Distribution Committee Members Brendan Duffy (Chair) Adrian Broad (Deputy Chair) Barbara Cameron Ann Chapman Nadarajah Manoharan Dot McKinnon Vicki Beagley Donald Campbell Tawhiti Kunaiti Board Members Diane Anderson Michael Feyen Karen Naylor Oriana Paewai Barbara Robson Management Team Kathryn Cook, CEO Scott Ambridge, GM, Enable New Zealand Keyur Anjaria, GM, People & Culture Judith Catherwood, GM, Quality & Innovation Ken Clark, Chief Medical Officer Celina Eves, ED, Nursing & Midwifery Chiquita Hansen, CEO, Central PHO Craig Johnston, GM, Strategy, Planning &

Performance Steve Miller, Chief Information Officer Gabrielle Scott, ED, Allied Health Stephanie Turner, GM, Maori & Pacific Neil Wanden, GM, Finance & Corporate Services David Sapsford, CE, Acute & Elective Specialist

Services Lyn Horgan, OE, Acute & Elective Specialist

Services Bart Baker, CE, Cancer Screening Treatment

Support Cushla Lucas, OE, Cancer Screening, Treatment &

Support Syed Zaman, CE, Elder Health & Rehabilitation OE, Elder Health & Rehabilitation Marcel Westerlund, CE, Mental Health &

Addictions Vanessa Caldwell, OE, Mental Health & Addictions Dave Ayling, CE, Primary, Public, Community

Health Debbie Davies, OE, Primary, Public, Community

Health Jeff Brown, CE, Women & Children’s Health OE, Women & Children’s Health Jill Matthews, MAGS Megan Doran, Committee Secretary (HCAC) Communications Dept, MDHB External Auditor Board Records Ministry of Health Nicola Holden, Account Manager Public Copies (9) www.midcentraldhb.govt.nz/orderpaper

MidCentral District Health Board

A g e n d a

Healthy Communities Advisory Committee

Part 1

Date: 1 May 2018

Time: 1.30pm

Place: Board Room Board Office Heretaunga Street Palmerston North

Contact Details Committee Secretary Telephone 06-3508928 Facsimile 06-3508926 Next Meeting Date 12 June 2018 Deadline for Agenda Items 25 May 2018

11

MidCentral District Health BoardHealthy Communities Advisory Committee Meeting

Tuesday, 1 May 2018

Part 1O r d e r 1. ADMINISTRATIVE MATTERS 1.30pm

1.1 Apologies

1.2 Late Items

1.3 Conflict and/or Register of Interests Update

Pages 5-7

1.4 Minutes of the Previous Meeting

Pages: 8-11Documentation: minutes of 20 March 2018 Recommendation: that the minutes of the previous meeting

held on 20 March 2018 be confirmed as a true and correct record.

1.5

1.6

Recommendations to the Board

To note that all recommendations contained in the minutes were approved by the Board.

Matters Arising from the Minutes

To consider any matters arising from the minutes of the meeting held on 20 March 2018 for which specific items do not appear on the agenda or in management reports.

2. PARTNERSHIPS & CONSUMER 1.35pm

2.1 Disability Report

Pages: 12-29Documentation:

Recommendation:

report from Senior Portfolio Manager, Health of Older People dated 12 April 2018 that the Committee note the continued work being done to advance the health and wellbeing of the disability population; note the areas of focus for 2018/19.

22

2.2 Disability Support Service Transformation Update

Pages: 30-32Documentation: report from the General Manager, Enable

New Zealand and Executive Director, AlliedHealth dated 11 April 2018

Recommendation: that the Committee notes the update andprogress of the transformation of theDisability Support System.

2.3 Ora Konnect – Development of an IFHC model for the South Western Suburbs of Palmerston North - update

Pages: 33-38Documentation: report from Operations Director Maori

Strategy and Support | Programme Lead OraKonnect dated 10 April 2018

Recommendation: that the progress update on theadvancement of Ora Konnect be noted.

3. PERFORMANCE REPORTING 2.05pm

3.1 Drinking Water Update

Pages: 39-47Documentation: report from Medical Officer of Health,

Manager Public Health and Drinking Water Assessor dated 11 April 2018

Recommendation: that the implications for MDHB arising from the Havelock North Drinking Water Inquiry, the Ohakea PFAS Contamination and the Longburn Community Drinking Water fluoride event be noted.

3.2 Pharmacy Contract Update

Pages: 48-53Documentation: report from Portfolio Manager, Clinical

Services dated 16 April 2018Recommendation: that the update on the Pharmacy Contract be

noted.

3.3 Strategy, Planning & Performance Operating Report

Pages: 54-71Documentation: report from the General Manager, Strategy,

Planning & Performance dated 13 April 2018Recommendation: that this report be noted

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4. COMMITTEE’S WORK PROGRAMME 2.35pm

Pages: 72-75Documentation: report from General Manager, Strategy,

Planning & Performance dated 19 April 2018 Recommendation: that progress against the 2017/18 work

programme be noted.

5. LATE ITEMS

To discuss any such items as identified under item 2.

6. DATE OF NEXT MEETING

12 June 2018

7. EXCLUSION OF PUBLIC

Recommendation: that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference Sexual & Reproductive Health Contract Reconfiguration

Contract negotiations and commercially sensitive pricing information

9(2)(j)

“In Committee” minutes of the meeting held on 20 March 2018

For reasons stated in the previous agenda

44

Please advise all changes to Jill Matthews, Manager, Administration & Communication Page 1 of 3

REGISTER OF INTERESTS: SUMMARY, APRIL 2018 Name Date Company/Organisation Nature of Interest Anderson, Diane 1.7.16 Nil Broad, Adrian 24.6.14 Manawatu Horowhenua Tararua Diabetes

Trust Trust Manager.

9.12.13 Palmerston North City Council Councillor. Cameron, Barbara 25.4.13 Manawatu District Council Councillor.

Member & Deputy Chair, Manawatu District Licensing Committee

1.11.16 Ministry of Social Development Member, MSD’s Community Response Forum. 27.2.18 Sport Manawatu Board Member Chapman, Ann 17.12.13 Otaki Mail Part Owner. 18.5.12

Otaki Community Health Trust Member.

21.12.07 Gen-i Son is employee. 29.4.16 Central Region’s Technical Advisory Service Grandson is an employee. Duffy, Brendan 3.8.17 MITO Board Member. 3.8.17 Local Government Commission Commissioner. 3.8.17 Electra Trust Trustee. 3.8.17 Environmental Legal Assistance Fund,

Ministry for the Environment Deputy Chair.

3.8.17 Business Kapiti Horowhenua Inc (BKH) Chairperson 3.8.17 Life to the Max, Horowhenua Chair. Feyen, Michael 5.12.16 Horowhenua District Council Mayor.

Manoharan, Nadarajah

9.12.13 Surgical Educators of the Royal Australasian College of Surgeons

Educator.

9.12.13 Private Otorhinogology Practice, Palmerston North

Owner.

9.7.17 Aroha Ultimate Care Wife is an employee (facility manager) McKinnon, Dot 5.12.16 Whanganui DHB Chairperson. Cousin of Whanganui DHB General Manager 9.2.17 NZ DHB Chairs’ National Executive Member. 9.2.17 Health Practitioners Disciplinary Tribunal Member.

9.2.17 Health Sector Relationship Agreement

Committee Member

9.2.17 Four Regions Trust (formerly known as Powerco Trust)

Chair.

9.2.17 Whanganui Eyecare and Medical Trust Husband is chair. 21.3.17 Moore Law & Associates Legal Executive, Director and Shareholder. 4.7.17 20 DHBs (Central Region’s Technical

Advisory Service) Member, National Health Workforce Strategy

21.3.17 Chardonnay Properties Limited Part owner. 19.12.17 ERSG Board Member 19.2.17 Regional Governance Group Chair Naylor, Karen 6.12.10 MidCentral DHB Employee. 22.9.15 New Zealand Nurses Organisation Member & Workplace Delegate

Board Member 9.10.16 Palmerston North City Council Councillor. Paewai, Oriana 1.5.10 Rangitane o Tamaki nui a Rua CEO. 1.5.10 Te Runanga o Raukawa Governance Group Member. 1.5.10 Manawhenua Hauora Chair. Member, Child Health Tamariki Ora District

Group. 13.6.17 Te Whiti ki te Uru Co-ordinating Chair. 13.6.17 Tararua Hauora Services Charitable Trust Trustee. 13.6.17 Central Primary Health Organisation Member, Alliance Leadership Team (Central

PHO Board). 13.6.17 Feilding Health Care Member, Clinical Governance Group. 13.6.17 Manawatu District Council Member, Nga Manu Taiko, a standing

committee of the Council. 13.6.17 Te Ohu Auahi Mutunga (TOAM) Member, Governance Board. 13.6.17 Before School Checks (B4SC) Collective Member. 13.6.17 Nga Kaitiaki o Ngati Kauwhata Inc Committee member. 13.6.17 Te Tihi o Ruahine Whanau Ora Alliance Member.

55

Please advise all changes to Jill Matthews, Manager, Administration & Communication Page 2 of 3

Robson, Barbara 19.7.16 Kind Hearts Trust Board Member. 1.11.16 Royal NZ College of GPs

Member (consumer representative), Health Care Home Standard Working Group.

10.12.01

Federation of Women’s Health Councils Aotearoa NZ (Inc)

Co-convenor.

31.5.10 Medicines Review Committee Consumer Representative. Feb 13 Ministry of Health Member, Electronic Oral Health Record Design

Group. Member, Consumer Reference Group – National Workforce Strategy Project (MoH & HWNZ)

11.10.16 Ernst & Young Daughter is an employee – Business Advisor. COMMITTEE MEMBERS Beagley, Vicki 5.10.15 Massey University Employee, research office. 5.10.15 Arohanui Hospice Husband, John Freebairn, is the current chair. 5.10.15 Supportlinks/Enable New Zealand Son receives respite care. 11.10.16 Palmerston North City Council Member, District Licensing Committee. Campbell, Donald 2.7.14 Nil Emery, Dennis 1.9.15 Arohanui Hospice Employee. 1.9.15 Manawhenua Hauora Member. 1.9.15 Ngati Maniapoto me Ngati Kauwhata Iwi Iwi descendent of both tribes. 1.9.15 Nga Kaitiaki O Ngati Kauwhata Inc, Feilding

- NKOK Chairman

1.9.15 Feilding Integrated Family Health Centre Through the Iwi of NKONK 1.9.15 Te Tihi O Ruahine Whanau Ora Trust 1.9.15 Whanau Ora Strategic Innovation &

Development Group (WOSIDG), Palmerston North

Chairperson / Member.

1.9.15 Whaioro Mental Health Trust – P. North Board Member & Iwi Trustee. Hartevelt, Tony 14.8.16 Otaki Family Medicine Ltd Independent Director. 14.8.16 Merck Sharpe & Dohme (Merck)

(NZ operations for Global Pharmaceutical Company)

Elder son is NZ market access manager.

14.8.16 Fairfax Media Younger son is news director for Stuff.co.nz Kirkcaldie, Ewen 1.8.08 PKF Rutherfords Ltd Director. Kolbe, Anne 22.7.16 Kolbe Medical Services Ltd Director and joint owner. 22.7.16 Communio, NZ Senior Consultant and Contractor. 22.7.16 Whanganui DHB Member, Risk & Audit Committee. 22.7.16 Health Research Council of NZ Husband chairs the clinical trials advisory

committee. 22.7.16 Auckland University Holds an adjunct appointment (Associate

Professor level). Husband is also an employee of Auckland University (Professor of Medicine, FMHS).

22.7.16 Australian Medical Council Husband is a member of the Medical School Advisory Committee, and leads the Medical Specialties Advisory Committee Accreditation Team.

22.7.16 Royal Australasian College of Physicians Husband is a member of the College’s governance working party, and chairs the revalidation working party.

22.7.16 EXCITE International Board Member, and Chair of Advisory Council. 22.7.16 Medicare Benefits Schedule Review

Taskforce (Australia) Senior Advisor/ Government taskforce to review the Medicare Benefits Schedule.

22.7.16 Institute of Environmental Science & Research (ESR)

Daughter employed as forensic scientist.

13.3.17 Siggins Miller, Australia Senior Advisor & Associate. Kunaiti, Tawhiti 20.7.10 Central Primary Health Organisation Employee. Wife is an employee – Contracts

Administrator. (28.10.16) 28.10.16 Manawhenua Hauora Manawhenua representative on HCAC 28.10.16 Te Tihi O Ruahine Whanau Ora Alliance

Trust Employee – Pou Whakarae, Principal Cultural Leader.

28.10.16 Whanau Ora Strategic Innovation Development Group (WOSIDG)

Member.

66

Please advise all changes to Jill Matthews, Manager, Administration & Communication Page 3 of 3

28.10.16 New Zealand College of Clinical Psychologists

Council Member for NZCCP as Pou Whakarae, Principal Cultural Leader.

Temple-Camp, Cynric

3.2.15 Breastscreen Coast to Coast Lead Pathologist. 23.7.13 International Academy of Pathology Board Member.

1.7.08 Medlab Central Ltd. Business Unit of Sonic Health Care Ltd

CEO.

1.7.08 MidCentral Health (MCH) Wife is employed as a Medical Consultant by MCH.

1.7.08 National Coronial Pathology Services Advisory Group to Ministry of Justice

Member

1.7.08 T-Lab Director. 7.4.09 Ministerial Advisory Group Member. MANAGEMENT Cook, Kathryn 4.5.15 Aspen Pharma Sister is an employee. 1.7.16 Central Region’s Technical Advisory Service Director. Ambridge, Scott 20.8.10 Nil Anjaria, Keyur 17.7.17 MidCentral DHB Wife is a user of the Needs Assessment &

Service Co-ordination Service. Clark, Kenneth 3.8.10 Dr Kenneth Clark Ltd Private gynaecology practice, Palmerston

North. Coglan, Michele 3.2.16 Nil Hansen, Chiquita 9.2.16 MidCentral DHB Employed by MDHB and seconded to Central

PHO 8/10ths. 9.2.16 Central PHO Central PHO’s CEO. Johnston, Craig 19.2.16 Central PHO Member, Alliance Leadership Team. 19.4.16 MidCentral DHB Son is an employee of MidCentral DHB and

works within hospital services. Miller, Steve 18.4.17 Puriri Trust & Puriri Farm Partnerships Director. Farming business. Scott, Gabrielle 19.8.16 MidCentral DHB Son is a casual employee of MidCentral DHB

and works within various hospital services. Turner, Stephanie 17.2.16 Waingawa Ltd Director. Farming business. Wanden, Neil 16.2.16 Opus International Wife is a major shareholder. Matthews, Jill 1.3.16 Nil Amoore, Anne 23.8.04 Nil Small, Jeff 2002 Allied Laundry Services Limited (ALSL) Director (appointed by MDHB’s Board)

Horgan, Lyn 1.5.17 Coronial Services Sister is Coroner based in Wellington.

