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HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN AGENDA

25 October 2016 1

HOSPITAL ADVISORY COMMITTEE

NOTICE OF MEETING

OPEN MEETING

A meeting of the Advisory Committee Members of Nelson Marlborough District Health Board will be

held on Tuesday 25 October 2016 at 9.30am

Seminar Centre Room 1 Braemar Campus Nelson Hospital

Our VISION is: “leading the way to healthy families”

Our MISSION is to: “work with the people of our community to promote, encourage and enable their health, wellbeing and independence.”

Our VALUES are:

RespectWe care about and will be responsive to the needs of our diverse people, communities and staff

InnovationWe will provide an environment where people can challenge current processes and generate new ways of working and learning

TeamworkWe create an environment where teams flourish and connect across the organisation for the best possible outcome

IntegrityWe support an environment which expects openness and honesty in all our dealings and maintains the highest integrity at all times

HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN AGENDA

25 October 2016 2

HAC MEETING AGENDA

Section Agenda Item Time Attached Action

PUBLIC FORUM 9.30am

1 Welcome, Karakia, Apologies, Registration of Interests

9.40am Attached Resolution

2 Confirmation of previous Meeting Minutes, Correspondence

9.45am

Attached Resolution

2.1 Action Points Attached Resolution

3 Clinical Services Report Attached Resolution

4 Presentation:

Janice Wilson and Heather Shotter from HQ&SC

11.00am

5 Glossary Attached Note

Meeting finish 12.30pm

PUBLIC EXCLUDED MEETING 12.00pm Resolution to exclude public RECOMMENDATION THAT the Committee resolve itself into a Committee of the whole and that in terms of the NZ Public Health & Disability Act 2000, the public be excluded while the following items are considered: Minutes of a meeting of HAC Committee Members held on 28 June 2016 (Clause

34(a) Schedule 4 of New Zealand Public Health & Disability Act 2000)

GM Clinical Services Report - To protect information that is subject to a delegation of confidence (Clauses 32(a) and (b) Third Schedule NZ Public Health & Disability Act 2000)

HOSPITAL ADVISORY COMMITTEE NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN MEETING

Welcome, Apologies, Registrations of Interest 1-1

WELCOME, KARAKIA AND APOLOGIES

Apologies Paticia O’Brien



REGISTRATIONS OF INTEREST – HAC MEMBERS

Name Existing – Health Existing – Other Interest Relates To Possible Future Conflicts

Gerald Hope (Chair)

CE Marlborough Research Centre

Director Maryport Investments Ltd

CE at MRC landlord to Hill laboratory services Blenheim

Landlord to Hills Laboratory Services Blenheim

Alan Hinton Nil Trustee, Richmond Rotary Charitable Trust

Trustee, Natureland Wildlife Trust

Trustee, Nelson Bays Community Foundation

Trustee, Garin College Education Trust

Trustee, Nelson Christian Trust

Director, Solutions Plus Tasman Ltd

General Manager, Azwood Ltd

Secretary, McKee Charitable Trust

Support of local worthy causes

Education and support of endangered species

Support of local charities

Assisting students with financial assistance

Local, national and international support

Business consultancy

Heating fuels and landscaping facilities

Tertiary scholarships and general philanthropy

Supply of heating fuel to NMDHB

Jessica Bagge Marlborough District Council

Image Signs

District Councillor

Signwriter

Jenny Black (ex-officio)

Chair of South Island Alliance Board

Life Member of Diabetes NZ

Chair of National Chairs



Patricia O’Brien Life member of the NZ Anaesthetic Technician’s Society Inc

Dana Wensley

Mother receives home care through the DHB

Spokesperson for PEN

Member of National Ethics Advisory Committee

International human rights organisation that represents the rights / interests of writers. Being the NZ spokesperson means that I am committed to advocate for the right to freedom of speech and freedom of expression. This covers writing and the spoken word, whether it is in fiction, non-fiction, satirical, workplace setting etc.

Lawyer

Dawn McConnell Te Atiawa representative and Chair of Iwi Health Board

Director Te Hauora O Ngati Rarua

Trustee, Waikawa Marae

Regional Iwi representative, Internal Affairs

MOH contract

As at 30 June 2016


Minutes 2-1

MINUTES OF MEETING

MINUTES OF A MEETING OF THE HOSPITAL ADVISORY COMMITTEE OF NELSON MARLBOROUGH DISTRICT HEALTH BOARD HELD AT THE NURSES REC HALL, WAIRAU HOSPITAL ON TUESDAY 28 JUNE 2016 AT 9.30AM Present: Gerald Hope (Chair), Dana Wensley, Patricia O’Brien, Alan Hinton, Jessica Bagge, Dawn McConnell, Luke Katu, Jenny Black (ex officio) Apologies: Pam Kiesanowski, Judy Crowe (lateness) In Attendance: Pat Heaphy, Brigid Forrest, Jenny Black (Marlb), Patrick Smith, Judy Crowe, Chris Fleming (CE), Peter Bramley (GM Clinical Services), Hilary Exton (Director Allied Health/Acting GM SP&AS), Eric Sinclair (GM Finance & Performance), Nick Baker (Chief Medical Officer), Ros Gellatly (Chief Medical Advisor Primary), Gaylene Corlett (Minute Secretary) Karakia: Patrick Smith

SECTION 1: MEMBERS OF THE PUBLIC Jean Wilson, Steve Vallance

SECTION 2: APOLOGIES AND REGISTRATIONS OF INTEREST Noted.

SECTION 3: MINUTES OF PREVIOUS MEETING AND CORRESPONDENCE 3.1 Minutes of the Committee Meeting 26 April 2016 Jenny Black (Marlb) attended the last meeting.

Moved: Jenny Black Seconded: Patricia O’Brien RECOMMENDATION: THAT THE MINUTES OF THE MEETING HELD ON 26 APRIL 2016 BE ADOPTED AS A TRUE AND CORRECT RECORD ONCE AMENDED. AGREED


Minutes 2-2

SECTION 4: ACTION POINTS Item 1 – agenda item. Completed. Item 2 – noted the non vaccinated staff, on average, had 15.6 days sick last year, and the vaccinated staff, on average, had 16.4 days sick. The challenge remains that we are amongst the lowest of DHBs in the country for staff vaccinations. It was agreed that a presentation be given by Infection Control about what we are going to do differently next year. Item completed. Item 3 – Public Health continue to pursue the issue around advertising for cigarette sales. Ongoing. Item 4 – work in progress Item 5 – update in GM’s report. Completed.

SECTION 5: REPORTS 5.1 Clinical Services GM Clinical Services gave an update on Clinical Services. Clinical Services delivered 1,827 case weights for the month of May (99.6% of plan). Elective target for next year is 76 orthopaedic and 72 additional discharges as part of an increased delivery for the South Island. We are ESPI compliant for the four month wait times in FSA and elective procedures. Challenge continues in district wide triage around referrals with consistency and equity. The challenge is managing the “front door” to match the capacity and resource of services we have to the demand, where there is no district wide triage. Improvements noted in endoscopy with 95% of urgent cases seen <14 days, 76% of non-urgent cases seen < 42 days, and 64% of surveillance seen < 84 days. Improvements have been noted in CT and MRI wait times. Improvements in ED noted with 96.8% of patients in May admitted and discharged within 6 hours. There is a challenge with increasing presentations at night in Nelson. Noted the ED5000 project has made good progress in reducing presentations to ED in Wairau, although there is still a challenge as even though the number has reduced, Wairau ED is still 5,000 presentations more than Nelson. Noted some presentations may be due to the shortage of GPs. Noted the PHO is actively working on resolving this issue. The positive message is the communication between ED, GPs and the community is working. Cataracts are ahead by 27 year to date; joints are 104 ahead of plan. We are now matching delivery to plan. Noted the scoring tool used nationally rates if a person needs to have surgery, however more patients are classified eligible through the scoring tool than we are required to do for our population. It was noted that the number of Nelson Marlborough patients receiving hip and knee surgery are still amongst the highest in the country. Noted use of allied health with physiotherapy is proving beneficial for patients around self management for a first option, rather than seeking surgery immediately, plus it better prepares them for when surgery is needed.


Minutes 2-3

FCT targets noted with 79% year to date compared with 56% last year (62 day target), and 83% year to date compared with 81% last year (31 day target). Noted there is multidisciplinary team discussions around the best pathway of care for an individual with cancer. This can create a challenge around timeliness when patients need to go out of the district for surgery. Queried about NMDHB reliance on Canterbury DHB which could make it difficult to meet the 62 day target. It was noted the Southern Cancer Network are aware of concerns about cancer care across the South Island.

