· web viewa delirium tool was finalised and shared for use in si facilities during the week of...

Quarter 3 2017-18

Table of ContentsSouth Island work that supports the New Zealand Health Strategy 3

Clinical Services 4

Southern Cancer Network 4

Child Health SLA 8

Mental Health and Addiction SLA 10

Health of Older People SLA 12

Palliative Care Workstream 13

Cardiac Services Workstream 14

Elective Services Workstream 17

Major Trauma Workstream 19

Public Health Partnership 22

Stroke Services Workstream 24

Key Enablers 26

Quality and Safety SLA 26

Information Services SLA 28

Workforce Development Hub 30

2

South Island Alliance work that supports the New Zealand Health Strategy

3

Value and high performance

Te whāinga hua me te tika o ngā mahi

One teamKotahi te tīma

Smart system

He atamai te whakaraupapa

Closer to home

Ka aro mai ki te kāinga

People-powered

Mā te iwi hei kawe

All New Zealanders Live wellStay wellGet well

The St John trauma destination policy has been update and redistributed. DHBs are in agreement but staging points in some rural areas are not always clear so discussion will be held with St John to resolve this.

Regional support for the implementation of the Bowel Screening Programme continues through the South Island Clinical Leads group. A South Island Equity Plan discussion document has been drafted.

Preparations for implementation of the South Island Patient Information Care System (SI PICS) in Nelson Marlborough DHB continues with a final decision about go-live being made following a review of readiness currently being undertaken.

The inaugural cross-agency Hauora Alliance Steering Group meeting was held on 27 February. It was agreed the initial focus would be developing a cross-agency First 1,000 Days project. Collectively, the South Island has

achieved the target of 90 percent of cancer patients receiving treatment within 62 days of being referred with high suspicion of cancer. While two DHBs are still working towards the target, it is positive that as a region we are delivering faster cancer treatment for our communities.

Work to align South Island public health governance, leadership and operations continues, with the South Island Public Health Strategic Framework agreed to, a work group established to progress sustainable on-call arrangements, and a single planning template developed.

KEY AREAS DELIVERABLES

Timeliness of services across the cancer pathway (FCT)

1 Support DHBs to deliver the extended FCT target of ‘At least 90% of patients receive their first treatment within 62 days of being referred with a high suspicion of cancer and a need to be seen within 2 weeks by July 2017’

Q1,2,3,4

2 Support DHBs with undertaking and delivering the FCT Round 2 Funded Projects

Q1,2,3,4

3 Undertake a focused review to understand the ‘Route to Service Access/Diagnosis’ for all South Island cancer patients, with a focus on first presentation through ED

Q2

4 Continue to support the maintenance or improvement of the 31 day Indicator: proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment within 31 days (85% target for PP30 31 day indicator)

Q1,2,3,4

5 Development of comparable timely, cancer pathways for the SI Q1,2,3,4

6 Undertake an annual assessment of the Cancer Clinical Priorities, through the South Island/SCN Cancer Clinical Leads Group

Q1

7 Supporting DHBs in preparation for the introduction of a national bowel screening programme - focus on services to support the delivery of additional cancer cases

Q1,2,3,4

8 Support DHBs with the implementation of the Early Lung Cancer Guidance (to be published shortly)

Q1,2,3,4

Service coordination and quality improvement

9 Multi-disciplinary meetings: Complete the rollout of the regionally agreed MDT recommendations and service improvement initiatives started in 2015-16

Q1,2,3,4

10 Multi-disciplinary meetings: Review South Island MDM System against national specification

Q1,2,3,4

11 Multi-disciplinary meetings: Focused work to support findings from MDT meeting review e.g. meeting etiquette, training - MDT Coordinators, Chairs, referral requirements/timelines for radiology/pathology review, MDM resourcing

Q1,2,3,4

12 Multi-disciplinary meetings: prioritisation of cases for discussion at MDMs

Q1,2,3,4

13 Survivorship: Rollout of (national) Supportive Care Framework across the South Island

Q1,2,3,4

14 Survivorship: TBA

15 Support implementation of the National Radiation Oncology Plan

Reducing inequalities

16 Improved collection of ethnicity data across the whole health spectrum

Q1,2

17 Support the rollout of the Maori Cancer Pathways Project across the South Island

Q1,2

18 Review and develop a plan to increase the uptake of cervical screening among Maori communities (Te Waipounamu Maori Leadership Group (TWMLG) Priority area)

Q1,2

19 Support the collaborative regional working of both TWMLG & the SI CCG and integrate as co-partners into the regional plan

Q1,2,3,4

20 Support the rollout and implementation of the Psychosocial and Supportive Care Initiative across the South Island, and assess early findings

Q1,2,3,4

South Island Cancer Intelligence Service

21 Develop a plan to support and implement the NZ Cancer health Information Strategy across the South Island

Q1,2,3,4

22 Produce and further develop a Quarterly Cancer Dashboard to understand progress against cancer standards and targets, and to identify areas for service improvement

Q2,4

23 Develop a regional strategic cancer plan to identify priorities out to 2025.

Q2,4

KEY PROGRESS IN QUARTER 3Timeliness of Services Across the Cancer Pathway (FCT)

1-6 The South Island Clinical and Operational Leadership Group for Cancer continues to focus on Faster Cancer Treatment as their first priority. Ensuring more patients are able to benefit from the 62-day health target continues to be a focus for our improvement work across the region. While not all DHBs have achieved the 90% health target, progress with the programme of work overall is gratifying, reflecting that the consolidated result for all South Island DHBs has reached 90%, and the continued good progress towards completion of the Ministry funded service improvement initiatives. Additional breach code narratives requested by the MOH continue to be closely monitored, recognising they are designed to help provide further information and visibility locally. The impact of inter district flow (IDF) on FCT pathways continues to be reported in the FCT dashboard to enable greater visibility of the impact of patients accessing

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SOUTHERN CANCER NETWORK

service across DHB boundaries. Clinical staff across the South Island have highlighted the need for greater visibility of patients on the FCT pathway. The South Island DHBs and SCN are working towards establishing an FCT indicator that will be visible on the patient record. The indicator’s development is included in the draft work plan for 2018/19.The SCN has supported SI DHBs in delivery of the following MOH-funded FCT projects: Ongoing: Improving the Cancer Pathway for Maori (SI-wide, led by NMDHB) Ongoing: Diagnostics Fast Track Clinics (SDHB) Completed: Pathway Entry, Routes to Diagnosis, part A: Emergency

presentations (SDHB) Ongoing: Pathway Entry, Routes to Diagnosis, part B: all cancers (SI-wide, led by

SDHB) Completed: Melanoma, find the spot Ongoing: Gynaecology High Suspicion of Cancer Referral Pathway (CDHB) Ongoing: Valuing patient’s time in complex cancer: Head and Neck (NMDHB &

CDHB)All these project are on track to be completed by June 2018. The Pathway Entry – Emergency Department (ED) presentations & Routes to Diagnosis – stage B project is of particular interest as it is one of three similar projects across New Zealand where the focus is on timeliness of diagnosis and the impact of certain pathways on morbidity and mortality. The South Island work is in the final stages of analysis and write up and will inform our work plan for 2018/19 and future years.

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SCN continues to be linked into the SI Clinical and Operational Leadership Group for Cancer, to monitor impact of programme implementation on cancer volumes for DHBs as the bowel screening programme rolls out. The regional coordination centre is now established, supporting the programme across the South Island, as SDHB moves to implementation.

Service Coordination and Quality Improvement9-12 SCN continues its support leading three separate projects within the ‘Supporting

MDM’ portfolio:

1. The adoption of the South Island cancer MDM System (SIMMS). As at the end of Q3 we now have four Canterbury MDMs and one Nelson Marlborough MDM on the new system. A meeting to define requirements to deliver all MDMs on Health Connect South (HCS) was held in February with the SCN Manager, project manager and SDHB IT developer. It was agreed that there was a need to

gather requirements from remaining MDM Chairs in Canterbury and NMDHB in order to quantify scale of work remaining and plan accordingly. A joint commitment has been made to close monitoring of the development work, against a revised timeline for the remaining work. The first meeting of the SI MDM Change Request Group was held and decisions made regarding progression of suggested improvements to the system. A prioritisation method was trialled and overall worked well. This is being undertaken to manage the project within its overall scope.

2. SCN has completed the work on the “MDM Gap Analysis” as requested by the Ministry as part of the Cancer Health Information Strategy. This project enabled the South Island District Health Boards (DHBs) to measure the gap from the current of SIMMS and identify options to progress towards the future MDM state as per new Ministry guidance released in 2016. The report was approved by the SI MDM Governance Group in early February then submitted to the Ministry. It was pleasing to see that the SI MDM system achieved almost 90% of the Ministry’s MDM Future State Requirements. We now await the Ministry’s review of all Network reports and its advice as to next steps.The Ministry was unable to support two of the MDM Gap Analysis reporting deliverables, however given the importance of local/regional reporting for SI clinicians we are progressing a trial extract from the MDM system and will undertake one-off matching with data from the Canterbury data warehouse as a “proof of concept” to identify benefits and to see how this could be replicated as a model for other MDMs using the SIMMS. The Ministry have accepted that these deliverables cannot be achieved due to lack of resources on their part, so notwithstanding those issues the work can be considered complete.

