COMMUNITY AND PUBLIC HEALTH & DISABILITY SUPPORT ADVISORY COMMITTEE MEETING
Tuesday, 30 October 2012 9.00am
Board Room, 3rd Floor, The Princess Margaret Hospital, Christchurch
AGENDA COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE MEETING To be held in the Board Room, 3rd Floor, the Princess Margaret Hospital, Christchurch Tuesday 30 October 2012 commencing at 9.00am ADMINISTRATION
9.00am
Apologies 1.
Interest Register Update Committee Interest Register and Declaration of Interest on items to be covered during the meeting.
2.
Confirmation of the Minutes of the Previous Meeting & Matters Arising 4 September 2012
3.
Carried Forward/Action List Items
REPORTS/PRESENTATIONS
4.
Better Sooner More Convenient Q1 (CPH&DSAC)
5.
Planning & Funding Exception Report (CPH&DSAC)
6.
Drinking Water Quality Issues– Oral Update (As requested previous meeting)
9.15am
Carolyn Gullery General Manager, Planning & Funding Carolyn Gullery Sandy McLean Portfolio Manager, Planning &Funding Evon Currie General Manager, Population Health
9.15am-9.30am
9.30am-10.00am
10.00am-10.15am
(CPH)
MORNING TEA
7.
10.15am-10.30am
Dr Nicola Austin
− Child & Youth Workstream Update – oral update − Introduction Gateway Assessments – oral update − Progress Report B4 Schools Checks – oral update − Early Start Programme – oral update
10.30am-11.30am
Linda Stokes Julie Potter /Jackie Cooper Michael James
(CPH&DSAC)
8.
9.
10.
Christchurch Education Reforms – Public Health Aspects – Oral Update ( as requested Board meeting 20 September 2012) (CPH) Sth Island Public Health Project – Oral Update –as previously requested by the Committee (CPH) Community & Public Health Exception Report (CPH)
ESTIMATED FINISH TIME
AGA - CPHDSAC Agenda- 30 Oct 12
Evon Currie
11.30am-11.50am
Evon Currie
11.50pm-12.05pm
Evon Currie
12.05pm-12.20am 12.20pm
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AGENDA INFORMATION ITEMS
− − − −
CPH & Ecan Joint Work Plan Final submission Parental Leave Bill – for information as requested by Committee Chair Briefing Akaroa Weather Event 13 October –- for information as requested by Committee Chair 2013 Meeting Dates – for information as adopted at the 17 October 2012 Board meeting
Date of Next Meeting: 26 February 2013 commencing at 9.00am
AGA - CPHDSAC Agenda- 30 Oct 12
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ATTENDANCE
COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE
Olive Webb (Chair) Peter Ballantyne Anna Crighton Elizabeth Cunningham Wendy Dallas-Katoa Jonathan Darby Andrew Dickerson Wendy Gilchrist Aaron Keown Chris Mene Bruce Matheson David Morrell Mary Richardson Susan Wallace
Executive Support
David Meates – Chief Executive Mary Gordon – Executive Director of Nursing Stella Ward – Executive Director Allied Health Carolyn Gullery - General Manager Planning and Funding Evon Currie – General Manager, Population and Public Health Hector Matthews – Executive Director of Maori & Pacific Health Murray Dickson - General Manager - Corporate Services Kay Jenkins - Executive Assistant - Governance Support Kevin Roche – Assistant Board Secretary
AGA - CPHDSAC Agenda Attendance List - October12
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COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE MEMBERS’ INTERESTS REGISTER COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE REGISTER OF MEMBERS’ CONFLICTS (As disclosed on appointment to the Board/Committee and updated from time-to-time, as necessary) OLIVE WEBB
Institute of Applied Human Services Limited (IAHS) – Chairperson Provides individual consultation, service advice and workforce training in the Intellectual Disability area, on contract to various individuals and providers in Australasia. New Zealand providers of Intellectual Disability services are usually funded by the Ministry of Health. IAHS has no contracts with Canterbury DHB. Special Olympics New Zealand – Trustee As well as providing sporting events, also provides health screening and assistance. IHC/IDEA Services Assist in introducing government funded annual health checks for people with intellectual disabilities promoting this with GP’s and other primary health care professionals and working to achieve funding for this. Hororata Community Trust - Trustee PETER BALLANTYNE
West Coast District Health Board, Appointed Member – Deputy Chair Bishop Julius Hall of Residence, Trust Board Member University of Canterbury, Council Member The University of Canterbury provides certain services to the Canterbury DHB Deloitte – Consultant Deloitte carries out certain consulting assignments for the Canterbury DHB from time to time. Spouse, Claire Ballantyne is a Canterbury DHB employee (Ophthalmology Department) ANNA CRIGHTON
New Zealand Historic Places Trust – Board Member Governance of New Zealand Heritage. Canterbury DHB owns buildings that may be considered by the Trust to have historical significance. Christchurch Heritage Trust – Trustee - governance of Christchurch Heritage. Historic Places Aotearoa Inc - President ELIZABETH CUNNINGHAM
Te Runanga o Ngai Tahu (TRONT) – Director Governance body for Ngai Tahu Canterbury District Police Advisory Group – Co Chair Item 1 - CPHDSAC - Interest Register - Oct 2012
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South Island Oncology Research Group – Chair Manawhenua ki Waitaha - Member Representative of Te Runanga o Koukourata. Manawhenua ki Waitaha is a collective of health representatives of the seven Ngai Tahu Papatipu Runanga that are in the Canterbury DHB area. There is a memorandum of Understanding between Manawhenua ki Waitaha and the Canterbury DHB. Maori Women’s Welfare League – President Rapaki Branch The Maori Women’s Welfare League has contracts through the Ministry of Health for the delivery of health services for Maori. Kawa Whakaruruhau Roopu Bachelor of Nursing/Midwifery Christchurch Polytechnic – Chair A committee of Christchurch Polytechnic, Department of health services, providing input and oversight in relation to course programmes. Registered RMA (Resource Management Act) Commissioner From time to time I am asked to sit on these panels given my involvement with the Regional Council and in particular understanding the Maori issues around Section 8 of the RMA Act. If conflicts arise they will be advised. University of Otago, Christchurch – Research Manager, Maori (0.6FTE) I am part of the Senior Management Team. The University has various relationships with the Canterbury DHB, including medical training, research, the provision of library services, and leasing of premises. WENDY DALLAS-KATOA
Toitū te Kāinga, Te Rūnanga o Ngāi Tahu –Health and Social Development Te Kahui o Papaki ka Tai – Member Maori Advisory Group to Pegasus Health/Partnership Health Manawhenua Ki Waitaha – Trust Member Manawhenua Ki Waitaha is a collective of health representatives of the seven Ngāi Tahu Papatipu Rūnanga that are in the Canterbury DHB area. There is a memorandum of understanding between Manawhenua and the Canterbury DHB. NSP Kaitiaki Advisory Group – MoH Appointed Member Whakaruruhau Komiti – National Breastfeeding Committee Member Partnership Health PHO “Te Kei o te Waka”– Board Member– iwi/manawhenua representative Partnership Health Canterbury is a Primary Health Organisation (PHO). The PHO has entered into an agreement with the Canterbury DHB under which the PHO agreed to provide a range of health care services and the management tasks associated with the delivery and funding of these services. The PHO has the power to subcontract the delivery of any or all such services and associated management tasks. National Health Promotion Forum – Chair, Maori Advisory Group Community Services Service Level Alliance Healthy Christchurch – Steering Committee Item 1 - CPHDSAC - Interest Register - Oct 2012
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Ngāi Tahu representative to this Committee
JONATHAN DARBY
Toastmasters International I am a member of two Toastmasters clubs and hold an executive role in one. No conflicts of interest are anticipated regarding my involvement. Parafed Canterbury This organisation provides sporting and other opportunities to people with disabilities. They also provide services to the same. No conflicts of interest are anticipated. Lotteries Individuals with Disabilities Distribution Committee - Member This is a Committee of the Lotteries Commission responsible for allocating grants for mobility and communication equipment to help people with disabilities achieve independence and gain access to the community. No conflicts of interest are anticipated but will be addressed as appropriate should they arise.
