133 Molesworth Street
PO Box 5013
Wellington 6140
New Zealand
T+64 4 496 2000
4 June 2020
Shay McGuinness
By email: [FYI request #12625 email]
Ref: H202002328
Dear Dr McGuinness
Response to your request for official information Thank you for your request under the Official Information Act 1982 (the Act) on 14 April 2020 to
the Ministry of Health (the Ministry) for:
“Please provide all emails between the following
senior individuals in the Ministry of Health (MoH) and Auckland District
Health Board (ADHB) regarding the provision of helicopter air ambulance
services.
ADHB
1. Ailsa Claire
MoH
1. Ashley Bloomfield
Note:
1. Applicable dates are 1/7/2019 to 10/3/2020
2. Emails include those sent, received or cc'd and include any
attachments."
As this is restricted to emails only between 2 individuals I believe that you should be able
to respond promptly.”
On 13 May 2020, the due date for responding to your request was extended under section 15A
of the Act as further consultation was required.
Nine documents have been identified within scope of your request. The table in Appendix 1 lists
the specific grounds under which I have decided to withhold information. Where information is
withheld from a document, the grounds are also noted in the document itself.
I trust this information fulfils your request. Under section 28(3) of the Act you have the right to
ask the Ombudsman to review any decisions made under this request.
Please note that this response, with your personal details removed, may be published on the
Ministry of Health website.
Yours sincerely
Emma Prestidge
Acting Deputy Director-General
Health System Improvement and Innovation
Page 2 of 4
Appendix 1: List of documents released
#
Date
Title
Decision on release
1
12 July 2019
AA update
Released with some information
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
Where information is deemed out of
scope of the request, this has not
been provided.
2
5 August 2019
NR Air ambulance helicopter
Released with some information
service
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
2A 5 August 2019
Email attachment
Released in full.
3
8 August 2019
Procurement of an additional IHT Released with some information
helicopter
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
4
7 November
Helicopter service failure this
Released with some information
2019
morning
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
5
13 December
Northern Region Air Ambulance Released with some information
2019
Governance Group
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
Where information is deemed out of
scope of the request, this has not
been provided.
6
13 December
Crewing and Asset Plan
Released with some information
2019
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
7
17 December
Memo - Air Ambulance Issues in Released with some information
2019
the Northern Region
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
7A 17 December
Email attachment:
NASO Memo - Released with some information
2019
Air Ambulance Issues within the withheld under section 9(2)(f)(iv) of
Northern Region
the Act, to protect the confidentiality
Page 3 of 4
#
Date
Title
Decision on release
of advice tendered by Ministers of
the Crown and officials.
7B N/A
Email attachment
Released in full.
8
31 January 2020 Minutes - Governance Group
Northern Region Air Ambulance Released with some information
Service
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
8A 24 January 2020 Minutes - Governance Group
Released with some information
Northern Region Air Ambulance withheld under section 9(2)(k) of
Service
the Act, to prevent the disclosure or
use of official information for
improper gain or improper
advantage.
9
7 February 2020 Air Ambulance
Released with some information
withheld under section 9(2)(a) of
the Act, to protect the privacy of
natural persons, including that of
deceased natural persons.
9A 5 February 2020 Email attachment: Brief
Released in full.
justification for two additional
ECMO machines, ADHB
Page 4 of 4
Document 1
Out of scope
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INFORMATION
From: Ailsa Claire (ADHB)
Sent: Friday, 12 July 2019 12:53 p.m.
To: [email address]; [email address]; [email address];
RELEASED UNDER THE OFFICIAL
Debbie Holdsworth (WDHB)
Cc: Nick Chamberlain (NDHB); Jo Brown (WDHB)
Subject: FW: AA update
Kia ora Ashley
Document 1
Please see below yet another example of the major clinical risk resulting from the in ability of the
Northern air ambulance supplier to meet the contract requirements.
Nic can better illustrate the implications from Northlands point of view but we have now multiple
instances where the NICU and ECMO transfers were not just at risk but could not have actually occurred.
In other instances had there been a patient utilising the air ambulance for this purpose Northland would
have been without any cover.
We have an IMT in place, coordinated with Northland to deal with this issue.
I can not emphasise strongly enough how serious this situation is and my lack of confidence in the
current supplier to resolve the situation.
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In fact in a recent meeting they said they would continue to be in breach.
The resolution of incidents seems to rely on ADHB staff being called out at all hours of the night with no
responsibility being taken by NASO out of hours and inaccurate reporting of actually availability.
My staff who are being relied on day and night to deal with the issues arising are beyond tired.
This is completely unsustainable and we strongly advise that another air ambulance with crew be
immediately moved to the Northern Region and that the procurement of the “5th” air ambulance take
INFORMATION
place. Without the procurement of an additional air ambulance we will continue to be reliant on a
provider clearly unable to deliver the contract. If they get into a position to deliver the contract and we
find that level of provision is sufficient to deal with PICU and ECMO transfer it could be decommissioned
later.
Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
From: Jo Brown (WDHB)
Sent: Thursday, 11 July 2019 6:34 PM
To: Ailsa Claire (ADHB)
<[email address]>
Cc: Joanne Gibbs (Dir Provider Services)(ADHB)
<[email address]>
Subject: AA update
Hi Ailsa
See email trail below and my communication to NASO re today’s situation. If effect
• We had an issue overnight with the only Whangarei helicopter unavailable due to
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maintenance
• The North Shore helicopter flew to Whangarei to do an IHT
• Due to subsequent helicopter crew stand down requirements approx. 10 hour period (0215
– 1145) where only single helicopter in Northern region capable of being tasked for PICU/NICU
IHT and no helicopter for Northland or ECMO IHT
Document 1
• This outage was not notified to us by NASO – see communication at the bottom of the email
trail from supplier that Shay subsequently investigated to then crystallise that there was no
helicopter between these hours
• The attached email is an additional email from ARHT chief pilot telling us of aircraft
availability that is inconsistent with other communication regarding today’s capacity
Our key messages to NASO:
• We can’t sustain this level of communication from us being needed
• The information being provided regarding asset and crew availability is incorrect
• NASO/NRHL need to take control of communication and join this up
• Suggested NASO/NRHL leadership need to be managing and responding to these issues out
of hours rather than leaving this for DHBs to manage
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NASO advise
• they are expecting the visiting expert who is due to report tomorrow/early next week will
provide them with a view of what the problems are and the veracity of the forward information
being provided
• the DG returns from leave early next week and will be briefed and we can expect advice re
next steps after that
INFORMATION
Thanks for your support
Regards
Jo
From: Jo Brown (WDHB)
Sent: Thursday, 11 July 2019 1:00 p.m.
To: [email address]; [email address]
Cc: [email address]; '[email address]'; Shay Mc Guinness (ADHB)
Subject: RE: ZK-ISJ Online
Hi All
Further to Shay’s email below we have received the attached notification re ARHT asset availability. This
situation is becoming increasingly untenable as the asset availability is changing hourly and we need
NASO to be recognising this and responding to this with updated contingency arrangements as the
issues emerge.
There are a number of issues here:
•
RELEASED UNDER THE OFFICIAL
Staffing is clearly impacting capacity therefore this suggests the level of staff do not exist
within the provider to support the hours of availability they have advised in the daily schedule.