3. The findings from the MDM ‘quality’ review were released in early 2017 and the SCN is undertaking work with SI MDMs to implement the recommendations and actions identified as a result of the findings. The MDM Charter (including MDM etiquette guidance) has been shared with MDM Chairs for input. This was widely distributed to all MDM members in early April. A MDM Coordinator workshop is booked for April 2018. This will include pathology and radiology sessions to support data entry in these sections of the electronic proforma as well as other related topics. Work on reviewing MDM coordinator resourcing is underway, we are currently seeking to determine the scope and approach for this work. MDM Chair training will be undertaken in Q4. We are currently seeking feedback as to the best way to deliver this including local or regional forums.

13 He Anga Whakaahuru, Supportive Care Framework has been recommended by the

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NZ Regional Cancer Network Collaborative as a reference tool to inform national supportive care standard development. The planned review of the current South Island DHB position against national guidance/models for supportive care has been impacted by the time taken in developing national supportive care and survivorship guidance. This work is being incorporated into the revised approach nationally to tumour standard development and consideration of its place as a core standard for development nationally. Once the national approach is confirmed, the next steps will include identification of key stakeholders and relevant guidance/models from across the sector to scope areas of priority for patient and whānau supportive care services in the South Island.

15

The South Island Regional Radiation Oncology Partnership is continuing work focussing on tumour streams where variation is notable, developing recommendations for greater consistency in treatment. The recommendations for the treatment of early stage breast cancer have been finalised and are currently being implemented. The recommendations in relation to this work are being prepared for consideration by the South Island Alliance Leadership Team. The next tumour stream under consideration will be colorectal.

Reducing Inequalities16-19 Te Waipounamu Māori Leadership Group (TWMLG) continues its active leadership

and support of three projects focused on Māori health. The projects are:1. The delivery of a report identifying key motivations and barriers to participation

in cervical screening for Māori communities in the South Island. This project used qualitative methodology and involved participation of screeners, users and service providers. Following feedback received, the author is currently undertaking refinements on the final report. An updated version to be presented to Te Waipounamu Māori Leadership Group at its June 2018 meeting.

2. A project with a focus on providing coordinated and joined up services for Māori patients with cancer across the South Island (Project B). The identification of gaps and barriers to care has been the basis for recommendations and development of implementation plans for each of the DHBs. Implementation of local initiatives is now underway across the four participating South Island DHBs. The initiatives being undertaken include:

Improving accessibility to information for whānau who speak Te Reo Māori, and linking consumers and health professionals to consistent online resources.

A kaupapa Māori programme for whānau that addresses early signs and symptoms of cancer and understanding of the services and

support available. Increasing local linkages and collaboration between cancer service

providers across the cancer pathway – Māori health providers, community and hospital service providers.

Training and education activities for health professionals supporting cultural competency and improving referral processes.

3. A third South Island wide project being led out of NMDHB has a focus on educating service teams, through a Māori Health Educator approach (Project A). Work is continuing on developing the education and other initiatives of the project into a ‘package’ that describes what has been done and how. This is to facilitate the next phase of the project where some aspects will be offered for delivery in other parts of the South Island. SI DHBs will be able to choose which initiatives fit in with their plans which have been developed under ‘Project B’.

DHBs have identified local initiatives to improve the collection, storing and output of ethnicity data through Project B. There is also a regional focus on improving ethnicity data from Te Herenga Hauora and a national focus with the release of updated HISO Ethnicity Data Protocols. Scoping is being undertaken for an initiative that takes into account this existing work. The proposal will be informed by findings from the Southern Cancer Network Routes to Diagnosis project and align to initiatives to target inequitable health outcomes for vulnerable and high risk populations.TWMLG members have commended the development of information to identify unwarranted variation in radiation oncology practice and the use of this data to inform the treatment of breast cancer by radiation therapy. TWMLG members noted DHB initiatives identified in the Improving the Cancer Pathway for Māori projects and encourage continued activity for sustainable benefits. TWMLG made recommendations to the Southern Cancer Network on the draft work plan for 2018/19. TWMLG will develop a work programme aligned to the finalised work plan.The South Island Cancer Consumer group (SICCG) continues to provide a forum for consumer engagement and input on key SCN initiatives. Recently members discussed the Routes to Diagnosis work and some of the potential ‘roadblocks’ for patients understanding symptoms or accessing care. Guidance was also sought from the group about online resources and raising awareness of the evidenced-based sites available that provide accredited information for consumers. Members highlighted the importance of utilising patient voices and experiences in the development of improvement initiatives. SCN has a responsibility to incorporate these perspectives in all aspects of its work.

20 SCN continues to provide support to the Regional Steering Group for the Psychological and Supportive Care Initiative across the South Island. The Ministry

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has recently approved their ongoing oversight of the Cancer Psychology and Social Support Initiative for a further period of two years. The initiative is being reviewed nationally and Upper South Island services are due to take part in this evaluation in April 2018. The SCN Steering Group continues to take a keen interest in the effectiveness of the pathway that this initiative offers newly diagnosed patients, especially with regard to timeliness of access and use of the specialist capacity the initiative offers.

South Island Cancer Intelligence Service21 NZ Cancer Health Information Strategy is yet to be finalised for implementation

22

The quarterly FCT dashboard has been strengthened to give greater focus on service improvement and the actions needed to improve performance. Feedback on these changes has been positive with the dashboard recipients expressing satisfaction over the global picture it provides for South Island performance. The dashboard will continue to be provided in its current format on a quarterly basis. No further work is planned for this initiative, however further development will be considered again in the future once the new national cancer strategy and plan is available.

23

The draft work plan for 2018/19 has been aligned to the wider South Island Alliance Strategic Planning process through 2017/18 that has resulted in a Vision Statement, Strategic Goals and Principles. The current strategy ‘refresh’ for the alliance has been confirmed as a restatement of the current framework (2017-20 Health Services Plan), but is one which goes further into detail, seeking to provide specific guidance to the service level alliances, work streams and other collaboration groups around six priority focus areas. These include “Turning Data into Information”, highly relevant to SCN’s work focusing on the importance of supporting better use of data to inform improvement work. For SCN this will include a continuation of the development of tools to provide quality information with clinicians, patients and families to inform their decision making. In addition the guidance from the Ministry of Health regarding the priorities for Cancer Services, through a new strategy and plan for cancer services will provide a foundation for further engagement with the South Island Sector on our own strategic cancer plan.

Tumour Standard Reviews[from 16- 17 work plan]

The SCN Steering Group have endorsed the key findings of the Lung Tumour Standards audit report which will inform future revision/development of tumour standards. The project closure will be completed with working group members contacted to acknowledge the significant contribution they have made to the project. The key findings of the Gynaecological tumour standards audit report will be considered by the working group, along with an any service improvements that have been undertaken during the time taken to complete the review to support the

completion of this work.

CHALLENGESFaster Cancer Treatment

1

Overall, the South Island improved on the 62-day Health Target performance. Ensuring more patients are able to benefit from the 62-day health target continues to be a focus for our improvement work across the region. There is recognition that the 62 day target captures the care provided to only a small proportion of cancer patients and that we need to be vigilant in identifying opportunities for improvement in patient experience and timeliness of cancer detection diagnosis, treatment and care. This includes understanding and resolving the barriers that prevent timely access, including those that are excluded from the target.

Multi-Disciplinary Meetings

10

The pilot data extraction to the Ministry of Health and the definition of reports for clinical use, as part of the “Gap Analysis” have been confirmed by the Ministry CHIS team as not being able to be delivered. Given the importance of providing reporting back to clinicians and managers we will seek to still deliver this for South Island MDMs using our local data repositories and resource.

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Growing Up Healthy

1Working cross-sectorally to better manage the safety of vulnerable children and reduce family whanau violence. Q4

2Support the SI DHBs to understand and respond to information reported from e-Prosafe Q4

3Work with maternity services to continue to reduce Sudden and Unexpected Death in Infants in the South Island with particular emphasis on Maori and Pacific populations.

Q1,2, 3,4

Young Persons Health

4In partnership with Health Promotion Agency, SI Public Health Partnership and SI Mental Health and Addictions SLA, implement recommendations of SI ED scoping exercise (subject to funding)

Q3

5Support DHBs to implement the Ministry of Health’s Sexual and Reproductive Health Action Plan as it relates to teen pregnancy. This item has been de-prioritised.

Q3

Access to Child Health Services

6a

Support interventions to reduce ambulatory sensitive hospitalisations for skin infections, eczema and dermatitis with an emphasis on at risk children and families, Maori and Pacific 0-5 years. This item has been de-prioritised.

Q2,3

6b

Improve Maori and Pacific engagement with WellChild Tamariki Ora providers to support reduction in ambulatory sensitive hospitalisation rates for skin infections, eczema and dermatitis. This item has been de-prioritised.

