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West Coast District Health Board Te Poari Hauora a Rohe o Tai Poutini

BOARD MEETING 4 MARCH 2005

AGENDA

AND MEETING PAPERS

TABLE OF CONTENTS

TABLE OF CONTENTS 1

AGENDA 3

BOARD MEMBERS’ DISCLOSURES OF INTERESTS 5

ABBREVIATIONS 7

DRAFT MINUTES OF THE WEST COAST DISTRICT HEALTH BOARD MEETING HELD FRIDAY 28 JANUARY 2005 10

CHAIRMAN’S REPORT 23

CHAIRMAN’S CORRESPONDENCE FOR FEBRUARY 2005 24

CHIEF EXECUTIVE’S REPORT 25

FINANCE REPORT 29

WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEETINGS 43

DRAFT MINUTES HOSPITAL ADVISORY COMMITTEE MEETING 44

DRAFT MINUTES OF THE DISABILITY SERVICES ADVISORY COMMITTEE MEETING 51

ADVISORY COMMITTEE MEMBERSHIP 55

PRIMARY MENTAL HEALTH STRATEGIC PLAN 58

KARAKIA 60

INFORMATION PAPERS 61

ADVISORY COMMITTEE MEMBERS’ TERMS OF APPOINTMENT 62

WCDHB Meeting Papers 4 March 2005 Page 1

AGENDA

FOR THE WEST COAST DISTRICT HEALTH BOARD MEETING TO BE HELD IN THE BOARD ROOM, CORPORATE OFFICE,

GREYMOUTH ON FRIDAY 4 MARCH 2005 COMMENCING 9:15 AM

Karakia

1. Welcome

2. Apologies

3. Standing Orders

4. Disclosures of Interests

5. Minutes of the Meeting held Friday 28 January 2005

6 Matters Arising

7 Board Correspondence

8. Chairman’s Report

9. Chairman’s Correspondence

10. Chief Executive’s Report

11. Finance Report

12. Reports from Board Advisory Committees

13. Advisory Committee Membership

14. Primary Mental Health Strategic Plan

15. Date of Next Meeting

16. Information Papers IN COMMITTEE • Minutes of the Meeting held Friday 28 January 2004

• Matters Arising • Board Member Items • Crown Financing Agency Loan Renewal • Capital Charge • DSS Funding • Primary Practice • WCDHB/CDHB Partnership Agreement • Capex

- Grey Base Hospital Elevator Services • Contracts

- Coast Care Trust - Clinical Training Agency

• Implementation of 2004/05 District Annual Plan • 2005/06 District Annual Plan • District Strategic Plan • Risk Register

OIA 1982 5.9(2)(i) Commercial NZPHDA Sch 3 cl 32(a)

• RACS Report Update OIA 1982 5.9(2)(g)ii Personal Information NZPHDA Sch 3 cl 32(a)


BOARD MEMBERS’ DISCLOSURES OF INTERESTS

Member Disclosure of Interest Professor Gregor Coster Chairman

• Director - PHARMAC • Director - Cornwall Management Limited • Director - Cornwall Nominees Limited • Chairman - New Zealand Institute of Rural Health

Dr Christine Robertson Deputy Chairman

As self employed person, does work on contract for: • HealthPAC - regularly • Comcare Charitable Trust - regularly • WCDHB - occasionally • HDANZ (Health and Disability Auditing New Zealand Ltd) –

occasionally Husband is Deputy Chair of the Board of Coast Care Trust and is a Justice of the Peace who undertakes judicial duties in Court. Also Alternate Controller for Civil Defence for the Grey District Council

Ms Robyne Bryant • Member - New Zealand Nurses Organisation • Member - New Zealand College of Midwives • Member - Mawhera Maori Women’s Welfare League • Employed by Coast Health Care as a Maori Mental Health

Worker • Trustee - Board of Coast Care Trust • Member - PSA

Mrs Julie Kilkelly • Member - Pharmaceutical Society • Member - New Zealand College of Pharmacists • Member - Pharmacy Defence Association • Director - Kilkelly Kartage Ltd • Trustee - West Coast PHO Board – Co-opted Pharmacist • Director - Olsen’s Pharmacy (since 2002)

Mr Mohammed Shahadat • Member - New Zealand Law Society • President - Hokitika Lions Club 2001-2002 • Principal Partner - Murdoch James and Roper

Dr Malcolm Stuart • Employed by WCDHB as Head of Department, Anaesthesia and Consultant Anaesthetist

• National Committee - Australian New Zealand College of Anaesthetists

• Member - Association of Salaried Medical Staff As a self employed person: • Medical Advisor - St John Ambulance Service

Mr John Vaile • Director - Vaile Hardware Ltd • Wife no longer employed by WCDHB but retains an interest in

an unresolved employment matter


Dr Carol Atmore • Contracted by WCDHB and South Link Health as GP Liaison Officer

• Member - South Link Health • General Practitioner - employed by Dr Mark McLaughlin • Decision Support Software Editor - Enigma Publishing

(Auckland based)

Mr Brian Wilkinson • Registered Pharmaceutical Chemist • Justice of the Peace

Mrs Glenys Baldick • Chairman - Health Sector Welfare Society • Chairman - Junior Doctors’ Round Table • Trustee - Nelson Hospital Equipment Trust


ABBREVIATIONS

# NOF Fractured Neck of Femur (broken hip) 1° Primary 2° Secondary 3° Tertiary A+ Auckland Healthcare A&E Accident & Emergency ASMS Association of Salaried Medical Specialists AT&R Assessment, Treatment & Rehabilitation Unit ALOS Average Length of Stay ANDRG Australian National Diagnosis Related Group BDC Buller District Council CAA Child Acute Assessment CAMHS Child & Adolescent Mental Health Service CAP Canterbury Association of Physicians CC Complications & Co-morbidity CCMAU Crown Companies Monitoring Unit CCN Clinical Charge Nurse CD Clinical Director CDHB Canterbury DHB CEA Collective Employment Agreement CFA Crown Funding Agreement CHA Crown Health Association CHL Canterbury Health Limited CICU Cardiac Intensive Care Unit COMRAD Radiology Reporting System CPAC Clinical Priority Assessment Criteria CPHAC Community & Public Health Advisory Committee CSSD Central Sterile Supplies Department CTA Clinical Training Agency CWD Case Weighted Discharge DAO Duly Authorised Officer DDG Deputy Director General DHB District Health Board DNA Did Not Attend DON Director of Nursing DOSA Day Of Surgery Admission DRG Diagnostic Related Grouping DSAC Disability Services Advisory Committee DSD Disability Support Directorate DSS Disability Support Services EAP Employee Assistance Programme ED Emergency Department EMT Executive Management Team ENT Ear, Nose and Throat ER Employment Relations FSA First Specialist Assessment GP General Practitioner HAC Hospital Advisory Committee HFA Health Funding Authority


IEA Individual Employment Agreement IRF Inter Regional Flow HAHS Hospital and Health Services HMD Hospital Monitoring Directorate (former CCMAU) HFA Health Funding Authority HHS Hospital & Health Service HR Human Resources HTG Hospital Technical Group ICD 9 International Code of Diseases ICU Intensive Care Unit IEC Individual Employment Contract IPA Independent Practice Association (GP Group) ISDN Integrated Services Digital Network IT Information Technology Kai Arahi Term generally refers to “guide” and /or advisor KPI’s Key Performance Indicators LMC Lead Maternity Carer MECA Multi Employer Collective Agreement MHAC Mental Health Advisory Committee MOH Ministry of Health MOSS Medical Officer Special Scale. A doctor with 4+ years post-graduate experience but not a

specialist MRT Medical Radiation Technologist NMDHB Nelson/Marlborough DHB NGO Non Government Organisation NICU Neonatal Intensive Care Unit NZNO New Zealand Nurses Organisation OP Outpatients O&G Obstetrician and Gynaecologist OIA Official Information Act PBFF Population Based Funding Formula PCG Project Control Group Pegasus One of the IPA’s PHO Primary Health Organisation PMS Patient Management System Primary Services Services that receive self referred patients PRIME Primary Response in Medical Emergencies PNA Professional Nursing Advisor PSA Public Services Association QA Quality Assurance QHNZ Quality Health New Zealand RDA Resident Doctors Association RFP Request for Proposal RHA Regional Health Authority RHMU Residual Health Management Unit RMO Registered Medical Officer. A junior doctor with 0-4 years post-graduate experience Runaka Assembly Secondary Services Services where a primary carer must refer patients. Provided in a hospital supported by

specialists, and meeting standard clinical criteria SHO Senior House Officer SMT Senior Management Team SOI Statement of Intent Stargarden Payroll System Tamariki Children – usually refers to children up to and including 14 years of age Tangata Whenua People of the land”, most commonly referring to traditional Maori Iwi occupants of a region or

district Tino Rangatiratanga Absolute Sovereignty


STD Sexually Transmitted Diseases WTF Waiting Times Fund Ora Services Term used to describe all activities that promote health and prevent diseases that are

undertaken in the primary care setting for children and their families and whanau WCDHB West Coast DHB Whanau Family Whanau Ora Health and wellbeing YTD Year to Date


DRAFT MINUTES OF THE WEST COAST DISTRICT HEALTH BOARD MEETING HELD FRIDAY 28 JANUARY 2005 AT 11:03AM IN THE BOARDROOM, CORPORATE

OFFICE, GREYMOUTH

PRESENT Gregor Coster, Chairman

Christine Robertson, Deputy Chair Glenys Baldick Brian Wilkinson John Vaile Julie Kilkelly Carol Atmore Robyne Bryant Malcolm Stuart Mohammed Shahadat

IN ATTENDANCE John Luhrs, Chief Executive Ebel Kremer, General Manager Operations Wayne Champion, Chief Financial Manager Vikki Carter, Community Liaison Officer Alison McDougall, Minute Secretary

APOLOGIES Nil Karakia – Robyne Bryant

1. APOLOGIES, WELCOME

The Chairman welcomed everyone to the meeting. No apologies were received.

2. STANDING ORDERS

The Chairman waived the Standing Orders unless there is reason to reinstate them later in the meeting.

3. DISCLOSURES OF INTERESTS

The following amendments were made to Board Members’ disclosures of interest:

Gregor Coster


• Amend, “Chairman - New Zealand Institute of Rural Health” • Remove, “Trustee – Goodfellow Foundation” Carol Atmore • Add, “Decision Support Software Editor - Enigma Publishing (Auckland based)” Glenys Baldick • Add, “Trustee - Nelson Hospital Equipment Trust”

4. MINUTES OF THE PREVIOUS BOARD MEETING HELD 17 DECEMBER 2004

• Page 12, Item 11.4, replace “oncology brochure” with “palliative care communications booklet“

• , Item 12, add after last paragraph, “A Board member queried if it were possible for new Board members to met with the Chief Financial Manager regarding interpretation of Board reports. The Board agreed this option will be made available to new members.”

• Page 14, fourth paragraph, add, “It was noted by a Board member that the intake in November 2005 is intended to be PGY2 only.”

• Page 14, first and fifth paragraphs, amend, “recommendation surrounding” to “recommendation seeking”.

Moved: Brian Wilkinson, Seconded: Julie Kilkelly

It was RESOLVED that the Minutes of the West Coast District Health Board meeting held December 2004 were a true and accurate record subject to the amendments above.

5. MATTERS ARISING

Discuss the written advice received from the MoH with Poutama Ora on the Memorandum of Partnership with Papatipu Runanga. On hold. Consider staggering the date of expiry for Advisory Committee members terms. Due March 2005. The Chairman requested Board members refer to the information papers regarding Advisory Committee membership and terms. The Chairman requested the Advisory Committee Chairs meet to discuss community members and provide feedback on members and the current process at the next Board meeting.

Action: Advisory Committee Chairs

Moved: Gregor Coster, Seconded: John Vaile Motion: THAT Chairs of the Board Advisory Committees meet and recommend to the March 2005 Board meeting the membership and length of terms for members of Board Advisory Committees.


Motion carried. Prepare a paper noting a range of options for the Board in relation to GP practice ownership. Included in In Committee papers. Complete. Obtain data around primary care referrals from the West Coast to other DHBs, a breakdown by service and data on time spent on CDHB waiting lists for services WCDHB does not provide. Primary care data to be reported to CPHAC and secondary data reported to HAC. Due March 2005. Prepare a paper on the services WCDHB can provide relating specifically to paediatrics including integration with CDHB. Included in the Chief Executive’s Report. Completed. Write to the Electoral Officer (copy Internal Affairs) voicing the concerns of the Board regarding the STV system and delay in election results. Write a letter of thanks to the Internal Affairs Communications Officer. Completed. Prepare a scoping paper on the Rural GP Postgraduate Training Programme noting arrangements need to be in place by April 2005 for a November 2005 commencement. Due March 2005. Work with the Sexual Health Co-ordinator and her team to produce a scoping paper on the sexual health service in Buller with consideration to future expansion to South Westland. Due March 2005. Develop a process for consulting with Committees and the Board on the DAP planning process and present to the Board for sign off. The Chief Executive noted this matter was considered at the Board and Advisory Committee planning workshop yesterday and the item is completed for the 2005/06 year. A community consultation process will occur towards the end of this March for the DSP. The Chairman advised he has instructed the Community Liaison Officer to prepare a media release on community consultation. The General Manager Planning and Funding has agreed to provide the Board with a more formal planning process and this item will remain on the Action and Responsibility List until this has been completed. Arrange for Community and Public Health’s West Coast Public Health Plan to be circulated to all Board members once it has been finalised. The Chair, CPHAC advised the final report has not yet been received. BMS Visit by Ruth and Jim Vause. A Board member queried the outcome of the visit to BMS by Ruth and Jim Vause. The Chief Executive advised the Vauses did visit BMS with a Practice Nurse. The Vauses also visited Greymouth. A formal report has not yet been received, however the meetings were positive with a good exchange of ideas. Jim Vause was particularly impressed by the PriSM project. The Chairman requested a summary of the report be provided to the Board in a format suitable for public release.

Action: Management Board Financial Reports.


A Board member advised she has spoken with the Chief Financial Manager about having a one on one meeting to provide assistance in the interpretation of financial reports supplied to the Board in papers. The Board member also spoke to the presenter of the first workshop session yesterday and he suggested a one day Institute of Directors course which may be beneficial for new Board members. The Chairman advised that the Board does approve travel and other expenses for Board members including course fees to assist them in their work with the Board. Several Board members expressed interest in the IOD course and the Chairman requested Management investigate the cost of conducting the course on the West Coast for the entire Board in comparison to the cost of sending individual members to attend the course in Christchurch.

Action: Management

Moved: Gregor Coster, Seconded: Malcolm Stuart Motion: THAT the West Coast District Health Board approves travel, accommodation and course fees for members to attend the Institute of Directors Financial Reporting and Analysis Course for Directors to be held in Christchurch on 22 June 2005. Motion carried.