This needs to be clarified urgently and an understanding of the options to manage this
crystallised quickly
Document 1
• There is still not joined up communications between the two parties within the JV and we
continue to get “updates” from the supplier without any accompanying plan to mitigate. This is
very concerning and seems to place the onus on us as DHB reps to manage the risks hourly
• We need the communication process and accountabilities clarified today – it is unacceptable
that Shay continues to get pushback from those in the system who continue to fail to recognise
the hierarchy of clinical decision making
• We (Shay and I and other colleagues) cannot be left to resolve these issues on a 24/7 basis
and NASO needs to be available to manage these communications and contingencies on a 24/7
basis
Andy/Clare - happy to discuss by phone this afternoon as we need some urgent resolution on these
matters given the daily problems we are dealing with
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Regards
Jo
From: Shay Mc Guinness (ADHB)
Sent: Thursday, 11 July 2019 12:19 p.m.
To: [email address]; [email address]
Cc: Jo Brown (WDHB);
[email address]; '[email address]'
Subject: FW: ZK-ISJ Online
INFORMATION
Can we try and get a timeline on what exactly happened here?
It looks like:
• ISJ went u/s at around 21.45 whilst preparing to head to Kaitaia for an IHT (back to Whangarei)
• We were notified (by email) of this at 22.55
• IAL was then tasked (?By NEST or Airdesk) to complete the above IHT (It flew from North Shore
to Whangarei hospital to collect the clinical team for the IHT)
• IAL completed the IHT at 02.15 and relocated to the NEST Whangarei base where it ? went off-
line due to pilot hours
• IAL remains at Whangarei this morning due to flight crew availability (rather than weather) –
Dues back around 14.00
The questions we need to ask are:
1. Is there a proper way of the right people being notified of service issues?
2. What is the escalation process for contingency plans? – The Airdesk was not prepared to accept
that it may not be appropriate to task HKZ on a primary mission.
RELEASED UNDER THE OFFICIAL
3. Is it appropriate that ?NEST/? Airdesk tasked the only remaining ECMO capable helicopter to
Kaitaia for an IHT? (or should there have been, at a minimum, some discussion with ADHB?)
4. What is IALs availability for the rest of the day (given crew duty times)?
Document 1
I think we need to formalise contingency plans for “what happens if helicopter xx goes offline
unexpectedly?” – and these need to be agreed by all parties – especially the Airdesk. This is a NASO
function as the Airdesk/SJA are clearly not prepared to take instructions from DHBs.
This is the second time in 10 days that we have been left with a single aircraft in Northern Region and
that aircraft is not capable of all mission types.
I note that we now have limited 2nd aircraft availability in Auckland (nothing after 17.00).
Regards
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Shay
From: Pilots
<[email address]>
Sent: Thursday, 11 July 2019 11:44 AM
To: Maintenance Advise Group
<[email address]>
Subject: ZK-ISJ Online
Good Morning All,
INFORMATION
As of 11:45 ISJ is back online.
IAL will be repositioned back to Northshore this afternoon as soon as I have a crew to get it down.
Kind regards,
Ron
Pilots
Line Pilot
T: +64 9 983 2251 | M: N/A
E: [email address]
http://www.nest.org.nz
RELEASED UNDER THE OFFICIAL
Document 2
From:
Ashley Bloomfield/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>
Cc:
[email address], russel .[email address], [email address],
Monique Burrows/MOH@MOH
Date:
05/08/2019 11:17 am
Subject:
NR Air Ambulance Helicopter Service
Sent by:
Jo Waugh
Dear Ailsa
Please find attached a response to your letter dated 25 July 2019.
Refer to ‘Document 2A’
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05082019093559-0001.pdf
Kind regards
Ashley
Dr Ashley Bloomfield
Director-General
Ministry of Health
email: [email address]
Mobile: s 9(2)(a)
www.health.govt.nz
INFORMATION
RELEASED UNDER THE OFFICIAL
Document 2A
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INFORMATION
RELEASED UNDER THE OFFICIAL
Document 3
From:
Ashley Bloomfield/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>
Cc:
"Nick Chamberlain (NDHB)" <[email address]>, Keriana
Brooking/MOH@MOH, Monique Burrows/MOH@MOH, "Jo Brown (WDHB)"
<[email address]>
Date:
08/09/2019 05:41 pm
Subject:
Re: Procurement of an additional IHT helicopter
Kia ora Alisa,
Thank you for your thoughtful response. I apologise for the time it took for us to get to an agreed
position, but I want to assure you that the MoH team will make the design and execution of the
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procurement process a priority and will work in partnership with Auckland and Northland DHB
staff throughout.
I agree that the service specifications need to be jointly agreed.
It is important to note that ARHT has not made a decision to outsource its operations to a
specialist aviation organisation. It is a proposal that is currently subject to staff consultation. The
interim Chief Executive of ARHT is open to considering other options that would deliver the
INFORMATION
step change in performance required to meet our expectations, and is gathering information from
staff and sector experts in this regard. The provider has promised to share the option set and
analysis with NASO before any decision on a change to operations is made. NASO will work to
ensure that appropriate due diligence and transition planning is in place for the preferred option
for change, whatever that may be, and we will of course also involve your team.
I understand the importance and the urgency of stabilising national IHT services and am pleased
to hear that Jo Brown and Monique Burrows are already working to progress the procurement
process.
As you may know, I have also asked the team to explore all immediate options to increase the
number of helicopters and crew in the northern region to help ensure service continuity in the
short term while we work through the procurement process and implement the outcome.
Ngā mihi
Ashley
Best regards
Ashley
RELEASED UNDER THE OFFICIAL
Dr Ashley Bloomfield
Director-General of Health
s 9(2)(a)
Document 3
On 6/09/2019, at 11:53 AM, Ailsa Claire (ADHB
) <[email address]> wrote:
Dear Ashley,
I am writing on behalf of Nick and myself in response to the internal MOH memo dated 2 September,
that was sent to us the same day, regarding the MOH view of the Auckland DHB procurement process to
establish a 5th helicopter to support national IHT service coverage in the Northern region.
It is encouraging that the MOH acknowledges the need for this additional capacity.
It is clear the MOH view regarding the rigour of the ADHB procurement process is different from the
view of my expert advisors. Given the view of the MOH I am unable to proceed with the supply option
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we have identified and this leaves us with the only option to pursue which is the MOH procurement
process. The alternative option proposed by the MOH has a number of uncertainties associated with it
and is therefore not an acceptable option to ADHB.
The Northern region DHBs have been engaged in weekly, daily and sometimes multiple daily discussions
with NASO in an endeavour to manage the risks to patients and staff, and gaps in service delivery with
the current provider. Unless there are additional helicopters of the right specification procured the
current situation will not improve in the medium term. The continued increased clinical risk as a result
of insufficient capacity is being managed by the DHBs and there is an urgent need to get additional
INFORMATION
longer term sustainable capacity secured in the Northern region.
I do not have confidence in the existing provider and I am concerned by the advice that they have made
a decision to subcontract elements of the service to a third party. I would strongly urge the MOH to
ensure there is an appropriate risk assessment of any subcontracting proposal, with an appropriate level
of scrutiny and due diligence to enable the MOH to provide assurance that the service will not
deteriorate further, and the risks to patients and staff not increase, as a result of any new arrangement.
We need the MOH procurement process to be initiated urgently and completed within the timeframes
your team indicate is achievable. Our teams will need to work closely to ensure there is a successful
outcome able to be implemented within the 6 – 8 week timeframe and this will require an improved
approach to collaboration with the DHBs.
I would like an assurance from you that the MOH will agree the service specifications with us and this is
particularly important with respect to the type of helicopter to be procured. We support the need for
interoperability of equipment, crew and aircraft, yet the current contract has allowed the provider to
implement different types of aircraft exacerbating the current problem of insufficient capacity. We
would like to see this rectified in the subsequent commissioning of an IHT aircraft that is interoperable
with the assets that are certified to undertake Northland IHT and national IHT services.