Theatre cancellations continue to be a concern with overbooked lists and acutes taking priority. Actions to address these issues include texting and ringing patients prior to surgery, theatre management software, preadmission process, theatre governance. Noted “Null Speciality” in Nelson has the highest number of cancellations, and DNA gynaecology is high at 15 (Nelson). It was requested that the GM Clinical Services investigate these two issues and report back at the next meeting. Noted the new vascular surgeon, from Scotland, will start in October. She will work regionally out of Canterbury, but will be based in Nelson. Discussion was held on the need to ensure partners and family get integrated into the community to assist with them staying in the district. Noted specialised moving companies offer more than just relocating household goods. It was suggested that HR (through the GM Clinical Services) investigate how we utilise these services to support the settlement of families and not just the individual. Noted financials are adverse $139k for the month; $6,059m negative variance year to date. Discussion held on the budgeting process noting errors were made when forecasting for 2015/16. The GM Clinical Services has been more rigorous in budget rounds in regards to trends in spend. There is confidence in the budget process, noting the demand driven nature of some of the items, but there are risks. Discussion: Noted the needle exchange website is not working. Could an alternative option be having needle exchange available in a pharmacy. It was requested that the GM Clinical Services look into this suggestion. Noted the percentage of Maori population waiting over 62 days is high. It was noted that funding has been secured for pathways for Maori with cancer to improve timeliness of care. Noted the numbers of Maori with cancer are small. Noted immunisation for 5 year olds shows a large decrease in children from the last reporting period. Noted the target is 95% with May results 64% and April 85%). It was requested that the GM Clinical Services investigate the drop in May results. PRESENTATION ON EMERGENCY MANAGEMENT Peter Kara presented on emergency management. NMDHB is legislated under the CDEM Act 2002 for emergency management. Every 6 weeks a regional advisor from MOH visits to check on our emergency planning. We use the South Island network to ensure we are up to date. Alignment of business continuity is undertaken through BCI good practice guidelines.


Minutes 2-4

Emergency Management – resilience, cost benefit, resource benefit, resumption of business as usual, clinical, preservation of life, community we serve. Resources include:

NMDHB has 110 staff CIMS 4 trained. CIMS is mandated through government for use by all government agencies)

Disaster air shelter

On site emergency power supply

On site emergency water

DHB radio network

Satphones

Other – civil defence cabinets Discussion: Noted Support Works know of 90% of clients in the community that would require assistance in a civil defence emergency. Civil Defence will be relied on for others. There is a welfare centre set up with Civil Defence and the welfare coordinator liaises with the DHB. Discussion was held on succession planning for our Emergency Manager noting he meets on a quarterly basis with the South Island Emergency Coordinators, and also meets nationally to swap ideas and provide advice/assistance. If Pete left the DHB, the MOH advisor would step in. Internally, in the restructured model, Pete has moved from Clinical Governance to the Support Services Team and the 2IC to that team is will be working closely with Pete to growing and learn the role.

Moved: Jessica Bagge Seconded: Dana Wensley

RECOMMENDATION:

THAT THE COMMITTEE RECEIVES THE CLINICAL SERVICES REPORT.

AGREED

SECTION 6: PRESENTATIONS 6.1 Paper-lite 2020 – Digital health 2015 Patrick Ng presented on Paper-lite 2020 – Digital Health 2015. Ora*care released. 1994 • Ora*Care & Concerto separated in January 2015 • Establishment of our ‘BUS’ to remove linked applications from Ora*Care

(implementation of triggers)


Minutes 2-5

As well as PICS, we are systematically investing in regional software platforms. The IT Strategy 2015 was approved by the Board. Hospital processes are currently very paper-based. Paper lite wins to date include: • ED re-engineering processes leveraging inhouse developed ED At A Glance (EDaaG) • Fully paperless ePRF solution with St John (only one in the country) • No longer request paper medical charts in ED • EDaaG continues to be developed as a paperless ED clinicians tool Initial business cases and capex approved (awaiting HCS implementation): • e-Triage. Will make triaging of referrals electronic rather than paper-based • e-Laboratory sign-off. Business rules have been created. Awaiting HCS • e-Radiology sign-off • e-Radiology ordering is imminent. Key initiatives towards paper-lite include: • Patientrack (early warning scores, bedside care, electronic document templates,

electronic workflow) • MedChart and ePrescribing initiatives • Mobility roll out to support Patientrack, eMeds, Clinical Comp • Transforming paper medical charts to electronic health records. Emedicine manages dispensing of medicine at the bedside instead of the usual prescribing forms (break medicine down to single dosage, package in pharmacy and barcode, scan patient wrist band, scan single dose and these should match on the computer or notification if any problems with medicine being dispensed). However, we are not that far advanced yet. Eprescribing is when GPs write scripts. MedChart is the logical first step of the four emedicine, eprescribing initiatives. Question: How will clinicians know where to add the updated data after they have treated a person. It was noted recent publicity from unions about implementing new IT systems which will result in decrease in staff numbers. It was stated that the staff reduction will be in medical records staff not medical secretaries or clinical administration staff. Our digital hospital future: • HealthOne as a means of connecting with primary care and sharing key information to

enable effective overall patient care • Portals as a means of engaging patients electronically rather than through letters in

the mail. Discussion held on those clients that do not have computers or smart phones. It was noted that there is a large divide at the moment, however it is envisaged that going forward people will be more technology competent as they get older. Alternative methods will always be available for those without the technology. Discussion was held on health data for research noting core applications that capture data will be regional. Discussions have been held at the regional governance group level on how we put good data governance around regional applications so the information can be extracted for the whole region, and used for medical research.


Minutes 2-6

Discussion held on contingencies in place for digital failure, back up storage etc. Noted over the next few years it will become regional in terms of applications. This means from a hardware point of view, that it will be located in Canterbury not Nelson. This will allow for better resilience than we have at present. Connections to the server take a different route than originally used, and not just through one route, meaning if one is damaged we can use the other. Regarding storage, NIP was introduced to move all DHBs into infrastructure as a service, ie all servers and storage held in a national data centre like Auckland and Canterbury. Noted the proposed contract has fallen over and Health Alliance are working on alternatives. There is no national solution at the moment. Discussion held on how the health records will integrate nationwide noting the platforms will work in the South Island initially. Nationally we are working with the National Health IT Board on a national health platform. Locally we would have a set of data and that would roll up to a national health record that would have a sub set of that information. There is an obligation on the National IT Health Board to take a business case to Treasury and Cabinet on what a national electronic health record would look like. If funding is granted, more work will be done on this. 6.2 PICS Patrick Ng presented on PICS – proposed way forward. Challenges to date include the software vendor and regional team have struggled to accurately estimate software development effort and timeframes. This has led to the timeline slipping several times. Current proposed timeline would have us receive the software in December 2017 that would mean a ‘go-live’ in March 2018, 2.5 years later than the original dates. The NMDHB team reviewed all software components with Orion: • Health working to the concept of a full replacement of Ora*Care but allowing added

functionality to come in later software releases • Identified 22 functional items for review • Orion Health will deliver the 22 functional items by December 2017, but we would

release these later as we would release the August software drop first. There is an area of risk. We have waited patiently for our turn to implement PICS. However, CDHB and the regional team are suggesting that CDHB may wish to continue the roll-out of outpatient functionality more broadly across their hospitals whilst we implement NMDHB PICS. This would add risk to the NMDHB implementation, as the development teams at Orion Health are very constrained (hence the slip in software release dates), and the regional team must focus on NMDHB to make it successful. The regional team are completing an impact assessment on the option of a broader roll-out at CDHB in parallel to NMDHB, however, this will invariably add risk to NMDBH and we should strongly advocate against this idea.


Minutes 2-7

PUBLIC EXCLUDED

Moved: Dana Wensley Seconded: Alan Hinton

THAT the Committee resolve itself into a Committee of the whole and that in terms of the NZ Public Health & Disability Act 2000, the public be excluded while the following items are considered:

Minutes of a meeting of HAC Committee Members held on 26 April 2016 (Clause 34(a) Schedule 4 of New Zealand Public Health & Disability Act 2000)

DHB Directorate Reports – To protect information that is subject to a delegation of confidence (Clauses 32(a) and (b) Third Schedule NZ Public Health & Disability Act 2000)

AGREED

Meeting closed at: 12.36pm

NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN MEETING

Action Points – HAC Open 2.1-1

ACTION POINTS - HAC Open Meeting Held on 28 June 2016

Action Item #

Action Discussed Action Requested Person Responsible

Meeting Raised In

Due Date Status

1 Clinical Services Report: Winter Peak

Vaccination data captured from last year be matched with sick leave taken to see if those taking sick leave had had vaccinations Presentation be given by Infection Control team on initiatives for vaccinations next year

Peter Bramley

Peter Bramley

27 October 2015 28 June 2016

2017

GM Report

2 Clinical Services Report: Discounted Cigarettes

Update on request to remove zigzag logo in shop signage

Public Health Services are pursuing this issue with the business concerned

Peter Bramley 27 October 2015

23 August 2016

GM Report

3 GM Report GM to look into how the LOS graph on page 3-23 can be easier to read and the data more meaningful

Peter Bramley 26 April 2016 23 August 2016

Completed

4 GM Report: Theatre Cancellations

GM investigate theatre cancellation stats:

a) High number of cancellations in Null Specialty field in Nelson

b) High number of DNA for gynaecology in Nelson

Peter Bramley 28 June 2016 23 August 2016

Completed

5 GM Report: HR, through GM, investigate how we utilise Peter Bramley 28 June 2016 23 August Gm Report

NELSON MARLBOROUGH DISTRICT HEALTH BOARD OPEN MEETING

Action Points – HAC Open 2.1-2

Recruitment services of relocation companies to support the settlement of families, not just the individual being employed by the DHB

2016

6 GM Report: Needle Exchange

GM to look into the suggestion of an alternative option of having needle exchanges available in a pharmacy in Motueka


Carried forward as for GM Strategy, Primary & Community responsibility

7 GM Report: Immunisation

GM to investigate the drop in May results for 5 year old immunisations


Carried forward as for GM Strategy, Primary & Community responsibility


Clinical Services Report 3-1

Status This report contains: For decision Update Regular report For information

MEMO

To: HAC Members

From: Christine Nolan, Acting GM Clinical Services

Date: 18 October 2016

Subject: Clinical Services Report

Clinical Services has delivered 1,899 caseweights for month of September (102% of plan). The NMDHB met the four month EPSI requirement that no one waits longer than four months; 12 patients waiting longer than four months for a first specialist assessment and 10 patients waiting longer than four months for an elective procedure at the end of August 2016.