6. BOARD CORRESPONDENCE

Moved: Malcolm Stuart, Seconded: Christine Robertson It was RESOLVED that the Board correspondence Inwards was accepted and Outwards endorsed.

7. CHAIRMAN’S REPORT

7.1 Meeting With CDHB Chairman, CEO and Senior Management

The Chairs, CEOs and senior management of WCDHB and CDHB met in Christchurch on 21 December 2004 to discuss the implications of the Memorandum of Understanding between the two Boards, particularly regarding collaborative arrangements for the provision of secondary care services. This particularly refers to Surgical and Paediatric services, but other clinical services are intended to be covered by the arrangement. It was noted that the Minister of Health requires both Boards to enter into discussions, agree a draft plan by May, and that the Chairs should meet with her by June 30th 2005 to discuss and agree the plan. The purpose of this agreement is to ensure that the people of the West Coast obtain continuing access to clinical services, particularly general and orthopaedic surgery, and paediatrics, where there have been recent pressures. The collaboration and assistance of Canterbury DHB will be important to achieve the best available service.

7.2 Crown Financing Agency

The Chairman and CEO met with Dr Ray Naden, consultant working for the Crown Financing Agency in regard to the funding for the WCDHB. Work in regard to renewal of the Board loan is progressing and a report from the CFA to the MoH is expected in the near future. It is


further expected that the Board will also receive a copy of the report in due course. The Chairman anticipates that this report will be positive for the Board.

7.3 Resignation of the CEO

The Chairman advised he received verbal notification of the resignation of the CEO, John Luhrs, by telephone on Christmas Eve in order to take up a role in the private sector. Subsequently written confirmation of the resignation has been circulated to all Board Members. The Minister of Health, State Services Commission and the WCDHB Executive Management Team have all been notified. The CEO notes that he is willing to work until such time is mutually agreed between the Board and CEO. Both parties note that John’s departure is on the best of terms. The Board will be considering the CEO Recruitment process at the In Committee section of the Board meeting and the Chairman expects that an announcement is likely to be made when the Board resumes in the public section this afternoon.

7.4 Westlake Consulting Ltd

The Chairman has had communication with Richard Westlake of Westlake Consulting Ltd regarding providing workshop seminar advice to the Board in the area of governance. He presented to the Board yesterday.

7.5 Grafton Report

The Buller District Council has received the Grafton Report. The Chairman advised he has been in telephone discussion with the Mayor of the Buller District Council, Martin Sawyers, regarding the report, and noted to him that the Board will receive the report at this Board meeting. The Chairman advised the Mayor has agreed to meet in Wellington on Monday 21 February to discuss the way forward. The Chairman advised he believes that there is considerable agreement as to the process forward, and looks forward to working with the Buller District Council and community.

7.6 Healthwest PHO

The Chairman advised he met with Alan Greenslade (CEO) and Christine Smith (staff member and West Coaster) of the HealthWest PHO at their invitation on Wednesday 19th January at the HealthWest office. They discussed their proposal that they were in a position to provide assistance to the West Coast PHO in regard to support, advice, salaried arrangements, etc, and the Chairman agreed to convey that information to the West Coast PHO Chair, Maureen Pugh, and to WCDHB management. That has been completed.

7.7 Pharmac Board Meeting

The Chairman attended the Board meeting held on Wednesday 26th January in Wellington.

7.8 Remaining Board Member Appointment

The Chairman advised this matter is still with the Minister of Health and he understands that the Minister and Ministry of Health are in discussion with Ngai Tahu. An announcement is not expected until February or possibly even March.

Moved: Gregor Coster, Seconded: Brian Wilkinson It was RESOLVED to accept the Chairman’s report.


8. CHAIRMAN’S CORRESPONDENCE

Moved: Gregor Coster , Seconded: Christine Robertson It was RESOLVED that the Chairman’s correspondence Inwards was accepted and Outwards endorsed.

9. CHIEF EXECUTIVE’S REPORT

9.1 District Annual Plan 2004/05

The Chief Executive noted the 04/05 DAP now been signed off by the Minister with an approved year end deficit of $2.68m.

9.2 Rural GP Training

The Chief Executive advised he met with the Undergraduate Programme Co-ordinator, Isla Tenbeth. Her report of her visit to the West Cost is exceptionally positive. The postgraduate programme is making significant progress and three or four critical success factors have been identified including finalisation of costings. Greville Wood has been appointed to the CTA working party. A Board member suggested it may be appropriate for the Board to write a letter to Greville Wood acknowledging his outstanding work on both programmes. The Chairman requested the Chief Executive write a letter to Greville Wood and letters to the three GPs thanking them for providing a placement for these students.

Action: Chief Executive

9.3 District Annual Plan 2005/06

The Chief Executive advised Planning and Funding is now focussed on the 05/06 DAP with a first draft submission date of 12 March. Funding will be a challenge however the project being undertaken with the CFA will assist in identifying WCDHB’s needs on an ongoing basis.

9.4 Recruitment

The Chief Executive noted WCDHB has now commenced a significant recruitment campaign for vocationally registered GPs on the West Coast consistent with the ASMS MECA.

9.5 Tikanga Recommended Best Practice

The Chief Executive advised the Tikanga Best Practice document is currently being worked through with staff. The Chief Executive noted he attended the opening of the new Marae at Bruce Bay and mention was made in the Prime Minister’s speech that the Marae will have access to the internet, provided by WCDHB as part of the PriSM project.

9.6 CEO External Meetings

A Board member requested more information on the meeting with Dr Mark McLaughlin. The Chief Executive advised he requested a meeting from a Planning and Funding perspective as Management had heard Dr McLaughlin intended to leave the West Coast. Dr McLaughlin attended the meeting with Tony Kokshoorn, Mayor, GDC and Maureen Pugh as Chair of the


PHO. GP services in the Grey District were discussed generally and the types of facilities and services to be provided in the future. Dr McLaughlin is intending to depart this year and he will provide a firmer date closer to the time. The meeting did not occur with the DHB represented as the provider of services, but as the funder. Dr McLaughlin may have some recommendations that may be best presented to the Board by Dr McLaughlin himself after discussions with the PHO. The Chair of the PHO is taking the matter to the PHO for discussion and will report back to the WCDHB with any recommendations.

Moved: Carol Atmore, Seconded: Mohammed Shahadat It was RESOLVED to accept the Chief Executive’s Report

10. FINANCE REPORT

The Chief Financial Manager advised the budget has been updated to reflect the new DAP. The Chief Financial Manager noted the Holidays Act has still not been budgetted for and he is awaiting confirmation from the Ministry it will fund DHBs for that cost. The accounts in this month’s report are the November accounts as due to the Christmas period and staff being on leave over this time and the earlier meeting of the Board, the December accounts were not available for the papers. The Chief Financial Manager advised that ytd the DHB is performing $906k better than budget. Provider arm revenue is down as it has not been paid for health outputs due to lack of staff and difficulty in recruiting. The funder arm buys health outputs from the provider arm and the Chief Financial Manager expects to see the current situation corrected over the course of the year. In December the provider arm achieved all of its budgetted outputs despite the holidays, mainly because of a full compliment of staff, particularly in orthopaedics. The month result is slightly worse than budget due to the impact of the Holidays Act, as Labour Day in October effects the November result. The Chief Financial Manager is forecasting that the full year result will be worse than budget mainly because of the additional cost of recruitment and transfers to Christchurch. Accordingly he expects the overall result will be $300k worse than budget, which is an improvement on the initial forecast of $500k. A Board member queried if the CFA loan is likely to be rolled over for more than 6 months. The Chief Financial Manager advised that the signed DAP only gives funding certainty for the current year. Interest rate hedging is in place for approximately one third of the loan and the expected increase in interest rates has been accounted for in the deficit. The cost to the DHB is in the tens of thousands rather than hundreds of thousands. The Chairman queried the exact figure for the capital charge. The Chief Financial Manager advised it is roughly $78k per month. A Board member noted the Chief Financial Manager alluded to health outputs in his report and there may be a bigger cost than budgetted if the DHB is relying on short term locums. The Chief Financial Manager advised the cost of air transfers, recruitment and extra staffing in order to do longer theatre runs are contributing factors. A Board member queried the accounts payable liabilities showing an 8% variance. The Chief Financial Manager advised this may be a timing issue or a budgeting error when the DAP was updated. Much of accounts payable is managed by HealthPAC. A Board member requested a brief update on the PriSM project. The Chief Financial Manager advised the project is roughly one month behind target, however IT has resolved issues with Telecom and the pilot site is already connected in Hari Hari.


Moved: Christine Robertson, Seconded: Mohammed Shahadat It was RESOLVED to accept the Finance Report.

11. TRANSPORT PAPER

The Chief Executive advised the paper draws together a number of factors in association with the Regional Council. WCDHB is not funded to provide transport and the paper is designed to give an overview of the current situation and will be taken further in the strategic planning process. The difficulty arises in the DHB’s role of health care provider and in terms of a funder of health services not transport services. The paper has been provided for information and will be taken up with District and Regional Councils. A Board member noted there is funding available from the Ministry for health assessments and it would be useful if the paper were to identify what services are provided where and with estimated travelling times and costs so that even if the DHB does not fund transport the paper can be presented to Councils to provide information to the community. A Board member queried if any formal groups have been set up to address transport issues. The Chief Executive advised there is a regional transport group however there are no existing intersectoral groups. The Board member suggested it may be appropriate for the Board to initiate an intersectoral group. The Chairman advised the paper is a good basis, however it needs to give clear recommendations to the Board on how to proceed with the matter including timeframes needed to attend appointments, recommendations on intersectoral work and who qualifies for Ministry funding. A Board member noted local authorities are required to produce a Long Term Community Plan and Councils will produce this before June of this year so consultation should start now as Councils will be seeking the Board’s views. This will also provide an opportunity for the Board to take a more active role particularly with the Regional Council. A Board member suggested the paper could also include use of the Whanau Facility in conjunction with transport services. The Chairman requested the paper be resubmitted to the Board with additional information and recommendations for the Board.

Action: Management

12. REPORTS FROM ADVISORY COMMITTEES

12.1 Hospital Advisory Committee

12.1.1 Items of Interest

HAC noted the low cervical screening rate for the West Coast and recommends the Board consider further action be taken as both funder and provider of services. The Chief Financial Manager is forecasting overall volumes to be on target for year end with costs slightly up on budget. HAC was delighted by the recent advertisement in NZ Doctor magazine attracting GPs to the West Coast area.

12.1.2 Reporting Back on Board Referred Items


HAC has received the first quarterly report on Trendcare (high level variances between services) and will continue to monitor the key issue identified. There appears to be a silo approach to staff utilisation. Action is in place to reduce this and is likely to be reflected in the data in the next quarter’s report which will also have some refinements to add value to the report.

12.1.3 Seeking Approval for Further Consideration

HAC seeks approval to advance the development of a Secondary Care Plan starting with a scoping paper in April. HAC seeks permission to change dates and duration of meetings, if necessary, to accommodate deliberation on/input into the DSP and Secondary Care Plan while maintaining the ability to monitor operational/financial figures in a timely fashion.

Moved: Christine Robertson, Seconded: Glenys Baldick Motion: THAT the West Coast District Health Board empower the Hospital Advisory Committee to advance development of the Secondary Care Plan and advise the Board regularly on progress. Motion carried. Moved: Christine Robertson, Seconded: Glenys Baldick Motion: THAT the West Coast District Health Board agrees that the Hospital Advisory Committee be able to change dates and duration of meetings if needed to accommodate deliberation on the DAP and DSP while maintaining the ability to monitor operational and financial figures in a timely manner. Motion carried.

Board members noted that any proposed meeting dates should be finalised as soon as possible and that amended meeting times should be kept to a minimum and notified well in advance.

12.1.4 Recommendations to the Board

HAC recommends to the Board that the social meetings between Board, Management and senior clinicians be continued on a six monthly basis. The Chairman noted that the Board has advised EMT it is interested in continuing meetings and requested that the next lunch be organised for the May Board meeting in Hokitika with another again in June in Greymouth to include GPs. Cervical Smears The Chairman noted that HAC received information that only 68% of West Coast women are up to date with cervical smears. This is the lowest rate of all DHBs. The Chair, HAC advised she understands the item is coming up for CPHAC and since the figures are more likely to be funder issues rather than provider it may be more appropriate for CPHAC to consider the


matter. CPHAC can advise HAC of any areas for improvement identified for the provider arm.

Moved: Julie Kilkelly, Seconded: Carol Atmore Motion: THAT the West Coast District Health Board delegates to the Community and Public Health Advisory Committee issues related to the low cervical smear rates on the West Coast and requests the CPHAC to advise the Board on action to be taken. Motion carried.

12.2 Community and Public Health Advisory Committee

The Chair, CPHAC noted there has not been a CPHAC meeting since the last Board meeting. The Chair, CPHAC noted that as a result of yesterday’s workshop, the Advisory Committee meetings scheduled for May be rescheduled to occur in April to allow input into the planning process and that the CPHAC meeting times be extended from 12:30pm to 1:30pm.

Moved: Julie Kilkelly, Seconded: Robyne Bryant

Motion: THAT Community and Public Health Advisory Committee times be extended from 12:30pm to 1:30pm and that the Disability Services Advisory Committee and Community and Public Health Advisory Committee should meet on 13 April 2005. Motion carried.

The Deputy Chair requested contact details for all Board and Advisory Committee members be circulated to Board members as soon as possible.

Action: Minute Secretary

12.3 Disability Services Advisory Committee

The Chair, DSAC advised a meeting was held in December, however the minutes are not yet available.

13. IN COMMITTEE

Pursuant to Clause 32a, Schedule 3 of the New Zealand Public Health & Disability Act 2000 members of the public are to be excluded from the portion of Friday 28 January 2005 meeting of the West Coast District Health Board that relates to the following items on the grounds that the public conduct and discussion of the following items would enable the WCDHB to carry out, without prejudice or disadvantage, commercial activities granted by Section 9(2)i of the Official Information Act 1982.


• Draft Advisory Committee Minutes – In Committee • Grafton Group Report • Contracts

− West Coast PHO • 2004/05 District Annual Plan • Risk Register Pursuant to Clause 32a, Schedule 3 of the New Zealand Public Health & Disability Act 2000 members of the public are to be excluded from the portion of the 28 January 2005 meeting of the West Coast District Health Board that relates to the following items on the grounds that the exclusion of the public is to allow the maintenance of effective conduct of public affairs through the protection of such Ministers, officers, and employees of the West Coast DHB from improper pressure or harassment and that this disclosure would prejudice the protection granted by Section 9(2)(g)ii of the Official Information Act 1982. • CEO Recruitment • RACS Report Update

Moved: Gregor Coster, Seconded: Christine Robertson It was RESOLVED to move into In Committee at 12:31pm

14. MOVING OUT OF IN COMMITTEE

Moved: Gregor Coster, Seconded: Julie Kilkelly It was RESOLVED to move out of In Committee at 2:02pm

15. NEXT MEETING

Friday 4 March 2005, 9:15am, Boardroom, Corporate Office, Greymouth.

