Community and Public Health Advisory Committees Meeting ...€¦ · - Asian, Migrant and Refugee Health Gain 4. ... Member Te Ora, Maori Medical Practitioners Step-daughter is a surgical

Community and Public Health

Advisory Committees Meeting

Wednesday 29 August 2018

10.00am

Venue

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

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Karakia

E te Kaihanga e te Wahingaro

E mihi ana mo te ha o to koutou oranga

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

Kia U ai matou ki te pono me te tika

I runga i to ingoa tapu

Kia haumie kia huie Taiki eee.

Creator and Spirit of life

To the ancient realms of the Creator

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

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

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

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

Well Being to All.

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Auckland and Waitemata DHBs Community and Public Health Advisory Committee Meeting 29/08/18

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

29 August 2018

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 10.00am

COMMITTEE MEMBERS Sharon Shea – Committee Chair (ADHB Board member) Max Abbott - WDHB Board member Judith Bassett – ADHB Board member Edward Benson Cooper - WDHB Board member Zoe Brownlie - ADHB Board member Sandra Coney - WDHB Board member Warren Flaunty - Committee Deputy Chair (WDHB Board member) Matire Harwood - WDHB Board member Lee Mathias - ADHB Board member Robyn Northey - ADHB Board member Allison Roe - WDHB Board member Board chairs:

Judy McGregor – Ex-officio as WDHB Board Chair Pat Snedden – Ex-officio as ADHB Board Chair

MANAGEMENT Dale Bramley - WDHB, Chief Executive Ailsa Claire - ADHB, Chief Executive Debbie Holdsworth - ADHB and WDHB, Director Funding Karen Bartholomew - ADHB and WDHB, Director Health Outcomes Nicole Song - WDHB, Board Secretary

Apologies: Allison Roe, Zoe Brownlie and Judith Bassett

AGENDA

KARAKIA ACKNOWLEDGEMENTS 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?

Items to be considered in public meeting

1. AGENDA ORDER AND TIMING

2. CONFIRMATION OF MINUTES

10.00am 2.1 Confirmation of Minutes of the meeting held on 06/06/2018

Actions Arising from previous meetings

3. STANDARD REPORTS

10.05am 3.1 Planning, Funding and Outcomes Update

- Executive Summary - Planning - Primary Care - Child, Youth and Women - Health of Older People - Mental Health and Addictions - Māori Health Gain - Pacific Health Gain - Asian, Migrant and Refugee Health Gain

4. INFORMATION PAPER

10.55am 4.1 Metro Auckland DHB Healthy Weight Action Plan for Children : First Report on Actions

11.10am 5. GENERAL BUSINESS

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Auckland and Waitemata District Health Boards

Community and Public Health Committees

Member Attendance Schedule 2018

NAME April June August November

Sharon Shea

Max Abbott

Judith Bassett

Edward Benson Cooper

Zoe Brownlie

Sandra Coney

Warren Flaunty

Matire Harwood

Lee Mathias

Robyn Northey

Allison Roe

attended absent * attended part of the meeting only ^ leave of absence # absent on Board business + ex-officio member

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Community and Public Health Advisory Committee (CPHAC)

REGISTER OF INTERESTS

Committee Member

Involvements with other organisations Last Updated

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

19/03/14

Judith Bassett Trustee - A+ Charitable Trust Shareholder - Fisher and Paykel Healthcare Shareholder - Westpac Banking Corporation Husband – Fletcher Building Husband - shareholder of Westpac Banking Corporation Granddaughter - shareholder of Westpac Corporation Daughter – Human Resources Manager at Auckland DHB

17/05/17

Edward Benson-Cooper

Chiropractor – Milford, Auckland (with private practice commitments) 07/12/16

Zoe Brownlie

Programme Supervisor at Auckland Regional Public Health Service Member – PSA Union Board member - RockEnrol Partner – Youth Connections, Auckland Council Partner – Aro Arataki Children’s Centre Committee Son – Aro Arataki Childcare Centre

26/06/17

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

15/12/16

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

06/06/18

Dr Matire Harwood

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

10/05/18

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Committee Member

Involvements with other organisations Last Updated

Lee Mathias Chair - Health Promotion Agency Chair - Health Innovation Hub (until the end of the Viclink contract in line with the director appointment) Chair – Medicines New Zealand Director - Health Alliance Limited (ex officio Auckland DHB) Director/shareholder - Pictor Limited Director – Pictor Diagnostics India Private Limited Director - Lee Mathias Limited Director - John Seabrook Holdings Limited Trustee - Lee Mathias Family Trust Trustee - Awamoana Family Trust Trustee - Mathias Martin Family Trust Member – New Zealand National Party

07/08/18

Robyn Northey Shareholder of Fisher & Paykel Healthcare Shareholder of Oceania Member – New Zealand Labour Party Husband - member Waitemata Local Board Husband – shareholder of Fisher & Paykel Healthcare Husband – shareholder of Fletcher Building Husband – Chair, Problem Gambling Foundation Husband – Chair, Community Housing Foundation

05/07/17

Sharon Shea Principal - Shea Pita Associates Ltd Provider - Maori Integrated contracts for Auckland and Waitemata DHBs Provider – Hapai Te Hauora Board member – Alliance Health Plus Iwi Affiliations: Ngati Ranginui, Ngati Hine, Ngati Hako and Ngati Haua Sub-contractor - Te Ha Oranga/Te Runanga o Ngati Whatua Director – Healthcare Applications Ltd Husband - Part owner Turuki Pharmacy Ltd, Auckland Husband - Board member - Waitemata DHB Husband – Director Healthcare Applications Ltd

09/07/18

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

02/11/16

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

28/06/18

Pat Snedden Director and Shareholder – Snedden Publishing & Management Consultants Limited Director and Shareholder – Ayers Contracting Services Limited Director and Shareholder – Data Publishing Limited Trustee - Recovery Solutions Trust Director – Recovery Solutions Services Limited Director – Emerge Aotearoa Limited and Subsidiaries Director – Mind and Body consultants Ltd Director – Mind and Body Learning & Development Ltd Shareholder – Ayers Snedden Consultants Ltd Executive Chair – Manaiakalani Education Trust Chair – National Science Challenge Programme – A Better Start Chair – The Big Idea – Not-for-profit-trust Director – Te Urungi o Ngati Kuri Ltd Director – Wharekapua Ltd Director – Te Paki Ltd Director – Ngati Kuri Tourism Ltd Director – Waimarama Orchards Ltd Chair – Auckland District Health Board Director – Ports of Auckland Ltd

12/6/18

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2.1 Auckland DHB and Waitemata DHB Community and Public Health Advisory Committee Meeting 06 June 2018

Recommendation:

That the draft minutes of the Community and Public Health Advisory Committee meeting held on 06 June 2018 be approved.

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Minutes of the meeting of the Auckland DHB and Waitemata DHB

Community and Public Health Advisory Committees

Wednesday 06 June 2018

held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.06am

Part I - Items considered in Public Meeting COMMITTEE MEMBERS:

Sharon Shea (Committee Chair - ADHB Board member) Max Abbott (WDHB Board member) Judith Bassett (ADHB Board member) Edward Benson-Cooper (WDHB Board member) (until 12 noon, item 4.1) Zoe Brownlie (ADHB Board member) Warren Flaunty (Committee Deputy Chair - WDHB Board member) Lee Mathias (ADHB Board member) Robyn Northey (ADHB Board member) Allison Roe (WDHB Board member)

ALSO PRESENT:

Dale Bramley (WDHB Chief Executive Officer) Debbie Holdsworth (ADHB and WDHB, Director Funding) Karen Bartholomew (ADHB and WDHB Acting Director Health Outcomes) Jennifer Dann (ADHB Communications) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

Sue Claridge, Auckland Womens Health Council Aroha Hudson, Te Puna Manawa HealthWest Gaylene Sharman, Te Puna Manawa HealthWest Ann-Marie Woodward, Te Puna Manawa HealthWest

KARAKIA:

Sharon Shea opened the meeting with a prayer. WELCOME:

The Committee Chair welcomed those in attendance at the meeting.

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APOLOGIES:

Apologies were received and accepted from Sandra Coney, Matire Harwood, Ailsa Claire, Jane McEntee (ARPHS) and Andrew Old (Auckland DHB Chief Strategy/Participation and Improvement) and for early departure from Dale Bramley.

DISCLOSURE OF INTERESTS

There were no declarations of interests relating to the agenda. Warren Flaunty noted that he was no longer a Director of Westgate Pharmacy and that this could be removed from his register of interests.

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

2. COMMITTEE MINUTES 2.1 Confirmation of Minutes of the Auckland and Waitemata DHBs’ Community and Public

Health Advisory Committees Meeting held on 04/04/18 (agenda pages 7 to 13) Resolution (Moved Lee Mathias/Seconded Robyn Northey) That the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 04 April 2018 be approved. Carried Matters Arising (agenda pages 14)

Debbie Holdsworth summarised the matters arising reported. In response to a question from Lee Mathias regarding data collection at Statistics New Zealand (action point 1), it was noted that the DHB Funding team has experienced epidemiologists engaged on population statistics. The team reports regularly and works with Statistics NZ, while this is reported it could be done more formally as part of the Asian Health Plan reporting; it was requested that this be at a more granular level.

3. STANDARD REPORT 3.1 Planning, Funding and Outcomes Update (agenda pages 15 to 48)

Debbie Holdsworth (Director Funding) introduced the report. Matters covered in discussion and response to questions included:

That the Minister of Health’s letter of expectation and the funding envelope have been received. Annual Plans for both the Auckland and Waitemata DHBs are being prepared.

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Priorities set by the Minister were as expected, with one new priority around child wellbeing that is in line with work already underway at the DHBs.

That with regard to diabetes care and data recorded, Tim Wood noted that there will be total review around screening and co-design work is close to commencing. He noted that at this stage changes in diabetes data is not being seen, but it is hoped in time there will be a change in statistics; a recent agreement with PHOs is to have a much stronger emphasis in this area.

In response to a question about improving Maori and Pacific stats, Tim Wood noted that there is a piece of co-design work underway with a session focussed on Maori and Pacific people that did not engage with their GP held. Lee Mathias referenced the work undertaken by the Heart Foundation’s Pacific Heartbeat team; Tim acknowledged this work and advised that they are cognisant of the work and it is hoped the co-design work will assist in improving approaches to diabetes care.

In noting the rest home audits as reported, Kate Sladen confirmed that the unannounced audits are included in the total. It was also clarified that the type of audit with the most corrective actions were the certified audits and not the unannounced audits.

That both DHBs are meeting some of the Child, Youth and Women health targets with gains seen in immunisations and raising healthy kids. Work continues on steps to improve the Rheumatic fever rate along with cervical screening and oral health.

Noting that while there have been some improvements in oral health over the past year, more in depth updates were requested for the Committee including statistics and what is being done to improve rates.

Further information was requested on the matter concerning tobacco being sold to minors (page 47 of the agenda); while penalties were reported it is not clear what happened to the three places that sold tobacco to minors.

In response to a question about whether the DHB makes it easy enough for people to obtain diabetes tests and retinal screening, Tim Wood advised that the DHBs are looking at both where it is ideal to deliver the service and how to make it more convenient. There are two models underway, at Waitemata DHB the programme is run by an organisation that undertakes screening in the community and Auckland DHB undertakes the majority of its screening at the Greenlane Clinical Centre. Work underway is to determine where the best locations are for screening, although this may not be the answer and more education in the community about the importance of retinal screening may be needed. Information is given to patients on screening; however, ensuring it is conducive is important.

That it is intended to provide an update as part of the annual planning process on the number of adolescents who are enrolled in the private sector for dental health.

That dental care for elderly people is included in a care plan and is audited.

Noting that the DHBs hosted the Mental Health Inquiry Panel and have made submissions.

The Planning and Funding Team has supported a number of submissions including on addiction, youth voice, housing, collaborative actions in Auckland Central, funding approaches and sustainable property values and impact on sustainable contracting. It was noted that the youth voice submission was an online contracted NGO to engage a hui across the sector. It included 80 voices, some current service users, an online survey and several groups were run. The Committee requested a copy of the submissions submitted be provided in the Diligent Boardbooks resource centre.

The Committee Chair summarise the Committee’s discussion and that information on the types of levers used to achieve improved performance would be beneficial for the

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Committee to receive. She acknowledged the work being undertaken and the social, cultural and economic determinants being worked with every day.

4. INFORMATION ITEM 4.1 HPV Self- sampling for Cervical Screening – Research update (agenda pages 49-57)

Karen Bartholomew (Director, Health Outcomes), Aroha Haggie (Manager, Maori Health Gain) and Helen Wihongi (Research Advisory Maori) presented this item. Karen Bartholomew introduced the report and acknowledged the large group of people involved in this collaborative piece of work. She summarised the project and its purpose noting that a kaupapa Maori lens and co-design lens had been taken with a focus on health literacy. The report to the Committee is the results of the feasibility study. Matters covered in discussion and response to questions included:

Study 1 included 84 women who completed the HPV self-testing.

In response to a question about risk, Karen Bartholomew advised that there is always a potential risk the test is done incorrectly. Time has been spent in focus groups to make sure information is provided on how to complete the test correctly and that the instructions are good. If human cells are not detected in the test then the screening can be repeated.

That a large randomised roll-out to approximately 7,000 Maori, Pacific and Asian women is scheduled to take place to inform the larger study. It is anticipated that there will be a 20 per cent response rate.

Learning from the DHBs Maori Health Strategy includes engagement with the community and understanding personal experiences; a more positive experience with clinicians can be a significant decision maker for patients. Another aspect is the engagement in terms of co-design of process and how to encourage more women to participate in the larger study. It was also noted that it has been demonstrated that access is more difficult for Maori women and to support the process, work is underway with Maori Providers, which literature says will assist in being more successful; the initially study demonstrates this.

It was noted that the initial study was undertaken mostly through GPs; the next larger study will involve Maori Providers.

In the second larger study test kits will be mailed to homes; the study will identify if mail or clinic based pick ups are preferred. Studies undertaken overseas show the answer is variable.

The age bracket chosen for the study is 30 years of age and is targeted for a group of women who have never been screened or are very overdue. Currently the highest rate of cervical screening is between the ages of 20 and 30 years of age.

Resolution (Moved: Lee Mathias/Seconded: Edward Benson-Cooper) That the Community and Public Health Advisory Committees:

1. Note that the HPV self-sampling research programme has been established to address inequity in cervical cancer outcomes and access.

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2. Note that Feasibility Study (Study 1) includes an approach to optimise the novel technology for Māori women first, and includes a series of focus groups and an evaluation of cultural appropriateness and women’s experience.

3. Note that Study 1 is now complete, and that the results have informed the larger Randomised Controlled Trial (Study 2) which has begun recruitment in May 2018.

Carried

5. GENERAL BUSINESS

The Waitemata DHB Chief Executive Dr Dale Bramley thanked the interim Board Chairs for their leadership from February 2018. He also acknowledged the appointments of the new Chairs for Auckland DHB and Waitemata DHB, Pat Snedden and Judy McGregor respectively. The Committee Chair thanked the community members who had attended the meeting. The meeting concluded at 11.00am

SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS’ COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 06 JUNE 2018

CHAIR

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Actions Arising and Carried Forward from Meetings of the Community and Public Health Advisory Committees as at 20 August 2018

Meeting Agenda

Ref Topic

Person Responsible

Expected Report Back

Comment

06/06/18 3.1

Oral Health Provide more in depth updates including statistics and what is being done to improve rates.

