategic role and BAU role which means necessary topics are FYI, for discussion, for recommendation and for decisions”. A member asked for “More decisions for recommendation rather than papers for information which could be easily circulated without having to be part of the meeting in some cases”.

Standing items A member said that “Collaboration issues could be highlighted in this meeting”. The suggestion might be that it is “collaboration” that is the standing item and the actual paper topic would change from meeting to meeting according to what the “issues” are. Other topics recommended by a manager are “Links with other social agency work. Not sure if whole of system is captured when hospital provider absent. Nor does such absence facilitate discussion about truly innovative approaches to healthcare delivery. Where is patient or community voice?”

The merit and relevance of both the regional and local focus were questioned by several respondents. This member said “I am not the least bit interested in what is happening in Mt Roskill, Tamaki etc, just as I am sure the Auckland members are not interested in the activities of our Health Links etc. Regional items such as Maori Health Care, Asian Health Care, Pacific Health Care and Pharmacy Services are regional and are ideal to discuss at a joint meeting. We must not remove ourselves from our community”.

No and Maybe – changing the Committees topics will/ might not deliver benefits

Range of topics A manager said that the current range is good, but “We do also need a regular item on driving down inequalities and on longer term population health goals. These are missing at the moment i.e. differences in life expectancy, quality of life measures and key population health outcomes desired by the CPHAC”.

Presentation of topic This member makes a point made by several other respondents, that “The 'regular' items are part of the committees' area of accountability. They should be reported regularly - but if there is no particular issue with one or more then members can read their papers and the item will not need extensive discussion”.

Content With regard to selecting and conveying the content about regular topics, the same member quoted directly above said “Good to have the updates but there is not always comment or debate on the topics. It is more important for the committees to have thorough knowledge of these core governance issues than to be entertained by presentations. Personally, I feel that I don't fully understand the links between the DHBs and primary care providers and I don't know enough about improvements or planned improvements in delivery of primary care, so I welcome presentations on those matters”.


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6.4 Style and format of papers

Would changing the style and format of the Committees' papers help the Committees perform their functions more efficiently and effectively? Role Yes Maybe/

Not sure No

Joint A & WDHB Governance 1 1

WDHB Governance

ADHB Governance 2 1 1

WDHB Management 1 1 4

ADHB Management 5 2

Total 9 4 6

Again, the respondents across all role types were split as to whether change would deliver benefits, although Auckland DHB management respondents tended to be more certain change would be beneficial than the Waitemata DHB management respondents.

Yes and Maybe - changing the paper style and format will/ might deliver benefits

The explanations provided by the respondents for their ‘yes’ or ‘maybe/ not sure’ answers raised the same themes.

Medium Several managers and members said that current standard medium – paper – is not ideal and also that there is not necessarily one ideal type. The CPAHC papers and agenda could best based on an electronic medium. A manager said “Papers should be sent electronically and also as hard copy but considerably tighter format. The web site for accessing papers and minutes should be made easier for the public (and those with disabilities) to access.”

A member said “E-papers please; while they may not change the quality of the debate they do save a few trees and plenty of labour.”

A manager noted that, if there are to be templates, there may need to be templates of the same kinds of papers (e.g. information as opposed to decision paper templates) for different kinds of medium (e.g. hard-copy and e-copy).

Template/ standardised structure There were a range of opinions about the usefulness and appropriateness of a template. Committee members asked for a standard format in terms of structure “Papers need to have a standard format and need not be too long but focus in the issues and possible solution options”.

A manager, who also agreed that there is good reason to have a standardised approach, said that “The current format isn’t that clear or fit for purpose. The most suitable format ties into the paper’s role i.e.: as to whether it’s a FYI, discussion, recommendation, or decision paper and the associated information requirements”.

Another manager questioned the value of having a template at all. She said “Not so bothered about a template. Style guides and templates must be flexible since it’s the content that counts, not the formatting”.


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The members, and some managers, asked for a standard format in terms of content too. A member observed that “Papers currently come with sections exclusive to each Board. Papers are becoming more ‘joint’ as the two Boards become more integrated. The single Primary Care Team and Public Health Unit are leading the way at the moment, while there is additional impetus with the Integration projects. The papers coming to CPHAC are therefore likely to change over time in response to those changes as well”.

And a manager agreed that our organisations still have a way to go in terms of generating shared content “Style, content and level of detail still not aligned. Makes it hard to read through and digest consistently”. Executive summary Of all paper sections, the executive summary received most comment. It was singled out as the area where improvements can still be made. We have for a long time discussed much better executive summaries. There is an improvement with some papers but a lot more is required.

Another member said “A succinct executive summary with an explanation of the context of any decision to be made would make reading papers simpler”.

Length The length of papers was remarked on too. Management and members both called for shorter, more succinct papers and suggested how this could be done: • Many of the papers are long and repetitive in style. • Keep papers short and to the point. Detail in appendices.

No – changing the paper style and format will not deliver benefits

Change would not benefit the Committees’ performance The only respondent who offered explanation for his/her response said “While there is some formatting that would improve papers overall, any minor changes would not assist the committee perform their functions more effectively”.

6.5 KPI information

Would changing the KPI information help the Committees perform their functions more efficiently and effectively?

Role Yes Maybe/Not sure No Joint A & WDHB Governance 1

WDHB Governance 1 1

ADHB Governance 3 1

WDHB Management 2 3

ADHB Management 3 3

Total 9 7 2

The respondents, especially the managers, were sure or somewhat sure that making changes to the reporting of KPIs could deliver benefits. The respondents who replied ‘no’ to this question did not explain their answer.

Yes and maybe – changing the KPI information will/ might deliver benefits Which ones? A manager said that the current set of KPIs “We are lacking longer term aspirational outcomes for population health and especially Maori health. These should be tracked over time”.


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Identifying what the Boards’ performance indicators should be is, as this member says “context sensitive and change over time. They evolve as priorities change and are not fixed in any way”. To this manager, this means that the set of KPIs reported to the committees needs to be “Tied to role of the Committees and their associated information requirements. Currently the KPIs relate to BAU monitoring”.

In addition to the suggestion above, that the Committees might see a need for longer-term aspirational KPIs, a member said that the Committees need “more outcome-orientated metrics”.

A manager said that the “KPIs must allow assurance and assessment of risk. Should reflect trends and be sensitive to real change”.

To help determine if this set is the right set, a member suggested that “Maybe a discussion at the meeting about the relevance of current KPIs and whether members now feel they are just right, need refinement or are inappropriate?”

Supporting information Some members and managers asked for more supporting information about the KPIs.

One member asked for “fuller explanations in the papers about meeting (or not) the KPIs” and a manager said “They need to know how the KPIs are being met. It might help if trends and warning markers are identified and drawn to the committees' attention”.

The format of the KPI information was raised as an area for improvement by a member who asked for management to provide KPI data “in simple visual form with focused comments and interpretation”.

Alignment/ collaboration A manager notes that the DHBs are collaborating “to develop a succinct set of KPIs that is more regularly reported. This set needs to align with the Maori, Pacific and Asian Health action plans and the external reporting to the MoH, included in the annual report etc. This is already work in progress, but has taken a significant effort from the WDHB public health physician and planning analyst to achieve”.

That work in this area is delivering benefits, on a learning curve and gathering momentum was noted by another manager who noted that “Linking both organisations onto one graph is useful and now that we have very similar SFSPs, it makes comparison easier”.

6.6 Process for preparing papers

Can the processes for preparing Committee reports be improved?

Role Yes Maybe/Not sure No

Joint A & WDHB Governance 1 1

WDHB Governance 1

ADHB Governance 2 2

WDHB Management 3 1

ADHB Management 3 3

Total 9 7 1

The response to this question is a fairly strong agreement between governance and management that there is potential to be more efficient and effective on this point.


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Yes and Maybe – changing the paper approval process will/ might deliver benefits

Evidence-base A manager said that papers need to be “Substantiated by facts, not impression”.

Paper selection Several questioned the approach taken to keeping the Committees in touch with their regular topics. The suggestion is that standing items don’t need to come to the Committee as an agenda item every meeting, but “It is not always possible to predict in advance what will and what will not need to be discussed”.

Collaboration Several managers noted the difficulty of working across the two DHBs. One called for “more streamlined and consistent requirements for the joint papers”. Another noted that “working across two DHBs is really hard as an author as each paper may involve six or so people across two organisations. The development of the shared agenda, the drafting of joined papers and getting these to sign-off and approved in time for deadlines involves considerable complexity, lots of duplicated effort, lots of excessive bureaucracy, and lots of stress for staff. An area for much streamlining”. A member notes that “The major difficulty is the development of the respective DAPs and other plans which require a formidable amount of reading in a very short time”. To address paper preparation issues, a manager suggests that “The two DHBs need to sort out a process and stick to it. 1) Agenda setting late in the piece should be tidied up. Set by Chair through the CPFOs. Any variance should be appropriately agreed. 2) An inordinate length of time between papers due and the meeting. A lot of writing between due date and final printing. 3) Not seeing papers till due date is frustrating. Leads to drawn out finalising of papers. 4) Not seeing a complete set of the agenda until it’s bound means that can lead to surprises as to what is included and how it is put together”.

Another manager notes that “Preparation of reports is reliant on the goodwill and relationship between the relevant ADHB and WDHB staff. For those areas where there has been historical collaboration, the preparation of joint reports has occurred more easily, but for those areas where new ways of working have to be established at the same time the report is being prepared this has been more difficult. Each time the reports are prepared, there are lessons learned which provide benefit to the Committees”.