Clinical Services Winter Peak - Issues relating to the privacy of staff and their sick leave are being discussed between Infection Control and Human Resources before any further investigation can proceed. The Influenza Technical Advisory Group are meeting again in November 2016, where strategies and discussion will take place. Once this has been decided a presentation will be forthcoming to HAC

Discounted Cigarettes - The matter is before the Courts

LOS Graph – Resolved

Theatre Cancellations - The Theatre Management System (TMS) fix required to address this problem went live on 14 October. Future reports should show a reduction as staff training and utilisation improves

Recruitment - The GM Human Resources responded: “whilst we cannot rely on relocation companies supporting the settlement of families to our area we do think the Organisation or hiring manager plays a big part in the settlement programme”

Please see Financial Report in Section 5 of this Report.

General The Clinical Service delivered 1,899 caseweights (102%) of plan for September. Acute caseweight activity was 99% of plan for the month with 1,229 actual caseweights being delivered against a plan of 1,236. Elective Caseweight activity was 108% of plan for the month with 670 actual caseweights being delivered against a plan of 621.



Discharges Health Target for YTD August 2016/17 was 1,256 discharges against a plan of 1,247; nine discharges above plan

NMDHB Summary - Activity YTD

Caseweights

NMDHBSeptember 2016

Service

Unit Code Description TypeAnnual

Plan

Budget

YTD

Actual

YTD

YTD

Volume

Variance

Actual %

Complete

vs YTD

Plan

Last FY-

YTD

Actual

Budget

Month

Actual

Month

Month

Volume

Variance

Last FY

Month

Actual

Medical M00001 General Medicine Acute 4600 1274 1177 -97 92% 1261 414 374 -40 438

Elective 250 68 64 -4 94% 65 23 17 -6 21

M00001 Total 4850 1342 1241 -101 92% 1326 437 390 -46 459

M05001 Emergency Medicine Acute 1584 404 419 14 104% 412 129 130 1 119

M05001 Total 1584 404 419 14 104% 412 129 130 1 119

M10001 Cardiology Acute 1020 270 254 -16 94% 268 92 83 -9 95

Elective 502 131 73 -58 55% 90 48 23 -25 34

M10001 Total 1522 401 327 -75 81% 359 139 106 -33 128

M15001 Dermatology Acute 14 4 4 0 112% 4 1 1 0 1

M15001 Total 14 4 4 0 112% 4 1 1 0 1

M25001 Gastroenterology Acute 22 6 0 -6 7% 10 2 0 -2 4

Elective 30 8 12 4 146% 10 3 5 2 4

M25001 Total 52 14 12 -2 87% 20 5 5 0 8

Medical Total 8022 2166 2003 -163 92% 2121 711 632 -79 715

Surgical D01001 Inpatient Dental Acute 20 4 3 -2 63% 4 0 2 2 2

Elective 190 52 55 3 105% 56 17 23 6 24

D01001 Total 210 56 57 1 102% 60 18 25 7 26

S00001 General Surgery Acute 2450 639 502 -138 78% 517 198 180 -18 161

Elective 1550 398 435 36 109% 444 136 168 32 171

S00001 Total 4000 1038 936 -101 90% 961 335 348 14 333

S05001 Anaesthesia Services Acute 0 0 2 2 0% 1 0 0 0 1

S05001 Total 0 0 2 2 0% 1 0 0 0 1

S25001 Ear, Nose and Throat Acute 70 16 32 15 195% 27 6 7 1 11

Elective 497 121 123 2 102% 111 40 38 -1 33

S25001 Total 567 138 155 18 113% 138 46 46 0 45

S40001 Ophthalmology Acute 14 4 7 4 205% 6 1 2 1 3

Elective 351 81 99 18 122% 76 28 37 9 26

S40001 Total 365 85 106 21 125% 83 29 39 10 29

S45001 Orthopaedics Acute 2150 533 535 3 101% 515 146 191 45 186

Elective 2719 677 612 -65 90% 586 198 241 43 190

S45001 Total 4869 1210 1147 -62 95% 1101 344 432 88 376

S70001 Urology Acute 200 50 65 15 129% 93 13 23 10 35

Elective 570 138 167 29 121% 149 56 48 -7 69

S70001 Total 770 188 232 43 123% 241 69 71 3 103

S75001 Vascular Acute 36 0 0 0 0% 1 0 0 0 -2

Elective 277 0 7 7 0% 11 0 0 0 -4

S75001 Total 313 0 7 7 0% 11 0 0 0 -6

Surgical Total 11094 2714 2643 -71 97% 2596 840 962 121 906

W C & Y M55001 Paediatric Medicine Acute 530 131 165 34 126% 155 39 47 8 47

Elective 70 19 9 -10 48% 16 6 0 -7 7

M55001 Total 600 150 174 24 116% 171 45 46 1 55

S30001 Gynaecology Acute 245 56 64 8 115% 63 21 31 10 21

Elective 800 212 184 -28 87% 235 66 69 4 70

S30001 Total 1045 268 248 -20 93% 298 86 100 14 91

W06003 Neonatal Inpatient Acute 430 121 104 -18 85% 109 40 21 -19 43

W06003 Total 430 121 104 -18 85% 109 40 21 -19 43

W10001 Maternity inpatient (DRGs) Acute 1430 404 397 -7 98% 292 133 138 5 94

W10001 Total 1430 404 397 -7 98% 292 133 138 5 94

W C & Y Total 3505 943 923 -20 98% 870 305 306 1 283

Grand Total 22621 5823 5568 -255 96% 5587 1856 1900 43 1904

Note that last FY volumes are as per that years casemix model



MoH / Production Plan Elective Discharges

September 2016

Service

Unit Code Description TypeAnnual

Plan

Budget

YTD

Actual

YTD

YTD

Volume

Variance

Actual %

Complete

vs YTD

Plan

Last FY-

YTD

Actual

Budget

Month

Actual

Month

Month

Volume

Variance

Last FY

Month

Actual

Medical M00001 General Medicine - Discharges Elective Disch 17 5 2 -3 43% 1 2 0 -2 0

Arranged Admit 10 3 3 0 108% 5 1 1 0 1

General Medicine - Discharges Total 27 7 5 -2 68% 6 2 1 -1 1

M10001 Cardiology - Discharges Elective Disch 98 26 14 -12 55% 17 9 4 -5 3

Arranged Admit 15 4 3 -1 75% 2 1 2 1 0

Cardiology - Discharges Total 113 30 17 -13 58% 19 11 6 -5 3

M15001 Dermatology - Discharges Arranged Admit 6 2 0 -2 0% 0 1 0 -1 0

Dermatology - Discharges Total 6 2 0 -2 0% 0 1 0 -1 0

Medical Total 146 38 22 -16 57% 25 14 7 -7 4

Surgical D01001 Dental - Discharges Elective Disch 18 5 1 -4 20% 3 2 1 -1 1

Arranged Admit 1 0 0 0 0% 0 0 0 0 -1

Dental - Discharges Total 19 5 1 -4 20% 3 2 1 -1 0

MS02016 Skin Lesions excisions Elective Disch 475 122 126 4 103% 142 42 34 -8 33

Arranged Admit 0 0 0 0 0% 5 0 0 0 1

Skin Lesions excisions Total 475 122 126 4 103% 147 42 34 -8 34

S00001 General Surgery - Discharges Elective Disch 1210 311 390 79 125% 337 106 151 45 132

Arranged Admit 264 69 41 -28 60% 52 21 14 -7 18

General Surgery - Discharges Total 1474 380 431 51 113% 389 128 165 37 150

S05001 Anaesthetics - Discharges Arranged Admit 60 15 12 -3 80% 11 5 2 -3 8

Anaesthetics - Discharges Total 60 15 12 -3 80% 11 5 2 -3 8

S25001 ENT - Discharges Elective Disch 680 166 188 22 113% 168 54 66 12 54

Arranged Admit 20 5 5 0 107% 4 2 1 -1 0

ENT - Discharges Total 700 171 193 22 113% 172 56 67 11 54

S40001 Ophthalmology - Discharges Elective Disch 690 159 183 24 115% 135 55 69 14 45

Arranged Admit 26 7 12 6 185% 7 2 4 2 3

Ophthalmology - Discharges Total 716 166 195 29 118% 142 57 73 16 48

S45001 Orthopaedics - Discharges Elective Disch 1108 276 263 -13 95% 279 81 106 25 92

Arranged Admit 334 83 89 6 108% 85 23 37 14 31

Orthopaedics - Discharges Total 1442 359 352 -7 98% 364 103 143 40 123

S70001 Urology - Discharges Elective Disch 446 108 157 49 145% 115 43 47 4 -58

Arranged Admit 170 43 77 35 181% 53 11 26 15 -37

Urology - Discharges Total 616 151 234 83 155% 168 55 73 18 -95

S75001 Vascular - Discharges Elective Disch 70 0 6 6 0% 10 0 0 0 -10

Arranged Admit 31 0 1 1 0% 0 0 0 0 0

Vascular - Discharges Total 101 0 7 7 0% 10 0 0 0 -10

Surgical Total 5603 1368 1551 183 113% 1406 448 558 110 312

W C & Y M55001 Paediatric Medical - Discharges Elective Disch 0 0 0 0 0% 0 0 0 0 0

Arranged Admit 1 0 0 0 0% 0 0 0 0 0

Paediatric Medical - Discharges Total 1 0 0 0 0% 0 0 0 0 0

S30001 Gynaecology - Discharges Elective Disch 825 219 192 -27 88% 236 68 70 2 72

Arranged Admit 151 34 71 37 207% 45 13 43 30 23

Gynaecology - Discharges Total 976 253 263 10 104% 281 80 113 33 95

W C & Y Total 977 253 263 10 104% 281 81 113 32 95

Grand Total 6726 1659 1836 177 111% 1712 542 678 136 411

The Elective Health Target section in the CSR reflects MoH criteria.