Hancock, Muriel 1.2.18 MidCentral DHB Sister an employee (registered nurse in ICU) Nolan, Chris Russell, Greig 3.10.16 City Doctors Minority shareholder. 3.10.16 NZ Medical Council Member, Education Committee. Downing, Eileen 2.9.10 Nil Andrews, David Smith, Jo 27.8.10 Nil Nepia-Tule, Claudine

1.9.10 Nil

Bradnock, Barb 26.8.10 Nil Jermey, David 31.8.17 Central Primary Health Organisation Member, Alliance Leadership Team Ayres, Vivienne 26.8.10 Nil Channing, Chris 27.8.10 Nil Els, Johan 28.10.16 Nil Tanner, Steve 16.2.16 Nil Brogden, Greg 16.2.16 Nil Purdy, Darry 13.10.17 Ross Intermediate Trustee 13.10.17 Graham Wastney Family Trust Trustee 13.10.17 Spotless Facility Services Limited Brother-in-law an employee (not at MDHB

site) 13.10.17 Setpoint Solutions Limited Brother-in-law an employee (but not for

MDHB) 13.10.17 Crossroads Church Attendee Manderson, John 16.2.16 Nil

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Unconfirmed Minutes

MidCentral District Health Board

Minutes of the Healthy Communities Advisory Committee meeting held on Tuesday, 20 March 2018 at 1.30pm at MidCentral District Health Board Offices, Board Room, Gate 2, Heretaunga Street, Palmerston North

PART 1 PRESENT Brendan Duffy (Chair) Adrian Broad (Deputy Chair) Barbara Cameron Ann Chapman Dot McKinnon (ex Officio) Vicki Beagley Donald Campbell IN ATTENDANCE Kathryn Cook, Chief Executive Diane Anderson, Chair, Quality & Excellence Advisory Committee Oriana Paewai, Committee Member, Quality & Excellence Advisory Committee Craig Johnston, General Manager, Strategy, Planning & Performance Neil Wanden, General Manager, Finance & Corporate Services Stephanie Turner, General Manager, Maori & Pacific Judith Catherwood, General Manager, Quality & Innovation Deborah Davies, Acting Service Manager, Community Services Gabrielle Scott, Executive Director, Allied Health Kelly Isles, Project Manager Angela Rainham, Project Manager Jo Smith, Senior Portfolio Manager Jonathon Howe, Communications Manager Megan Doran, Committee Secretary OTHER Public: (0) Media: (0) 1. ADMINISTRATION MATTERS 1.1 APOLOGIES There were apologies from members Nadarajah Manoharan and Tawhiti Kunaiti. 1.2. Notification of Late Items

88

Unconfirmed Minutes

There were no late items 1.3. Conflict and/or Register Of Interests Update Amendment to the Register of Interests Barbara Cameron advised she is now involved with Sport Manawatu. Declaration of Conflicts in Relation to Today’s Business No declarations were advised in relation to the meeting. 1.4. MINUTES OF THE PREVIOUS MEETING It was recommended:

that the minutes of the previous meeting held on 13 February 2018 be confirmed as a true and correct record.

1.5 Recommendations to Board

It was noted that the Board approved all recommendations contained in the minutes. 1.6 Matters Arising from the Minutes There were no matters arising from the minutes. 2. STRATEGIC AND OPERATIONAL PLANNING 2.1 Kainga Whanau Ora & Presentation Materoa Mar CEO Te Tihi o Ruahine Whanau Ora Alliance presented to the Committee. This presentation was well received and the Committee asked to receive regular updates. 2.2 Locality Plans The Project Manager, Strategy, Planning and Performance introduced the report which included the full plan for Manawatu (as an example), which were an ‘inward facing’ document, and the Action Plans for all four localities, which are ‘community facing’ documents. The action plans document were tangible actions that the community can see, feel or experience and is written in a community friendly manner. The action plans have been checked with the local advisory group, community members and relevant health professionals and were now in the final draft stage. It was reported that the Otaki Locality Plan was slightly behind the other three plans but would be completed in time to be presented alongside the others to April meeting of the Board.

99

Unconfirmed Minutes

Members noted that it was important that the plans are well socialised out in the communities. There was discussion about the amount of work detailed in the action plans, particularly given the current environment of constraint. Management pointed out that the actions in the action plans were often similar across plans, and that they were spread across a range of agencies, not just the DHB. Also, that all the actions have been worked through with the relevant providers. The CE advised the meeting that the Clusters would be taking the lead on the implementation of the Locality Plans and that the actions in the Locality Plans would be taken through into the Clusters operational plans etc. It was recommended:

That the progress in the development of health and wellbeing plans be noted and; the committee endorse the final drafts being submitted to the Board.

3. PERFORMANCE REPORTING 3.1 Strategy, Planning & Performance Operating Report 4.3.1 – Update on Manawatu Gorge Closure The preferred route for the Manawatu Gorge replacement was discussed. The Committee expressed pleasure that a decision had been made but noted that work on the new route is not scheduled to start until 2020 with a completion date in 2024. It was recommended: that this report be noted. 4. COMMITTEES’ WORK PROGRAMME It was recommended:

that progress against the 2017/18 work programme be noted. 5. LATE ITEMS There were no late items. 6. DATE OF NEXT MEETING 1 May 2018

1010

Unconfirmed Minutes

7. EXCLUSION OF THE PUBLIC It was recommended:

that the public be excluded from this meeting in accordance with the Official Information Act 1992, section 9 for the following items for the reasons stated:

Item Reason Reference “In Committee” minutes of the meeting held on 13 February 2018

For reasons stated in the previous agenda

Confirmed this 1st day of May 2018 ………………………………………… Chairperson

1111

COPY TO:

Strategy, Planning &

Performance MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440 Phone

Fax +64 (6) 350 8928 +64 (6) 355 8926

For:

Decision

Endorsement

X Noting

To Healthy Communities Advisory Committee

Author Senior Portfolio Manager, Health of Older People

Endorsed by GM Strategy, Planning & Performance

Date 12 April 2018

Subject Disability Report

RECOMMENDATION

It is recommended that the Committee:

• note the continued work being done to advance the health and wellbeing of the disability population;

• note the areas of focus for 2018/19.

Strategic Alignment

This report is aligned with MidCentral DHB’s Strategy, in particular the strategic imperatives to “partner with people and whanau to support health and wellbeing”, and “achieving equity of outcomes across communities”.

Glossary

DAP – Disability Action Plan

DHBs – District Health Boards

DHB’s – District Health Board’s

DSS – Disability Support Services

InterRAI – International Resident Assessment Instrument

MidCentral DHB – MidCentral District Health Board

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MoH – Ministry of Health

NGOs – Non Government Organisations

NZ – New Zealand

1313

1. PURPOSE This report updates the Committee on work being done in the district to advance the prinicples of the NZ Disability Strategy. It is for information only; no decision is required. 2. EXECUTIVE SUMMARY A strong focus on disability continues across the sector with all services contributing. In 2017/18 the Consumer Council was established and this will increasingly assist in strengthening the disability voice in our planning and service development. This includes support for the development of a formal co-design and engagement framework for the DHB, which will be a significant step towards person and whanau centred care. Also of note, actions arising from the Health and Wellbeing planning process (locality planning) include a number aimed at supporting people with a disability, including older people. These will be advanced by the service clusters being established. Further planning for the redevelopment of Palmerston North Hospital’s acute care services and Ward 21 will take place next year and this will require a strong disability lens. Annual Planning is underway across the district. One focus in improving the accessibility of information to enable people with a disability to understand their choices so they are able to make good decisions and better manage their own wellbeing. Enable NZ plans to launch a new information gateway website “Firstport”. In terms of the older age group, MidCentral DHB is well advanced on a procurement exercise for home-based support services. This is referred to as the Excellence In Homecare project and its purpose is to provide improved home-based and respite care. The latest update from the Ministry of Health is attached and showcases their workplan including the Whaia tea o Marama (Maori Disability Action Plan), Faiva Ora (Pasifika Disability Action Plan), the Respite Strategy and Community Residential Strategy. 3. BACKGROUND Whilst DHBs have responsibility for planning and funding the full range of health and disability services for the over 65 years population, for those under 65 years DHBs are responsible for planning, funding and providing only health services. The Ministry of Health retains responsibility for planning and funding disability services. This includes disability services for children and adults. The development of disability services is guided by the Disability Strategy 2016-2026 (http://www.odi.govt.nz/nz-disability-strategy/). This strategy was launched in November 2016 from the Office for Disability Issues and is supported by companion and interrelated plans and strategies that strengthen the system as a

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whole. These include the Pasifika Disability Strategy, Kaiawhina Workforce and Carers Strategy. Annual reporting on outcomes of the various strategies are published on the Office for Disability Issues website. The Office of Disability continues to lead the work-plan around disability issues. The latest Disability newsletter attached to this report can be found at: https://www.health.govt.nz/system/files/documents/pages/dss-newsletter-no68-feb-2018.pdf The Disability Strategy centres on a number of broad outcome areas which include education, employment, health and well-being, justice, accessibility, attitudes, choice and control and leadership. The existing national Disability Action Plan is the primary vehicle for implementation of actions to support the achievement of the Strategy. The current Disability Action Plan follows the example of Better Public Services, the Plan by focusing on actions to achieve shared results. Progress against this work is reported through the Minister of Disability Issues annual report to Parliament. 4. OUR LOCAL RESPONSE TO DISABILITY 4.1 2017/18 Closer to home, an important consideration for the DHB is to ensure people with disabilities receive the health services they require, with good outcomes and positive patient experiences. MidCentral Health has reported regularly to the Quality and Excellence Advisory Committee on areas such as the Accessibility Self Audit Update and the Patient Experience Survey. Strategy, Planning and Performance report annually a contracts update, which provides assurance that obligations and standards relating to the care of people with disabilities are carried through to Non Governmental Organisations and private providers of publicly funded health services. Also, DHBs and Enable NZ reports through various forums on their activity. The needs of the community are largely being met well. Forums with NGO’s continue and feedback is positive. A number of items have concluded for the 2017/18, year with some changes occurring going forward in line with improved models of care. Some of the headline initiatives are detailed below: 4.1.1 Regulation of the Home and Community Workforce This was a key workstream during the 2017/18 year off the back of the 2014 Settlement Agreement occurring between Ministries, DHBs, Unions and Providers. Key aspects included regularisation, in-between travel and pay equity. While due diligence and reporting still feature strongly, the programmes are largely business as usual. 4.1.2 National Model of Care Work – Home and Community Support Services Through the Healthy Ageing Strategy, there was a need to identify and implement models of care that are person-centric, needs based and equitable, and deliver high-value, high-quality and better outcomes through home and community support services across New Zealand. As part of this work there has been involvement of service users and their family and whanau, reviewing the needs

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assessment and service coordination services to ensure assessment and care planning are culturally appropriate and meet the needs of Maori and other priority population groups. The work seeks to address concerns around increasing complexity, working across funding streams, sustainability in rural areas, lack of integration, outdated service delivery approaches, public perceptions of entitlement, lack of flexibility and restorative approaches (for some) and so forth. A key deliverable is “People Powered”. Services would encourage clients to have more say, responsibility, flexibility of service, more individualised funding, choice of providers and a wider range of services available. An initial co-design event occurred in June 2017 which identified eight key themes: social connectivity, experiments and simulation, technology, joined-up services, navigation, life plans, identify and access to information. This piece of work will build understanding, develop choices and support the making of decisions. This work is looking at interRAI data, and includes wider data such as the disability allowance, acute care information, and housing and residential care use. The outcome of this work is exciting and will provide an extensive profile of use of services across the sector for populations. The second round of workshops for this national work occurred in March 2018, one of these was held in Palmerston North. 4.1.3 Local Excellence in Homecare Project MidCentral DHBs response to a change in model of care was to launch the ‘Excellence in Homecare’ project. Key activity is retendering Home and Community Support Services for better outcomes. This work is still in train with the initial phase on track for completion within the next two months. The broader work will consider different ways of delivering similar/same services but which give wider choice to clients. This includes broadening the access to individualised funding so that people can purchase their own requirements that are flexible in nature, and potentially retirement villages providing a choice for their own staff to service those living in retirement communities. The outcome of this work will be reported to the Committee in line with this activity. 4.1.4 In-home Respite Care An initiative identified in 2017 sought to realign some funding from dedicated rest-home beds to in-home respite in order to support those carers whose spouses were not suitable for attendance at a day programme. The pilot is small; a total of ten clients thus far are eligible for the service. To date, the programme is working well and is an alternative to out of the home respite. Carers are able to receive a break, attend to key hobbies, or tasks outside the home knowing their spouse or family member is comfortable. Home and Community Support deliver the care into the home as a bulk package of care.

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4.1.5 Enable New Zealand Update Enable New Zealand has recently launched its new information gateway website, Firstport; a site which delivers valuable information to disabled people and their family/whanau about what support people can access to help them live more independent lives. Firstport helps to navigate visitors to a variety of options they can then explore in order to make informed decisions about their care and requirements. Firstport has been designed to be clear, consistent and accessible for anyone visiting the site. It also features latest local, regional and international news and details of events that might be of interest. www.firstport.co.nz. 4.1.6 Enable New Zealand’s EASIE Living Centre The Centre had a layout refresh in October 2017 and feedback from customers has been positive. The Centre has a mobile van that travels throughout the MidCentral/Whanganui districts, as well as Hawkes Bay and Taranaki, visiting lifestyle villages, shows and community groups. Two open meetings were held at the EASIE Living Centre in the last quarter. The first invited people to hear first-hand from two parents of children with disabilities. The second was to celebrate Down Syndrome day on 21 March, during which the Down Syndrome Society took the opportunity to launch its latest media campaign. Enable New Zealand is a founding member of the Regional Coalition Strategy established in 2017 to develop a Disability Strategy for the Manawatu. The group met in March to workshop guidelines to assist in that development, and will meet again in May. The Community Disability Support Services Manager, Enable New Zealand co-presented the Age Friendly strategy at a public meeting held at Palmerston North City Council Chambers. Eight strategies were presented to the audience for feedback and comment. Further feedback on this will be provided as the strategies are confirmed. 4.1.7 Paid Family Carer Policy MidCentral DHB implemented a Paid Family Carer Policy in 2014 off the back of national work for family carers through the Ministry of Health under 65 services. Largely, DHBs aligned their policies to the national work and this policy for most people has worked well. The New Zealand Public Health and Disability Act (2000) (the Act) required DHBs to have a family care policy that allows payment to some family members for providing health and disability support services to an adult disabled member of the same family in certain circumstances and where there are good reasons to do so. Part four of the Act also affirmed the principle that in the context of the funding of health and support services, families generally have primary responsibility for the well-being of their family members. Any payments for such services delivered by the paid family members of disabled people must be within sustainable limits.