CPHAC

29/08/18 Update on Adolescent Oral Health provided as part of the PFO update.

06/06/18 3.1

Submissions Copy of the submissions submitted to Mental Health Inquiry Panel to be made available in Resource Centre on Diligent Boardbooks.

Actioned.

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3.1 Planning, Funding and Outcomes Update

Recommendation:

That the report be received.

Prepared by: Wendy Bennett (Manager Planning and Health Intelligence), Trish Palmer (Funding and Development Manager Mental Health and Addiction Services), Ruth Bijl (Funding and Development Manager Child, Youth and Women’s Health), Tim Wood (Funding and Development Manager Primary Care), Kate Sladden (Funding and Development Manager Health of Older People), Aroha Haggie (Manager Māori Health Gain), Lita Foliaki (Manager Pacific Health Gain), and Raj Singh (Project Manager Asian, Migrant and Refugee Health Gain) Endorsed by: Dr Debbie Holdsworth (Director Funding) and Dr Karen Bartholomew (Acting Director Health Outcomes)

Glossary AH+ - Alliance Health Plus ARC - Aged Residential Care ARDS - Auckland Regional Dental Service ARPHS - Auckland Regional Public Health Service CADS - Community Alcohol and Drug Service CDA - Combined Dental Agreement CLP - Community Learning Programme CPHAC - Community and Public Health Advisory Committee CTO - Community Treatment Orders CVD - Cardiovascular Disease DHB - District Health Board HBHF - Healthy Babies Healthy Futures HCSS - Home and Community Support Services HPV - Human Papilloma Virus HVAZ - Healthy Village Action Zones IPS - Individual Placement and Support MACGF - Metro Auckland Clinical Governance Forum MMR - Mumps, Measles and Rubella MoH - Ministry of Health MoU - Memorandum of Understanding NGO - Non Governmental Organisation NHC - National Hauora Coalition NIHI - National Institute of Health Innovation PHAP - Pacific Health Action Plan PHO - Primary Health Organisation SLM - System Level Measures TWOW - Te Whanau O Waipereira

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1. Executive Summary This report updates the Community and Public Health Advisory Committee (CPHAC) on Auckland and Waitemata District Health Boards’ (DHB) planning and funding activities and areas of priority, since its last meeting on 6 June 2018. It is limited to matters not already dealt with by other Board committees or elsewhere on this meeting’s agenda. Highlights

A new Nurse led X-ray service is up and running on Great Barrier Island. The service is based on the nurse-led model developed by Canterbury DHB for their remote and rural general practices, including the Chatham Islands. Canterbury DHB shared their training resources and model of service

The first national report on HPV immunisation coverage, since the vaccine was introduced for boys in 2017, is available. Auckland DHB leads the country with 83% of 12 year old girls fully immunised (current target is 70%), as well as demonstrating success in equitable coverage for Māori (84%) and Pacific (87%).

Both Auckland and Waitemata DHBs continue to exceed the Raising Healthy Kids target for all ethnicities with 100% and 99% respectively of children having their referrals acknowledged within 30 days

Early progress with the Individual Placement Support prototype is excellent. Recruitment has only been in place for six weeks and already 20 participants have been signed up for IPS support

The Auckland City Mission has embarked on an ambitious rebuild of existing services with demolition and rebuilding of their Hobson Street premises underway. The Planning and Funding team are supporting the design process to relocate the existing Community Alcohol and Drug Service (provider arm) medical detox service from Pitman House to a new facility in Hobson Street. Consultation with the Auckland City Mission, Community Alcohol and Drug Service teams and the architects around design and floor plan configuration is now underway

The Māori Health and Health Gain team with the support of the lead CEO Māori Health, with the support of the lead CEO Māori health, have established a set of pipeline projects with opportunities to accelerate Māori health gain have been identified through a range of vehicles – the Māori Life Expectancy Report, the Whānau House Health Needs Assessment, the Māori Health Plan, the equity re-focussing of the System Level Measures Plan, the DHB and Nga Painga Hauora outcomes frameworks, the review of the integrated contracting processes, work of colleagues and horizon scanning of evidence and technologies

The Waitemata DHB Asian PHO enrolment rate has increased by 1% to reach 89%, with 2,551 new enrolees in the last quarter. We have surpassed the 2% incremental increase target of 87% by 30 June 2018 for Waitemata DHB Asian PHO enrolment

2. Planning

2.1 Annual Plans

The first draft of the 2018/19 Auckland and Waitemata DHB Annual Plans were presented to the respective July Board meetings for review and approval to submit. The Ministry of Health (MoH) have delayed the deadline for submission of the first draft to 27 July to account for the nurses’ strike. The first draft has been submitted to the MoH and we expect feedback on this over

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August. The second draft will be presented to Board in September after we receive and respond to Ministry feedback.

2.2 Annual Report

Development of the 2017/18 Annual Report continues. The first drafts will be presented to the September Auckland DHB’s Finance, Risk and Assurance Committee meeting and Waitemata DHB’s Audit and Finance Committee Meetings.

2.3 System Level Measure Improvement Plans

The 2018/19 SLM Improvement Plan has been completed, endorsed by the metro-Auckland Alliance Leadership Team and approved by the MoH, who noted they continue to be impressed by the approach and investment in the development of the plan and also that they use this as an exemplar Plan both within the Ministry and out in the sector.

2.4 Ministry of Health Achieving Equity in Health Outcomes work programme

The MoH have established joint Ministry and sector co-leadership and governance arrangements to advance the Government’s priorities; Achieving Equity, Child Wellbeing, Mental Health and Primary Health Care. Dr Dale Bramley, CEO Waitemata DHB, is the sector co-sponsor for the Achieving Equity work programme alongside Alison Thom, Māori Leadership at the Ministry of Health. This work programme aims to: build understanding through data, analytics and insights work with system partners enhance innovation and trial responsive service models weave an equity focus into the operational landscape facilitate an equity focus across the other priority areas.

2.5 Auckland and Waitemata DHB Quarterly Performance Scorecard

The Auckland and Waitemata DHB CPHAC Scorecard is a standardised tool used to internally review and track performance against a range of measures including National Health Targets for both Auckland and Waitemata DHBs. The Scorecard below shows indicator performance against target for each DHB for Quarter 4 of the 2017/18 year.

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a. Better help for smokers to quit - primary care Actual Target Trend a. Better help for smokers to quit - primary care Actual Target Trend

Total 92% 90% p Total 89% 90% p

Māori 92% 90% p Māori 88% 90% p

Pacific 92% 90% p Pacific 89% 90% p

Other 92% 90% p Other 89% 90% p

Increased immunisation (8-month old) Increased immunisation (8-month old)

Total 94% 95% Total 92% 95% p

Maori 86% 95% Maori 86% 95% p

Pacific 94% 95% p Pacific 90% 95% q

Asian 97% 95% q Asian 96% 95% q

Other 93% 95% q Other 91% 95% p

Raising Healthy kids Raising Healthy kids

Total 100% 95% Total 99% 95%

Maori 100% 95% Maori 100% 95%

Pacific 100% 95% Pacific 100% 95%

Asian 100% 95% Asian 100% 95%

Other 100% 95% Other 98% 95% p

Oral Health - % Infants enrolled at 2 years Actual Target Trend Oral Health - % Infants enrolled at 2 years Actual Target Trend

Total 84% 95% q Total 90% 95% p

Māori 65% 95% p Māori 73% 95% q

Pacific 87% 95% q Pacific 86% 95% p

Asian 72% 95% q Asian 77% 95% p

Other 101% 95% q Other 105% 95% q

Oral Health - % enrolled utilisation at 2 years Oral Health - % enrolled utilisation at 2 years

Total 76% 75% p Total 74% 75% p

Māori 63% 75% p Māori 62% 75% p

Pacific 64% 75% p Pacific 58% 75% p

Asian 82% 75% p Asian 80% 75% p

Other 79% 75% p Other 78% 75% p

HPV immunisation coverage - girls HPV immunisation coverage - girls

Total 83% 70% p Total 60% 70%

Maori 84% 70% p Maori 56% 70% q

Pacific 87% 70% q Pacific 58% 70% q

Asian 72% 70% q Asian 69% 70% p

Other 91% 70% p Other 58% 70% p

PHO enrolment Actual Target Trend PHO enrolment Actual Target Trend

Total 82% 90% q Total 91% 90% q

Māori 76% 90% Māori 83% 90%

e. Pacific 101% 90% qe. Pacific 101% 90%

Asian 70% 90% Asian 89% 90% p

Other 88% 90% q Other 93% 90%

d. Diabetes management d. Diabetes management

Total 62% 75% q Total 63% 75% q

Māori 53% 75% q Māori 49% 75% q

Pacific 51% 75% q Pacific 53% 75% q

Other 70% 75% q Other 67% 75% q

Actual Target Trend Actual Target Trendc. HBSS clients with Clinical interRAI in last 2 yr 91% 95%

c. HBSS clients with Clinical interRAI in last 2 yr 69% 85% q

ARC residents LTCF interRAI w/in 230 days of previous 84% 85% q ARC residents LTCF interRAI w/in 230 days of previous 84% 80% p

ARC residents HC interRAIs prior to LTCF interRAI 89% 98% p ARC residents HC interRAIs prior to LTCF interRAI 80% 98% q

Performance indicators: Trend indicators:

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

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

Performance was maintained

d. May 18. Aligns with MACGF indicator; differs from MoH indicator

e. >100% due to mismatch of the underlying population projections and primary care database ethnicity

categorisations.

a. Jun 18. Source prelim MOH quarterly report

b. December 2017

c. Mar 2018

Contact:

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

Planning, Funding and Health Outcomes, Waitemata DHB

Auckland and Waitemata DHB Quarterly Performance Scorecard

CPHAC Outcome ScorecardJune 2018

2017/18

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

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

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

variations perceived to be large.

Health Targets - Auckland DHB

How to read

Child, Youth and Women - Auckland DHB

Primary Care - Auckland DHB

A question?

Key notes

Health Targets - Waitemata DHB

Child, Youth and Women - Waitemata DHB

Primary Care - Waitemata DHB

Health of Older People - Auckland DHB Health of Older People - Waitemata DHB

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3. Primary Care 3.1 Nurse led X-ray service in Great Barrier Island

Great Barrier Island lies in the outer Hauraki Gulf, 100km north-east of central Auckland. With an area of 285 square kilometres it is the sixth-largest island of New Zealand.

Aotea Health is the sole provider of primary care on Great Barrier with a main clinic in Claris and a satellite clinic at Port Fitzroy. These clinics have an enrolled population of nearly 1000 patients. During the summer season an influx of visitors sees the population increase markedly and should the need arise for secondary services, Auckland DHB Hospital is the closest choice to service these visitors.

Until recently, Dr Ivan Howie provided the local x-ray service at Aotea Health. Dr Howie has since retired and the continuation of the local x-ray service, reliant on outdated wet film processing, was at risk of discontinuation.

To mitigate this risk, a business case was developed for a new model of x-ray service delivery on Great Barrier Island for patients who present with suspected uncomplicated distal limb fractures (forearm, wrist, hand, ankle and foot). The service is based on the nurse-led model developed by Canterbury DHB for their remote and rural general practices, including the Chatham Islands. Canterbury DHB shared their training resources and model of service.

Two nurses from Aotea Health have been trained by the Greenlane Clinical Centre MRT Team Leader, Sarah Stansfield, with Nicola O’Carroll providing training on the Auckland DHB Radiology IT systems. ISL New Zealand supplied and installed the digital retrofit for the existing AMX4 x-ray machine.

The project to digitally upgrade the existing AMX4 x-ray machine and provide associated training for nurses to take limited x-rays is now operational at Aotea Health on Great Barrier Island. The new service used the upgraded machine and sent their first digital x-ray from Great Barrier to Auckland DHB Radiology on 22 June 2018 (Figure below).

The project met its objectives:

to ensure the on-going provision of x-ray services on Great Barrier Island

to facilitate the transition to a nurse-led x-ray service on Great Barrier Island

to provide equitable access for the population of Great Barrier Island by continuing to provide a timely service closer to home

to enable near real-time review of x-rays at Auckland DHB and provision of specialist advice back to GPs on the Island to support community patient management and avoid the need for transfer to Auckland City Hospital.

Project partners were:

Dr Kate Aitken (radiology advisor to the Rural Alliance)

healthAlliance (IT and Technology project support)

Auckland DHB Radiology (overseeing the project, providing initial training, ongoing training and service support)

Auckland DHB Nursing Scope of Practice Committee (approving and supporting the nurses through an expanded scope of practice)

ISL Medical and Scientific NZ

Auckland PHO

Aotea Health

Auckland DHB Planning, Funding and Outcomes.

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Registered nurse, Wendy Millward, with the first digital x-ray taken on Great Barrier Island

3.2 National Health Targets

‘Better Help for Smokers to Quit’ DHB Target: 90% of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. The ‘Better Help for Smokers to Quit’ result is reported as a National Health Target. Auckland DHB has achieved the primary care ‘Better Help for Smokers to Quit’ health target in Q4, 2017/18. Preliminary results from the PHOs showed Auckland DHB performance at 91.8%. Waitemata DHB came close to achieving the target and preliminary result shows Waitemata DHB at 88.5%.

Overall, the results highlight an improvement in the performance of both Auckland and Waitemata DHBs with this health target.

At a PHO level all of the Auckland DHB’s PHOs successfully achieved the primary care ‘Better Help for Smokers to Quit’ health target. ProCare also achieved the target in Waitemata DHB, while Comprehensive Care PHO failed to achieve the target. This is despite an increase in performance by National Hauora Coalition (NHC) (which is a network partner of Comprehensive Care). Table 1 below has the results by PHO for Q4.

Table 1: PHO Results for Better Help for Smokers to Quit 90% Target (Q4, 2017/18)

DHB PHO Target %

Auckland DHB

Auckland PHO 92.9%

Alliance Health Plus 90.1%

National Hauora Coalition 94.4%

ProCare 91.2%

Waitemata DHB Comprehensive Care 85.6%

ProCare 91.0%

All PHOs prioritised activities and events as per their smokefree plans to proactively reach more smokers and achieve the target. The Primary Care team monitored the PHO performance closely and required the Waitemata DHB PHOs to provide weekly reports on their smoking cessation activities. Despite the activities that Comprehensive Care undertook they failed to improve their result from the previous quarters. A contributing factor to Comprehensive Care’s result is that they are unable to get monthly data on the brief advice status of patients from all practices, the PHO is therefore unable to follow-up these patients with brief advice and support to quit.