Given the ongoing and extreme clinical risk for patients into the foreseeable future we need to have the
RELEASED UNDER THE OFFICIAL
MOH procurement process expedited and underway immediately.
Regards,
Ailsa
Document 4
From:
Ashley Bloomfield/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>
Cc:
Keriana Brooking/MOH@MOH
Date:
07/11/2019 06:56 am
Subject:
Re: Helicopter service failure this morning
Kia ora Ailsa
Yes the team updated me on this yesterday. We will certainly be looking into it.
Best regards
Ashley
ACT 1982
Dr Ashley Bloomfield
Director-General of Health
s 9(2)(a)
On 6/11/2019, at 3:01 PM, Ailsa Claire (ADHB) <[email address]> wrote:
Kia ora Ashley
INFORMATION
I thought you should see this to understand what we are dealing with on a regular basis.
We had a significant delay in obtaining a helicopter for a time-critical retrieval this morning
(using the ADHB Regional NICU team to retrieve a premature infant from Whangarei ),
compounded by a complete failure in communications by ARHT.
The timeline is:
At 03.47 NZAAS Flight Coordination Service were contacted by NICU to arrange an urgent
retrieval from Whangarei hospital (i.e. Collect ADHB NICU team from ACH, transport team to
Whangarei and return with the patient).
At 03.49 ARHT paging service contacted – no reply by 03.55
At 03.55 ARHT hotline called – call diverted to paging service
At 04.03 hotline called again – diverted to paging service again
At 04.10 one of the ARHT off-duty pilots contacted (after trying several) – advised (after he
checked TracPlus) that the crew were flying but he also said that the crew on duty may not able
to do IHTs due to not being trained
Attempts to phone Roger Hortop (ARHT chief pilot) calls not answered
At no point was the paging service messages replied to
RELEASED UNDER THE OFFICIAL
Finally contacted NEST who responded (with a delay) – helicopter flew down from Whangarei
and landed ACH 05.45. By this time the ADHB clinical team were out of hours so a further delay
whilst awaiting a relief team. Aircraft left ACH at 08.00.
This is a significant delay compounded by a lack of adequate communication from ARHT. ARHT
informed us yesterday that all training was now complete so it would be helpful to know why
Document 4
we have been told that they couldn’t have completed the mission anyway due to the duty crew
not being trained
Note that NZAAS followed the agreed procedure for activating an NRHL aircraft but the lack of
communication by ARHT is unacceptable.
The process of our flight coordinators having to contact ARHT to determine if they are available
and willing to do an IHT on a mission-by-mission basis creates unacceptable delays.
ADHB have instigated a formal incident review however I would appreciate assurance that NASO
will also be investigating this.
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Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
INFORMATION
RELEASED UNDER THE OFFICIAL
Document 5
Out of scope
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INFORMATION
RELEASED UNDER THE OFFICIAL
Document 5
Out of scope
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INFORMATION
From:
"Graham Dyer" <[email address]>
To:
"Ailsa Claire (ADHB)" <[email address]>, "[email address]"
<[email address]>, "Ashley Bloomfield" <[email address]>,
"Nick Chamberlain (NDHB)" <[email address]>, "Russel Simpson"
<russel .[email address]>
Date:
13/12/2019 09:58 am
Subject:
RE: Northern Region Air Ambulance coverage, crew and asset availability
Hi Ailsa,
RELEASED UNDER THE OFFICIAL
I’ve seen some of the correspondence on this. In summary the answer from ARHT is that the AW169
can reach Whangarei, Rotorua, Gisborne, Hastings, Taranaki, Taupo, New Plymouth and Wanganui 100%
of the time in a single hop, and Palmerston North and Hutt 90% of the time (if having to fly at night
and/or in poor weather). These capabilities are assuming a full load including equipment and personnel
for PICU and ECMO. This assumes refuelling at the destination, which is standard practice against
potential delays on return.
Document 5
ARHT believe that the AW169’s have a similar capability to the S76C++ (3hrs flight time and 2.8hrs
respectively), which is greater than the BK117 at 2.2 hrs.
Hope that this high level work covers what you need for the Board.
Happy to talk this through if useful.
Kind regards
Graham
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Graham Dyer, ACC Enterprise Adviser - Health
Tel (04) 819-5151 / Mobile
/ Ext: 45151
s 9(2)(a)
ACC cares about the environment – please don’t print this email
unless it is really necessary. Thank you.
INFORMATION
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"Graham Dyer" <[email address]>, "[email address]"
<[email address]>, "Ashley Bloomfield" <[email address]>,
"Nick Chamberlain (NDHB)" <[email address]>, "Russel Simpson"
<russel .[email address]>
Date:
13/12/2019 08:47 am
Subject:
RE: Northern Region Air Ambulance coverage, crew and asset availability
This is worrying.
There must be a way to assess payload and distance.
Its done all the time in the aviation industry.
We are not looking for “all circumstances” .
Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M:
RELEASED UNDER THE OFFICIAL
s 9(2)(a)
From: Graham Dyer [mailto:[email address]]
Sent: Friday, 13 December 2019 8:24 AM
To: Ailsa Claire (ADHB) <[email address]>; [email address]; Ashley Bloomfield
<[email address]>; Nick Chamberlain (NDHB)
Document 5
<[email address]>; Russell Simpson <[email address]>
Subject: RE: Northern Region Air Ambulance coverage, crew and asset availability
Hi Ailsa,
I asked the pilots at the meeting last week specifically about the questions that had been raised with
regard to load and distance. This was to try to address the situation of the data specifications from the
manufacturer being sent rather than lived experience. The response was that this is an almost
impossible question to answer as it will be impacted by wind, humidity, air speed, and a range of other
factors that mean that there is no absolutes that can be given for all circumstances. The only thing that
the pilots gave an absolute on was that the capabilities were better than those of the BK that the
AW169’s were replacing.
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Not sure from here how this is resolved. Would it be worth having the ARHT flight crew talk to the
FRAC?
Kind regards
Graham
INFORMATION
Out of scope
RELEASED UNDER THE OFFICIAL
Document 5
Out of scope
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"[email address]" <[email address]>, "Ashley Bloomfield"
<[email address]>, "Graham Dyer" <[email address]>, "Nick
ACT 1982
Chamberlain (NDHB)" <[email address]>, "Russel Simpson"
<russel .[email address]>
Date:
13/12/2019 06:02 am
Subject:
Re: Northern Region Air Ambulance coverage, crew and asset availability
Thank you.
We need specific information about load and distance for the Board. I hope this will resolve at
least this issue on Wednesday as it is not the main issue we have to deal with. As you say
crewing and availability are the issue plus I would say accurate information and timely response.
INFORMATION
I assume DHB staff will be involved in the governance group?
I would suggest an Exec Director not currently embroiled in this issue.
Regards
Ailsa
From:
Keriana Brooking/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>, "Ashley Bloomfield"
<[email address]>, "Graham Dyer" <[email address]>, "Nick
Chamberlain (NDHB)" <[email address]>, "Russel Simpson"
<russel .[email address]>
Date:
12/12/2019 07:02 pm
Subject:
Northern Region Air Ambulance coverage, crew and asset availability
Kia ora koutou
Yesterday Monique, Graham Dyer, Carleine, Peter (NASO Contract Manager) and I met with
Governance, Management, Clinical Director and Pilots from ARHT and the CEO of NEST. It was a
positive and constructive meeting.