Q2

7Support the South Island Diabetes Working Group to implement their workplan including understanding service delivery to Type 1 Diabetic consumers.

Q3

Regional obesity management programme

8 Develop and implement a childhood healthy weight programme Q4

9Align Childhood Healthy Weight Programme with MOH health target for child health Q4

10Work to reduce the number of dental ambulatory sensitive hospitalisations in 0-4 year olds. This item has been de-prioritised. Q4

11Sharing learnings from Healthy Families Christchurch and Invercargill. This item has been de-prioritised. Q4

12Improve uptake and use of South Island Regional Electronic Growth chart. Q1

Consumer Consultation

13 Develop a SI child/youth/parent/caregiver survey Q3

KEY PROGRESS IN QUARTER 3Growing up Healthy

1

A second SI Child Protection workshop is being planned for June. This was in response to the positive feedback from the initial workshop held in Feb 2017. This will progress the action points that include; human resourcing, training, leadership, standardisation of documentation, Paediatric Radiology- access to expertise, peer support.Infant Mental Health has been chosen as an area of work to support the First 1,000 days (Alliance strategic priority). SI MH SLA have endorsed the work and will assist by addressing infants’ environments through helping parents with a mental illness (people identified under Supporting Parents Healthy Children). They have added it to their draft 2018 - 19 workplan.

3

Progress of the regional SUDI project has slowed while national discussions are undertaken with GMs Planning and Funding regarding regional versus DHB SUDI programmes. The outcome of those discussions is not yet known. The scheduled National Results Based Accountability workshops have been postponed.

Young Persons Health

4

The South Island Child Health SLA Scoping Project - South Island Youth Alcohol Emergency Department Presentations Report was released to the sector. The SLA looks forward to further discussions on the next steps for this work.


7

The South Island Diabetes Working Group has drafted the workplan for 2018 – 2019 but continue to have challenges in achieving engagement from all districts with some meetings inquorate.

Regional Obesity Management Programme

9

The Evaluation of Community Interventions for Unhealthy Weight Pre-Schoolers in the South Island project is underway being undertaken by the University of Otago. The SICAG will provide guidance on an annual basis to SI DHBs to priority areas. This will be in the form of an Operational Document (one pager). Translation of BeSmarter tool is nearly completed for Tongan and Samoan communities. Public Health representative now on SICAG.

8STATUS KEY: Not Started Critical Caution On target Complete

CHILD HEALTH SLA

South Island Regional Electronic Growth Charts

12Work continues to provide access and data entry capability to e growth charts in Primary Care. There has been interest from NI DHBs in using the tool.

Consumer Consultation

13Fabio the frog project – CDHB have the application. Some technical problems encountered when using on some CDHB devices. Awaiting for the application to be installed on CDHB tablets.

CHALLENGES


7

Capacity of members to attend SI Diabetes Working Group Meetings. Work continues to resolve this with revised meeting times, consultation with members as to their capacity to attend, reduction of members from 11 to 8.



Alcohol and other drug services

1aAdvice provided to the implementation of a South Island withdrawal management plan including the new Substance Addiction Legislation (SAL)

Q1,2,3,4

1b Support the identification of Māori and Pacific population concerns Q2,4

1c Workforce Development needs identified and supported Q2,4

Youth Forensic 2Youth Hub and Spoke model evaluation and reporting to determine effectiveness of plan.

Q2,4

Workforce

3aContinue the engagement started with the South Island Mental Health and Addiction Workforce Development plan in 2016/2017

Q1,2,3,4

3bContinue to maintain and strengthen the Education and Training group.

Q1,2,3,4

3cEstablish and support the South Island Mental Health and Addiction Workforce Planning Work group

Q1,2,3,4

People with high & complex needs

4aIntellectual disability and mental health: support development of workforce for patients with Intellectual Disability and mental health issues

Q4

4bForensic Services: A gap analysis of the barriers to the transition between inpatient forensic services to community based services

Q2,4

People with low prevalence disorders

5Develop a plan to support the physical health of people with low prevalence disorders

Q4

Adult forensic services

6Prison screening data provided (Prison screening occurs within agreed timeframes with 80% of prisoners referred seen within 7 days of receipt of referral)

Q1,2,3,4

Suicide prevention planning and actions

7aFormation of working group/expert panel to provide advice and strategic planning

Q1,2,3,4

7bMāori and Pacific concerns are addressed as part of the work of the expert panel

Q2,4

KEY PROGRESS IN QUARTER 3New Substance Addiction Legislation - Substance Addiction Compulsory Assessment and Treatment Act (SACAT)

1A regional advisory group of key stakeholders continues to work closely with MoH and Matua Raki on the requirements of the new legislation

People with high & complex needs

4b

The forensics transition workgroup has started late in the workplan year so will work through 17/18 and 18/19, seeking to complete a gap analysis this year and make recommendations next year. MHASLA have endorsed this approach and the ToR for the workgroup.

People with low prevalence disorders

5Equally Well is the approach MHASLA have agreed to take to supporting the physical health of people with low prevalence disorders.

Suicide Prevention

7

Suicide prevention is a DHB annual planning item. Dr Evan Mason (SDHB) has joined the SLA and has agreed to lead a further piece of work commencing with a discussion with DHB Suicide Prevention Co-ordinators.MHASLA has also been in touch with GMs Maori (Te Herenga Hauora) about informing this work. Te Herenga Hauora have agreed to offer a date to discuss the item in the new year.

MONITORING / BUSINESS AS USUAL ACTIVITYAdult Forensic Services

690% (Nov), 74% (Dec) and 60% (Jan) of prisoners referred in CDHB were seen within 14 days of receipt of referral. More than 80% of prisoners referred in SDHB were seen within 7 days of receipt of referral.


MENTAL HEALTH & ADDICTIONS SLA

CHALLENGESWorkforce

3

This item remains as flagged in the 17/18 Q2 report. The SI MHA Workforce Development Plan has been drafted and includes 50+ actions on developing new “whole of systems” regional strategies and activities to build capacity and capability in:1. Leadership2. Cultural Fluency3. Models of Care4. Integration between Primary, Community/NGO and DHB/Specialist Workforces5. Inter-service and Across Service Collaboration6. Recruitment, Retention and Scope of Practice7. Education & Training8. Addiction Specific Workforce9. Family Safety and Wellbeing

The plan reflects the strategies that will need to be developed in line with the new national Health Workforce NZ plan. Workforce Development resource will be required to pursue this new work. This resource was previously provided by the Health Workforce NZ Regional Workforce Development Lead role provided via Te Pou, the national workforce centre. HWNZ has disestablished the role. MHASLA have met with HWNZ to emphasise the need to resource the new plan and MHASLA Chair has written to HWNZ, Te Pou and the other workforce centres highlighting this requirement. The Principal Adviser at HWNZ replied on 4th April to the Chair that the HWNZ Board would advise on funding for the Regional Workforce Development Roles when the 18/19 budget has been reviewed.



Strengthening dementia pathways

1aEnsure people with dementia and their families and whānau are valued partners in an integrated health and social support system that supports wellbeing and have control over their circumstances

Q2,4

1bProvide DHBs with on-going support and overview so that DHBs identify and strengthen components of dementia care pathways within the parameters of the New Zealand Framework for Dementia Care

Q2,4

1cSupport interventions which seek to minimise disparities between Māori and non-Māori in relation to the timely assessment and diagnosis of dementia and subsequent care planning

Q2,4

1dSupport South Island DHB’s with the implementation of the South Island Dementia Model of Care

Q2,4

2Improve the quality and consistency of dementia education and support programmes in operation to support family/whanau carers (e.g., Living Well with Dementia) and people living with dementia.

Q2,4

3Continue to expand Walking in Another’s Shoes programme to foster Person Centred Dementia Care across the health continuum including different levels of staff and management

Q1,4

4

Promote the concept of ‘Think delirium’ across South Island DHBs with regard to delirium prevention.Encourage the development of delirium pathways in all South Island DHBs to assist in the prevention, assessment and management of delirium across the care continuum and create consistencies in care.

Q1,2,3,4

interRAI

5aPromote South Island health professions to use the information from comprehensive clinical assessment (interRAI) proactively in plan of care and in service planning/ development.

Q1,2,3,4

5bMonitor interRAI reports to identify trends including any trends or differences that may exist between Māori and non- MāoriAnalyse specific areas of the data from all South Islands DHBs

Q1,2,3,4

Advance Care Planning

6Support DHBs to develop ACP system implementation with processes to embed ACP as standard practice for those who will benefit

Q2,4

7ACP L1A and L 2 Training is available in a planned manner for staff in each DHB district in South Island (subject to resources)

Q1,2,3,4

8

Support South Island DHBs to participate and support National Conversations that Count Day (CtC). CtC education (Peer education for the public delivered ‘by the public’) is available in each South Island DHB (as resources are available)

Q1,3

Restorative Model of Care

9

Older people will be supported to set and achieve goals by a co-ordinated and responsive health and disability support service that also enables them to maintain their social connections with community life.