There being no further business the meeting concluded at 4:26pm


MATTERS ARISING FROM THE WEST COAST DHB BOARD MEETINGS

Item No.

Board Meeting

Date

Action Item

Action Responsibility

Reporting Status

Agenda Item Ref

5 5 March 2004 Discuss the written advice received from the MoH with Poutama Ora on the Memorandum of Partnership with Papatipu Runanga.

Chief Executive On hold. On hold.

11 2 July 2004 Consider staggering the date of expiry for Advisory Committee members terms.

For Board consideration March 2005

14.1 5 November 2004 Obtain data around primary care referrals from the West Coast to other DHBs, a breakdown by service and data on time spent on CDHB waiting lists for services WCDHB does not provide. Primary care data to be reported to CPHAC and secondary data reported to HAC.

General Manager Planning and Funding

March 2005

13.1.1 17 December 2004 Prepare a scoping paper on the Rural GP Postgraduate Training Programme noting arrangements need to be in place by April 2005 for a November 2005 commencement.

Management March 2005

13.1.1 17 December 2004 Work with the Sexual Health Co-ordinator and her team to produce a scoping paper on the sexual health service in Buller with consideration to future expansion to South Westland.

Management March 2005

13.1.1 17 December 2004 Develop a process for consulting with Committees and the Board on the DAP planning process and present to the Board for sign off.

General Manager Planning and Funding

As soon aspossible.

Completed for 05/06

13.1.3 17 December 2004 Arrange for Community and Public Health’s West Coast Public Health Plan to be circulated to all Board members once it has been finalised.

Chair, CPHAC As soon asinformation is available.

5 28 January 2005 Meet to discuss the membership and length of terms for members of Board Advisory Committee community members.

Advisory Committee Chairs March 2005 In papers.


Item No.

Board Meeting

Date

Action Item

Action Responsibility

Reporting Status

Agenda Item Ref

5 28 January 2005 Provide a summary of the report on BMS by Ruth and Jim Vause in a format suitable for public release.

Management As soon asinformation is available.

5 28 January 2005 Investigate the cost of conducting the IOD Financial Reporting and Analysis course on the West Coast for the entire Board in comparison to the cost of sending individual members to attend the course in Christchurch.

Management March 2005 Completed.

9.2 28 January 2005 Write a letter to Greville Wood acknowledging his outstanding work on the GP training programmes and write to the three GPs thanking them for providing a placement for the students.

Chief Executive March 2005

11 28 January 2005 Revise the transport paper to include recommendations for the Board and information on timeframes for travel to attend appointments, who qualifies for Ministry funding, use of the Whanau Facility in conjunction with transport services, consultation with Councils and any other intersectoral work.

Management As soon aspossible.

12.2 28 January 2005 Circulate contact details for all Board and Advisory Committee members to Board members.

Minute Secretary March 2005 Completed.


CHAIRMAN’S REPORT

The Chairman will give a written update at the West Coast DHB meeting on Friday 4 March 2005.


CHAIRMAN’S CORRESPONDENCE FOR FEBRUARY 2005

Date Sender Addressee Details Response Date Response Details

23 January 2005 Hon Annette King Gregor Coster Congratulations on fluoridation campaign

24 January 2005 Anthony Hill, MoH Gregor Coster DHB Chairs’ Conference Not required

28 January 2005 Ria Earp, MoH Gregor Coster Publications for Board members. Not required

2 February 2005 Mark Prebble, State Services Commission

Gregor Coster Crown Entities Act 2004


CHIEF EXECUTIVE’S REPORT

RECRUITMENT / VACANCIES FOR JANUARY / FEBRUARY 2005 POSITION STATUS Senior Medical Staff General Surgeon Support for surgical services is in place.

Collaborative discussions are continuing with Canterbury DHB. A New Zealand Vocationally registered General Surgeon has been appointed on a permanent part-time basis and another potential candidate is in discussion.

Anaesthetist Actively recruiting. Discussions to progress a

collaborative arrangement with Canterbury DHB are underway for this area.

Orthopaedic surgeon The Interview Committee has met with a potential

candidate and unfortunately, this candidate was not suitable. Support for the existing team is in place with the appointment of two locum Orthopaedic Surgeons for a period of 3 months. A new recruitment drive is being initiated.

O&G A permanent O&G commenced 31st January 2005 and the other permanent O&G is due to commence 14th March 2005. Our current permanent O&G will continue on a part-time basis providing supervision.

GPs - Buller We are actively recruiting for candidates interested

in permanent placements. This activity is occurring concurrently with a search for locum cover. Cover is currently provided with both permanent and locum doctors in place.

GP Dobson As above with regard to the strategy for securing

GPs to Westport, an active search is underway whilst locum cover is in place in the medium term. One potential candidate interview scheduled.

GP South Westland Locum cover in place and as above, an active

search is underway. One possible candidate is in discussions. One potential candidate interview scheduled.

GP Grey Medical Centre Two potential candidates have expressed interest

and the recruitment process is in progress. One


POSITION STATUS potential candidate interview scheduled.

A&E MOSS In discussion with potential candidate. Nursing Staff RN Morice Interviews in progress EN Hannan Position advertised RN Reefton Position advertised Casual RN South Westland Position advertised ENs, RNs, Caregivers Buller Short listing RN Barclay Position advertised Mental Health Psychiatric Needs Assessor / Co-ordinator Position advertised OT Community Mental Health Position advertised Team Leader Acute IPU Short listing Allied Health Staff Pharmacist Position advertised Child Development Social Worker Position advertised Temporary CAMHS Worker Position advertised Other HR Manager External consulting firm actively recruiting for

potential candidates. Surgical Registrar Position advertised PA to DON Interviews in progress Clerical Assistant Reefton Short listing

DISTRICT ANNUAL PLAN 2005/06 Currently we are awaiting receipt of our funding envelope. This has been delayed (sector wide) and is not available at the time of writing this report. We understand first drafts of the DAP will still be required to be submitted to the Ministry of Health by 12 March 2005. it will be a challenge to meet this timeframe.

DISTRICT STRATEGIC PLAN – 3 YEARLY REVIEW The Board will be consulting this year on its District Strategic Plan which is reviewed on a three yearly basis. Details of the consultation process will be advised shortly.

UNDERGRADUATE GP TRAINING The first intake of three students in the Undergraduate GP Training Programme have been welcomed to the Coast by GPs, staff, Iwi and the community. This is an exciting programme and we look forward to feedback from the students and Dunedin School of Medicine following the completion of the inaugural five week course.


NURSES’ MECA The NZNO Nurses’ MECA has been ratified by NZNO members. The MECA, which will be effective from 1 April 2005, provides a significant “pay jolt” for members. After lengthy negotiations it is pleasing to see the matter concluded to the satisfaction of the parties, thereby providing additional certainty and stability in the workplace. Some other groups are advancing wage claims along similar lines ad are being referred to central government. DHBs are expected to settle wage negotiations within budgetted parameters.

CEO EXTERNAL MEETINGS • DHB CEOs - Teleconference • Tony Kokshoorn, Grey District Council – Greymouth • Canterbury DHB – Christchurch • Te Runanga o Makaawhio – Greymouth • Ministry of Health – Wellington • Crown Financing Agency – Wellington • MECA Negotiations – Christchurch • West Coast Development Trust – Greymouth • SISSAL – Teleconference • Verification NZ – Greymouth • Arrow International – Greymouth • West Coast Private GPs and PHO – Greymouth • MedTech – Greymouth • Telecom – Greymouth

Author: Chief Executive – 23 February 2005

TIKANGA RECOMMENDED BEST PRACTICE One of the key objectives of the WCDHB Maori Health Plan 2003-2006/Te Kaupapa Hauora Maori 2003-2006 is to improve the responsiveness of mainstream services to Maori needs and concerns. One of the actions within this plan is to establish a group of clinical people within the DHB to work on issues regarding Tikanga Recommended Best Practice thus advocating for the reduction of barriers to accessing services throughout departments in the WCDHB. On the 31st January a meeting was held in the Boardroom, present were the General Manager Maori Health and a number of clinical staff. This meeting was well attended by clinical staff, all of whom are keen to see the work around Tikanga Recommended Best Practice progressed within the WCDHB. The general discussion was positive with some very good practical issues being raised. This draft document is well supported by staff.

TE HERENGA HAUORA/SI DHB MAORI MANAGERS HUI On the 7th February, the South Island Maori Managers Network/Te Herenga Hauora met in Christchurch. The main focus of this meeting was to develop initiatives for a regional South Island proposal for funding from the Maori Provider Development Scheme. The South Island Maori


Managers also met with General Managers (GM) of Planning and Funding who were also meeting in Christchurch at this time. It was agreed that the two groups would meet at least once a year for the purpose of strategic planning and that South Island Maori Managers Network/Te Herenga Hauora would have one manager in attendance at least in part, at the GM Planning and Funding meetings which occur once a month.

WELCOME FOR GP UNDERGRADUATES On the 21st February, General Practitioner (GP) Undergraduates from the Dunedin School of Medicine Training Programme were welcomed to the West Coast by a local Ngati Waewae Kaumatua; other speakers included Dr Greville Wood, West Coast Programme Co-ordinator and John Luhrs, Chief Executive. After the formal part of the welcome was completed students spent time talking with clinical staff and management staff who were in attendance. Students were interviewed by the local newspaper and expressed enthusiasm about their welcome and the good start to their placement on the West Coast.

PRESENTATION TO CPHAC On the 16th February, the GM Maori Health made a PowerPoint presentation to CPHAC committee members regarding progress of the WCDHB Maori Health Plan 2003-2006/Te Kaupapa Hauora Maori 2003-2006. The presentation was aimed at providing an update on the plan’s progress to date. All DHBs throughout New Zealand are required to submit a Maori Health Plan to the Ministry of Health, which the WCDHB has done. Midway through this year we will be required to revise our Maori Health Plan and advise the Ministry of Health of this work.

AUDIT On the 17th February, the GM Maori Health met with Auditors working on certification for the WCDHB. The purpose of this meeting was to discuss issues and questions they may have as a result of the Audit. Overall they were very happy with the initiatives that the WCDHB has put in place around Maori Health. They were interested in the various training programmes that we have made available to staff as well as policies and procedures that have been written. They viewed the WCDHB Maori Health Plan 2003-2006/Te Kaupapa Hauora Maori 2003-2006 and the draft version of Tikanga Recommended Best Practice guidelines and were quite happy with the progress that has been made to date.

Author: General Manager Māori Health – 23 February 2005


FINANCE REPORT

Financial Overview January 2005

Actual Budget Variance Variance Last Yr Actual Budget Variance Variance Last Yr Full Yr Full Yr Full Yr ActMonth Month Month YTD YTD YTD Forecast Budget Last Yr

REVENUEProvider 4,128 4,363 (235) (5.4%) 4,318 29,551 30,542 (991) (3.2%) 29,779 51,916 52,316 52,013Governance & Administration 86 85 1 1.6% 84 635 587 48 8.2% 578 1,008 1,008 997Funds & Internal Eliminations 2,714 2,242 472 21.1% 2,089 17,510 15,692 1,818 11.6% 13,454 26,900 26,900 25,209

6,928 6,689 239 3.6% 6,491 47,696 46,821 875 1.9% 43,811 79,824 80,224 78,219

EXPENSESProvider Personnel 2,751 2,837 86 3.0% 2,622 18,192 19,221 1,029 5.4% 17,851 32,383 32,983 31,158 Outsourced Services 382 355 (27) (7.6%) 356 3,015 2,451 (564) (23.0%) 2,252 4,715 4,215 3,858 Clinical Supplies 439 411 (28) (6.8%) 421 3,261 3,348 87 2.6% 3,301 5,752 5,752 5,447 Infrastructure 930 1,022 92 9.0% 956 7,020 7,204 184 2.6% 6,907 12,357 12,357 11,965

4,502 4,625 123 2.7% 4,355 31,488 32,224 736 2.3% 30,311 55,207 55,307 52,428

Governance & Administration 140 173 33 19.0% 120 1,049 1,204 155 12.8% 936 2,070 2,070 1,731Funds & Internal Eliminations 2,203 2,127 (76) (3.6%) 2,064 15,772 14,891 (881) (5.9%) 13,427 25,527 25,527 24,498

6,845 6,925 80 1.2% 6,539 48,309 48,319 10 0.0% 44,674 82,804 82,904 78,657

Net Result 83 (236) 319 (135.2%) (48) (613) (1,498) 885 (59.1%) (863) (2,980) (2,680) (438)

OPERATING RESULTS The monthly result for January 2005 is a surplus of $83k, which is $319k better than budget ($236k deficit). The provider deficit of $452k is $112k worse than budget ($340k deficit). The governance and administration surplus of $24k better than budget ($10k deficit). The funder arm surplus of $511k is $396k better than budget ($115k surplus). The year to date (January) result is a deficit of $613k, which is $885k better than budget ($1,498k). The year to date provider deficit of $2,483k is slightly worse than budget ($2,228k). Other areas are significantly better than budget (governance and administration $203k and funder arm $934k).

REVENUE Revenue for the month was $6,928k. This was $239k (3.6%) better than budget of $6,689k. Provider revenue $4,128k is down $235k on budget ($4,364k), mainly due to wash-up liability to the funder arm for underproduction against contracted volumes of $269k1. Funder revenue $6,262k is up $222k on budget ($6,040k) due to adjustments to the funding envelope since the budget assumptions were set (March 2004), including the devolution of funding responsibility for Med Lab South. Year to date (January) revenue $47,696k is up $875k on budget ($46,821k).


1 We have not assumed that overproduction will be offset against underproduction except for where a specific trade-off has been agreed between the funder and provider.