Al meeting attendees discussed the availability (including over the holidays by way of variation with
extended asset and crew capacity) of the primary and secondary assets (including availability of crew) for
all tasking requirements and the agreement to use the S76A and BK117 (HKZ) for back up purposes
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only. The agreed configuration (as per the agreement) would see assets based and available to be
tasked from Ardmore and Whangarei.
NEST CEO confirmed to the group yesterday they have a small number of pilots (3) that need to
complete training for the S76C++ and subject to planning for anticipated tasking requirements over the
next 7 days, that activity wil be completed by the end of next week.
Document 5
The list of matters raised by ADHB has been captured (as per agreed process) and NASO are working
actively on a memo to al in this email outlining the matter, the Ministry of Health and ACC (NASO)
position, and what further action is required.
This memo (including recommendations) from the Ministry of Health and ACC (NASO) is planned to be
sent no later than next Tuesday and wil contain all other documents (in draft - assurance or final -
incident review report).
However there is immediate assurance information that could be shared with the group in this email
tomorrow, to provide Ailsa with information that can be discussed with the ADHB board next Wednesday.
After crewing and asset availability (which I can confirm is principal y contract compliant), the critical
matter to be addressed is concerns about safety of the AW169 and that has been well assured by CAA
(and further identified as of no concern in the draft assurance report). In addition, further matters like
improving crewing capacity and/or overal capacity (using improved modelling information), improved
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communication and relationships wil also be contained in the memo to be sent early next week.
Also outlined in the memo (to be sent early next week) is the establishment of a Northern Air Ambulance
Governance Group to oversee the recommendations from the memo, the assurance review report and
incident (06 November) review report. It is intended that this group govern the next steps to provide the
board of ADHB/NDHB with the assurance that National IHT and ADHB/NDHB IHT services have air
ambulance rotary wing assets tasked and available to them in a safe and timely fashion. Governance
group members (or their delegates) wil meet 1/2 hour weekly by teleconference from the week starting
06 January. Organising information on that wil be coming out to our EAs over the coming days.
INFORMATION
Nga mihi
Keriana Brooking
Deputy Director-General
Health System Improvement and Innovation
Ministry of Health, 133 Molesworth Street
PO Box 5013, Wellington 6145, New Zealand
Mobile: s 9(2)(a)
Email: [email address]
Kia ora, if this email reaches you out of hours, I don't expect a reply outside of your office hours,
it's just a convenient time for me to send an email, nga mihi.
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"Keriana Brooking" <[email address]>, "Ashley Bloomfield"
<[email address]>, "Nick Chamberlain (NDHB)"
<[email address]>, "Russel Simpson" <russel .[email address]>,
"Graham Dyer" <[email address]>
Date:
12/12/2019 06:43 am
Subject:
Fwd: National IHT coverage asset availability
Kia ora
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i have forwarded an email from Jo with which I completely agree.
It feels as if the situation is not improving and we are running out of time before Christmas .
We have a Board meeting next Wednesday and i would like to be able to take a
recommendation to the Board re use of helicopters for IHTs to that meeting.
I would appreciate your views.
Document 5
Regards
Ailsa
From: Jo Brown (WDHB) <[email address]>
Date: 11 December 2019 at 8:05:05 PM NZDT
To: Ailsa Claire (ADHB) <[email address]>
Cc: Joanne Gibbs (Dir Provider Services)(ADHB) <[email address]>, Shay Mc Guinness
(ADHB) <[email address]>
Subject: Fwd: National IHT coverage asset availability
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Hi Ailsa
Because of engineering issues over the weekend with the 2 x 76A helicopters being out of
service and the limited crew trained on the 76C++ leading to only one helicopter being
available, there was no opportunity to place a Whangarei helicopter in Auckland as Keriana
outlined in her email below was under discussion.
INFORMATION
Given we have no assurance regarding the crewing and maintenance of HKZ, we have no
visibility of the availability of this asset for national IHTs at any time during the week or
weekend (day and night), any week or weekend until such time as there is progress on the use
of the AW169s. The information provided to us says that HKZ availability is "crew dependent"
and as we have experienced this most often means it is
not available.
I note also that the draft assurance report was due early this week and I am not sure when we
can expect the outcomes of this report to be shared with us.
We have also been advised that there is a delay in finalising the report into the Nov 6 incident,
with Shay and Jo being advised that this is now not due to us this week in final form, until early
next week.
I am concerned that the cumulative effect of lost "days" in the timelines on each of these
issues, will lead to a delay in decision regarding the outcome of the procurement and therefore
a delay in establishing an interim arrangement to ensure there is a "5th" national IHT
designated helicopter in Auckland. The Helilink helicopter currently in Whangarei is due to be
withdrawn end of December and we must be getting close to it not being an option to extend
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this arrangement (with few working days left until Christmas).
Given the totality of the current context, I think we need to go back to MOH/NASO to get some
progress on returning a NEST helicopter to the North Shore before we are left with no options
before the Xmas/New Year/summer period. It will be increasingly difficult for NEST to
reorganise/change crew rosters (to be Auckland based) with insufficient lead-in time.
Document 5
Regards
Jo
Sent from my iPad
From:
Keriana Brooking/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>, [email address], "Russel
Simpson" <Russel .[email address]>, Ashley Bloomfield/MOH@MOH,
[email address]
Cc:
Monique Burrows/MOH@MOH
Date:
06/12/2019 06:29 pm
Subject:
National IHT coverage asset availability
ACT 1982
Kia ora koutou
There have been conversations over this week between NASO (in turn with ADHB) and NRHL about
national IHT coverage asset availability that I would like to update you on.
NRHL is not able to crew HKZ this weekend. This means that in the absence of the AW 169s being
accepted for use in IHT missions by ADHB, there is one national IHT capable asset available 24/7, based
in Whangarei.
This is the same asset configuration that has been in place for the past week, and it is accepted by al
INFORMATION
parties that this is far from ideal. Not least because the BK117 (HKZ) has reduced capacity relative to the
new assets and is expensive to maintain as it incurs flying hours and maintenance time that weren’t
planned for. I acknowledge the contingency planning and alternative tasking/clinical arrangements our
DHB clinical and operational staff have had to do while asset configuration has been limited or not
available. Further, decisions relating to purchasing additional asset availability for the Northern Region
wil be made within the fortnight.
NASO has tested with Paul Ahlers whether it is possible to move a S76C++ from Whangarei to Auckland
over the weekend to provide better IHT cover. It cannot be done for this evening, but may be possible for
tomorrow evening. An update is expected tomorrow morning.
The list of issues to be resolved to enable the use of AW169s for IHT missions is being worked on at
pace, and relates to the following topics:
- NASO led investigation into the 6 November delayed retrieval.
- Appropriate level of operational information relating to the AW169s to inform tasking guidelines.
- CAA investigation into reported safety concerns.
- Working relationship between ARHT and DHBs.
The assurance report is scheduled to be received in draft the week beginning 09 December and wil be
shared with all parties. Feedback on the report is welcome, with Ministry of Health, ACC and NASO staff
meeting with NRHL at Ardmore on Wednesday 11 December 2019.
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Ngâ mihi
Keriana Brooking
Deputy Director-General
Health System Improvement and Innovation
Document 5
Ministry of Health, 133 Molesworth Street
PO Box 5013, Wellington 6145, New Zealand
Mobile: s 9(2)(a)
Email: [email address]
Kia ora, if this email reaches you out of hours, I don't expect a reply outside of your office hours,
it's just a convenient time for me to send an email, nga mihi.