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The results are also shown in the Scorecard under Health Targets as well as in Figure 1 below:

Auckland DHB – 91.8%, ↑2.4% from the previous quarter

Waitemata DHB – 88.5%, ↑1.0% from the previous quarter Figure 1: Auckland and Waitemata DHBs ‘Better Help for Smokers to Quit’ performance (Q4, 2017/18)

Note: Q4 data is preliminary PHO data as MoH data not yet available. 3.3 Diabetes Management

DHB Target: A minimum of 75% of people with diabetes (aged 15 to 74 years) have good or acceptable glycaemic control (latest HbA1c less than or equal to 64mmol/mol) recorded in the last 15 months. Metro Auckland DHBs and PHOs are committed to improving population health outcomes for people with diabetes. To help achieve this goal, five regionally agreed Diabetes and Cardiovascular disease (CVD) clinical indicators have been prioritised for monitoring performance. All metro Auckland PHOs (seven) have been reporting anonymised practice level data relating to these five clinical indicators and the performance is being reported to the Metro Auckland Clinical Governance Forum (MACGF) (Table 2) since June 2017. These indicators were reviewed in July 2018 including the data specifications that support these indicators were also updated to improve data collection. This quarter showed an increase in the number of people with diabetes aged 15-74 years, with a recent HbA1c carried out within the last 15months. For example, there were 91% Waitemata and 89% Auckland DHBs patients with a recent HbA1c. When comparing the Quarter 4, 2017-18 results to Quarter 3, 2017-18, both DHBs experienced a 6% and 2% increase respectively.

0%

20%

40%

60%

80%

100%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2015/16 2016/17 2017/18

% Better Help for Smokers to Quit - Primary Care Source: MoH DHBSS Reports

ADHB - Overall WDHB - Overall MoH - Target

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Except for the Auckland DHB’s Pacific people with diabetes, both DHBs have shown some improvement in good or acceptable glycaemic control of the people with diabetes (Table 2). The Primary Care team continues to work with the PHOs to further improve the quality of data and reporting. Table 2: Auckland and Waitemata DHB performance against the MACGF Diabetes and CVD Clinical

Indicators 30 June 20181

1 Data Source: Numerator and denominator is extracted from the PHO enrolled data. The denominator is different than that for previous CPHAC reports and Ministry of Health reports.

Clinical Indicator Goal Auckland DHB Waitemata DHB

Māori Pacific Total Māori Pacific Total

Clinical Indicators – Long Term Conditions Management - Diabetes

HbA1c Glycaemic control:

Percentage of enrolled patients

with diabetes (aged 15 to 74 years)

who have good or acceptable

glycaemic control (latest HbA1c

less than or equal to 64mmol/mol)

recorded in the last 15 months

80% 52.0%

(↑0.5%)

50.2%

(↓0.1%)

61.6%

(↑0.2%)

54.5%

(↑4.4%)

54.9%

(↑0.9%)

65.5%

(↑2.5%)

Blood pressure control:


with diabetes (aged 15 to 74 years)

whose latest systolic blood

pressure recorded in the last 15

months is <140

80% 55.8%

(↓6.7%)

50.5%

(↓14.1%)

58.1%

(↓9.7%)

62.8%

(↓2.5%)

67.0%

(↓1.2%)

64.4%

(↓1.7%)

Management of

Microalbuminuria: Percentage of

enrolled patients with diabetes

(aged 15 to 74 years) who have

microalbuminuria in the last 18

months and are on an ACE inhibitor

or Angiotensin Receptor Blocker

90% 70.6%

(↓0.8%)

71.1%

(↓0.2%)

71.7%

(↑0.2%)

72.4%

(↓1.3%)

73.2%

(↑3.8%)

73.1%

(↑1.7%)

Clinical Indicators – Long Term Conditions Management – CVD

CVD Secondary Prevention:


with known cardio-vascular disease

who are on triple therapy (Statin +

BP lowering agent +

Antiplatelet/Anticoagulant)

70% 61.8%

(↑1.1%)

65.1%

(↑2.2%)

60.6%

(↑2.0%)

56.5%

(↑0.7%)

63.7%

(↑1.8%)

55.1%

(↓0.6%)

CVD Primary Prevention:


with cardio-vascular risk ever

recorded >20%, (aged 35 to 74

years, excluding those with a

previous CVD event) who are on

dual therapy (statin + BP Lowering

agent)

70% 43.7%

(↓1.3%)

50.6%

(↓4.1%)

45.2%

(↓3.0%)

48.9%

(↓1.7%)

57.8%

(↓0.8%)

45.3%

(↓0.3%)

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Due to this short reporting timeframe there has been minimal improvement in these indicators. This is in part due to the complex nature of diabetes management and ongoing data extraction issues. However, PHOs and DHBs are committed to improving diabetes outcomes with a specific focus on improving outcomes in our high need/risk populations (Māori, Pacific, Asian, those newly diagnosed with type 2 diabetes and those with poor glycaemic control). To achieve improved outcomes in the above clinical indicators, a holistic system wide approach is required and the first step is being undertaken as part of the Diabetes Service Level Alliance flagship project “Improving diabetes outcomes for people with diabetes through a co-design approach”. Data quality issues affecting this quarter’s data There were several data extraction issues experienced this quarter that affected the completeness of data received from the PHOs. These extraction issues include:

Dr Info experienced data extraction issues which affected both ProCare and Comprehensive Care. This issue resulted in a less complete data set from these PHOs. These extraction issues resulted in missing values or measurements ie HbA1c and CVD risk assessment results

Alliance Health Plus experienced data extraction issues with their new data warehouse resulting in a decrease in the diabetes and blood pressure data sets. This has skewed the Auckland DHB blood pressure management figures for this quarter

Data is still not able to be extracted from the Profile for Mac Patient Management System

Issues still exist for extraction data from the Patient Management System My Practice Performance against the five regionally agreed clinical indicators at a DHB level There continues to be significant performance variations between ethnic groups (Figure 2). For example, there is a 8% to 12% variation in the number of Māori and Pacific people with good or acceptable diabetes control when compared to the total diabetes population. These ethnic variations have remained consistent since April 2017. The Diabetes Service Level Alliance work programme is specifically designed to improve diabetes-related outcomes of Māori, Pacific and other high-risk populations. Figure 2: DHB performance, by ethnicity, against the MACGF diabetes clinical indicator – Glycaemic Control (July 2017 – June 2018)

Auckland DHB Waitemata DHB

Practice level data provided by the PHOs across both DHBs, highlighted there were four out of 114 (4%) Auckland DHB practices and four out of 79 (5%) Waitemata DHB practices, that had achieved the glycaemic control target of 80% of their practice population with diabetes having an HbA1c

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<64mmol/mol in March 2018 (Figures 3 and 4). The practice level data continues to show a large variation in performance against this target between practices.

Figure 3: HbA1 Glycaemic Control: Percentage of enrolled diabetic patients with <=64 (aged

15-74 years) HbA1c recorded in the last 15 months – Auckland DHB, June 2018

Total Healthcare - Auckland ProCare - Auckland National Hauora Coalition - Auckland

Auckland PHO

Alliance Health Plus Target

Figure 4: HbA1 Glycaemic Control: Perentage of enrolled diabetic patients with <=64 (aged 15-74

years) HbA1c recorded in the last 15 months – Waitemata DHB, June 2018

Total Healthcare - Auckland ProCare - Waitemata National Hauora Coalition - Waitemata

Comprehensive Care

Alliance Health Plus Target

3.4 Cardiovascular Disease (CVD)

Auckland and Waitemata DHBs have achieved and sustained the 90% CVD risk assessment target at a total population level since September 2014 (Figure 5). However, both DHBs have yet to meet this target for the Māori population. Māori men aged 35-44 years, who are the population least likely to receive a CVD risk assessment, are being targeted with the aim to achieve the target of 90%. The current screening rate for Māori men aged 35 to 44 years is 71.6% (↓2.4%) and 68.1% (↓0.1%) for Auckland and Waitemata DHBs respectively. The PHOs are undertaking the following activities to achieve the 90% target in Māori men:

All PHOs are providing their practices with NHI lists of those who are due for a CVD risk assessment and Māori men aged 35-44 years are prioritised above all other populations

Alliance Health Plus were incentivising Māori men aged 35-44 years to have their CVD risk assessment completed by offering a $35 Rebel Sport voucher. The PHO has reported a moderate increase in their CVD risk assessment rates for Maori men across their network of practices

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Alliance Health Plus and National Hauora Coalition (NHC) have also undertaken outreach clinics in local marae to engage high risk population groups and complete CVD risk assessment in those who attend these clinics

NHC are working to identify outreach locations to target Maori men aged 35-44 years. Their data show that this population group currently attend primary care once every 2+ years.

ProCare are focusing on improving their triple therapy rates in those who have experienced a previous CVD event and this is highlighting the need for up-to-date CVD risk assessments.

Figure 5: ‘More Heart & Diabetes Checks’ performance for Auckland DHB and Waitemata

(Q4, 2017-18)

Note: More Heart and Diabetes Checks Q4, 2017/18 – Preliminary Data, Ministry of Health.

Blood Pressure Control in patients with diabetes: The percentage of enrolled patients with diabetes (aged 15-74 years) whose latest systolic blood pressure recorded was <140mmHg in the last 15 months has declined during this quarter. This is due to data extraction issues experienced by Alliance Health Plus, ProCare and Comprehensive Care (Figure 6).

40%

50%

60%

70%

80%

90%

100%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

% More Heart & Diabetes Checks (Source: MoH Quarterly Report)

Overall - ADHB Overall - WDHBTarget - ADHB Target - WDHB

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Figure 6: Blood pressure control of patients with diabetes – July 2017 to June 2018


Management of microalbuminuria in patients with diabetes The number of people with diabetes and microalbuminuria who are on an ACE inhibitor or Angiotensin Receptor Blocker (Figure 7), has remained relatively stable during the last 18 months. Furthermore, there was no significant variation in management rates between ethnic groups. The low management rates may be due to the under-reporting of microalbuminuria and further analysis is required once a complete dataset is recieved.

Figure 7: Management of microalbuminuria in patients with diabetes – July 2017 to June 2018


Secondary CVD risk prevention The secondary CVD risk prevention clinical indicator is defined as the percentage of enrolled patients with known CVD who are on triple therapy (Statin + BP lowering agent + Antiplatelet/Anticoagulant) (Figure 8). Auckland and Waitemata DHBs, along with PHOs, are focused on improving secondary CVD risk management rates. It is an area where significant and rapids improvements can be achieved that results in a reduction in number of people experiencing a subsequent CVD event. Improving secondary CVD risk management rates will also further benefit improvements in blood pressure

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management for our diabetic populations as the prescribing of triple therapy will have a positive effect on this clinical indicator. Secondary CVD risk prevention rates in the total population remained relatively stable for both Auckland and Waitemata during this quarter. Across both Auckland and Waitemata DHB, Pacific people continue to have the highest rates of secondary CVD risk prevention management. Secondary CVD risk management rates in people with diabetes are significantly higher than those seen in the total population and the target in this population has been achieved (Figure 9).

Figure 8: Secondary CVD risk prevention in the total enrolled population by ethnicity July 2017 to June 2018


Figure 9: Secondary CVD prevention in patients with diabetes by ethnicity,

July 2017 to June 2018


Primary CVD risk prevention The primary CVD risk prevention clinical indicator is defined as the percentage of enrolled patients with CVD risk ever recorded >20% (aged 35 to 74 years) and who are on dual therapy (statin + BP lowering agent). This excludes those with a previous CVD event.

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In Auckland DHB, the primary CVD risk prevention rates declined during this quarter. This is likely to be related to the data extraction issues experienced during this quarter. In Waitemata DHB, the primary prevention rates remained stable over the same period. Figure 10: Primary CVD risk prevention in total enrolled population by ethnicity



Figure 11: Primary CVD risk prevention in those with diabetes by ethnicity



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4. Children, Youth and Women 4.1 Immunisation

4.1.1 Immunisation Health Target Auckland DHB achieved 94% of babies fully immunised by 8 months of age in Q4 17/18, slightly below the 95% national Health Target. Waitemata DHB did not reach the health target, achieving 92%. However, both DHBs exceeded the national average of 91% for this quarter.

Quarter 4 Result for all infants turning 8 months – Auckland DHB (as at 30/6/18)

Turning 8 months in Q4

Last quarter Q3 17/18

This quarter Q4 17/18

Decline and opt off

Total 94.0% 93.9% 3.0%

Māori 86.4% 86.1% est. 7.9%

Quarter 4 Result for all infants turning 8 months – Waitemata DHB (as at 30/6/18)

Turning 8 months in Q4

Last quarter Q3 17/18

This quarter Q4 17/18

Decline and opt off

Total 91.5% 91.7% 4.6%

Māori 84.0% 85.9% est. 7.7%

Following a number of strategies to improve uptake for Māori we are pleased to report a 2% improvement for Waitemata DHB in the equity gap. The sustained focus continues and additional efforts are being made to remove the equity gap. The national Maori coverage is 86% Over quarter 4, the Outreach Immunisation Service increased home visiting including a Saturday home visiting service and which appears productive. We are encouraging continuation of this activity. PHOs have encouraged GPs to make phone contact with whanau with the aim of providing more information and/or supports. The DHBs and Plunket collaborated on an additional mobile service for tamariki Māori and Pacific babies who were not responding to the Outreach Immunisation Service. The mobile service was active for nine days and immunised 14 Q4 babies, as well as six other children, in addition to a number of other positive outcomes. The two month trial has been reviewed and funding is now extended to roll the service out for a full year in 18/19. Negotiations have started with Plunket. The relatively higher decline rate for Māori in both DHBs was raised with PHOs at the Alliance Leadership meeting in early May. The PHO managers across Auckland and Waitemata DHBs have agreed to standardise a programme of data-matching with the Patient Management Systems and NIR. This is expected to commence in October, after the next MedTech upgrade. Work continues to progress the Co-Design project with Te Whanau O Waipareira (TWOW) to develop better targeted communication resources. TWOW have started providing immunisation via their Well Child Tamariki Ora services, with six over-due babies now immunised. Other immunisation targets had variable results. Auckland achieved the 95% target for immunisation of two year olds, however Waitemata DHB achieved 92%. Both DHBs reached 85% of five year olds being fully immunised, which is below the 95% target, and less than the national coverage of 88%.

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4.1.2 Antenatal immunisations In addition to the health target, the Metro Auckland Alliance Leadership Team has committed to a focus on antenatal immunisation. This work is aligned to the System Level Measures Activity. The second round of distribution of antenatal vaccination reminder cards is now complete, including a new card for antenatal influenza immunisation. These cards have been distributed to primary care, pharmacies and Lead Maternity Carers.