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Policy advice currently is being collected to help guide future discussions on the extension of this policy to other members of the family. Paying family members has enabled a more sustainable service for some families and removed some of the access barriers. Populations that have particular benefit from this service are those with cultural and language preferences. 4.2 2018/19 Year The key focus for 2018/19 will be the establishment of our service clusters, all of whom will have a focus on disability and equity. The clusters will also be implementing the actions from the Health and Wellbeing Plans developed for the Horowhenua, Manawatu, Otaki and Tararua districts. These include actions to improve accessibility through the use of technology, both for service provision and for requesting services such as prescriptions. There are also actions to improve the flexibility of hospital booking systems and in the Horowhenua district, compassion housing and a continuity of care for home support pilot are planned. The Consumer Council is now in place and will continue to play a key role in advocating and promoting the needs of people with a disability. Developing a co-design process for the DHB is a major project in which the Council will be involved. The other key focus area for 2018/19 will be the redevelopment of the acute care areas at Palmerston North Hospital and Ward 21. A co-design process will be taken to this work, and the needs and input of the disabled community will be critical. 5. SUMMARY Overall, more is being done to drive person centered care, more choice and options available to those who experience disability. Progress since last quarter includes achieving this change through new commissioning approaches, service improvement opportunities and information portals. 6. RECOMMENDATION It is recommended that the Committee:

• note the continued work being done to advance the health and wellbeing of the disability population;

• note the areas of focus for 2018/19. Jo Smith Senior Portfolio Manager Health of Older People & Palliative Care

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Disability Support Services e-newsletter

From Toni Atkinson Group Manager Disability Support Services

No. 68 February 2018 ISSN 2253-1386

Contents

Page 2

Enabling Good Lives 2

Page 4

System transformation5

Page 5

Spotlight on quality

Page 6

Project updates 7

Page 8 Provider news

Page 10

Upcoming disability events

Page 11

New staff at Disability Support Services9

Happy New Year everyone! The team is back from their summer holidays and re-energised for the coming year. Here in Wellington we have had some fabulous weather over the holiday period and I hope you are enjoying a great summer where you are.

There are some big pieces of work from Disability Support Services over the coming year, including an update of Whaia te ao Marama (Māori Disability Action Plan), Faiva Ora (Pasifika Disability Action Plan), the Respite Strategy and Community Residential Strategy.

We are pleased to have worked with a small group of providers and the New Zealand Disability Support Network (NZDSN) to progress the residential pricing model to test our assumptions and comment on the way the model works. I would like to thank those providers for their contribution so far.

We are also looking to move pay equity funding into some of our contract lines over the next few months and will be writing to providers to ask for feedback on how we plan do this.

Lastly, the system transformation team is busy finalising a more detailed plan for the MidCentral region. We will be working closely with the team on the transition planning for these changes. We are excited by the proposed changes and are keen to support the transition process.

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Christchurch Hannah Perry, Enabling Good Lives Lead, Ministry of Health

Kia ora koutou. The Enabling Good Lives Christchurch team has already linked with over half the young people who are expected to leave school this year. It is helpful to start early with planning and thinking about life beyond school.

People can use their Enabling Good Lives personal budgets and use them to get the most out of their last year at school. Some students have chosen to employ a favourite teacher aide outside of school hours, go on a camp and push themselves physically, or buy equipment to improve their independence.

The Enabling Good Lives independent facilitators are looking forward to meeting with many of the 2018 school leavers and whānau at our annual ‘meet the independent facilitator family event’ on Saturday 3 March. This will be followed by the ‘Next Steps’ expo on 16 April, where we partner with community organisations and service providers to showcase the groups and connections that Christchurch has to offer (details on page 10).

We will also be hosting a variety of events and forums through the year as we start to think about what the transformation of the disability support system might mean for us in Canterbury. The first meetings are on 8 and 9 March and we will have invitations out soon.

In the meantime, earlier Enabling Good Lives participants are getting on with their good lives. There are young people who are flatting with their friends, and pooling their budgets so they have the support they require, when they want it and from people they choose to work with. Some people are pursuing further education at a variety of places including ARA, National Trades Academy and Hagley Community College.

Finally, we hear wonderful stories about people having fun and developing strong friendships and relationships with others. There is a young man who invites his friends over for a swim (in what has been a very hot summer!); a woman whose fine weaving is made into a garment (pictured) and sold in a shop; and a young man who loves working outside and has secured a job at a gardening store and café.

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WaikatoKate Cosgriff, Director, Enabling Good Lives Waikato

There are now more than 300 disabled people and families involved in Enabling Good Lives Waikato. They are diverse in every way: their age, ethnicity, geography, living situation, family make up and support, dreams and goals and disability.

Two hundred and forty-three people have personal budgets and are buying the supports, services and items that make sense for them. The remaining 60 people are working through the Enabling Good Lives process and will move to budgets over the next couple of months.

Demand for Enabling Good Lives remains high, with 102 people currently waiting to join.

The Enabling Good Lives Waikato leadership group continues to ensure the work of the demonstration is well supported and aligned with the Enabling Good Lives principles and approach. In addition, regular forums run by families, disabled people and providers also support the Enabling Good Lives approach. The leadership group is contributing to the system transformation work.

In December, a tangata whaikaha hui was held in Hamilton, attracting people from Huntly/Ngaruawahia, Raglan/Kawhia, Te Awamutu and Hamilton. Twenty-three disabled Māori and whānau attended. The major aim of the hui was to connect participating whānau with each other and share information and stories. Feedback was that people thoroughly enjoyed themselves, especially meeting others, sharing kai and karaoke. A second hui is being planned for south Waikato.

Enabling Good Lives Waikato needs to be able to respond easily and quickly to changes in people’s lives. Sometimes people need budget increases and, at other times, their budget can reduce and this needs to be an easy and straightforward process.

A recent example is of a one-off, 12-month investment into a young person, Brigid. She used her Enabling Good Lives budget to connect with community activities, improve her communication, purchase one-on-one mentoring from a service provider, secure a part-time job, attend a conference, join the gym and to help her become comfortable going out.

Brigid’s mum summarised their year with Enabling Good Lives: ‘The support from Enabling Good Lives has enabled Brigid not only to achieve the plan we originally put in place, but so much more. I feel Brigid has been able to achieve the strategies she will need to be successful next year and be able to cope with what lies ahead.’

There is other recent feedback.

This, from Rose: ‘I can’t believe how this has changed Te Kaha and my life, we are able to be free, spontaneous and to live life. I am allowed to be Te Kaha’s mother and act like a mother, not a keeper . . . we can live life like ordinary people. I can ensure the best for Te Kaha and we as a family can plan the future with and for Te Kaha. Enabling Good Lives has given us freedom and Te Kaha independence from service provider life.’

Another young woman and her mum described that Enabling Good Lives gave them back independence and the control of her life that the disability took away. ‘Enabling Good Lives enabled us to make a whole shift to look at life differently and try things again. We should be renaming Enabling Good Lives to . . . Hope.’

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Sacha O’Dea, Programme Lead, Ministry of Health

It’s been a busy start to the year as we meet with new Ministers about the prototype for the transformed disability support system, planned to be rolled out in MidCentral later this year.

To recap where we’ve got to: the system transformation team was formed in April 2017. We then had a three-month co-design process with the sector where we came up with the high-level design. That was followed by almost 20 working groups developing the detailed design.

Before Christmas, the team set up virtual testing groups for the information front end hub; funding mechanism for disabled people and whānau; information tools, pathways and processes; team roles; system responsiveness; provider analysis and capability; and environmental support services. We are using an online space called Loomio that helps groups to read documents, test ideas and make collective decisions. The prototypes which the working groups have developed are posted on Loomio and people are reading and commenting on these.

Now we are working on a Cabinet paper that is asking for agreement to the detailed design for the prototype to be rolled out in MidCentral, for the funding to do that, and for decisions on what funding comes across from other government agencies. It also outlines the process for making decisions about how organisations will be arranged to support the new disability support system.

Virtual testing groups in regards to safeguarding and network building have been set up in the last week, along with virtual testing groups on government interfaces such as ACC, Education and the Ministry of Social Development. We will also be starting new working groups on market shaping, brand and identity, Whānau Ora and organisational arrangements for the new system.

Up to this point, communication has been about the design process, what we’ve been doing in terms of working groups and testing groups and how it’s being pulled together. This year it will focus much more on what the changes will look like in practice and what it will mean for you, whether you are a disabled person, a family member, a provider or you are currently working within a NASC or a government agency.

Thank you to everyone who has participated and provided feedback. There is still time to be part of virtual testing groups. If you are interested in taking part, please contact us at  STfeedback@moh.govt.nz

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Christina Curd, Senior Advisor, Ministry of Health

ComplaintsAnyone can make a complaint to the Ministry of Health about problems or concerns with a Disability Support Services-funded service. We aim to resolve all complaints within 20 working days, depending on their complexity. If a complaint is not resolved in 20 working days, complainants can expect regular updates on the status of their complaint.

The information collected from complaints gives Disability Support Services opportunities to look at how to improve the quality and delivery of Ministry-funded services for disabled people.

Number and types of complaintsDuring 2016/17, Disability Support Services received 41 complaints relating to 27 providers, with an average of 3.4 complaints per month. This was a decrease in complaints received compared to the previous year (66 complaints). This continues the trend over the last 10 years of a decreasing number of complaints received by Disability Support Services.

We want a culture where people can speak up about the supports they receive and use the complaints process as an opportunity to improve the quality of provider services. As only seven of the 41 complaints made last year were by disabled people, we also need to seek ways to make the complaints process more accessible. Most complaints were made by relatives of the people using the services (including partner, parents or other family members).

The most common reason for complaints (71%) was about service delivery (eg, inappropriate care, understaffing and vetting of staff, communication). The second most common reason for complaints (17%) was about allegations of abuse including staff to client, client to staff or client to client.

For more information on who to contact if you’ve got a question about Ministry-funded disability support services, or to make a complaint, go to: www.health.govt.nz/your-health/services-and-support/disability-services/more-information-disability-support/contact-disability-support-services

We are always looking at how we can improve our complaints process and make it more accessible to people with disabilities. If you have any suggestions please contact us on dsscomplaints@moh.govt.nz

Spotlight on Quality

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Transforming RespiteDeborah Mills, Development Manager, Ministry of Health

We expect to see good progress in implementing the respite strategy during 2018. During the next few months we will:

• publish information on the disability respite market on the Ministry’s website – this is to support providers to respond to opportunities for service development arising from implementation of the respite strategy. The document includes information about the number/age/ethnicity of Disability Support Services’ clients in each region and provides a snapshot of what services are currently available and the potential gaps

• make the results of a disability respite stocktake available online – this is to help disabled people and their whānau to find out about the respite options currently available in each region

• continue with planning to change Carer Support to ‘flexible respite budgets’. Once available, families will be able to use flexible respite budgets to achieve a break from caring in the way that suits them best. We will also release new purchasing guidelines that will show families how the budgets can be used.

Disabled people, their families/whānau and existing or new providers of disability support are welcome to contact us at any time to discuss the opportunities that may be available for them through changes to respite (respitestrategy@moh.govt.nz).

Te Ao Mārama: The Māori Disability Advisory GroupJason Moses, Senior Advisor Maori, Ministry of Health

Disability Support Services is looking for new members for Te Ao Mārama, the Māori Disability Advisory Group. Te Ao Mārama is responsible for:

• monitoring the implementation of Whāia Te Ao Mārama, the Māori Disability Action Plan

• providing advice to Disability Support Services (and the wider Ministry of Health) on the effectiveness of the plan to improve the lives of tāngata whaikaha Māori (Māori people with disabilities)

• providing advice and support to the future design and implementation of the disability support system.

Members of Te Ao Mārama should:

• have a good understanding of and connections to Te Ao Māori (the Māori world)

• be excited and passionate about improving the disability support system so that it is more responsive to the needs of tāngata whaikaha Māori and their whānau

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7DSS e-newsletter February 2018

• be able to translate their experience of living with a disability, or as a caregiver or parent of a tāngata whaikaha Māori, into possible service improvements and future actions

• be available and willing to provide timely advice to Disability Support Services on providing health and disability services to tāngata whaikaha Māori.

If you are interested in being a member of Te Ao Mārama, please contact Jason Moses on jason_moses@moh.govt.nz or telephone 021 936 864.

Faiva Ora: Pasifika Disability Action PlanBella Bartley, Contract Relationship Manager, Ministry of Health

Faiva Ora: National Pasifika Disability Plan 2016–2021 builds on past achievements of previous Faiva Ora plans1 and provides a coordinated and collaborative response by the Ministry of Health (the Ministry) to address issues faced by Pacific people with a disability. Support from across government agencies, health and disability services, DHBs and NGOs is required for addressing the needs of Pacific peoples with disabilities and their families.

Over the next five years, the Faiva Ora plan will deliver four priority outcomes and will focus on:

1. improving outcomes for Pasifika disabled children, youth and their families

2. strengthening Pasifika communities to engage with and support people with disabilities and their families to participate in their communities

3. increasing the cultural responsiveness of disability support services

4. stakeholders working together to address challenges experienced by Pasifika disabled people and their families.

In 2017, the Ministry contracted Le Va to lead the implementation of some actions of Faiva Ora. Le Va works alongside Vaka Tautua and various community groups and services to ensure important health and disability messages and information to access support is reaching the Pasifika community.

Faiva Ora Community Innovation Fund provides an opportunity for innovative projects from Pasifika community groups and support for people who support Pasifika people with disabilities. It is aligned with priority outcome 2 of the Faiva Ora Action Plan 2016–2021. This innovation fund helps community groups and individuals with disabilities to live independently, raise awareness of disability services and challenge and eliminate stigma.

The Faiva Ora Community Innovation Fund has been promoted widely within the health and disability sector and also on all of Le Va’s social media platforms. Applications have now closed for 2017–18. The assessment process is under way and successful applicants will be notified.

Engaging Pasifika cultural competency training programme ensures that the health and disability workforce learn how to effectively engage with Pasifika disabled people and their families.

1 Faiva Ora 2010–2013; Faiva Ora 2014–2016

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Le Va delivered five training sessions in late 2017 in Auckland, Palmerston North and Christchurch. A total of 148 disability workers successfully completed the Engaging Pasifika programme. Participants were from 13 health and disability organisations. Providers are encouraged to contact Le Va to book training time for staff on (09) 2613490 or visit the website: www.leva.co.nz

Faiva Ora Leadership Group (FOLG) enables Pasifika people with disabilities and their families to champion Pasifika disability issues by having their views represented at the highest levels in New Zealand. The first Faiva Ora Leadership group meeting for 2017/18 was held on 11 December, 2017. The next meeting is scheduled for April this year. The group has also provided valuable feedback and input into the system transformation project.

New serviceLiz O’Callaghan, Development Manager, Ministry of Health

Over recent years the Ministry of Health has identified the need to develop individualised services for a small number of people currently living within mental health and intellectual disability services.

These people have an intellectual disability and/or mental health conditions. They have been in long-term hospital level care but have not made significant gains in moving towards community placement. This group often present significant risk to themselves and/or others.

The Ministry is working with Capital and Coast District Health Board (CCDHB) to develop a business case for a new service for this group of people. A number of single units at Ratonga Rua Hospital in Porirua, Wellington, have been suggested to be used for this service. This will give this small group of people increased independence, a greater quality of life and a reduction in restrictive practice. The project is still in its early stages of development.

The Ministry will be running information sessions on the new service over the coming months. Regular updates will also be available on the Ministry’s website.

Community Living delivers accessible housing Charlotte Tollervey, Advisor Communications, Community Living Trust, Hamilton

Five new houses at 32 Fifth Avenue, Enderley have now become homes to the people we support. The new houses were in response to the lack of affordable housing in our community and for suitable homes for the people we support.