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INFORMATION
RELEASED UNDER THE OFFICIAL
Document 6
From:
Keriana Brooking/MOH
To:
"Ailsa Claire (ADHB)" <[email address]>
Cc:
"Ashley Bloomfield" <[email address]>, "[email address]"
<[email address]>
Date:
13/12/2019 05:05 pm
Subject:
Re: FW: Crewing and Asset Plan V1.20 - response required please
Kia ora Ailsa
Thanks for your prompt reply and action on this matter
Keriana Brooking
Deputy Director-General
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Health System Improvement and Innovation
Ministry of Health, 133 Molesworth Street
PO Box 5013, Wellington 6145, New Zealand
Mobile: s 9(2)(a)
Email: [email address]
Kia ora, if this email reaches you out of hours, I don't expect a reply outside of your office hours,
it's just a convenient time for me to send an email, nga mihi.
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"Ashley Bloomfield" <[email address]>, "[email address]"
INFORMATION
<[email address]>, "[email address]"
<[email address]>
Date:
13/12/2019 04:07 pm
Subject:
FW: Crewing and Asset Plan V1.20 - response required please
Kia ora
Can unreservedly apologise for this email.
It is unacceptable and we are dealing with this.
Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
From: Jo Brown (WDHB)
Sent: Friday, 13 December 2019 2:16 PM
To: Ailsa Claire (ADHB) <[email address]>; Joanne Gibbs (Dir Provider Services)(ADHB)
<[email address]>
Subject: Fwd: Crewing and Asset Plan V1.20 - response required please
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FYI
Begin forwarded message:
Document 6
From: "Shay Mc Guinness (ADHB)"
<[email address]>
Date: 13 December 2019 at 1:39:29 PM NZDT
To: "[email address]" <[email address]>, "Jo Brown (WDHB)"
<[email address]>
Cc: "[email address]" <[email address]>,
"[email address]" <[email address]>,
"[email address]" <[email address]>, "Jo Mack (ADHB)"
<[email address]>, "Melissa Nathan-Patuawa (NDHB)"
<Melissa.Nathan-
[email address]>, "[email address]" <[email address]>,
"Sarah Hoyle (NDHB)"
<[email address]>
Subject: RE: Crewing and Asset Plan V1.20 - response required please
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Hi Monique,
So in summary:
1. NASO only contracted for 3 IHT capable helicopter which falls below the specifications in the original
RFP – without any discussion with the DHBs
2. You haven’t answered the question regarding why we are not being told the availability of HKZ on a
shift-by-shift basis now.
3. You have to stop regurgitating false information from the provider – use of the Whangarei helicopters
INFORMATION
for IHTs has had no impact of C++ training.
4. I’m glad that NASO has new staff – but I am unconvinced that with the current NASO and MoH
“leadership” that this will result in any improvement to the appalling level of contract management that
we have witnessed from NASO/MoH in this sector.
5. Misinformation and lies appears to be the modus operandi of NASO and the MoH
In summary, the continued failure of NASO and the MoH to contract an adequate level of service will put
patients lives at risk – you should be ashamed of your part in this and the incompetence of those around
you.
Shay McGuinness
Clinical Director of Air Ambulance Services
ADHB
From: [email address] <[email address]>
Sent: Friday, 13 December 2019 12:59 PM
To: Jo Brown (WDHB)
<[email address]>
Cc: [email address]; [email address]; [email address];
Jo Mack (ADHB)
<[email address]>; Melissa Nathan-Patuawa (NDHB)
<Melissa.Nathan-
[email address]>; [email address]; Sarah Hoyle (NDHB)
RELEASED UNDER THE OFFICIAL
<[email address]>; Shay Mc Guinness (ADHB)
<[email address]>
Subject: Re: Crewing and Asset Plan V1.20 - response required please
Kia ora Jo,
Document 6
A number of the things you raise below have been captured already in the outstanding issues list we
developed in relation to use of the AW169s, a response to which wil form part of suite of material Keriana
wil deliver to decision makers early next week. This suite of material wil also cover off decisions relating
to the Helilink asset and comments made by the ARHT Chief Pilot recently.
In relation to asset availability I recognise that it is important that this is clarified to enable you to plan
accordingly.
The provider is currently meeting the contracted obligations in relation to crew and asset availability. This
includes the AW 169 assets based at Ardmore. I acknowledge that this is not your desired state, but it is
what is what has been purchased.
The use of the BK HKZ is for a backup asset in the event that the primary and secondary asset is not
available (for example maintenance). This is il ustrated in the crew and asset plan where HKZ is
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scheduled to be crewed from 10:30 – 21:30 on the 16th December when IZB is undergoing a one day
scheduled maintenance. There is no contractual expectation that the BK asset is crewed over and above
the primary and secondary crafts.
The provider has indicated that due to tasking of national IHTs to Whangarei that this has impacted on
their ability to complete training of their pilots to their plan. The provider is currently having to mix the
assets and crew, however, again they are meeting their contracted crew and asset availability.
We are confirming arrangements internal y about primary point of contact for you on operational matters
and on-call arrangements over Christmas. I can talk you about this on our call.
INFORMATION
Lastly an introductory email to new members of the NASO team is certainly on my to-do list and I wil get
this to you ASAP.
Monique
Monique Burrows Group Manager Primary Health Care System Improvement and Innovation
Acting Manager Office of the Deputy Director-General
Health System Improvement and Innovation
Ministry of Health
Mobile: s 9(2)(a)
From: "Jo Brown (WDHB)"
<[email address]>
To:
"[email address]" <[email address]>,
Cc:
"[email address]" <[email address]>, "[email address]"
<[email address]>, "[email address]" <[email address]>, "Jo Mack (ADHB)"
<[email address]>, "Shay Mc Guinness (ADHB)"
<[email address]>, "Melissa Nathan-Patuawa (NDHB)"
<[email address]>, "Sarah Hoyle (NDHB)"
<[email address]>,
"[email address]" <[email address]>
RELEASED UNDER THE OFFICIAL
Date: 12/12/2019 03:22 p.m.
Subject: Crewing and Asset Plan V1.20 - response required please
Hi Monique
Document 6
I am sending this email directly to you as we are not receiving responses to our emails directly from the NASO
team. As discussed at our TC last week (Friday) I would appreciate there being clarification of who is the
responsible person in NASO who will be responding on a timely basis to our requests for information or
clarification. I note the number of MOH/NASO individuals included on the emails yet we are not getting any
responses to questions from anyone. I am not comfortable that new names are being added into these email
loops without knowing who people are and their roles and responsibilities and whether they can help us get the
information we need. Can you please confirm who you think should be responding to us as it is completely
confusing to me at this point in time.
I believe the ADHB CEO has already clarified with the DDG that we need to be receiving timely and complete
responses to questions that directly pertain to the daily operational capacity and management of our IHTs
(Northland and national) to enable our clinical and operational leaders and our clinical teams to do their job. Can
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we please get this resolved and expectations agreed noting this is needed before the Christmas/New Year period
when we will be reliant on single individuals in MOH/NASO on an “on call” basis.
Specifically – in respect of outstanding information (emails from last week):
•
We have asked for HKZ information to be more appropriately provided - as advised on many occasions
previously there is no knowledge on any day/night, week or weekend, whether HKZ is able to be deployed. Both
Shay and I have requested this and we have had no response to our previous emails so it is very disappointing to
see the commentary below is completely silent on HKZ capacity and capability (and the asset and crew plan v1.20
is unchanged in respect of this).