PHO/practice level analysis of pregnancy immunisation coverage was shared with PHOs. Improvement strategies are under investigation to address the wide range of results across practices. The Auckland Regional Public Health Service (ARPHS) has released a suite of social media communications promoting antenatal immunisations as well as collaborating on a TV show for Attitude. The Auckland DHB communications team are working on a concept design promoting key health messages for pregnant women. Funding to provide vaccinations alongside antenatal clinics was approved by the Auckland DHB Chief Executive in May 2018. Work is progressing well with the Maternity service manager. The service is fully scoped and recruitment to the role (1.6FTE) is underway. Waitemata DHB already has an opportunistic vaccinator which partially covers the WTH antenatal clinic. 4.1.3 Mumps catch up programme Since early 2017, metro Auckland has been experiencing an outbreak of Mumps, with 1288 reported cases as of 19 July 2018. The school based MMR vaccine catch up programme in the Waitemata DHB area (five schools) has been completed, delivering nearly 1,500 immunisations. A similar programme commenced in term 2 in Auckland DHB at five Auckland DHB area schools and will extend into a further four schools over term three. The programme has generally been well received by school communities. ARPHS continues to lead the communications across the region. 4.1.4 Human Papilloma Virus (HPV) Immunisation This is the first national report on HPV immunisation coverage since the vaccine was introduced for boys in 2017. The target is currently set at 70% for girls and will move to include boys in June 2019 once a full birth cohort of 12 year old boys have been offered immunisation in school year 7. Auckland DHB continues to lead the country with 83% of 12 year old girls fully immunised, as well as demonstrating success in equitable coverage for Māori (84%) and Pacific (87%). Waitemata DHB did not achieve the 70% target, with coverage remaining steady at 60%. Some of the factors for the lower coverage included rolling out the service for boys, staff changes which affected the intensive follow up of consent forms, as well as not providing catch up programmes for students who were not at school on vaccinating day. These issues are being addressed in 2018 with catch up sessions planned a week later at all schools. The shortage of HPV vaccine in primary care may also have affected those in this cohort. With the current shortage of stock, both DHBs are offering dose 2 HPV to students who had received dose 1 in primary care. There is concern that the current shortage will affect completion of this years’ programme. Provisional results show the addition of boys to the programme has been positive with uptake for boys even higher than girls in schools. The 2018 year is progressing well with higher uptake for dose 1 in both DHBs in comparison with 2017 data.

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4.2 Obesity Health Target – ‘Raising Healthy Kids’

Both Auckland and Waitemata DHBs continue to exceed the Raising Healthy Kids target for all ethnicities with respectively 100% and 99% of children’s referrals acknowledged within 30 days. A new service is being launched to provide more intensive support for pre-school children who are identified via the healthy weight target, and their whanau. The Auckland and Waitemata DHB Positive Parenting and Activity Programme is tailored for Māori, Pacific and Asian whānau and will be delivered by providers that have strong connections with targeted communities. The first cycle of the programme is scheduled to start in August and will be delivered by Alliance Health Plus (AH+) in Auckland DHB and Te Whanau o Waipareira Trust in Waitemata DHB. This will add a comprehensive referral option for the B4 School Check team and General Practice teams. The 2018 Healthy Auckland Together Monitoring Report outlines the local trends in obesity. In stark contrast to all other age groups, this report shows a positive trend of improvement in overweight and obesity for four year olds. (Figure 12) The trend is consistent across almost all ethnic and gender groups, however clear disparities by ethnicity still exist. Māori children are 2.1 times more likely to be overweight or obese than European/Other children, and Pacific are 2.9 times more likely. Since 2012 these disparities have increased slightly from figures of 1.9 and 2.8 respectively.

Figure 12: Proportion of overweight and obese 4 Year olds by Ethnicity and Gender in Auckland

4.3 Utilisation of Oral Health Care for Adolescents in Auckland and Waitemata DHBs

Background Publicly funded oral health care is universally available for children and adolescents until the day before they turn 18. From birth to year 8, services are provided by the Waitemata DHB provider arm Community Oral Health Service – Auckland Regional Dental Service (ARDS). After that, oral healthcare is primarily provided by private dentists contracted to DHBs. As well as private dental practices, there are three large mobile providers who take mobile dental clinics into some secondary schools. In Auckland DHB, these providers provide services to three quarters of adolescents seen (within the publicly funded system), and in Waitemata DHB, two providers see nearly half (46%) of the adolescents. A very small number of high risk adolescents continue to receive services from the Auckland Regional Dental Service. Students are eligible for services regardless of whether they are attending a school, training institute or working. The service for adolescents is provided via a nationally consistent agreement, the Combined Dental Agreement (CDA). The agreement also covers Special Dental Services for children in year 8 and

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below who have been referred from the School dental services. These children are not able to be treated by the school dental service due to medical or management reasons. There are two components of service for adolescents:

A standard (capitated) package of care for all adolescents which covers an annual examination and all other necessary consultations, diagnostic services, operative and preventative treatment within the 12 month period.

Services outside of the capitated package are paid on a fee for service basis.

The CDA excludes services that are not within the scope of practice of a general dentist, dental therapist or dental hygienist such as sedation and orthodontic treatment. The service is supported by the Auckland Region Adolescent Oral Health Coordinator who coordinates the transfer of year 8 children from ARDS to contracted dentists, and supports access to services through data analysis, liaison with contracting dentists and working with schools to increase access for mobile services. A part time Approving Dental Officer also supports the programme by approving treatments that require DHB pre-approval prior to the contracting dentist providing the treatment. Expenditure Contracting dentists claim for services based on DHB of service. Table 4 below outlines the expenditure over the last two years. Table 4: Expenditure on Adolescent Oral Health*

DHB 2016-17 2017-18

Auckland $3,064,427 $3,603,554

Waitemata $4,045,367 $4,584,411

*excludes CDA expenditure on Special Dental Services Utilisation The MoH has set a utilisation target of 85% of adolescents from school year 9 – 17 years to receive annual dental care. This is measured by identifying unique individuals using the claims data from contracting dentists and adding any adolescents seen by Community Oral Health Services (ARDS in the Auckland region). Graph 1 shows Adolescent Utilisation since 2004. Across the Northern Region, only Auckland DHB has achieved the target of 85% (in 2012 and 2013). The following year there was a significant decrease to 76%. This is thought to be due to updating of the census denominator, as there were no significant changes in service delivery. Prior to 2016, coverage was reported by DHB of Service. Since 2016, it has been compulsory for dentists to include an NHI number when making a claim. This has allowed the MoH to analyse and report the coverage by DHB of domicile and by ethnicity. Many adolescents travel across DHB boundaries to attend secondary school and this is seen in the change in reported utilisation in 2016 and 2017, compared to previous years. In particular, Auckland DHB has seen a drop in utilisation to more accurately reflect the DHB of domicile coverage. Tracking the Northern Region result shows fairly consistent coverage of around 70% since 2014.

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Utilisation by ethnicity Tables 5 and 6 below show utilisation by ethnicity for Auckland and Waitemata DHBs. Access by Māori students is extremely concerning, sitting at less than 50% for both Auckland and Waitemata DHBs. Work is currently underway to identify potential causes for the low utilisation of Māori students. Pacific students in Auckland DHB appear to have the highest utilisation of all ethnicities however there is still a long way to go to achieve the 85% target. Pacific coverage in Waitemata is similar to that in Auckland but 9% lower than Other. Significant work is required to ensure equity of utilisation for Māori and Pacific adolescents. Table 5: 2017 Adolescent Dental Coverage for Auckland DHB

Ethnicity Number of people seen

Estimated population

Coverage

Māori 1,379 2,880 48%

Pacific 3,095 4,495 69%

Asian 4,082 6,740 61%

Other 7,133 10,735 66%

Total 15,689 24,850 63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

A

n

n

u

a

l

u

t

i

l

i

s

a

t

i

o

n

year

Graph 1: Adolescent Dental Utilisation

Northland

Auckland

Waitemata

CountiesManukau

NorthernRegion

Target

TOTAL NZ

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Table 6: 2017 Adolescent Dental Coverage for Waitemata DHB

Ethnicity Number of people seen

Estimated population

Coverage

Māori 2,435 5,230 47%

Pacific 2,461 3,615 68%

Asian 4,267 6,350 67%

Other 14,153 18,485 77%

Total 23,316 33,680 69%

Utilisation by School The MoH has provided raw claims data for 2016 and 2017. This is allowing DHBs to undertake their own analysis on uptake of services. Initial analysis shows that, unlike most other health services, on average, lower decile (high deprivation) schools have higher utilisation of the adolescent oral health services than higher decile (low deprivation) schools. Higher utilisation is also often seen in schools with mobile providers who attend onsite. All decile 1-3 schools with greater than 100 students have a mobile that visits the school at least once a year. Next steps Unfortunately there is no standardised outcome indicator (such as caries free or DMFT) available for adolescents. Work is planned to develop some quality assurance indicators that will be able to be shared with contracting dental providers. Now that the DHBs have two years of claims data we are able to track adolescent use of the service from transfer from ARDS to where adolescents are being seen each year. A focus of this analysis will be trying to understand why Māori adolescents are not accessing the service and what is working well in low decile schools that can be replicated in the other schools to improve Māori and Pacific utilisation. Analysis will also be undertaken to explore whether local services are available to all adolescents, whether they are in school or not. Auckland and Waitemata DHBs also plan to add questions to the secondary school health stocktake to better understand oral health service provision. Conclusion Utilisation of adolescent oral health services has remained around 70% in the Northern region since 2014. Of particular concern is the number of Māori and Pacific adolescents who are missing out on services. Work is currently underway to understand what the barriers to service are and to develop a plan for improving adolescent utilisation. The plan will be presented to the November Community and Public Health Advisory Committee meeting. 4.4 School Based Health Services

The Ministry of Health has announced plans to expand the Enhanced School Based Health Services to include decile 4 high schools from 1 July 2018. Enhanced School Based Health Services are youth appropriate primary care nurse-led services accessible by students at their place of education, with a focus on screening, sexual health and mental health and addictions. The new funding will enable the expansion beyond the current service for 16 decile 1-3 high schools, alternative education units and teen parent units to include all decile 4 state high schools. Auckland and Waitemata DHBs have funded two decile 4 schools, Mt Roskill Grammar and Massey High School for some years. We are now preparing to extend services to three further decile 4 schools of Selwyn College, Avondale College and Rodney College. Funding has also been allocated to establish services in the new decile 1-3 schools of Vanguard Military School and Middle School West Auckland from January 2019.

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All services need to be agreed with school leadership and are subject to a range of factors such as having suitable facilities available. However we aim to deliver the same model in these schools as our established services, nurse-led, supported by general practitioner clinics in schools. 4.5 Maternal Health

The Perinatal Mortality Review Committee reported their twelfth annual findings recently. Maternal suicide remains the leading cause of maternal morbidity. Of note, young mothers (aged under 20 years) and Māori, Pacific and Indian ethnicity are all associated with poorer outcomes. As we increasingly focus on the first 1000 days of life (which includes the pregnancy), the identification of those at higher risk of poor outcomes and offer of more wrap around services will be a focus area for additional resources. The re-development and upgrade of the birthing rooms at Birthcare has been completed. The rooms are now more spacious and have modern birthing couches in addition to spa baths. The re-development has been co-designed with Lead Maternity Carers and consumers. Improvements in the number of women birthing at Birthcare will be closely followed. The co-design of the new primary birthing facility at Waitakere continues. 4.6 Healthy Housing

The Kainga Ora (Healthy Housing) service has a priority focus on pregnant women and those with young babies. The service is now well established with a steady stream of referrals coming in from a range of sources. To date in Auckland and Waitemata DHBs, there have been 1650 referrals to Kainga Ora. 1134 families have had access to healthier home interventions. A significant proportion of the referrals are for families where there was a newborn baby or hapu woman. As part of the social work interventions, these women may be referred to smoking cessation services or immunisation, amongst other interventions such as entitlements available through the Ministry of Social Development. 4.7 Cervical and Breast Screening

A project manager has been appointed to progress a Breast Screening data match project as part of the Māori Health Pipeline. In the absence of a population register for Breast Screening, data match opportunities are being investigated in an attempt to improve registration and screening with the Breast Screening Lead Providers as well as improve invitation and recall to the service on a two yearly basis. The focus is on improving coverage for Maori women. We will try to apply relevant lessons learnt from the breast screening datamatch to the cervical screening programme. Approaches to improve targeting services for cervical screening are being developed. The Cervical Screening Register team (ARPHS) are working with the Funder on how we might better meet the needs of women on the register who have a clinical result from screening that has not been adequately followed up. Our aim is to better support these women to access services. The Funder is also working with PHOs to better target women with the highest risk of adverse outcomes. This will be supported by a review of the focus of the ‘free screen’ contracts with PHOs. The collaboration with Well Women and Family Trust around targeted outreach continues. The National Cervical Screening Programme has recently circulated advice around the delay to the implementation of HPV primary screening, due to the requirement for a new register to support the programme. This is now anticipated after 2021, once the Bowel Screening Register is completed. However, one aspect of the HPV primary screening programme guidelines, a new age for entry into the National Cervical Screening Programme of 25 years will be introduced this year.

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All women should continue on the current three year recall (unless they have a clinical history) until the implementation of the new HPV primary screening protocol and the completion of their first screen under this new programme.

5. Health of Older People 5.1 Age Residential Care (ARC)

ARC sector representatives were comfortable with the price increase and pay equity uplift to the ARC bed day rates for 2018/19. The feature of ‘overs’ and ‘unders’ due to including pay equity in the bed day rates will be lessened compared to 2017/18 and a transitional fund and process has been agreed in advance for those providers who do end up with a material pay equity deficit. DHBs have also agreed that in the event that the nursing settlement is significantly higher than the ARC price increase (2%) then we will enter discussions as to how any potential flow on pressure could be addressed. A Northern Region stakeholder forum for the ARC Funding Model Review was held in early July. The scope of the Review is to:

examine the strength and weaknesses of the existing ARC funding model

facilitate a transparent process for selecting a preferred funding model, and transition plan

consider the alignment between ARC policy and funding settings and those of other health and social services.

Key areas of discussion at the Forum were: the lack of sensitivity of the current four levels of care and the concept of a case mix in a new model; the possibility of separating accommodation and care costs; a ‘revolving door’ more easily enabling short term stays. 5.2 Aged Residential Care Audits

The table below has the audits undertaken in 2017/18 and the resulting corrective actions

Quarter 1

Quarter 2

Quarter 3

Quarter4

ADHB WDHB ADHB WDHB ADHB WDHB ADHB WDHB

Total Number of audits 9 6 14 9 9 7 18 9

Unannounced audits (surveillance)

1 2 5 4 4 4 9 1

Average number of corrective action per audit

1.7 4.7 2.9 4.1 2.3 5 1.5 3.4

facilities > 5 corrective actions 1 2 2* 4 0 3 1* 3

Corrective actions for health & safety (% of total CAs)

9(60%) 13 (46%) 17 (42.5%) 11(30%) 5 (33%) 18 (50%) 11 (40%) 20 (94%)*

Facilities with no corrective actions

4 0 2 0 1 1 7 2

Facilities achieving a continuous improvement* *

4 0 4 0 2 0 7 3

Number of complaints the DHB received on ARRC

5 3 2 5 3 1 10 6

* Provisional audit - new build

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** The gold standard attainment against an audit criterion is ‘continuous improvement’ (CI). CI is achieved

when a criterion is fully attained and continuous improvements against the Health and Disability Sector Standards are demonstrated indicating quality improvement processes in place against service provision and consumer safety or satisfaction.