ANDREW DICKERSON
Health Care of the Elderly Education Trust - Chair Promotes and supports teaching and research in the area of care of older people. Recipients of financial assistance for research, education or training could include employees of the Canterbury DHB. Canterbury Medical Research Foundation – Member Provides financial assistance for medical research and research facilities in Christchurch. Recipients of financial assistance for research, education or training could include employees of the Canterbury DHB. NZ Historic Places Trust - Member The Trust promotes the identification, preservation and conservation of the historical & cultural heritage of New Zealand. Canterbury District Health Board owns buildings that may be considered by the Trust to have historical significance. No Conflicts of Interest are envisaged for the following interests, but should a conflict arise this will be discussed at the time. NZ Gerontology Association - Member Professional association that promotes the interests of older people and an understanding of ageing. Hope Foundation for Research on Ageing - Member Promotes research on New Zealand’s ageing population and its implications for the future. Osteoporosis (Canterbury) Inc. - Member Provides support, information and advice to people with osteoporosis. Neurological Foundation of New Zealand Inc. - Member
Item 1 - CPHDSAC - Interest Register - Oct 2012
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Provides support and information to people with diseases and disorders of the brain and nervous system. Abbeyfield New Zealand Inc. - Member Promotes and establishes community housing for lonely and socially isolated older people using the Abbeyfield model. Consultant I have a private consultancy specialising in management consultancy services (including communication management, communication strategy and marketing) to the not for profit sector, professional associations, social service and public sector agencies. WENDY GILCHRIST
Human Rights Review Tribunal – Appointed Member Tribunal is a statutory body dealing with cases brought under the Human Rights Act 1993, the Privacy Act 1993 and the Health and Disability Commissioner Act 1994. Animal Diagnostics Ltd – Accounts Manager Animal Diagnostics is a laboratory dealing in herd testing, part owned by my husband. The company may collaborate with CHL. Member CERA Community Forum This is a community forum formed under the Canterbury Earthquake Recovery Act to provide the Minister with information and advice on earthquake recovery matters. Child Help Line – Board Member My husband Dr Nigel Gilchrist is employed as a specialist consultant physician with the CDHB. No potential conflict of interest is expected and should this arise it will be declared at that time. Dr Nigel Gilchrist is also the founding Director of the Canterbury Geriatric Medical Research Trust (est 1986), a charitable trust that leases space from Canterbury DHB and also provides some charitable works for the Canterbury DHB at no cost to the Canterbury DHB.
AARON KEOWN
Christchurch City Council and Shirley Papanui Community Board – Member I am an elected member of the Christchurch City Council (CCC) and also a member of the Shirley Papanui Community Board and a member of a number of other Council committees. Canterbury Development Corporation – Director. No conflicts of interest are anticipated from these roles but will be discussed at the appropriate time should they arise. Canterbury Regional Transport Committee - Christchurch City Council Representative Grouse Entertainment – Director and Shareholder BRUCE MATHESON
Brannigans Ltd – Founding Shareholder/Director. Is a human resource consulting business – a potential conflict of interest may exit in the provision of any consulting services to the Canterbury DHB. Item 1 - CPHDSAC - Interest Register - Oct 2012
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Freshpork NZ Ltd- Director Engaged in farming, processing and marketing of pork meats in New Zealand – no conflict of interest is anticipated. Southern Engineering Solutions Ltd – Advisory Role Designs and manufactures machinery & equipment for the food processing industry in New Zealand and Australia The McLean Institute – Board of Governors. The Chair of the Canterbury DHB is an ex-officio member of the Board of Governors pursuant to an Act of Parliament. The McLean Institute operates Holly Lea, a rest home which provides residential aged care services under contract with the Canterbury DHB. Snap Internet Ltd - Employed as a Consultant. This company is an internet provider which provides services to the CDHB.
CHRIS MENE
Christchurch Polytechnic Institute of Technology (CPIT) - Advisory Board Member to Bachelor of Applied Science CPIT is a tertiary institution and I contribute as an industry advisor into the Bachelor of Applied Science (with Speciality) degree course. This course includes two specialities which are (1) Physical Activity Health and Wellness and (2) Sports Science. This is a voluntary position. Stopping Violence Services (Canterbury) - Board Member Stopping Violence Services is a social services provider which provides violence prevention services to perpetrators of violence. This is a voluntary position. Shirley-Papanui Community Board (Chairperson) The CCC is a Territorial Local Authority and the Shirley-Papanui Community Board is the statutory body elected to serve that metropolitan ward. I have been elected onto the Community Board and into the role of Community Board Chairperson for the three year period until October 2013. No conflicts of interest are anticipated from this role but will be discussed at the appropriate time should they arise. Canterbury Clinical Network – Project Manager, Child & Youth Workstream Contracted to Pegasus Health Christchurch City Council (CCC) Resource Management Panel Member The CCC is the decision making body for resource consent matters in Christchurch City. I serve occasionally as a panel member. Wayne Francis Charitable Trust - Board Member The Wayne Francis Charitable Trust is a philanthropic family organisation committed to making a positive, and lasting contribution to the community. The Youth focussed Trust funds cancer research which embodies some of the Trust’s fundamental objectives – prevention, long-term change, and actions that strive to benefit the lives of many. Partnership Health Canterbury – Project Manager Partnership Health Canterbury is a Primary Health Organisation and I am contracted to manage projects and facilitate events. No conflicts of interest are anticipated however where there is a perceived or real conflict of interest this will be addressed at the time.
Item 1 - CPHDSAC - Interest Register - Oct 2012
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DAVID MORRELL
British Honorary Consul Interest relates to my supporting British nationals and relatives who may be hospitalised arising from injury related accidents, or use other services of the Canterbury DHB, including Mental Health Services. In addition a conflict of interest may arise from time to time in respect to Coroners’ Inquest hearings involving British nationals. Nurses Memorial Chapel Trust –Chair (Canterbury DHB Appointee) Trust responsible for Memorial on the Christchurch Hospital site. Historic Places Trust – Subscribing Member The Trust’s mission is to promote the identification, protection, preservation and conservation of the historical and cultural heritage of New Zealand. The Trust identifies records and acts in respect of significant ancestral sites and buildings. The Trust has already been involved with Canterbury DHB buildings. My wife is a member of the Hospital Ladies Visitors Association – no potential conflict of interest is expected and should this arise it will be declared at that time. Honorary Canon- Christchurch Cathedral The Cathedral congregation runs a food programme in association with Canterbury DHB staff.
MARY RICHARDSON
Christchurch Methodist Mission - Executive Director SUSAN WALLACE
Member – West Coast DHB Appointed board member West Coast DHB Te Rūnanga o Ngāi Tahu - Affiliated Member of TRONT. Māori Women’s Welfare League (MWWL) Member of Maori Women’s Welfare League, is a recipient of Ministry of Health funding for HEHA programmes. Chairperson - Rata Te Awhina Trust Is a West Coast Maori provider affiliated with He Oranga Pounamu and recipient of Ministry of Health funding. Te Waipounamu MWWL -Area Representative to National Executive of MWWL.
Item 1 - CPHDSAC - Interest Register - Oct 2012
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MINUTES DRAFT MINUTES OF THE COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE held in the Board Room, 3rd Floor The Princess Margaret Hospital on Tuesday, 4 September 2012 commencing at 9.00am
PRESENT
Olive Webb (Chairperson); Peter Ballantyne; Elizabeth Cunningham; Anna Crighton; Wendy DallasKatoa; Jonathan Darby; Andrew Dickerson; Wendy Gilchrist; Bruce Matheson; Chris Mene; David Morrell and Mary Richardson. APOLOGIES
Apologies for absence were received and accepted from Susan Wallace and Aaron Keown. And for lateness from Wendy Gilchrist (arrived at 10.08am). EXECUTIVE SUPPORT
David Meates (Chief Executive); Carolyn Gullery (General Manager, Planning and Funding); Evon Currie (General Manager, Population Health); Katia De Lu (Accountability Coordinator, Planning and Funding); Kay Jenkins (Executive Assistant, Governance Support) and Kevin Roche (Assistant Board Secretary). IN ATTENDANCE Item 4
Dr Daniel Williams – (Community & Public Health) Item 5
Jane Cartwright – (CEO, Partnership Health) Janice Donaldson – (Project Facilitator) Item 6
Hector Matthews – (Executive Director, Māori & Pacific Health) 1. INTEREST REGISTER
Chris Mene noted changes had been previously advised under separate cover. Wendy Dallas-Katoa advised she would be providing some amendments to her existing declaration. There were no other declarations of conflicts of interest in respect to the agenda for the meeting or amendments to the interest register. 2.
MINUTES OF THE PREVIOUS MEETING AND MATTERS ARISING
Resolved (06/12) (Moved: Anna Crighton; Seconded: Elizabeth Cunningham - carried) “That the minutes of the meeting of the Community and Public Health and Disability Support Advisory Committee held on 3 July 2012 be confirmed as a true and correct record” MINS-CPHDSAC- Sep 2012
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It was noted that a presentation on Health Hubs would be made to the meeting of the QFARC that afternoon 3.
CARRIED FORWARD/ACTION LIST ITEMS
The Committee noted the carried forward list.. (Mary Richardson arrived at 9.08am) 4.