Year to date provider revenue $29,551k is down $991k on budget ($30,542k), mainly due to wash-up liability to the funder arm for underproduction against contracted volumes of $1,272k1. Areas with significant underproduction include orthopaedic, gynaecological and paediatric surgery and paediatric and general medicine (all relating to difficulties attracting and retaining medical specialists). Age related AT&R (Assessment, Treatment and Rehabilitation) volumes are also down (related to patient demands), as are intellectual disability services (relating to patient numbers at Seaview). One area of notable overproduction is general surgery, where we have made use of available theatre capacity brought about by the shortage of specialist staff in other surgical disciplines. Accident and emergency attendances are also significantly over target year to date. This overproduction ($480k total), has not been recognised in our accounts as we have not changed the mix of services purchased by the funder arm. Instead, we plan to manage our throughput throughout the remainder of the year, so as to still achieve our planned volume and mix of outputs for the year. Year to date funder revenue $43,148k is up $870k on budget ($42,278k) due to adjustments to the funding envelope since the budget assumptions were set (March 2004), including the devolution of funding responsibility for Med Lab South

EXPENSES Expenses for the month of January 2005 ($6,845k) were $80k less than budget ($6,925k). Provider expenses for the month are under budget by $123k. Personnel costs are under budget ($86k). Medical costs are down on budget ($26k) due to

the mix between employed and contracted Medical Staff. Nursing costs are over budget due to the Holidays Act. Allied Health costs are below budget due to unfilled vacancies (Social Work and Mental

Health). Outsourced Services are above budget ($27k) as we have engaged locum Medical Staff

due to an inability to recruit directly (this offsets our variance on Medical Staff). Other Clinical and Client Costs are up on budget due to the cost of transferring acute

patients to other centres for treatment. Funder arm expenditure is down against budget for the month. In reality, funder arm expenditure has increased, due to the devolution of contracts, such as with Medlab South (these increases are matched by increased revenue), however, this increase has been offset by the credit for the wash-up liability owed back to the funder arm by the provider for underproduction against contracted volumes. Year to date (January 2005) expenses ($48,309k) were on budget ($48,319k). Year to date provider expenses are under budget by $736k. The reasons for this match the reasons outlined for the monthly result: Personnel costs are under budget ($1,029k) due to the difficulty in attracting and retaining key clinical staff. Outsourced Services are above budget ($564k) as we have engaged locum Medical Staff in order to cover some of these vacancies. Treatment Disposables are under budget due to declining patient numbers at Seaview. Diagnostic Supplies, Instruments and Equipment and Patient Appliances are all significantly under budget due to our reduced volumes. At the same time, Other Clinical and Client Costs are up on budget due to the cost of transferring acute patients to other centres for treatment. Most categories of Infrastructure Costs are down on budget due to reduced patient numbers.


Interest and Financing costs are over budget due to capital charge payments on our equity balance, which is significantly higher than budget due to our favourable year to date financial result.

Year to date funder arm expenditure is $64k down against budget. The reasons for this match the reasons outlined for the monthly result, ie: increased expenditure relating to contracts devolved after the budget was set have been offset by the credit for the wash-up liability owed back to the funder arm by the provider.

FORECAST We are forecasting that our 2004-05 result will be slightly worse than budget due to reduced surgical throughput during the time taken to recruit a replacement orthopaedic surgeon. The extent of this deterioration in financial performance will depend on the mix of patients presenting for surgery, our ability to attract locum staff and the time taken to secure the services of a permanent surgeon.

2004-05 DISTRICT ANNUAL PLAN (DAP) The Minister of Health has now approved our 2004-05 District Annual Plan. Budget figures in this report have been updated accordingly.

STATEMENT OF FINANCIAL POSITION Current liabilities remain unconventionally high due to RHMU financing for $11.2m being of a short-term nature. The short-term rollovers of this loan reflect uncertainty about our funding status, which is related to the delays experienced in getting our DAP approved. Current employee liabilities have reduced from prior months but are still slightly higher than budget due to the mix of redundancies that resulted from the closure of Huia Villa at Seaview. Overall our Balance Sheet has improved significantly, with our debt to debt plus equity ratio now at 46.0%, compared with 50.8% this time last year. This improvement reflects our favourable 2003-04 financial result.

CASHFLOW Cashflow remains adequate for current activities.

CAPEX Approved capital expenditure for the 2004-05 financial year to date (31 January 2005) of $1,763k exceeds year to date budget ($1,300k). These figures include the combined PACS/SAN/IT Infrastructure Project that was approved In Committee at the November Board meeting, but does not include the iSOFT Patient Administration/Clinical Information System Project approved In Committee at the December Board meeting, as this project is still subject to the National Capital Approval Process.


DEBTORS Debtors remain in control.

IT PROJECTS – PRISM (PRIMARY INTEGRATION SYSTEMS MANAGEMENT PROJECT) The pilot phase of the PrISM project is underway at Hari Hari and the project is proceeding to plan.

IT PROJECTS – PACS (PICTURE ARCHIVING AND COMMUNICATIONS SYSTEM) The first parts of the PACS project are the Network Infrastructure Upgrade and tender process for the Storage Area Network (SAN). On the Network Infrastructure Upgrade front, a preferred location has been identified for a new IT server room in order to accommodate the PACS server and SAN. This location is within the current Grey Base Hospital building. The tender process for the SAN has also been initiated.

IT PROJECTS – PAS / CIS (PATIENT ADMINISTRATION SYSTEM / CLINICAL INFORMATION SYSTEM) Southland DHB are now in the detailed implementation planning process for their PAS / CIS project. We are actively involved in this with Southland DHB, however are still in the process of seeking regional and national capital committee approval for our PAS / CIS implementation.

Author: Chief Financial Manager – 17 February 2005


DHB CONSOLIDATED - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF JANUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full YrRevenueCore MoH Funding 6,185 6,024 161 2.7% 5,935 42,774 42,165 609 1.4% 38,897 71,841 72,241 69,867 Other MoH Funding 448 422 26 6.2% 317 2,876 2,956 (80) (2.7%) 3,179 5,071 5,071 5,278 Patient / Consumer Sourced 201 205 (4) (2.0%) 192 1,531 1,435 96 6.7% 1,413 2,460 2,460 2,504 Non Health Related 94 39 55 143.6% 47 515 264 251 94.9% 323 452 452 570

6,928 6,689 239 3.6% 6,491 47,696 46,821 875 1.9% 43,811 79,824 80,224 78,219

Payments to Providers 2,203 2,127 (76) (3.6%) 2,064 15,772 14,891 (881) (5.9%) 13,426 25,527 25,527 24,497

Personnel CostsMedical Personnel 541 567 26 4.6% 478 3,124 3,879 755 19.5% 3,355 6,264 6,664 6,041 Nursing Personnel 1,164 1,123 (41) (3.7%) 1,159 7,645 7,571 (74) (1.0%) 7,441 12,998 12,998 12,979 Allied Health Personnel 622 715 93 13.0% 609 4,479 4,805 326 6.8% 4,303 8,018 8,218 7,379 Support Personnel 113 102 (11) (10.8%) 99 713 714 1 0.1% 680 1,226 1,226 1,184 Management / Admin 396 422 26 6.2% 335 2,808 2,886 78 2.7% 2,550 4,966 4,966 4,491

2,836 2,929 93 3.2% 2,680 18,769 19,855 1,086 5.5% 18,329 33,472 34,072 32,074

Outsourced Services 397 367 (30) (8.2%) 370 3,112 2,537 (575) (22.7%) 2,347 4,864 4,364 4,019

Clinical SuppliesTreatment Disposables 79 84 5 6.0% 92 604 653 49 7.5% 601 1,117 1,117 1,015 Diagnostic Supplies 6 10 4 40.0% 14 77 71 (6) (8.5%) 73 125 125 153 Instruments & Equipment 79 69 (10) (14.5%) 56 593 641 48 7.5% 621 1,113 1,113 1,017 Pt Appliances, Implants, Prostheses 63 71 8 11.3% 93 520 689 169 24.5% 749 1,031 1,181 1,170 Other Clinical & Client Costs 212 177 (35) (19.8%) 166 1,467 1,294 (173) (13.4%) 1,257 2,366 2,216 2,092

439 411 (28) (6.8%) 421 3,261 3,348 87 2.6% 3,301 5,752 5,752 5,447 Infrastructure CostsHotel Services, Laundry & Cleaning 209 221 12 5.6% 215 1,521 1,581 60 3.8% 1,556 2,703 2,703 2,630 Facilities 247 269 22 8.3% 268 1,822 1,913 91 4.7% 1,905 3,276 3,276 3,274 Transport 79 99 20 20.4% 75 652 679 27 4.0% 612 1,176 1,176 1,109 IT Systems & Communication 82 101 19 19.1% 90 631 710 79 11.1% 669 1,218 1,218 1,148 Democracy 18 32 14 44.1% 19 174 230 56 24.5% 136 396 396 239 Professional Fees & Expenses 24 50 26 52.3% 33 271 352 81 23.0% 268 606 606 464 Other Operating Costs 311 317 6 1.9% 304 2,324 2,222 (102) (4.6%) 2,125 3,815 3,815 3,756

970 1,091 121 11.1% 1,004 7,395 7,688 293 3.8% 7,271 13,189 13,189 12,620

Expenses Total 6,845 6,925 80 1.2% 6,539 48,309 48,319 10 0.0% 44,674 82,804 82,904 78,657

Surplus (Deficit) 83 (236) (319) 135.2% (48) (613) (1,498) (885) 59.1% (863) (2,980) (2,680) (438)


DHB PROVIDER ARM - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF JANUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full Yr

RevenueCore MoH Funding 3,533 3,817 (284) (7.4%) 3,880 25,622 26,717 (1,095) (4.1%) 25,680 45,359 45,759 45,077 Other MoH Funding 330 304 26 8.4% 206 2,053 2,134 (81) (3.8%) 2,400 3,661 3,661 3,943 Patient / Consumer Sourced 201 205 (4) (2.0%) 192 1,531 1,435 96 6.7% 1,413 2,460 2,460 2,504 Non Health Related 64 37 27 74.9% 40 345 256 89 34.7% 286 436 436 489

4,128 4,363 (235) (5.4%) 4,318 29,551 30,542 (991) (3.2%) 29,779 51,916 52,316 52,013

Personnel CostsMedical Personnel 541 567 26 4.6% 478 3,124 3,879 755 19.5% 3,355 6,264 6,664 6,041 Nursing Personnel 1,164 1,123 (41) (3.7%) 1,159 7,645 7,571 (74) (1.0%) 7,441 12,998 12,998 12,979 Allied Health Personnel 622 715 93 13.0% 609 4,479 4,805 326 6.8% 4,303 8,018 8,218 7,379 Support Personnel 113 102 (11) (10.8%) 99 713 714 1 0.1% 680 1,226 1,226 1,184 Management / Admin 311 330 19 5.8% 277 2,231 2,252 21 0.9% 2,072 3,877 3,877 3,575

2,751 2,837 86 3.0% 2,622 18,192 19,221 1,029 5.4% 17,851 32,383 32,983 31,158

Outsourced Services 382 355 (27) (7.6%) 356 3,015 2,451 (564) (23.0%) 2,252 4,715 4,215 3,858

Clinical SuppliesTreatment Disposables 79 84 5 6.0% 92 604 653 49 7.5% 601 1,117 1,117 1,015 Diagnostic Supplies 6 10 4 40.0% 14 77 71 (6) (8.5%) 73 125 125 153 Instruments & Equipment 79 69 (10) (14.5%) 56 593 641 48 7.5% 621 1,113 1,113 1,017 Pt Appliances, Implants, Prostheses 63 71 8 11.3% 93 520 689 169 24.5% 749 1,031 1,181 1,170 Other Clinical & Client Costs 212 177 (35) (19.8%) 166 1,467 1,294 (173) (13.4%) 1,257 2,366 2,216 2,092

439 411 (28) (6.8%) 421 3,261 3,348 87 2.6% 3,301 5,752 5,752 5,447 Infrastructure CostsHotel Services, Laundry & Cleaning 209 220 11 5.0% 214 1,514 1,572 58 3.7% 1,544 2,687 2,687 2,615 Facilities 247 269 22 8.2% 268 1,821 1,909 88 4.6% 1,901 3,270 3,270 3,271 Transport 76 93 17 18.3% 73 611 636 25 3.9% 576 1,101 1,101 1,021 IT Systems & Communication 82 101 19 18.8% 90 631 707 76 10.7% 667 1,213 1,213 1,144 Interest 182 177 (5) (2.8%) 165 1,339 1,239 (100) (8.1%) 1,146 2,128 2,128 2,002 Professional Fees & Expenses 16 30 14 46.7% 22 176 209 33 15.8% 153 358 358 244 Other Operating Costs 118 132 14 10.6% 124 928 932 4 0.4% 920 1,600 1,600 1,668

930 1,022 92 9.0% 956 7,020 7,204 184 2.6% 6,907 12,357 12,357 11,965

Expenses Total 4,502 4,625 123 2.7% 4,355 31,488 32,224 736 2.3% 30,311 55,207 55,307 52,428

Allocated from Governance & Admin 78 78 0 0.0% 79 546 546 0 0.0% 541 936 936 936 Surplus (Deficit) (452) (340) (112) 32.9% (116) (2,483) (2,228) (255) 11.4% (1,073) (4,227) (3,927) (1,351)


DHB GOVERNANCE AND ADMIN - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF JANUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget Last Full Yr

Revenue 86 85 1 1.6% 84 635 587 48 8.2% 578 1,008 1,008 997

Personnel CostsManagement / Admin 85 92 7 7.6% 58 577 634 57 9.0% 478 1,089 1,089 916

Outsourced Services 15 12 (3) (25.0%) 14 97 86 (11) (12.8%) 95 149 149 161

Infrastructure Costs 0 Transport 3 6 3 51.6% 2 41 43 2 5.5% 36 75 75 88 IT Systems & Communication 0 0 0 100.0% 0 0 3 3 100.0% 2 5 5 4 Professional Fees & Expenses 8 20 12 60.6% 11 95 143 48 33.6% 115 248 248 220 Other Operating Costs 14 13 (1) (10.2%) 18 80 90 10 11.0% 90 154 154 126 Democracy 15 29 14 48.6% 17 159 204 45 22.2% 120 350 350 216

40 69 29 41.9% 48 375 484 109 22.5% 363 832 832 654

Expenses Total 140 173 33 19.0% 120 1,049 1,204 155 12.8% 936 2,070 2,070 1,731

Allocated to Provider (78) (78) 0 0.0% (79) (546) (546) 0 0.0% (541) (936) (936) (936)Surplus (Deficit) 24 (10) 34 (336.8%) 43 132 (71) 203 (286.5%) 183 (126) (126) 202

DHB FUNDER ARM - STATEMENT OF FINANCIAL PERFORMANCE FOR THE MONTH OF JANUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD Forecast Full Budget YTD ActualPersonal HealthFunding Received 4,549 4,329 220 5.1% 4,202 31,158 30,303 855 2.8% 29,607 51,948 51,948 52,590 Provider Payments (4,240) (4,258) 18 (0.4%) (4,236) (29,714) (29,807) 93 (0.3%) (29,747) (51,097) (51,097) (52,043)

309 71 238 335.9% (34) 1,444 496 948 191.0% (140) 851 851 547 Mental HealthFunding Received 795 794 1 0.1% 831 5,565 5,560 5 0.1% 5,403 9,532 9,532 9,268 Provider Payments (777) (794) 17 (2.2%) (886) (5,552) (5,561) 9 (0.2%) (5,376) (9,533) (9,533) (9,259)