6.7 Other opportunities

The respondents were asked, “Are other opportunities for the Committees to deliver additional benefits?”. Many opportunities were put forward in a range of areas and the relative promise and merit of those opportunities is relative to what the overall goal or purpose of the Committees and their joint meetings are.

Focus and function Several respondents made the point made by this member, who said the Committees “needs to be focussed”, but the respondents did not agree what that focus should be. Lack of clarity of overall function as to purpose of committee. A precise definition of its purpose will help identify the ideal membership, topics and meeting arrangements. The Committee is to decide what their role is as they advise the Board. Clearly they should have a strategic role and a BAU/ monitoring role.


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Bringing a focus back on local issues could, according to this member, deliver additional benefit “if it was possible to have a Local CPHAC meeting, even quarterly”. Another member said that “CPHAC should be the eyes and ears for the Boards on Primary Care and the wellness of the population”.

A similar point was made by a manager who says that the Committees could be more effective if they were to “Not just focus on issues related to hospitals, but consider and understand their population health responsibility. Focus on prevention and Community development programmes”.

And in terms of whether the Committees should meet their purpose by monitoring, debating or making recommendations and decisions a member said “I would like to see more robust debate. I accept that having members of the public may at times make this difficult but then that is the reason for the statutory committees. I would like to see more of "the work" of boards done at CPHAC, for example debate about particular services - community, primary and so forth. I would like to see more policy recommendations coming out of CPHAC. For the most part it is a reporting session rather than discussion, dialogue and debate”.

Connecting with our communities Some members and managers see the committees as having potential to be more effective and efficient by more closely engaging with our communities. There could be far greater effort made to involve the public and allow for public deputations and media involvement. This has been severely diminished since 2001. CPHAC members could have far greater visibility with the community and be more active attending community meetings and canvassing ideas from communities of interest. This is more the local government model but works well. There needs to be a person responsible for welcoming visitors, offering them refreshments, making sure they have an agenda, making sure they know they may raise an issue, staff should wear name tags, and CPHAC to have names clearly visible on the table in front of them.

7. Discussion and Conclusion

7.1 Reflecting on the survey process

Just over half of those invited to participate in the review process replied (53%), with a slightly lower return rate from governance than management. The response rate is not too good, but is welcomed. Given the short window of opportunity to reply, a heavy demand was placed on participants and some could have been deterred and even prevented from responding “I am happy to complete the survey below but clearly deadlines are too tight. I have a packed diary but it will get done”. Another respondent took issue with the survey process and questions, saying “Can I say that this survey is nigh on useless. It is designed to stop us talking about the things that really matter here. What a surprise”.

7.2 Final comments

These final comments are offered to help the Committees decide on a suitable response to the review findings. When the survey feedback is considered as a whole there are some strong overarching themes. The notion ‘theme’ refers to a meaningful clustering of connections across the survey responses. The themes show that there is a range of observed, expected or assumed Committee roles and functions.


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The range of roles and functions has associated with it a range of options for membership composition, topics for consideration, information requirements and meeting arrangements. The survey feedback shows that, according to the respondents, the range of roles and functions that CPHAC has include: • An expert/ advisory responsibility to the Board and a democratic responsibility to the

communities the members represent, which can be difficult to meet simultaneously • Numerous obligations to both the Board and Government as defined by statute, policy and

strategy, some of which are difficult to meet simultaneously • Existing as a forum for members to be informed, monitor, debate, formulate

recommendations, and/or make decisions on behalf of the Board and/ or the communities they represent, which can again be difficult to satisfy simultaneously.

It is recommended that the survey outcomes inform discussion about these points with regard to defining the Committees’ core roles and functions. The discussion might help the Committees maximise their effectiveness in relation to their overall purpose.

Following that discussion, re-endorsing or amending the Committees’ Terms of Reference (see appendix) may be beneficial. The Committees’ meeting arrangements, the topics they consider and the kinds of information management provides to them and how management does that could then be tailored/ fine-tuned, if and as required.


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Attachment 1 E-MAIL CPHAC review - please respond Sent Wed 11/04/2012 2:09 p.m. to Committee members and management -- At the 14 March meeting of CPHAC there was a paper describing a review of the combined meetings of the Waitemata and Auckland DHBs’ CPHAC Committees. The purpose of this review is; to review the function and benefits of the combined advisory committees [and] should consider the topics discussed compared with other Board committees, the style and form of the papers provided, the key performance information provided and opportunities for streamlining the approach to the committees. The paper proposing the combined meeting of the Committees and their TOR is attached FYI. The DHBs’ senior management and support staff who regularly engage with CPHAC are also being asked to feed into the review process. The review is based on a survey and would greatly benefit from your input. Please CLICK HERE to complete the survey and reply by first thing Monday morning (16 April). There are only 8 questions in the survey. The key to making sure the review is useful is to provide a detailed explanation as to why you answered yes, no or maybe. You are welcome to call me if you would prefer to be interviewed over the phone. The analysis will begin first thing next week to make sure that I can get every respondent’s contribution analysed and a report written-up before CPHAC meets again on 2 May. I will use quotes to illustrate the survey’s key findings where respondents make a point better than I can. I will protect the respondents’ anonymity but in a tight-knit community like ours I can not promise it. The challenge is to remove detail that might identify a person while retaining enough context to ensure the quote is meaningful. If you would like further information about the review process you can contact me, either directly or via your Committee secretary.


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Attachment 2 Terms of Reference

AUCKLAND and WAITEMATA DISTRICT HEALTH BOARDS Community and Public Health Advisory Committees Terms of Reference 1. Establishment

The Community and Public Health Advisory Committees (CPHAC) are established by the Boards of the Auckland District Health Board (“ADHB”) and Waitemata District Health Board (“WDHB”) under section 34 of the New Zealand Public Health and Disability Act 2000 (“Act”). The Boards may amend the terms of reference for the Committees from time to time. While constituted as each Board’s separate CPHAC they will meet and act as one committee.

2. Functions of Committees The functions of the CPHACs of the ADHB and WDHB are to: • Advise the Boards on:

a) The needs of the resident populations of the ADHB and WDHB districts b) Any factors that the committees believe may enhance or degrade the health status of the

resident populations of the ADHB and WDHB districts; and c) Priorities for use of the health funding available to either or both ADHB and WDHB

• The aim of CPHACs’ advice will be to ensure that service delivery provided for the ADHB and WDHB populations maximises the overall health gain for the populations through: a) All interventions the ADHB and WDHB have provided or funded or could provide or

fund for the populations; b) All policies the DHBs have adopted or could adopt for their populations

• The Committees’ advice must not be inconsistent with the New Zealand Health Strategy

3. Responsibilities (a) The Committees will be responsible for review and advice to the Boards to:

• Ensure that the Committees and Boards have a global view of the health needs of the Auckland and Waitemata district populations.

• Assess recommendations from management about health services to be provided by the ADHB and WDHB to their respective resident population.

• Develop principles to determine priorities for using finite health funding to meet the needs of their populations.

• Establish and maintain processes to enable Maori to participate in, and contribute to, strategies for Maori health improvement.

• Continue to foster the development of Maori capacity to participate in the health and disability sector and provide for the needs of Maori.

• Establish and maintain processes to enable Pacific people to participate in, and contribute to, strategies for Pacific health improvement.

• Continue to foster the development of Pacific capacity to participate in the health and disability sector and provide for the needs of Pacific people.

• Interpret the local implications of the nation-wide and sector-wide health goals and performance expectations.

• Formulate the prioritisation framework for ADHB and WDHB to achieve an equitable and efficient funding mix between services and population groups.


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• Ensure the effectiveness of the Northern Region’s Health Plan and ADHB’s and WDHB’s annual plans and advise the Boards on the plans’ effectiveness in meeting district health needs and meeting Government health goals.

• Provide oversight and monitoring of the contracting processes for service agreements with other providers of health and disability support services. This will include: - ensuring appropriate systems, policies and procedures are in place for auditing and

monitoring the performance, capacity and sustainability of contracted providers. - reviewing and providing advice on associated legal, service and financial risks.

• Improve collaboration and coordination of services between the ADHB and WDHB to effectively and efficiently provide for the needs of the populations served.

(b) The Committees will identify issues and opportunities in relation to the provision of health services that the Committees considers may warrant further investigation and advise the Boards accordingly.

4. Relationship with Boards and Management

(a) The Committees are established by and accountable to the Boards. The Committees’ role is advisory only, and unless specifically delegated by a Board from time to time in accordance with clause 39(4) of Schedule 3 of the Act, no decision-making powers are delegated to the Committees.

(b) The Committees shall receive all material and information for review or consideration through the respective Chief Executive Officers.

(c) The Committees shall provide advice and make recommendations to the Boards only. (d) The Committees are to comply with the standing orders of the ADHB and WDHB based

on the model standard standing orders.

5. Membership (a) The membership of the CPHACs will comprise of:

• ____ Board members from ADHB • ____ Board members from WDHB • ____ appointed members

(b) The Chairperson(s) of both ADHB and WDHB will mutually agree upon the appointment of the Chairperson of the CPHACs.

(c) The Boards will endeavour to appoint, as members of the Committees, persons who together will provide a balance of skills, experience, diversity and knowledge to enable the Committees to carry out their functions.

(d) The Boards will ensure that the Committees include representation for Maori in accordance with section 34 of the Act and for Pacific people.