CORE FUNCTIONS PUBLIC HEALTH -PRESENTATION
(CPH & DSAC) Dr Daniel Williams, Community and Public Health (CPH) provided a presentation outlining the Core Functions of Public Health. Included with the agenda had been a copy of the 2011 report of the NZ Public Health Clinical network “Core Public Health Functions for NZ”. The objective of that report had been to assist the Ministry of Health and DHBs in optimising public health service delivery. The presentation provided information on: A health system that keeps people healthy – and the outcomes achieved from this. The history of public health in NZ - including the core functions project. The principles of public health. The core public health functions: − Health assessment and surveillance, understanding health status, health determinants, and disease distribution. − Public health capacity development ensuring services are effective and efficient. − Health promotion enabling people to increase control over and improve their health. − Health protection protecting communities against public health hazards. − Preventive interventions, population programmes delivered to individuals. The implications of this for the Ministry of Health, Community and Public Health, South Island Public Health Partnership, and Canterbury Health System. The Committee discussed the presentation with Dr Williams and issues raised related to: The possible impacts of the proposed Local Government Amendment Bill on the public health aspects of Local Authorities’ work and in particular the determinants of health, and the extent to which the new legislation might divert and minimise the work of TLAs in this area of public health. Dr Williams explained that while the viewpoint of Community and Public Health had not been formally submitted to the Select Committee their views had, however, been incorporated into the submission lodged by a PHO. The CEO commented that it seemed this legislation did not mesh very well with the overall policy objectives in relation to public health. The General Manager Population Health commented that she saw some real risks of moving away from the current close working relationships with TLAs e.g. Dr Anna Stevenson working for both the Christchurch City Council and Community and Public Health. The Committee noted the work being done collaboratively by Community and Public Health (CPH), outside of a legal framework with Local Authorities, on health issues via multi agency initiatives such as Healthy Christchurch. The potential risks that now existed from internal air travel – Dr Williams advised that air travel was included in the report and border control was part of the core functions of public health. The involvement of the Education sector in health – Dr Williams commented that he saw education as a key partner with public health nurses involved/visiting schools. Funding - Community and Public Health tried to make the most of the resources available. MINS-CPHDSAC- Sep 2012
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The article in the Listener which stated that of the 21,000 homes with over $100k of damage in Canterbury only 150 had been fixed to date. Dr Williams agreed that this was an issue for public health and also mental health. If the core functions of CPH were constrained by budget? It was advised that CPH were constantly challenging how they worked and were not stuck on historical practices. Evon advised that they were not in a position of not doing work due to a lack of funding and had sufficient funding to do priorities. . The Committee received the presentation.
5.
HEALTHY HOMES – PRESENTATION
Evon Currie, General Manager Population Health and Jane Cartwright, CEO Partnership Health and Janice Donaldson, Project Facilitator provided a presentation outlining the Healthy Homes initiative. Evon Currie provided an introduction to the presentation and she noted that warm housing had been an issue since before the earthquakes. She said the position statement adopted by the Canterbury DHB in 2012 on air quality and home heating had clarified the CDHB position and that it was an area were the Canterbury DHB could make a difference. They worked with primary care, Ministry of Social Development, CERA and other organisations. The topic of housing was an ongoing one for CERA and she also tabled for information a copy of the key Canterbury indicators as at August 2012, produced by the Department of Building & Housing, showing the upwards movement in rents and house prices in the Canterbury region. This showed that house rentals in the last three months had risen by significant increases. Jane Cartwright and Janice Donaldson then spoke to a PowerPoint presentation which provided information on: The Health Focussed Housing Strategy – CDHB position statement of June 2012 , Healthy Christchurch Framework, the agreed high level strategic direction for Canterbury. Canterbury Health System Opportunities for action: − Advocacy The health sector is in a strong position to advocate on housing and housing quality − Report on the impact of housing related issues on health - health can capture information and support research on the effects of poor housing on people’s health and wellbeing, enabling better targeting and advocacy. − Identify people with health and housing risks, and link with appropriate support - health has opportunities to engage with people and identify those most at risk of housing-related health issues. − Funding and/or partnering specific actions - Housing-related investment e.g. Healthy Housing and Warm Families projects. − Openness to referrals for help − Selected current activities – Sustainable homes working party (CERA-led): aims to positively impact rebuild. − Warmer Canterbury working group (Health-led): joined up activity over winter. − Well evidenced input into Draft City Plan, 100-day plan etc: impact at design stage. − Winter Warmth brochures & packs. − Support for Home Energy Checks (CEA); CPH/CEA calendar. − Healthy Homes & Warm Families projects. The Healthy Homes Project - Phase 1 and Phase 2 - 5 partners in this project. Proactive warm families. Making a difference. MINS-CPHDSAC- Sep 2012
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Jane Cartwright then spoke on the Healthy Homes Project. Partnership Health PHO was not the only organisation in this project, there were five partners in total which provided funding. She noted that the non EQC policy statement regarding the installation of insulation at the time of earthquake repairs might be reviewed. She also tabled a draft copy of the Home Heating Guidelines. The Committee noted: The advice of Evon Currie regarding the significant number of people who die each year from housing related issues. The extent to which progress was being made in improving insulation in homes. There was still a need to look at how information was being received. The minimum standards required for rental housing - and how the standards of rental housing might be influenced. The draft pamphlet that had been produced on home heating – this was considered to be an excellent document. The Committee received the presentation noting the need for the CDHB to be seen as “visibly aggressive” on these issues relating to healthy homes.. 6.
MAORI & PACIFIC HEALTH REPORT
The Executive Director, Māori & Pacific Health, Hector Matthews spoke to the report. He commented that Māori & Pacific Health was not a discrete activity e.g. housing pressures also impacted on the Māori and Pacific communities. While there were some discrete services when engaging with the community, most contact occurred in services such as GP and public health nurses etc. The position and role of Manawhenua ki Waitaha in the health sector was then explained together with information on the Māori & Pacific providers in the Canterbury DHB area. As previously requested Mr Matthews spoke to the update on the Rangatahi Work Programme contained in the report. The Committee then took the opportunity to discuss the report and issues raised related to: The possible closure of schools by the Ministry of Education in Christchurch which had a significant number of Maori & Pacific students. A presentation to the Committee from the Pacific Reference Group is also to be arranged. Additional information on the progress against the Māori Health Action plan for the 2011/12 year was also provided by the General Manager, Planning & Funding, Carolyn Gullery. She drew attention to the percentage of the total population enrolled with a PHO and the gap in respect to Māori enrolment and commented she expected there would always be a gap, the issue was how Maori identified themselves when they enrolled as opposed to what they had stated in the census. Cervical cancer - work is under way to bring this into line with the service provided for breast screening. The Committee noted the report. 7.
PLANNING & FUNDING EXCEPTION REPORT
(CPHDSAC & DSAC) The General Manager, Planning and Funding, Carolyn Gullery spoke to the report and invited Committee Members to ask questions. MINS-CPHDSAC- Sep 2012
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Matters then discussed by the Committee related to: The improvements underway to make the alcohol and other drug (AOD) service more flexible and responsive. It was agreed that the Planning and Funding Portfolio Manager would make a presentation to a future meeting of the Committee on this initiative. Delays to acute surgery – the CEO advised that capacity for acute surgery had been extended – one of the issues over the next five years, however, would be capacity constraints. Acute readmission rates for mental health and if the increase over the last 3-4 months represented a trend. The General Manager Planning and Funding advised there had been a slight increase in the length of stay (LOS) but it was not possible to tell at this stage if this was a trend. Information on this would be brought back to the next meeting. Under 18 years of age flu vaccinations were down in comparison with the previous year – was there a reason for this? Ms Gullery advised that research was being undertaken to try and establish the reasons for this. Services for youth, children and babies - the Canterbury DHB is establishing a child youth workstream as part of the Canterbury Clinical Network and more activity would be seen over the next year. It was suggested a presentation on this come back to the Committee. Maternity Journey – information on Māori engagement was provided in the report. The Committee noted the update 8.
BETTER SOONER MORE CONVENIENT Q4
(CPH&DSAC) The General Manager, Planning and Funding Carolyn Gullery spoke to the report which provided a quarterly update on progress with the implementation of the Better, Sooner, More Convenient (BSMC) Business Case for the fourth quarter to 30 June 2012. The report provided a summary of key achievements, followed by progress against the BSMC year two deliverables. Ms Gullery advised that the Canterbury DHB was making significant gains in a number of areas. In respect to ARC (aged residential care) admission rates for both over 65 year olds and acute admission rates for over 65 year olds, the rates were both declining which released funding for investment in other areas. There had been a 50% reduction in admissions post CREST against the 10% expected. In response to a question about the achievement against the targets for Leadership and Support it was noted that while the Leadership and Support service level alliance (SLA) had not been able to agree on plans for restructure the amalgamation of Partnership Health PHO and Pegasus Health was proceeding. The Committee noted the report.
9.
HEALTH TARGETS Q4
(C&PH) Carolyn Gullery, General Manager Planning and Funding spoke to this report which provided information on the Canterbury DHB’s progress against the National Health Targets for Quarter 4 (April – June 2012.) The Committee discussed the report and in particular: MINS-CPHDSAC- Sep 2012
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The national DHB comparison tables in relation to Heart & Diabetes Checks and the performance of the Canterbury DHB at the bottom of this table with only a 20 % rating. It was advised that it was unlikely the Canterbury DHB would achieve this as it was a cumulative target over five years and the CDHB had started late. Practices were instead concentrating on those at risk. Shorter stays in ED – and the COPD taskforce. It was noted that over recent months St Johns had been involved in the diversion of some patients away from ED to GPs. This was, however, about to stop. The Board Chair also mentioned the need for the Canterbury DHB to make more public the work it had done in avoiding gridlock over this period.
The Committee noted the report. 10.