Analysis of all audits undertaken in 2017/18 has been completed. The tables below show the number of corrective actions in 2017/18 compared with previous years and the main areas (i.e. Health and Disability Service Standards) receiving corrective actions during the year. 5.3 Home and Community Support Services (HCSS)

HCSS pay equity for 2018/19 will no longer be advance payments with a wash up approach. This was an extremely complex process requiring large data submissions from HCSS providers. A provider ‘bespoke’ pay equity rate will be added to the base hourly rate. The bespoke rate is the difference between a provider’s old 2017/18 wage rate (weighted average) and the new wage rate (weighted average) plus on costs, training and growth factors. A review of the Auckland DHB HCSS case mix cost model is being undertaken by the University of Auckland (Accounting and Finance Department) who developed the original model for the DHB in 2009. Aspects covered by the review will be: assumptions and, practices and policies built into the model; amendments required due to the introduction of inbetween travel, guaranteed hours and pay equity; changes required due to changes in the model of care; and potential to include short term and respite clients in the model. This review is not to renegotiate the price but changes would include relativities between case mix categories. The Waitemata HCSS Working Group is developing a new HCSS model of care. Fortnightly meetings are being held and the group is currently focusing on a patient pathway to achieve a timelier, flexible and streamlined service. The DHB is also working with the MoH on the Future Models of Care Project

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and is cognisant of aligning with this framework, where appropriate, when it is released at the end of July. HealthCERT has compiled and summarised the feedback on the national consultation on the Medication Guidelines developed by Waitemata DHB and its HCSS providers. The Working Group, including the Waitemata DHB members, will be reconvening to work on this feedback. 5.4 Other Health of Older People Activity

There is ongoing promotion of the Falls Prevention programme. E-referrals to the in home strength and balance programme and the community exercise classes are now operating. Work is underway to include falls risk on the Patient Dashboard in general practice for eligible patients.

6. Mental Health and Addictions 6.1 Mental Health and Addictions Support Worker Pay Equity

The Mental Health and Addiction Support Workers (Pay Equity) Settlement Agreement (2018) was approved by Cabinet on 18 June 2018. The MoH Pay Equity team have been working with DHBs, Funders and Providers nationally, to determine worker eligibility for Pay Equity, and to calculate Pay Equity payment for all eligible providers. On 27 July the MoH on behalf of DHBs made the following pay equity payments to eligible providers:

Retrospective funding for 1 July 2017 – 30 June 2018, to enable providers to meet their obligations to pay back-pay to eligible workers who worked during this time (providers are required to pay each eligible worker the correct back-pay within one month of receiving this funding).

Three months forward funding to enable providers to start paying eligible workers the new pay-rates. The funding is for three months in advance (July – September 2018) to ensure providers have sufficient cash flow to do so.

Contribution to increase leave liability. This is a one off payment to contribute to the increase in leave liability resulting from the new pay equity rates.

All payments have been calculated based on nine months’ workforce data provided by each provider. A full year wash-up is currently in progress to calculate any under or over payment.

The MoH have requested that DHBs not vary contracts as of 1 July to incorporate contract uplift. There will be a 1 October 2018 variation, backdated to 1 July 2018, which will incorporate pay equity funding into contracts as well as the contract uplift. MoH Pay Equity team will work with DHBs to develop the variations.

6.2 Government Inquiry into Mental Health and Addictions

The purpose of this inquiry is to:

hear the voices of the community, people with lived experience of mental health and addiction problems, people affected by suicide and people involved in preventing and responding to mental health and addiction problems, on New Zealand’s current approach to mental health and addiction, and what needs to change.

report on how New Zealand is preventing mental health and addiction problems and responding to the needs of people with those problems.

Recommend specific changes to improve New Zealand’s approach to mental health, with a particular focus on equity of access, community confidence in the mental health system and

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better outcomes, particularly for Māori and other groups with disproportionally poorer outcomes.

Inquiry Panel members meetings with groups and regional centres will continue into August 2018. The Inquiry Panel met with a large Waitemata DHB representative group in May followed by separate meetings with Community Alcohol and Drug Service (CADS) and Regional Forensic Service. After more than 250 meetings with groups and individuals since March, meeting over 2,000 people in 24 centres from Kaitaia to Invercargill at “Meet the Inquiry Panel community forums”, and receiving nearly 5,500 submissions, the Inquiry team is now winding up on meetings, concentrating on analysing all the information gathered and starting to write the report due with Government on 31 October. It is for the Government to decide how to respond to the Inquiry's report after 31 October. In the meantime, the terms of reference state that ‘the Government is already taking steps to address some immediate service gaps and pressures, including increasing funding for alcohol and drug addiction services, increasing resources for frontline health workers, putting more nurses into schools, extending free doctors’ visits for all under 14-year-olds, providing teen health checks for all year 9 students and providing free counselling for those under 25 years of age. 6.3 Contract Value, Operational Costs and NGO Sustainability

Funders and Planners with NGO partners are starting a project to identify funding approaches and price volume schedules for Addiction services. This work follows on from a project report about property value, costs and approaches from NGO Providers experiencing significant gaps in contract value and operational costs. This report was tabled at the Auckland DHB Finance, Risk and Assurance meeting and the Waitemata DHB Audit and Finance meeting in June 2018 with an abridged anonymised version of report providing a submission to the Inquiry. Significant financial and service sustainability risks, in particular from rising staff costs and increasing Auckland property values and costs are impacting on delivery of services and meeting contractual requirements within contract values. Reliance on philanthropic funding and cross subsidising of contracts is also highlighted as a significant risk for the mental health and addictions sector. Addiction service contract values and volumes still reflect the original Blueprint funding distribution (within Auckland and Waitemata DHB) with separated bed day rate and FTE allocation. There has been no DHB funded increase in the volume addiction since 2010. Aligned with significant increasing demand for treatment, there has been a changing profile of service users (more complex with multiple drug addictions, increasing meth addiction, younger cohort, increased co-existing disorders (mental health and addiction issues). In order to keep up with demand and changing clients profile different behaviour management and treatment modalities have been required and implemented. All these evolutions require differing key staffing and service inputs, with significant workforce development costs and investments.

6.4 People experiencing sheltered homelessness

Ira Mata, Ira Tangata: Auckland’s Homeless Count will be taking place across the Auckland region on 17 September 2018. The count will cover the Auckland region – including Wellsford in the north, Waiuku in the south, Piha in the west and the Hunua Ranges in the east. The count is funded by Auckland Council and being delivered by Housing first Auckland, with support from the Housing first Auckland collective. The point in time approach being used for Ira Mata, Ira Tangata will provide a snapshot of people living without shelter (on the street and in cars) and of people in temporary accommodation. The information of people in temporary accommodation will not be collected through surveying people directly but provided at a service level by providers. For Ira Mata, Ira Tangata accessing “temporary accommodation” data will include inviting providers of these services

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(and those that could be considered to provide accommodation of a temporary nature) to be involved in the count by supplying anonymous service level. Ira Mata, Ira Tangata presents an opportunity to provide a more accurate picture for policy makers and service planners on Aucklanders’ living without shelter and in temporary accommodation. Organisations that could be considered to provide accommodation of a temporary nature include:

Transitional housing providers

Women’s Refuge crisis services

Corrections

District Health Boards (inpatient services, emergency departments, residential support services and respite services).

DHBs are working with this project to identify those service users in temporary accommodation that meet the definition of “homelessness”, with processes to count these people within our services to be established by 17 September 2018. 6.5 DHB and NGO Reporting Accommodation Categories

Housing fulfils a physical need for shelter and provides social functions of individual respite and the basis for family life. Access to safe, adequate and affordable housing are well recognised as core indicators of personal and communal wellbeing, and overcrowded or inadequate housing has been linked to negative health and social outcomes. Peace and Kell (2001) noted that housing difficulties, homelessness and transience were significant problems for Mental Health and Addictions service users. They identified three issues that emerged from interviews with both provider and service user groups:

the unaffordability of suitable housing relative to income.

problems relating to benefit income and benefit debt (also an affordability issue).

discrimination in finding and retaining housing. These three issues can be classified as barriers in the sense that they are beyond the scope of mental health and addiction service provision to remedy on their own. DHB and NGO provided Mental Health and Addictions services are required to report into PRIMHD accommodation categories as follows:

Independent.

Support – that is accommodation financially supported whether partly or fully by DHBs.

Homeless. The Figure below provides the different types of living situations classified under PRIMHD accommodation categories.

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There are challenges in collecting accurate housing data for DHB specialist services due to difficulty in extracting specific data from HCC into PRIMHD reporting, so these challenges prevent DHBs from being assured the housing data in HCC is accurate and up to date. Outside the Council project the metro DHBs are starting a project to agree to business rules and processes to improve entry of housing information. In order to overcome the current limitations of HCC that cannot be amended within the current system, then explore where there is a technical solution to the challenges. However, given that there is a negative relationship between poor-quality housing and Mental Health and Addictions problems, it is important that this project is completed as key stakeholders in the Mental Health and Addictions sector need to understand the living situation of service users and work with other agencies to influence change in this area. 6.6 Individual Placement Support (IPS) Waitemata DHB

IPS is an evidence-based practice that integrates employment and mental health services to support people with severe mental health conditions to find and stay in work. The Government’s 2017 Budget provided funding to purchase up to 500 IPS places over four years to be provided by the Adult Mental Health Services at Waitemata DHB. We began a nine month prototype in June 2018 which runs through to February 2019, supporting up to 50 people aged 18-35 with severe mental health conditions (including schizoaffective disorders, and bipolar affective disorders) accessing community mental healthcare with Waitemata DHB. A decision to progress to full trial will be informed by the evaluation of the prototype, which also has a specific focus on ensuring effectiveness for Māori. 80% of the places in the prototype will be for people on a main benefit with Work and Income, with the remaining places for non-beneficiaries. Early progress with the IPS prototype is excellent. Recruitment has only been in place for six weeks and already 20 participants have been signed up for IPS support. Most of these people are receiving benefits and half are Māori, so it is reaching the right people.

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The first monthly report, up to 30 June 2018, was issued to the MSD in July 2018. Minister Sepuloni made a visit to Waitemata DHB Adult Mental Health Services to gain a more detailed understanding of the IPS service, and was impressed by what she heard. The visit was attended by Waitemata DHB staff including Judy McGregor, the new Board Chair, members of the Planning, Funding and Outcomes team, Mental Health Services Clinical Management and representatives from West Auckland Adult Mental Health Services and Moko (Māori Mental Health) Services. Workwise management also attended along with their employment consultants who deliver the IPS service. MSD staff from Service Design also attended accompanied by their colleagues associated with regional Work and Income. 6.7 Registration of Interest to the Health Workforce NZ Development Fund

Funders and Planners made a registration of interest with the aim of providing workforce development for mental health and addiction peer support workers/kaiāwhina working in the Waitemata and Auckland DHB funded services. Combined funding for these roles across both DHBs is over $57m. A shift in the focus and broadening out across the continuum of care has recently occurred with these roles now providing primary mental health functions, in collaboration with our PHO and NGO partners, as part of our Fit for the Future programme. If successful the proposed initiative would further support the development needs of this workforce, to meet current and future evolving requirements for their contribution as valued members of an integrated service delivery team seeking to improve population health and wellbeing outcomes. People with lived experience of mental illness and addiction (‘service users’) offer a unique contribution to mental health and addiction services, and the perspectives of those with a lived experience are utilised in the planning and implementation of our services. The proposed workforce development approach will foster a culture that promotes service users’ participation and recovery. Service users will be encouraged into a range of roles, both within consumer-led services and across the continuum of services. The use of the term ‘kaiāwhina’ to describe non-regulated support worker roles within our sector, does not adequately convey our commitment to ensuring that people with lived experience are included as an important part of the support workforce (and non-regulated roles) that are funded across our mental health and addictions response continuum. Hence throughout registration of interest document we describe our workforce group as “peer support worker/kaiāwhina”. In addition, the valuable perspective and experience of family and whānau supporting a loved one with a mental illness and/or addiction will also be seen as an asset within the mental health and addiction workforce development and implementation process. Kaiāwhina is the over-arching term to describe non-regulated roles in the health and disability sector. The term does not replace the specific role titles, for example: healthcare assistant, orderly, mental health support worker. Kaiāwhina are respectful and empower others competently using a holistic, strengths-based approach in a wide range of roles with consumers who have health and/or disability needs. We are aware that Health Workforce New Zealand (HWNZ) and Careerforce are developing a workforce action plan for the health and disability kaiāwhina2/non-regulated workforce, in recognition that only a small percentage of the estimated number of non-regulated workers in the health, mental health, aged care, public health and disability services sector are receiving training3. Our proposed approach is consistent with the HWNZ framework4, and would inform ongoing

2 The Ministry’s Mental Health and Addiction Workforce Action Plan 2017–2021 uses the term kaiāwhina which is used interchangeably

with ‘support worker’ and ‘non-regulated’ workforce. 3 Information retrieved from https://www.careerforce.org.nz/about/workforce-development/kaiawhina/ on 22 June 2018.

4 As outlined at https://www.workforceinaction.org.nz/

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workforce development planning for the whole workforce. The competency and capability of the kaiāwhina workforce underpins each of the four priorities identified in the Ministry’s mental health and addictions workforce action plan. We currently have limited resources to provide support for this workforce, the registrations of interest seeks funding for:

Workforce needs assessment at a local/DHB level.

Workforce development opportunities informed by local needs and drivers, evaluation and continuous quality improvement.

Building on and consolidating successful innovation and emerging new services involving this workforce.

Learning and development to enable a more effective peer support worker/kaiāwhina role to address serious and unacceptable inequities in the physical health of people with mental health and addiction problems, which continues to worsen for this population relative to their general population counterparts.

Strengthening collaboration across the sector, and specifically with primary care.

Improving our capability to respond to emerging trends – including those related to methamphetamine and synthetic cannabinoid issues.

The perspective of those with a lived experience will be utilised in the planning and implementation of services.

We seek HWNZ funding to develop and implement a training and development programme for mental health and addiction peer support workers/kaiāwhina, initially within Auckland and Waitemata DHB locality. Expansion to the whole of the northern region would be anticipated subject to funding, consultation and negotiation with Northland DHB and Counties Manukau Health. Auckland DHB and Waitemata DHB fund NGOs across Auckland to provide an extensive range of services. Our priorities for service delivery and development are: Māori, Pacific Peoples, Asian, Migrant and Refugee, Infants, Children and Youth (to avert future adverse outcomes), and older populations. 6.8 Integrated Detox Services with CADS and Auckland City Mission

The Auckland City Mission has embarked on an ambitious rebuild of existing services with demolition and rebuilding of their Hobson Street premises underway. As part of the rebuild process the existing social detox facility has been relocated to new premises located in Avondale, with the first clients in situ whilst the rebuild is undertaken. The Planning and Funding team are now supporting the design process to relocate the existing CADS (provider arm) medical detox service from Pitman House to the new facility in Hobson Street. Consultation with the Auckland City Mission, CADS teams and the architects around design and floor plan configuration is now underway, with contracting an architectural consultant to ensure that the floor plan meets the needs of the clinicians and is able to provide the key functional requirements of the service model of care and achieves good outcomes for future service users. In addition the project needs to contract an addiction consultant to work with the CADS team to develop the model of care to support integration between social and medical detox services, primary care and social services. Two pieces of work will be run concurrently design and floor plan and model of care for integrated services. The details of appointing consultancies are in the latter stages of finalisation. The preferred approach is to run a series of two to three workshops with key staff in the first instance to explore and agree on floor plan and layout. The first workshop will be held on 3 August, the next is the following week and a third is scheduled but may not be required if progress is quick surrounding any key issues raised in the first two workshops.