(e) The Boards will appoint any external appointees as members in accordance with the following process: • The Chair and Deputy Chair of each Board together with the respective Chief

Executive Officer will evaluate potential members in accordance with the criteria determined by the Boards and make recommendations to the Boards as to the proposed appointments.

• The Boards will make the final appointments (if any) to the Committees.

6. Meeting Procedure (a) The Committees shall meet in a combined forum every six weeks. Meetings shall be

conducted in accordance with: • The requirements of the Act • The Standing Orders of ADHB and WDHB

(b) ADHB and WDHB CEOs will ensure adequate provision of management and administrative support to the CPHACs’ function including attendance of the CEOs and Chief Planning and Funding Officers.


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(c) The venue for the meeting will normally alternate between an agreed ADHB and WDHB site, with technology (e.g. video or teleconferencing) aiding from remote locations where appropriate.

(d) The quorum of each meeting shall be, if the total number of members of the Committees is an even number, half that number; but if the total number of members is an odd number, a majority of the members.


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INFORMATION ITEMS


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4.1 Community/Consumer Engagement Update Recommendation: That the report be received. Prepared by: Margaret Willoughby (Co-ordinator Rodney Health Link) and Imelda Quilty-King (Community Engagement Co-ordinator, Waitemata DHB) Glossary HLN - Health Link North MSD - Ministry of Social Development NSCHV - North Shore Community Health Voice PHO - Primary Health Organisation RHL - Rodney Health Link WDHB - Waitemata District Health Board

1. Introduction/Background

In November 2010, the Auckland Council was established which replaced North Shore City, Waitakere City and Rodney District Councils in the Waitemata District Health Board’s district. In addition to the local boards and wards established as part of the Auckland Council, further area groupings of Auckland South, Auckland East, Auckland North and Auckland West were implemented. Auckland North encompasses the wards of Rodney, Albany and North Shore. The local boards within these wards are: Devonport/Takapuna, Kaipatiki, Hibiscus Coast and the Bays, Upper Harbour and Rodney. Historically, District Health Board boundaries have been aligned with local government boundaries. The Ministry of Social Development driven Community Response Forums are also based around the Council’s Auckland North and Auckland West groupings. To support a comprehensive community engagement process for our North communities, which is aligned with these new local government groupings, a shared decision has been taken by North Shore Community Health Voice (NSCHV), Rodney Health Link (RHL) and Waitemata District Health Board (WDHB) to support service delivery from a central point. (Decisions re staff/models of service delivery are yet to be formalised). This timing is also aligned with the review of the Waitemata DHB community engagement service specifications and contracts with the health links / voice as their three year term comes to an end on 30 June 2012.

2. Challenges and Opportunities

New challenges include: • To establish communication with newly created communities i.e. Upper Harbour and

Albany • To establish a web of networks to capture health concerns, provide information and engage

for and behalf of both communities and WDHB projects throughout Auckland North


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• New opportunities include: to engage and inform community voice in locality planning and liaise with primary care through Primary Care Organisations (PHOs)

• Sharing of information and collaboration to reduce duplication in networking and engagement i.e. with Ministry of Social Development (MSD) and local boards. One of the functions of local boards is to consult and engage with their local communities and produce local community plans.

3. Progress to date

• The third and final public meeting required under the constitution of Rodney Health Link took place on Monday 21 May 2012

• At this meeting, it was agreed unanimously that Rodney Health Link would not dissolve itself but that it would take up the challenge and the opportunity presented to become a stronger more effective group by amalgamating with North Shore Community Health Voice

• North Shore Community Health Voice’s Board has nominated four board members to work with four board members from Rodney Health Link’s Board to progress this amalgamation

• To this end, the Board and Rodney Health Link Members agreed to change the name of Rodney Health Link to Health Link North (HLN) and agreed the proposed updates required to the current constitution to accommodate this change

• Recent meetings with Waitemata DHB staff i.e. Group Planning Manager, Janine Pratt and Community Engagement Co-ordinator, Imelda Quilty-King, have clarified specifications for a new contract to reflect the new challenges and opportunities of this amalgamation

• An implementation Board has been set up with members from Rodney Health Link and North Shore Community Health Voice. A planning meeting has already been held and the Implementation Board is confident that the new entity can be up and running and ready to implement the new Waitemata DHB contract by 1 July 2012.

__________________________________________________________________________________________________________________________________________


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4.2 Child Health Collaborative Planning Update Recommendation: That the report be received. __________________________________________________________________________________________ Prepared by: Dr Tim Jelleyman (Head of Division, Medical: Child Women and Family Services, Waitemata DHB) and Dr Richard Aickin (Director of Child Health, Auckland DHB)

Glossary

DHB - District Health Board 1. Executive Summary

This purpose of this paper is to update on progress with the Child Health Collaborative Planning between Auckland and Waitemata DHBs. Key steps include: 1. Northern Regional Health Plan agreed: regional planning process along with Northland

and Counties Manukau DHB child health leaders.

2. Consultation through Waitemata on the shared Child Health Improvement Plan.

3. Establishing the Auckland-Waitemata General Paediatric Clinical Governance Group.

4. Initial modelling of North Shore acute paediatric service commenced, to be progressed through the Clinical Governance group.

5. Commencement of service planning for child health rehabilitation services to inform Wilson Centre facilities development.

6. Continued collaborative work on population health strategies including Immunisation and the ‘Before School Check’ (of the Well Child/Tamariki Ora programme).

2. Introduction/Background

Child health planning has commenced between Auckland and Waitemata DHBs’ clinical leadership to aim for better alignment of strategic goals, facilities planning and referrals, transfer and communication systems. Child health planning continues to be shaped by regional process and the aim is where relevant to align local planning with the broader strategies.

The child health services in Waitemata and Auckland DHBs are to some extent complementary, with Auckland DHB taking a lead on tertiary and surgical services, while Waitemata DHB is developing a strong programme linking General Paediatrics to Primary Care and other community services.

Together, Auckland and Waitemata comprise 55% of the Northern Region child (0 – 14 years old) population, and 21% of the New Zealand Child Population. NZ Statistics Department medium projections estimate a 2021 child population for the Auckland/Waitemata region at 210,000 (See Table 1).

__________________________________________________________________________________________________________________________________________


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Table 1 Population Projections 0 – 14 year old children, Northern Region, 2006 (base) -20211

Series Medium Projections

Year 2006 2011 2016 2021

Area

Auckland and Waitemata DHB 186,600 191,300 200,200 210,000

Northland DHB 35,250 34,550 34,350 34,450

Counties Manukau DHB 115,500 122,700 130,200 137,800

Northern region (4 DHBs) 337,350 348,550 364,750 382,250

Total New Zealand 888,300 898,900 917,400 936,500

3. Progress

Northern Regional Health Plan The four northern DHBs’ Child Health teams have identified five main priority areas where by working together regionally, it is expected to achieve significant difference to health outcomes of children in the region. These areas are: rheumatic fever, lower respiratory tract infection, Sudden Unexpected Death in Infants (SUDI), skin infections (cellulitis and abscesses) and accidental injuries. The intent is to build on work developed in DHBs and other agencies and pool resources as far as possible. The Northern Regional Health Plan is currently being finalised for the 2012/13 year, and the child health component will drive a work plan for the next few years. It is expected that improvement in these indicator conditions will require whole system improvements and so will have wider benefit in fact than the specific conditions identified.

Child Health Improvement Plan 2012-2017 (Auckland and Waitemata) Auckland initiated a significant piece of work developing the Child Health Improvement Plan through a process of wide consultation in the Auckland district. The Waitemata Child Health leaders were involved in its development. Now the plan has been developed further to include the Waitemata child population and a process of consultation with the Waitemata stakeholders is currently underway. This will be presented to the DHBs in the next three months. This plan takes a life course approach, with emphasis on getting health optimised early in life to benefit the longer term health and development life trajectories. Achieving equity of health outcome which involves focused effort with priority groups including Maori, is at the forefront of the strategy. Enablers to achieve these outcomes are also considered.

Auckland-Waitemata General Paediatrics Clinical Governance Work to establish this bilateral district Clinical Governance group is underway with a project manager funded to support the process of initial set up. Clinical (nursing, medical, allied health) and management leaders will comprise the initial membership. A key part of starting work for this group will involve a review of acute services to refine the model of care that will underpin the distribution of inpatient beds and short stay facilities including the proposed North Shore Paediatric Short Stay unit.

1 http://www.stats.govt.nz/, accessed 23 Mar 2012.

__________________________________________________________________________________________________________________________________________


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Primary care DHB leadership is combined across the Auckland and Waitemata districts, and this paediatric collaborative governance structure will align well with the primary care team, which improves the opportunity for consistency at that key interface for the services.

North Shore Acute Paediatric Services Initial work has begun to consider the model of care for a North Shore Paediatric Short Stay Unit that will participate in the continuum of acute paediatric medical care with the North Shore Emergency Care and Child Health Services. Options for clinical staffing models and facilities are now being developed to put forward for recommendation that will take into consideration patient and family experience, clinical safety and best spend. Further analysis is required to refine the recommendations, and the Clinical Governance Group will be engaged with establishing the recommendations.