18 (0) 18 (38963.6%) (55) 13 (0) 13 (4109.7%) 27 (2) (1) 9 Disability SupportFunding Received 802 834 (32) (3.8%) 809 5,669 5,836 (167) (2.9%) 3,234 10,005 10,005 7,277 Provider Payments (648) (790) 142 (17.9%) (702) (5,542) (5,528) (14) 0.2% (3,128) (9,477) (9,477) (7,202)

154 44 110 250.0% 107 127 308 (181) (58.8%) 106 529 528 75

Funds ManagementFunding Received 86 83 3 4.0% 84 602 579 23 4.0% 577 992 992 997 Interest on Funds Account 30 0 30 0.0% 7 154 0 154 0.0% 36 0 0 81

Allocation to DHB Governance (86) (83) (3) 4.0% (84) (602) (579) (23) 4.0% (577) (992) (992) (997)30 0 30 0.0% 7 154 0 154 0.0% 36 0 0 81

TotalsTotal Funds Revenue 6,262 6,040 222 3.7% 5,933 43,148 42,278 870 2.1% 38,856 72,477 72,477 70,213 Total Funds Expenditure (5,751) (5,925) 174 (2.9%) (5,908) (41,410) (41,474) 64 (0.2%) (38,828) (71,099) (71,099) (69,501)Surplus (Deficit) 511 115 396 345.0% 25 1,738 804 934 116.2% 28 1,377 1,378 712


DHB CONSOLIDATED - STATEMENT OF FINANCIAL POSITION AS AT JANUARY 2005

Actual Budget Variance Variance Last Yr Act

Current AssetsCash 2,746 3,096 (350) (11.3%) 2,422 Short term Investments 2,256 1,256 1,000 79.6% 906 Debtors & Prepayments 6,649 6,937 (288) (4.2%) 6,223 Inventory 604 578 26 4.5% 626 Assets for Sale 210 210 0 0.0% 364

12,465 12,077 388 3.2% 10,541 Non Current AssetsLand & Buildings 19,626 20,395 (769) (3.8%) 20,774 Equipment (incl IT) 5,386 5,179 207 4.0% 5,080 Vehicles 88 120 (32) (26.7%) 141 Investments 2 0 2 0.0% 2

25,102 25,694 (592) (2.3%) 25,997 Current LiabilitiesAccounts Payable 6,867 6,127 740 12.1% 7,570 Employee Entittlements 3,943 3,897 46 1.2% 3,654 Current Portion of Term Loans 11,284 41 11,243 27422.0% 11,547

22,094 10,065 12,029 119.5% 22,771

Net Funds Employed 15,473 27,706 (12,233) (44.2%) 13,767

Term LiabilitiesEmployee Entittlements 2,200 2,120 80 3.8% 2,175 Other Term Liabilities 6 11,201 (11,195) (99.9%) 215

2,206 13,321 (11,115) (83.4%) 2,390 Crown EquityCrown Equity 43,147 45,147 (2,000) (4.4%) 41,130 Retained Earnings (29,923) (30,810) 887 (2.9%) (29,798)Trust Funds 43 45 (2) (4.4%) 45

13,267 14,382 (1,115) (7.8%) 11,377

Net Funds Employed 15,473 27,703 (12,230) (44.1%) 13,767


DHB CONSOLIDATED - STATEMENT OF CASHFLOWS FOR THE MONTH OF JANUARY 2005

Actual Budget Variance Variance Last Yr Act YTD Actual YTD Budget Variance Variance Last YTD

Operating ActivitiesOperating Receipts 623 6,684 (6,061) (90.7%) 3,616 46,023 46,405 (382) (0.8%) 76,276

Payments to Personnel 2,646 2,925 279 9.5% 2,426 18,615 19,827 1,212 6.1% 31,364 Payments to Providers 1,126 1,225 99 8.1% 3,932 6,837 8,937 2,100 23.5% 12,879 Interest & Capital Charge 127 732 605 82.7% 1 2,026 2,714 688 25.4% 1,104 Payments to Suppliers, GST, etc 4,285 2,359 (1,926) (81.7%) 2,806 18,638 17,137 (1,501) (8.8%) 27,314 Operating Payments 8,184 7,241 (943) (13.0%) 9,165 46,116 48,615 2,499 5.1% 72,661 Net Cashflow from Operating (7,561) (557) (7,004) 1257.1% (5,549) (93) (2,210) 2,117 (95.8%) 3,615

Investing ActivitiesSale of Fixed Assets 0 0 0 0.0% 0 0 0 0 0.0% (26)Increase (Decrease) in Investments 0 0 0 0.0% 0 1,000 (2) (1,002) 50100.0% 350 Purchase of Fixed Assets 45 220 175 79.6% 64 1,101 1,540 439 28.5% 1,632 Net Cashflow from Investing (45) (220) 175 (79.6%) (64) (2,101) (1,538) (563) 36.6% (2,008)

Financing ActivitiesFinancing ReceiptsEquity Injections 0 2,000 (2,000) (100.0%) 0 0 2,000 (2,000) (100.0%) 2,078 Loans Raised 0 0 0 0.0% 0 0 0 0 0.0% 11,195

0 2,000 (2,000) (100.0%) 0 0 2,000 (2,000) (100.0%) 13,273 Financing PaymentsRepaid Debt 2 9 7 77.8% 5 72 168 96 57.1% 11,688

2 9 7 77.8% 5 72 168 96 57.1% 11,688 Net Cashflow from Financing (2) 1,991 (1,993) (100.1%) (5) (72) 1,832 (1,904) (103.9%) 1,585

Opening Cash 10,354 1,883 8,471 450.0% 8,041 5,012 5,012 0 0.0% 1,820 Net Cashflow (7,608) 1,214 (8,822) (726.9%) (5,618) (2,266) (1,916) (350) 18.3% 3,192 Closing Cash 2,746 3,096 (350) (11.3%) 2,422 2,746 3,096 (350) (11.3%) 5,012


WEST COAST DISTRICT HEALTH BOARD DEBT REGISTER

Lender's name RHMU BNZ Toyota BNZLoan Identified As Renewal CT Scanner Lease OverdraftDebt Amount - face value $11,195,000 $104,562 $100,724 $3,600,000Instrument type Term Loan Amortised Loan Lease OverdraftFixed / Floating interest rate Fixed Fixed Fixed FloatingFixed rate 6.71% 8.64% VariousFloating rate base and margin BKBM+0.225%Interest payment frequency Quarterly Quarterly Monthly DailyCovenants (Debt to Debt + Equity ratio) 55% 55% 55%Covenants (Interest Cover EBID) 1.3x 2.5x 3.0x

Next Payment Due When 31/3/05 28/2/05 17th of month any time How much $11,195,000 $26,140 $3,834 any amount

Next Rollover / Refinance Due When 31/3/05 N/A How much $11,195,000 N/A Plan Refinance RHMU Pay off over 5 years

3 month roll over

February 2004 BNZ CT Scanner 26,140$ March 2005 Term Loan Fixed 11,195,000$

Interest Rate HedgingThe West Coast DHB has engaged in a 5 year interest rate swap, effectively fixing the refinancing rate of $4.3M of its RHMUloan at 6.78% per annum for 5 years commencing 1 July 2004.This swap is effectively "in the money" as it has locked in a fixed 5 year rate which is cheaper than the 5 year rate that wouldhave been offered by RHMU.

Upcoming Loan Repayments

(Excludes Overdraft and Lease Payments)

AS AT JANUARY 2005


Fortnight Ended 22/02/2005 08/03/2005 22/03/2005 05/04/2005 19/04/2005 03/05/2005 17/05/2005 31/05/2005 14/06/2005

Opening Balance 2,559,506 774,644 3,482,092 537,715 1,449,027 716,240 (2,236,760) (226,615) (2,220,755)

Cash InRevenue 343,765 3,828,588 823,623 3,966,312 897,214 250,000 3,940,144 950,000 4,790,144 Loan Funds - - - - - - - - - Equity 1,000,000 - - - - 1,680,000 - 1,000,000 - Asset Sales - - - - - - - - -

Cash OutPayroll Costs 890,432 870,000 880,000 1,030,000 980,000 870,000 880,000 880,000 860,000 Creditors Payments 1,333,195 300,000 1,878,000 750,000 650,000 1,678,000 750,000 1,878,000 750,000 GST - 400,000- - 325,000 - 300,000 - 300,000 - PAYE / ACC 300,000 325,000 325,000 300,000 - 300,000 300,000 300,000 325,000 Loan & Interest Pmts - 26,140 - - - - - 26,140 - Capex 605,000 - 685,000 650,000 - 1,735,000 - 560,000 -

Closing Balance 774,644 3,482,092 537,715 1,449,027 716,240 (2,236,760) (226,615) (2,220,755) 634,389

AssumptionsThat dementia unit construction will commence in AprilThat $1M of deficit support will be received in late FebruaryThat $1.68M of deficit support will be received in late AprilThat $1M of equity for development (the dementia unit) will be received in late May

WEST COAST DISTRICT HEALTH BOARDCASH FLOW FORECAST AS AT 17 FEBRUARY 2005


WEST COAST DISTRICT HEALTH BOARDDIRECTORS SCHEDULE

SUMMARY OF EXPENDITURE YEAR TO DATE TO 31 JANUARY 2005Note: Figures GST Exclusive

Actual Budget VarianceAnnual Budget

Directors Fees 98,479 108,500 (10,021) 186,000

Directors ExpensesTravel Expenses 15,912 23,331 (7,419) 39,996Other 8,421 2,912 5,509 4,992Total 24,333 26,243 (1,910) 44,988

Advisory Committee Costs 17,921 36,169 (18,248) 62,004Election Costs 36,064 23,331 12,733 39,996

TOTAL EXPENSES 78,318 85,743 (7,425) 146,988

WCDHB BOARD OF DIRECTORS FEES & EXPENSES $176,797 $194,243 ($17,446) $332,988


Financial Performance Indicators for January 2005

Net result after tax $000 83 -236 -48

Net Result/Net Funds Employed % (Annualised) % 6.4 -10.2 -4.2

Earnings* /Net Funds Employed % (Annualised) % 37.4 7.4 16.8

Revenue/Net Funds Employed (Annualised) times 5.4 2.9 5.7

Debt** /Debt + Equity (BNZ definition) % 64.7 61.9 68.9

Debt*** /Debt + Equity (CFA definition) % 46.0 43.9 50.8

Revenue/Fixed Assets (Annualised) times 3.3 3.1 3.0

Interest cover times 7.4 2.3 6.2

** Debt exclusive of Overdraft - Bank of New Zealand definition of Debt / Debt + Equity*** Arranged Debt inclusive of Overdraft - Crown Funding Agency definition of Debt / Debt + Equity

Month Actual

Month Budget

* Earnings = operating surplus/(deficit) before interest, capital charge, tax and depreciation.

Month Last Yr

NOTES 1 Net result as a percentage of Net Funds Employed-

Provides a projected annual return on Long Term Funding based on current months performance.

2 Earning / Net Funds Employed-

Provides a projected annual return, from normal operations, as a percentage of Long Term Funding, based on current months performance.

3 Debt to Debt + Equity Ratio

A measure that indicates the extent to which assets are financed by debt (excluding any overdraft balance). (This is consistent with the Bank of New Zealand definition of debt).

4 Interest Cover-

Shows ability to meet interest expense from Operating Surplus. Calculated as: operating surplus before interest, capital charge and depreciation divided by interest expense.


GLOSSARY OF FINANCIAL TERMS Assets - Economic resources owned or controlled by the WCDHB, as a result of past transactions, for the entity’s future benefit.

Current Assets are those assets that are expected to be converted into cash in the next accounting period, i.e. within the next 12 months.

Non Current Assets are long-term assets that are held for use in the productive process and are not expected to be converted into cash in the next accounting period. CAPEX (Capital Expenditure) - The Purchase of non-current assets. Capital Charge – All DHBs are required to pay capital charge in order to recognize the cost of financial resources vested in them by the Crown. Capital Charge is levied at 11% per annum on the DHBs Crown equity balance. Capital charge is equivalent to the value of dividends and capital gains that shareholders would normally require from a private organization. Debt - An obligation of WCDHB to pay a sum of money within a specified time.

Debt to Debt + Equity Ratio - A measure that indicates the extent to which assets are financed by debt. (Excluding any overdraft balance). (This is consistent with the Bank of New Zealand definition of debt).

Equity (Owners Equity, Shareholders Funds) - A claim against the assets of the WCDHB. Represents a residual claim to all assets not claimed by holders of external liabilities. FTE - Full Time Equivalent employees

Interest Cover - Shows ability to meet interest expense from Operating Surplus. Calculated as: Operating surplus before interest, tax & depreciation divided by interest expense. Liabilities - An amount owed by WCDHB to non-owners. Current Liabilities are obligations to pay an amount or perform a service in the next accounting period, i.e. within the next 12 months. Non-Current Liabilities are those obligations requiring settlement beyond the next accounting period. Net Funds Employed - The total of Non current Liabilities plus Total Shareholders’ Funds.

NHPIDE (Nursing Hours Per Inpatient Day Equivalent) - Nursing Hours is the sum of total hours spent in direct patient care over each shift. Calculated as: Actual Nurse hours divided by total inpatient bed days.

Operating Surplus- Surplus attributable to ordinary and continuing operations. Leave Liability – The total amount of accrued leave benefits owing to employees. Covers Annual, Long Service and Parental leave as well as Retirement Gratuities and Lieu days owing.

Author: Chief Financial Manager – 17 February 2005


WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEETINGS

PLEASE NOTE: THE MINUTES OF THE COMMUNITY AND PUBLIC HEALTH

ADVISORY COMMITTEE MEETING HELD ON 16 FEBRUARY 2005 WILL BE SENT UNDER SEPARATE COVER.


DRAFT MINUTES HOSPITAL ADVISORY COMMITTEE MEETING HELD FRIDAY 28 JANUARY 2005 AT 8:02AM

IN THE BOARDROOM, CORPORATE OFFICE, GREYMOUTH

PRESENT:

Christine Robertson, Chair Glenys Baldick, Deputy Chair Brian Wilkinson, WCDHB Member Gregor Coster, WCDHB Chairman Barbara Beckford Kathryn Cannan Margaret Moir Richard Wallace (for part)

IN ATTENDANCE:

John Luhrs, Chief Executive (for part) Ebel Kremer, General Manager Operations Wayne Champion, Chief Financial Manager Malcolm Stuart Julie Kilkelly Alison McDougall, Minute Secretary

APOLOGIES: Gregor Coster (lateness) John Luhrs (lateness)

1. WELCOME, APOLOGIES & AGENDA

The Chair welcomed everyone to the meeting and introduced the two new members of the Committee, Brian Wilkinson and Glenys Baldick, who is also the Deputy Chair.