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6.9 Three year Action Plan for Auckland DHB Mental Health and Addiction Services

The Mental Health and Addictions directorate at Auckland DHB is leading the Mental Health and Addiction Programme Board project to develop a three-year action plan. This plan will be developed in collaboration and partnership with Auckland DHB service staff, consumers, whānau, NGOs, primary care and other sector partners in the Auckland DHB area to develop a three year action plan for mental health and addictions, aiming to improve the experience and outcomes for service users. This work builds on the momentum created by the national mental health and addictions inquiry. The improvement team at Auckland DHB have lent their support and expertise and will be facilitating interactive sessions, pulling the feedback together under the governance of the Auckland DHB Mental Health Addiction Programme Board. In order to develop a plan that adequately meets the needs of consumers; we need perspectives and bold ideas from as many people as possible.

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6.10 LookUp 2018

LookUp 2018 builds on successful events in 2015, 2016 and 2017, where increasing numbers of young people have engaged in a well-being event. This is a free one-day event for at least 150 young Auckland people to explore wellbeing around a specific theme that is a priority for them. The LookUp Youth event grew out of a recommendation from the Auckland DHB Integrated Child and Youth Mental Health and Addiction Direction 2013-2023. The event is co-designed by a group of skilled young professionals aged 22-29 from partner organisations. Auckland DHB funds LookUp with additional sponsorship and funding from other sources, including Starship Foundation. It has become a popular annual event, well supported by young people, schools and the community. We continue to achieve our goal of attracting more young people to the event each year. Previous themes have

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been; mental wellbeing, wellbeing around Alcohol and other Drugs and Relationships. The theme for 2018, identified by a group of young people, is “Listen Up! Exploring Wellbeing through Youth Voice”.

LookUp started from feedback by young people (14-24-year olds), who told us they were interested in wellbeing, looking at solutions and ways of being when things got tough in terms of their mental health and addiction issues. They showed us there were new and innovative ways of working with them which were more effective than traditional ways, including the use of creativity, technology and service innovation. Look Up – Inspiring innovative ways to wellbeing – is the opportunity for young people and professionals to explore this in a practical and experiential way together.

Three streams, integral to the original Look Up event were:

Creativity: the space where we showcase those that use creativity and arts to inspire and enrich our health and wellbeing. You get to try and experience these different ways of working and find out what really works for you!

Technology: Services need to engage young people in environments where we interact, such as the internet and new digital media. We also need to explore the use of a variety of tools and networks, including mobile phones, social networking sites, games and virtual worlds

Service Innovation: It is widely recognised co-designing services with the people seeking to use them improves them. That is why” strengthening the voice” is an integral part of Auckland DHB’s Integrated Child and Youth Mental Health and Addictions Direction 2013–2023. A key component is ensuring youth voices are heard and they guide our approach and actions.

Look Up has been about inspiring young people to think about innovative ways to wellbeing by connecting young people and health professionals. Through a series of conversations, we want to encourage young people to celebrate building resilience in a way that is unique to them, know how to safely navigate their experiences and know where to go for help.

Look Up’s intention over the last four years has been:

To engage a diverse group of 100 or more young people in activities that foster reflection of relationships and support networks in their lives, equipping them with tools and resources, in a youth-development and strengths-focused manner, leading to positive health outcomes

To engage 50 or more professionals to learn alongside young people, be positively influenced by a youth-leadership approach, to gain a deeper understanding of what is important to young people around their thinking of relationships and to be exposed to new tools and resources, leading to an increase in youth participation in the sector and youth-friendly approaches

To capture young people’s experiences and common themes on the day – leading to systemic advocacy and services that better reflect their needs.

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7. Māori Health Gain 7.1 MoU Contracts

Outcomes contract design and negotiation has been completed with Te Runanga o Ngati Whatua and Te Whanau o Waipareira. These agreements are now aligned to the Auckland DHB and Waitemata DHB Māori Outcomes Framework – Nga Painga Hauora and agreements have been secured for a three year period. In addition to completing the contracts, we have met with both parties to translate the service specifications into tangible programmes of work. In particular, we have focused resources on supporting Te Runanga o Ngati Whatua who are currently down 2.0 FTE in their MoU support department. They will be hiring to these roles in July 2018, and we have communicated our expectations to see these rolls fulfilled by mid-August 2018. Mr Antony Thompson has recently been confirmed as the Manukura Hauora (General Manager – Health). 7.2 Cardiac Rehabilitation Prototype

The Whanau House based Cardiac Rehabilitation Prototype is underway and currently in the recruitment phase of the programme. A total of four clients are currently on the new pathway, while three have confirmed appointments (delayed by the nursing strike), another six are yet to confirm the best appointment time for them and their whanau. Recruitment will continue until a total of 20 clients are reached for the Prototype. WaiResearch have been confirmed as our evaluator for the programme. They will commence work in August when the bulk of clients are six weeks into the service pathway and are able to provide valuable data to the evaluation team. The Prototype is due to end in December and will inform a service change initiative for Cardiac Rehabilitation and long term condition contracts in the community managed by the Māori Health Gain Team, PFO. 7.3 Taitamariki Substance Misuse Service Development

In July, the Waitemata DHB Board supported the second Whanau House Health Needs Assessment Business Case – Taitamariki Substance Misuse Service. This is a youth focused/whanau inclusive substance misuse prevention service aimed at complimenting existing services in West Auckland by filling a gap in intensive youth and whanau focused addiction counselling, out of school positive messaging and development programmes, packages of care for direct positive youth development, and connecting a range of services operating in this space and locality. The business case will be developed into a service specification, and relationships with key stakeholders will be built over a series of workshops planned for July and August. The service is due to start in January 2019 (development/ planning/relationship building/protocol development), and open for the first clients in June 2019. 7.4 Maori Community Treatment Orders (CTOs)

The Community Treatment Orders are an area of focus as part of the Māori Health and Annual plans. A CTO is covered under the Mental Health Act and is intended to support people experiencing a mental illness which causes or may cause serious harm to themselves or others. Compulsory treatment under the Act provides an opportunity for a person experiencing a serious mental illness to begin to live well in the community and take self-ownership of their health care. This is promoted through a focus on regular collaborative consultation between compulsory patients and clinicians and the statutory presumption in favour of minimally restrictive treatment in the community. During the last financial year the following activity was completed regarding the Māori CTO indicator. The activity for this period consisted of 3 defined steps.

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1. Complete and document a refined definition for the CTO indicator. 2. Analyse pathway and treatment data. 3. Development of recommendations for evidenced-based interventions.

Step 1 Auckland and Waitemata DHBs worked collaboratively with the MoH to agree and document a robust definition with more nuanced reporting for the CTO indicator (to be completed by Jun 2018). The DHB proposed the new definition but this definition, while acknowledged was not accepted by the MoH. We will continue to raise this issue, and to provide a report to Te Tumu Whakarae for further consideration nationally. Step 2 Auckland and Waitemata DHBs undertook an analysis of the treatment data to understand pathways, gaps and opportunities for improvement (to be completed by Jun 2018). Firstly the Māori Health gain team in collaboration with the Health Gains Team, Dr Andrew Howie and Dr Hinemoa Elder developed an auditing tool.

Auckland DHB used the tool to complete an audit of the 39 Maori service users under a CTO within the Kaupapa Maori Mental Health services. The main findings from the audit were; that no Mental Health Review Tribunal applications for Maori services users were submitted in the last 3 years and that there was minimal whānau inclusion in S76 reviews (when clinician meets with service user to review current progress). It was suggested that another audit be carried out at a mainstream community mental health service that supported Maori service users under a CTO. Auckland DHB has planned to deliver this activity during the next year.

Waitemata DHB used a variation of the tool to complete an audit, looking at the use of community treatment orders across all Waitemata DHB Māori mental health services. The audit reviewed the background, indications, and clinical profile of clients who were initiated on a community treatment order in Waitemata DHB during 2017. This audit found that the Act was being used appropriately across different ethnic groups when a CTO was initiated but this audit did not include service users already under a CTO. Auckland DHBs findings (although only completed on the kaupapa Māori mental health services) found similar results so both DHBs will also undertake another audit to assess these patients and the application of CTO’s.

Step 3 Auckland and Waitemata DHBs developed recommendations for evidenced-based interventions to address the disease and health burden (to be completed by Jun 2018).

The clinical director of the Kaupapa Maori mental health services at Auckland DHB has implemented some new protocols based on the findings of the initial audit. She is prioritising getting whanau involved at the S76 reviews and is going to review and look to improve the processes around Mental Health Review Tribunal applications for Maori service users. This activity is on-going.

In Waitemata, the first steps were taken towards implementing recommendations for service improvement such as presentation of audit findings, staff education and training for medical staff and DAOs around application of CTOs; and set up a process for regular review of new applications for CTOs. Additionally cultural competency training or support for teams has also been discussed but progress on this activity is currently unknown. In summary, Waitemata are intending to extend the audit to look at clients already on a CTO as well as a more in depth analysis of patient experience.

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Current Progress: Since we started monitoring this indicator in September of 2016, Auckland DHBs numbers have not improved and in fact have stayed relatively stable around 500, which is higher than the national average. Waitemata on the other hand have improved their numbers by approximately 10% and are now sitting around the national average.

Since monitoring started of this indicator in September 2016, Waitemata DHB has seen a 10% reduction in CTO’s and Waitemata DHB is now sitting around the national average. Auckland DHB and Waitemata DHB 12-month rolling rate per 100,000 population (note that historical quarterly figures can change due to subsequent updates, also note the NZ total is a unique client count)

ADHB Baseline

May-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Mar-18

ADHB Māori 525 441 456 470 480 463 436 510 514 505 521 540 505

ADHB non-Māori 133 121 132 136 139 142 131 134 134 125 130 137 139

NZ Māori 303 296 394 294 294 303 303 287 289 292 294 297 299

NZ non-Māori 102 99 100 99 100 102 101 96 96 95 95 96 96

0

100

200

300

400

500

600

Jun

-15

Au

g-1

5

Oct

-15

De

c-1

5

Feb

-16

Ap

r-1

6

Jun

-16

Au

g-1

6

Oct

-16

De

c-1

6

Feb

-17

Ap

r-1

7

Jun

-17

Au

g-1

7

Oct

-17

De

c-1

7

Feb

-18

ADHB Section 29 rate per 100,000

ADHB Māori ADHB non-Māori

NZ Māori NZ non-Māori

WDHB

May-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Mar-18

WDHB Māori 394 362 370 374 357 349 347 357 306 322 304 288 296

WDHB non-Māori 116 112 115 115 117 118 119 121 112 111 102 97 97

NZ Māori 303 296 394 294 294 303 303 293 295 292 294 297 299

NZ non-Māori 102 99 100 99 100 102 101 97 97 95 95 96 96

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7.5 Māori Health Pipeline Projects

The Māori Health and Health Gain team, with the support of the lead CEO Māori health, have established a set of pipeline projects with opportunities to accelerate Māori health gain have been identified through a range of vehicles – the Māori Life Expectancy Report, the Whānau House Health Needs Assessment, the Māori Health Plan, the equity re-focussing of the System Level Measures Plan, the DHB and Nga Painga Hauora outcomes frameworks, the review of the integrated contracting processes, work of colleagues and horizon scanning of evidence and technologies. There is an opportunity to develop a more streamlined pipeline for proposals, project implementation and evaluation. These projects will test the methodology and approach of using a pipeline approach. The areas of focus currently being progressed are:

Lung Cancer Screening (Health Research Council proposal)

Alternative Pulmonary Rehab model (developing a kapa haka based intervention)

Community Cardiac Rehab Prototype

Datamatch between PHO’s and Māori providers

Breast Screening datamatch

Cervical Screening proposal for intensive outreach for high-grade follow up Further projects will be developed over time 7.6 Toi Tu Evaluation

The Toi Tu evaluation is underway (Toi Tu is a Nurse Practitioner lead paediatric community service targeting Maori who have a referral from Starship for issues that need medical support but can be managed in the community, such as skin infections and respiratory issues). This is a process evaluation focused on what is currently delivered, to whom and where, what are the gaps versus needs of the service and what potential improvements can be made across the patient journey for this cohort. Interviews with staff have been conducted. The evaluation is being overseen by a steering with membership from Planning and Funding, Starship and the community provider, a final report is expected to be completed for sign-off by the steering group by mid-September 2018.

0

100

200

300

400

500M

ay-1

5

Jul-

15

Sep

-15

No

v-1

5

Jan

-16

Mar

-16

May

-16

Jul-

16

Sep

-16

No

v-1

6

Jan

-17

Mar

-17

May

-17

Jul-

17

Sep

-17

No

v-1

7

Jan

-18

Mar

-18

WDHB Section 29 rate per 100,000

WDHB Māori WDHB non-Māori

NZ Māori NZ non-Māori

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8. Pacific Health Gain 8.1 PHAP Priority 1 – Children are safe and well and families are free of violence

The following is the annualised results of the Healthy Babies Healthy Futures (HBHF) programme, in relation to the different elements of the programme, for the financial year of 2017/18. Performance against Pacific targets are identified, as well as performance for the rest of the programme (delivered to Maori, Chinese and South Asian populations). The service is provided by West Fono, targeting Pacific women/parents, HealthWest, targeting Maori women/parents, Chinese New Settlers Services Trust, targeting Chinese and Asian mother/parents and The Asian Network Inc. targeting Indian and South Asian mothers/parents. A. Community Learning Programme (CLP) The Community Learning component of HBHF consists of six modules,delivered in a face-to-face setting to pregnant women or parents of children aged 2 years and under. The modules are: 1. Being healthy for your baby 2. Making healthy food choices 3. Practical food preparation of healthy meals 4. Reading food labels 5. Shopping smarter 6. Keeping active Number of CLP groups facilitated

ACTUAL TARGET PERFORMANCE

PASIFIKA 12 12 100%

HBHF 49 42 116%

Number of eligible mothers completed the CLP


PASIFIKA 126 100 100%

HBHF 468 370 126%

DHB Location of CLP groups

AKL WAITEMATA COUNTIES MANUKAU

PASIFIKA 1 11 0

HBHF 32% 69% 4%

B. TextMATCH Service The TextMATCH component of the HBHF service is provided by the National Institute of Health Innovation (NIHI), University of Auckland and consists of text messages being sent to pregnant women and parents of children aged two and under. The messages provide information to encourage healthy and safe lifestyle choices. It also encourages those not well linked to health services to access appropriate antenatal, postnatal and infant healthcare. People enrolled to TextMATCH


PASIFIKA 254 250 102%

HBHF 930 1000 93%

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Feedback from mothers

Sadia (pregnant mother said) “I like the weekly messages and try to follow them and its helping me a lot.”

A South Asian mother said “I am a doctor by profession back in my country, but still found these messages very useful especially in the NZ context.”

A mother commented “He rawe nga whakamarama motaku haputanga!: These are great tips for my pregnancy.”

Love receiving helpful tips and advice for my baby. Very soon I’ll be having my second baby so I’ll love to continue to hear from you.”