COMMUNITY & PUBLIC HEALTH (CPH) EXCEPTION REPORTS
(CPH) Evon Currie, General Manager Population Health spoke to this report which provided exception reporting against the Canterbury DHBs key priorities, annual plan and core directions. The report was taken as read. In addition the Medical Officers of Health, Dr Ramon Pink and Dr Alistair Humphrey attended to allow for discussion by the Committee on the issue of drinking water quality, and the recent contamination of drinking water and disease outbreaks in two local authority areas within the Canterbury DHB district. The Committee discussed at some length the issue of representation on the Environment Canterbury Water Management Committees by both CPH staff and Board members at governance level and noted that CPH did, however, still provide technical advice to the Zone Committees. In respect to the recent contamination of water supplies in the Darfield area Dr Humphrey explained that normally a multi barrier approach was taken by TLAs to avoid contamination which included protection of the source supply , reticulation system and water treatment if required. In this instance there had been a lack of communication to users in a timely manner and failure to chlorinate the supply. It was noted that there would soon be a governance meeting with ECan at which this issue could be discussed. A work plan was also about to signed with ECAN. The Committee resolved Resolved (06/12) (Moved: Anna Crighton; Seconded: Elizabeth Cunningham - carried) Resolution: i. That the Committee express to the Board its concern at the low quality standard of drinking water within some areas of Canterbury, and asks Community & Public Health to report back to it with a proposal how this might be improved with specific emphasis on governance issues.
INFORMATION ITEMS
-
CCC Community Board Area Profiles
MINS-CPHDSAC- Sep 2012
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-
South Island Alcohol Position Statement (As adopted Board meeting 19 July 2012)
There being no further business the meeting concluded at 12.06 pm .
Confirmed as a true and correct record: ___________________ Olive Webb Chair
MINS-CPHDSAC- Sep 2012
____________________ Date
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CARRIED FORWARD/ACTION ITEMS COMMUNITY AND PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY COMMITTEE CARRIED FORWARD/ACTION ITEMS AS AT 30 OCTOBER 2012 DATE
ACTION
COMMENTARY
STATUS
2009
1.
18 June 2009
Survey of People with Disabilities - experience with Canterbury DHB services
Update provided to 28 February 2012 meeting – opportunities exist for web based survey once new CDHB web site fully developed. /established – to be kept under review. New CDHB working group has also now been established to develop a patient experience survey – possibility might be incorporated.
Under review.
2.
20 August 2009
NZ Disability Strategy – Formulation of a CDHB Disability Action Plan
CDHB Disability Action Plan to be prepared based on 2001 MoH Disability Services Strategic Plan – Chief Medical Officer sponsor.
Draft plan prepared and presented to EMT – No further update available
3.
17 May Board
Presentation on Early Childhood Programmes
Incorporated with Child & Youth Workstream presentation
On agenda for today’s meeting
4.
3 July 12
Disability Support - Update
Paper to 3 July 2012 CPH&DSAC - update to come back to the Committee in 6 months time following referral to EMT
Scheduled for February 2013 meeting
5.
3 July 12
Pacific Health Presentation - including Pacific Reference Group
Pacific Reference Group to report to the Committee
For CPAC February 2013 meeting
2012
Item 3 - CPHDSAC October 12 -Carried Forward Action Items
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BSMC PROGRESS UPDATE – Q1 2012/13 TO:
Chair and Members Community and Public Health & Disability Support Advisory Committee
SOURCE:
Planning & Funding
DATE:
30 October 2012
Report Status – For:
1.
Decision
Noting
Information
ORIGIN OF THE REPORT
This report is submitted to the Ministry on a quarterly basis as an update on progress with the implementation of the Better, Sooner, More Convenient (BSMC) Business Case. 2.
RECOMMENDATION
That the Community and Public Health & Disability Support Advisory Committee notes the content of the first quarter BSMC progress report. 3.
SUMMARY
This report includes a bulleted summary of key achievements, followed by progress against the BSMC Year Three Deliverables. 4.
APPENDICES
Appendix 1:
BSMC Progress Report – Q1 2012/13
Report prepared by:
Katia De Lu, Accountability Coordinator, Planning & Funding
Report approved for release by:
Carolyn Gullery, General Manager, Planning & Funding
CPHDSAC-Oct 12-BSMC Q1
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Better, Sooner, More Convenient Canterbury’s Progress Report – Quarter 1 2012/13 (July to September 2012)
Contents What does ‘Better, Sooner, More Convenient’ mean for the Canterbury community? ............................................................ 3 Services Closer to Home ........................................................................................................................................................ 3 Delivering on Ministry expectations .......................................................................................................................................... 4 Year Three deliverables ......................................................................................................................................................... 4 Flexible Funding Pool ............................................................................................................... Error! Bookmark not defined. Free afterhours care for children under six ........................................................................................................................... 4 Alliancing & clinical leadership .............................................................................................................................................. 4 Community pharmacy ............................................................................................................................................................ 4 Nursing services ..................................................................................................................................................................... 5 Health needs analysis ............................................................................................................................................................ 5 Improved outcomes ............................................................................................................................................................... 5 Infrastructure ......................................................................................................................................................................... 6 Year Three Deliverables ............................................................................................................................................................. 7 1
Urgent care ................................................................................................................................................................. 7
2
Aged care .................................................................................................................................................................... 8
3
Children and youth health ........................................................................................................................................ 13
4
Primary and secondary integration ........................................................................................................................... 15
5
Urban integrated family health and social service networks .................................................................................... 15
6
Rural health workstream .......................................................................................................................................... 16
7
Long‐term conditions ................................................................................................................................................ 17 Respiratory disease ................................................................................................................................................... 17 Diabetes .................................................................................................................................................................... 19 Cardiovascular disease .............................................................................................................................................. 21
8
Māori health ............................................................................................................................................................. 22
9
Pacific health ............................................................................................................................................................. 23
10
Communication......................................................................................................................................................... 23
11
Information technology ............................................................................................................................................ 24
12
Alliancing ................................................................................................................................................................... 25
13
Diagnostic services .................................................................................................................................................... 25
14
Community pharmacy ............................................................................................................................................... 26
15
Laboratory ................................................................................................................................................................ 26
16
Flexible funding pool ................................................................................................................................................. 27
17
Immunisation ............................................................................................................................................................ 27
Better, Sooner, More Convenient Progress Report
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What does ‘Better, Sooner, More Convenient’ mean for the Canterbury community? The Canterbury Health System is continuing to work to:
Develop and realign services to support people/whānau to take increased responsibility for their own health;
Develop primary health care and community services to support people/whānau in a community‐based setting and provide a single point of ongoing continuity (usually general practice); and
Release secondary care based specialist resources to be responsive to episodic events and the provision of support to primary care.
Services Closer to Home During the first quarter of 2012/13 (July to September 2012):
Four Integrated Family Health Centres provided services to their local communities in Amuri, Methven, Rakaia and Kaiapoi. More IFHCs (urban and rural) are under development – see page 15.
473 people have been referred to the Community‐Based Falls Prevention Service.
The CREST service supported 490 people: 442 on discharge from hospital and 48 referrals directly from general practice, supporting these people with home‐based rehabilitation services.
Canterbury’s new Medication Management Service delivered 358 first reviews and 273 follow‐ups, helping people to better manage their medications.
Cantabrians received 403 spirometry tests and 217 sleep assessments in the community, without the need for a hospital visit.
Cantabrians received 769 services like steroid injections and aspirations through general practice (495) or the Community Musculoskeletal Service (274), without having to wait for a hospital orthopaedic appointment.
Cantabrians received 532 subsidised skin lesion excisions, 49 subsidised mirena insertions and 85 subsidised pipelle biopsies from GPs in the community, without the need for a hospital visit.
162 patients received diabetes self management support from their GP team under one of Canterbury’s two diabetes subsidies: 84 when first diagnosed and 78 to learn how to use insulin.
12,865 calls to general practices were answered by the nurse‐led afterhours phone triage service available throughout Canterbury, providing callers with afterhours health advice and guidance.
Canterbury’s Acute Demand Management Services accepted 7,190 referrals – ensuring these people received the urgent care they needed in the community without having to go to ED.
94% of people attending a Canterbury ED were admitted or discharged within 6 hours, just slightly short of the Health Target in spite of a difficult flu season.
13 Appetite for Life healthy lifestyle courses have been delivered to help people make small changes that make a big difference to their health and wellbeing.
91% of eight‐month‐olds were fully immunised, protecting them from a range of preventable illnesses and achieving the new Health Target of 85%. The target was also achieved for Māori (88%) and Pacific (94%) eight‐ month‐olds.
Canterbury health professionals made 22,050 referrals through the Electronic Referral Management System, ensuring prompt care for their patients through accurate and complete referrals to the most appropriate provider.
10,085 referrals have been submitted to Community Referred Radiology, ensuring prompt diagnoses for patients in the community, without the need for a specialist referral. 90% of these referrals were accepted, showing the high quality of referrals and GP referring practices.
Health professionals had access to 610 pathways, referral pages and other resources on the Health Pathways website, assisting them to provide consistent and integrated care to their patients.