Gregor Coster joined the meeting at 8:04am

2. DISCLOSURES OF ADVISORY COMMITTEE MEMBERS’ INTERESTS

Gregor Coster • Remove, “Trustee – The University of Auckland Primary Health Care Trust • Amend, “Chairman - New Zealand Institute of Rural Health” • Remove, “Trustee – Goodfellow Foundation”


Barbara Beckford

• Add, “Member - National Ethics Committee” Christine Robertson • Amend, “Husband is Deputy Chair of Coast Care Trust…”

3. MINUTES OF THE LAST MEETING

• Page 10, Item 4, seventh paragraph, second sentence should now read, “…urgent cases, 6 months waiting time for semi urgent…”

Moved: Barbara Beckford, Seconded: Kathryn Cannan

It was RESOLVED that the Minutes of the Hospital Advisory Committee Meeting held Friday 3 December 2004, were a true and accurate record of the meeting subject to the above amendments.

4. MATTERS ARISING / ACTION & RESPONSIBILITY LIST

Discuss a morning tea or lunch with clinicians, Board, HAC and EMT members with EMT. Completed. The Chair queried if there is a plan for regular meetings. The Chief Executive advised that meetings could be held on a six monthly or quarterly basis. Gregor Coster suggested a six monthly meeting with clinicians would be appropriate. Seek further clarification from the South Island Advocacy Service on the figures provided to HAC at the Service’s presentation at the August meeting. The Chief Executive advised this item is in progress.

Richard Wallace joined the meeting at 8:17am

Provide an update on progress with Nurse Practitioners locally and on a national level. Due April 2005. Provide an update on the role of the GP Liaison Officer prior to the position’s March review. Due March 2005. Provide a report on implementation of the evaluation tool for Trendcare along with the measures to be used in the evaluation. March 2005. Provide the first quarterly report (high level) on variances between services and possible reasons for the variances. The General Manager Operations tabled the report.


Prepare a report with information on the impact of Credentialling and HPCA on the provider arm. Due March 2005. Provide exception reports on above as issues emerge through the credentialling process in relation to the HPCA. Ongoing and as needed. Provide a breakdown of maternity figures in Greymouth on the proportion of primary and secondary deliveries and the number of caesareans and inductions. Agenda item. Ensure any new abbreviations used in papers are added to the list provided. In progress. Clarify the potential conflict of interest for a training provider in terms of their ability to be both the identifier of unmet needs and a possible provider. Included in papers. Provide reasons why patients, some urgent, are waiting 18 months to be seen in some service areas. Included in papers. Agenda Items from the previous meeting. The Chair advised that the effect of IDFs on the provider arm was included on the Agenda for the previous meeting. This is an issue that is to go to the Board first, which will take place sometime in first half of this year. The Board may or may not identify issues for the provider arm. The Chair advised she discussed the HNA with the General Manager Planning and Funding. The HNA is underway and only available electronically at the moment. The General Manager Planning and Funding provided information for timing of planning processes at yesterday’s workshop. The General Manager Planning and Funding would like the draft DSP/associated processes to be prepared and reviewed by the Advisory Committees. There will then be opportunities to feed into other documents. In order to meet the February deadline the Chair suggested that the General Manager Planning and Funding should send out the draft consultation process document to HAC members, who are then to provide feedback to the Chair, who will collate responses and forward to Planning and Funding. The Chair will ask for Board approval to alter the HAC timetable to allow input to occur at later stages.

5. CORRESPONDENCE

Moved: Margaret Moir, Seconded: Barbara Beckford It was RESOLVED that the correspondence Inwards was accepted and Outwards endorsed.

6. STRATEGIC GOVERNANCE MATTERS

6.1 Draft Health Needs Assessment Regional Project 2004


Resolved as per discussion in Matters Arising.

6.2 Trendcare

The Chair noted at the last meeting that it was decided that HAC now requires quarterly reports on high level variations between services and any possible reasons for these variances. The General Manager Operations advised the tabled paper is very high level and identifies some of the inefficiencies identified, particularly in CCU and Parfitt, mainly as they are such a high acuity areas. The two new Nurse Managers are focussing more on nursing hours per patient, particularly utilisation throughout the hospital and moving away from the silo approach. The General Manager Operations noted that a Committee member has suggested it may be useful to have an occupancy line and this will be included for the next report. A Committee member suggested a line should also be included for resourced beds. The Chief Executive advised that resourced beds are the number of beds being staffed whether they are occupied or not. The Committee member suggested this issue needs to be monitored by HAC, with points identified being referred to the Board The committee decided it would be good for HAC to consider configuration issues in general in its advisory role to the Board. The Chair will raise these items with the Board at today’s meeting seeking approval for committee involvement A Committee member suggested that all these issues could be included in a Secondary Care Plan. The Chair advised she will seek approval from the Board to pursue development of the Secondary Care Plan, with the possibility of a scoping paper presented to HAC for the April meeting and consideration given to a longer meeting to allow discussion.

7. CHIEF EXECUTIVE’S REPORT

7.1 Recruitment

The Chief Executive advised Management has started on a positive and “aggressive” marketing campaign for GPs based on the new SMO MECA. The new MECA means vocationally registered GPs are included on the specialist scale. The first advertisement in line with the MECA appeared in the 26 January issue of NZ Doctor magazine as an A4 sized advertisement. The Chief Executive acknowledged the input of the Board Chairman and EMT in production of the advertisement, as well as the Rural GP Network. The website advertising through the Rural GP Network has also been revisited and Management has agreed to blind advertisements in US and Canadian publications. A Committee member queried if the GPs currently employed by WCDHB are being offered the same package as advertised. The Chief Executive advised that vocationally registered WCDHB GPs who are members of ASMS are aware they will be entitled to the new rates. WCDHB has also advised non-ASMS members they are willing to negotiate. WCDHB’s non vocationally registered GPs are already paid at a rate higher than the scale in the agreement. The Committee member advised it would not be appropriate to be offering greater salaries to locums than the permanent staff. The Chief Executive advised that locums are employed for a short time and they are paid the locum rate which is constantly changing depending on the individual.

7.2 WCPHO Funding

A Committee member queried progress on moving the PHO from interim to access funding. The Chief Executive advised a submission has been made to the Ministry of Health by


WCDHB on behalf of the WCPHO. A presentation was given to Ministry of Health officials by the General Manager Planning and Funding and GP Liaison Officer and was positively received, although at this stage no formal response has been received.

7.3 Neighbourhood Nursing Innovation

A Committee member requested a formal update on the Neighbourhood Nursing Project. The Chief Executive advised Management should be able to provide a detailed update for the next meeting after the management of change process is complete.

7.4 Cervical Screening Services

The percentage of smears taken on the West Coast was queried and a Committee member noted the figure for the West Coast is 64% ,the lowest in the country. The Committee member advised she has investigated this figure and notes that most of the smears are taken by GP practices. She has requested the issue as an agenda item for the next CPHAC meeting. It was suggested that the matter be noted to the Board and the Board may then decide to refer the matter to CPHAC and the WCPHO.

7.5 PHO Progress

A Committee member queried if there is an implication for the provider arm with a private GP in Greymouth leaving the Coast. The Chief Executive advised it is a funder issue in terms of the GP being the owner of a practice that is a member of the PHO. The Chief Executive advised he recently met with the GP, Grey District Council Mayor and Chair of the WCPHO and this will see a positive initiative with a health centre being proposed for Greymouth. Gregor Coster noted he has discussed the matter with Damien O’Connor and Damien has indicated support for WCDHB plans to develop GP provision in Greymouth and would publicly support an application for capital funding. The matter will be discussed by the Board.

7.6 Further Information Requested at the Previous Meeting

7.6.1 Maternity Figures

A Committee member queried the period of time measured in the data. The General Manager Operations will clarify this for the next meeting. The high rate for caesareans was noted. The Chief Executive advised that in the most recent MoH Hospital Benchmark Report, the WCHDB is consistent on rates. HAC discussed whether it would be appropriate to seek further information on caesarean rates. The Chair requested Management provide 12 month retrospective data for the April meeting.

Action: General Manager Operations

7.6.2 Waiting List Times

A Committee member noted the waiting time for colonoscopies appears to be high and requested clarification of figures. Malcolm Stuart noted that the figures may relate to surveillance colonoscopies which are entered into the system for each year even though the patient may only need the procedure every five years. The patient remains in the system so they do not fall off the list. A Committee member advised these patients should not be on the waiting list as they are elective and would like this process benchmarked with other DHBs to ensure the information is being represented correctly.

Action: General Manager Operations


Moved: Barbara Beckford, Seconded: Margaret Moir It was RESOLVED to accept the Chief Executive’s report.

8. FINANCE REPORT

The Chief Financial Manager advised that the report produced for this month’s papers includes the accounts for November. The December accounts will be reported in the next meeting papers. The Chief Financial Manager advised that the 2004/05 DAP was accepted in December last year and the budget has been updated to reflect that. Revenue is $500k under budget ytd with the ytd result for whole DHB deficit provider revenue is down due to under production as a result of a lack of key clinical staff. The November result is worse than budget primarily due to the impact of the Holidays Act and the cost of locums and transfers. Underproduction for December is at zero despite theatre shutdown over Christmas and the provider arm should achieve throughputs for the year. The overall deficit forecast for the year is now $300k worse than budget which is an improvement on the initial forecast of $500k worse than budget. A Committee member noted that A&E attendances are up and queried if this can be predicted. The General Manager Operations advised it is dependent on the number of GPs in the area and subsequent overflow on A&E. The Chair queried if signing of the DAP has done anything to ensure the DHB has a longer term for the loan roll over. The Chief Financial Manager advised the loan was rolled over in December for three months. The next roll over may be for 6 months as the DAP only covers the 04/05 year and there is no funding certainty for the 05/06 year. The CFA is currently undertaking a review of the WCDHB’s financial position as part of its loan review. A Committee member noted the Capex budget is exceeded for the ytd. The Chief Financial Manager advised that overspend relates to unbudgeted expenditure on PACS of around $600k. This was originally planned for the following year but brought forward due to the situation with orthopaedics.

Moved: Christine Robertson, Seconded: Brian Wilkinson It was RESOLVED to accept the Finance report.

9. OPERATIONAL INDICATORS

A Committee member noted ophthalmology figures are included with outpatients and there is a waiting list over 18 months. The General Manager Operations advised there were difficulties with CDHB providing service and NMDHB were approached to provide service. An arrangement was made with a private provider from Nelson provides a service in Greymouth and Buller. CDHB have requested WCDHB revisit the ophthalmology agreement and the General Manager Operations and Chief Executive are visiting CDHB to discuss. Services are also being provided on the surgical bus. The Chair requested ophthalmology figures be provided in a graph for it’s own speciality and include a comment to explain the graph.


10. KEY ISSUES / ITEMS OF INTEREST TO REPORT TO THE BOARD

10.1 Recommendations to the Board

HAC recommends that six monthly meetings be organised for Board and HAC members with management and senior clinicians.

10.2 Seeking Approval for Further Consideration

• HAC seeks approval to advance the development of a Secondary Care Plan starting with a scoping paper in April.

• HAC seeks permission to change dates and duration of meetings, if necessary, to accommodate deliberation on/input into the DSP and Secondary Care Plan while maintaining the ability to monitor operational/financial figures in a timely fashion.

10.3 Reporting Back on Board Referred Items

• HAC has received the first quarterly report on Trendcare (high level variances between services) and will continue to monitor the key issue identified. There appears to be a silo approach to staff utilisation. Action is in place to reduce this and is likely to be reflected in the data in the next quarter’s report which will also have some refinements to add value to the report.

10.4 Other Items of Interest

• HAC noted the low cervical screening rate for the West Coast and recommends the Board consider further action be taken as both funder and provider of services.

• The Chief Financial Manager is forecasting overall volumes to be on target for year end with costs slightly up on budget.

• HAC is delighted by the proactive approach taken by Management in recruitment of GPs.

Kathryn Cannan left the meeting at 9:56am

11. NEXT MEETING DATE

The next meeting will be held on Friday 1 April 2005 at 8:00am in the Boardroom, Corporate Office, Greymouth. The Chief Executive noted this will be his last HAC meeting before his departure from WCDHB and recorded his thanks for the support of the Committee. The Chair recorded her thanks to the Chief Executive for the support he has provided in progressing the work of the Committee.

12. ATTENDANCE AND ADMINISTRATION FORMS

Actioned.

There being no further business to discuss the meeting concluded at 9:59am


DRAFT MINUTES OF THE DISABILITY SERVICES ADVISORY COMMITTEE MEETING

HELD ON WEDNESDAY 16 FEBRUARY 2005 IN THE BOARD ROOM, CORPORATE

OFFICE COMMENCING AT 8.33 AM PRESENT: John Vaile, Chairman, WCDHB member

Mohammed Shahadat, Deputy Chair, WCDHB member Elinor Stratford Dianne Lewis Maureen Frankpitt Gloria Hammond

IN ATTENDANCE: Hecta Williams, General Manager Mental Health Melanie Penny, Planning & Funding Analysis

Bianca Kramer, Minute Recorder APOLOGIES: Gregor Coster, Chair WCDHB

Christine Robertson, WCDHB Kevin Hague, General Manager Planning & Funding 1. WELCOME / APOLOGIES The Chairman welcomed everyone to the meeting. 2. DISCLOSURE OF INTEREST No change 3. AGENDA CHECK No change 4. MINUTES OF LAST MEETING

Page 5 Under the heading “Disclosure of Interest” – Wife no longer works for DHB as unresolved employment issues, should read as – has unresolved

Page 6 Under the heading Item 13, 3rd paragraph, change the wording to read “It might be possible for Active West Coast to administer a fund if available, also correct the spelling of Halberg Trust Under the heading Item 15 in the first paragraph, change effecting to affecting.

Page 7 Under the heading “Action and Responsibility List”, should read as – copies of to have an ordinary life

Moved: Elinor Stratford , Seconded: Maureen Frankpitt


It was RESOLVED that the Minutes of the Disability Services Advisory Committee meeting held 15 December 2004 were a true and correct record following the amendments listed as above.