Q2,4

Workforce 10

Work with HWNZ and DHBSS to develop a sustainable mechanism for collecting a minimum workforce data set on the health workforce working in health of older people outside the DHB provider arm by 30 June 2018

Q4

KEY PROGRESS IN QUARTER 3Dementia

1-4

SI regional collaboration and discussion meeting held 8 March 2018 to progress the NZ Dementia Framework and encourage uptake of SI Dementia Model of Care – ‘Dementia is Everybody’s Business’. All DHBs are looking at how to ‘define’ the navigation role – who does this when and how the person (and the health team) knows who it is. Plans are being made for Dr Matthew Croucher to visit each DHB in Q4 to champion the uptake and progress of items 1 – 3.A Delirium tool was finalised and shared for use in SI facilities during the week of World Delirium Day (14 March 2018). HOPSLA is still evaluating the uptake.

interRAI

5a-b

A South Island Videoconference presentation was held 8 February 2018 to hear the findings of the Summer Student Analysis – Topic: ‘Factors associated with loneliness and social isolation amongst adults aged 50-74. interRAI infographics are reviewed and shared each quarter – whilst the information is useful, as yet there are no trends.

Advance Care Planning

6-8

SI ACP Implementation Ideas workshop was held 6 March 2018. The quarterly SI ACP Steering group discussion was held 4 April – the Steering Group is grappling with how best to assure similar systems and processes across the SI with the Electronic ACP system. The SI Electronic ACP format is nearing completion – set for a late May 2018 release.


HEALTH OF OLDER PEOPLE SLA


Information technology and services

1a

To inform and influence the development of information systems within the South Island that will deliver a more efficient and safer transfer of patient information between Palliative Care Providers (including Hospice services) across the SI while reducing costs and risk

Q4

1bFollowing the completion and evaluation of the current pilot, support the development and the roll out of Palliative Care interRAI across the South Island

Q3

Hospice and Hospital palliative care services

2a

Use the information from Hospital and Hospice Surveys and the evaluation of palliative care in primary care (PHOs ARC and P&F) to promote regional consistency and access to resources. Inform and influence South Island DHBs so services are aligned to the Resource and Capability Framework for Adult Palliative Care and the work of the National Adult Palliative Care Review

Q4

2bWorking within the National Paediatric Palliative care Guidelines: provide high level guidance within the South Island to those providing Paediatric palliative care

Q4

Primary and community care

3a

Based on the survey findings and best practice, develop and support the model of care that reflects the integration of specialist, secondary and primary care into a seamless palliative care service in the South Island.

Q4

3bPartner with St John to understand how palliative and end of life care is provided and how it can be improved

Q4

3cExplore and understand how Palliative Care is delivered by Maori organisations and other ethnic minority providers

Q3

3dExplore opportunities to provide guidance on the substantive competencies for allied health professionals undertaking education in palliative care in South Island.

Q3

Networking and engagement

4

Through benchmarking against the data collected through VOICES, which includes communication with Consumers and Maori on their experience of End of life; determine what and where improvements are called for and use this information to improve performance in the delivery of palliative care in the South Island

Q4

KEY PROGRESS IN QUARTER 3Palliative Care surveys

2a, 3a

An overarching paper has been drafted drawing together then findings of the Primary Care including ARC, PHOs and DHB Planning and Funding, Hospital and Hospice surveys. Collectively these surveys provide a unique view of palliative care service across the system. The Workstream is consulting with SPaIT with a view to releasing the reports and findings and engaging with South Island Services to develop next steps to address the findings. The PCW look forward to sharing the complete report with the Palliative Care sector in the near future.

Network and engagement

4

VOICES contract with University of Canterbury has been extended for 12 months. Extension required due to challenges with ethics approval and obtaining death data. Now using NoticeMatch data. Questionnaires have been posted to all regions other than Canterbury. Some questionnaires have been completed and returned.

CHALLENGES

Allied Health – Palliative Care

3d

An Allied health project lead is still to be found to lead the project on preparation, education and support for Allied Health while delivering Palliative Care in non-specialist areas (expected the role would be 2 hours per week to lead for a fixed period). SI DAHs have looked to their DHBs for nominations, but no suitable person has been identified so far. Compounding the challenge, the PCW Allied Health member has resigned due to capacity issues. The Workstream will continue to work with SI DAHs and SI Workforce Development Hub to find a way forward.

4


PALLIATIVE CARE WORKSTREAM


South Island Model of Care

1aSouth Island Cardiac Model agreed and implemented consistently in the region (within resources available)

Q2,4

1bSouth Island Alliance Leadership Team approves the recommendations of the model of care project group.

Q2

1cRecommendations adopted by the cardiac workstream and specific project groups established

Q2

1d Implementation of change evidenced by audit Q4

2Access to tests: all South Island DHBs recording and storing ECGs on common repository

Q2,4

3aOptimal HealthPathways: STEMI Pathway in conjunction with St John implemented

Q2

3bOptimal HealthPathways: Common Accelerated Chest Pain pathway implemented in South Island hospitals

Q2

3cOptimal HealthPathways: review and audit Acute Chest Pain Pathways in Emergency Departments

Q4

Equity of access 4

Monitor access rates for high risk population groups. Prepare reports at Q2 and Q4 from ANZACS QI data to show intervention rates for Maori, Pacific and Asian people to help identify and address any issues.

Q2,4

Meeting national indicators

5Support South Island DHBs to address any challenges that arise with providing appropriate cardiac care and meeting standardised intervention rates

Q1,2,3,4

6Support South Island DHBs in the continued achievement of national indicators around equity of access

Q1,2,3,4

Heart failure 7Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure (within available resources)

Q4

Workforce training

8Implement recommendations formed in conjunction with National Network (subject to resource constraints)

Q4

Transporting cardiac patients

9Guidelines for transporting cardiac patients agreed in 2013 and updated 2015/16 are consistent for the South Island

Q4

KEY PROGRESS IN QUARTER 3South Island Model of Care

1

A workplan to address sustainable cardiac services for the South Island is being drafted and will be the responsibility of the SI workstream to implement. Progress on this has been slow as it is critical that we reach agreement across the region. It is expected the workplan will be finalised in Q4, with a view to beginning implementation in Q1 18/19.

The plan is focussed on three main areas of delivery, being:

Delivery areas ‘preparing for increasing demand’ and ‘managing people and the community’ will include actions and responsibilities for data, pathways, transport, tests, workforce, emerging technology, supporting national initiatives and primary/secondary/tertiary interaction.

The Workstream, with the support of South Island CEOs, agree that a crucial step to service quality improvement will be establishing a Governance and Audit structure in DHBs and that the NMDHB approach will be looked to for guidance in this area.

The workstream has identified that representation from the Urban Primary Care sector will be required to assist with confirming and implementing the plan.


Service quality improvementPreparing for increasing demandManaging people and the community

CARDIAC SERVICES WORKSTREAM

STEMI Pathway

3a

To ensure the implementation of the National STEMI Pathway in the South Island Region, final agreement needs to be confirmed on the proposed boundaries for STEMI coordination/PCI catchments and the potential 0800 number. It is intended to complete this requirement at the SI Workstream’s May meeting. In support of the STEMI Pathway, St John has developed a business case for the funding of pre-hospital fibrinolytic kits and will present this business case to the DHB GMs planning and funding and COOs in May. This is slightly delayed but still making good progress.

ACCP Pathway

3c

Representatives of the rural sector have met with Martin Than’s team and shared the pathway worked up by Rory Miller in Thames who will keep working on this with Martin. Consensus was it’s the best interim solution until POC hsTn assays become available.

MONITORING / BUSINESS AS USUAL ACTIVITYMeeting national indicators

5/6

Graphs are attached to show that the region continues to perform very well against ACS targets.Tables showing Standard Intervention Rates of the region’s performance in angiography, angioplasty and cardiac surgery; and surgery volumes and wait lists, are attached to show the region’s performance.

CHALLENGESSouth Island Model of Care

1b,c

Progress has been slow due to the need to ensure agreement on a model that is well accepted and feasible to implement across the region. Although the slow progress is frustrating, this will result in a better, more sustainable outcome.

2

Some progress has been made with the regional ECG repository project, including completing test transmitting of ECGs from St John ambulances to EDs. However, the project is currently all but stalled because of a lack of resource allocation from the CDHB IS Group as staff are assigned to other priorities. Discussions are being held at appropriate levels to address this.