C. Engaging Mothers to talk health and create a plan for better nutrition and increase physical

activity This component of the HBHF service requires the service provider to engage in a conversation with pregnant women and mothers of young children, with the objective of understanding their health goals, needs and the barriers to achieving and meeting these. A“SMARTER plan for change” is then completed together.

Mothers engaged in a healthy conversation


PASIFIKA 280 200 140%

HBHF 1056 800 132%

D. Promoting HBHF to eligible mothers in the community HBHF providers are required to promote the service in the communities they are responsible for and work with organisations that engage with pregnant mothers and children to also promote the service. This component is measured by the number of promotional forms that are signed by eligible mothers. Completed promotion forms by eligible mothers for the year 2017 - 2018


PASIFIKA 356 350 102%

HBHF 1622 1750 92%

E. Communications to communities Providers are required to produce a quarterly newsletter Number of people receiving HBHF quarterly e - newsletters

ACTUAL

PASIFIKA 371

HBHF 2082

The service is funded by the Ministry of Health and funding has been confirmed for the current financial year.

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8.2 PHAP Priority 2 –Pacific People are smoke-free

Pacific Smokefree Community Champions Training:

Consultation with Pacific Communities, Enua Ola and Healthy Village Action Zones (HVAZ) community/church groups was undertaken through a survey. This has been completed and is being analysed by a Pacific smoke-free trainer

A Project Steering Group will be convened o to look at the results of the survey o to decide on training methodology o to decide on the logistics of delivery .

HVAZ and Enua Ola groups will put forward members of their churches/groups to be trained and they will be the smoke-free champion for their church/group. 8.3 Priority 3 – Pacific people are active and eat healthy

The Aiga Challenge is an eight-week weight loss competition that takes place annually, between churches/groups who are part of the Enua Ola and HVAZ programmes. The Enua Ola programme is funded by Waitemata DHB and delivered by West Fono. 35 churches/groups are part of the programme, 25 in West Auckland and 10 on the North Shore. 42 churches are part of the HVAZ programme, funded by Auckland DHB and delivered through Procare for 14 churches, AH+ PHO for 14 and Tongan Health Society for 14. The following tables identify the number of people who have participated in the Challenge since 2013 and the providers that are responsible for assisting the churches/groups to implement the Challenge. Aiga Challenge Participation:

Provider 2013 2014 2015 2016 2017/2018

Procare/HVAZ 243 517 569 588 602

AH+/HVAZ 305 173 471 473 *

THS/HVAZ 119 230 447 369 *

West Fono/Enua Ola 654 904 826 1156 1187

Total 3334 3838 4322 4602 1789

*Aiga Challenge has not been held

The following tables identify the number or people who completed the Challenge.

0

100

200

300

400

500

600

700

800

900

1000

Axi

s Ti

tle

Aiga Challenge Participation 2013-2018

Procare

EO Nth Shore

EO West

AH+

THS

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Aiga Challenge Completion

Provider 2013 2014 2015 2016 2017/2018

Procare/HVAZ 242 477 544 556 550

AH+/HVAZ 305 148 415 330 *

THS/HVAZ 119 137 307 327 *

West Fono / Enua Ola 651 519 453 859 732

Total 3330 3295 3734 4088 1282

*Aiga Challenge has not been held

Over these years 84 people have maintained their weight or have maintained their weight loss meaning their current weight is similar or less than their weight recorded at the beginning of the first Aiga Challenge. We will further analyse the data. 8.4 PHAP Priority 4–People seek medical and other help early

The Fanau Ola Integrated Service is delivered by AH+ PHO through a contract with Auckland DHB. Packages of care are delivered to families with multiple health and social service needs. The package is based on the needs of a family. This service is delivered by nurses and social workers/community health workers and can be delivered in the home. A package of care is priced at $2,122.89 and the service was for 330 families for the 2017/18 financial year. The health needs of a family are responded to by the health providers and their social service needs are referred to appropriate providers. In the year to June 2018, packages of care were delivered to 432 families (102 families above the target). The following clinical outcomes are being tracked over the time period that individual family members are offered the service:

weight and BMI reduction

reduction in Hba1c

Hba1c below 65mmol

improved lipids profile

blood pressure within normal range

Blood pressure reduced.

0

100

200

300

400

500

600

700

800

Axi

s Ti

tle

AC - No. people comple challenge 2013-2018

Procare

EO Nth Shore

EO West

AH+

THS

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In addition, secondary care data is captured in relation to length of stay at hospital, and hospital admissions. This has enabled a closer look at the correlation between interventions delivered through the Integrated Services programme and its impact (actual and potential) on secondary care services. Appendix 1 reflects client group characteristics

9. Asian, Migrant and Refugee Health Gain 9.1 Increase the DHBs’ capability and capacity to deliver responsive systems and strategies to

targeted Asian, migrant and refugee populations

We continue to work on the actions from the Asian, migrant and refugee health plan 2017-2019. 9.2 Increase Access and Utilisation to Health Services

Indicators:

Increase by 2% the proportion of Asians who enrol with a PHO to meet 87% target (Waitemata) and 71% target (Auckland) by 30 June, 2018. Current rate 89% (Waitemata) and 70% (Auckland) as at Q1 2018/19)

80% of eligible Asian women will have completed a cervical sample by 2020 (current rate 69.2% (Waitemata) and 53.4% (Auckland) as at March 2018.

The Waitemata DHB Asian PHO enrolment rate has increased by 1% to reach 89%, with 2,551 new enrolees in the last quarter. We have surpassed the 2% incremental increase target of 87% by 30 June 2018 for Waitemata DHB Asian PHO enrolment. For the 2018/19 the proposed Waitemata DHB target is 91% by 30 June 2019. At 70%, the Auckland DHB rate fell short of reaching its target of 71%, although there were 1,225 new enrolees. For 2018/19 the proposed Auckland DHB target for Asian enrolment is 72% by 30 June 2019. Current activities:

We are working with Auckland DHB Mental Health and Addictions directorate and Planning, Funding & Outcomes Mental Health team in partnering with Asian, migrant and former refugee consumers, family members, NGOs and other sector partners in the Auckland DHB area to develop the three year action plan for mental health & addictions. The Asian, migrant and refugee workshop is planned for 8 August

Participated at the Government’s Inquiry into Mental Health and Addiction, Ethnic Community Forum on 24 July

Provided assistance in shortlisting candidates for the Patient, whānau and community representative applicants for the new Auckland DHB Patient and Whānau Centred Care Board

We continue to deliver various health seminars/events to increase awareness of the health system and enrolment with a family doctor (GP), including education establishments (student orientation days) and settlement partners

We are continuing to liaise with stakeholders for conducting the Oral Health and Healthy Eating survey to investigate Chinese, Filipino, Middle Eastern and Indian parents’ and caregivers’ knowledge, attitudes and behaviours towards their child’s healthy eating and oral health. The findings will inform decision making of culturally appropriate provision of oral health services and development of tailored oral health and healthy eating information.

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We coordinated feedback from an Asian, migrant and refugee health gain perspective for the Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Young People and Adults in Aotearoa, New Zealand. Hauora Tāhine-Pathways to Transgender Healthcare Services’ document.

Indicator: Increase opportunities for participation of eligible refugees enrolled in participating general practices as part of the Refugee Primary Care Wrap Around Service funding

Activities include:

Planning to deliver a refugee health forum to primary care health professionals (6 August) on the topic: Living with complex conditions (HIV and Female Genital Mutilation)

Roll out of the Refugee Primary Care Wrap Around Service Agreements for 2018/19. There will be a new service component available within this Agreement starting 2018/19, with the aim to increase access to general practice for refugee and asylum seeker background patients (up to 10 years living in the Country): [New] 90 minutes consultation (Capped at one visit per year per patient). The other service components within this Agreement remain the same: Extended consultation (45 minutes consultation in total) and Flexi-Consult Funding component (15 minutes).

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Appendix 1: AH+ MICROSOFT POWER BI – DATA DISPLAY TOOL – ALL PROVIDER NHIs 2017/18

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4.1 Metro-Auckland District Health Board Healthy Weight Action Plan for Children: First Report on Actions

Recommendation:

That the Community and Public Health Advisory Committee:

1. Review the Report on Action Plan Indicators (Section 4 and Appendix 1) and provide feedback, noting this is a work in progress.

2. Note the proportion of Māori and Pacific children in the “obese” BMI category has decreased since 2012. During the same time period smaller decreases have occurred for European/Other children.

3. Note this plan sits alongside the Healthy Auckland Together (HAT) Plan 2015 – 2020.

Prepared by: Rebecca McCarroll (Public Health Dietitian) and Ruth Bijl (Funding and Development Manager – Women, Children and Youth) Endorsed by: Dr Karen Bartholomew (Director Health Outcomes), Dr Debbie Holdsworth (Director Funding), Lita Foliaki (Pacific Health Gain Manager), and Aroha Haggie (Māori Health Gain Manager)

Glossary BMI - Body Mass Index CPHAC - Community and Public Health Advisory Committee DHB - District Health Board GPs - General Practitioner HAT - Healthy Auckland Together HBHF - Healthy Babies Healthy Futures

1. Executive Summary The Metro-Auckland DHB Healthy Weight Action Plan for Children was developed in accordance with our vision that “All Tamariki in the Auckland Region of New Zealand are of a healthy weight”. Health sector led actions were established in the plan, to contribute to the cross-sectoral response required to address childhood weight management. This is the first report on action plan indicators, which inform progress made in the implementation of the plan. Actions and indicators are presented by DHB and target population: women of childbearing age, pregnant women, pre-school and school aged children and adolescents. This first report on action plan indicators is being presented to CPHAC to provide an update on progress and an opportunity for feedback.

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2. Strategic Alignment

Community, whānau and patient centred model of care

In order to support tamariki to maintain a healthy weight throughout childhood, we must measure how effective we are at supporting whanau and communities to address the environments and behaviours that impact on their ability to make healthy food choices and keep active.

Emphasis and investment on both treatment and keeping people healthy

The action plan indicators have been developed with the aim of measuring how we protect tamariki from developing an unhealthy weight. Assisting them to maintain a healthy weight is an important part of ensuring they have the best start to life.

Service integration and/or consolidation

This is the first report on indicators for the Healthy Weight Action Plan for Children. The three metro-Auckland DHBs have worked together to consolidate measures to ensure, where appropriate, consistency in data collection and reporting across the region. The Healthy Weight Action Plan for Children has been designed to sit alongside the Healthy Auckland Together (HAT) Plan 2015 – 2020, which has separate actions and indicators.

Intelligence and insight

We believe that the actions and indicators outlined within this report will contribute toward the cross-sectoral response required to address childhood weight management.

Evidence informed decision making and practice

A literature review of evidence and stocktake of current activities was undertaken to inform the actions in the plan. Key stakeholders provided feedback on the indicators.

Outward focus and flexible, service orientation

The plan has been designed with the specific goal of supporting tamariki to maintain a healthy weight throughout childhood. As the plan is intended to be a living document, the actions and indicators will be reviewed and developed over time.

Operational and financial sustainability

Implementation of the majority of the plan will be undertaken within the current budget, where this is not the case the resources have been highlighted or phased.

3. Background Monitoring and evaluation is critical to any new programme or activity. It allows us to assess whether we have delivered on the goals, aims and objectives of the programme, whether we have achieved the desired outcome and to assess the relative contribution of different components or processes. Monitoring and reporting on the Healthy Weight Action Plan for Children will occur at six monthly intervals. For indicators that are already reported on elsewhere, information on progress toward meeting the indicator(s) is provided. For some individual programmes instituted as part of the plan, more rigorous monitoring and evaluation plans have been developed. Annual monitoring of the current and future health of Aucklanders is also undertaken by HAT; obesity, nutrition and physical activity rates are monitored, alongside other environmental indicators, such as transport infrastructure and the supply and marketing of food. From the 2018 HAT monitoring report the proportion of Māori (10.9%) and Pacific (19.6%) children (4 year olds) in the heaviest “obese” BMI

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category has decreased since 2012 (13.5% and 24.3% respectively). During the same time period smaller decreases have occurred for European/Other children.

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4. Report on Action Plan Indicators (Auckland and Waitemata DHBs) Full report (Appendix 1) Actual Target

Women of childbearing age

Scope enablers for weight loss / maintenance for Pacific people

Scope an adult obesity service as part of the bariatric pathway

Implement the National Healthy Food and Drink Policy 50% 100%

Promote Green Prescription to Primary Care; increase Māori referrals 14.5% 12%

Pregnant women

Measure number of pregnant women referred to Green Prescription n=65 none

Engage with mothers about improving nutrition and physical activity (Healthy Babies Healthy Futures)

Māori 102% 100% Pacific 136% 100% Asian 104% 100% South Asian 104% 100%

Support research related to healthy eating during pregnancy and Gestational Diabetes Mellitus

Infancy / Pre-school aged children

Enhance the pregnancy and parenting education smartphone app and website

Provide culturally appropriate postnatal breastfeeding support Evaluate community peer support breastfeeding pilot

Train GPs, primary care nurses and well child staff on having healthy weight conversations with families with overweight children

Complete a gap analysis of healthy food environments in and around Kohanga Reo, Pacific Language Nests and ECEs

School aged children and adolescents

Deliver a comprehensive, multi-component whānau-focused physical activity and nutrition programme for overweight/obese school aged children and adolescents

Key

Achieved / on track Not Achieved but progress made Substantially Achieved but off target Not Achieved / off track

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5. Highlights From this first report on action plan indicators the following highlights have emerged:

The National Healthy Food and Drink Policy is being successfully implemented across the three metro-Auckland DHBs; the implementation plan is on track being 50% complete.

Green Prescription referral targets for Māori clients have been exceeded:

Auckland DHB referral target = 11%, achieved = 15%; Waitemata DHB referral target = 13%, achieved = 14%.

The number of pregnant women enrolled in Green Prescription has increased over the past year in both DHBs.

The Healthy Babies Healthy Futures (HBHF) team have successfully engaged with specific vulnerable community groups (Māori, Pacific, Asian, and South Asian) to have healthy conversations with mothers about improving nutrition and physical activity – all engagement targets have been exceeded, engagement with Pacific mothers was exceptional: 136% of target.

Three randomised controlled trials (TARGET, GEMS and HUMBA studies) related to healthy eating during pregnancy, including women with Gestational Diabetes Mellitus, are progressing well and are on track.

GPs, primary care nurses and Well Child Tamariki Ora staff have been trained across the region on having conversations about healthy weight with families with overweight children; 95% of participants identified an increase in confidence following these sessions.

More than 80% of four year olds who are identified as obese at the B4 School Check have a healthy weight goal setting plan and accept a referral for further support. This is above the national average.

A gap analysis of healthy food environments in and around Kohanga reo, Pacific Language nests and ECEs has been completed to determine areas for future DHB support. Dietitian resource has been allocated to begin some of this work.

6. Off track The following actions are currently off track:

Scoping of an adult obesity service as part of bariatric pathway has been delayed until a joint pathway has been agreed. Waitemata DHB provider is currently working through detail and resource for implementation.

Pregnancy and parenting education smartphone app and website is receiving good feedback regarding utilisation from target groups, however content and promotion of resource still to be reviewed.