Child Rehabilitation Service Waitemata leases facilities for Child Rehabilitation from the Wilson Trust. The Wilson Centre in Takapuna is where the Child Rehabilitation Service is primarily based. The Wilson Trust has approached Waitemata DHB, initiating discussion around their proposed development of facilities and seeking commitment to continuation of the lease and advice on what facilities would support the clinical rehabilitation services. This piece of work requires clarification of the health care models that will shape the services of the future and provides the opportunity to move the service into a centre that contributes tertiary rehabilitation to the wider region and nationally through a clinical network. The existing collaboration between Auckland and Waitemata is now to be strengthened to move this discussion quickly forward. Initial discussions with the clinicians (Paediatric Rehabilitation Specialists, nurse and allied health leads) and Auckland and Waitemata Child Service managers has commenced this process of development that will start with the models of rehabilitative healthcare and consider what a regional child rehabilitation service should be and the proposed role as a leader for the national network.

Population Health Collaboration Auckland and Waitemata’s Child Health clinical leaders and Funding and Planning teams currently participate in the Auckland metro group (including Counties Manukau), which meets monthly to consider population health activities across the region. This includes, for example, immunisation, well child/tamariki ora programmes for preschoolers and oral health. Auckland and Waitemata are shortly to appoint an Immunisation Coordinator lead across their two districts. There continues to be information shared around ‘Before School Checks’ to identify ways to achieve improved coverage and confidence concerning quality. There is considerable potential to strengthen the collaboration and work with Counties Manukau through this forum that focuses on population health determinants, related programmes and is also continuing to engage with the Auckland Council in relation to the Auckland Plan.

4. Next steps

1. Starship Options Analysis paper is being presented to the Auckland DHB seeking a

commitment to a clear strategic path regarding the development of Starship physical facilities. This is required to underpin the collaborative planning.

2. The commencement of work by the joined paediatric clinical governance group with General Paediatric and Emergency Medicine leaders initially focussing on acute paediatric services for the two districts.

3. The Child Health Improvement Plan will have progressed through Waitemata consultation process and is to be finalised and presented for endorsement by both district health boards.

__________________________________________________________________________________________________________________________________________


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4.3 Cervical Screening Update Recommendation: That the information be noted. Prepared by: Dr Peter Sandiford (Public Health Physician, Waitemata DHB), Carol Stott, Strategy and Planning Manager – Child, Youth and Women’s Health, Auckland DHB), Ruth Bijl (Associate Strategy and Planning Manager – Women’s and Youth Health, Auckland DHB), Stephanie Muncaster (Programme Manager Chronic and Palliative Care, Waitemata DHB)

Glossary ADHB - Auckland District Health Board ARPHS - Auckland Regional Public Health Service DHB - District Health Board ISP - Independent Service Providers NCSP - National Cervical Screening Programme NSU - National Screening Unit, a division of the National Health Board PHO - Primary Healthcare Organisation WDHB - Waitemata District Health Board WONS - Well Women’s Nursing Service (now Well Women and Family Trust)

1. Executive Summary

The cervical cancer screening programme (NCSP) aims to prevent cervical cancer. This paper provides an update on the current status of the NCSP and on strategies underway to substantially increase coverage within Auckland and Waitemata DHBs.

New strategies are being implemented to reduce inequalities and improve cervical screening coverage rates. These include:

– The establishment of an Auckland regional coordination service which will be responsible for developing and implementing a range of tactics to increase coverage (with a service review planned after the first year of operation)

– An increased number of free smears available through primary care for priority group women

– The establishment of a metropolitan Auckland cervical screening governance group which will be accountable for achieving coverage targets.

2. Background There has been a significant improvement in the key outcomes for the NCSP nationally with rates of cancer and deaths decreasing between 1996 and 2009. Nationally, rates of cervical cancer (incidence) nearly halved from 10.5 to 5.4 per 100,000 for women of all ethnicities, and more than halved, from 25.0 to 10.4 per 100,000, for Māori women. Mortality also declined significantly from 3.8 to 1.8 per 100,000 for women of all ethnicities, and from 13.0 to 4.7 per 100,000 for Māori women (http://www.nsu.govt.nz/news/4811.aspx#4821).


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Further reductions in disease are likely to be seen as the HPV vaccination programme takes effect, however these changes will be over the longer term. In the meantime, maintaining high cervical screening coverage rates remains important.

The primary issue in the Auckland area is equity of coverage for Maori, Pacific and Asian women. Only half of the eligible Maori women are screened on time (53.1% ADHB, 49.3% WDHB) and just over half of Asian women are screened on time (55.2% ADHB, 52.9% WDHB). Cervical screening coverage rates for Pacific are markedly better in Auckland than in Waitemata (72.8% ADHB, 60.2% WDHB) with rates in Auckland around ten percentage points above the national rate. This is likely to be associated with effective Pacific leadership and the strong Parish nursing network (a component of the Auckland DHB funded Healthy Village Action Zone (HVAZ) Pacific education and engagement programme) which prioritises cervical screening. ‘Other ethnicities’ coverage rates in both Auckland and Waitemata DHBs are above the National rate, but total coverage rates in Auckland and Waitemata DHBs are slightly below the national rate of 75% (73.4% ADHB, 73.6% WDHB). (See appendix 1 for detailed data).

There is a multiplicity of funding streams, management lines and providers. Both nationally and locally managed services contribute to cervical screening programme outcomes. Services include: – Health Promotion – National Cervical Screening Programme (NCSP) register administration – Free smears for priority group women – Laboratory – Colposcopy services

A range of providers deliver services including: – General practices – DHB provider arms – Auckland Regional Public Health Service (ARPHS) – Community laboratories – Independent Service Providers (ISPs)

Primary Healthcare Organisations (PHOs), District Health Boards (DHBs) and the National Screening Unit (NSU) purchase services to meet programme objectives. DHBs use baseline funding as well as revenue funding from the NSU to purchase services.

Auckland DHB exited a regional contract with Well Women’s Nursing Service (WONS) to provide smear taking services at the end of 2011. The baseline funding associated with this contract has been used to purchase a greater number of free smears for women through PHOs. Revenue funding is also used to purchase free smears for priority group women.

The National Screening Unit (NSU) continues to contract WONS to provide health promotion and free smears for women in metropolitan Auckland. The NSU funds a further three ISPs in the Auckland area for a range of services including health promotion. The four ISPs are funded approximately $1 million per annum in total. The NSU contracts with Auckland DHB for regional register administration services. This contract was, until recently, a direct relationship between ARPHS and the NSU. Auckland DHB now hosts this contract for the service provided by ARPHS.


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The NSU has had contracts in place in other regions for regional coordination for over ten years. It has been the NSU’s view that ARPHS provided coordination services in Auckland but this was not ARPHS’s understanding. In April 2012, the NSU entered into an agreement with Auckland DHB to host a regional coordination service on behalf of the three Auckland DHBs.

3. Risks/Issues

Failure to achieve higher coverage rates results in inequity, women experiencing unpleasant and costly health interventions, unnecessary morbidity and mortality and wasted programme and health resources.

System fragmentation is of concern. Fragmentation is seen in provision, funding and accountability and may contribute to consumer confusion and poor performance. The establishment of the new Auckland regional governance structure and of the coordination services are means to address this issue but do not necessarily alter underlying fundamentals. As such outcomes can not be guaranteed, but a review of both the terms of reference of the governance group and the effectiveness of the coordination service will be undertaken after the first year of operation. In addition, the DHBs will continue dialogue with the NSU regarding system fragmentation and approaches to address this.

4. Auckland regional strategy to reduce inequalities and improve overall cervical screening coverage rates

The NSU’s recent decision to establish a Cervical Screening Coordination Service hosted by Auckland DHB was informed by an independent report (Marwick 2011). Marwick considered that the following factors may contribute to lower coverage: – No regional coordination or any “individual or body tasked with acting regionally to help

achieve uniformly high coverage” – Central contracting by the NSU with individual ISPs making it more difficult for DHBs to

implement local or regional changes – Primary care practices that do not have the “will, knowledge, skills, resources and systems”

to deliver high screening coverage rates – Poor linkage between ISPs and primary care

The Marwick report argued that regional coordination was needed to help improve coverage and should focus on: – Strategic commitment and planning – Developing and maintaining commitment – Information dissemination – Integration

Discussions between the three Auckland DHBs about the coordination service led to recognition that governance arrangements needed to be improved. As a result, the three DHBs are establishing a Metropolitan Auckland Cervical Cancer Screening Governance Group. This Group will perform a role similar to local immunisation governance groups by providing strategic oversight and guidance on approaches to increasing cervical screening coverage.


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Strong PHO and primary care involvement in the governance group is planned and will be crucial to the success of this new strategy. The Coordination Service will be tasked with preparing a strategic plan by September 2012. This plan will be guided by the Governance Group. The Coordination Service will then be tasked with implementing and reporting against this plan. The new governance structure is shown in appendix 2.

The first meeting of the governance group is scheduled for 28 May 2012. Stronger governance arrangements with clear accountability for coverage targets are expected to improve cervical screening coverage. However, risks associated with fragmented services remain, particularly with ISPs sitting outside of the direct control of the DHBs. This issue will continue to be addressed between the DHBs and the NSU. A new Coordination Service is due to recruit a Coordinator in May 2012. The Coordinator will work at a systems level with primary care. They will also build strong relationships across the range of providers and be passionate about increasing cervical screening coverage rates. Their first KPI is to produce a strategic plan which details tactics to increase coverage and reduce inequity.

Access to free smears also improves coverage. Smears are funded by the NSU at $24.62 per smear. Primary care has indicated that this is insufficient. The DHBs have now contracted PHOs to provide a capped volume of free smears to priority group women (Maori, Pacific, Asian and under-screened women over the age of 30 years) at a rate of $40 per smear. PHOs demonstrated during a trial of funding at this level that screening increased. PHOs have been supportive of this approach and are actively working with practices to increase coverage.