In 2014, a property within Community Living Trust’s own portfolio was identified as having the potential to provide such housing.

Provider news

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In 2015, the decision was made to demolish the existing building and develop five new homes in its place. Demolition began in July 2016, with groundwork starting in August 2016.

The homes were completed in August 2017 and the site now has three, two-bedroom units and two, four-bedroom houses.

Being in the convenient Hamilton location of Enderley and offering affordable housing that also meets the needs of those living with an intellectual disability and/or a physical disability, the houses were quick to be tenanted.

The build was headed by our Property and Assets Manager – Ron Pollock, who lived and breathed the project and to whom we are so grateful for his dedication and tenacity. At the opening event Ron commented: ‘The project’s greatest success was the way that numerous contractors worked alongside each other, new and existing partners really came together to support the project.’ The homes have all been designed according to the Lifetime Design principles, ensuring accessible, adaptable, inclusive and usable housing. The homes all meet the 33 design features listed to gain a Lifemark award including level entry points, widened doors and passageways, and provision for future installation of a stair lift. Community Living also opted to install fire sprinkler systems throughout to add an additional level of safety for residents, sound proofing, and HRV fresh air systems. The homes have been constructed from quality, sustainable materials to extend the lifetime of the properties.

Our Chief Executive Marese McGee commented: ‘We’re proud to be providing much needed safe, secure and healthy homes for those with intellectual disabilities or those in need of social housing in Hamilton.’

The houses were officially opened at a ceremony with Stu and Camille from The Breeze Waikato and with many of the partners who assisted with the build, staff and board members.

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Show Your Ability – 2018Enable NZ information sessions on disability support system change The next steps for transforming New Zealand’s disability support system is under way. Come along to one of the information sessions.

Information Sessions at Show Your Ability 2018Information sessions from Enable New Zealand on the Ministry of Health disability support system transformation are being presented at Show Your Ability 2018 at the following times:

Auckland ASB Showgrounds, Tuesday 27 February 2018, 8–9 am and 2–3 pm

Hamilton Claudelands Event Centre, Thursday 1 March 2018, 8–9 am and 2–3 pm

Palmerston North Central Energy Trust Arena, Friday 2 March 2018, 8–9 am and 2–3 pm

Christchurch Pioneer Recreation & Sports Centre, Monday 5 March 2018, 8–9 am and 2–3 pm

Dunedin Edgar Stadium, Tuesday 6 March 2018, 8–9 am

Registration to attend is not required.

Next Steps Expo 16 April 2018The Next Steps Expo showcases the different community groups and organisations that support Enabling Good Lives.

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Contact Disability Support ServicesEmail: disability@moh.govt.nz Phone: 0800 DSD MOH (0800 373 664)

Web: www.health.govt.nz/disability

To be added to the email list of this newsletter, or if you no longer wish to receive this newsletter, please email disability@moh.govt.nz

Kia ora tatou

My name is Victoria Parsons and I am the new Development Manager in the Family and Community Support team in Disability Support Services.

I have joined Disability Support Services after working as an Educational Psychologist at the Ministry of Education. Prior to this I also worked as a communications specialist with the NGO sector and within government. In all my roles I have supported schools and communities to create cultures that are inclusive and responsive to children and their families. I am looking forward to working in Disability Support Services to support children and their families access the right support to enable them to thrive and lead good lives.

I will be responsible for the Autism Spectrum Disorder portfolio and working with Child Development Services. As part of this work I will be representing Disability Support Services on the cross-agency Enabling Good Lives project.

I am passionate about working as part of a team to create services that are child and whānau centred and finding ways to deliver consistent and integrated support.

Please contact me with any ideas, comments or questions at victoria_parsons@moh.govt.nz

New staff at Disability Support Services

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COPY TO: Enable New Zealand PO Box 4547

Palmerston North 4442 Phone +64 (6) 353 5800

For:

Decision

Endorsement

√ Noting

To Healthy Communities Advisory Committee

Author Scott Ambridge, General Manager Enable New Zealand

Gabrielle Scott, Executive Director Allied Health

Endorsed by Kathryn Cook, CEO MidCentral District Health Board

Date 11 April 2018

Subject Disability Support System Transformation Update

RECOMMENDATION

It is recommended that the Committee:

• notes the update and progress of the transformation of the Disability SupportSystem.

Strategic Alignment

This report is aligned with MDHB’s strategy, specifically achieving equity of outcomes across communities. This is relevant for disabled people and their whanau who face significant barriers to participation and citizenship. It is also aligned with the goal to connect and transform primary, community and specialist care as the work in this area will change the way in which current DHB services interface with the new system and in the longer term may also drive service change.

Glossary

DHB – District Health Board DIAS – Disability Information Advisory Service DSS – Disability Support Services EGL – Enabling Good Lives ENZ – Enable New Zealand MDHB – MidCentral District Health Board MoE – Ministry of Education MsD – Ministry of Social Development OT – Oranga Tamariki

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1. PURPOSE

The purpose of this report is to update the Healthy Communities Advisory Committee on the DSS Transformation for MDHB.

2. BACKGROUND

The new (detailed) design for the DSS transformation is in the final stages of development after the high level design was presented and approved by Cabinet mid-2017.

The high level design was developed by a co-design group comprising people with disabilities and family representatives, supported by a number of officials including the General Manager, Enable New Zealand.

Detailed design across twenty-plus working groups took place in the latter half of 2017 through to March 2018 that also included virtual (on line) testing of the various work streams. This work has informed the second Cabinet paper that went Government in early April 2018.

3. UPDATE

Since the last update the following activities relating to the DSS transformation are summarised below:

• The final Cabinet paper has been presented to Government in April, later thanfirst anticipated. A verbal update on the Cabinet recommendations will beprovided at the meeting.

• Government Ministers (Sepuloni, Genter), associated with the MidCentralprototype, will be making a public announcement in Palmerston North, to theRegional Leadership Group, on Thursday 26 April.

• The Ministry of Health has commenced discussions with Enable New Zealand oncontract and service changes required to support the transformed system.

• The focus now shifts to implementation at MidCentral, specifically:1. The planned go live date is still October 2018.2. Identifying the critical functions needed for the go live date.3. The prototype will be refined using a try, learn, adjust approach.

3.1 Regional Leadership and Governance

Leadership and Governance at a local level is an important attribute of the new system. The Regional Leadership Group has been in place for four months to provide oversight of the MidCentral prototype, and is made up of disabled people, families/whānau and providers – local officials from the Ministries of Health, Social Development, Education and Children. The General Manager Enable New Zealand, and the Executive Director Allied Health, represent MDHB on this group.

It is intended that a Governance group will be formed, made up of a sub-group from the Regional Leadership Group. There will be a formal appointment process and this is planned for the coming months. The Governance group will be accountable to its community, the Regional Leadership Group, as well as to the Minister for Disability Issues and Associate Minister of Health.

The Governance group will:

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1. Ensure the prototype is implemented as designed.2. Ensure the culture reflects the Enabling Good Lives principles.3. Make decisions about funding and4. Make recommendations about how the prototype can be improved based on

evidence from the monitoring and evaluation processes.

3.2 Local Officials Working Group

An important feature of the new system is to reduce the current siloed approach to delivering disability support services across government agencies. In order to achieve this a local officials group has been established (comprising MoE, MSD, OT, MDHB and local government) to support the roll out of the prototype at MidCentral.

The group is being facilitated by the Ministry of Health and is still very much in the “storming and forming” phase. Whilst in the early stages there is an acknowledgment by all agencies that the way services are currently delivered can be improved. A small example of this is the multiple referral forms that disabled people need to complete when engaging with the different government agencies.

3.3 Integrated Service Models

All MDHB clusters will at times interface with the proposed prototype at MidCentral with staff from Women’s and Children’s Health, Elder Health & Rehabilitation, Mental Health and Addictions and Public, Primary and Community having more regular interface with the transforming system.

The planning phase for clusters will need to consider any potential service impacts or changes as a result of the transformation of DSS. As a first step the General Manager Enable New Zealand and the Executive Director, Allied Health will provide an update to the MDHB Executive Leadership Team to consider the most appropriate next steps.

4. RECOMMENDATION

It is recommended that the Committee:

notes the update and progress of the transformation of the Disability Support System.

Scott Ambridge Gabrielle Scott General Manager Executive Director Enable New Zealand Allied Health

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COPY TO:

Strategy, Planning &

Performance MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440

For:

Decision

Endorsement

X Noting

To Healthy Communities Advisory Committee

Author Wayne Blissett, Operations Director Maori Strategy and Support | Programme Lead Ora Konnect

Endorsed by Craig Johnston, GM Strategy, Planning & Performance

Date 10th April 2018

Subject Ora Konnect – Development of an IFHC model for the South Western Suburbs of Palmerston North - Update

RECOMMENDATION

It is recommended:

• that the progress update on the advancement of Ora Konnect be noted.

Strategic Alignment

This report is aligned to MidCentral DHB’s strategy and strategic imperatives, particularly, Achieving Equity of Outcomes Across Communities

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Glossary

CIO – Chief Information Officer

CPHO – Central Primary Health Organisation

ELT – Executive Leadership Team

IFHC – Integrated Family Health Centre

IT – Information Technology

MidCentral DHB – MidCentral District Health Board

PMS – Practice Management Software

SW – South Western

Whanau Tahi – An integrated technology platform used by Te Pou Matakana the North Island Whanau Ora Commissioning Agency

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1. PURPOSE The purpose of this paper is to provide a progress update of Ora Konnect - the development of an Integrated Family Health Centre model for the South Western suburbs (Awapuni, Highbury & Cloverlea) of Palmerston North. 2. SUMMARY Ora Konnect takes a fresh approach to improving health and wellbeing by focusing on the strengths and opportunities that exist in the defined community that is the SW suburbs of Palmerston North.

Focussed effort has continued to progress Ora Konnect beyond a concept to a practice reality. Key achievements since the last update includes: • finalisation of the Project Implementation Plan and Work Breakdown Schedule • increased Community Participation including; Te Aroha Noa; Highbury Whanau

Centre; and The Palms • ora Links Hosting – Next Planned for 24nd May at The Palms • exploration of a physical presence in Highbury to create a face and place to

actively promote Ora Konnect for the community • formulation of a Communication Plan and Approach • active engagement with IT for both MDHB and CPHO • budget request to fund to the original Case for Change investment to continue

progress for 18/19 • programme outline to formal Alliancing Agreement with Dr Iain McCormick 3. BACKGROUND In 2014 the Karanga te rā Karanga te ao community profile was commissioned for the purpose of informing future strategies to enhance health and social service provision in the SW suburbs of Palmerston North City. The aim was improving the health and wellbeing of the SW communities. The name Karanga te rā Karanga to ao, a call that “summons and welcomes in a new day and a new dawn”, exemplifies the innovative approach required to advance current capabilities and address a highly complex system. The profile provided an understanding of the issues these communities face and identified the challenges and the areas that require attention. It also acknowledged existing strengths and the invaluable potential that resides within the SW suburbs. The interview feedback and shared ideas highlight the need for change, and joined

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up care and support. On the basis of the findings presented in the report the following recommendations were made: • Develop a model of service delivery that improves integration and coordination

of health and social services • Continue to build relationships within the SW suburbs • Expand and refine the service mapping exercise • Maintain a clear focus on the Population being served Ora Konnect provides the opportunity to transform health and social service delivery, into an approach that will meet the needs of Whānau now and to the future. The SW suburbs “community voice” has clearly stated that Whānau need greater flexibility around how and when services are delivered, what these services are, and the importance of connecting up providers so that the services are focused around client need rather than agency/service provider constraints. This has been key in developing the communication approach adopted by Ora Konnect. Rather than developing a formal consultation process, Ora Konnect is connecting with existing Community events and opportunities so it is viewed as part of the community rather than existing outside of the community. Ora Konnect represents a purposeful departure from the status quo of a ‘bricks and mortar approach’ and will require some experimentation, risk and commitment. This is particularly so with the IT platform that forms the ‘gel’ to connect whanau with services. Since approval of the Case to Change the focus has been translating the concept into a practical reality through the adoption of a project management approach. 3.1 PROGRESS UPDATE Since the last update to HCAC, the Ora Konnect Project has continued to progress at pace. The Project Implementation Plan and Work Breakdown Schedule have been completed and endorsed by the Steering Group and the Project Team. Following HCAC’s feedback there has been increased community conversations and participation with the Highbury Whanau Centre, Te Aroha Noa and The Palms. Further opportunities to connect with The Health Hub Project have been commenced also. There is a clear plan to work with interested partners on the Alliancing Agreement, with June 2018 the agreed milestone for a draft Alliance Agreement. Dr Iain McCormick from the Executive Coaching Centre will be leading this component of work in partnership with the Project Team. This approach is commencing with an educational evening hosted by CPHO for interested parties who may wish to join the Alliance outside of those who are already engaged with a particular focus on GP Teams, Pharmacy and cross sector partners. This will then progress to formal workshops leading to the formal Alliance Agreement. Formal meetings have been held with the CIO MDHB and IT Manager CPHO in developing an approach to identifying the best Integrated IT Platform for Ora Konnect. CPHO is endorsing a move to a new technology platform – Indice for Primary Health.

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Meetings have also been held with the CEO and IT Development Manager of Whanau Tahi to explore the most cost effective way to deliver access to whanau. One current opportunity is being able to import the current GP enrolled population and have a virtual registration for Ora Konnect, allowing access across a range of GP Practices via the virtual network. This would be a cost effective approach that would not incur extra costs onto GP Practices or agencies. This work stream continues to be a priority focus moving forward. A web presence is currently being developed by the Project Co-ordinator that will link with other key partner sites to create a joined up approach to promoting Ora Konnect for Whanau. Ora Konnect has been promoted as a key activity across the Primary Health component of the MDHB Annual Plan 18/19 and the MDHB Operational Plan 18/19. The Ora Links Network held on the 22nd February was very successful and included new members to the table including Te Aroha Noa and The Palms. 3.3 Next Steps During the next quarter the focus is on;

• Continue to deliver against the Project Implementation Plan and Work Breakdown Schedule

• Implement the Alliancing Plan in partnership with Dr Iain McCormick and the interested partners with the completion of an Alliance Agreement by June 2018

• A request for the Programme to be funded to the amount requested in the Approved Case for Change $230K has been made to ensure that the momentum gained can be sustained as part of the MDHB Annual Plan 18/19

• Continue to work on the Due Diligence programme with CIO MDHB and IT Manager CPHO to ensure the best integrated technology platform to invest in is consistent and integrated with IT development across MDHB and CPHO

• Sustain Ora Konnect Links as a community network and resource link for Ora Konnect – Next Forum 24th May 2018

• Develop a physical presence in Highbury to create an opportunity to promote and gain more community understanding around Ora Konnect.

• Continue to build the conversation with the Community and ensure ongoing community engagement and support.

• A further update will be provided to the Committee at their September meeting.