INFORMATION
•
There has been no response to Shay’s email of 3 December asking for the minutes of the Equipment and
Certification meeting (on that day) to record comments made by the Chief Pilot. I have been advised by others in
the team that the minutes have not been circulated at all and this delay is unusual. Can you please confirm the
reason for the delay and ask your team to circulate these minutes ASAP
With respect to this update v1.20:
•
I note the email commentary provided by Barry below with the asset and crew plan v1.20 is a “NRHL”
summary (copied from the asset and crew plan) and this is not helpful to us. The summary does not provide the
clarification we need (as detailed in this feedback – and last week’s). We are not receiving any informed
commentary from NASO about the gaps in the supplied capacity and what is being done to address these supply
‘gaps’. We have raised this before, and the lack of any NASO commentary in respect of what is being done as
contract manager to resolve the supply ‘gaps’ is problematic.
•
I note in this update the reference to the 76C++ crew training occurring in the first two weeks of December
and I note that this “two weeks” ends this week. It is hard to interpret from the commentary below whether there
will be two NEST assets simultaneously available for IHTs as per the contracted hours (1 X 24/7 and 1 X 10 hours)
on a daily basis while this training continues. Can you please provide this confirmation that NEST will be crewing
as per the contracted capacity
•
Can you also please confirm our understanding that based on the asset and crew plan from Monday the two
76C++ will be the ‘primary’ assets in use and available for the contracted hours.
•
Can you please provide us with an update regarding extending the HGW lease arrangement to enable a 76C
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to be relocated back to North Shore ASAP, and can you please confirm that HGW continues to be the first option
for pre-hospital missions thereby enabling the NEST assets to be available for both Northland and national IHTs
(note this is particularly important given the next bullet point)
•
The ARHT crewing arrangements continue to state that
only one of the Auckland assets are (and will be)
2PIFR. This means that while we already agree that the contracted four helicopters is insufficient capacity for the
Northern region, the supply agreement is actually only providing three “national IHT” capable helicopters. The
Document 6
crewing approach by the provider is having a direct impact on the ability to use HKZ for national IHTs, and will
continue to be a problem when the AW169s are in use for national IHTs. While the asset and crew plan states HKZ
is available “crew dependent” all of the data points to this being not available at all
•
Can I please ask you to get the asset and crew plan updated to correctly identify the availability of HKZ so it is
completely transparent where the Auckland national IHT gaps are on a daily basis – and if this is day and night
every day then this needs to be made explicit
In addition can I also please ask that you clarify the MOH expectations of the supplier in respect of the contracted
capacity currently not being provided. The lack of a national IHT capable asset in Auckland seems to be a
reduction/withdrawal of service and I am not sure if this has been discussed and agreed between NASO and the
supplier. Can you please confirm if this is the case?
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Happy to discuss further by phone if that is helpful
Regards
Jo
Out of scope
INFORMATION
RELEASED UNDER THE OFFICIAL
Document 6
Out of scope
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INFORMATION
RELEASED UNDER THE OFFICIAL
Document 6
Out of scope
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INFORMATION
RELEASED UNDER THE OFFICIAL
Document 7
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"[email address]" <[email address]>
Cc:
"Graham Dyer" <[email address]>, "[email address]"
<[email address]>, "Nick Chamberlain (NDHB)"
<[email address]>, "Russel Simpson" <Russel .[email address]>,
"[email address]" <[email address]>, "[email address]"
<[email address]>
Date:
19/12/2019 11:57 am
Subject:
RE: Memo - Air Ambulance Issues in the Northern Region
The Board resolutions are as below. The Northern Region is working with Russell to respond to the
report and other recommendations.
Coms will go out today.
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That the Board approve the use of the AW169 for inter-hospital transfers.
That the Board approve the reverting of tasking to ARHT
Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
From: [email address] [mailto:[email address]]
INFORMATION
Sent: Thursday, 19 December 2019 11:34 AM
To: Ailsa Claire (ADHB) <[email address]>
Cc: Graham Dyer <[email address]>; [email address]; Nick Chamberlain
(NDHB) <[email address]>; Russell Simpson <[email address]>;
[email address]; [email address]
Subject: RE: Memo - Air Ambulance Issues in the Northern Region
Kia ora koutou
Ailsa, many thanks to you and Nick for supporting this process and then carefully considering and supporting the
recommendations. I understand your Board has also approved.
Both Scott and I have signed off on the recommendations.
I want to acknowledge the very challenging circumstances we have been dealing with and the stress this has created
for all parties. For the record, I am wholly confident that Ministry staff have acted professionally and honestly
throughout in working with all parties to find solutions, and will continue to do so
Kind regards
Ashley
Dr Ashley Bloomfield
Director-General
RELEASED UNDER THE OFFICIAL
Ministry of Health
email
: [email address]
Mobile: s 9(2)(a)
www.health.govt.nz
Document 7
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"[email address]" <[email address]>, "Russel Simpson"
<Russel .[email address]>
Cc:
"Nick Chamberlain (NDHB)" <[email address]>, "Graham Dyer"
<[email address]>, "[email address]"
<[email address]>, "[email address]" <[email address]>
Date:
17/12/2019 04:46 pm
Subject:
RE: Memo - Air Ambulance Issues in the Northern Region
Kia ora
Thank you for this.
This is clearly a comprehensive report and the Northern Region need time to consider it fully before
commenting which we will do via Russell.
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Nic and I will also work via Russell re future governance, tasking and provision of the 5th air ambulance.
In terms of the immediate discussion at our Board tomorrow I think we need to be mindful that AW169
have only been available for interhospital transfers since the 3rd week in November. It feels rather
strange that ADHB decision taken soon after this is the reason for the provider not being able to meet
the contract since 1 April.
Further the information that would have enabled ADHB to agree to staffing these aircraft had been
requested 3 + months ago. The panel, for instance, appeared to be unaware that scale and weight of
INFORMATION
ECMO equipment and staff. The information is needed to allow the tasking guidelines to be established.
This information re load and distance has not being provided until today.
I feel the report unfairly blames ADHB for a position which is not of our making.
I have repeatedly said to you that if the assurance can be forthcoming ADHB would reconsider its
position which is after all about staff protection.
We now have that data on page 15 and will make a recommendation to the Board tomorrow.
In relation to tasking we asked that an urgent review of the incident which occurred on Nov.6th to allow
us to be assured that the provider would answer their phones to allow tasking to take place.
Unfortunately the review of the incident has only now been made available to us and some how links
tasking issues to the basic fact they just did not answer their phones.
I understand the issues re tasking is a national one which we will discuss with Russell.
In the short term we will recommend to the Board to go back to tasking via ARHT.
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We wil come back to you with the Board decision.
Given your assurance and confidence in the provider I look forward to a full and comprehensive service
being provided for our patients.
Ngā mihi
Document 7
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
From: [email address] [mailto:[email address]]
Sent: Tuesday, 17 December 2019 12:34 PM
To: Ailsa Claire (ADHB) <[email address]>; Nick Chamberlain (NDHB)
<[email address]>; Russell Simpson
<[email address]>; [email address];
[email address]; [email address]
Subject: Memo - Air Ambulance Issues in the Northern Region
Importance: High
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Kia ora koutou
Please find attached a memo, the purpose of this memo is to provide a summary of current issues with the air
ambulance service within the northern region, the Ministry of Health’s (the Ministry) and Accident Compensation
Corporation’s (ACC) position in relation to those issues, and to propose a set of recommendations to allow the
service to move forward.