Getting the right balance between the various tactics including health promotion, primary care systems, identification of under screened women and removing barriers to their participation in the programme such as through free smears, will be overseen by the governance group.

Waitemata DHB is also exploring options to improve Pacific coverage by applying lessons from Auckland DHB’s positive experiences in raising Pacific coverage rates (currently 12.6% higher than Waitemata’s).

5. Conclusion Both Auckland and Waitemata DHBs are committed to improving cervical screening coverage and reducing inequity. Effective governance, improved coordination, reduced system fragmentation and reducing barriers such as through provision of free smears are being actioned to achieve equitable cervical screening coverage targets. The new Governance Group will monitor progress against higher targets.


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Appendix 1

Cervical screening coverage rates in Auckland, Waitemata and New Zealand by ethnicity

Table 1: Auckland District Health Board Cervical Screening Coverage Rates

Auckland DHB NCSP Coverage by Ethnicity 2007 - 2011 Source: NSU

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep

-07

Sep

-08

Sep

-09

Sep

-10

Sep

-11

Per

cen

tag

e (%

) Asian Auckland

Maori Auckland

Other Auckland

Pacific AucklandTotal Auckland

Asian Auckland 47.2% 49.4% 51.3% 52.5% 52.1% 55.2%

Maori Auckland 43.3% 46.5% 49.0% 51.0% 52.0% 53.1%

Other Auckland 83.5% 85.6% 87.0% 87.4% 89.5% 86.8%

Pacific Auckland 50.5% 57.2% 62.4% 66.9% 68.9% 72.8%

Total Auckland 67.2% 69.7% 71.5% 72.5% 73.5% 73.4%

Sep-07 Sep-08 Sep-09 Sep-10 Sep-11 Dec-11

Table 2: Waitemata District Health Board Cervical Screening Coverage Rates

Waitemata DHB NCSP Coverage by Ethnicity 2007 - 2011 Source: NSU

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep

-07

Sep

-08

Sep

-09

Sep

-10

Sep

-11

Per

cen

tag

e (%

) Asian Waitemata

Maori Waitemata

Other Waitemata

Pacific WaitemataTotal Waitemata

Asian Waitemata 47.0% 49.7% 52.4% 53.7% 50.6% 52.9%

Maori Waitemata 42.0% 45.0% 46.8% 47.9% 48.3% 49.3%

Other Waitemata 81.1% 84.0% 85.8% 85.9% 85.7% 84.3%

Pacific Waitemata 47.3% 53.3% 57.9% 60.4% 58.0% 60.2%

Total Waitemata 69.8% 72.7% 74.5% 75.0% 73.9% 73.6%



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Table 3: National Cervical Screening Coverage Rates

New Zealand NCSP Coverage by Ethnicity 2007 - 2011 Source: NSU

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Sep-0

7

Sep-0

8

Sep-0

9

Sep-1

0

Sep-1

1

Per

cen

tag

e (%

) Asian Total New Zealand

Maori Total New Zealand

Other Total New Zealand

Pacific Total NewZealandTotal Total New Zealand

Asian Total New Zealand 48.8% 51.3% 53.6% 55.0% 53.8% 56.2%

Maori Total New Zealand 50.3% 53.7% 55.6% 56.8% 57.1% 58.0%

Other Total New Zealand 79.7% 81.9% 83.0% 83.6% 83.4% 82.9%

Pacific Total New Zealand 49.1% 54.9% 58.9% 61.4% 59.8% 61.7%

Total Total New Zealand 70.8% 73.2% 74.5% 75.3% 74.8% 75.0%



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DHB Tier 1 or 2 Leadership Groups

Metropolitan Auckland Cervical Cancer Screening

Governance Group (MACCSGG)

Three DHBs:ADHB

CMDHBWDHB

Maori Pacific Asian

Coordination Service

(Manager and Coordinator)

Consumer

3 GP/PHO

(eg Procare, NHC, AH+)

Women’sCancer

Specialist

Population Health

/Screening

NCSP Register (ARPHS)

Coordination Service Report

NCSPRegister Report

ISP’s Report

Primary Care/

PHO Report

Planning and

Funding

Accountability of the MACCSGG:

The MACCSGG is accountable to the three Auckland DHBs for cervical

screening coverage rates in each of the three DHBs,

particularly for priority group women

MACCSGG Purpose:• Provide strategic advice and approve strategic and annual plans of the Coordination Service• Approve Service Coordination Budget annually• Review effectiveness of Coordination Service annually• Receive reports from the Coordination Service• Report up to and provide advice to SMTs as appropriate• Engage member organisations to increase buy-in to strategic direction• Facilitate achievement of metro Akld cervical screening coverage targets•Set annual screening targets

Members will be encouragedto represent more than one area

Appendix 2 Governance The structure of the Metropolitan Auckland Cervical Cancer Screening Governance Group is shown below.


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STANDARD MONTHLY REPORTS


57

5.1 Primary Care Update Recommendation: That the report be received. Prepared by: Andrew Coe (Group Manager Primary Care) and Stuart Jenkins (Clinical Director Primary Care), Waitemata and Auckland DHBs

Glossary A&M – Accident and Medical Centre AH+ – Alliance Health Plus ALT – Alliance Leadership Team ARC – Aged Residential Care ATD – Access to Diagnostics BFG – Better Sooner More Convenient Primary Care Funding Group BSMC – Better sooner more convenient primary health care CAP – Community Acquired Pneumonia CHF – Congestive Heart Failure COPD – Chronic Obstructive Pulmonary Disease DAP – District Annual Plan DHB – District Health Board DVT – Deep Vein Thrombosis FFP – Flexible Funding Pool IFHC – Integrated Family Health Centre ISRW – Improving service and reducing waits NHC – National Hauora Coalition OPP – Optimal Prescribing Programme PHO – Primary Health Organisation PMH – Primary Mental Health PMS – Patient Management System POAC – Primary Options for Acute Care PPP – PHO Performance Programme RFP – Request for Proposals ROI – Registration of Interest TIA – Transient Ischaemic Attack WOC – Whānau Ora Centre

1. Introduction

This report provides an update on matters relating to Primary Care up to the end of April 2012. It includes progress on: • The three BSMC business cases • The regional annual plan projects to improve primary-secondary system efficiency • Clinical networks • Other relevant key activity.


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Workstream support of 2011/12 MoH Letter of Expectations

2 Clinical leadership (Clin lead)

1 Improving service, reducing

waits

3 Services closer to

home (SCH)

4 Health of older people

(HOP)

5 Regional collaboration (Reg collab)

2. Workstream progress

Workstream Letter of

Expectations RAG Achievements/Progress Future work Risks & management

2.1 BSMC business cases

GAIHN Clinical leadership Regional Collaboration

• The revised GAIHN ALT has met once (5 April) and agreed their role and function as follows:

a. Agree immediate priorities for collaborative activity [and take these back to respective organisations for approval as required]

b. Provide oversight to ensure these priorities are being addressed within their organisations and through the core GAIHN work programme

c. Take a 3-5 year view to identify future priorities. • A process is underway to appoint a new

independent Chair • A process is underway to recruit a new programme

manager • Discussions are underway with both NHC and

AH+ about closer collaborative arrangements.

• Tighten up processes around approval of GAIHN business cases and make them explicit

• Review current activity and align to funding and expectations.

• GAIHN budget does not align with the work programme. The DHBs need to carefully scrutinise the GAIHN budget in light of the revised reduced core programme

• Lack of clarity on the non-core programme initiatives. Further work is required around the GAIHN proposals to determine costs and benefits

• No formal links with other Auckland business cases. This issue is being progressed.

NHC (Auckland DHB only)

Clinical leadership

• The regular operationally focussed monthly meeting to address Auckland issues occurred on 5 April. The meeting has been re-established with the most appropriate people from NHC following its national alignment process.

• Finalisation of annual plan content

• Locality view of PPP targets for Jul-Dec 12.

• Alignment between business case activity and locality development is critical. Consultation and inclusion in process of developing annual plan and in governance of localities vital.

Overall progress summary key: Red, Amber, Green (RAG)

Some concern regarding progress

Not achieved or stopped due to change of plan

or resource

Project on track to time, cost, quality and

business benefit


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• Bi-monthly partner DHB teleconferences to discuss progress and transitional activities. The next teleconference has been set for 9 May. Main issues in progress to date are annual planning, diabetes improvement package and locality level view of the PPP

• A high level draft view of NHC activities 2012/13 has been submitted for inclusion in each of the DHB’s annual plans

• Two meetings have been held between NHC, the Integrated Primary Care Team, He Kamaka Oranga and Ngati Whatua to discuss inclusion of NHC activities in the annual plan and agree work plan for 2012/13. A further meeting is required as the submitted annual plans still do not fully meet NHC’s expectations.

• NHC have a localities approach drafted which is broadly about how NHC can engage with the Board on provider networks and localities to support the implementation of their business case. This has not been widely circulated as yet and the DHB will consider this in the implementation of their planned localities approach in Auckland DHB.

AH+ (Auckland DHB only)

Clinical leadership

• Regular monthly meetings have continued between Alan Wilson, Acting CEO and Auckland DHB/Counties Manukau DHB primary care and Pacific teams

• A meeting was held at AH+ on 5 April and Alan outlined the team and operational changes

• A number of operational contractual/reporting issues are being worked through for 10/11 and 11/12 and will be resolved before close of 11/12

• Agreement over 10/11 cervical screening contract

• 11/12 cervical screening contracts to be put in place

• Outstanding reporting being processed

• Finalisation of annual plan content.