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4. RECOMMENDATION It is recommended: that the progress update on the advancement of Ora Konnect be noted. Wayne Blissett Operations Director Maori Strategy and Support | Programme Lead Ora Konnect

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COPY TO:

Specialist Community &

Regional Services MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440

For:

Decision

Endorsement

x Noting

To Healthy Communities Advisory Committee

Authors Dr Robert Weir, Medical Officer of Health

Dr Robert Holdaway, Manager Public Health

Mr Peter Wood, Drinking Water Assessor

Endorsed by Deborah Davies, Operations Executive, Primary, Public & Community Health

Date 11 April 2018

Subject Drinking Water Update

RECOMMENDATION

It is recommended:

• that the implications for MDHB arising from the Havelock North Drinking Water Inquiry, the Ohakea PFAS Contamination and the Longburn Community Drinking Water fluoride event be noted.

Strategic Alignment

This update relates to the statutory and contractual responsibilities for the Public Health Service regarding the safety of community drinking water supplies and is aligned to the MDHB Strategy.

Glossary

CEOs – Chief Executive Officers

DHBs – District Health Boards

DWAs – Drinking Water Assessors (employed by PHS)

DWSNZ – Drinking Water Standards New Zealand

HBRC – Hawkes Bay Regional Council

HDC – Hastings District Council

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HPO – Health Protection Officer

HRC – Horizons Regional Council (Manawatu-Whanganui Regional Council)

JWG – Joint Working Group

MDHB – MidCentral District Health Board

MfE – Ministry for the Environment

MoH – Ministry of Health

MOoH – Medical Officer of Health

NZDF – New Zealand Defence Force

PDP – Pattle Delamore Partners Limited

PFAS – Per- and polyfluoroalkyl Substances

PHS – MidCentral Health’s Public Health Service

PHUs – Public Health Units

RFP – Request for Proposal

RMA – Resource Management Act

RoI – Registration of Interest

TLAs – Territorial Local Authorities

WSP – Water Safety Plan

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1. PURPOSE The purpose of this paper is to update the Committee around the Report of the Havelock North Drinking Water Inquiry (Stages 1 & 2), the contamination of surface and groundwater around RNZAF Base Ohakea by PFAS, and a recent event involving the Longburn Community Drinking Water Supply. 2. HAVELOCK NORTH DRINKING WATER CONTAMINATION 2.1 Background In August 2016 there was an outbreak of gastroenteritis in Havelock North (population around 14,000). It is estimated that some 5,500 people were affected. Campylobacter was identified as the cause of the illness. The outbreak resulted in 45 people being hospitalised, and was associated with three deaths. The financial cost has been calculated to be just over $21 million. The outbreak was traced to contamination of the water supply by runoff from recent rainfall which had washed sheep faeces into a pond, and subsequently entered the aquifer. The bores had been presumed to be secure, so the water was untreated. Government launched a two-phase Inquiry into the outbreak. 2.2 Inquiry Report - Stage 1 The first phase focused on what happened, the cause of the outbreak and an assessment of the conduct of those responsible for providing safe drinking water to Havelock North, with some of the key summary points being: • Hawkes Bay Regional Council (HBRC) failed to meet their responsibilities under

the RMA to act as guardian of the aquifers. • HBRC imposed a generic condition on water intake permits, then failed to

adequately monitor compliance with the conditions on the permits. • Hastings District Council (HDC) did not properly manage the maintenance of

plant and equipment or keep records of that work. It was slow to obtain a report on bore head security and it did not carry out recommended improvements.

• There was a critical lack of collaboration between the Hawkes Bay Regional Council (HBRC) and the Hastings District Council (HDC).

• The absence of regular and meaningful cooperation resulted in a number of missed opportunities that might have prevented the outbreak.

• The DWAs employed by Hawkes Bay District Health Board, were too hands-off and should have been stricter in ensuring that the HDC complied with its responsibilities.

2.3 Regional (Manawatu-Whanganui) Response to the Havelock North

Inquiry Following release of the Stage 1 Report in December 2016, Horizons Regional Council (HRC) has been leading a joint project involving staff from each of the seven local authorities in the region, and our MDHB DWAs. HRC commissioned Pattle Delamore Partners Ltd to undertake a Community Drinking Water Assessment across the Horizons Region. The report, which was released in November 2017, identified 29 water supplies from 55 sources within the region that are operated by territorial authorities, and which provide water to communities of more than 500 people. Whilst HRC acknowledge that this was just

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a snapshot, the report did highlight a number of issues with the overall compliance of these supplies. A work programme was developed in order to further understanding of the risks posed to communities and to provide information around the security of the drinking water supplies so that any necessary improvements can be made. Stage 1 – Catchment area risk assessments The first step is to delineate a groundwater protection zone around the supplies and to undertake a desktop review to identify potential sources of contamination. Following this assessment, a workshop will be facilitated to familiarise attendees with local water resources (including ‘how groundwater works’), identified risks to groundwater and surface water supplies, leading into a session around Water Safety Plans. Stage 2 – Borehead inspections Bore heads represent a potential point of entry for contamination of drinking water supplies. At present there is little information around the current status of bore heads across the region. Each bore head is to be inspected against a consistent set of criteria, providing a reference point for future assessments against any future standards. The report will provide a short summary of the findings for each bore, and recommendations for any remedial works that might be required. Stage 3 – Update the risk assessment and recommendations Following completion of stages 1 & 2, the initial PDP stocktake will be refreshed, incorporating the latest compliance inspections and any new information that has become available. Workplan progress to date HRC released a Registration of Interest (RoI) document on 27 March 2018. This document seeks to establish a shortlist of potential suppliers to work through a Request for Proposal (RFP) process. The tender process will close at 4 pm on Monday 16 April. The indicative timeframe for completion of the three stages of this work plan is 30 June 2018. 2.4 Inquiry Report - Stage 2 Terms of reference for Stage 2 required the Inquiry to investigate and make recommendations in respect of:

• Any legal or regulatory changes or additions necessary and desirable to prevent or minimise similar incidents.

• Any changes or additions to operational practices for monitoring, testing, reporting on and management of drinking water supplies, implementation of drinking water standards, contingency planning, and responses by local and central government to address lessons from the incident and

• Any other matter which the Inquiry believes may promote the safety of drinking water and/or prevent the recurrence of similar incidents.

The Stage 2 report was released on 6th December 2017. It can be viewed at: www.dia.govt.nz/government-inquiry-into-havelock-north-drinking-water The report contains 51 recommendations in total. These were divided into those that could, (if accepted), be implemented within a short timeframe, and those that would be expected to take longer to complete. Summary headings are included

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below – the detailed recommendations can be found in the Inquiry Report, including who the recommendation is directed at. Urgent and Early Recommendations include:

• Promulgate the six fundamental principles of drinking water safety. • Abolish the Secure (Bore) Classification System. • Encourage Universal Treatment. • Establish a Drinking Water Regulator. • Interim improvements at and by the Ministry of Health including taking

urgent steps to administer and enforce the existing regulatory regime. • Amend RMA to expressly recognise drinking water source protection. • Accelerate NES Regulations review. • Encourage joint working groups (JWGs). • Urgently amend the Health Act.

Further Recommendations to Prevent Recurrences include:

• Mandate universal treatment. • Establish a licensing and qualifications system for drinking water supplies

and operators. • Develop a separate Drinking Water Act. • Amend the legislation by removing the “all reasonable steps” test in a

number of clauses, making compliance mandatory • Review the Drinking Water Standards New Zealand (DWSNZ). • Mandate collaboration (JWGs). • Create dedicated and aggregated drinking water suppliers. • Improve resourcing and capability of DWAs. • Implement amended NES regulations. • Review Water Safety Plans (WSPs), to ensure that leadership, governance

and management understand and address the risks at a strategic level, and that critical control points are included in the WSPs.

• Strengthen enforcement of WSPs by DWAs. • Require an Emergency Response Plan and Boil Water Notice documentation. • Improve the testing and laboratories regime. • Prohibit new below-ground bore heads.

Government Response to the Stage 2 Report It is important to note that at this point, these are recommendations, which may or may not be accepted and implemented by Government. The Government is currently reviewing how to improve the management of drinking water, storm water and waste water (three waters) to better support New Zealand’s prosperity, health, safety and environment. It is understood that any changes arising from the Havelock North inquiry are being considered in the context of this wider review. Local response to the Stage 2 report Although it is acknowledged that the recommendations have not yet been adopted by Government, there was a clear criticism in the Stage 2 report around the failure of the Ministry to act promptly on some of the recommendations in the Stage 1 report. There are aspects of the Stage 2 report that can, and should be implemented rapidly, as they fit within the current regulatory framework, and align with best practice. Some of these are reliant on our working with the Ministry, and in a consistent manner with public health services within other DHBs, whilst others can be undertaken at the local level:

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Recommendation 8 The CEOs of DHBs should advise suppliers to appropriately and effectively treat, pending any change to the law and/or the DWSNZ. We are fortunate that all public supplies in this area are treated, and have been treated for some years. Nevertheless, it was felt prudent that we reinforce this message.

• Actions taken: Letters have been sent to the CEOs of the drinking water suppliers in this region who supply communities with populations of at least 500 people, emphasising the need to maintain effective drinking water treatment systems and to actively monitor these systems to ensure they are working effectively. Recommendation 13 The Ministry of Health, via the DWAs and Medical Officers of Health, should take urgent steps to administer and enforce the existing regulatory regime, having regard to the findings and recommendations in the Stage 2 report. The Annual Drinking Water Survey 2016/17 identified a number of instances of non-compliance on the part of local suppliers with the DWSNZ and/or the legislation. Following the release of the Stage 1 report, the Ministry asked our PHS to write to local suppliers, asking them to provide information around how they propose to address the issues relating to their non-compliant supplies, and within what timeframe.

• Actions taken: This information has been collated and provided to the Ministry of Health. Recommendation 18 DHBs/PHUs should establish, as soon as is practicable, (with the assistance of the MoH) a JWG responsible for oversight of drinking water safety in their respective regions. Such JWGs should operate along the lines of the Hawkes Bay JWG.

• Actions taken: As noted above, the collaborative process is already underway in this region. Governance for this work is through the combined CEOs, with formalisation of the process planned. It is expected that Terms of Reference will need to be drafted. The terms of reference for the Hawkes Bay JWG have been sourced as a starting point for consideration. Recommendations 38 & 39 All DWAs and Medical Officers of Health should adopt a rigorous approach to the requirements for approving and reporting on implementation of WSPs. DWAs should action any failures to implement a WSP promptly and effectively with, where appropriate, compliance orders and/or other enforcement action. Approving and monitoring implementation of WSPs is a core (scope) function for DWAs. While the WSP represents the primary method for monitoring compliance by drinking water suppliers, it is also an important tool for a water supplier’s management and operational staff to actively understand and manage public health

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risks. It should be a “living document” that is owned by the water supplier and understood by the operator.

• Actions taken: In the wake of the August 2017 hearings and a letter from the Ministry of Health dated 18th August 2017, the DWAs have been working with suppliers to encourage identification and incorporation of critical control points. This piece of work needs to continue so as to ensure that the WSPs identify and mitigate risks effectively. The time frame outlined in Recommendation 14(i) has already passed, and the Government response will determine the time frame placed on water suppliers to include critical control points in WSPs. The next stages will be to look at our processes around approving, reviewing, and monitoring the implementation of WSPs. These procedures are now included in Section 8 of the Environmental Health Manual and are being reviewed on a national basis. 3. HEAVY METAL TESTING – HOROWHENUA DRINKING WATER SUPPLIES Subsequent to the release of the Havelock North Drinking Water Inquiry findings and recommendations, questions were raised around the levels of heavy metals in drinking water supplies in Horowhenua, and the potential impact that these might be having on health of our communities. The Horowhenua District Council (HDC) organised for testing to be undertaken of drinking water from Foxton, Foxton Beach, Levin, Tokomaru and Shannon. The samples were tested for a range of metals including (but not limited to) lead, arsenic, chromium, manganese and mercury. All of the test results fell below the Maximum Allowable Value (MAV), and in many cases were below the limits of detection. It is envisaged that the testing will be repeated in around 5 year’s time. 4. RNZAF BASE OHAKEA PFAS CONTAMINATION On Monday 27th November 2017 MDHB’s Public Health Service was advised by the Ministry of Health (MoH) that the New Zealand Defence Force (NZDF) and Ministry for the Environment (MfE) were investigating the possible contamination of surface and groundwater surrounding two RNZAF Bases (Ohakea and Woodburne), by PFAS. PFAS are a class of man-made chemicals that have been used since the 1950s in the production of a wide range of products that resist heat, stains, grease and water, including furniture protectants, floor wax and specialised firefighting foam. They are persistent in the environment and in the human body, and are resistant to environmental degradation. They also bio accumulate in the tissues of living organisms for long periods of time. The Ministry of Health (MoH) has confirmed that exposure to PFOS and/or PFOA will not pose any significant health effects today. It is also recognized that these compounds accumulate in the body but we don’t fully understand the effects this could have on human health in the long-term. Therefore, a precautionary approach is being taken to the situation surrounding Base Ohakea.

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Initial testing on the base confirmed that PFAS were present in surface and groundwater samples. Computer modelling suggested that a number of properties to the south-west of the base might have been contaminated. The sampling programme (which our staff were not involved in) took place between 7th and 20th December. The initial investigation was contracted to Pattle Delamore Partners Limited (PDP) by NZDF. Samples have now been analysed, the results received and collated, and individual landowners provided with their results. Round 1 water testing results: Of 26 groundwater samples collected from properties around Base Ohakea, PFAS were detected in 19 samples (73 percent). Thirteen samples exceeded the interim drinking water guideline levels, and five of these were recorded as being from bores currently used for drinking water. PFAS were also detected in all of the eight surface water samples, with levels exceeding the interim drinking water guidelines in five of the samples.

• The PDP report recommended extending the area under investigation to include additional properties, based on updated modelling data. Additional samples were also to be taken from the original ground and surface water sources in order to ascertain any seasonal variation in the levels of PFAS.

Round 2 water testing: The second round of sampling commenced in late February, and has now been completed. We are currently awaiting the results, which are scheduled to be released in late April. While MDHB’s PHS has had no direct involvement in the second round of testing, it is understood that testing took place on a number of additional properties. Further sampling rounds are scheduled for late May and mid September 2018. Arrangements for GP visits for residents from affected properties Members of three households whose PFAS levels exceeded the interim guidelines during round 1 of testing have taken up the offer of a consultation with their GP, following the protocol developed by the Ministry of Health. Alternative drinking water supplies NZDF have provided bottled water to residents whose properties have been under investigation. PHS has worked with Manawatu District Council to estimate the cost of a more permanent alternative supply. Proposed action PHS will continue to provide support to NZDF and MfE as requested.