So far for December 2019, NRHL has fulfilled the contract requirements for service availability. However, there are
residual matters that have been raised by northern region DHBs that require resolution before the service can be
INFORMATION
utilised effectively. The matters fall into three broad categories: competency of ARHT and the performance and
safety of the AW169 helicopter; regional capacity; and tasking. These concerns are addressed in the memo and
supporting documentation is attached (in the memo and separately).
ADHB, ARHT and NEST are all holding governance meetings within the next two days. NEST have advised in
advance of their board meeting that they are finding it very difficult to continue the current protocol of ADHB only
tasking NEST and is placing strain on the overall service provision for Northern Region. ARHT have advised in
advance of their board meeting that they are in a position to meet ADHB's IHT tasking requirements.
Graham and I are happy to talk urgently about the content of the memo, it is critical that this information is used to
enable decisions to use the full suite of available assets for the services (including tasking) as soon as possible, from
this week is preferable.
Refer to ‘Document 7A’
Memo - Air Ambulance Issues in the Northern Region FINAL 17 December 2019.pdf
Operational information sent to ADHB 04 December 2019.xlsx
Refer to ‘Document 7B’
Regards
Keriana Brooking
Deputy Director-General
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Health System Improvement and Innovation
Ministry of Health, 133 Molesworth Street
PO Box 5013, Wellington 6145, New Zealand
Mobile: s 9(2)(a)
Email
: [email address]
National Ambulance Sector Office
Memo
Air Ambulance Issues within the Northern Region
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Date:
17 December 2019
To:
Dr Ashley Bloomfield, Director General-Health, Ministry of Health
INFORMATION
Ailsa Claire, Chief Executive, Auckland District Health Board
Dr Nick Chamberlain, Chief Executive, Northland District Health Board
Russell Simpson, Chief Executive Whanganui DHB and lead DHB Chief Executive for
ambulance
Scott Pickering, Chief Executive, Accident Compensation Corporation
From:
Keriana Brooking, Deputy Director-General Health System Improvement and Innovation,
Ministry of Health
Graham Dyer, Enterprise Advisor, Accident Compensation Corporation
Subject:
Air ambulance issues within the northern region
For your:
Approval / Decision
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1
Purpose
To provide a summary of current issues with the air ambulance service within the northern
region, the Ministry of Health’s (the Ministry) and Accident Compensation Corporation’s
(ACC) position in relation to those issues, and to propose a set of recommendations to
allow the service to move forward.
Background
In 2018, Cabinet approved the first phase procurement for a new air ambulance (rotary)
contract that included prehospital, regional and national inter-hospital transfer (IHT)
services. In March 2019, Northern Rescue Helicopter Limited (NRHL) was awarded the
contract for the northern region. NRHL is a joint venture between the two historical
providers of the service: Northern Emergency Services Trust (NEST) and Auckland Rescue
Helicopter Trust (ARHT). NRHL was the sole applicant for the region in the 2018 tender for
air ambulance services.
The new contract means that the Ministry and ACC are contracting on behalf of the DHBs,
managed by the National Ambulance Sector Office (NASO). This represents a change to
past practice whereby the northern DHBs had directly contracted for IHT services and
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managed those contracts.
As part of the implementation of the new contract, NRHL reconfigured the location of its
assets, resulting in the removal of a helicopter from the North Shore, which Auckland DHB
had been using primarily for IHT retrieval missions. In its RFP submission, NRHL indicated it
would no longer provide a dedicated helicopter for IHT services, and that IHT service
provision would be spread across the entire NRHL fleet. This proposal was accepted by the
RFP evaluation panel.
INFORMATION
NRHL’s proposal included bringing in four new assets to the region. Since the beginning of
the contract, a combination of delays in onboarding the new assets, reduction in
availability in existing assets due to major unplanned maintenance, turnover in key staff
within NRHL, operational challenges and the removal of the dedicated asset at North
Shore has led to continual contingency management activity. This has resulted in elevated
clinical risk, diversion of demand and system uncertainty, and has placed tremendous
pressure on those involved and strained relationships.
In addition, a lack of reliable data and compressed timeframes in which to complete the
procurement process, coupled with immediate implementation, meant that capacity
requirements for the region could not be predicted with certainty, and the ability to
improve this during transition was denied.
So far for December 2019, NRHL has fulfilled the contract requirements for service
availability. However, there are residual matters that have been raised by northern region
DHBs that require resolution before the service can be utilised effectively. The matters fall
into three broad categories: competency of ARHT and the performance and safety of the
AW169 helicopter; regional capacity; and tasking. These concerns are addressed in turn
below.
ARHT and the
Issues
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AW169s
A number of matters regarding the stability of ARHT operations and the safety of the
AW169 helicopter have been raised by Auckland DHB and anonymously by another party.
The matters relating to ARHT include staff turnover at the governance and leadership level,
the impact of introducing new aircraft and relocating bases, a long period of demand
diversion due to asset unavailability, communication and relationship challenges.
2
The matters relating to the AW169 helicopter include general safety issues and operational
performance capability. A log of these issues, with responses, can be found at Appendix A.
On 6 November 2019, a delay in response by ARHT to a time-critical IHT request led to
ADHB changing its tasking protocol to direct all IHT tasks to NEST. This has impacted
significantly on flying hours, crew availability and maintenance across the NRHL fleet,
which is placing additional pressure on the provider and adding cost to service provision.
Auckland DHB, on advice from its Audit and Risk Committee, is not allowing staff to fly on
the AW169 helicopters for IHTs but is allowing its Emergency Department doctors to utilise
these assets for pre-hospital missions.
Response
Provider capability
In July 2019, in response to concerns about NRHL’s ability to deliver on contractual
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expectations, NASO commissioned Phil Hogan of Heliport Design Group to review the
organisation and make recommendations for improving organisational performance and
aviation safety. The provider accepted all the recommendations in the report and has been
actively implementing changes.
In November 2019, NASO contracted an assurance assessment team to assess compliance
by NRHL (and its subcontractors) against the current contract with NASO, and progress
against the recommendations in the July Phil Hogan report. The assessment was led by Phil
Hogan and included a chief pilot assessor and specialist engineer. A summary report is
INFORMATION
available at Appendix B.
The assurance assessment team noted in the summary report that:
•
The progress being made by NRHL is consistent with the organisation and its sub-
contractors establishing and maintaining the appropriate governance, capability and
capacity to meet its obligations under the contract into the future.
•
The two Trusts have made substantial progress since July, when the Hogan Report
was completed and are now either achieving full compliance or will achieve full
compliance in the short-term, subject to the final certification of all aircraft by CAA,
which the Assurance Panel understands is imminent.
Safety of the AW169 helicopter
The Civil Aviation Authority (CAA) has been clear (excerpts from CAA emails are shown
below – copies available on request), in response to questions from both NASO and
Auckland DHB, that it has no safety concerns with ARHT or the AW169 helicopter.
“ARHT has been certificated against the requirements of Civil Aviation Rule (CAR) Part 119,
which means it has the appropriate systems in place to manage the risks of its operation,
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including management oversight, appropriately trained and competent pilots, suitable
operational procedures and suitable aircraft maintenance programmes.”
“The CAA is well aware of the changes the Trust has been going through and has been
providing oversight during those changes.”
“
…the CAA currently does not have any safety issues with the AW169 or ARHT.”
3
CAA has also received an anonymous complaint about the safety of the AW169 helicopter.
It responded in an email that while the investigation was incomplete the information
received does not alter the view on the airworthiness of the aircraft.