Better, Sooner, More Convenient Progress Report
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Delivering on Ministry expectations Year Three deliverables Ministry requirement: Quarterly reports outlining progress against the key deliverables in the jointly agreed Year Three Implementation Plans, including resolution plans for any areas of slippage against deliverables. Progress against each of the key deliverables in the Year Three Implementation Plan is outlined from page 7.
Free afterhours care for children under six Ministry requirement: In quarter one, confirm 60% coverage level for free afterhours for children under the age of six as of July 2012. Report progress against increasing this service coverage level to 75% by June 2013. Identification of and progress against the activities to ensure free afterhours services to children under six years of age. 85% of Canterbury children under six now have access to free afterhours care. Sections 1.1 and 3.3 provide further detail.
Alliancing & clinical leadership Ministry requirement: Description of how all necessary clinicians and managers (primary/community and secondary) will be involved ongoing in the process of development, delivery and review. The Canterbury Clinical Network (CCN) is an alliance of the region's health leaders. Established with the explicit inclusion of the DHB as a key partner, the group also includes urban and rural GPs, nurses, hospital specialists, pharmacists, wider primary care providers, allied health professionals, NGOs, Māori and Pacific health providers, and relevant community groups, along with Manawhenua ki Waitaha, PHO and IPA representatives. The group is transforming health care to significantly improve the delivery of patient care in the community, with a ‘whole of system’ approach to performance. The Alliance Leadership Team (ALT) oversees the Network’s strategic direction and directs the prioritisation of work within the programme. Its membership is predominantly clinical, with eight out of twelve members identifying as clinicians. The following workstreams (led by clinicians, with predominantly clinical membership) are in place:
Aged Care
Mental Health
Child and Youth
Rural
Pacific Health
Other groups fulfil the functions of workstreams in the areas of:
Māori Health
Active Service Level Alliances (SLAs) are in place for:
Acute Demand Management Services
Immunisation
Aged Residential Care
Kaikoura Health
Community Services (community nursing and home services) and subgroups
Laboratory
Pharmacy
Flexible Funding Pool
Radiology
Projects are underway focussing on structural supports for the changes being put in place by the workstreams and SLAs; these include Integrated Family Health Services and the Collaborative Care Programme. Over the past 12 months, more than 360 people have engaged in planning through the CCN to improve the way that the Canterbury health system works. This includes more than 160 doctors, 80 nurses and 60 pharmacists, along with allied health professionals, consumers, clinical managers and managers. The engagement of organisations with the CCN approach is defined within the CCN District Alliance Agreement. Individuals working within the ALT and SLAs signify their alignment with the objectives and values of the Network through signing the CCN Charter. Refer to section 12 for progress on broadening the range of partners within the Alliance Framework.
Community pharmacy Ministry requirement: Activities to integrate community pharmacy. 6 community pharmacies have joined the district level alliance and are acting as demonstration sites for new dispensing arrangements that support providing expert advice to prescribers and patients. Refer to section 14 for more information. Better, Sooner, More Convenient Progress Report
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Nursing services Ministry requirement: Activities to expand and integrate nursing services. Current activity is focused on the development of coordination roles that will sit within IFHCs and general practice outside of these centres. These roles will include the identification of people who require more assistance to remain healthy in the community, agreeing care plans, putting these in place and ensuring that plans are carried out.
Health needs analysis Ministry requirement: Evidence of health needs analysis of population by localities. A range of initiatives are at various stages of development that work to match health need to the services provided to the people of Canterbury. Pacific and Māori Primary Healthcare reports have been developed, which assess outcome and process measures relating to these populations. The Integrated Family Health Service (IFHS) project includes several components that assess the health needs of the enrolled populations in order to inform service planning. This includes:
Analysis of enrolled populations and their use of healthcare services is carried out to inform the urban IFHCs and local populations for other developments (such as the Kaikoura IFHC, Rangiora Hub and Ashburton IFHC). Analysis includes consideration of population dynamics in future years.
The various developments also focus on the perceived highest area of need for development of new models of care.
Risk stratification of the population to assess likelihood of hospital admission or readmission and will develop responses to support people to stay healthy in the community.
The health of older people has been prioritised for specific attention in Canterbury, based on the level of need driven by demographics and health system behaviour.
Improved outcomes Ministry requirement: Identification of targeted areas/patient groups for improved outcomes as a result of enhanced primary and community service delivery (with a focus on managing long‐term conditions) including: a.
Identification of and achievement against targets for the number of people that are expected to be appropriately managed in primary/community setting instead of secondary care
b.
Identification of and achievement against targets for growth reduction in ED attendance, acute inpatient admissions and bed days
c.
Identification of and achievement against a target for the prevention of readmissions for the 75+ population (and any other target populations)
d.
Identification of, and achievement against, new service activity in quantified patient terms
Updates on service improvements for the management of long‐term conditions – particularly cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD) and stroke – can be found in section 7. a & d.
Achievements regarding people being appropriately managed in community (rather than hospital) settings and new service activity in quantified in patient terms are outlined throughout this report, with key achievements highlighted on page 3.
b.
Section 1 outlines the urgent care workstream’s progress in ensuring that only people who need hospital services present at ED and that others receive timely and appropriate urgent care in the community.
c.
Section 2 outlines the aged care workstream’s progress in supporting older people to live well in their own homes and communities, with services such as CREST (2.1) and the Community Falls Prevention Service (2.5) working to prevent hospital admission and readmission amongst the 75+ population. In addition, section 7.5 highlights the work underway to better support patients with COPD in the community and hence reduce admission and readmission rates for this target population.
Better, Sooner, More Convenient Progress Report
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Infrastructure Ministry requirement: Identification of and activities (with timeline) to ensure infrastructure and revenue streams appropriate to support the identified change in activities and service delivery model. Progress against the above infrastructure and revenue stream milestones. Supporting infrastructure includes HealthPathways (see section 4), Integrated Family Health Centres both urban (section 5) and rural (section 6) and a wide range of information technology solutions (section 11). The Flexible Funding Pool (section 16 and page Error! Bookmark not defined.) supports service delivery. Work is underway to design two community hubs; one in central Christchurch and one in Rangiora. These facilities will provide services that are specialist in nature but do not require access to the full range of functions provided within a hospital. Clinicians are heavily involved in this planning work to ensure that services provided in these centres are able to be safely provided outside of a hospital and that the critical mass of the hospital system is not damaged. The aim is to ensure that people are able to access a greater range of services closer to home and in a more timely way than has been available in the past. The types of services that are being considered include: urgent care (24 hour) services, ambulance, primary birthing, diagnostics, coordination of services and community services. Further detail will be provided following further engagement with clinical leadership.
Status indicators Result
Meaning
9
We have completed the target.
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Positive progress is underway towards delivering the output as planned or before the planned date.
Better, Sooner, More Convenient Progress Report
8 C
We have not completed the target. Positive progress is underway towards delivering the planned output although it will be late.
6
Year Three Deliverables 1
Urgent care Action
Target
By
Status
1.1 Review afterhours utilisation by children under six and agree protocols for free afterhours access in line with national timeframes.
60% of the population under six have access to free afterhours care
Q1
9
Support GP practices to provide a free afterhours nurse phone advice and triage service.
75% of the population under six have access to free afterhours care
Q4
9
1.2 Continue to develop and refine acute demand services to target patients with the greatest capacity to benefit and support those with a high level of need to access appropriate urgent care in the community rather than in hospitals
1.3 Engage St John Ambulance crews to use the Ambulance Referral Pathway and acute demand services to safely manage appropriate patients in the community.
1.4 Enable proactive management of vulnerable patients in the community, including community observation and increased access to urgent diagnostics. Continue to promote calling general practice as first point of contact (phone) 24/7.
1
Data will be provided annually in the Quarter 4 report.
>18,000 urgent care packages provided in the community.
>250 patients utilise the ambulance referral pathway.
The proportion of the population presenting to ED will remain below 18%.
Q4
Q4
Q41
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Current Achievement/Progress 85% of Canterbury’s population under the age of six has access to free afterhours care on the basis of an interim arrangement that has been put in place with afterhours providers. A long‐term solution is being developed. Growth in Acute Demand Management Services (ADMS) referral volumes have continued, with 7,190 referrals during Quarter 1. Average daily referrals in September were 84 per day (the same period last year was 56 per day). This rate of referrals is ahead of the rate required to achieve the annual target and ensures patients receive community‐based urgent care where clinically appropriate. The Chronic Obstructive Pulmonary Disease (COPD) workstream is now demonstrating results, with a significant percentage of patients with COPD being diverted through the agreed COPD Ambulance pathway to primary care settings. The information from St. John shows that in the 3 months from July to September, 214 patients were diverted to primary care environments to be managed rather than to ED. In July this represented 19%, August 42% and in September 40% of the overall number of patients presenting with this condition. Despite the significant challenges of influenza over the last quarter, very early indications are starting to show that there is a decrease in hospital attendances and admissions with a respiratory coded problem over the last 4‐6 weeks. We are continuing to monitor this on a week‐by‐week basis. Acute Demand liaison teams within the hospital and ED continue to
2
Reduction in the growth rate of acute medical admissions.