Where discharge type is one of the following:

1. Elective discharge from a surgical purchase unit

2. Elective surgical discharge from a non surgical purchase unit

3. Arranged discharge from a surgical purchase unit

4. Arranged surgical discharge from a non surgical purchase unit

Note that the caseweight section is aligned with the Price Volume Schedule and Production Plan caseweights (includes IDF inflows) while the MoH

Elective Health Target discharges are aligned to the MoH and Production Plan discharges (excludes IDF inflows)

This means that the MoH Elective Health Target discharges show patients whose caseweights are displayed in both Elective AND Acute sections

of the caseweight report, depending on their status as a Waitlist or an Arranged admission



Outpatient Attendances

First Specialist Assessments

NMDHBSeptember 2016

Service Unit Code Description Annual PlanBudget

YTD

Actual

YTD

YTD

Volume

Variance

Act %

Complete

vs YTD

Plan

Last FY-

YTD Actual

Budget

Month

Actual

Month

Month

Volume

Variance

Last FY

Month

Actual

Medical M00002 General Medicine - 1st attendance 1500 409 293 -116 72% 349 136 109 -27 121

M10002 Cardiology - 1st attendance 790 206 160 -46 78% 199 75 51 -24 81

M15002 Dermatology - 1st attendance 290 73 81 9 112% 65 24 20 -4 25

M20004 Diabetes - 1st attendance 103 28 21 -7 75% 21 9 5 -4 11

M25002 Gastroenterology - 1st attendance 1000 272 145 -127 53% 208 91 53 -38 78

M30002 Haematology - 1st attendance 116 32 43 11 136% 18 11 22 11 8

M40002 Infectious Diseases - 1st attendance 44 12 9 -3 75% 16 4 4 0 3

M45002 Neurology - 1st attendance 350 95 72 -23 76% 63 32 29 -3 30

M50020 Oncology - 1st attendance 400 109 105 -4 96% 107 36 32 -4 41

M50022 Radiation Oncology - 1st 170 46 45 -1 97% 47 15 22 7 19

M60002 Renal Medicine - 1st attendance 50 14 18 4 132% 4 5 3 -2 1

M65002 Respiratory - 1st attendance 215 59 58 -1 99% 5 20 18 -2 2

M70002 Rheumatology (incl immunology) - 1st att 320 87 120 33 138% 81 29 38 9 49

Medical Total 5348 1441 1170 -271 81% 1183 487 406 -81 469

Surgical S00002 General Surgery - 1st attendance 2800 720 679 -41 94% 644 246 216 -30 262

S25002 Ear Nose and Throat - 1st attendance 1300 317 407 90 128% 441 104 138 34 178

S40002 Ophthalmology - 1st attendance 1400 323 455 132 141% 416 112 159 47 147

S45002 Orthopaedics - 1st attendance 1900 473 461 -12 97% 448 139 170 31 157

S45004 Fracture Clinic - 1st attendance 2100 523 514 -9 98% 576 153 194 41 193

S70002 Urology - 1st attendance 1300 315 222 -93 70% 321 127 71 -56 142

S75002 Vascular Surgery 1st Attendance 240 0 58 58 0% 20 0 29 29 6

Surgical Total 11040 2671 2796 125 105% 2866 881 977 96 1085

W C & Y M55002 Paediatric Medical Outpatient - 1st at 950 259 234 -25 90% 250 86 80 -6 85

S30002 Gynaecology - 1st attendance 1425 378 376 -2 100% 387 117 204 87 125

W03002 1st obstetric consults 775 219 227 8 104% 176 72 81 9 65

W C & Y Total 3150 855 837 -18 98% 813 275 365 90 275

Grand Total 19538 4968 4803 -165 97% 4862 1643 1748 105 1829

Subsequent Attendances

NMDHBSeptember 2016


YTD

Actual

YTD

YTD

Volume

Variance

Act %

Complete

vs YTD

Plan

Last FY-

YTD Actual

Budget

Month

Actual

Month

Month

Volume

Variance

Last FY

Month

Actual

Medical M00003 General Medicine - Subsequent attendance 2000 545 449 -96 82% 540 182 129 -53 191

M10003 Cardiology - Subsequent attendance 705 184 151 -33 82% 186 67 71 4 84

M15003 Dermatology - Subsequent attendance 335 84 63 -21 75% 111 28 19 -9 42

M20005 Diabetes - Subsequent attendance 400 108 98 -10 91% 95 36 32 -4 37

M25003 Gastroenterology - Subsequent attendance 1000 272 99 -173 36% 258 91 23 -68 85

M30003 Haematology - Subsequent 400 109 123 14 113% 109 36 44 8 45

M40003 Infectious Diseases - Subsequent 50 14 12 -2 88% 13 5 2 -3 5

M45003 Neurology - Subsequent attendance 850 232 165 -67 71% 211 77 39 -38 78

M50021 Oncology - Subsequent attendance 3240 883 845 -38 96% 796 294 278 -16 313

M50023 Radiation Oncology - Subsequent 300 82 48 -34 59% 78 27 21 -6 28

M60003 Renal Medicine - Subsequent attendance 450 123 123 0 100% 85 41 30 -11 31

M65003 Respiratory - Subsequent attendance 157 43 57 14 133% 1 14 5 -9 0

M70003 Rheumatology (incl immunology) - Subsequ 916 250 254 4 102% 234 83 106 23 83

Medical Total 10803 2926 2487 -439 85% 2717 981 799 -182 1022

Surgical S00003 General Surgery - Subsequent attendance 3750 964 981 17 102% 923 330 320 -10 356

S25003 Ear Nose and Throat - Subsequent attenda 2000 488 602 114 123% 539 160 225 65 197

S40003 Opthalmology - Subsequent attendance 6600 1525 1611 86 106% 1590 528 530 2 536

S45003 Orthopaedics - Subsequent attendance 3900 971 959 -12 99% 921 285 324 39 301

S45005 Fracture Clinic - Subsequent attendance 2400 598 605 7 101% 523 175 205 30 187

S70003 Urology - Subsequent attendance 2200 534 579 46 109% 537 215 229 15 234

S75003 Vascular Surgery Subsequent Attendance 400 0 22 22 0% 66 0 5 5 14

Surgical Total 21250 5079 5359 280 106% 5099 1692 1838 146 1825

W C & Y M55003 Paediatric Medical Outpatient - Subsequ 2550 695 674 -21 97% 640 232 236 4 211

S30003 Gynaecology - Subsequent attendance 1300 345 293 -52 85% 306 107 130 23 91

W03003 Subsequent obstetric consults 800 226 210 -16 93% 192 75 79 4 77

W C & Y Total 4650 1265 1177 -88 93% 1138 413 445 32 379

Grand Total 36703 9270 9023 -247 97% 8954 3086 3082 -4 3226



Medical & Surgical Procedures

NMDHBSeptember 2016


YTD

Actual

YTD

YTD

Volume

Variance

Actual %

Complete

vs YTD

Plan

Last FY-

YTD Actual

Budget

Month

Actual

Month

Month

Volume

Variance

Last FY

Month

Actual

Medical M00006 General Medicine - Blood Transfusions 680 185 148 -37 80% 156 62 58 -4 44

M15004 Dermatology - UV Treatment 460 115 122 7 106% 80 38 122 84 80

M20007 Diabetes - Fundus Screening 1800 487 458 -29 94% 427 162 158 -4 121

M45004 Neurology - Botulinum toxin therapy 120 33 33 0 101% 36 11 33 22 36

M60008 Renal Medicine - Incentre dialysis 1650 449 341 -108 76% 436 150 107 -43 130

M65005 Respiratory - Bronchoscopy 35 10 13 3 136% 5 3 6 3 1

MS02009 IV Chemotherapy - cancer - Any health sp 2500 681 751 70 110% 578 227 279 52 206

MS02020 Sleep apnoea - assessment 150 41 34 -7 83% 1 14 6 -8 0

MS02021 Sleep apnoea - long term treatment 280 76 292 216 383% 347 25 11 -14 -6

Medical Total 7675 2077 2192 115 106% 2066 692 780 88 612

Surgical M25008 Capsule Endoscopy 7 2 0 -2 0% 1 1 0 -1 1

MS02005 Gastroscopy - Any Health Speciality 950 244 202 -42 83% 180 84 51 -33 62

MS02007 Colonoscopy - Any Health Speciality 2000 514 504 -10 98% 340 176 187 11 123

MS02014 Colonoscopy and Gastroscopy (Performed together, ie top & tail)100 26 28 2 109% 27 9 6 -3 9