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5. LONGBURN DRINKING WATER FLUORIDATION DOSAGE EVENT While Palmerston North residents have been able to access fluoridated water for many years now, fluoridation of the Longburn Community Drinking Water Supply commenced more recently. Council approved the installation of fluoride dosing in the Longburn supply through the 2017/18 year Annual Budget Consultation process. The plant was commissioned in March 2018. During routine monitoring at 1pm, Tuesday 3 April, elevated fluoride levels were detected in the water supply. Laboratory testing confirmed the elevated levels at 8.7mg/l, which is above the target level of 0.7–1.0mg/l. On notification, the dosing system was immediately switched off. Samples were taken, followed by a complete flushing of the entire Longburn network. By 5pm on Tuesday 3 April, fluoride levels in the water supply had dropped to 0.2mg/l. Samples on 28 March and 4 April tested by a certified laboratory show the fluoride level to be well within the target level. An investigation has identified that the incorrect dosing started on Thursday 29 March following an unauthorised change made by a contractor, and continued over the Easter holiday period. Levels found in the water supply were well below any short-term exposure guidelines, therefore no acute health effects would be expected from this incident. There is also expected to be no risk of any long-term impacts given the very short period of exposure. Information about the event has been posted on the Palmerston North City Council website. Anyone concerned about their health has been advised to see their GP or ring Healthline on 0800 611 116. 6. RECOMMENDATION It is recommended:

that the updates around the Havelock North Drinking Water Inquiry, the RNZAF Base Ohakea PFAS response and the Longburn Community Drinking Water Fluoridation event be noted.

Dr Robert Weir, Medical Officer of Health

Dr Robert Holdaway, Manager Public Health

Mr Peter Wood, Drinking Water Assessor

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COPY TO:

Strategy, Planning &

Performance MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440 Phone

Fax +64 (6) 350 8928 +64 (6) 355 8926

For:

Decision

Endorsement

X Noting

To Healthy Communities Advisory Committee

Author Steve Carey, Portfolio Manager – Clinical Services

Endorsed by Craig Johnston, GM Strategy, Planning & Performance

Date 16 April 2018

Subject Pharmacy Contract Update

RECOMMENDATION

It is recommended:

• that the update on the Pharmacy Contract be noted.

Strategic Alignment

This report is aligned to MidCentral DHB’s strategy and strategic imperatives, particularly, Achieving Equity of Outcomes Across Communities.

Glossary

IPSCA - Integrated Pharmacist Services in the Community Agreement

Central PHO: Central Primary Health Organisation

Central TAS: Central Technical Advisory Services

CPSA - Community Pharmacy Services Agreement 2012

DHB – District Health Board

MidCentral DHB – MidCentral District Health Board

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1. PURPOSE The purpose of this paper is to provide an update on community pharmacy contracting. A new contact has been developed and is being consulted on. No decision is required. 2. SUMMARY MidCentral DHB currently holds contracts with 32 local pharmacies across the MidCentral district. These contracts were nationally negotiated between DHB and representatives nominated by the community pharmacy agreement holders, and expire on 30 June 2018. A national process has been underway to develop a new contract consistent with the national Pharmacy Action Plan 2016-20. This is referred to as the Integrated Pharmacist Services in the Community Agreement (IPSCA). The development process has has included a formal consultation process which concluded on 10 April 2018. As part of the consultation, two local meetings were held. The first was for local pharmacists and sector agents and was well attended. The second meeting was for other interested parties and stakeholders. The feedback provided by those in attendance at the consultation meetings has been amalgamated into the National consultation process. 3. BACKGROUND The Community Pharmacy Services Agreement (CPSA), similarly to Primary Health Organisation and Age Related Residential Care agreements, was negotiated nationally. The CPSA has been the national contract for community pharmacy services since 2012 and has been renegotiated for each new contracting period, with the current contract extension ending 30 June 2018. 3.1 Pharmacy Action Plan During 2015-2016 the Pharmacy Action Plan 2016-20, and the vision for Integrated Pharmacist Services in the Community, developed during earlier stakeholder Hui was released. The Action Plan’s focus areas were: • Population and personal health has a people-powered focus. Pharmacists

will provide public health interventions that support their patients in the community to manage their own wellbeing, having the best possible healthcare throughout their lives, and to have easy access to support close to their home. For example, pharmacists will contribute to screening for and reducing medication utilisation concerns, and to work towards improving population health literacy.

• Medicines management services sees pharmacists delivering value and high

performance. Pharmacists will work collaboratively as part of an integrated healthcare team that helps to improve health outcomes by providing a comprehensive range of medicines management services. For example, Feilding Health Centre whereby pharmacists are working in general practice teams to deal with polypharmacy – that is, issues related to prescribing many medicines or inappropriate medicines.

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• Minor ailments and referral aims to have services being delivered closer to

home. Patients will have equitable and timely access to self-care advice, treatment of minor ailments, acute demand triage and appropriate referrals. Examples of such services: emergency department triage services, which may include pharmacists and other members of the health care team; Clinical Pharmacists following up post discharge patients to facilitate medication alterations with the purpose of reducing readmission; and, in primary care, potential community based minor ailment services for priority populations.

• Dispensing and supply services objective is to use the current pharmacist

workforce and smart systems more effectively. This will include redesigning the dispensing process to ensure an accessible, sustainable and efficient medicines supply chain. When smart systems are used effectively, all New Zealanders can have timely and equitable access to these services; wherever they live. For example, the use of accuracy checking technicians will make pharmacists more accessible to New Zealanders and through the improved use of electronic prescribing systems in aged care, we will reduce waste and provide more integrated healthcare services.

The Action Plan’s key tools for influencing change are: • Leadership This is an essential part of our ‘one team’ vision. A cohesive team approach to leadership is needed within the pharmacy profession and across the health and disability sector. To progress towards our vision, everyone needs to think and act differently, to clarify leadership roles and to look at how they interact with others so that they can focus efforts to improve the system. Active partnerships with people and communities are needed at all levels.

• Smart systems Technology will be easy to access and contribute to improved health outcomes. The actions here are critical to the success of the Plan, strongly align with the national information technology strategy and help to create a high-performing system that people have confidence in. • Workforce The capacity and skills of the existing pharmacist workforce will be fully used while we also develop their skills so that in the future this workforce can deliver a wider range of integrated services in a wider range of settings. Culturally competent practice is essential; in particular, it acknowledges the special relationship with Māori and the commitment to partnership, protection and participation under the Treaty of Waitangi. • Regulation A robust regulatory regime is vital for delivering high-quality integrated health services that are safe and effective. To achieve this vision, the Government is ensuring that the law helps rather than hinders progress towards this vision. The Action Plan indicates which actions are likely to be priorities over the next five years. However, all actions are agile to change if there are changes in priorities, costing and funding available over the period this Plan covers.

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It was widely acknowledged through comprehensive consultation processes that a new approach was required to meet the aims and objectives in the Pharmacy Action Plan 2016-20, and to allow for innovation and local service development. The work of bringing the vision and actions into reality will be managed via the new contract agreement. National negotiations have resulted in a new draft agreement being created, the Integrated Pharmacy Services in the Community Agreement (IPSCA). 3.2 Aims The structure of IPSCA has been developed in a similar style to the national Primary Health Organisation and Age Related Residential Care agreements. Both provide for an Evergreen contract period, with separate service schedules sitting under the head agreement. Being an Evergreen agreement provides surety of ongoing funding without requiring the setting of artificial deadlines for annual contract re-negotiations. IPSCA aims to provide a flexible contracting approach, which will allow for service changes and improvements to be negotiated. These changes will be reflected in individual services, negating the need for wholesale re-contracting. IPSCA has been drafted so that there will be no changes in funding or service requirements from day one of the agreement – therefore ensuring continuity within our community. Changes will only occur after negotiation and consultation with pharmacists and their representatives. Some services have a requirement for national negotiations, while other will be negotiated and developed locally. This provides greater freedom for DHBs to contract for the service mix required for particular communities in order to improve health outcomes. As part of the consultation, discussion was had around only offering the IPSCA agreement to those establishing a brand new pharmacy or to new owners purchasing existing pharmacy businesses from current CPSA holders. All feedback from the consultation will be analysed and used to inform required changes to IPSCA prior to it being offered to pharmacy agreement holders. 3.3 Emerging Themes Over five weeks, from 5 March to 10 April 2018, the 20 District Health Boards (DHBs) throughout New Zealand sought the views of pharmacy owners, pharmacists, other health professionals and providers, other health stakeholders and consumer groups on how to deliver on the strategic direction of the Pharmacy Action Plan 2016-20. There were 865 attendees at the DHB consultation meetings including two national hui, two meetings with young pharmacists and meetings with key stakeholders including individual consumer groups. Two meetings were held within the Manawatu region in relation to the agreement consultation. The first was for pharmacist contract holders, pharmacists and sector agents. Representatives of Central TAS and the Ministry of Health were at the meeting in support of MidCentral DHB. The second meeting was open to other stakeholders and interested parties. The meeting was widely advertised in the media and through the DHB’s networks but

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was not well attended. Present were representatives of Central PHO and Te Tihi o Ruahine. In addition to the meetings organised by MidCentral DHB, there were other local meetings organised by various groups – for example, by Green Cross Pharmacy and the Pharmacy Guild. As part of the consultation, DHBs sought feedback on a proposed new contract for pharmacist services (IPSCA), and a one-year extension of the current CPSA 12 Agreement. DHBs received nearly 1600 consultation responses; 1470+ responses to the online survey and a further 120+ emailed consultation responses, in addition to the feedback provided through the national and local meetings. Feedback to MidCentral DHB through the meetings and through other mechanisms has been general support for the concept of enabling innovation and development within pharmacist services, with greater emphasis on utilising the clinical skills that pharmacists have. There have been two areas of concern arising from the pharmacy sector. Firstly, there is a concern that patient safety might be affected by the separation of pharmaceutical supply and professional advisory services. DHBs have responded that patient safety is the priority concern. In the first year product supply and professional advisory services will be contracted together, and DHBs will formally consult with the sector and regulatory bodies before any DHBs allow a separation of the functions. Further, the intention of DHBs is that any future arrangements will ensure that patients continue to have access to both services. The second issue raised is the possibility that DHBs will disinvest from community pharmacy. A previous iteration of the current pharmacy contract included a ‘funding floor’ for community pharmacy; this is not a feature of the new arrangements. DHBs have responded that DHB contracts do not normally include a funding floor, and that DHBs have no intention of disinvestment, either nationally or locally from community pharmacy services – a sentiment echoed by the DHB Chief Executives. Within MidCentral DHB, our local pharmacy investments will be guided by our Strategic Plan (2016) – ensuring that we a purchasing the correct and effective health outcomes for our community. Community services, including pharmacy, will play a key role in keeping people well, in their homes and communities, and out of hospital. Additional funding will be allocated for IPSCA agreement holders for new services and staff development towards providing more clinical services. This will be $4.1m nationally for new services ($160,432 within MidCentral), with the funding for the Professional Advisory Services Support payment still being developed as part of annual budgeting processes. This additional funding will not be available to those pharmacies that remain operating under the CPSA for 2018/19. 4. NEXT STEPS The feedback is currently being collated into a document - the Summary of Consultation Feedback, which identifies the main themes present in the feedback that DHBs received during the consultation. All submissions received via an online questionnaire or by email will be appended to the document when it is made publicly available later in April via the Central TAS website.

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All feedback from the consultation will be analysed and used to inform required changes to IPSCA. The final version of IPSCA will be offered to pharmacists to sign by the end of June 2018 with the new agreement taking effect on 1 July 2018. At present, the CPSA expires on 30 June 2018. District Health Boards will extend the term of the CPSA for any current CPSA providers that do not wish to move to the new contract for a further 12 months through to 30 June 2019. 5. RECOMMENDATION It is recommended: that the update on the Pharmacy contract be noted. Steve Carey Portfolio Manager – Clinical Services

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COPY TO: Strategy, Planning & Performance MidCentral DHB

Heretaunga Street PO Box 2056

Palmerston North 4440 Phone

Fax +64 (6) 350 8928 +64 (6) 355 8926

For:

Decision

Endorsement

X Noting

To Healthy Communities Advisory Committee

Author Craig Johnston, General Manager, Strategy, Planning & Performance

Endorsed by Kathryn Cook, Chief Executive

Date 13 April 2018

Subject Strategy, Planning & Performance Operating Report

RECOMMENDATION

It is recommended:

• that this report be noted

Strategic Alignment

This report aligns to the MidCentral Strategy and to the Annual Plan.

Glossary

CDWX – City Doctors / White Cross CPHO – Central PHO DHB – District Health Board DHBs – District Health Boards GP – General Practitioner GP Teams – General Practice Teams FRAC – Finance, Risk and Audit Committee HCAC – Healthy Communities Advisory Committee IMAC – Immunisation Advisory Centre LMC – Lead Maternity Carers MDHB – MidCentral District Health Board MidCentral DHB – MidCentral District Health Board NEP – Newborn Enrolment Programme NIR – National Immunisation Register OIS – Outreach Immunisation Service PHARMAC - Pharmaceutical Management Agency

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PHO – Primary Health Organisation POAC – Primary Options for Acute Care QEAC – Quality & Excellence Advisory Committee RSP – Regional Service Plan SEQUAL – Supportive Education and Quality Palliative Care

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1. PURPOSE This report provides the Committee with an update on the activities of Strategy, Planning and Performance. It is for the Healthy Communities Advisory Committee’s information and discussion – no decision is required. 2. SUMMARY The Strategy, Planning & Performance team welcome Steve Carey to the role of Portfolio Manager, Clinical Services. In the Primary and Population Health cluster a new after-hours urgent primary care service launched at the beginning of April. The new free-phone 0800 373 030 service will enable people to have faster and more convenient access to expert clinicians. In particular, patients will avoid unnecessary cost as there is no charge to speak to a clinician. Additionally patients will avoid unnecessary travel to Palmerston North and time spent in a waiting room. In the Child and Women’s Health cluster MDHB will be entering into discussion with the Primary Birthing Centre for the 2017/18 contract. It is expected the number of primary births contracted will increase, MDHB will continue to purchase primary births and post-natal stays only at this time. 3. STRATEGIC AND ANNUAL PLANNING 3.1 Locality Planning Health and Wellbeing Plans for Horowhenua, Otaki, Manawatu and Tararua have been signed off by the Board pending some final edits. These edits have been completed and Te Reo integrated. The final graphics will be completed by 20 April. A plan is under development to socialise these with the communities. A meeting will be held with the integrated cluster working group to ensure implementation of the Health and Wellbeing Plans is incorporated into Cluster planning. The development of Palmerston North locality planning is underway. 3.2 Annual and Operational Planning DHBs are not in a position to produce an Annual Plan for approval by the Board and the Minister of Health until the annual planning guidance material, government priorities, including the Minister’s Letter of Expectations, and funding allocations are advised. The Funding Envelope is expected at the time of the 2018 Budget announcements at the end of May. In the meantime, the DHB’s Operational planning and budgeting process for the 2018/19 year continues to be guided by the planning priorities and assumptions approved by the Board in December 2017. A review and rework of plans and budgets has occurred in more detail with each service cluster group and enabler group, which has resulted in an improvement to the original forecast deficit budget. The proposed savings initiatives currently in the budget have focused extensively on cost reductions and efficiencies, most of

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which have minimal impact on patients and the community. To date, there are no significant service change proposals being proposed that would return a significant financial benefit within the 2018/19 year and that do not compromise our current strategic intentions. This is now the subject of further discussion and review in order to close the funding and budget gap. It is anticipated that a draft Operational Plan and budget would be prepared for consideration by the FRAC at their meeting in early June. 3.3 Regional Planning Regional service planning for the 2018/19 year has focused on strategy development in four priority areas – Cancer services, Cardiac services, Mental Health and Addictions and Regional Clinical Care Arrangements (specialty areas of cardiac, neurosurgery and vascular surgery). There is an active regional programme of work to develop specific plans for each of these priorities. The draft RSP will be developed once the planning guidelines and priorities for regional planning are advised by the Ministry of Health and subsequently incorporated into the work programmes. In terms of the centralAlliance, five service areas have been set as priorities for the 2018/19 year. These are: • Urology services. • Renal services. • Laboratory services. • Chemotherapy services. • Cardiac Health System Plan. These priorities all relate to work programmes that are already underway. 3.4 Health Targets The following Health Targets were achieved for March

• Improved access to elective surgery – 104 percent year to date. • Raising Healthy Kids – 99 percent total and 100 percent Maori population

groups. • Faster cancer treatment – 100 percent and 96 percent year to date. • In quarter two Better help for smokers to quit, Maternity, was achieved for

the total population group 90 percent and for Maori 92 percent. (Primary and Maternity data not yet available for period ending March). The following Health Targets were not achieved

• In quarter two, at 88 percent, Better help for smokers to quit, Primary was two percentage points below target but not dissimilar from the national average.