A breast feeding peer support initiative as part of the Wahine Atawhai programme was piloted through Plunket. However, our evaluation showed that the pilot did not successfully engage target populations. Consequently, the programme was stopped. We are currently planning a breastfeeding support service for women with Ngati Whatua. The Healthy Mothers and Babies programme has Le Leche trained staff however they don’t provide a specific breastfeeding support service. There are also specific antenatal classes in Auckland DHB for both Maori and Pacific that address breastfeeding.

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Evaluation of a community peer/mentor support breastfeeding programme pilot demonstrated that recruitment targets for at risk populations (Māori, Pacific and low-SES women) were not met. The programme has been discontinued. Future options for reaching at risk populations are being explored.

7. Conclusion Monitoring and evaluation is critical to any new programme or activity. It allows us to assess whether we have delivered on the goals, aims and objectives of the programme, whether we have achieved the desired outcome and to assess the relative contribution of different components or processes. This first report on action plan indicators for the Metro-Auckland DHB Healthy Weight Action Plan for Children is been presented to CPHAC to provide an opportunity for members review progress, and provide feedback on the reporting. The action plan indicators have been developed collaboratively across the region, with consistency in data collection and reporting, where appropriate. There will be 6-monthly updates to CPHAC on progress on actions outlined in the plan.

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APPENDIX 1 - Populated Healthy Weight Action Plan for Children Reporting Template: August 2018

Women of Childbearing Age

Actions Time-frame Measures

Priority Popn ADHB WDHB CMDHB Notes

Survey Pacific women and men who have maintained weight loss from the Aiga challenge for three years regarding enablers to weight loss maintenance by December 2016 and utilise survey findings in a review of the Aiga challenge.

Dec-17 % who have maintained weight loss in past three years; narrative enablers to weight loss/maintenance complete (Y/N)

46 38 Narrative enables to weight loss/maintenance complete. Aiming for new Pacific objective for next round of reporting.

Investigate access barriers to bariatric surgery for Māori and Pacific women of child bearing age.

Jun-18 # of Bariatric surgeries in 2017/18:

Māori 17 18 Total surgeries 2016/17, ADHB: 82; WDHB: 98; CMH: 156. Total surgeries 30 Jun 17 - 30 Jun 18 ADHB: 70; WDHB: 95

Pacific 22 10

Scope what an Adult Obesity Service (intensive lifestyle intervention Tier2-3 service) might look like as part of the bariatric pathway.

Dec-17 Complete (Y/N) On hold On hold

Promote Green Prescription to primary care and identify and address barriers to primary care referrals.

Jul-18, Jul-19, Jul-20

# of adults enrolled in Green Prescription by ethnicity

Māori 579 609 1481 # referred provided as opposed to # enrolled.

Pacific 857 565 1788

Implement the National Healthy Food and Drink Policy in DHB-owned sites. Baseline audit Follow-up audits

Jul-18, Jul-19

50% compliant 100% compliant

50% 50% 50%

Work with ARPHS and Healthy Families NZ through Healthy Auckland Together (HAT) to implement the National Healthy Food and Drink Policy for Organisations in the community.

Dec-18 # of organisations who have begun implementing the Policy

Dec-18 n=1 implementation across whole site

See notes Some HAT organisations have begun implementation across all 3 DHB catchment areas (n=3) - this implementation is however partial, i.e. across 'some' of the organisation's sites.

Work with DHB contracted providers to support implementation of aligned healthy food and drink policies.

Dec-18 # of providers who have the Policy in their contract

97 114 >95% of local contracts had policy included in 2017/18 contract renewal n=~300

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Pregnant Women



Ensure culturally appropriate antenatal education available to promote and support breastfeeding.

On-going

Deliver contracted volumes of breastfeeding related programmes with 80% of services delivered to the priority populations (Maori, Pacific and Quintile 5)

Maori At Risk At Risk Achieved/ Complete

ADHB/WDHB: Culturally appropriate antenatal education is available which supports and promotes breastfeeding. Specific programmes targeting priority groups are in place. CMDHB: 80% is the total percentage across four separate programmes delivered by four providers.

Pacific At Risk At Risk Achieved/ Complete

Quintile 5

At Risk At Risk Achieved/ Complete

Providing women and their families with key breastfeeding messages through textMATCH messaging, community promotion, and teaching practical skills for better nutrition and increased physical activity.

On-going

% of target (1000) and of people receiving textMATCH service

93.6% Data not reported per DHB. HBHF will be looking into this in 2019.

Working with partners to engage with specific vulnerable community groups (Māori, Pacific, Asian, and South Asian).

Jun-18 % of target (1000) and of mothers engaged in healthy conversations

Maori 102%

Pacific 136%

Asian 104%

South Asian

104%

Further strengthen HBHF connections with maternity services, Kohanga reo, Churches and ECEs to increase access to the HBHF programme.

Dec-17 # of Community Learning Programme (CLP) groups held within community settings

13/49

Promoting HBHF to pregnant mothers at the earliest possible stage when engaging with DHB services.

Dec-17 % of target (1650) and of mothers given the opportunity to engage with a HBHF provider

98%

Continue the development of Te Rito Ora service and B4 baby services which engage with women in antenatal period to support breastfeeding.

Jun-18 70% women accessing the service will be fully/exclusive breastfeeding at six weeks (aligned to the WCTO indicator targets)

Not Achieved

Te Rito Ora has a 59% breastfeeding rate at 6 weeks, comparative to the overall rate of 58% across the CMH region. Breastfeeding rates increase to 60% at 12 weeks and 71% if women have been enrolled in the programme antenatally.

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Incorporate referrals to Green Prescription and healthy weight gain in pregnancy conversations into existing Auckland Regional Health Pathways.

Dec-18 Health Pathways updated to include referral options for pregnant women, e.g. Green Prescription (Y/N)

Not Achieved

Not Achieved

Not Achieved

Feedback has incorporated and pathway changes drafted. This is not yet live on the Health Pathways website.

Establish a baseline(1) and increase(2) referrals of pregnant women into Green Prescription for healthy weight management.

Dec-18 # pregnant women enrolled in Green Prescription

Baseline (2016-17): n=24 2017-18: n=52

Baseline (2016-17): n=3 2017-18: n=13

2017-18: n=20

CMH: new reporting indicator in system, so no baseline available and relies on accuracy of use as this is new.

Develop Pathway for management of pregnant women with high BMI.

Dec-18 Pathway developed and implemented (Y/N)

Achieved Antenatal Management of Obesity/Morbid Obesity Guideline' needs reviewing. - Last Updated: 15/03/2016 Date First Issued: 26/11/2012.

Undertake research on related to healthy eating during pregnancy and Gestational Diabetes Mellitus.

Dec-20 Feedback from study Principle Investigator of the progress of the 3 studies:

See notes See notes See notes Target: neonatal data being cleaned; 6-monthly data collection near complete GEMS: recruitment phase HUMBA: recruitment complete; 12-monthly data collection to finish December 2018

Undertake quality research TARGET* Recruit women for multisite study.

TARGET: to complete recruitment by Oct 2017

Achieved/ Complete

Achieved/ Complete

Achieved/ Complete

Gestational Diabetes Mellitus Study of diagnostic thresholds (GEMS)* Recruit women for multisite study.

GEMS: to have 50% recruitment by Dec 2018

On Track On Track On Track

Healthy Mums and Babies Study (HUMBA)** Undertake the study in partnership with UoA, Recruit women into the HUMBA study, Implement findings into practice.

HUMBA: to finish data collection by Dec 2018


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Infancy / Pre-school Aged Children



Enhance the pregnancy and parenting education smartphone app and website to encourage all women, particularly Māori, Pacific and Asian, to breastfeed for at least the first six months of their baby’s life.

Jun-18 % of Māori and Pacific women who breastfeed at three months (Target of 70% of babies are exclusively or fully breastfed at three months).

Maori Off Track Off Track PP37. Note: website and app available, good feedback regarding utilisation from target groups for website. However, content and promotion of resource due for review.

Pacific Off Track Off Track

Postnatal support through Titifaitama and Wahakura Wananga including peer support and breastfeeding support groups.

# who attend support groups.

Maori Achieved Achieved PP37.

Pacific Not achieved

Achieved PP37. No specific Pacific breastfeeding support groups in Auckland DHB.

Intensive post-natal support through Te Rito Ora service including peer support and home visits.

Jun-18, Dec-18, 6-monthly report

# of visits in 6 month period (Target - Kaitipu Ora Workers will engage with clients a minimum of 3x in Week 1 postnatally, and then weekly until Week 12).

702 n=127 Lactation Consultant visits + 575 Kaitipu Ora visits.

Evaluate effectiveness of Auckland DHB breastfeeding community clinic and home visiting approach and integrate learnings into future efforts.

Mar-18 Build findings from evaluation into contract for the 17/18 financial year (Y/N).

Achieved/ Complete

Note: programme is continuing.

Community cooking courses to support pregnant woman and parents and whānau of 0-2 year olds to make healthy, affordable and culturally appropriate meals which meet the nutrition needs of pregnant women and infants and toddlers.

Ongoing # of participants that complete the course.

28 Note: 34 total women attended 1 or more sessions, 28 completed the full series.

Evaluate the community peer/mentor support breastfeeding programme pilot to ascertain its success with Māori, Pacific and low-SES women.

Dec-17 Evaluation outcome report complete (Y/N).

Achieved/ Complete

Achieved/ Complete

Note: programme was discontinued as did not successfully reach target population.

Enhance the training plan for GPs, nurses and other relevant health professionals to increase their confidence in having culturally appropriate conversations about child weight and healthy lifestyles with families.

Ongoing 90% of participants who identified an increase in confidence with having conversations about healthy weight following the sessions.

Achieved Achieved Achieved ADHB/WDHB: 95% of participants identified an increase in confidence with having conversations about healthy weight following the Raising Healthy Kids training sessions.

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School-Aged Children and Adolescents



Strengthen support for schools to implement healthy food and beverage policies by achieving an 80% adherence

Dec-19 WDHB/ADHB: 80% of contracted schools have a healthy food and drink policy. CM Health: Introduce a healthy food and drink policy in Mana Kids schools.

On Track On Track At Risk ADHB/WDHB: Youth Health Programme Manager is working with Enhanced School Based Health Services (ESBHS) schools to ensure they have a policy in place. CMH: Initial interest to implement policy exists with Mana Kidz, follow up to be had.

In collaboration with HAT and Healthy Families NZ, engage intersectorally to support a gap analysis of healthy food environments in and around Kohanga reo, Pacific Language nests and ECEs to determine areas for future DHB support.

Jun-18 Gap analysis complete. Achieved/ Complete

Achieved/ Complete

At Risk CMH: Establishing relationship with Healthy Families NZ.

Utilise INFORMAS survey results, along with information from the Heart Foundation, ARPHS and Healthy Families NZ sites to engage with high-priority ECEs and schools to support development and implementation of food policies and healthy food environments.

Jun-19 # of ECEs and schools prioritised for support; # of ECEs and schools supported.

0 0 0 ADHB/WDHB: Work beginning in August 2018. CMH: awaiting the commencement of Programme Manager, Maori Child Health role to progress initial business proposals within/alongside Maori Health and other providers looking at engaging in this space i.e. Mana Kidz.

Contract a provider to deliver a whānau-focused physical activity, nutrition and parenting programme for pre-school children identified as being ≥98th centile, including a psychological component and development of specific approaches for Māori and Pacific populations.

WDHB/ADHB Dec-18 CM Health Jun-18

# of children enrolled; # of Māori and Pacific children enrolled (baseline)

Maori On Track On Track Achieved/ Complete

ADHB/WDHB: Service will commence August 2018. Contracts with selected providers have been finalised following an RFP process and development of a co-designed model. CMH: Otara Health Charitable Trust deliver Active Futures to priority population groups - 84% of children engaged in programme are Maori or Pacific.

Pacific On Track On Track Achieved/ Complete

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Contract a provider to deliver a whānau-focused physical activity and nutrition programme for overweight/obese school aged children and adolescents, including specific approaches for Māori and Pacific communities.

Jun-18 # of children enrolled; of Māori and Pacific children enrolled.

Maori 34 51 59 All: # referred provided as opposed to # enrolled CMH: Total number of referrals (all ethnicities) = 286. Of this total, 140 children were enrolled (49%).

Pacific 132 63 170

Undertake communication activities to promote and familiarise primary care / WCTO partners with target.

On-going

By December 2017, 95% of obese children identified in the B4SC programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.

Achieved Achieved Achieved

Ensure referral process for referrals from B4 school provider to primary care for children with BMI>98th centile is in place and all obese children are referred to primary care and that referral is acknowledged (electronic referral process in CM Health, paper based in Auckland DHB/Waitemata DHB).

On-going

Percentage of declined referrals to primary care programmes.

Maori 31% 11.0% 31% The total percentage of declines for ADHB: 17%, WDHB: 14% CMH: 27% SOURCE: Before School Checks Monthly Report to end of June 2018.

Pacific 10% 11% 23%

Provide community, primary and secondary care training by dietitian on use of Be Smarter brief intervention and goal setting healthy lifestyles tool and other resources so health professionals are confident to initiate conversations with families and talk about healthy weight to enable families to be as healthy as they can be.

On-going

# of training sessions delivered

Jan-18 to Jul-18: 31 people trained. Jul-16 to Jul-18: 83/138 GP practices received training

Jan-18 to Jul-18: 42 people trained. Jul-16 to Jul-18: 74/107 GP practices received training

1 Jul-17 to 31 Jun-18: 369 people trained

Staff trained include: GPs, primary care nurses, Well Child Tamariki Ora staff, Mana Kidz staff, school nurses, outreach health & immunisation staff, health coaches, nurse educators and a mental health coordinator.

Design and implement an evaluation of families and health professional engagement with Raising Healthy Kids referral pathway.

Dec-18 Evaluation plan complete with recommendations (Y/N)


Support the implementation of the regional growth chart solution for use in secondary care in metro Auckland DHBs.

Dec-18 An electronic growth chart is implemented in the metro Auckland DHBs

On Track On Track On Track ADHB/WDHB & CMH - user acceptance testing completed successfully; planned to go live date: 1 Aug 2018.

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Work with ARDS and the Northern Region DHBs to develop consistent health promotion messages using the common risk factor approach for obesity and oral health. Investigate translation into priority languages.

Jun-18 Message alignment complete with five key messages agreed upon. Priority languages identified and translation services costed.


Scope the feasibility for a pilot to assess measuring weight and height at the year eight dental check. The aim is to facilitate collection of data for population level monitoring of trends and to feedback to parents information on their child’s weight and growth. This pilot could potentially assess: - Consenting of children. - Impacts on clinic flow and staffing. - Scalability. - Data collection. requirements and utility - Communication of outcomes to parents. - Staff and consumer perspectives. - Identification of any adverse or unexpected outcomes. This would inform the assessment of whether this could be implemented across the region and the trade-off of costs compared to the potential impact of the information gained for children, their families and the sector as a whole.

Dec-18 Pilot complete At Risk CMH: Pilot has not been scoped

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Documents

Community and Public Health Advisory Committees Meeting ...€¦ · - Asian, Migrant and Refugee Health Gain 4. ... Member Te Ora, Maori Medical Practitioners Step-daughter is a surgical