Q41
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Target
By
Status
>1,100 people (65+) supported by CREST on discharge or direct GP referral.
Q4
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200 people (65+) supported by CREST upon direct GP referral.
Q4
C
20% reduction in acute hospital admissions for people supported by CREST services.
Q41
10% reduction in acute readmissions for people supported by CREST.
1 Q4
have a strong presence to enable patients to be ‘pulled’ from the hospital into primary care and community with the support of the Acute Demand nursing and medical teams. This is currently resulting in 50‐70 patients being pulled from the hospital on a monthly basis. The management of frequent ED attendees is currently progressing, and care plans are being produced for this cohort of patients at a rate of around 10 care plans per week. We now have in place over 330 comprehensive, multidisciplinary care plans for these patients. An increase in over 200 in the last quarter.
Aged care Action
2.1 Improve early intervention to support people with deteriorating health. CREST (Community Rehabilitation and Enablement Support Team) will be rolled out to maximum capacity by December 2012.
Current Achievement/Progress
CREST now is actively receiving referrals from Christchurch, Burwood and Princess Margaret Hospitals and some general practices. Over the past four months, CREST has rolled out to ED at Christchurch Hospital and working with Orthopaedic clients. Since 5 April 2011, 1,665 clients have used the CREST service, with 490 of these clients being for the period of 1 July to 30 September. 48 of these clients were from direct GP referral. The Cognitive Impairment Pathway has been implemented.
2.2 Implement the HealthPathways Cognitive Impairment Pathway to improve the community care of people with early dementia and memory loss.
2.3 Provide ‘Walking in Others’ Shoes’ dementia education training for community service providers.
Better, Sooner, More Convenient Progress Report
Pathway implemented.
Q1
9
Tailored dementia training programmes running.
Q1
C
Regular monitoring of referrals and service provision.
Q2
A concern is the apparent low rate of referral to Alzheimers Canterbury by primary care. Strategies to increase awareness and other measures are being taken to increase referral rates from general practice. Data is being sought on prescribing of anti‐ cholinergic drugs.
Home Based Support Services (HBSS) ‘Walking in Others’ Shoes’ training is due to commence in November 2012.
8
Since MMS started, more pharmacists have completed MUR training (104 to 184) and accreditation for MUR (45 to 90). While the number of MMS referrals is tracking slightly above target for this quarter, not all of these referrals will result in a medicine review (see below). 561 referrals were received in Q1, averaging 43 per week (slightly lower than the weekly average during the previous year).
2,000 MMS services completed.
C
Q4
2.4 Reduce harm from adverse medication reactions and optimize medicines use. Fully implement the Medication Management Service (MMS).
The implementation of the new Pharmacy Services contract saw a drop‐off of referrals from community pharmacists as they focus on signing up long‐term condition patients. It is expected that this effect will pass. Automatic referral of CREST patients to MMS continues, although not all of these meet MMS service criteria. So far this year, 101 people (18%) have been discharged from the service prior to the first consultation for a variety of reasons. Work is being done to generate more referrals that will meet criteria and to reduce patient refusals. 358 initial outcome reports have been received (102 arey et to be received). There is currently a 40/60 split between the mobile pharmacists and community pharmacy. For patients over 65, 284 initial outcome reports have been received, i.e. 79% of consultations.
2.5 Reduce harm from falls amongst people aged over 65. Implement the Community Falls Prevention Service with Falls Champions. Integrate falls prevention strategies across the sector. Train primary care teams.
Better, Sooner, More Convenient Progress Report
MMS service reports on outcomes.
Q4
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>800 people (65+) access community‐based falls prevention services.
Q4
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10% reduction in the proportion of the population (75+) presenting at ED as a result of a fall.
Q4
273 follow‐up reports have been received. Mobile pharmacists transfer a number of patients to community pharmacy after their initial consultation for follow‐up. For patients over 65, 250 follow‐ up reports have been received, i.e. 92%. MMS is reducing the need for Medication Oversight (MO) visits. The number of MO visits saved will be significant and will be reported in a subsequent quarter. By 30 September a total of, 1,163 people have been referred to the Community‐based Falls Prevention Service since it began on 1 February 2012. This is significant, as the target was set at 800 referrals for 12 months. This includes 473 referrals during the first quarter of 2012/13. Over half of the referrals are from primary care
9
10% reduction in the proportion of the population (75+) admitted to hospital as a result of a fall.
2.6 Promote “zero harm from falls” in inpatient settings including Aged Residential Care (ARC).
75% of ARC residents are receiving Vitamin D supplements.
and the community sector. Trend data are being collected. Data on the proportions of the 75+ population presenting at ED or admitted as a result of a fall will be provided in the Quarter 4.
Q4
Â
Q4
A falls prevention DVD is being distributed to all ARC facilities by the ACC Community Injuries Prevention Officer. The DVD interview between Carl Hanger and Professor John Campbell includes strategies for falls prevention quality improvement in ARC. Vitamin D in ARC data is currently unavailable from MoH, but we expect this to be available for the next report. Service implementation commenced on schedule on 1 July 2012. All new service users will commence on the revised model, and existing service users will be transitioned at review.
2.7 The phased rollout in Christchurch of the restorative home support model was put on hold in 2011/12 due to post‐earthquake changes in priority. This is to be continued in 2012/13.
Rollout to be 75% complete by June 2013.
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Q4
The service has been developed and is operating within an alliance framework through the Community Services SLA (CSSLA) formed in late 2011. The SLA and its two subgroups, the Quality Improvement and Operations Management groups, have designed a quality framework including reporting, communications and service specifications for the integrated community services model. An alliance agreement between the DHB and the three providers has been in place since 1 July, with providers formally joining the CCN District Alliance Agreement and a specific Community Services Service Level Agreement. As part of this approach, ongoing development of the service is expected through the CSSLA.
2.8 Ensure the progressive rollout of access to InterRAI to Canterbury clinicians.
InterRAI training provided to Home Based Support Service providers.
Q1
9
2.9 Ensure access to InterRAI reports is available to key stakeholders within the health system. For example primary care, community care providers and aged residential care. Provide evidence that nominated groups have read‐only access and information/training has occurred on interpretation of reports as required.
Two ARC InterRAI information sessions organised in 2012/13.
Q4
Better, Sooner, More Convenient Progress Report
The training has been completed for the majority of the Home Based Support Services staff, and the three providers are using the Contact Assessment with service users with non‐complex needs. Further training for new Community Services staff will be provided on an ‘as needed’ basis. Currently 15 Canterbury ARC facilities are using InterRAI. CDHB OPH community teams are using InterRAI.
More Canterbury ARC facilities use InterRAI – base 11 facilities.
9
Q4
At present, GPs can request ‘’read only’ access via CDHB’s InterRAI.
10
2.10 Optimise the availability of equipment to CREST patients through the revision of the CREST equipment pathway; the implementation of an appropriate system for equipment sourcing, retrieval and storage.
2.11 Advance Care Planning improved and recorded in the same way consistently across Canterbury.
Equipment sourcing, storage and retrieval processes in place.
Q3
CREST equipment pathway revised to reflect improved processes.
Q3
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Regular meetings between CREST OTs and Planning and Funding established to make ongoing quality improvements.
Q3
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Agree on strategy and training requirements.
Q2
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 The CREST equipment pathway has been updated, and regular meetings are being held between Planning and Funding and the CREST team to ensure the system works and to discuss future CREST service rollouts and the equipment needed to make this happen.
The South Island Health of Older People SLA is planning a one‐day regional service development Advanced Care Planning workshop in Christchurch on 30 October 2012.
Better, Sooner, More Convenient Progress Report
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KEY MEASURES: Age‐adjusted rates of acute hospital admissions and residential care admissions for elderly Acute Admission Rate Per 1,000
2008/09
2009/10
2010/11
2011/12
63.7 63.6
62.2
60
2009/10
2010/11
Qtr‐4
Qtr‐3
Qtr‐2
Qtr‐1
Qtr‐4
Qtr‐3
Qtr‐2
55
2008/09
Data relating to Q4 2011/12 aged residential care (ARC) are not yet stable, as not all claims for the period had been paid at the time this report was compiled. The current value is included; however, it will change as claims are processed. The graph above shows that ARC admissions have been reducing since 2010/11.
63.3
62.2
Qtr‐1
Qtr‐4
Qtr‐3
Qtr‐2
Qtr‐1
Qtr‐4
Qtr‐3
Qtr‐2
Qtr‐1
Qtr‐4
Qtr‐3
Qtr‐2
Qtr‐1
Qtr‐4
Qtr‐3
Qtr‐2
0
62.3
Qtr‐4
1
60.6
64.9
Qtr‐3
2
65
71.4 67.2 67.3
66.2 66.9
65.5
Qtr‐2
4.5 4.3 4.6 4.1 4.4 4.1
67.2
Qtr‐1
3
4.9
4.9 4.7 4.8
4.5
70
Qtr‐4
5.1 4.9
4
6.3
5.8
Qtr‐3
6.2
70.9
Qtr‐2
5
75
Qtr‐1
6
Acute Admissions Per 1,000
7
Qtr‐1
ARC Admissions Per 1,000
ARC Admission Rate Per 1,000
2011/12
The graph above relating to acute admission of people >65 years old shows the seasonal nature of acute admissions and that the number of admissions in the >65 age group was increasing, but has dropped off compared to corresponding periods in previous years. This data reflects both patients admitted acutely via ED and patients admitted acutely through direct referral by their GPs (this option has been available since May 2011).