MS02016 Skin lesion excisions 535 137 128 -9 93% 147 47 34 -13 30

S00008 Minor operations (Gen Surgery) 250 64 65 1 101% 32 22 26 4 15

S25006 ENT Minor procedure 1000 244 288 44 118% 286 80 109 29 116

S40005 Eye - Argon Laser 10 2 13 11 563% 13 1 2 1 6

S40007 Avastin (Intraocular injections) 2000 462 673 211 146% 542 160 214 54 187

S40008 Minor Eye Procedures 120 28 0 -28 0% 0 10 0 -10 0

S70005 Urology - Cystoscopy 450 109 114 5 104% 77 44 42 -2 33

S70006 Urology - Lithotripsy 30 7 0 -7 0% 9 3 0 -3 3

S70007 Urology - Urodynamics 68 16 18 2 109% 19 7 8 1 4

Surgical Total 7520 1856 2033 177 110% 1673 642 679 37 589

W C & Y S30006 Termination of Pregnancy 430 114 70 -44 61% 79 35 17 -18 20

S30008 Gynaecology - High cost Minor Procedures 100 27 10 -17 38% 39 8 4 -4 11

W03005 Amniocentesis 20 5 0 -5 0% 0 2 0 -2 0

W C & Y Total 550 146 80 -66 55% 118 45 21 -24 31

Grand Total 15745 4079 4305 226 106% 3857 1379 1480 101 1232



Improving Diagnostic Waiting Times - Colonoscopy: September diagnostic reporting is due to the Ministry on 20 October 2016. New requirements from 1 July 2016 with non-urgent diagnostic now requiring 70% of patients to be done within 42 days and 70% of surveillance patients done within 84 days of due date. NMDHB Colonoscopy information is as follows:



Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Total Number accepted referrals waiting outside 6

weeks (excluding referrals for scans that are planned

patient events) 51 86 93 65 68 37 47 82 92 37 32 16 18




patient events) 295 249 229 209 203 151 119 125 114 140 145 132 95




patient events) 19 26 24 25 21 12 9 16 29 17 6 6 12

Diagnostic Reporting Template -

MRI

Diagnostic Reporting Template - CT (DHB

wide)

Diagnostic Reporting Template - CTC

(DHB wide)

0

20

40

60

80

100

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Diagnostic Reporting Template - CT (DHB wide) Total Number accepted referrals

waiting outside 6 weeks (excluding

referrals for scans that are planned patient events)

Diagnostic Reporting Template - CT (DHB wide) Total Number accepted

referrals waiting outside 6 weeks (excluding referrals for scans that are planned patient events)

0

100

200

300

400

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Diagnostic Reporting Template - MRI Total Number accepted referrals

waiting outside 6 weeks (excluding referrals for scans that are planned

patient events)

Diagnostic Reporting Template - MRI Total Number accepted referrals

waiting outside 6 weeks (excluding referrals for scans that are planned patient events)

0

5

10

15

20

25

30

35

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Diagnostic Reporting Template - CTCTotal number accepted referrals waiting outside 6 weeks (excluding referrals for

scans that are planned patient events

Series2



Intervention Rates/Health Targets Cataracts Cataract intervention rates required for 2016/17 for NMDHB are 466 discharges. September 2016 delivered 58 cataracts against a plan of 45. Year to date delivery is 135 cataracts against a plan of 130.

Joints Joint intervention rates required for 2016/17 for NMDHB is 553 discharges (elective and acute). September 2016 delivered 49 joints against a plan of 51; note that actual delivery of 35 is made from up of coded discharges and procedure information from Theatre Management System so could be subject to change once coding is completed.



Additional Orthopaedic General Surgery Report



Other Orthopaedics Other Orthopaedic intervention rates required for 2016/17 for NMDHB is 763 discharges (elective and acute). August 2016 delivered 87 other orthopaedics against a plan of 127 = (40). We therefore need to increase the bookings for other orthopaedic surgeries in the coming months to meet the agreed target of 763 other orthopaedic procedures. Cardiac Surgery Cardiac Surgery intervention rates required for 2016/17 for NMDHB is 103 discharges with an average of nine per month. Delivery to end of August 2016 is 20 discharges, 11 acute and nine elective; 18 through Wellington and two through Christchurch Bariatric Surgery NMDHB bariatric surgery intervention rates required for 2016/17 are combined as a South Island region target volume. Patients will be assessed against the Bariatric Surgery scoring tool and those that meet the threshold will proceed to surgery regardless of domicile. Delivery to end August 2016 notes zero Nelson Marlborough domiciled patients receiving bariatric surgery year to date. Shorter Stays in Emergency Department In September 95.7% of patients were admitted and discharged within the six hour guideline.

Health Target NMDHB is required to deliver 7517 discharges in 2016/17. August 2016 Ministry Reports indicate we have delivered 1,256 discharges against a plan of 1,247 (100.7%).



ESPI Results ESPI 1 Update ESPI 1 compliance (acknowledgement and acceptance of referrals) is now able to be reported electronically.

13 out of 20 services district wide are non-compliant for September (two services red) for referrals being prioritised sometimes known as triaged within 10 days of acceptance. As at report run date of 7 October, there are 156 referrals prioritised > 10 days and 196 pending triage update.

The DHB is required to have maximum two services non-compliant only in order to ensure the target of 90% of referrals triaged within 14 days is achieved. ESPI 1 and National Patient Flow (NPF) A letter dated 28 June 2016 to Chief Operating Officers indicates that DHBs have made progress in implementing National Patient Flow which has resulted in improved data collection around referral notification information. This has resulted in a number of DHBs identifying that their current approach to reporting of ESPI1 is not as accurate as once thought.

DHBs should be using the most complete and reliable information available to report against ESPIs. Some DHBs have signalled plans to transition to using their internal NPF data to complete their outpatient template, but have raised concerns around the risk of financial penalties from a ‘red’ ESPI. Service Managers will re-enforce prioritisation step within five days.

To support DHBs to shift to the most accurate data the MOH are removing the non-compliant ‘red’ level for ESPI1 for 2016/17.

NMDHB falls into this category. From July 2016 ESPI 1 reporting has been taken from the triage graphs as displayed below. This will result in a change to our ESPI1 status. We have the 2016/17 financial year to ensure referrals are prioritised, triaged and notified within 15 calendar days otherwise in the 2017/18 year there will be a risk to our elective funding.



August ESPI Results



Theatre Cancellations Current theatre cancellations for September 2016 are showing as 61; 46 for Nelson and 15 for Wairau. Theatre cancellations are now being reported from the electronic theatre management system. YTD cancellations are 165.



ESPI’s – 4 Months



Faster Cancer Treatment (FCT) Oncology Audit NZ were rigorous in their audit of this programme and due to poor understanding of the process and limited clinical knowledge, considerable time was required by the FCT Co-ordinators and Intelligence and Reporting team to support the auditors and take them step by step through data collection and explain why patients were included or excluded. The new Ear Nose and Throat project resource has been recruited and process mapping is successfully underway. The lung tumour stream audit has been completed.

MDM (Multidisciplinary Meetings) FCT team members attended the on line demonstration of the Southern MDM tool. All were impressed and support Southern Cancer Network (SCN) finding a way that this can be hosted in Southern but accessible for the rest of the South Island. Neurology This team are actively engaged in establishing prioritisation criteria, modelled from those used in Hawkes Bay. The threshold in NMDHB does appear high with volumes accepted exceeding capacity. A teleneurology clinic was held using the technology purchased for telestroke. The clinic appears to have gone well with a registrar in Nelson conducting the physical examination. This was organised expediently to enable ESPI targets to be met so the choice of patients was not ideal however it remains an option in the future. Stroke The initial evaluation of the telestroke pilot has been undertaken with an increase in the thrombolysis rates. The pilot is due to conclude 31 December 2016. The evaluation also indicates a need for ongoing financial support for the Wellington stroke team to support this initiative if it is to continue in the same format although early indication is that the model could be adapted for NMDHB without extra cost to DHB.

Dermatology The Physician has now confirmed that he intends to retire in the early part of 2017. An agreement has been sent to his practice for a one year confirmation of the UVB contract. NMDHB does not have any other site for this service to be provided or another provider option. Gastroenterology and Hepatology Pharmac released the new Hep C antivirals effective 1 July and approximately four to five patients are being initiated on treatment a week. Nursing resource and a fibroscanner is required locally to fully initiate the programme. There is continued pressure via the South Island Alliance for MOH to purchase fibroscanners and NMDHB may look at how to do this in conjunction with West Coast DHB to retain funding for nurses and achieve a mobile service. ICCU The Director position has been appointed – to commence November 2016.

EMERGENCY NELSON Triage, Total Presentations by Visit



Quality The quality report for Nelson ED has now been printed and distributed. This is a good start to describe the current situation. A number of initiatives that have been introduced in Wairau for the ED 5000 Project are being considered in Nelson. 14 out of 30 days Nelson did not achieve the 95% in six hour target so renewed emphasis is required in this area.

EMERGENCY WAIRAU

Triage, Total Presentations by Visit



Breaches of 6 Hour Target in Wairau

PROJECT UPDATES

ED 5000 Commitment continues to this process with odd days showing low volumes but higher acuity contributing to less ability to meet the six hour target.