• Shorter stays in ED – 78 percent, 84 percent year to date. • Increased immunisation – 91 percent both total and Maori population Groups

for this quarter.

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Better Help for Smokers to Quit Target Action Plan The Smoking Brief Advice Target is that: 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months. Despite meeting this 90 percent target in Quarter 1 2017, the target figure in the past two quarters, has not been met. Quarter 3 figure achieved only 86.04 percent, a decline from 88.08 percent in Quarter 2. Central PHO have a Smoking Brief Advice Improvement plan in place with the following goals and associated objectives to support achievement of ‘Better Help for Smokers to Quit’ target as below: Goals:

1. Meet or exceed the Ministry of Health’s expected 90 percent target. 2. Ensure sustainable methods of giving and recording Smoking Brief Advice

are used and education/support is available for General Practice Teams to achieve this.

3. Maintain equity in all high-risk populations throughout the Mid Central Health region.

Objectives:

1. Re-establish 90 percent health target for PHO enrolled patients through Increased quit attempts through the provision of brief advice, offer of nicotine replacement therapy initiation, and referrals to smoking cessation services.

The Better Help for Smokers to Quit Target Action Plan is provided for your information as Appendix 1. Shorter Stays in the Emergency Department Health Target Action Plan The Shorter Stays in the Emergency Department (SSIED) target states that 95 percent of patients will be admitted, discharges or transferred from the emergency department (ED) within six hours. ED length of stay is seen as a measure of the quality of acute (emergency and urgent) care across the hospital. When the target was introduced in 2009, MidCentral DHB started from a baseline of 75 percent. A number of work programmes and initiatives were introduced and by 2015 the target was consistently achieved. During 2016 achievement against the target slowly declined and in May 2017 fell below 90 percent for the first time since June 2014. The third quarter result for 2017/ 2018 was 80.8 percent. In 2017 the Francis Health Group engaged with Medical Services commencing a programme of work which included improving patient flow across the service. At the start of 2018, Francis Health Group commenced a similar programme with the Emergency Department. Whilst this work is still in the early stages the first three weeks of April 2018 has seen a moderate improvement with a target achievement of 86 percent. The following Action Plan goal is to consistently achieve the target by introducing sustainable systems and pathways. Achievement of the target will improve the patient experience and the health and wellbeing of the MidCentral DHB population.

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The Shorter Stays in the Emergency Department Health Target – Action Plan is provided for your information as Appendix 2. Immunisation Target Action Plan The Immunisation target is that 95 percent of eight-month-old infants will have their primary course of immunisations on time. There has been a decline in coverage rates in the past four months. However, of note the one-month coverage rate has increased in the past fortnight from 90 to 95 percent following intensive monitoring. A trend of note is the increased decliner/opt-off rate higher than the NZ average for the last three months, with no distinct trend associated with GPTeam enrolment (6 percent compared to 4.6 percent). The immunisation stakeholder group consisting of representatives across the sector has a work programme with the following goals and associated objectives to support achievement of this target as below. Goals:

1. Meet or exceed the Minister’s National Immunisation targets. 2. Increase coverage levels for National Schedule vaccination events at four, eleven and twelve years. 3. Maintain equity in coverage levels for vaccinations on the National Schedule, by ethnicity and deprivation.

Objectives

1. Children • Achieve & Maintain the Ministry of Health Targets:

• 95 percent of 8 month old infants are fully immunised. • 95 percent of two year olds are fully immunised and coverage is

maintained. • 95 percent of four year olds are fully immunised by age 5 years reported

quarterly.

2. Pregnant Women • Increase uptake of both Influenza and Pertussis Vaccination in pregnant

women. The objective of high rates of immunisation uptake in pregnant women is also focussed on the preparation for timely immunisation of babies. National immunisation awareness week is imminent from April 30 to 2 May with a number of activities planned to increase overall immunisation awareness. The Immunisation Action Plan to mitigate the low target is provided for your information as Appendix 3. 4. CLUSTER MATTERS 4.1 Healthy Ageing and Rehabilitation 4.1.1 Report on Caring for our Older Kiwis A report was released on 12 April by the New Zealand Aged Care Association, which is a membership organisation representing for Aged Residential Care

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facilities across New Zealand. The report uses interRAI data information and asserts the existence of “postcode” health across New Zealand. It interprets the length of time between date of assessment and admission to a facility as an indicator of delay in health care. This does not give any consideration to interventions and supports that may have been provided in the interim. In fact, a success story would be that once a person has been assessed and interventions have been provided to improve their on-going independence, then the longer they are able to stay at home before entering permanent residential care. The failing in the commentary around the report is that the data did not report the link between an initial assessment, the intervention, and then a follow up assessment to measure the success of the intervention. This is primarily because usually a subsequent assessment is not completed unless there is a clear and further decline in a person’s health status. MDHB encourages people to remain in their homes for as long as it is possible to safely do so. The district variation across New Zealand is due to various DHB programmes in play in the community supporting people to stay at home. A number of variables also include rurality, family support availability, and the health needs of the individual. The report can be found on the New Zealand Aged Residential Care Association website at https://nzaca.org.nz/policy/caring-for-our-older-kiwis/ 4.1.2 Cluster development The Healthy Ageing and Rehabilitation cluster has been rigorously involved in annual planning for the 2018/19 year, at the same time reviewing all current services for opportunities for further efficiencies. The Clinical Lead is in post with a core team of support finalising service aspects for the coming year. 4.1.3. Excellence in homecare project The Excellence in HomeCare project is progressing well. One aspect of this project is the retendering of Home and Community Support Services. This process is under way. The committee will receive further information about the Excellence in Home Care project and the outcome of the retendering in due course. 4.1.4 Generalist palliative care services The National Healthy Ageing Strategy is the platform for much of the development work around generalist palliative care in the community. Generalist palliative care is in good form across our district due to the well-connected Hospice and general practice approach and the new SEQUAL (Supportive Education and Quality Palliative Care) training model supporting aged residential care. The rising number of deaths in New Zealand due to the ageing population means that palliative care will feature significantly within future services. Much work is being completed now to understand the workforce needs for the future both nationally and locally. Due to workforce constraints and the place of death (aged residential care) much of the need and focus will be on services delivered by aged residential care providers with support from general practice.

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4.2 Mental Health and Addictions Separate Reports have been provided to the Joint HCAC and QEAC Committee for:

• Special report Maternal Mental Health • Special report National Mental Health Inquiry

A Separate Report has been provided to the QEAC Committee for:

• The Mental Health and Addictions Operational Plan update. 4.3 Women’s & Child Health 4.3.1 Primary Birthing Unit In November 2017, MidCentral District Health Board contracted with Te Papaeioa Birthing Centre for one hundred and fifty Primary births at their new facility in Ruahine Street Palmerton North. The contract is to continue for eight months until 30 June 2018. As of 10 April 2018, 118 babies have been born at the facility, which has exceeded all expectations. On 27 March 2018, the facility celebrated (with a morning tea) their 100th baby with many from across the sector attending. The facility has worked alongside Lead Maternity Carers and the Clinical teams at MidCentral Health to achieve excellent communication and relationships. This has resulted in a very popular and successful service with an excellent safety profile. It is encouraging to note that of the 118 babies born 33 percent are first time mothers. The transfer rate in labour to MidCentral Health has been lower than anticipated at 13 percent. Over the next month, the District Health Board will be entering into discussion with the facility for the 2018/19 contract. The DHB will continue to fund only Primary Births and the associated post natal stays, but at a higher volume reflecting the service activity. This decision has been made alongside Clinical Input to ensure our focus continues to increase Primary Birthing numbers across the district. This aligns and connects with the work being completed in the hospital focussed on reducing the Caesarean section and medical intervention rate. 4.4 Primary & Population Health Separate reports have been provided for:

• Ora Konnect update • Water Quality update • Pharmacy contract update

4.4.1 Changes to After-hours Urgent Primary Care 8pm to 10pm In December 2017 City Doctors/White Cross (CDWX) approached CPHO and MDHB with concerns about the financial sustainability of CDWX services in our district. Since December the three parties were engaged in a process of exploring the issues and options. Various contributing factors were identified, and a range of potential solutions explored.

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At the end of March 2018 CDWX advised MDHB and CPHO of their decision to close at 8pm each night, instead of 10pm. This change took effect from 9 April. An interim solution has been established to ensure that the public can continue to access urgent primary care services between 8pm to 10pm. The Palms Medical Centre in collaboration with local GPs have agreed to provide an after- hours service that can be accessed by a new district wide free-phone number: 0800 373 030. The new telephone service is provided by Homecare Medical and is available every day from 6pm to 10pm. After an initial triage by a Homecare Medical clinician, the 0800 373 030 service will connect people to their local afterhours service between 6pm and 8pm. From 8pm to 10pm people will be connected with a MidCentral based clinician who is trained and qualified to triage urgent medical issues. If a face-to-face consultation is required, an appointment will be offered with a GP, Nurse Practitioner or Practice Nurse at Palms Medical Centre, Palmerston North. CPHO is monitoring services volumes, including data from Palmerston North Emergency Department in this period and as we transition to a long-term model. The after-hours urgent Primary Care free-phone model provides some definite advantages for patients. It will enable people to have faster and more convenient access to expert clinicians. In particular, patients will avoid unnecessary cost as there is no charge to speak to a clinician. Additionally patients will avoid unnecessary travel to Palmerston North and time spent in a waiting room. The new interim service commenced on Monday 9 April will continue whilst a permanent model is developed in collaboration with the Primary Care community. This work will occur over the next few months and will include a review and update the MidCentral district After-Hours Plan. 4.4.3 U-Kinetics Replacement Procurement Update The procurement of a new service is nearing completion. The evaluation panel has identified a preferred provider, having evaluated the tender submissions and interviewing shortlisted respondents. MidCentral will shortly be undertaking contract negotiations with the preferred provider and MidCentral are on track to have a new service contracted by the beginning of June 2018, to start seeing clients from the beginning of July 2018. 4.5 Acute & Elective Services Winter planning continues. There has been no reduction in the demand experienced in primary and secondary care services, with March having the second highest number of Emergency Department presentations recorded. MidCentral Provider and Central PHO continue to work closely together to plan for the 2018 winter workload. The PHO team are working to better support high risk vulnerable patients in primary care over the winter period with a range of initiatives to increase access to acute care on a daily basis. These include GP telephone triage at the beginning of each day in the larger IFHCs, the provision of walk in acute care clinics and a focus on wellness/care planning for those with long term conditions in the months leading up to winter. Access to Primary Options for Acute Care (POAC) has been extended to four practices in the Horowhenua region bringing the overall

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population coverage to 60 percent. POAC volumes continue to increase quarter on quarter. The Acute Demand Management district group, formed in September 2017, has developed a draft strategy encompassing elements of acute demand management across the system. Primary and Secondary care are considering the potential risks and preparing for the potential impact from influenza given the possibility of New Zealand experiencing a similar season to that seen during the Northern Hemisphere winter. The funded influenza vaccine this year covers four strains and is a better match against the strain circulating in the Northern Hemisphere. Both organisations are offering staff free flu vaccines, with a target of 80 percent of healthcare workers vaccinated. Vaccinations are also available from GPs and community pharmacies. 4.6 Cancer Screening and Treatment 4.6.1 National Bowel Screening Programme The National Bowel Screening Programme is for men and women aged 60 to 74. There are 27,250 people eligible in MidCentral district. It is expected that 50-60 percent of the eligible population will participate initially with 7.5 percent of these returning a positive test and around 90 percent of those proceeding to colonoscopy. Four in every 100 people returning a positive test will be diagnosed with cancer. The bowel screening pathway is made up of multiple stages. Those identified as eligible are sent a test kit from a national centre in Auckland. This Centre also coordinates the processing, analysis and management of completed tests and results. It hosts a free call number, sends letters to participants following a negative result and notifies GPs electronically of all results. The Centre advises the local DHB endoscopy service of all positive results. For all positive results primary care is required to contact the patient directly to discuss the result and refer to colonoscopy, if required or wanted. They also have a key role in encouraging participation, helping achieve equity, and raising awareness of bowel cancer symptoms and family history of bowel cancer. Individual DHBs are then responsible for delivering colonoscopies, overseen by four bowel screening regional centres that support clinical leadership, and manage quality and equity in their area. The regional centre for MDHB is in Hutt Valley. DHBs continue to be responsible for surgical and cancer treatment as per normal processes. MDHB is expected to begin screening in June 2019. The project team is established and has been compiling information to inform a national business case, to be presented to the Ministers of Health and Finance at the end of May. The information provided by MDHB is currently being reviewed by the Ministry and we await feedback. Other local activities include the establishment of a Steering Group with two Hui planned in our region; an ‘establishment workshop’ for late May 2018 and an

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‘Equity Hui’ mid to late June 2018. A number of key stakeholders from within the region will be invited to participate in these activities. 4.6.2 BreastScreen An analysis of the results for BreastScreen, as at the end of March 2018, shows persistent inequities in coverage. 77 percent of the eligible population of 27,760 are participating, and returning to screening, as expected. However, this means that 6,508 women are not participating, with 1,389 of these Maori women and 136 Pacific women. While the majority of women not participating are neither Maori nor Pacific women, coverage for both these groups falls below both the national target of 70 percent and the current coverage for other women. This is concerning as where groups do not achieve the 70 percent target for breast screening they do not experience the full population benefit of reduced breast cancer mortality. Populations with coverage in excess of 70 percent should experience a 30 percent reduction in mortality. There are inequities not only between ethnic groups but between age ranges and this information is being used to drive targeted plans for MDHB. Current coverage by ethnic group and age group is shown in the graph below.