Canterbury's Age Standardised Discharge Ratio for Acute Admissions 65+ 1.2 Discharge Rate
Both the Urgent Care and Aged Care work programmes are working to reduce the rate of ED presentations. Further understanding is provided by considering the aged standardised discharge ratio for patients aged 65+ (graphed to the right). This measure compares the rate of admissions for this group of people with the rate across the rest of New Zealand and shows that Canterbury has a consistently lower rate of admission than the national rate. This reflects the effectiveness of the Canterbury health system in reducing the number of acute admissions in this age group by several hundred per month.
1.0 0.8 0.6
0.83
0.80
0.81
0.82
0.83
0.81
Q3
Q4
Q1
Q2
Q3
Q4
0.89
0.87
0.87
Q2
Q3
0.79
0.76
0.80
0.80
0.77
Q4
Q1
Q2
Q3
Q4
0.87
0.4 0.2 0.0 2008/09
Q1
2009/10
2010/11
Canterbury Standardised Ratio
2011/12
Q1 2012/13
National Admission Rate
Better, Sooner, More Convenient Progress Report
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3
Children and youth health Action
Target
3.1 Establish the CCN Child and Youth Health Workstream and develop two key 2012/13 work programmes.
Child and Youth work programmes established.
By
Status
9
Q1
Current Achievement/Progress The Child and Youth workstream held its inaugural meeting in May 2012 and has subgroups working in child health and youth health respectively. The workstream’s work plan spans eight key themes: Access, Navigation, Communication, Interagency Collaboration, Vulnerable Children/Youth, Transition, Workforce and Other. The initial ideas generation phase resulted in the development of more than 50 areas to explore. In September, the CCN Alliance Leadership Team endorsed the work plan, noting that some conversations are yet to occur over the resources required to implement the plan. The ALT noted the impressive breadth of engagement that has occurred in order to generate the two work plans, which identify actions for the coming two years. Child: ‘Make it Better’ Improve health collaboration with schools; Improved communication with whānau/families; Improved communication with stakeholders; Child Navigators; Services that focus on vulnerable children; Provide direction for Child Health work programmes; and ‘CaSE’ Care System Education. Youth: Ensure each young person has a ‘Health Home’; Improve health literacy among youth; Improved communication with stakeholders; Right point of entry; Enhancing the system of care for youth; Youth voice representation; and ‘CaSE’ Care System Education.
3.2 Enhance collaboration around protection, prevention and early intervention strategies: Identify initiatives to reduce smoking in pregnancy as part of the development of a wider strategy for reducing Sudden Unexplained Death in Infants (SUDI). 3.3 Support the implementation of zero‐fee after hours GP visits for children under six.
Progress towards 90% of women who identify as smokers at the time of confirmation of pregnancy being offered advice and support to quit.
75% of the population under six have access to free afterhours care.
Q4
9
Q4
The Ministry of Health collect this data directly from lead maternity carers (LMCs). Information from the Ministry of Health is not available at this time. 85% of Canterbury’s population under the age of six has access to free afterhours care on the basis of an interim arrangement that has been put in place with afterhours providers. A long‐term solution is being developed.
Better, Sooner, More Convenient Progress Report
13
We are very close to activating our electronic notification to Well Child/Tamarki Ora providers when the baby leaves the birthing facility. 3.4 Support children being enrolled at birth with general practice, WellChild/Tamariki Ora and oral health providers.
90% of all new babies will have an identified WellChild/Tamariki Ora provider or GP by 2 weeks of age.
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Q4
We have reviewed data for each quarter last year and can see that we reached the required targets. Last year 94% of babies had an identified WellChild/Tamariki ora provider when they left the birthing facility. (This excludes a small number of babies where a provider is not required, e.g. moving overseas, deceased) (See also 17.3 below.)
3.5 Support the B4 School Check (B4SC) Clinical Advisory Group to closely monitor access to Checks, referral patterns, and the growth and development of the service.
80% of children in deprivation Quintile 5 receive a B4SC.
Identify population patterns and track the movement of high‐need families around Canterbury.
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Q4
3.7 Involve Well Child/Tamariki Ora providers and general practice in identifying children most at risk of tooth decay and support their families to maintain good oral health and access preventive care.
3.8 Investigate and implement alternatives to the current solely private practice‐based service model for adolescents to engage more young people in the service – particularly those at low decile schools.
Better, Sooner, More Convenient Progress Report
PHOs are reviewing delivery models to ensure that there are no barriers to access.
80% of children in Quintiles 0‐4 receive a B4SC.
Q4
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Gateway Assessment processes established and running.
Q1
9
This service is established and managing coordination of assessments and processes involved.
100% of children referred by CYF are receiving Gateway Assessments.
Q2
Â
By the end of the quarter, 100% of children referred by Child, Youth and Family (CYF) in Quarter 1 had either commenced or completed their Gateway Assessment.
>66% of 0‐4 year olds are enrolled in DHB‐ funded oral healthcare services.
Q3
>90% of children enrolled in school and community dental services are examined according to planned recall.
Q3
>65% of five year olds are caries free (no holes or fillings).
Q3
>75% of all eligible adolescents use DHB‐ funded dental care.
Q4
Use PHO mobile engagement teams to improve B4SC uptake amongst Māori, Pacific and Quintile 5 children. 3.6 Develop a service for vulnerable children and young people that incorporates Gateway Assessments and other aligned and complementary services.
In Quarter 1, 65% of Quintile 5 and 72%% of Quintile 0‐4 children had completed B4SC.
The new B4SC nurse coordinator is reviewing education for providers.
Oral health data is reported annually in Quarter 3.
Adolescent use of DHB‐funded dental care is reported annually in Quarter 4.
14
4
Primary and secondary integration Action
Target
4.1 Continue to link clinicians across the health system to build trust and ways of working together that maximise patient outcomes. Expand the range of clinical pathways between primary and secondary care to ensure patients receive the right care at the right time from the right provider, support the reduction in waiting times and maximise the value provided by clinicians right across the health sector.
5
470 HealthPathways available across the Canterbury system.
By
Status
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Q4
Current Achievement/Progress A total of 422 pathways, 66 referral pages and 42 resources are live. This includes 41 pathways, 11 referral pages and 4 resources which are being reviewed. Reviews are occurring in child health, gastroenterology, gynaecology and respiratory. 80 patient information pages are in place.
Ongoing active review of current HealthPathways.
Qly
9
By
Status
51 pathways, 6 referral pages and 3 referral pages are in draft currently. These are in infectious diseases, genetics and acute orthopaedics.
Urban integrated family health and social service networks Action
Target
5.1 Develop and support the implementation of eight Integrated Family Health Centres (IFHCs) and networks within Christchurch.
6 urban IFHC/networks under development.
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Q4
Current Achievement/Progress Seven groups have business cases concluding currently. These are being provided to the groups for their consideration. A further three groups have business cases under development at the moment. These ten groups currently provide general practice services to over 83,000 people. A further nine groups are actively considering joining the process.
5.2 Support the development of two Community Hubs across Canterbury to provide a range of outpatient and community specialist activity alongside extended primary care.
Identified community hubs are scoped.
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Q4
Clinicians and managers from across the health system are actively involved in working to consider the range of services that should be provided in hubs. Architects, clinicians and managers will be brought together for a design workshop in the second quarter.
Better, Sooner, More Convenient Progress Report
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6
Rural health workstream Action
Target Advice is developed for Integrated Family Health Services within the Ashburton TLA. Framework recommendations will be provided by March 2012 and further developed during 2012/13 financial year. Rural Workstream meetings continue throughout the 2012 calendar year at approximately 6 weekly intervals.
6.1 The Rural Health Workstream will develop integrated family health services including the development of IFHCs in rural Canterbury.
Status
Q3 & Q4
Qly
Current Achievement/Progress
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Sound progress has been made towards an IFHC in Ashburton. Population and demand analyses have been provided for all practices and their populations in the Ashburton TLA, along with further financial and business analysis. The draft of the second stage business case has been completed. Facility requirements are under consideration.
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Rural Workstream meetings have been held monthly. The workplan has been constructed with seven sub‐workstreams (workforce, IT, rural hospitals and IFHC, older persons, nursing in the community, mental health and allied health services), which are underway.
Rural Workstream networks with other SLAs and workstreams are developed ensuring sound communication channels.
Q4
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The Rural Workstream is engaging with other work areas and integrating activity across the system. Presentations have been made by other SLAs and workstreams to create an awareness of relevant activities and to facilitate communication channels.
Construction of Darfield IFHC underway.