• Sustainability.


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• Discussions have begun on contract reviews for 12/13

• A meeting was held with Alan Moffit, Acting Clinical Director on 3 May to agree annual plan content/direction

• Next regular meeting scheduled for 23 May.


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Workstream Letter of Expect-

ations RAG Achievements/Progress Future work Risks & management

2. 2 Improve Primary – Secondary System Efficiency: The Regional Annual Plan projects. A summary table of performance against annual plan targets is given below at section 3

Regional afterhours

Improving service, reducing waits Clinical leadership Services closer to home

• Reporting data is now being collected from A&Ms, EDs and telephone triage to establish baseline based on the past two years. HealthAlliance is scoping the requirements for a permanent reporting solution.

• The Network Agreement (previously Deed) has been signed by Counties Manukau DHB and Auckland DHB. The Agreement is now with Waitemata DHB for signing

• Free Afterhours For under-6s. In response to a request for clarification, the MoH has confirmed that the requirement is that there will be 60% coverage by 1 July 2012 and rising to 95% over a period of time. This means that 60% of under-6s will have access to free afterhour services within a 60 minute drive. Synergia has undertaken work for the three Auckland DHBs to assess current rates and has confirmed that the three Metro Auckland DHBs already have 97.65% coverage

• The Overnight Services Review document is being drafted with the scoping of additional work being completed. The additional work involves investigating the A&M and ED data by localities. The four overnight contracts will be extended until 31 October 2012 as agreed at the Regional Funding Forum. This will allow for the review to be completed and a decision on the way forward to be made.

• A further round of interim reporting will be undertaken and is due by the end of May

• The implications of the Government’s new policy of free afterhours visits for under-6’s still need to be worked through if the DHBs wish to extend the number of A&M clinics offering free afterhours for under-6s

• The draft overnight review will be completed and presented to the BSMC Funder Group for approval before it is released for wider feedback.

• Seven of the eleven A&M clinics in the network are currently free for under-6’s. If the remaining four clinics wish to take up this option, then DHBs and A&Ms will need to work through the implications of this

• There is concern that there may be a movement of patients from visiting their medical home during normal office hours to visiting an A&M

• No current links with the IFHC or locality strategy

• Missing key clinics i.e. Coastcare at Whangaparoa

• The DHBs have been unable to complete the Overnight Services Review by 31 March 2012 as originally planned. Additional analysis to inform the review has been identified and is underway. The Regional Funding Forum agreed to extend the four current overnight contracts until 31 October 2012 to allow for the completion of the review.


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Access to diagnostics

Improving service, reducing waits Services closer to home

• As at 20 April 2012, 109 of the 119 Auckland DHB practices have accessed the programme to date (91%), 52 of the 64 Counties Manukau DHB practices have accessed the programme to date (78%)

• Pilot practices across Auckland and Manukau have been testing the new clinical triage criteria and are confident that the programme is working well. The changes were released to all the practices with Access to Diagnostics installed on Friday the 20th of April. The PHOs have all been notified and have been asked to pass the information onto the practices

• Development work is continuing in order to create a link from Access to Diagnostics to POAC. A regional subgroup has been established to continue discussions with regards to alignment and a meeting of the subgroup has been scheduled for 8 June 2012

• Access to Diagnostics contract variation for 2012/13 has been drafted and circulated to relevant parties for their review.

• Meeting organised for 8 June at East Health to progress ATD-Radiology link with POAC and continue discussion around Paediatric Radiology

• Progressing MedTech Licensing negotiations.

• Non ProCare Practices that use MedTech as their Patient Management System (PMS) are not able to access the web-based forms included in this programme as they do not hold the relevant license agreement with MedTech. Rollout of ProExtra into the remaining eligible Counties Manukau DHB practices now on hold until the Regional MedTech licensing contract negotiations are finalised.

• HealthAlliance is leading licensing negotiations on behalf of the Auckland region and met with MedTech on 19 April to present concerns with their revised agreement. MedTech was receptive but did not commit to any of the changes. Paul Roseman (ProCare) has agreed to provide a written update to the Steering Group as well as an update to be published in the Primary Care Monthly Newsletter.


63



Minor skin surgery: skin lesions

Improving service, reducing waits

• As at 31 March 2012, 729 of the 900 target volumes have been achieved, a variance of -171.

• Approximately 35 applicants from Metro DHBs were received from the ROI. The review panel met on 23 April to review the shortlisted applications and their 50-case log books in depth. Total of 9 applicants (5 from Auckland DHB, 2 from Counties Manukau DHB & 2 from Waitemata DHB) were successful subject to sit visits. Once site visits are complete, the clinical review panel will be in a position to make their final recommendations and award contracts. It is anticipated that the final selection process will be complete by the end of May 2012.

• A number of other options are also being explored by the Steering Group around widening the scope of the project to include referrals for pigmented and benign lesions. Waitemata DHB is currently leading this process.

• Site visit to successful applicants

• Decision around widening project scope.

• Within Auckland DHB, only two GPs are participating, 8 participating in Waitemata DHB and 7 in Counties Manukau DHB.

• There is currently an ROI concerning minor skin surgery to fill in gaps. It is anticipated that the ROI process will be complete by the end of May 2012.

Clinical pathways (GAIHN)


• Transient Ischaemic Attack – Signed off by ACN (Active Clinical Network) GAIHN Senior Partners agree in principle to implementation of pathway but requested feasibility study to be undertaken in each DHB as a first step

• Chronic Obstructive Pulmonary Disease – ACN reviewed pathway and believe it requires further work on spirometry issues re diagnostic spirometry capacity before sign off

• Community Acquired Pneumonia – Signed off by ACN. Senior Partners agree it can be implemented now by PHO’s and DHB’s as there appears to be no significant budget implications

• Implementation of pathways requires significant change management process (communication, CME campaigns, practice implementation visits) in primary care, in addition to well integrated implementation across DHB’s and PHO’s.


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• DVT – signed off by ACN. Senior Partners want to pilot it in a small area first. POAC will also need expansion to include D-dimer Point of Care test kit distribution

• Chronic Kidney Disease – Pathway development continues

• Gout – Pathway is near completion • Depression – Regional agreement that a unified e-

clinical decision tool is required. Favoured solution at this stage is the Counties Manukau DHB CCM module. There is also regional agreement on utility of a pre-consultation screening tool

• Cellulitis – Not started as yet • CHF – Not started as yet.

Pharma-ceuticals: optimal prescribing (Auckland DHB) (GAIHN)

Improving service, reducing waits Clinical leadership

• The cell groups have focused on improved management of cardiovascular disease and review of medicines in elderly patients and reducing polypharmacy (one group in April and May)

• Bulletins on appropriate use of diuretics and management of constipation have been developed

• ProCare has meet with Waitemata DHB quality use of medicines team and is promoting the SafeRx resources via the members’ website and GP cell groups.

• The Optimising Prescribing Team has engaged with the national Manage My Medicines IT initiative.

• Process milestones are now on track with the exception of budget tracking and reporting due to complexity of Pharmaceutical Rebates from PHARMAC

• Complexity involved in agreeing realised savings due to rebates and other factors involved in pharmaceutical budgets

• Workforce sustainability during last quarter of a two year contract.


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Pharma-ceuticals: quality use of medicine (Waitemata DHB)

Improving service, reducing waits Clinical leadership Health of Older People

• Over 723 medication reviews conducted in a sample of age related residential care facilities have been completed to date and communicated to GPs. The data collection for evaluation is underway and initial 8 months results analysed. Summary of evaluation which is very positive will be reported in the near future.

• Interim drug chart is in testing phase. • Roll-out with education is being planned for ATR

pharmacists, retail pharmacists, ATR charge nurses/staff, residential care facilities, doctors and GNS. Anticipated go live date is now early Aug 2012

• Presentation about the interim drug chart given to RACIP, GNS and ARC Quality Group in April.

• Request from a GP to start ARC Pharmacy services in an ARC facility in Northcote will go to Steering Group for consideration.

• As with any new drug chart, there is the potential for error. This will be mitigated by comprehensive education of all staff who are involved in medication management.

Primary Mental Health (Auckland DHB)


• The third steering group meeting has not occurred and no further meetings have been set at this stage

• Data analysis for last six months underway.

• Due to a lack of personnel, minimal further work has been undertaken on this project in April. A new programme manager has come on board and it is hoped that will free up time for this project to be completed.


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2.3 Clinical networks

West Auckland Health Network (Waitemata DHB)

Clinical leadership Regional Collaboration

• Consultation volumes permission letter sent to West Auckland Practices

• Engagement of West Auckland practices underway to understand medical affiliations and the network approach through Jonathan Simon (WAHN Medical Director) & Stuart Jenkins (Clinical Director – Primary Care)

• Henderson – meetings have taken place with Whanau House and West Auckland Health Care; project plan for Henderson IFHC drafted and available for viewing

• Westgate – a meeting has been held with Richard Selkon of Westgate and a project plan has been drafted as is available for viewing

• New Lynn –a series of workshops with practice staff have been held; modelling & analysis underway; draft of the strategic business case is under construction

• Regular fortnightly meetings have been held with Martin Hefford, Director Primary Health & Community Services of Counties Manukau DHB to align approaches where sensible.