Cardiology and Cardiothoracic Procedures: Intervention rates per 10,000 to 31 December 2017. Posted on MoH Quickr site April 2018

Nelson Marlborough

West Coast Canterbury South Canterbury

Southern

Angiography

National Intervention Target Rate per 10,000

34.06 34.06 34.06 34.06 34.06

Standardised Intervention Rate per 10,000

30.22 31.58 35.88 27.85 36.37

Expected discharges

652 150 1774 264 1145

Actual discharges 578 139 1868 216 1223

Variance from National target

Significantly below

Not Significantly different


Significantly below


Angioplasty


12.69 12.69 12.69 12.69 12.69


9.04 13.40 13.18 10.74 13.03

Expected discharges

247 57 677 100 435



Significantly below





Cardiac surgery


5.78 5.78 5.78 5.78 5.78


5.17 5.31 5.37 5.27 7.92

Expected discharges

108 25 293 44 190



Significantly below


Significantly below


Significantly above

DHB ranked out of 20Region ranked out of 71 is highest ranking

Ranked for Angiography Ranked for Angioplasty Ranked for Cardiac Surgery

Nelson Marlborough 13 20 15

West Coast 10 4 12

Canterbury 7 6 11

South Canterbury 19 16 13

Southern 6 7 1

South Island excl NM 1 3 1

South Island incl NM 3 5 2



Improve equity of access to elective services

1aImprove equity of access, system quality and practice in selected elective service areas through the establishment of project, team and methodology

Q1,2,3,4

1b

Identify baseline for Māori access (current and evidence) in selected priority areas Including access to primary care, and referrals into services.When collecting health data, this will be recorded separately by Māori & non Māori

Q1,2,3,4

1cCollate and share innovations in the selected service areas via best practice documents and use of HealthPathways

Q1,2,3,4

2Support South Island DHB management of regional electives volumes including the longer term approach to electives across the South Island that maximises resources

Q1,2,3,4

Bariatric surgery 3Support management of South Island Bariatric Surgery Service by CDHB with the introduction of an independent Chair

Q4

Plastic Surgery 4Implement agreed process to access Plastic surgery for post bariatric patients

Q2,4

Vascular Services

5Implement the nationally agreed Vascular Services model of care in the South Island

Q2,4

Eye Health Services

6a Develop sustainable Model(s) of Eye Health Care for the South Island Q2

6b Complete model(s) of care and agree implementation process Q3

6cRecommend a transition pathway, including resource implications, to achieve the desired model(s).

Q4

Maxillofacial Services

7 Agree a sustainable South Island plan for Maxillofacial Services Q1,3

Otolaryngology 8 Agree a sustainable South Island plan for ENT Services Q1,3

Orthopaedic Services

9 Agree a sustainable South Island plan for Orthopaedic Services Q1,3

Colonoscopy / bowel screening

10Support South Island DHBs to meet Colonoscopy Waiting Times Indicators

Q2,4

11South Island planning to support Bowel Screening Regional Centre development and implementation and Tranche 2 & 3 rollout schedule

Q1,2,3,4

Urology 12 Consistent Urology follow-up and surveillance processes Q4

KEY PROGRESS IN QUARTER 3Eye Health

6

Eye Health faces increases in demand and SI DHBs have been working on service improvement plans funded by the MOH. The SI project has complemented this work, and the RANZCO work to develop AMD and Glaucoma guidelines. It has been useful to share information about what each DHB is doing, otherwise DHBs are internally focused and may not think about new ways of working which are proving successful in other DHBs and which may be transferrable or adaptable. Rather than regular meetings, and the formal development of sustainable models of Eye Health for the SI, the project agreed to trial a 2 pronged approach: Email updates of service developments; Annual meeting to showcase developments

Oral Maxillofacial

7

SI Oral Maxillofacial services are a small sub-speciality, and vulnerable to changes in volume and personnel, especially unplanned or un-notified changes. Workforce and changing service demand are the two most pressing service issues e.g. anticipated retirements at 3 sites in next 12-18 months; trauma and cancer cases are driving demand, and both have treatment timeframe pressures. The project is considering options to sustainably address these service issues.

Otolaryngology

8

This work was discontinued November 2017, by consensus. SI services are still perceived to be small and vulnerable, and subject to increased complexity e.g. head and neck cancers but there was insufficient momentum to continue the project once the critical vulnerability of the SCDHB and SDHB (Southland) services had passed. The project team encouraged SDHB and CDHB to work together to prepare for changes in Southland service.Issues to consider for future projects:

Proactive planning together as a SI health system network to ensure sustainable services in small, sub-specialist areas, and avoiding planning in the heat of a crisis would be highly desirable

HealthPathway development would be most efficient if it was SI wide, and locally published.

Orthopaedic9 This project has not progressed due to lack of DHB resource to engage.

Colonoscopy/Bowel Screening10 The SI Clinical Leads group continues to meet 6 weekly to support DHBs meeting


ELECTIVE SERVICES WORKSTREAM

indicators. DHBs have faced sustained symptomatic referral pressures, acknowledged by the MOH, and perhaps driven by the impending bowel screening programme rollout.

11

The SI Clinical Leads group has assisted SI planning. The SI BSRC has been established within SDHB with appointment of the programme manager who is attending steering group meetings in NMDHB, SCDHB, SDHB and will take over administration for the SI Clinical Leads Group. Recruitment for the primary and secondary clinical leads is about to commence. A draft SI Equity Plan discussion document has been developed.

MONITORING / BUSINESS AS USUAL ACTIVITYBariatric Surgery

3

Bariatric Surgery: CDHB manage the service with support of revamped Multi-Disciplinary Selection Committee after discontinuation of Steering Group. The service continues to be overseen by, and reported to, joint group comprising GMs Planning & Funding, Hospital GMs and Chief Medical Officers.

CHALLENGESOverarching challenges

The challenge is engaging SI DHBs working in vulnerable service areas to integrate a SI approach when looking at recruitment or innovative ways to deliver services. The combined GMs Planning & Funding, Hospital GMs and Chief Medical Officers’ group is crucial to leading this approach.



South Island Major Trauma Plan

1South Island Major Trauma regional plan is reviewed and updated: South Island region focuses on implementation of local and regional trauma systems

Q2,4

NZ Major Trauma Minimum Dataset

2a

South Island data collection and input into national major trauma registry no more than 30 days after patient discharge.Achievement of quality improvement markers as defined by the National Major Trauma Clinical Network

Q1,2,3,4

2bSouth Island ethnicity and rurality data by site is known including patient outcomes

Q1,2,3,4

Clinical leadership

3Responsibilities identified and assigned for Clinical lead and coordinator roles in each DHB

Q1

4 Trauma committees established in each DHB Q2

5Clinical leaders agree to and follow guidelines and inter-hospital transfer processes

Q1,2,3,4

Destination policies

6Implement Regional Destination Policies in collaboration with DHBs, Ambulance and Air Transport providers

Q2

KEY PROGRESS IN QUARTER 3South Island Major Trauma Plan

1

The South Island region features in the National Trauma Network’s 2016/17 Annual Report as reporting a full major trauma dataset and thereby contributing to the gathering of national knowledge and trends.

NZ Major Trauma Minimum Dataset

2b

Discussions are being held with Midland regarding access to more detailed data. At this stage, the completeness and accuracy of the limited amount of data cannot give meaningful information or indicate any trends but processes are being discussed to allow this in the future.

Trauma Committees4 All but one DHB have active Trauma Committees.

Destination policies

6

The St John trauma destination policy has been update and redistributed. DHBs are in agreement but staging points in some rural areas are not always clear and discussion will be held with St John regarding maps to help define these, similar to the STEMI pathways.

MONITORING / BUSINESS AS USUAL ACTIVITYNZ Major Trauma Minimum Dataset

2a

See the two reports below: DHB report 30 day target report 030418 Major trauma volumes for Q3

The South Island region features in the National Trauma Network’s 2016/17 Annual Report as reporting a full major trauma dataset and thereby contributing to the gathering of national knowledge and trends.

CHALLENGESClinical Leadership

3

Enthusiasm shown for improving all aspects of trauma care is not matched by DHBs allocation of resources. Those responsible for gathering and recording data are overloaded. Options are being considered for the input of all SI data at one or two sites involving administration staff which will allow Trauma Nurse Coordinators to focus on more clinical work.


MAJOR TRAUMA WORKSTREAM

Major Trauma 30 Day target report:Patients discharged 1 Nov- 31 Dec 2017

Data qualifications:Includes all patients with ISS* > 12.Does not include patients who died† (any ISS)Region indicates region of Arrival Facility for all individual admissions in that region (data are not by entry person/entry Facility but for every admission by facility of arrival within each region). Days from discharge to record closure were computed for each individual admission and compared with the 30-day target.

For patients discharged 1 Nov, 2017 – 31 Dec, 2017:

Region DHB % Target metNorthern Auckland 33.3%

Counties Manukau 4.0%Northland 89.5%Waitemata 0.0%All 35.3%

Midland Bay of Plenty 22.2%Lakes 75.0%Tairāwhiti 0.0%Taranaki 58.3%Waikato 19.6%All 31.3%

Central Capital and Coast 91.1%Hawke’s Bay 46.2%Hutt Valley 17.6%Mid-Central 0.0%Wairarapa 66.7%Whanganui 33.0%All 62.8%

South Island Canterbury 100.0%

Nelson Marlborough 64.7%South Canterbury 25.0%Southern 82.6%West Coast 50.0%All 79.8%

ALL All Region/DHBs 52.3%

Notes: Each day the Midland Trauma System interrogates the entire trauma registry database. It compares record status (Open or closed) for that day to the record status for the previous day and logs any change in status. A date/time stamp is also applied to that change in record status. While a record may be re-opened at some time in the future, only the first change from an open to a closed status is retained and used for purposes of this report.