ASSESSMENT TREATMENT AND REHABILITATION (ATR) NELSON

Quality A visit from Australasian Rehabilitations Outcomes Centre (AROC) demonstrated objectively areas of both development and achievement for both ATR units. It was obvious for the major impairment groups of stroke, fracture neck of femur and deconditioning where improvements could be made and how the functional impairment measures could be used in day to day practice.



FCT Monthly Report - August 2015 Reporting Month: July 2016 - Quarter 1 2015-2016

As at 26/08/2016

62 Day Indicator Records

TARGET SUMMARY

Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days

90% 10% 87% 13% 76% 32% 88% 12% 83% 17%

Number of Records 18 2 27 4 22 7 45 6 239 49

Total Number of Records 20 31 29 51 288

55 62 98 59 63

Within 62 Days Exceeded 62 Days Within 62 Days Exceeded 62 Days

1 82% 18% 56% 44%

64 14 141 109

78 250

63 108

YEAR TO DATE

Tumour Stream % Within 62 Days

Within

62 Days

% Exceeded

62 Days Exceeded 62 Days

Total

Records Column1 Ethnicity Column2 % Within 62 Days

Within

62 Days

% Exceeded

62 DaysExceeded 62

Days

Total

Records

Brain/CNS #DIV/0! 0 #DIV/0! 0 0 asian not further defined 100% 1 0% 0 1

Breast 99% 92 1% 1 93 don't know 0% 0 100% 1 1

Gynaecological 100% 18 0% 0 18 european not further defined 50% 5 50% 5 10

Haematological 89% 16 11% 2 18 latin american /hispanic 100% 1 0% 0 1

Head & Neck 58% 11 42% 8 19 N/A 100% 1 0% 0 1

Lower Gastrointestinal 85% 22 15% 4 26 not stated #DIV/0! 0 #DIV/0! 0 0

Lung 62% 21 38% 13 34 nz european 85% 196 15% 34 230

Other 100% 1 0% 0 1 nz maori 63% 12 37% 7 19

Sarcoma 0% 0 100% 1 1 other Asian 100% 1 0% 0 1

Skin 84% 31 16% 6 37 other ethnicity 100% 2 0% 0 2

Upper Gastrointestinal 92% 11 8% 1 12 other european 94% 16 6% 1 17

Urological 54% 15 46% 13 28 response unidentifiable 50% 1 50% 1 2

Blank 100% 1 0% 0 1 samoan 100% 1 0% 0 1

All Streams 83% 239 17% 49 288 southeast asian 100% 1 0% 0 1

tongan 100% 1 0% 0 1

Grand Total 83% 239 17% 49 288

85% of patients had their 1st

treatment within: # days

Quarter 4 Previous Year

Completed Records


Aug -2016

(in progress)Jul-16 Jun-16

Quarter 1

(in progress)Year to Date




TARGET SUMMARY

Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days

89% 11% 83% 17% 87% 13% 86% 14% 84% 16%

Number of Records 24 3 25 5 40 6 49 8 411 78

Total Number of Records 27 30 46 57 489

26 31 28 28 34

Within 31 Days Exceeded 31 Days Within 31 Days Exceeded 31 Days

88% 12% 81% 19%

118 16 292 70

134 362

27 39

YEAR TO DATE

Tumour Stream% Within

31 Days

Within

31 Days

% Exceeded

31 DaysExceeded

31 Days

Total

Records Column4 Ethnicity Co

lum

n2

% Within

31 Days

Within

31 Days

% Exceeded

31 DaysExceeded 31

Days

Total

Records

Brain/CNS 100% 12 0% 0 12 European not further defined 91% 10 9% 1 11

Breast 95% 21 5% 1 22 Indian 0% 0 100% 1 1

Gynaecological 86% 18 14% 3 21 N/A 100% 1 0% 0 1

Haematological 89% 34 11% 4 38 Not stated 100% 2 0% 0 2

Head & Neck 67% 16 33% 8 24 NZ European 85% 355 15% 65 420

Lower Gastrointestinal 92% 87 8% 8 95 NZ Maori 88% 15 12% 2 17

Lung 98% 42 2% 1 43 Other Asian 50% 1 50% 1 2

Other 100% 5 0% 0 5 Other Ethnicity #DIV/0! 0 #DIV/0! 0 0

Sarcoma 67% 2 33% 1 3 Other European 75% 24 25% 8 32

Skin 79% 19 21% 5 24 Response Unidentiable 100% 2 0% 0 2

Upper Gastrointestinal 98% 45 2% 1 46 Tongan 100% 1 0% 0 1

Urological 68% 99 32% 46 145 #DIV/0! #DIV/0! 0

Blank 100% 11 0% 0 11 #DIV/0! #DIV/0! 0

All Streams 84% 411 16% 78 489 Grand Total 84% 411 16% 78 489

85% of patients had their 1st

treatment within: # days

Quarter 4 Previous Year


Aug-2016

(in progress)Jul-16 Jun-16

Quarter 1

(in progress)Year to Date

Completed Records



Highlight of Month/Year

Endoscopy reached all three targets for third consecutive month.

ESPI 2 and 5 are yellow for the month.

Health Targets were reached and addressed last month’s negative target and are now in a positive variance for the month and YTD.

Elective Services

Health Targets –Target for 2016/17 is 7,593

September required 460

September result internally for surgical provisionally +39 for the month YTD +48

The other surgical procedures (Cardiology) and IDF will be more determinate of the final result

Additional HT Orthopaedic Surgery – The Friday PM list in theatre is not yet resourced, and not required, however NMDHB ran two ACC lists and in addition a list of Ortho minors was provided but no surgeons were available.

MOH Scheduling Patient Booking Initiative Approved – (ELFI) and Admin Changes

Three work streams engaged and active with their priorities; reducing theatre cancellation, preoperative patient flow, and data accuracy

Elective Service Manager is participating in this improvement process to ensure NPF alignment requirements and Ora-care interface and electives.

Centralised Referral Centre

Running parallel with ELFI is the District Referral Centre initiated in Wairau this month through Clinical Support and Service Manager is bridging the two projects to maintain alignment with ELFI

Endoscopy district wide triage will roll out into centralised process also.

Contract Volumes 2016/17

72 additional elective surgery cases to be completed in the 2016/17 year

These have been agreed and built into the production plan across Gynaecology, Plastics, Vascular and Ophthalmology

FYI 2016/17 our volumes move from 7,445 to 7,593 an increase of 138 HT over all plus increased ACC expectations of an additional $200k of revenue

Orthopaedics initiative brings a further 49 other orthopaedic procedures and 28 joints – the joints will be achieved but we are lagging behind with the other procedures with a plan now in place to address this.

Theatre

August saw a total of 252 elective theatre sessions utilised across the district to complete 499 Elective Health Target patients. This means an average of 1.98 Health Target patients were treated per elective theatre session.



Executive: GMCS Period: September 2016

September September September YTD YTD YTD Full Year

Actual Budget Var Actual Budget Var Budget

Revenue

12 - Ministry of Health 129,639 131,432 (1,794) 703,183 718,990 (15,806) 2,875,958

14 - Other Government - Other DHBs 35,925 9,373 26,553 77,567 19,630 57,937 78,367

15 - Other Government - ACC 361,191 355,243 5,947 1,165,549 1,023,473 142,076 4,118,477

16 - Other Government - Other (91,134) 7,212 (98,345) 41,872 21,635 20,237 86,540

17 - Patient and Consumer Sourced 398,185 359,705 38,480 997,376 944,066 53,310 3,760,039

18 - Other Income 12,674 40,796 (28,122) 193,645 106,111 87,534 425,487

19 - Internal Income 17,163,733 17,154,320 9,413 51,484,747 51,462,961 21,786 205,851,843

Total Revenue 18,010,213 18,058,081 (47,867) 54,663,939 54,296,865 367,074 217,196,711

Workforce

21 - Medical Personnel 2,918,895 3,097,442 178,547 8,978,030 9,298,329 320,299 40,754,100

31 - Outsourced - Medical Personnel 295,565 75,223 (220,342) 717,225 210,589 (506,636) 851,284

Total Medical 3,214,461 3,172,665 (41,796) 9,695,256 9,508,919 (186,337) 41,605,384

22 - Nursing Personnel 2,865,900 2,870,150 4,250 8,586,476 8,581,406 (5,070) 38,265,429

32 - Outsourced - Nursing Personnel 2,319 40 (2,280) 10,862 119 (10,744) 518

Total Nursing 2,868,219 2,870,189 1,970 8,597,338 8,581,525 (15,813) 38,265,947

23 - Allied Health Personnel 236,844 235,958 (886) 706,192 707,940 1,748 3,098,175

33 - Outsourced - Allied Health 3,318 6,863 3,545 19,804 18,099 (1,705) 73,273

Total Allied Health 240,162 242,821 2,659 725,996 726,039 43 3,171,448

24 - Support Personnel 37,361 44,769 7,408 139,670 134,328 (5,342) 589,817

Total Hotel Services 37,361 44,769 7,408 139,670 134,328 (5,342) 589,817

25 - Management/Administration Personnel 114,169 115,749 1,580 371,964 371,048 (916) 1,616,646

Total Management/Admin 114,309 115,749 1,440 372,104 371,048 (1,056) 1,616,646

Total Workforce Costs 6,474,513 6,446,194 (28,319) 19,530,363 19,321,858 (208,505) 85,249,241

Outsourced Services 106,262 100,066 (6,197) 275,788 264,422 (11,367) 1,058,150

41 - Treatment Disposables 726,632 680,417 (46,215) 1,784,232 1,777,443 (6,789) 7,125,666