5. MATTERS ARISING FROM LAST MEETING There were no matters arising from the minutes. 6. ACTION AND RESPONSIBILITY LIST

Copies of “To have an ordinary life” were handed out to the committee members. The Chairman will follow up the letter inviting the West Coast PHO to attend the next

DSAC meeting 7. QUALITY & SAFETY PROJECT

The report will be placed on the agenda for discussion at the next meeting. 8. DEMENTIA UNIT UDATE

The General Manager Mental Health updated the committee on the progress made. A Canterbury District Health Board team are to the lead project, (the same team used for CHCH women’s hospital), subject to final signoff. Subject to any unforeseen factors, the Dementia Unit should be in place by March 2006. One possible hold up would be the availability of contractors, as there is so much work at the moment contractors do not appear to be tendering for the bigger projects. Concept plan – will be reviewed after an Architect has been appointed. Costs have increased quite significantly. Does the concept plan now meet the needs? a user group process. Will be based on what’s best for the patients. When formal project management is in place next step is to tender out to find an Architect. Next comes agreeing on design and adjusted cost. Then funding will be worked on. Steering groups have been set up to work through their processes, need to align the mental health and older persons, they will develop service provision frame work. Workgroup is being set up this week. General Manager Mental Health attended a meeting with the Ministry of Health last week and discussed the project, including the increasing cost, and what is needed to do ensure funding. The staff at Seaview have been updated on the progress and management of change issues are currently being worked through with them. The transporting of staff from Hokitika to the new unit in Greymouth will follow the same format as when the in-patient unit was relocated to Grey Base Hospital. This will also depend on the number of staff travelling.

9. INCLUSION OF MENTAL HEALTH ISSUES INTO DISABILITY SERVICES ADVISORY

COMMITTEE

Mental Health Advisory Committee (MHAC) has been disestablished. The three remaining advisory committees will be pick-up sections relevant to their own areas. Community Pubic Health Advisory Committee (CPHAC) will takeover Primary Mental Health DSAC will take over Secondary, Community, disability and Hospital Advisory Committee (HAC) will monitor the provider arm services. MHAC members, report to board before term of present


members, sitting members will be asked to reapply, so that we have continuity on the committee.

10. DISTRICT STRATEGIC PLAN

Melanie Penny, Planning & Funding Analyst, gave explanation of the draft document and recommend it be used as a loose guide. Any suggestions are to be forwarded to Bianca Kramer as soon as possible.

11. REGIONAL LAND TRANSPORT COMMITTEE

To be carried over until the next meeting 12. WATER FLUORIDATION

Melanie Penny, Planning & Funding Analyst, spoke to the committee about the Water Fluoridation project currently being worked on. It has been established that those with a disability do have worse oral health, a number of reasons where given for this, not always a fault of the individual. The high cost of dental treatment is prohibitive to a large number of people, and then there is the need for further visits. With Water fluoridation, you don’t have to remember to buy it and there is no need to change behaviour patterns to benefit. Fluoridation works well for those with higher decay rates, for those groups it can reduce decay by half. Water Fluoridation is cheap, Ministry of Health provide 100% cover for the cost of setting up and then it is approximately 50c per year per person to carry on. Originally, it was felt Councils were against but times have changed and information is more readily available. Planning & Funding Analyst said they have meetings arranged to give their presentation to council meetings, they will be visiting Westland District Council tomorrow. This presentation was given to the Board and approved. 80% of the population have their own natural teeth, fluoridation is not only beneficial to children. Those not on reticulated water, will still benefit from the ‘halo effect’, children going to school, adults going to work and drinking fluoridated water (tea, coffee etc) while there. Some water filters do filter the fluoride out, at this stage the information as to which ones was not available.

13. GENERAL BUSINESS

This item was not on the agenda, Committee member just wanted to make a comment regarding quality and safety and barrier free audits. The committee member would like the Board to consider having a barrier free audit run so any changes made can be barrier free. A barrier free audit looks at heights of light switches, safety measures for those who are visually and hearing impaired (fire alarms etc), physical barriers toilets etc. 1:5 have some form of disability and they are not always visible. Standards need to be taken into account in the planning stage, building standards for disabled and barrier free standards are two different things, barrier free standards are tighter than the building standards.


That DSAC recommends that the Board undertakes a barrier free audit of all its facilities, including incorporating barrier free principles into the planning of any new building facilities and alterations.

Another point brought up was “What is the DHB doing in terms of disability training for staff?” Go back and review at the plan and see what it indicates. This is to be placed on the agenda for the next meeting.

14. NEXT MEETING

Wednesday 4 May 2005 15. ATTENDANCE AND ADMINISTRATION FORM

The Chairman asked the committee to fill in the attendance and administration forms and return them today.

There being no further business the meeting closed at 9.45am


ADVISORY COMMITTEE MEMBERSHIP


RECOMMENDATIONS TO WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEMBERSHIP MARCH 2005

From Chairs of the Advisory Committees: J Kilkelly, C Robertson and J Vaile The Chairs of the Board’s Advisory Committees have identified several points in relation to Advisory Committee membership. 1. Due to the expiry of the terms of some current community appointed committee members

there will be the following vacancies as of 01/05/05:

− HAC 4 ( R.Wallace, M, Moir, K. Cannan, B. Beckford ) − DSAC 3 ( M. Frankpitt, E. Stratford, G. Hammond ) − CPHAC 2 ( B.Greer, L. Mason )

2. There are some of the above who have served one or more 3 year terms. There is no

statutory barrier to re-appointing community Advisory Committee members for a further term. However, the Board has indicated that it wishes to give the community, as well as current members who have completed one or more 3 year terms, the opportunity to contribute to the work of the Board through appointment to its Committees. The Board has indicated its wish not to make further re-appointments without first carrying out the Board’s policy and procedure for obtaining Committee members.

3. Of the members whose term expires on 01/05/05, two (B. Beckford, HAC and B. Greer,

CPHAC) were appointed within the last 2 years with terms of appointment for less than 3 years.

4. There are two members of CPHAC (G. Wood and B. Beckford) the status of whom needs to

be clarified as well as their term of appointment. 5. During the earlier filling of a CPHAC vacancy, an unsuccessful candidate was asked if he

wanted to be contacted to apply for future Committee vacancies and he indicated that he would be interested.

6. There is a need to stagger the terms of appointment for the purpose of continuity. 7. The appointment process must ensure that all three Committees have at least one Maori

member. The Advisory Committee Chairs recommend that the Board: i. Extends to three years the current term of appointment of :

− B. Beckford, HAC, from 1/5/05 to 25/6/06 (appointed 25/6/03) − B. Greer, CPHAC, from 1/5/05 to 12/11/06 (appointed 12/11/03)

ii. Confirms that G. Wood, CPHAC is an ex officio member with the duration of his term being

tied to that of his office and


Confirms that B. Beckford, CPHAC, is an appointed member with the expiry date of September 07

iii. Proceeds to advertise for the following vacancies:

− HAC 3 members − DSAC 3 members − CPHAC 1 member

iv. Writes a letter to the current members whose term is not being extended:

− Thanking them for their service to the Committees on which they have served − Outlining the reason why they are not automatically being re-appointed − Inviting them to re-apply on the understanding that, in the event that there are more

applicants than vacancies, they will go through the appointment process with any other applicants as per the Board’s policy and procedures.

v. Invites the two community members who were serving on MHAC at the time of its demise, to

apply on the same basis as any current HAC, DSAC and CPHAC member whose membership has expired.

vi. Invites any member of the community/previous suitable candidates for vacancies whom it is

believed could contribute to the work of the committees, to apply making clear that their appointment will be subject to them successfully going through the appointment process.

vii. Makes the terms of appointment as follows:

− HAC 1 for 2 years and 2 for three years − DSAC 1 for 2 years and 2 for three years − CPHAC 1 for 3 years

viii. Ensures that each committee has at least one Maori member:

− HAC currently met By R. Wallace whose term expires 1/5/05 − DSAC may be met by appointing to DSAC the yet to be appointed Maori Board

member − CPHAC met by membership of Board member R. Bryant and if term of B. Greer is

extended

Author: Christine Robertson – 9 February 2005


PRIMARY MENTAL HEALTH STRATEGIC PLAN

RECOMMENDATION: THAT the West Coast District Health Board approve the Primary Mental Health Strategic

Plan, and the budget and activities associated with implementation.


PRIMARY MENTAL HEALTH STRATEGIC PLAN The WCDHB Primary Mental Health Strategic Plan outlines the strategic direction and recommended actions for developing services in primary care and in further integrating primary and secondary mental health service provision on the West Coast. The Strategic Plan has been developed based on national and international research, and considerable consultation with community organisations, individuals and service providers to meet the needs of the West Coast population, in line with Ministry of Health guidelines. Consultation identified a number of issues both in providing and accessing Primary Mental Health Services on the West Coast, which can be addressed developing strategies to: • Enhance and strengthen Primary Mental Heath including Alcohol and Other Drug Services, • Improve the Integration between Primary and Secondary Care providers, • Create a Mentally Healthy and Supportive Community • Improve Access to Primary Mental Health Care Pivotal to the implementation of the Plan is the development of an ‘Access West Coast’ Committee, to form the communication link required to develop an integrated Mental Health Service and to facilitate and monitor the implementation of the Primary Mental Health Strategic Plan. Further, the draft Plan has formed the basis of a successful PHO application for additional funding for primary mental health innovations, which will ensure that key strategies can be piloted within a short period of time. Implementation of the Plan is budgeted to cost $299,450 with $220,000 of new funding approved by the Ministry of Health for PHO Mental Health Innovations (for a 2 year pilot), and $60,000 anticipated to be funded through Services to Improve Access Funding. RECOMMENDATION: THAT the West Coast District Health Board approve the Primary Mental Health Strategic Plan, and the budget and activities associated with implementation. Hecta Williams Shona McLeod GM Mental Health Research & Planning Analyst


Primary Mental Health Strategic Plan

December 2005

West Coast District Health Board Primary Mental Health Strategic Plan February 2005

1

Primary Mental Health Strategic Plan

To develop a comprehensive Mental HCare through prom

intervention – secondaa

O

Enhance Primary MentServices

Strengthen Primary MeServices

Improve Integration be Create a Mentally Heal Improve Access to Prim

Strategy Priority

Access West Coast Establish First Primary Care Liaison Worker

High

Brief Intervention Service

High

Facilitate Improved Access to Primary Care through GP Link

High

Mäori Health Liaison Worker

High

Training and Education Medium – High

Family Counselling Service

Medium - High

Health Promotion Medium – High Shared Care Medium Discharge Planning Medium

Peer Support Medium Support Groups Medium

Objective: Ensure ImplementatiStrategic Plan

Mentally Healthy West Coast coeffective and integrated health pr

menta


Vision:

mmunities with fair and equitable access to omotion/prevention, primary and secondary l health services.

Aim:

ealth System with an integrated Continuum of otion – prevention – primary care – early

ry care – rehabilitation – long term care across ll diagnosis and severities.

bjectives:

al Heath including Alcohol and Other Drug

ntal Heath including Alcohol and Other Drug

tween Primary and Secondary Care thy and Supportive Community ary Mental Health Care

Responsibility Time frame

DHB and PHO April 2004 Access West Coast Employed by June

2004 Access West Coast Developed by August

2005 Secondary Service & Access West Coast

End of 2005

Access West Coast Scoping completed by December 2005

Access West Coast / Primary Care Liaison Worker

Begin August 2005

DHB to lead Begin by January 2005

DHB & CPH Finish by Dec 2006 Access West Coast Finish by Dec 2006 Secondary Service & Access West Coast

Finish by Dec 2006

Access West Coast Finish by Dec 2006 Access West Coast Finish by Dec 2006

on and Monitoring of the Primary Mental Health

2

Strategies: Access West Coast Activities: Establish an ‘Access West Coast’ Committee to

• Facilitate and monitor the implementation of the Primary Mental

Health Strategic Plan. • Form the communication link required to develop an integrated

Mental Health Service

Performance Indicators

• Committee established with representation from primary and secondary mental health providers and community stakeholder representation, including Maori

• Report to the West Coast District Health Board – through MHAC • Strategies in the Strategic Plan allocated to Access West Coast are

implemented successfully, including for Maori.

Priority • Establish First Responsibility • WCDHB and WCPHO Time Frame • Established April 2005

Objective: Strengthen Primary Mental Heath including Alcohol and Other Drug Services on the West Coast

Strategies: Mental Health and Alcohol and Other Drug Liaison Worker


3

Activities: • Establish a Mental Health and Alcohol and Other Drug Liaison Service, which is responsive to the needs of the community (including to Maori), to provide assistance to Primary Practitioners with patient management, screening, assessment, care planning, and referral for patients presenting with Mental Illness in General Practice.

• The Primary Practice Liaison worker should be targeted to assist

with the 3-17% of the population with a mild to severe mental illness, and will carry no caseload.

• The liaison worker would also provide training and education

opportunities for General Practitioners and Practices Nurses in both a formal and informal way, (and to Rural Nurse Specialists and other Primary Health Providers through formal training).

• The service should also create a much-needed vital link between

primary and secondary providers, providing a constant and dedicated presence in relation to the training of primary care providers in the provision and management of mental health patients.

• Alternative funding to pay General Practices a set fee for services

provided to each patient, including face to face consultations, phone contact with the liaison worker and any administration required should be investigated. This will ensure the that increased cost to practices of providing primary mental health services, which are nationally and internationally acknowledge to cost more (through more frequent visits, increased length of time required for consultations and increased practice nurse and GP time) are fairly compensated for.

• Referral Pathways will be clearly defined so that all groups of

providers know exactly where to refer to, which should ensure timely follow up.


• Working Links with primary and secondary providers, established and maintained

• Links with Mäori providers and within Maori communities

established and maintained

• Patients acceptability, and provider buy in to scheme

• Satisfaction with service by patients and providers

• Improved access to secondary support, for primary providers

• Decrease in inappropriate referrals to secondary service/increase in appropriate referrals to secondary service.

• Increased outcomes for clients-HoNOS reports show increase or no


4

decline in patient outcomes.

• Reporting indicates equitable access by age, gender, ethnicity, and rural location.

Priority • High Responsibility • Access West Coast Time Frame • June 2005

Objective: Enhance Primary Mental Heath including Alcohol and Other Drug Services on the West Coast

Strategies: Develop a Brief Intervention Service

Activities: • Engage with PHO and about the specific needs of Brief Intervention

Service. • Establish Funding for Brief Intervention Service, employing


5

Suitability Qualified Health Professionals to provide up to 6 free individual counselling sessions, for patients diagnosed with a mild-moderate mental illness (3-17% of population with mental illness), including Alcohol or Other Drug Addiction, who do not require secondary referral and not eligible for ACC funded counselling.

• This service should be flexible to allow group sessions/courses to be

developed if this is clinically indicated. For individuals who require more than 6 sessions a referral should be made by either the Primary Provider or the Brief Intervention Workers to Coast Health Care Mental Health Service.

• The Brief Intervention Service should be mobile covering Westport

Greymouth and Hokitika on a regular basis and more rural areas by appointment.

• Referral to the service should occur through General Practitioners,

Practice Nurses, and Rural Nurse Specialist, and upon screening through Te Waka Hauora.