• Secure consultation volume data for practices that have given permission

• Continue practice engagement visits to develop Clusters and outline network approach

• There is a risk that a sufficient proportion of practices will not provide consultation volume data for a representative West Auckland sample. Jonathan Simon and Stuart Jenkins are meeting practices to explain the intention behind the data collection and analysis.

Integrated Family Health / Whānau Ora Centres (Waitemata DHB)

Services closer to home

• Negotiations for the IFHC lease of Whānau House in Henderson complete and approved with Waitemata DHB leasing the space that was to be an A&M from 1 July

• A meeting occurred between the New Lynn IFHC team, the programme manager and Waitemata DHB estates on 12 April to resolve outstanding lease issues

• As an outcome of this, a Board paper was drafted for mid-May to agree the rental space in New Lynn IFHC.

• Sapere ISG continues to work with the two IFHC developments through the practices concerned to reengineer their processes to improve capacity.


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• Work is now underway to work with the surrounding

practices and secondary care to develop new integrated models of care wherever possible (see detail under west Auckland Health Network section).

2.4 Other activities

Unspent funds • The Ministry of Health have provided the DHBs with their interpretation of the level of PHO unspent funds.

• This information has been passed to the DHB financial analysts for confirmation.

• A paper will go to the A&F committee before the end of the year confirming amounts for each PHO and to agree next steps.

• Agreement as to unspent funds for each PHO and agreed action plans.

• Risk exists that there will be a lack of engagement from the PHOs in the agreed best use of these unspent funds.

Waitemata DHB Primary Care Nursing Work-force (Waitemata DHB)

Regional Collaboration

• The seven nurses on the February 2012 Nurse Entry to Practice (NETP) Expansion Programme have completed their three month interim portfolios. These nurses are employed in the primary health care setting while completing the year long programme for new graduate registered nurses.

• The Competence Assessment Programme (CAP) for registered nurses to return to practice commences in May. Four nurses will be undertaking this programme in the primary health care setting.

• Waitemata DHB is working with Counties Manukau DHB to develop an integrated model of care for complex lower leg wounds which will be piloted in both Waitemata and Counties Manukau DHB.

• The model involves integration between District Health Board (DHB) District Nursing Service, Community Allied Health and a cluster of General Practices within the two localities for a defined group of high risk patients with complex leg wounds.

• The project scope and model of care are in

• Sourcing primary health care placements for September intake to the new graduate programme

• Develop implementation plan

in conjunction with participating practices and the District Nursing Service. Confirm funding model.

• Risk of lack of engagement by

either party. Pilot with General Practice, District Nursing and Allied Health teams who are willing to work with an integrated model of care.


68



development.

• Engagement with practices and the District Nursing and Allied Health Services around project participation has commenced.

• Initial discussion with National Shared Care Programme Pilot has commenced to use the shared care plan as an enabler.

ProCare • ProCare is in the process of restructuring their organisation to better meet the emerging Primary Care environment. The new structure allows a wider cross section of Health Professional to be members of ProCare and will enhance greater service integration. In addition, changes to ProCare’s operational management are underway to facilitate better alignment with DHBs’ locality approach.

• The DHBs are working collaboratively with ProCare, with key individuals participating in the West Auckland Network development. We understand that ProCare is realigning their peer groups to match the geographical localities.

• ProCare to present additional detail to the DHBs.

• Risks have not been fully identified but will be managed as further detail emerges.


69

3. Summary of Annual Plan Targets

Initiative

Regional Actual Targets RAG summary Month

April YTD

30/04/12 YTD

30/04/12 To

30/06/12

1. Acute Demand / POAC 1,5151 17,082 16,670 20, 000

2. Access to Diagnostics

DAP Target 1 Rate of referrals that do not meet the clinical triage criteria from GPs to radiology are </= to 20% by 30/06/12

8.9%2 N/A 25%3 20%

DAP Target 3 Volume of DHB-funded GP-requested diagnostic radiology procedures performed in the community will increase by 10% across the Metro Auckland DHBs, on 2010/11 volumes by 30/06/12

932 10,847 8,399 10,396

3. Minor skin surgery 1200 procedures for people requiring minor skin lesion surgery in the community (Counties Manukau DHB 400, Waitemata DHB 500, Auckland DHB 300) by 30/06/12

*894 *(March data)

*635 *(March data)

*800 *(March data)

1,2005

1 Preliminary Figures for April: not all referrals had been received and processed by month end 2 The actual % is the average of Auckland DHB, Counties Manukau DHB and Waitemata DHB triage criteria failure rates 3 The target % is based on the end point target graduated over time 4 Volumes are based on the referrals sent out during the month for Waitemata DHB and Auckland DHB and actual procedures completed for Counties Manukau DHB 5 Community based skin lesion procedures during 2011/12


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71

5.2 Planning and Funding Update Recommendation: That the report be received.

Prepared by: Denis Jury (Chief Planning and Funding Officer ADHB), Debbie Holdsworth (Chief Planning and Funding Officer WDHB), Julie Helean (Manager Planning and Service Development ADHB), Janine Pratt (Group Planning Manager WDHB), Tim Wood (Group Funding Manager WDHB) and Cliff La Grange (Group Finance Manager WDHB) Glossary ARDS - Auckland Regional Dental Service ARPHS - Auckland Regional Public Health Service B4SC - Before School Check CHC-LTS (IFP) - Chronic Health Care - Long Term Service (Interim Funding Pool) DHB - District Health Board DNA - Did not attend GP - General Practitioner HBSS - Home Base Support Service IDF - Inter District Flow IMAC - Immunisation Advisory Centre NGO - Non Government Organisation NIR - National Immunisation Registration OHBC - Oral Health Business Case PHO - Primary Health Organisation SDG - Service Development Group

1. Summary

This report updates the Committees on Auckland and Waitemata DHBs’ Planning and Funding activity for the month of May 2012.

2. Summary of activities in common

2.1 Planning

The final drafts of the annual plans and Northern Region Health Plan were submitted on 18 May in line with the National Health Board deadlines. There are still some areas to be agreed, and we are awaiting feedback from the National Health Board on these draft plans to see whether we have responded appropriately to the feedback previously received. A verbal update will be provided at the meeting on further feedback and any areas still outstanding. We are now focused on the statement of intent which is developed from specific modules of the annual plan. We are working to have the Auckland DHB and Waitemata DHB statements of intent aligned. Our next step is to develop the business plans which are the operational documents for each DHB based on the annual plan and other internal DHB objectives. Approval of the final annual plans and statements of intent is through the individual boards as per the resolutions at the May Board meetings, i.e. delegated to specific Board members.


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2.2 National Pharmacy Services Agreement

The national Community Pharmacy Services Agreement consultation process has now closed. The Auckland DHB meeting on 16 April was well attended with over 80 pharmacists. The Waitemata DHB meeting was on 12 April and was also well attended. There was some concern amongst pharmacists at the shortness of the consultation period when a significant change in service funding models was being proposed. All consultation submissions have now received a formal response and have been collated at the Central Region’s Technical Advisory Services website (http://www.centraltas.co.nz). Auckland and Waitemata DHBs are considering how best to support community pharmacists through the transitional process to the new model. The Metro Auckland Variation is to be extended with a few slight amendments. Further work on the issue of pharmaceutical waste is being undertaken to consider a cost effective systematic response. The metro Auckland DHBs are to make participation in Testsafe compulsory for community pharmacies.

2.3 Child Health Collaboration

Aligning Contracts and Service Provision In addition to the previously noted joint immunisation operations manager, we are discussing a proposal to jointly tender for a provider of Outreach immunisation services (currently IMAC and ProCare) and NIR administration (currently ARPHS and ProCare). We believe that there are probably some significant efficiencies to be realised. The possibility of this including Before School Check services is also being discussed. Child Health Plan 2012-2017 Consultation with key Waitemata stakeholders is underway. A number of consultation meetings with Maori, Asian and parents of children with disabilities have been held. An online survey tool is up and running and remains open until 3 May 2012 (http://se.buzzchannelgroup.com/default.aspx?u=4784f4608dde4f6a9ddb90cf573ca9bd&h=4094). Feedback will be considered and the current draft Child Health Improvement Plan will be amended to reflect the needs of children and their families in both DHBs. It is likely that the completed plan will be presented to the July CPHAC. 2.4 Oral Health – Mobile services in to schools

Recent correspondence and subsequent discussion with the Ministry of Health regarding the decision by schools and their Boards to not accept the provision of an on-site mobile oral health service has highlighted that this is not an issue outside of the Auckland metro region. The Ministry of Health has agreed that Auckland and Waitemata DHBs are able to notify them of any schools with low adolescent oral health utilisation who also refuse the provision of an on site mobile service. The Ministry of Health will then inform and work with the Ministry of Education to agree an approach with individual schools regarding this.

2.5 Mobile Ear Clinics

Clinics Clinics are provided from mobile vans (Child & Family have two mobile ear caravans) in high need areas within West Auckland and more rural areas within the district as well as from DHB and community sites in Rodney and on the North Shore.


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Ear nurses decide the location of the ear caravans in conjunction with the Vision Hearing Technicians, parking at schools or other community venues in high deprivation areas where there are higher hearing failure rates. Ear nurse clinics are generally well attended. Parents/caregivers usually make an appointment by phone, choosing the time and venue they would like to attend, with a reminder letter being sent (Rodney) or a phone call made (North Shore and Waitakere) prior to the appointment, to encourage attendance. In Waitakere, the wait for a clinic appointment is presently two weeks, while in Rodney or the North Shore children are currently waiting two months or more for an appointment (due to less clinic availability). 12-16 children are seen per clinic and attendance is generally good. There are usually no more than two did not attend (DNA) or appointments cancelled on the day per clinic.