42 - Diagnostic Supplies & Other Clinical Supplies 64,129 53,904 (10,225) 149,987 140,293 (9,694) 562,382

43 - Instruments & Equipment 80,107 107,917 27,810 281,546 290,158 8,612 1,012,770

44 - Patient Appliances 30,296 27,157 (3,139) 76,831 70,620 (6,212) 283,183

45 - Implants and Prostheses 636,242 609,776 (26,467) 1,615,459 1,583,758 (31,701) 6,339,244

46 - Pharmaceuticals 717,115 661,308 (55,807) 2,051,096 1,742,782 (308,314) 6,974,844

47 - Other Clinical & Client Costs 394 167 (227) 477 439 (39) 1,746

Clinical Supplies 2,254,915 2,140,646 (114,270) 5,959,629 5,605,493 (354,136) 22,299,835

51 - Hotel Services, Laundry & Cleaning 357,461 378,503 21,042 987,358 1,039,839 52,481 4,174,521

52 - Facilities 10,158 2,083 (8,075) 24,450 5,517 (18,933) 22,070

53 - Transport 20,943 16,565 (4,378) 56,951 43,576 (13,375) 173,793

148 - Depreciation 0 0 0 0 0 0 0

56 - Professional Fees & Expenses 1,917 5,060 3,143 5,750 13,486 7,737 53,685

57 - Other Operating Expenses 68,575 59,795 (8,780) 145,982 155,329 9,347 624,128

Infrastructure 478,766 475,036 (3,730) 1,279,696 1,291,684 11,988 5,181,853

6105 - Personal Health to allocate 0 0 0 0 0 0 0

6235 - Primary Health Care Strategy - Other 17,988 17,965 (22) 52,162 53,895 1,734 215,581

6279 - Paediatric Inpatients 0 0 0 448 0 (448) 0

6289 - Travel & Accommodation 0 0 0 0 0 0 0

6290 - Inter District Flows Personal Health - Own

DHB Population 3,274,631 3,210,921 (63,710) 9,696,474 9,632,763 (63,710) 36,131,054

Provider Payments 3,311,439 3,247,706 (63,733) 9,805,544 9,743,119 (62,425) 36,572,477

81 - Internal Transfers 28,952 27,875 (1,077) 81,673 83,625 1,952 336,763

Internal Allocations 28,952 27,875 (1,077) 81,673 83,625 1,952 336,763

Total Costs 12,654,848 12,437,523 (217,325) 36,932,694 36,310,201 (622,493) 150,698,318

Net Result 5,355,366 5,620,558 (265,192) 17,731,245 17,986,664 (255,419) 66,498,393

FTEsSeptember September September YTD YTD YTD Full Year

Actual Budget Var Actual Budget Var Budget

20 - Medical Personnel 162.82 172.63 9.81 158.52 172.63 14.11 173.11

22 - Nursing Personnel 459.23 463.34 4.10 455.76 461.51 5.75 463.91

2402 - Allied Health Personnel 47.21 47.74 0.53 46.76 47.74 0.98 47.76

26 - Hotel Services 11.00 12.44 1.44 13.15 12.44 (0.71) 12.44

28 - Management/Administration 17.59 17.18 (0.41) 19.63 19.18 (0.45) 19.18

697.85 713.32 15.47 693.82 713.49 19.67 716.40



Christine Nolan Acting General Manager Clinical Services

RECOMMENDATIONS: THAT THE COMMITTEE RECEIVES THE GM CLINICAL SERVICES REPORT.

Nelson Marlborough District Health Board Open Meeting

Glossary 5-1

GLOSSARY OF COMMONLY USED ACRONYMS, ABBREVIATIONS AND MAORI TRANSLATION

ABC Ask about their smoking status; brief advice to quit; cessation A4HC Action for Healthy Children A&D / AOD Alcohol and Drug / Alcohol and Other Drugs A&R Audit & Risk Committee ACC Accident Compensation Corporation ACMO Associate Chief Medical Officer ACNM - Associate Charge Nurse Manager ACU Ambulatory Care Unit ACP Advanced Care Plan ADR Adverse Drug Reactions ADM Acute Demand Management ADON Associate Director of Nursing AE Alternative Education AEP Accredited Employer Programme AIR Agreed Information Repository ALOS Average Length of Stay ALT Alliance Leadership Team (short version of (TOSHALT) AMP Asset Management Plan AOD Alcohol and Drug AOHS Adolescent Oral Health Services AP Annual Plan with Statement of Intent ARC Aged Residential Care ARF Audit Risk and Finance ARCC Aged Residential Care Contract ARRC Aged Related Residential Care ASD Autism Spectrum Disorder ASMS Association of Salaried Medical Specialists AT&R Assessment, Treatment & Rehabilitation BSCQ Balanced Score Card Quadrant BA Business Analyst BAU Business as Usual BCTI Buyer Created Tax Invoice BFCI Breast Feeding Community Initiative BFCI Baby Friendly Community Initiative BHE Blenheim BOT Board of Trustees BS Business Support BSI Blood Stream Infection BSMC Better, Sooner, More Convenient CAR Corrective Action Required CaaG Capacity at a Glance CAMHS Child and Adolescent Mental Health Services CARES Coordinated Access Response Electronic Service CBAC Community Based Assessment Centres CBF Capitation Based Funding CBSD Community Based Service Directorate CE (CEO) Chief Executive (Chief Executive Officer) CEA Collective Employee Agreement CDHB Canterbury District Health Board CCDHB Capital & Coast District Health Board (also called C & C) CCDM Care Capacity Demand Management CCDP Care Capacity Demand Planning CCF Chronic Conditions Framework CCT Continuing Care Team


Glossary 5-2

CCU Coronary Care Unit CDEM Civil Defence Emergency Management CDHB Canterbury District Health Board CDM Chronic Disease Management CEG Coordinating Executive Group (for emergency management) CeTas Central Technical Advisory Support CFA Crown Funding Agreement or Crown Funding Agency CFO Chief Financial Officer CGC Clinical Governance Committee CHFA Crown Health Financing Agency CHS Community Health Services CIMS Coordinated Incident Management System CIO Chief Information Officer CLAB Central Line Associated Bacteraemia CLAG Clinical Laboratory Advisory Group CME Continuing Medical Education CMI Chronic Medical Illness CMO Chief Medical Officer CMS Contract Management System CNM Charge Nurse Manager Concerto IT system which provides clinician’s interface to systems COHS Community Oral Health Service COO Chief Operating Officer COPD Chronic Obstructive Pulmonary Disease COPMI Children of Parents with Mental Illness CPHAC Community and Public Health Advisory Committee CPIP Community Pharmacy Intervention Project CPNE Continuing Practice Nurse Education CP Chief Pharmacist CPO Controlled Purchase Operations

CPSOG Community Pharmacy Services Operational Group

CPU Critical Purchase Units CR Computed Radiology CRG Christchurch Radiology Group CRISP Central Region Information Systems Plan CSR Contract Status Report CSSD Central Sterile Supply Department CSSD Clinical Services Support Directorate CT Computerised Tomography CTA Clinical Training Agency CTC Contributions to Cost CTC Computerised Tomography Colonography CTANAG Clinical Training Agency Nursing Advisory Group CTU Combined Trade Unions CVD Cardiovascular Disease CVDRA Cardiovascular/Diabetes Risk Assessment CWD Case Weighted Discharge CYF Child, Youth and Family CYFS Child, Youth and Family Service DA Dental Assistant DAH Director of Allied Health DAP District Annual Plan DAR Diabetes Annual Review DBI Diagnostic Breast Imaging DBT Dialectical Behaviour Training DHB District Health Board DHBNZ District Health Boards New Zealand DHBRF District Health Boards Research Fund


Glossary 5-3

DIFS District Immunisation Facilitation Services DiSAC Disability Support Advisory Committee DGH Director General of Health DMH Director of Maori Health DNA Did Not Attend DONM Director of Nursing and Midwifery DR Disaster Recovery DR Digital Radiology DRG Diagnostic Related Group DSP District Strategic Plan DSS Disability Support Services DT Dental Therapist DWCSP District Wide Clinical Services Plan EAP Employee Assistance Programme EBID Earnings Before Interest & Depreciation ECP Emergency Contraceptive Pill ECWD Equivalent Case Weighted Discharge ED Emergency Department EDA Economic Development Agency EDaaG ED at a Glance EFI Energy For Industry ELT Executive Leadership Team EMPG Emergency Management Planning Group ENS Ear Nurse Specialist ENT Ears, Nose and Throat EOI Expression of Interest EPA Enduring Power of Attorney EQP Earthquake Prone Building Policy ERMS ereferral Management System ESA Electronic Special Authority ESOL English Speakers of Other Languages ESPI Elective Services Patient Flow Indicators ESR Environmental Science & Research ESU Enrolled Service Unit EVIDEM Evidence and Value: Impact on Decision Making FCT Faster Cancer Treatment FF&E Furniture, Fixtures and Equipment FFT Future Funding Track FMIS Financial Management Information System FOMHT Friends of Motueka Hospital Trust FOUND Found Directory is an up-to-date listing of community groups and

organisations in Nelson/Tasman FPSC Finance Procurement and Supply Chain FRC Fee Review Committee FSA First Specialist Assessment FST Financially Sustainable Threshold FTE Full Time Equivalent FVIP Family Violence Intervention Programme GM General Manager GMS General Medical Subsidy GP General Practitioner GRx Green Prescription hA healthAlliance HAC Hospital Advisory Committee HBI Hospital Benchmarking Information HBSS Home Based Support Services HBT Home Based Treatment H&DC / HDC Health and Disability Commissioner