Q1
C
Construction of the Darfield IFHC will begin on 15 October 2012 and will be completed during 2013.
Construction of Kaikoura IFHC completed.
Q4
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A business case for the Kaikoura build has been submitted to the Capital Investment Committee.
9
Underway. CDHB, community and RCPHO are working together to design a health hub/IFHC with shared facilities (office space, kitchen, laundry, etc.), some respite /palliative care beds and the integration of the present Pompallier House (up to level 3 rest home care) and a pharmacy on a central level site in Akaroa. Funding options are not clear at this stage. Identification of gaps and development of a model of care for the Akaroa / Little River area continue.
Business Case for Akaroa IFHC underway.
Better, Sooner, More Convenient Progress Report
By
Q2
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6.2 Undertake the scoping of the northern corridor to understand utilisation and determine a framework that supports appropriate models of care for this population.
7
Integrated Family Health Services advised on for the Northern Corridor. Framework recommendations will be provided by June 2012 and further developed during 2012/13 financial year.
Qly
Target
By
Status
The North Canterbury Health Hub will be located in Rangiora. Project management consultants have been contracted to fast‐track progress on the hub’s design along with the design of the Central City Hub. The Rangiora Hub will be accessible 24 hours a day, seven days a week as part of a network of integrated services. In addition to acute care backed by telemedicine, it will provide a primary birthing facility, postnatal care, convalescent care, observation beds for acute patients, a St John Ambulance base, outpatient clinics, diagnostics, community mental health services and opportunities for other health‐related community services.
Long‐term conditions Action
Current Achievement/Progress
Respiratory disease The earthquakes have made the primary care ABC implementation challenging, with our population still focused on urgent needs like home repairs rather than making healthy lifestyle changes.
90% of enrolled smokers seen in general practice are provided with advice and help to quit.
7.1 Support the implementation of ABC in primary care with systems to provide and record the provision of smoking cessation advice.
Better, Sooner, More Convenient Progress Report
C
Q4
Nonetheless, our results continue to improve. Canterbury general practices have reported giving 12,635 smokers brief advice and help to quit in the year to 30 June 2012. This is an increase of 2,166 over the 3 months since the last quarter and represents 25% of current smokers expected to be seen in general practice in that period. Primary care’s efforts to date have focused on recording patient smoking status, and this has paid off: all PHOs have now recorded the smoking status of at least 70% of their eligible population. As the focus shifts into providing quit advice and support, we expect to see an increased rate of improvement in performance over 2012/13. The Canterbury DHB has procured Txt2Remind for all practices to use for ABC and other activities.
>200 people enrol with the Aukati Kaipaipa smoking cessation programme.
Q4
This data is collected on a six‐monthly basis and will be included in the next report.
>7,000 Canterbury residents seek additional cessation support from ‘Quitline’ services.
Q4
This data is collected annually and will be included in the Q4 report.
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4 large group ABC training sessions are delivered in primary care.
Q4
C
The planning in this area has been amended. One large group round will be provided (planned for March 2012) and ABC training and programme updates will be delivered to general practice teams by Practice Support Liaison staff and at small group meetings.
60% of community pharmacy staff complete ABC e‐learning.
Q4
9
69 Pharmacies (out of 109, i.e. 63%) have notified Canterbury Clinical Pharmacy Group that they have staff who have completed the training.
Stage I model focused on identifying people at risk of readmission validated.
Q1
9
Stage II model focused on first admission developed.
Q2
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7.3 Continue to develop a real‐time integrated SFN data set and introduce related data sets, including acute demand management, to inform and engage clinical staff in new solutions to influence demand.
Live weekly update of SFN data available.
Q1
9
Weekly updating of these data is in place.
7.4 Consolidate and refine the case finding of people with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnoea (OSA).
More people access spirometry tests in the community (for COPD) – base 1,118.
Q4
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In Quarter 1, Cantabrians received 403 spirometry tests and 217 sleep assessments in the community from general practice or mobile community teams, without the need for a hospital visit.
Collaborate with Māori health providers and deliver improved access to diagnostics and tailored respiratory programmes for Māori.
More people access sleep assessments in the community (for OSA) – base 690.
Q4
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These represent substantial increases compared to the same quarter last year (when 298 spirometry tests and 192 sleep assessments were delivered in the community).
7.2 Undertake predictive risk modelling to identify people at risk of readmission.
7.5 Enhance linkages with public health programmes for warmer homes and smoking cessation to support those at risk of respiratory disease.
Equitable access to respiratory services across urban and rural communities.
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Q4
Support seamless patient care and improved access to respiratory services for patients in rural communities. Explore the Continuous Positive Airways Pressure (CPAP) model of care that promotes and supports an annual patient review in the community.
Primary and secondary care access to nursing services in a collaborative approach with general practice.
9
Q4
Community respiratory Nurses (CRNs) are supporting general practices across Canterbury with management of COPD patients and providing training and support. CRNs are also supporting and working with Acute Demand Nurses with support for respiratory patients. A single point of entry has been established for pulmonary rehabilitation. The community respiratory physician is available to general practice for advice, support and education. The community respiratory physiotherapy model is currently being
Work towards an integrated, multidisciplinary approach
Better, Sooner, More Convenient Progress Report
The initial risk prediction model has been completed and validated against previous data. This is now being adapted for systematic use against the Canterbury data warehouse. A number of modifications to the model have been explored to seek improved performance. The systemic production of a ‘live’ list of patients at high risk of readmission will be produced within the next month. This will initially be piloted in two practices before wider dissemination.
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to the management of acute and sub‐acute COPD at multiple points of intervention through the system including: primary care, acute demand, ambulance, ED and hospital discharge.
Establish multidisciplinary home‐based care for lung disease.
Q4
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Q4
9
Q4
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Continue to support community‐based respiratory nurses and Allied Health professionals across the system to reduce hospital admissions.
100% of ‘frequently admitted’ respiratory Continue to invest in enhancing skills and competence in patients enrolled in CCMS. managing respiratory conditions. Expand Collaborative Care Management System (CCMS) capability to facilitate coordination between primary and secondary care providers for complex patients with long‐term conditions. Focus on cardiology and respiratory patients who are frequent attendees at ED and hospital.
7.6 Support continued investment in rehabilitation programmes to reduce the likelihood of an exacerbation or readmission and to support people to improve the quality of their lives.
10% reduction in COPD admissions and readmissions
More people access pulmonary rehabilitation programmes in the community – base 108.
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Q4
developed and will include a community cystic fibrosis physiotherapist. 214 patients with COPD who called an ambulance have been managed in primary care since 1 July 2012. This is 33% of ambulance calls for such conditions.
Pulmonary rehabilitation programmes are being delivered in the rural (Amberley/Cheviot/Rangiora/Ashburton) areas as well as within urban settings. During 2011/12 6 programmes had 83 attendees. During the first quarter of 2012/13, one course was run with 16 attendees. Marketing of Pulmonary Rehabilitation programmes is in place to increase the number of referrals.
Diabetes 7.7 The Integrated Diabetes Service (IDS) Development and Operational groups and the Diabetes Consumer Group will develop an integrated approach for people with diabetes in Canterbury that is ‘best for patient, best for system’.
Target ‘high needs’ group defined.
Q1
9
New Diabetes Care Improvement Package agreed.
Q1
9
Q2
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Implement a Diabetes Care Improvement Package which Strategy for newly diagnosed in place. enhances the provision of diabetes care across the
Better, Sooner, More Convenient Progress Report
The clinical governance group chairs and consumers defined ‘high needs’ patients for diabetes as part of the minimum standards of care developed for the Diabetes care improvement package Key stakeholders have developed Diabetes Care Improvement Package principles outlining minimum standards of care and outcomes. The package has been agreed, and we are currently working out the final contracting.
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enrolled population with a particular emphasis on high‐ risk / high‐needs groups.
84 people were newly diagnosed with Type 2 during Quarter 1 and received self management support from the GP team under Canterbury’s diabetes subsidy for general practice. This compares with 101 for the same quarter last year.
More people with diabetes (identified by general practice) are supported to manage their diabetes.
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Q4
Another 78 people received support in learning how to use insulin under Canterbury’s other diabetes subsidy. This compares with 45 for the same quarter last year. General practice has been encouraged to code patients with diabetes as part of the care improvement package. All patients are to be coded by March 2013. The Integrated Diabetes Service Development Group is working with consumers to support self management of diabetes. Conversations maps are being piloted across the region. Allied health is working to align education and training for consumers.
7.8 Continue to invest in programmes that support lifestyle and behavioural modification to support people most at risk of Diabetes and CVD.
90 Appetite for Life courses delivered in the community.
Q4
C
7.9 Continue to invest in programmes to manage people newly diagnosed with Type 2 diabetes and people with diabetes who are first starting insulin treatment.
More people newly diagnosed with Type 2 diabetes access support in the community – base 163.
Q4
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Design and implement clinical/patient education and tools for improving and supporting self management of diabetes. Provide support and training to general practice teams to enable them to provide good quality diabetes care in their local communities.
79% of the proportion of the population identified with diabetes have HbA1c