A district wide equity plan is in development and will be approved by Te Hononga in May for roll out from the next financial year. In the interim two campaigns are planned for May to improve screening coverage. May is a significant promotional month for the Breast Cancer Foundation, with the Pink Breakfast their leading campaign. Locally we will align with the national promotion and hold a Pink Door competition for the DHB, PHO and General Practice community. A remember to re-screen campaign is also being launched to encourage on-going participation. Following on from the successful ‘it’s time to screen’ promotion in October, local women will

56%

66% 66% 64% 66%

78%

55%

66%

89%

78%81%

78% 77% 76%82%

45 - 49 50 - 54 55 - 59 60 - 64 65 - 69

MDHB BreastScreen Coverage

Maori Pacific Other

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again front the campaign which will include billboard, poster and social media advertising. Business as usual activities, such as data matching and birthday card initiatives with general practice continue as planned. 4.6.3 Specialist Palliative Care Workforce development continues to be a focus for palliative care as reported earlier in this document. To this end, a local workshop is occurring in the month of April to consider the future workforce needs of both specialist and generalist services. 5. RECOMMENDATION It is recommended: that this report be noted Craig Johnston General Manager Strategy, Planning & Performance

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Appendix 1 Better Help for Smokers to Quit Target Action Plan

OBJECTIVE ACTIONS TO DELIVER IMPROVED PERFORMANCE LEAD MONITORING & PROGRESS

Re-establish Central PHO target of 90% or more of smokers receiving smoking brief advice and offer of referral to cessation support services in the last 15 months.

• Encourage all General Practice Staff to engage with smokers at every health encounter (face to face and phone) to ask about their smoking, give SBA and offer support to quit.

David Jermey, Portfolio Manager – Primary Care

Weekly and quarterly Practice data extract reports via Compass Health.

• Continue to have discussions with practices not actively engaging with delivery of SBA and offer of cessation support.

• Example of ‘starting conversations’ re: smoking, being sent to practices.

Kirsty Ward Clinical Champion

• Follow up with Practice Staff

• TOAM Matanga to actively participate in contacting of patients to give SBA and generate referrals for cessation support.

• Matanga having ‘dedicated time’ to focus on contacting patients to give SBA, and supporting other health professionals within the practice to participate between patients and during phone calls.

Kerry Metcalfe TOAM Liaison

• Increased referrals to TOAM

• Increased SBA’s demonstrated in weekly data extract

• Community Pharmacy Project to increase giving of SBA and offer of referral to cessation support

• Button Badges (e.g. Quit now, ask me how/ and Bilingual Version) being developed for pharmacy and general practice staff to wear to prompt stop smoking conversations.

• Supply of Free NRT from pharmacists for 1 week, SBA to be given and referral to TOAM when patient consents to this.

Clare Hynd /Margeurite McGuckin/Kirsty Ward

• Increased uptake of quit attempts and SBA’s being given.

• Cross-sector approach to share resources and information

• Weekly Clinical Quality meeting for SBA target has now extended to a multi-disciplinary focus, consisting of Central PHO, Mid Central Health Public Health Unit, Te Tihi, Community Pharmacy and TOAM to enable a cross-sector approach and a sharing of new ideas, and information and troubleshooting of identified barriers

Kirsty Ward/Caroline Clarke

• Weekly meeting (Wednesdays) following receiving of weekly Practice Data

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• Build morale and enthusiasm in General Practice Teams to engage with patients to give SBA and offer of support to Quit

• Roll out Smoking Brief Advice Olympics. Weekly prizes/staff treats for identified hard work of GPT’s to deliver SBA’s and offer support/referral to quit.

• Spot prizes for identified innovative ways to engage patient, collect data and ensure staff are’ having the conversations’.

Kirsty Ward • Review of weekly data. • Contact from staff re:

new ideas to engage their patient population who are smokers

• Provision of further education and support to record SBA referral codes

• Resource packs being sent to GP’s with screenshots of how to

record and code SBA’s etc appropriately. • Sustainable ways to improve SBA figures included in data pack. • ‘Examples of questions to start a SBA conversation provided’. • Examples of what information can be recorded (now not only

Smoking Brief Advice given in the community but now also that given in the DHB as per discussion with David Jermey).

Kirsty Ward • Conversations with Practice staff as resource packs are distributed.

• World Smoke Free Day Promotion

• 31st May 2018 – TOAM, Central PHO and Public Health working on resources/advertising and promotion for this currently

Julie Beckett • Resources in development

• High Level Conversations

• High level conversations needed with 4 high needs practices who are not achieving target on an ongoing basis.

Chiquita Hansen/Bruce Stewart

• Feedback to CQ weekly meeting

• Support for smokers who wish to try ‘Vaping to Quit’ and education and support of health professionals to give the correct information

• Updating practices with ‘latest’ MOH information and policy relating to vaping. Information also to be sent out with resource packs.

Kirsty Ward • Feedback from practice staff.

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Appendix 2 Shorter Stays in the Emergency Department Health Target Action Plan

OBJECTIVE ACTIONS TO DELIVER IMPROVED PERFORMANCE LEAD MONITORING & PROGRESS

Takatu Emergency Department Programme - Improve patient pathways across the Emergency Department

1. Through PDSA cycle testing introduce new ways of working for patient triage assessment and flow through the Sub-Acute Area.

2. Engagement with specialist teams has begun regarding the care and management of their patients whilst in the ED.

ED Leadership Team

Target rate monitored daily

Medimorph Medical Model of Care - Improve patient pathways for Medical patients.

1. Continue to review the management of the early morning handover meetings. Including patient allocation to teams.

2. Trial the placement of an SMO / Senior Registrar in MAPU. 3. Maximising the use of Rapid Assessment Clinic. 4. Improve patient flow with the fast tracking of patients to MAPU from

ED. 5. Development of the Interface Geriatric Service

Medical Services CD Target rate monitored daily. ALOS rates monitored monthly

Improve Mental Health response to patients presenting with potential mental health problems in ED

1. Six week trial extending the week day hours that a member of the mental health nurse liaison service is present in ED.

2. A one week trial of the ACT shift coordinator being based in ED after hours.

Alcohol & Other Drug Services Service Manager

Monitor response times monthly

Monitor and check validity and accuracy of data

1. Daily checking of WebPas data against the hard copy nursing and medical documentation.

2. Monitoring that the messaging to extract the data is correct.

Acute Care and Hospital Operations Service Manager & Data Analyst

Target data monitored daily

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Monitor the impact of the changes to the After Hours provision

1. Monitor the use of the telephone triaging service and use of the GP on-call telephone service.

2. Monitor presentation rates to ED during the time period impacted by the change

PHO Portfolio Manager & Acute Care and Hospital Operations Service Manager

Monitor data weekly

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Appendix 3 Immunisation Action Plan.

OBJECTIVE ACTIONS TO DELIVER IMPROVED PERFORMANCE LEAD MONITORING & PROGRESS

Work with lead maternity carers (LMC) 3. Focus on increased uptake of Boosterix and Influenza in pregnancy

Senior Portfolio Manager Maternal & Child health /Primary Care

NIR monitoring of uptake rate

Timely enrolment of all new borns. 4. Provide on-going support to the newborn enrolment programme’s

integration & alignment with General Practice

NEP Coordinator

Rate monitored fortnightly.

Monitor & maintain equity of coverage.

6. Milestone ages reports will be presented at Steering group & any discrepancies between ethnic groups and Decile groups will be discussed.

NEP Steering Group & NIR Team NIR Team & Steering Group

Rate monitored fortnightly.

Timely follow up of delayed immunisations.

3. Continue to work with General Practice Teams to ensure they use a precall policy.

4. NIR continue to supply monthly overdue reports for IFHC’s and bi-monthly to smaller practices.

Immunisation coordinator IMAC Regional advisor Immunisation Stakeholder Group

Immunisation team closely monitor the overdue list weekly with oversight of stakeholder group.

Overdue reports are provided monthly/bi-monthly.

Monitor and respond to decliner rate.

3. Continue to work with GP Teams to ensure they are using a recognised decliner process with families.

Immunisation coordinator

Immunisation team closely monitor decliner rates.

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4. Work with GP Teams to capture reasons for decline.

NIR Team Regular conversations with practice champions regarding documentation.

Follow up of non responders; Referral from Primary Care to Outreach Immunisation Services (OIS).

• Encourage integration between GP Teams and NIR Administration, to ensure prompt referral of children who meet priority criteria to OIS in a timely and efficient manner.

• Priority criteria = children overdue for immunisation 2 weeks after their due event at 6 weeks, 3 months, 5 months & 15 months of age.

Immunisation Stakeholder Group OIS GP Teams

All children who meet the priority criteria are referred to OIS.

Ongoing active communication and awareness raising.

• Campaign for national immunisation awareness week. Theme: ‘Immunisation throughout the lifespan’

o Identified local champions o Communicating local services- clinics and outreach o Community awareness

• Ongoing communication and awareness raising.

Immunisation stakeholder group GP Teams

Local champions promoting immunisation.

Media releases focussed on

• immunising on time

• Promoting vaccination for influenza for children, > 65 years and pregnant women.

Photos of local GP Teams clinics - t-shirts

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COPY TO: CEO’s Office MidCentral DHB

Heretaunga Street, PO Box 2056 Palmerston North 4440

Phone Fax

+64 (6) 350 8910 +64 (6) 355 0616

For:

Decision

Endorsement

X Noting

To Healthy Communities Advisory Committee

Author General Manager, Strategy, Planning & Performance

Endorsed by Chief Executive

Date 19 April 2018

Subject Committee’s Work Programme

RECOMMENDATION

It is recommended:

• that progress against the 2017/18 work programme be noted.

Strategic Alignment

This report is aligned to the DHB’s Strategy and key enabler, “Stewardship”. It discusses an aspect of effective governance.

Glossary

CCDM – Care Capacity Demand Manager

DHB – District Health Board

HCAC – Healthy Communities Advisory Committee

IFHC – Integrated Family Health Centre

MDHB – MidCentral District Health Board

MoH – Ministry of Health

PHO – Primary Health Organisation

QEAC – Quality & Excellence Advisory Committee

TBA – To be advised

VRM – Variance Response Management

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1. PURPOSE This report updates members on the 2017/18 work programme and subsequently scheduled reports. The report is for the Committee’s consideration and no decision is required. 2. BACKGROUND Each year the Board establishes a reporting framework for the DHB’s governance function. This purpose of the framework is to ensure the Board and its Committees receive the reports they require to enable them to carry out their function effectively. From the framework, work programmes for the Board and each committee are developed. The work programme sets out planned reporting points for routine reports and project updates. When events indicate a significant increase in risk within a project, that risk will be reported in an interim update. Brief updates are noted in Section 3 for a number of initiatives and, where relevant, an update on reporting dates. 3. 2017/18 WORK PROGRAMME - BRIEF UPDATES Reporting is generally occurring in line with the work programme. The draft annual plan is not yet in a form ready for the Committee’s consideration. When this is available, it will be submitted to the Committee’s next meeting. Unfortunately, Pharmac are unable to provide an on-site presentation at this time. A copy of the Committee’s work programme is attached – refer Appendix A. 4. RECOMMENDATION It is recommended:

• that progress against the 2017/18 work programmes be noted.

Craig Johnston General Manager, Strategy, Planning & Performance

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APPENDIX A – HCAC’s 2017/18 WORK PROGRAMME

Healthy Communities Advisory Committee: Standing Items Frqncy Jul Sep*

Oct Nov*

Feb Mar*

May Jun*

Jul Resp

Strategic & Annual Planning

• C/f 2016/17: Update against 2016/17 Maori Health Plan Indicators Annual X S Turner • 2018/19 Annual Plan – approach, priorities and financial assumptions Annual X C Johnston • Health needs assessment –update and impact for planning Annual X R Fong • Equity snapshot – update and impact for planning Annual X S Turner • 2018/19 Annual Plan – draft and workshop Annual X* X* X* C Johnston • Locality Planning (via Ops report with separate reports if decision required) 12-weekly X X X X X K Isles • 2018-19 Regional Service Plan – priorities and approach X* V Ayres • 2017/18 Funding Arrangements Document Annual X V Ayres • 2018/19 Funding Arrangements Document Annual X V Ayres • Mental Health Programme 12-weekly X* X* X* X* C Nolan/C Nepia-

Tule • Business Cases o Strategic Business Case – Ward 21 One-off X C Nolan

Partnerships & Consumer

• Disability update Annual X J Smith • NZ Disability Support Service Transformation 12-weekly X X X X X S Ambridge • Health Charter update (with key stakeholders in attendance, eg Police) Annual X C Hansen

Performance Reporting

• Operational Report, including regular updates re Kainga Whanau Ora 12-weekly X X X X X X X C Johnston • 2017/18 Annual Plan – implementation progress – MoH priorities Quarterly X* X* X* X* V Ayres • 2017/18 Annual Plan - implementation programme – MDHB initiatives 6-monthly X X V Ayres • Non-financial reporting, including health targets and system level measures Quarterly X* X* X* X* V Ayres

Integration

• Central PHO report and presentation Annual X* D Jeremy • PHARMAC report and presentation Annual X* G Sundararajah • Health Promotions Agency report and presentation Annual X C Johnston Standing Items due in Out Years: Strategic Plan review 2019/20

*=joint meeting or report

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Healthy Communities Advisory Committee: Other Matters Raised by Committee and/or ELT

Item Raised Scheduled Resp Status • VRM & Hospital Operations Centre June 17 TBA L Horgan & N Wanden • Presentations from: o Ministry of Health & Ministry of Education re disability programmes o Enable Good Lives Team o Levin Children’s Team

July 17 TBA

C Johnston

Completed Items • Update of MDHB/Horizons hosted forum re water quality within district,

including matter of trace elements in Horowhenua water and whether this was impacting the health (including mental health) of residents

Bd Sep 17 May 18 D Davies Completed

• Drinking Water Quality: MDHB work programme following Stage 2 Inquiry (to include roles and responsibilities as per Feb 18 discussion QEAC)

Rpt 2 Board Dec 17 April 18 R Weir & D Davies Completed

• Ora Connect: progress update Feb 18 rpt May 18 W Blisset Completed • Maternal mental health March 18 May 18 C Nepia Tule & C Nolan Completed • National mental health inquiry update March 18 May 18 C Nepia Tule & C Nolan Completed • Primary care after hours arrangements Wkly Update 6.4 May 18 D Jermey Completed • Outcome of MDHB/Horizons hosted forum re water quality within district* May 17 July N Glubb Completed • Presentation re child area – areas of intersection, eg disability, mental

health and paediatrics May 17 July 17 B Bradnock & G Scott Completed

• Details of Tu Kaha Conference June 17 TBA S Turner Completed • Horowhenua Report Bd, June 17 October C Johnston & L Horgan Completed • Proposed approach to communicating St John’s 111 Clinical Hub July 17 Sep 17 D Jermey Completed • Mental Health: regional residential review project Sep 17 rpt 28 Nov C Nepia-Tule & C Nolan Completed • Manawatu Gorge: update re MDHB’s involvement Board, Nov 17 Nov 17 C Johnston Completed • Commissioning framework –more information Board, Nov 17 Nov 17 C Johnston Completed • Child health team update 2 July 17 Feb 18 B Bradnock & G Scott Completed • IFHC for Awapuni, Highbury and Cloverlea area of town (Ora Connect) Board, Nov 17 Feb 18 W Blissett Completed • Update re accessing $1m for primary mental health services Bd Aug 17 Aug 17 C Johnston Completed • Presentation – Kaianga Whanau Ora March 18 W Blisset Completed • Update on discussions with Housing NZ re supporting their clients Weekly Update

1.12.17 March 18 B Bradnock Completed

• Locality Plans (final draft) March 18 K Isles Completed

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