Glossary 5-4

H&S Health & Safety HDSP Health & Disability Services Plan Programme HDU High Dependency Unit HEA Health Education Assessments He Kawenata Covenant, agreement, treaty, testament (PM Ryan Maori Dictionary pg 104) HEeADSSS Psychosocial tool – Home, Education, eating, Activities, Drugs and Alcohol,

Sexuality, Suicidality (mood), Safety HEHA Healthy Eating Healthy Action HEP Hospital Emergency Plan HESDJ Ministries of Health, Education, Social Development, Justice HFA Health Funding Authority HHS Hospital and Health Services HIA Health Impact Assessment HM Household Management HMS Health Management System HNA Health Needs Assessment HODs Heads of Department HOP Health of Older People HP Health Promotion HPI Health Practitioner Index HPV Human Papilloma Virus HR Human Resources HR & OD Human Resources and Organisational Development HSP Health Services Plan HQSC Health Quality & Safety Commission IANZ International Accreditation New Zealand IBA Information Builders of Australia IDF Inter District Flow IDSS Intellectual Disability Support Services IFRS International Financial Reporting Standards IHB Iwi Health Board

ILM Investment Logic Mapping

IM Information Management InterRAI Inter Residential Assessment Instrument IoD Institute of Directors New Zealand IPAC Independent Practitioner Association Council IPC Intensive Patient Care IPC Units Intensive Psychiatric Care Units IPG Immunisation Partnership Group IPSAS International Public Sector Accounting Standards IPU In-Patient Unit IS Information Systems ISSP Information Services Strategic Plan IT Information Technology JAMHWSAP Joint Action Maori Health & Wellness Strategic Action Plan JOG Joint Oversight Group KIM Knowledge and Information Management Kotahitanga Unity, accord, coalition, solidarity (PM Ryan Maori Dictionary pg 127) KPI Key Performance Indicator KHW Kimi Hauora Wairau (Marlborough PHO) LA Local Authority LCN Local Cancer Network LIS Laboratory Information Systems LOS Length of Stay LSCS Lower Segment Caesarean Section LTC Long Term Care LTIP Long Term Investment Plan LTCCP Long Term Council Community Plan


Glossary 5-5

LTO Licence to Occupy LTS-CHC Long Term Supports – Chronic Health Condition LTSFSG Long Term Service Framework Steering Group Manaakitanga Goodwill, show respect, or kindness to ((PM Ryan Maori Dictionary pg 172) Manawhenua Power, prestige, authority over land (HW Williams Maori Dictionary pg 172) Manawhenua O Te Tau Ihu O Te Waka A Maui – Referring to the eight iwi who hold tribal

authority over the top of the South Island (no reference) MA Medical Advisor MAC(H) Medicines Advisory Group (Hospital) MCT Mobile Community Team MDC Marlborough District Council

MDM Multidisciplinary Meetings

MDO Maori Development Organisation MDS Maori Development Service MDT Multi Disciplinary Team MECA Multi Employer Collective Agreement MEND Mind, Exercise, Nutrition, Do It MHAU Mental Health Admission Unit MHC Mental Health Commissioner MHD Maori Health Directorate MHDSF Maori Health and Disability Strategy Framework MHFS Maori Health Foundation Strategy MHINC Mental Health Information Network Collection MHSD Mental Health Service Directorate MHWSF Maori Health and Wellness Strategic Framework MMG Medicines Management Group MOE Ministry of Education MOH Ministry of Health MOH Medical Officer of Health MOA Memorandum of Agreement MOSS Medical Officer Special Scale MOU Memorandum of Understanding MOW Meals on Wheels MPDS Maori Provider Development Scheme MQ&S Maternity Quality & Safety Programme MRI Magnetic Resonance Imaging MRT Medical Radiation Technologist (or Technician) MSD Ministry of Social Development MSD Marlborough Services Directorate MSSD Medical Surgical Services Directorate NPA Nutrition and Physical Activity NRAHDD Nelson Region After Hours & Duty Doctor Limited NRL Nelson Radiology Ltd (Private Provider) NRT Nicotine Replacement Therapy MRSA Methicillin Resistant Staphylococcus Aureus NHBIT National Health Board IT NASC Needs Assessment Service Coordination NBPH Nelson Bays Primary Health NCC National Capital Committee NCC Nelson City Council NCSP National Cervical Screening Programme NETP Nursing Entry to Practice NGO Non Government Organisation NHCC National Health Coordination Centre NHI National Health Index NIR National Immunisation Register NM Nelson Marlborough NMDHB Nelson Marlborough District Health Board


Glossary 5-6

NMDS National Minimum Dataset NMH Nelson Marlborough Health NMIT Nelson Marlborough Institute of Technology NN Nelson NPA Nutrition and Physical Activity (Programme) NPV Net Present Value NRAHDD Nelson Regional After Hours and Duty Doctor Ltd NRSII National Radiology Service Improvement Initiative NSU National Screening Unit NTOS National Terms of Settlement NZHIS NZ Health Information Services NZMA New Zealand Medical Association NZNO NZ Nurses Organisation NZPH&D Act NZ Public Health and Disability Act 2000 OAG Office of the Auditor General OECD Organisation for Economic Co-operation and Development OIA Official Information Act OIS Outreach Immunisation Services OPD Outpatient Department OPF Operational Policy Framework OPJ Optimising the Patient Journey ORL Otorhinolaryngology (previously Ear, Nose and Throat) OSH Occupational Health and Safety OT Occupational Therapy PACS Picture Archiving Computer System PAS Patient Administration System P&F Planning and Funding PANT Physical Activity and Nutrition Team PBF(F) Population Based Funding (Formula) PC Personal Cares P&C Primary & Community PCBU Person Conducting Business Unit PCI Percutaneous Coronary Intervention PCO Primary Care Organisation PCT Pharmaceutical Cancer Treatments PDO Principal Dental Officer PDR Performance Development Review PDRP Professional Development and Recognition Programme PDSA Plan, Do, Study, Act PFG Performance Framework Group (formerly known as Services Framework

Group) PHS Public Health Service PHCS Primary Health Care Strategy PHI Public Health Intelligence PHO Primary Health Organisation PHOA PHO Alliance PHONZ PHO New Zealand PHS Public Health Service PHU Public Health Unit PIA Performance Improvement Actions PICS Patient Information Care System PIP Performance Improvement Plan PN Practice Nurse PPE Property, Plant & Equipment assets PPP PHO Performance Programme PSAAP PHO Service Agreement Amendment Protocol PSR Preschool Enrolled (Oral health) PT Patient


Glossary 5-7

PTAC Pharmacology and Therapeutics Committee PRIMHD Project for the Integration of Mental Health Data PVS Price Volume Schedule Q&SGC Quality & Safety Governance Committee QA Quality Assurance QHNZ Quality Health NZ QIC Quality Improvement Council QIPPS Quality Improvement Programme Planning System RA Radiology Assistant Rangatiratanga Autonomy, evidence of greatness (HW Williams Maori Dictionary pg 323) RDA Resident Doctors Association RDA Riding for Disabled RIF Rural Innovation Fund RIS Radiology Information System RFI Request for Information RFP Request for Proposal RICF Reducing Inequalities Contingency Funding RIS Radiology Information System RM Registered Midwife RMO Resident Medical Officer RN Registered Nurse ROI Registration of Interest RSE Recognised Seasonal Employer RSL Research and Sabbatical Leave SAC1 Severity Assessment Code SAC2 Severity Assessment Code SAN Storage Area Network SCBU Special Care Baby Unit SCN Southern Cancer Network SDB Special Dental Benefit Services SHSOP Specialist Health Services for Older People SI South Island SIA Services to Improve Access SIAPO South Island Alliance Programme Office SICF South Island Chairs Forum SICSP South Island Clinical Services Plan SI HSP South Island Health Services Plan SIRCC South Island Regional Capital Committee SISSAL South Island Shared Service Agency SLA Service Level Agreement SLATs Service Level Alliance Teams SLH SouthLink Health SM Service Manager SMO Senior Medical Officer SNA Special Needs Assessment SOI Statement of Intent SOPD Surgical Outpatients Department SOPH School of Population Health

SPaIT Strategy Planning and Integration Team SPAS Strategy Planning & Alliance Support SPE Statement of Performance Expectations SSBs Sugar Sweetened Beverages SSE Sentinel and Serious Events SSP Statement and Service Performance TCR Total Children Enrolled (Oral health) TDC Tasman District Council TLA Territorial Local Authority TOW Treaty of Waitangi


Glossary 5-8

TOR Terms of Reference ToSHA Top of the South Health Alliance

TPOT The Productive Operating Theatre

TRTT Te Roopu Tupu Tahi UG User Group USS Ultrasound Service U/S Ultrasound VLCA Very Low Cost Access VRA Vascular Risk Assessment WAM Wairau Accident & Medical Trust WAVE (Project) Working to Add Value through E-Information WEll Whanau Engagement, Innovation and Integration WIP Work in Progress WR Wairau YOTS Youth Offending Teams YTD Year to Date YTS Youth Transition Service As at 14 October 2016

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