*ISS – Injury Severity Score (at admission level).

†Where a patient dies, Coroner’s reports are required before records can be closed, it may take several months before these are received.

Prepared by A. Smith, Midland Trauma SystemReport date: 29/03/2018 07:31


Monthly major trauma event volume report for rolling 12-month period Prepared for Major Trauma National Clinical Network – April 2018

Indicative and not confirmed. Not for wider distribution but to show that the South Island Region is now contributing significant numbers to the National Registry

Monthly Trauma Event Volume Report: ISS > 12. NB: excludes deaths where ISS < 13.

Northern Midland Central South Island

Gra

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Month Auc

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Mid

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Sta

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Wha

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Wai

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Taur

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Rot

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Tara

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Wha

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Wel

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Haw

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Pal

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N

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Hut

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Wan

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i

Wai

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Chr

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Sou

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nd

Tim

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Dun

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Gre

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Wai

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Nel

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Apr-17 22 21 5 5 22 4 4 1 17 7 5 2 1 26 6 9 157

May-7 27 13 7 3 19 5 1 1 3 12 6 2 3 2 2 21 2 1 5 1 136

Jun-17 28 15 5 2 21 3 1 2 15 3 4 2 2 2 29 1 1 6 1 143

Jul-17 15 16 5 3 17 6 1 6 2 1 18 4 1 5 1 33 4 10 1 4 153

Aug-17 19 9 3 5 22 6 3 2 16 6 4 2 19 1 6 1 2 126

Sep-17 17 7 6 8 27 6 2 3 1 2 16 7 3 1 2 1 27 2 5 1 1 145

Oct-17 15 11 8 7 23 5 4 1 18 8 5 2 2 30 2 1 5 4 151

Nov-17 24 9 2 8 16 4 3 2 1 1 23 4 12 3 1 30 3 11 1 6 164

Dec-17 25 1 2 6 22 10 3 3 2 3 20 10 5 6 4 36 8 1 167

Jan-18 34 1 4 8 23 6 3 14 9 3 3 36 5 11 4 164

Feb-18 14 5 5 3 6 1 2 22 4 3 21 7 2 8 2 1 2 108

Mar-18 11 1 1 2 14 7 5 1 3 9 2 56240 103 63 60 216 62 25 24 11 7 205 75 41 29 10 16 313 33 9 93 7 4 24 1670



Collective Impact

1 Governance: Establishing an engaged cross-sector Public Health SLA Q4

2 Governance: South Island Public Health Strategic Framework developed and agreed Q4

3 Population health reporting: Initial South Island Population Health Report complete Q4

4 PHU infrastructure: Enhanced leadership alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

5 PHU infrastructure: strengthened operational alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

6 Evaluation: Evaluation of the South Island Public Health Partnership’s evolution and the SLA’s development

Q1,2,3,4

7 Communications: Positive profile and support of the PH SLAs work Q1,2,3,4

Māori

8 Promotion of key messages on South Island priority public health issues as they pertain to Māori by Te Herenga Hauora

Q1,2,3,4

9 Selection of a priority public health issue for Māori for a collaborative approach Q1

Environmental sustainability

10Comprehensive current data to inform next steps, including gap analysis and identification of potential useful and cost-saving measures for DHBs to consider

Q3

11

Promote awareness of the policy/position statement once South Island DHB Boards endorse. Utilise DHB Boards endorsement of sustainability to promote awareness and action in DHBs.

Q3,4

Health in all Policies

12

Promote awareness of the position statements once the South Island District Health Boards have endorsed them:

Water fluoridation Air Quality Warm Homes Sugar sweetened beverages Environmental Sustainability

Q2,3,4

13 Undertake new regional approaches/ initiatives to promote healthy eating and active lifestyles as identified in 20116/17.

Q1,2,3,4

14Identify and undertake regional approaches/initiatives re alcohol harm reduction, including contributing a regional population health perspective to the Alcohol Harm Reduction ED Project.

Q1,2,3,4

Rheumatic Fever 15Ongoing monitoring and collective South Island public health response to results

Q1,2,3,4

KEY PROGRESS IN QUARTER 3Collective Impact

1

The inaugural Hauora Alliance Steering Group meeting was held on 27 February. It was agreed to develop a First 1,000 Days project and extend the steering group by inviting nominated TLA and MSD leaders to participate. It was agreed to consult with central social sector agencies to explore funding options and to identify/map the various health and social sector alliances/collaborations active in the South Island. Initial discussions have taken place with Te Pūtahitanga regarding developing the framework by mapping the Te Pae Mahutonga approach to the Sustainable Development Goals.

2The Partnership’s South Island Public Health Strategic Framework was agreed.Limited analyst capacity is impacting on the timeframe, with delivery now expected in August 2018 to inform planning for 2019- 2020.

3The scope of a South Island Population Health Report focussing on the First 1000 Days has been developed, with input from the Hauora Alliance.

4 , 5

A workshop was held on 14 February to consider issues influencing the sustainability of “on call/ after-hours” arrangements for health protection services, with a view to identifying options for a South Island system. Terms of reference for a working group were confirmed with enablers supporting quality after hours service identified for development. Action is underway in relation to these areas, with a working group established and the next workshop planned for 17 May. A South Island template was agreed for PHU APs for 2018-2019. A commitment was made to work together to later review this template and develop a revised SI AP template for 2019-2020.

Health in All Policies

2b

A workshop regarding the actions of the SI PHUs re healthy weight and active lifestyles was held on 28 February. It was agreed to take a regional approach and form a Working Group to achieve this. Active transport, healthy food and Project Energize/WAVE were identified as regional priorities. The Convener will attend the bi-monthly meetings of the Child Health SLA’s Healthy Weight in Childhood Clinical Advisory Group to contribute on behalf of the SI PHUs and strengthen the connection between the groups.


PUBLIC HEALTH PARTNERSHIP

MONITORING / BUSINESS AS USUAL ACTIVITYPublic Health Network

The regional public health network continues to develop via the workgroups and analysts’ network. These groups include the Workforce Development Group, the Alcohol Working Group and the Environmental Sustainability Working Group.

The Programme Facilitator continues to meet regularly with the Child Health SLA facilitator and the National Coordinator of the Public Health Clinical Network regarding planning, progress and the connections between our approaches to mutual issues.

CHALLENGESHealth in all policies

The wide variation in the priority and resources that individual DHBs have allocated to environmental sustainability has resulted in inconsistent survey responses. As a result it has not been possible to complete the project. In mitigation a fresh approach has been developed, which includes an emphasis on regularly including a “green” section in the SIA newsletter to promote environmental sustainability initiatives in SI DHBs and advocacy of the development of a wider SIA approach.



Organisation of Stroke services

1a

People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see PP20 for definitions of a stroke unit and organised stroke services).Support interventions which seek to minimise disparities between Maori and non-Maori

Q1,2,3,4

1bEnsure that existing acute stroke pathway information that is available to primary care is consistent across the South Island.

Q4

Thrombolysis

2aAll people with stroke have access to a quality assured thrombolysis service (24/7)

Q1,2,3,4

2bSouth Island regional centres collaborate with local ambulance services to ensure pre-notification to hospital services

Q2,4

2cA telestroke service for SI DHBs will be scoped for embedding in the South Island within available resources

Q2,4

Regional inter-arterial clot retrieval service

3A regional Intra-arterial clot retrieval service based in CDHB to be scoped for the South Island

Q2,4

Rehabilitation and community stroke services

4a

All eligible people with stroke receive early active rehabilitation services and equitable access to community stroke services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team

Q1,2,3,4

4b

Work collaboratively with Stroke Foundation and Ministry of Health in order to Integrate Primary care at every opportunity including:

– Education– identifying prevention

Review Workstream membership and include primary care professionals

Q1,2,3,4

Workforce

5aDevelop a regional workforce plan that supports the delivery and achievement of high quality stroke care provision

Q2,4

5bCDHB and SIAPO will provide standardised thrombolysis education across the South Island regional centres via videoconference using a hub and spoke model

Q2,4

5cAll members of the interdisciplinary stroke team participate in ongoing education, training (a minimum of 8 hours stroke specific education per year (minimum standard) and service improvement programmes.

Q2,4

Information technology and analysis

6aIdentify actions that the region will take to support improved information management

6bIdentify trends in delivery of acute stroke services, thrombolysis, and rehabilitation services to detect disparity between Maori and non-Maori to inform improved service delivery

KEY PROGRESS IN QUARTER 3Thrombolysis

1a

The South Island is making progress with Lead Stroke Nurse appointments – Invercargill has appointed 0.5 fte and Dunedin is re-advertising a 0.7 fte position. NMDHB is yet to gain approval to release the funding to move forward with advertising a position. The Workstream continue to work with NMDHB on this.