• Referral may also be made by Community Mental Health Teams, on

completion of a comprehensive assessment, where the patients does not meet the criteria of the specialist service, but does require intervention. This referral should occur in with consultation with the patients Primary Care Provider, as that is where responsibility of care will be transferred to upon completion of intervention.


• Patients satisfaction with the intervention • Primary/Secondary Provider Satisfaction with the service • Maori tangata whaiora and provider satisfaction with service • Self reported outcome improvement • Clinical indicators of improved patient outcomes • Reduction in number of mild –moderate referrals to secondary

services/Increase in number of appropriate referrals made • Reporting indicates equitable access by age, gender, ethnicity, and

rural location. Priority • High Responsibility • Access West Coast Time Frame • Developed by August 2005

Objective: Enhance Primary Mental Heath including Alcohol and Other Drug Services

on the West Coast

Strategies: Facilitate a collaborative approach to the provision of Family Mental Health Counselling and Support Services.

Activities: • Ascertain the current extent and accessibility of Family Counselling Services on the West Coast.

• Establish relationships with current agencies that provide counselling

such as Family Focus, Relationship Service, and Rata Te Awhina and determine their current capacity to provide family mental health


6

counselling.

• Establish current eligibility criteria and referral processes and any gaps in current family health counselling available on the West.

• Establish accessibility and acceptability of family counselling

services for Maori, including by different cultural aspects, such as what is acceptable for Tangata whenua and what is acceptable for maata waka.

• Investigate existing group programs for children, adolescents, Mäori,

parenting, men’s or women’s groups; facilitate the development of programs if required.

• Work with existing agencies to promote the further development of

support for families and family members experiencing mental illness.

• Work with existing agencies to support children of families experiencing mental illness.

• Support providers to access currently available funding streams to

meet needs. Performance Indicators

• Gaps in current Family Health Counselling Services identified. • Service established, that are acceptable to and meet the needs of the

community.

• Service available/implemented monitored by funder.

Priority • High Responsibility • Access West Coast Time Frame • Begun by February 2005

Objective: Strengthen Primary Mental Heath including Alcohol and Other Drug Services on the West Coast

Strategies: Training & Education

Activities: PHO and Access West Coast to work together to identify training and

education needs for • General Practitioners • Practice Nurses • Rural Nurse Specialists

And to develop comprehensive, ongoing and culturally appropriate training plan for primary providers. Including

• Formal Training Courses


7

• Utilising placements in Secondary Services as a training tool • Informal 1:1 training with Mental Health Liaison Worker • Formal sessions identified as needed by Liaison Worker • Access to training provided by Secondary Services

Consideration should be given to opening this training up to other health providers and communities agencies, to ensure maximum utilisation of available resources and that a consistent message is given to service users.


• Completion of Mental Heath Training Plan for Primary Providers

• Ongoing monitoring of education and training requirements - shows a decrease in staff identifying Mental Health as an area of training need

• Increase in provider reported competence and confidence in

provision of primary mental health services.

• Increase in number of providers with formal qualifications in Mental Health

• Increase in number of appropriate referrals to secondary service

• HoNos or other MHSMART outcome measures shows no

decrease/increase in patient scores

Priority • Medium -High Responsibility • Access West Coast and Primary Care Liaison Worker Time Frame • Begun by August 2005

Objective: Improve access to primary Mental Health Care

Strategies: Facilitate improved access to primary care GP Link

Activities: • Appoint co-ordinator facilitate process.

• Develop a relationship with Work and Income New Zealand to ascertain ways to facilitate an improvement in the access individuals with mental illness, including alcohol and other drug, have to primary care, through the redistribution of disability allowance payments direct to General Practitioners.

• Ascertain number of patients in primary and secondary care that

would benefit form-improved access to primary care through this redistribution of their Disability Allowance to their General Practitioners.

• Consider implementing the project in stages, in Hokitika, Reefton,


8

Buller and Greymouth.

• This service should be evaluated 6 months from implementation.


• Relationship with Work and Income New Zealand established and maintained.

• Project acceptable to clients and primary providers.

• Ongoing Client, GP and Work and Income satisfaction with project.

• Increased access to primary health care services, including physical

health checks and screening (numbers reported compared to those received in year prior to Implementation).

• Ongoing improved access to mental and physical health services

• Improved physical and mental health status of clients, proven

through use of HoNOS and regular screening/early detection/.

• 95% of Secondary Mental Health Service clients linked to a GP or Rural Nurse Specialist.

• 95% of Maori clients of Secondary Mental Health Services are

linked to a GP or Rural Nurse Specialist or other primary health provider

Priority • High Rponsibility • Access West Coast and Secondary Mental Health Service Time Frame • Implemented by December 2005

Objective: Improve access to Primary Mental Health Care

Strategies: Investigate the possibility of a Mäori Health Liaison Worker, as a way of

improving Maori access to primary mental health services. Activities: • Scope out the details surrounding a Mäori Health Liaison Worker in

Primary Care services to work across all primary health diagnoses but including improving Maori patients access to Primary Mental Health Services.

• Includes an education and training role to enable Primary Health

Care Workers to gain education regarding health issues impacting the Maori population. This would include working with the Mental Health Liaison Worker on the Primary Mental Heath Training Plan

• Provide a vital link between primary care providers and Mäori

communities and service providers as well as iwi, hapu and whanau

• Investigate the use of funding for Services to Improve Access

Performance • Scoping completed successfully


9

Indicators • Funding secured for position

• Provider, community and patient satisfaction with service

• Improved access to Primary Mental Health Care

Priority • High Responsibility • Access West Coast Time Frame • Scoping completed by Dec 2005


10

Objective: Create a mentally healthy and supportive community

Strategies: Health Promotion

Activities: • Evaluate Current Mental Health and Alcohol and Other Drug

Promotion Services in conjunction with Community and Public Health, and other health promotion providers.

• Asses Mental Heath promotion Services in terms of services to

Maori and Maori health promotion Services in terms of the Mental Health Component.

• Develop a Mental Health and Alcohol and Other Drug Health

Promotion Plan: Including addressing stigma and discrimination, and the promotion of services (early access is a form of prevention).

Performance indicators

• Review of Mental Health and Alcohol and Other Drug Promotion Service completed.

• Recommendations from review Implemented.

• Mental Health and Alcohol and Other Drug Promotion Plan

completed which is acceptable to community, provider and funder.

• Target indicators set in developed plan are meet over time.

Priority • Medium -High Responsibility • WCDHB and Community and Public Health Time Frame • Begin ASAP – completed by December 2004.


11

Objective: Improve the integration of primary and secondary care.

Strategies: Shared Care Activities: • Engage with primary providers through Access West Coast and the

Mental Health Liaison Worker to strengthen relationship and implement the transfer of lead care of stable secondary care patients to General Practitioner, with support from secondary service or Mental Health Liaison Worker. General Practitioner as lead carer is part of the multidisciplinary team and collaborative care plans are developed, for suitable patients. Transfer of care or access back to secondary service is available if required.

• The multidisciplinary team involves the Maori Mental Health team

when appropriate.

• Establish number of patients suitable for shared care, insuring access to care plus funding when eligible.


• Shared care patient management plans developed for identified clients.

• Patient’s outcomes, using HoNOS continue to show

improvement/no deterioration for client.

• Increased integration and liaison between primary and secondary care providers – reported by primary and secondary care providers and evidenced through increase number of patients receiving shared care.

• Number of agreed transfers of care completed.

Priority • Medium Responsibility • Access West Coast Time Frame • Completed by December 2005


12

Objective: Improve the integration of primary and secondary care.

Strategies: Discharge Planning/transfers of care from IPU and CMH to Primary Care

Activities: • Engage with primary providers through Access West Coast and the

Mental Health Liaison Worker to strengthen relationship and identify mechanisms to facilitate General Practitioners or Practice Nurses attending discharge meetings, and being involved in discharge planning.

• Source funding for paying for GP or Practice Nurses to attend

meetings – capped if required.

• Introduce G.P/Practice Nurse participation at discharge planning meeting for their patients who have been in the top 3% who are stabilised and ready for discharge, as well as for unplanned discharges from both Community Mental Health Service and Manaakitanga Inpatient Service.

• Discharge Planning meetings will be

• Consideration should be given to the role of pharmacists in the

discharge planning process.


• Links between Primary and Secondary Services established and maintained.

• Number/percentage of planned discharges from secondary mental

health service to primary care involving GP or Practice Nurse.

• Number/percentage of unplanned discharges from secondary mental health service involving G.P or Practice nurse.

• GP, Practice Nurse, client, family/whanau, secondary service

satisfaction with care planning.

• Client shows improvement/no deterioration in HoNOS or other MHSMART outcome measures after 6 months.

• Improved access to physical health screening/checks assured.

Priority • Medium Responsibility • Access West Coast and Secondary Mental Health Service Time Frame • Completed by December 2005


13


Strategies: Peer Support

Activities: • Access West Coast to Monitor the Wellington Warmline Peer

Support Phone Services pilot.

• Investigate Warmline Implementation if Wellington Pilot is successful.

• Ascertain extent of need for Peer Support network/groups,

including the need for peer support for adolescents.

• Establish successful peer support networks/groups based on identified need.


• Successful Implementation of Warmline if indicated - including uptake and satisfaction of clients and providers with service.

• Peer support groups and networks established in areas

ascertained as requiring them.

• Satisfaction with peer support networks and groups implemented.

Priority • Medium Responsibility • Access West Coast and Primary Care Liaison Worker Time Frame • Completed by August 2006


14


15


Strategies: Support Groups

Activities: • Access West Coast to instigate a review of support groups

available in the community.

• Create resource/way to promote current support groups and services in the community.

• Investigate ways to facilitate the development of support groups

including support for Maori, as required.


• Resource of support services completed and distributed widely throughout the community.

• Successful support groups established as required – with

satisfaction from clients and providers. Priority • Medium Responsibility • Access West Coast Time Frame • Begun by August 2005

West Coast District Health BoardPrimary Mental Health Strategic Plan Budget

Strategy Associated costs Estimated cost Comments/ Notes

Access West Coast Democracy costs associated with establishment of Access West Coast Committee (attendance fees for participants, catering etc) $4,200 Calculated as follows: Attendance fees 10 members @12 meetings p.a @$30 fee =

$3,600; Catering $50 per meeting @ 12 meetings p.a

Primary Care Liaison WorkerCosts of establishing and running Mental Health Alcohol and Other Drug Liaison Service including salary, travel and office expenses, training & education, administration and payments to GPs

$119,000 in 1st yr $143,000 in 2nd yr

Funded by MOH for 2 years

Brief Intervention Service Salaries and on costs of Qualified HP to provide service (estimated 1 FTE) $100,000 Funded by MOH for 2 years

Facilitate Improved Access to Primary Care through GP link No specific costs identified - change in service $0

Facilitate collaborative approach to provision of Family Mental Health Counselling & Support Services No specific costs identified - change in service $0

Training & Education Training costs (including training and education costs for Kai Awhina position) ?

Training needs to be evaluated and costs to be determined, including training and education costs for Kai Awhina position. Costs to be borne by Providers (PHO/ DHB Provider)

Kai Awhina/ Maori Health Liaison worker for Primary Health Costs of Kai Awhina for Primary Health position including salary and on costs $60,000 Funding to be sourced (Services to improve access)

Health Promotion No specific costs identified - evaluation of current promotion service $0 Already budgeted for in Community & Public Health Promotion

Shared CarePayment to GPs/ pharmacists to attend multi-disciplinary team meetings and compensate for compliance costs associated with additional reporting requirements

$12,500 Estimated at $250 per payment, 50 patients per annum. Costs to be borne by PHO/ DHB Provider

Discharge Planning Attendance fees to GPs or Practice Nurses for participation in discharge planning meetings for patients $3,750 Calculated at $75 per meeting @50 visits per annum. Costs to be borne by PHO/ DHB

Provider

Peer Support No specific costs identified - evaluation of service $0 Warmline would not implemented unless funding received for costs of implemention. Estimated implementation costs to be determined.

Support Groups No specific costs identified - evaluation of service $0 Incidental costs to cover expenses may be incurred (e.g facilitator costs). Details not yet finalised.

Total estimated cost per annum $299,450

less: Funding from MoH -$219,000 Primary Care Liaison Worker ($119,000 in 1st yr and $143,000 in 2nd yr), Brief Intervention Service ($100,000)

less: additional Funding -$60,000 Funding will be sought for costs of Kai Awhina position ($60,000)

Total cost per annum after funding $20,450

Cost to DHB Provider Arm per annum $12,325Shared care and Discharge planning costs to be borne equally by PHO and DHB Provider

KARAKIA

E Te Atua i runga rawa kia tau te rangimarie, te aroha, ki a matou i tenei wa Manaaki mai, awhina mai, ki te mahitahi matou, i roto, i te wairua o

kotahitanga, mo nga tangata e noho ana, i roto i tenei rohe o Te Tai Poutini mai i Karamea tae noa atu ki Awarua.

That which is above all else let your peace and love descend on us at this time so that we may work together in the spirit of oneness on behalf of the

people of the West Coast.


INFORMATION PAPERS

WEST COAST DISTRICT HEALTH BOARD ADVISORY COMMITTEE MEMBERS TERMS OF APPOINTMENT

HOSPITAL ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date Dr Christine Robertson 7 February 2002

(Re-appointed 17 December 2004)

For the period served as an appointed Board member.

December 2007

Glenys Baldick 17 December 2004 For the period served as an appointed Board member.

December 2007

Brian Wilkinson 17 December 2004 For the period served as an elected Board member.

December 2007

Richard Wallace 1 May 2002 3 years 1 May 2005

Margaret Moir 1 May 2002 3 years 1 May 2005

Kathryn Cannan 1 May 2002 3 years 1 May 2005

Barbara Beckford 25 June 2003 1 May 2005

DISABILITY SERVICES ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date John Vaile 7 February 2002


For the period served as an elected Board member.

December 2007

Mohammed Shahadat 17 December 2004 For the period served as an elected Board member.

December 2007

Gloria Hammond 1 May 2002 3 years 1 May 2005

Maureen Frankpitt 1 May 2002 3 years 1 May 2005

Elinor Stratford 1 May 2002 3 years 1 May 2005

Dianne Lewis September 2004 3 years September 2007

Vacancy

COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE Member Date of Appointment Length of Term Expiry Date Julie Kilkelly 7 February 2002



December 2007

Dr Carol Atmore 17 December 2004 For the period served as an elected Board member.

December 2007

Robyne Bryant 7 February 2002 (Re-appointed 17 December 2004)


December 2007

Lindy Mason 1 May 2002 3 years 1 May 2005

Barbara Greer 12 November 2003 1 May 2005

Greville Wood Awaiting information

Cheryl Brunton Ex officio

Sharon Ransom September 2004 3 years September 2007

Barbara Beckford September 2004 Co opted appointee Ongoing

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