Waitakere • Four clinics per week are provided during mornings and early afternoons. • Clinics are held in the mobile ear van – sites include schools, community centres. • Each school term a mobile ear clinic itinerary is published and circulated to GPs,

community groups and other health care providers. North Shore & Rodney • One full day clinic per week is provided in the Pupuke Building at North Shore Hospital

using portable equipment. • One five hour clinic is held per month at each of the following sites - Wellsford,

Warkworth, Red Beach, and Birkdale Community Centre, with the ear nurse setting up portable otomicroscope and suction equipment in clinic rooms.

• These clinics are held in conjunction with the Vision Hearing Technician clinics (with the exception of Wellsford).

Auckland DHB Clinics • There are two static clinics that operate out of Greenlane Clinical Centre on a Tuesday

and a Thursday. These are full day clinics. • Mobile Ear Clinics (three vans at present) operate out of set schools and preschools

throughout the school year. These are determined each term in conjunction with the Vision and Hearing Technicians.

• During school holiday breaks the mobile ear clinic operates a weekly community clinic (in high deprivation areas) along with the community health worker.

• Mobile Ear Clinic itinerary can be found on HealthPoint – term by term. In Waitemata DHB, the mobile Ear Clinic visits the following schools: • Prospect Primary • Pomaria Primary • Glendene Primary • Henderson North School • Ranui Primary • Matipo Primary • Peninsula Primary • Royal Road School • Lincoln Heights School • Sunnyvale School • Kelston Primary • Kaukapakapa Primary • Paraki Primary


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• Helensville Primary • Woodhill Primary. In Auckland DHB, the mobile ear clinic visits the following schools: Central Cluster Schools Preschools - Te Papapa - Oranga - Onehunga - St Josephs (Onehunga) - St Josephs (Grey Lynn) - Richmond Road - Rosebank Road - Kura - Edendale

- Fakatauako TLN - Ritimana - Aogo Fa’a - Pune Ole Ole - Mata’anga

Tamaki Cluster Schools Preschools - Otahuhu - St Josephs (Otahuhu) - Sylvia Park - Panama Road - Bailey Road - Stanhope Road - Panmure Bridge - Tamaki Primary - Glen Taylor - St. Pius - Glen Brae - St Patricks - Fairburn P - Glen Innes - Pt England - Ruapotaka

- Church Street - Seugaga - Kenani TKR - Te Arapeta TKR - Te Tira Hau TKR - Teuila LN - To-onga Fungai - Feofa’aki - Te Taurere - Fetu Hake (Glen Brae) - Louolive

Wairaka Cluster Schools Preschools - Avondale Primary - St Marys Avondale - Glen Avon - Mt Albert Primary - Owairaka Primary - St Therese - Hay Park - May Road - Wesley Primary - Waterview - Mt. Roskill Primary - Dominion Road

- Fa’vae - Te Puna Owairaka - Nafanua - Rosebank LN - Apii Reo Tupuna - Te Puna Reo (With Kura)


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Mobile Ear Clinics: Referral System & Age Group Seen Auckland and Waitemata DHBs’ referral system is the same. The Ear Nurse clinics operate on an open referral system, with referrals accepted from parents, teachers (pre-school and school), vision and hearing technicians, public health nurses, Plunket, general practitioners, practice nurses, ear nose and throat specialists and audiologists. Specifically, children are referred if: • They fail screening completed by the Vision & Hearing Technicians and/or have poor

tympanometry results • They are noted to have suppurating (discharging) ears • They have suspected hearing loss • There are concerns about middle ear health (e.g. occluding wax) • They require wax removal • They have or are suspected to have otitis media • There are concerns about possible auditory processing difficulties and/or speech

development.

The service operates an open referral system and is provided to children of any age (infancy to school leaving age). At Auckland DHB, some secondary school students are seen as drop in clients.

Mobile Ear Clinics: Referral Prioritisation Both services operate a common referral prioritisation system. Once a referral is received they are classified as:

1. High Priority (seen within 72-hours). Children presenting with: discharging ears; wax which prevents them wearing hearing aids; and a foreign body in the ear

2. Medium Priority (seen within 2-months). Children who have been identified as having poor hearing, which is impacting on their learning, speech and/or behaviour or that has occurred following a known ear infection or Otitis Media with Effusion. Infants and toddlers who have a history of recurring Acute Otitis Media.

3. Low Priority (seen within 3-months). Children with occluding wax, which is not impacting on their development.

2.6 Mobile Asthma Clinics

Mobile Asthma Clinics are provided by the Asthma society. This service covers the three Auckland Metro DHBs. In Auckland DHB, the following schools receive the mobile service: • Waiheke High School • St Mary’s College • Selwyn College • Onehunga College • Mt Albert Grammar School • Avondale College • Selwyn College • Mt Roskill Grammar School • Western Springs College.


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In Waitemata DHB, the following schools receive the mobile service: • Birkenhead College • Northcote College • Kelston Boys • Kelston Girls College • Glenfield College. The mobile asthma service also goes into Primary, Intermediate and Secondary Schools for education on emergency kits to update staff both office and teachers. In addition to this they visit early childhood centres to educate the staff on asthma and what to do if a child has asthma while in their care.

3. Waitemata DHB Update

3.1 Funding

Before School Check (B4SC) Performance Concerted action has been underway to increase performance since March. Actions undertaken include direct communication by CEO to Waitemata PHO, weekly reporting to the PHO, increased capacity added by the provider arm to clear the vision and hearing backlog. As a result of these actions performance has risen dramatically. As at 28 May 67% of children have now had their checks. The target may now not be at risk and could be achieved if this level of improvement continues. Concerted efforts will continue to be made.


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3.2 Funder Finance

The April 2012 consolidated core result for the Waitemata Funder was $1.4m favourable to budget for the month and $4.6m favourable to budget for the year to date. This is the consolidated core result for the services provided by Waitemata Non Government Organisations, the services provided by Waitemata DHB for other DHB populations (IDF Inflows) and the services provided by other DHB for the Waitemata DHB population (IDF Outflows).

Funder NGOs The April core result for Funder NGO was $1.2m favourable to budget for the month and $2.5m favourable to budget for the year to date. The April month favourable position relates mostly to Community Pharmacy expenditure and results from a review of the drug rebate expectation. Drug rebates payments are receivable from PHARMAC retrospectively some four to six months after the expenditure is incurred. These are accounted for as earned according to PHARMAC forecast advices as well as current and historical payment trends. Expenditure relating to other NGO demand services continues to track within budget. Included in the year to date NGO results are IDF payments and/or accruals of $20.0m to Auckland DHB for the settlement of PHO capitation services. Similarly included is expenditure of $4.0m relating to Auckland DHB for the non capitation component of PHO services. These payments are utilisation based and are covered within the Funder NGO budgets.

Funder IDFs The April core result for Funder IDF was $232k favourable to budget for the month and $2.1m favourable to budget for the year to date. The favourable year to date position is mostly the result of a forecast wash-up receivable accrual relating to acute medical and surgical inpatients IDF utilisation. This is a net position and is inclusive of IDF Inflows and IDF Outflows. It also includes provisions for related risk and/or unrealised expenditure (for example, domiciles coding errors and long stay patients not yet discharged). Changes in IDF cost caused by changes in PHO practice memberships and/or enrolments growth continue to be accounted for within Funder NGO, as budgeted

4. Auckland DHB Update

4.1 Palliative Care

Progress was made this month in respect of aligning palliative care clients to the HBSS model, as they are currently exempt due to the short term, personal health nature of their diagnosis. This is being trialled, and will provide valuable alternatives to families of terminal clients for whom residential care was previously the only option. There has been strong requests made that this group sits alongside the CHC-LTS (IFP) group of clients within Auckland DHB A+links, but this needs to be strongly opposed through SDG as it flies completely in the face of integration and devolution of services. 4.2 Child Oral Health

The key activity in the oral health portfolio is the implementation of the Child and Adolescent Oral Health Business Case (OHBC).


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4.3 Mobile Dental Units

Five level one diagnostic mobile dental units have been commissioned and are currently being utilised for service provision by Auckland Regional Dental Service (ARDS). The sixth diagnostic van will be delivered in May. 4.4 Fixed Clinics

The Oral Health Business Case planned a total of thirteen new clinics consisting of one existing clinic refurbishment and twelve new fixed clinics. The clinics are due to be completed by the end of 2012. The building of the first and second phase clinics has been completed and the clinics are now treating patients. Significant progress has been made in the planning of the third phase of clinics. Construction of the Waiheke clinic is now complete and an official opening is scheduled for 5 June. Construction of the Orakei clinic is now underway with completion scheduled for 17 August. Construction of the May Road and Greenlane clinics will commence in July. 4.5 Before School Check (B4SC) programme

Auckland DHB remains below the expected national coverage level of 80% though the Alliance is optimistic about coming close to it, as there has been improvement over recent months. As previously mentioned consideration is being given to including B4SC in a joint tender with Waitemata DHB.

RESOLUTION TO EXCLUDE THE PUBLIC


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7. Resolution to Exclude the Public Recommendation: 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 item, 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 the Minutes of the Auckland and Waitemata DHBs Community and Public Health Advisory Committees Meeting with Public Excluded held on 02/05/12.

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.


Confirmation of Minutes As per the resolution from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

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


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

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


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