Thrombolysis

2

A project plan is being formalised to make progress with embedding a telestroke service with Christchurch as the ‘hub’ and a network of five ‘spoke’ hospitals (Grey Base, Timaru, Dunedin, Dunstan and Southland). Note NMDHB will continue to link with C&CDHB telestroke service. All SI DHBs are participating in the RedCap Regions Care stroke audit.

Regional intra-arterial clot retrieval service

4a,b

Work is progressing to obtain accurate measures for rehabilitation. AROC has agreed to produce a brief report using AROC data for each DHB and for the SI as a region specifically re stroke outcomes.

MONITORING / BUSINESS AS USUAL ACTIVITYStroke Measures

1,2,4Measures are reviewed each quarter and are included below with no significant trends noted. Service gaps relating to no Lead Stroke Nurse in SDHB & NMDHB are noted, and action is being progressed to address this.


STROKE SERVICES WORKSTREAM

South Island Stroke National Service Measures Q2 2017-18

80% of all stroke patients to be cared for in organised stroke unit (for smaller DHBs with demonstrated stroke pathway as ascertained by lead Stroke Clinician using definition by National Stroke Network).DHB Hospital Numerator Denominator (all

strokes – bleeds, clots & unspecified)

Percent cared for in organised stroke service

SDHB Dunedin 0 12 66 0%Invercargill 0 9 41 0%Dunstan 0 0 14 0%Oamaru 0 5 13 0%

CDHB Christchurch 185 25 186 87.68%Ashburton 0 6 16 0.00%

WCDHB Grey Base 8 2 7 89%

NMDHB Nelson 0 1 13 0.00%Blenheim 0 4 20 0.00%

SCDHB Timaru 25 4 26 83.33%

8 % of acute ischaemic stroke patients thrombolysedDHB Hospital Numerator Denominator

(excludes bleeds)Percentage

thrombolysedSDHB Dunedin 7 66 11%

Invercargill 4 41 10%Dunstan 0 14 0%Oamaru 0 13 0%

CDHB Christchurch 25 186 13.44%Ashburton 0 16 0.00%

WCDHB Grey Base 0 7 0

NMDHB Nelson 5 13 38%Blenheim 5 20 25%

SCDHB Timaru 3 26 11.5%

Proportion of those transferred to rehab- who are transferred within 7 days of acute stroke admission National measure - target 80%DHB Hospital Numerator Denominator Percentage seen

within 7 days

SDHB Dunedin 24 39 62%Invercargill 17 17 100%Dunstan 0 0 0Oamaru 0 0 0

CDHB Christchurch 43 211 20.38%Ashburton 8 22 36.36%

WCDHB Grey Base 3 9 33%

NMDHB Nelson 5 14 35.71%Blenheim 4 24 16.67%


Proportion of those referred to community rehab who are seen face to face within 7 days of inpatient discharge. National measure - target 80%DHB Hospital Numerator Denominator Percentage seen

within 7 days

SDHB Dunedin 0 0 0Invercargill 0 0 0Dunstan 0 0 0Oamaru 0 0 0

CDHB Christchurch 12 82 14.63%Ashburton 0 0 0

WCDHB Grey Base 1 1 100%

NMDHB Nelson 0 0Blenheim 0 0




Serious and adverse events

1 DHBs understand the National Reportable Events policy Q3

2Regional agreement on application of the new reportable events policy

Q4

3 Build regional capability in investigators of SAEs Q4

HQSC Projects4 Regional approach to HQSC Deteriorating Patient programme agreed Q4

5 Collaboration on HQSC Pressure Injury Prevention Programme Q4

Regional policies 6 Identify policies that could be regional policies Q4

Safety 1st

7a Regional South Island DHB Safety 1st reports Q4

7b Support ongoing development and review of Safety 1st Q4

7c Support the Safety 1st Control Group Q4

Tikanga 8 A stocktake of Tikanga in the South Island DHBs Q4

Regional quality improvement

9Explore regional approached to share learnings of improving quality of care

Q4

KEY PROGRESS IN QUARTER 3Reportable Events

2

South Island DHB training on reportable events has been scheduled to commence with a pilot on WCDHB on 20th April 2018.CDHB are also collaborating with HQSC on events to improve patient experience in specific services as a follow up to the ‘always events’ pilot.NMDHB is also responding to the patient experience survey results and designing small-scale interventions to improve communication around medications.

Regional capability in investigators of SAEs3 NMDHB has recruited a new risk manager and IAs are co-ordinating reviews.

SCDHB have seen a structural change in that the CMO has been replaced by a Project Officer for part of the High Performance, High Engagement work now underwayNurse Consultant FTE is now in place in CDHB to address a backlog of reviews. CDHB Quality Team follow-up on recommendations emerging from reviews but the clinical teams retain ownership of the event. There is fortnightly reporting on RCAs to the Executive Team. Other DHBs are considering similar centralised systems.WCDHB have mimicked the Mental Health process for reviews with a weekly

committee meeting with CMO, DoN, and QM determining process from the outset and overseeing throughout. This helps with family contact and approvals and operationalising recommendations.

Deteriorating Patient Project

4

SDHB systems have been revitalised in preparation for the Deteriorating Patient ProgrammeSCDHB have appointed a quality facilitator to the Deteriorating Patient ProgrammeSDHB Deteriorating Patient Programme workshop at Dunedin site scheduled for 16th MarchCDHB have already switched over to the NZ Early Warning Scores and the respiratory team is also developing guidance re oxygenation

Pressure Injury Prevention

5

SDHB Pressure Injury monitoring and testing has received some funding from ACC, SDHB are recruiting to a roleSCDHB pressure injury reporting continues alongside falls.A ‘how to’ guide for future PI data collection was tested with SDHB and will be redrafted by HQSCMore national work is needed on pain measurement

Safety1st

7The Project Manager has completed the report on regional supports and reports. The SIA Coordinator has met with the Quality Managers to discuss future regional supports for Safety1st

Tikanga

8The Quality Managers have been canvassed for information on such activity in their DHB. Brief responses have been received and circulated

MONITORING / BUSINESS AS USUAL ACTIVITY2018/19 Planning

The Deputy CEO of the Health Quality and Safety Commission joined both the November 2017 and February 2018 QSSLA face-to-face meetings. It was agreed a lot of work is underway and the 201819 workplan should seek to consolidate the progress to date rather than embark on new projects.


QUALITY & SAFETY SLA

Future Quality and Safety Measures

Gabrielle Nicholson and Billy Allen of HQSC met with the DHB Quality Managers on 14th Feb to discuss the new QSMs in more detail. Follow-up work on demographics queries and ‘pain score’ Vs ‘comprehensive pain assessment’ is underway. SCDHB opioid work is on hold but discussions have commenced with clinicians

WCDHB numbers are too small for the Opioid QSM and SDHB is seeking to integrate the opioid work as much as possible. Opioids data collection is being streamlined in CDHB who also have two HQSC pilots for the ‘Always’ events and Family/Patient escalation.

More work is needed to clarify how long it will take to carry out the samples for pain assessment

Mental Health and Addictions Quality Improvement InitiativeThe inaugural meeting of the MHA Quality Improvement Network (QIN) was held on 22 February 2018. The primary care network joined the MHA QIN for a session on adverse events. The programme’s first quality improvement national collaborative was launched with a national learning event in Wellington on 7 March. Evidence reviews are almost complete for the MHA QI programme priority areas. These reviews will inform quality improvement initiative development.

Chair of MHASLA sits on the national advisory body for the new HQSC Mental Health and Addictions Quality Improvement Initiative. MHASLA Chair will join the May 2018 meeting to discuss this new initiative.



Strategic Plan 1Complete review and refresh of the South Island Information Services Strategic Plan Q2

eMedicines Programme

2

ePrescribing and Administration (ePA): West Coast DHB ePrescribing and Administration project complete Deliverable removed from 2017/18 workplan due budget & resource constraints. Carried over to subsequent year for delivery.

18/19

3

ePrescribing and Administration (ePA): Nelson Marlborough DHB ePrescribing and Administration project complete for Wairau campus Deliverable removed from 2017/18 workplan due budget & resource constraints. Carried over to subsequent year for delivery.

18/19

4ePharmacy Management (ePM): Implementation of ePharmacy completed across DHBs

Q4 18/19

eReferrals Programme

5Stage 3: Complete South Canterbury DHB eTriage implementation Delivery timeframe amended from Q3 to Q2 2018/19

Q2 18/19

6Stage 3: Complete Southern DHB eTriage implementationDelivery timeframe amended from Q3 to Q4 2018/19

Q4 18/19

7Stage 3: Complete Nelson Marlborough DHB eTriage implementation Delivery timeframe amended from Q3 to Q4 2018/19

Q4 18/19

South Island Patient Information Care System (SIPICS)

8Canterbury DHB: Complete the progressive implementation of SI PICS into other Canterbury DHB sites Q4

9Nelson Marlborough DHB: Project go-live for Nelson Marlborough DHB Q3

10South Canterbury DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

11West Coast DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

12Southern DHB: Commence development of the implementation business case for SI PICS Q4

ED information solution

13 Identify the preferred South Island solution Q2

14Progress business case/implementation planning Deliverable removed from 2017/18 workplan Q4

Regional Service Provider Index

15 Identify the preferred South Island solution Q1

16 Progress business case/implementation planning Q2

17 Commence a phased roll-out Q4

eOrdering of Radiology tests


19Implementation of eOrdering Radiology tests completed for Nelson Marlborough, South Canterbury, West Coast DHBs Q4

20Confirm integration requirements of Southern DHB RIS platform into Regional éClair Clinical data repository Q4

Mental health

21Identify and confirm the preferred South Island approach for delivering the required mental health functionality Q4


23Support SCDHB, WCDHB, NMDHB and SDHB to progress a paper-lite strategy for transitioning paper mental health records into the electronic health record

Q4

Alerts and warnings

24Identify the preferred South Island solution Delivery timeframe amended from Q2 to Q4 due to resource constraints Q4


Clinical workflow 26Scope, agree and commence the implementation of the processes and structures to enable the SI DHBs to create, configure and manage automated clinical workflow

Q4

KEY PROGRESS IN QUARTER 3Strategic Plan

1

The IS SLA continue to work on finalising the revised SI IS strategy that will be used to inform the future direction of travel. The plan has strong linkages to the NZ Digital Health Strategy and the revised South Island Alliance Strategy. As part of reviewing and confirming the IS priorities for the South Island the IS SLA has reviewed its membership and has agreed to expand it to strengthen links with the SI PHOs and bringing on board an independent voice outside of health to assist with preparing the South Island response to the rapidly changing digital environment.


INFORMATION SERVICES SLA

eMedicines

4

ePharmacyThe current phase of the project is to enable the delivery of two detailed Project Definition Reports, 1 for CDHB (NMH, WCDHB) and one for SDHB (SCDHB) through an Implementation Planning Study (IPS) process that will define the approach, timeframe and cost for the transition from WINDOSE to the latest pharmacy software. The respective DHBs will be required to implement a programme structure that will support the transition. Weekly meetings have been scheduled for IS SLA and DXC to define the IPS schedule and required activities. High level regional IPS received. Plan to commence the IPS in early June 2018. Extended support arrangements for WINDOSE are being progressed with DXC, which will ensure support is in place until the DHBs transition onto ePharmacy.

South Island Patient Information Care System (SI PICS)

9

Gateway review completed for NMH. The programme is focused on supporting NMH with go live preparation. Recruitment process is ongoing for the required BAU resources to support SIPICS once NMH has gone live. WCDHB progressing development of Implementation Business Case, supported by the Regional Programme team. Discussions progressing with SCDHB & SDHB regarding sequencing, preparation and readiness for SIPICS implementation.NMH Go-live decision to be made following 12 April, readiness review. Software upgrade on schedule is for an April 1 release. Discussion around sequencing following the 1 April software release to be progressed in Mid-April. Workshop scheduled for April to review foundation design vs software built to date, to define the remaining development required.

Regional Service Provider Index (RSPI)

15-17

The project team, MoH and IBM have been working through the solution design and work breakdown structure that will inform the overall timeframe, resourcing and costs for the South Island Business case. The Indicative Programme financials have been identified for SI. The MoH have submitted a funding request for HPI upgrade. Business case progressing to June timeframe for approval.

eOrdering of Radiology tests

18,19

Hospital Radiology tests: Due diligence completed. IS SLA have confirmed the approach for radiology ordering across the SI hospitals. Negotiations are currently underway for a Radiology Hospital Order licencing framework. Timeframes have been amended accordingly, and so these deliverables have been marked caution.

ED Information Solution

13,14

Due diligence for a South Island ED Information Solutions has now been undertaken by both a clinical ED advisory group and the regional architecture group. It has been agreed, with the support of the IS SLA, that the following interim arrangements will be put in place: CDHB will take a tactical approach and implement a separate instance of EDaaG until such time as the IS SLA define a direction for ED clinical functionality. The interim arrangements reduces the priority of this activity. The

long term future direction will be determined following an evaluation post the CDHB implementation. It is possible that SCDHB & WCDHB could utilise EDaaG if the CDHB implementation is successful. SDHB currently utilise the ED functionality provided within iPM and do not require additional functionality.

Mental Health

21,22,23

Two workshops held in December assessed the RFI submissions, confirmed requirements and the basic underpinning philosophy.These workshops will be used to form the basis for providing direction regarding the next steps for addressing the requirements to deliver Mental Health Clinical Information functionality across the South Island.

To support DHBs to transition to paper-lite in the interim a number of initiatives have been supported. The South Island DHBs have agreed a single instance high-level risk format that will be available in Health Connect South. Additionally the IS SLA have supported the development of HoNOS, ECT and Seclusion forms that will be available for South Island DHBs in Health Connect South. Work is beginning to explore a common care planning process for SI Specialist Mental health services.

MONITORING / BUSINESS AS USUAL ACTIVITYHealth Connect South

South Island Alliance Orion Health Strategic Partnership: The South Island Alliance is currently operating under a letter of intent with Orion Health to deliver against agreed conditions laid out in the South Island Alliance Orion Health Strategic Partnership while contract negotiations are finalised.HCS Reliability: Independent review into improving the reliability of the HCS production environment has been approved by the IS SLA and the HCS host is currently working through implementing the recommendations of the review.

KEY AREAS DELIVERABLESWorkforce planning

1Health workforce data and intelligence is collected to support planning

Q1,2,3,4

2The pipeline for health workforce is aligned with health workforce need

Q1,2,3,4

3 Kaiāwhina workforce: Allied Health Assistants (AHAs) working Q1,2,


SOUTH ISLAND WORKFORCE DEVELOPMENT HUB

across the South Island health system have access to appropriate NZQA level 3 training 3,4

4Kaiāwhina workforce: the Careerforce NZQA Level 4 Health and Wellbeing qualification is included in the AHA development framework

Q4

5Kaiāwhina workforce: Allied Health Assistants (AHAs): An effective delegation model is in place for services where Calderdale Framework (CF) has been implemented

Q4

6An effective skill sharing model is in place for services where Calderdale Framework has been implemented Q4

7Ensure sustainability of workforce redesign model (CF)across South Island Q4

8Inter-disciplinary: A coordinated clinical simulation network for the South Island is established Q4

9Inter-disciplinary: South Island teams participate in the Health Care Challenge Q4

10Allied Health Scientific & Technical: regional clinical/professional leadership frameworks are implemented for smaller Allied Health & Scientific & Technical professions

Q4

11Medicine - new graduates: community based attachments (CBAs)are in place to meet requirements of new Medical Council curriculum

Q3

12Medicine - new graduates: support the DHBs to integrate the increased number of PGY1s (NZ citizens and permanent residents) into the workforce

Q2

13Nursing - new graduates: support the employment & orientation of new graduate nurses Q4

14 Midwifery: clinical leadership is further developed Q4

Priority (vulnerable) workforces

15Sonography: support for the training of Sonographers to meet the identified South Island need Q4

16Rural Health Medicine: the opportunity of a South Island rural health medicine clinical placement programme is explored to support vocational training

Q4

17 Imaging workforce is fit for purpose Q4

Workforce diversity

18 Improved employee ethnicity data collected by South Island DHBs Q4

19Increased Māori DHB clinical workforce, working towards reflecting the South Island population Q4

20Establish a framework for Cultural Competence Education which ensures it is embedded into practice for the non-Māori workforce. Q4

Workforce enablers

21Lippincott Clinical Procedures: the South Island and Midland Regions are working in partnership to develop designing a national Q4

framework for the management of Lippincott New Zealand instance

22Elearning platform: work with Ko Awatea to establish a single platform for NZ

Q2,3,4

23Elearning packages: an increased number of eLearning packages are available to the South Island health workforce which can be shared nationally

Q1,2

KEY PROGRESS IN QUARTER 3Rural Hospital Medicine (RHM) Training

16Very positive meetings have been held with the RNZCGGP and RDA supporting the organisation of a regional training programme for RHM trainees.

Māori Workforce

20

Pilot of Takarangi (cultural) Competency Framework has commenced on the West Coast. The second cohort commenced in March 2018. Feedback to date has been very positive in terms of staff, who have undertaken the training, demonstrating increased competence and confidence in working with Māori.

eLearning

22

There is a national working group developing a paper with recommendations for consideration by the national clinical leadership groups (DoNs, DAHs, CMOs) and GMs HR/P&C. A final draft of this paper will be circulated in April for consultation and feedback.

Nurse PrescribingA South Island regional approach to nurse prescribing has been agreed, this is a new piece of work. A policy and framework for implementation across the sector has been agreed. Currently there are 12 RN Prescribers with a further 17 on the RN Prescriber pathway.


· web viewa delirium tool was finalised and shared for use in si facilities during the week of...

Documents