“…the allegation does not warrant any immediate action or operational limitation. The
aircraft has been designed, manufactured, tested and certified by a competent aviation
authority (EASA) with extensive helicopter design experience. As with any helicopter, it
must be operated within the limitations stipulated in the Flight Manual.”
The assurance assessment report also considered concerns raised by Auckland DHB about
the safety of the AW169 helicopter and did not find any evidence to support these views.
In light of the above advice, the funders’ position is that the AW169s are fit for service with
respect to undertaking IHT missions. We request that Auckland DHB re-considers its
current stance and allows these aircraft to be tasked for this purpose.
6 November 2019 incident investigation
ACT 1982
NASO's response to the 6 November 2019 incident was to commission an in-depth
investigation that has resulted in a detailed report (see attached incident report
Appendix C). The report identified a number of service system failures in the tasking
process and recommended a number of improvements to tasking in the northern region.
The Ministry and ACC consider the investigation into this matter closed and that
consideration and implementation of recommendations continue as part of business as
usual with appropriate governance.
INFORMATION
Recommendations
1. That the Ministry and ACC strongly urge ADHB to immediately use the AW 169 for the
full range of IHTs.
2. That Auckland DHB takes the necessary steps to discontinue its tasking protocol for
national IHTs that currently preferentially utilises Whangārei based assets.
3. That NASO, NRHL and northern DHBs implement the recommendations of both the
Assurance Review Report and the incident investigation report.
4. That a governance group consisting of senior Ministry, ACC and DHB representatives
be established to work alongside NASO and key stakeholders to oversee the
recommendations from this memo, the assurance review report and the 6 November
2019 incident review report. It is intended that within the scope of this group, is
governing the next steps to provide the boards of Auckland and Northland DHBs with
the assurance that national and regional IHT services have air ambulance rotary wing
assets available to them in a safe and timely fashion. Governance group members to
meet weekly by teleconference from the week starting 6 January 2020.
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Crewing capacity
Issues
The contract with NRHL stipulates single pilot instrument flight rules (SPIFR) but allows for
two pilot IFR (2PIFR) for IHTs at the provider’s discretion. The current contract price is
based on SPIFR costs so would need to be adjusted for full 2PIFR operations.
4
Operational convention for Auckland DHB is 2PIFR for all IHT services. However, neither
NEST nor ARHT have sufficient crew for 2PIFR operations across all assets in the medium
term (see Appendix B).
Currently ARHT is providing one asset 2PIFR 24/7 with the second asset crewed single pilot
visual flight rules (SPVFR) day time only. NEST provides all operations 2PIFR. However, CAA
has signalled that changes to fatigue management rules will require additional crew if
NEST is to continue with this practise. NEST has advised NASO that this requirement is not
currently funded.
NEST has indicated that ADHB’s decision not to use the AW169s for IHTs has placed
enormous pressure on crewing availability, maintenance and operational management.
There will be increased pressure on crewing capacity as we approach the high season for
pre-hospital activity.
The funders’ position is that the contract relies on all assets being used for all services.
ACT 1982
Necessary redundancy is kept in the system to cover planned and some unplanned
maintenance. It does not cover selective utilisation of assets by DHBs. Non-use of available
provider capacity does not equate to service unavailability in a contractual sense.
Response
Currently ARHT is providing one asset 2PIFR 24/7 with the second asset crewed Single Pilot
Visual Flight Rules (SPVFR) day time only. The Assurance assessment team believes that
the crewing of the second asset is sub-optimal for aeromedical tasking and the range of
tasks likely to be encountered in the region. In terms of meeting the requirements of the
INFORMATION
contract, ARHT should maintain a minimum level of crewing for the second asset at SPIFR.
NASO has engaged with NRHL regarding the feasibility of increasing its capacity through
changes to its current service levels and including the provision of 2PIFR for all flights.
Recommendations
5. That NASO support 2PIFR for all flights in the northern region for the duration of the
current contract term, to facilitate the use of the AW169s for IHTs.
6. That NASO vary the contract, including pricing, to facilitate 2PIFR operations and
increase the crewing configuration within NRHL. It is anticipated that this pricing
increase will be funded within the Ministry’s ambulance appropriation.
Service capacity
Issues
ADHB advised NASO that there was insufficient contractual capacity to meet national IHT
requirements and subsequently went to market for a dedicated national IHT service. A
review by the Ministry of this procurement resulted in that process being suspended and a
separate procurement being led by the Ministry. The Ministry procurement is still live.
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There is now a full complement of crew and assets available for IHT across the region. The
selective utilisation of assets by ADHB has significantly reduced capacity for IHTs and is
disrupting the provision of services in the region. The decision has resulted in:
• inefficient asset utilisation
• undue burden on a single subcontractor to provide all IHT services
• increased crew fatigue affecting next day rosters
5
• increased costs of IHTs, particularly for Northland DHB
• undermining DHB clinical staff confidence in ARHT
• impacting operational relationship with both subcontractors
• de-skilling ARHT in the provision of IHTs
• impacting asset management and maintenance requirements
• increased operator stress and aviation safety risk.
Response
The Ministry and ACC have signalled that they would consider increasing capacity in the
region on receipt of evidence to support it.
ACT 1982
The assurance assessment team identified that IHT capacity issues could be resolved by
using all assets in the region. Therefore, the additional Helilink asset will not be used after
31 December 2019.
Recommendations
s 9(2)(b)(ii)
INFORMATION
8. That the Ministry and ACC work actively with the DHB to capture the IHT data to
inform an urgent modelling exercise to ensure sufficient regional capacity.
9. That subject to modelling, contracted capacity is adjusted to meet the need.
Tasking
Issues
Currently there are two interrelated systems for the coordination and tasking of air
ambulance helicopter assets. For pre-hospital missions, tasking is performed through the
Air Desk, and Auckland DHB IHT mission tasking is performed through the NZAAS Flight
Coordination Service.
The 6 November 2019 incident investigation and the assurance report have identified that
there are issues with the current tasking arrangements in the northern region. This is also
a concern of the providers.
The Ministry and ACC understand that there is general support from the northern region
DHBs for a centralised tasking and coordination service. Further work is required to
articulate the understanding of service requirements.
The establishment of a National Tasking and Clinical Coordination Centre was identified as
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a Phase 2 activity in the 10-year air ambulance strategic plan.
Response
It is recommended that options for centralised tasking and coordination in the northern
region be investigated as a first step.
6
At this stage, the funders do not have a preference as to what form a centralised tasking
and coordination function takes. We would like to work with stakeholders to scope this
work and examine options.
Recommendations
10. That NASO commence a co-design project to develop a centralised tasking and
coordination service incorporating prehospital and IHTs for the northern region, to be
overseen by the joint governance group proposed in recommendation 4 of this memo.
Relationships
It is acknowledged that there have been challenges that have tested relationships with all
parties involved. While it will be difficult to repair these relationships, it is not
unattainable. However, a commitment by all parties to work in a cooperative and
constructive manner is needed to move forward. The funders believe this can best be
facilitated through the development of a joint governance group and shared work
programme (see recommendation 4).
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Recommendations
It is noted:
• That the CAA has advised it does not have safety concerns with ARHT as a provider of
air ambulance services.
• That the progress being made by NRHL is consistent with the organisation and its sub-
contractors establishing and maintaining the appropriate governance, capability and
capacity to meet its obligations under the contract into the future.
INFORMATION
• That the lowest risk option for meeting IHT need in the region is to utilise all the assets
in the region.
It is recommended:
1.
That the Ministry and ACC strongly urge ADHB to immediately use the
Yes/No
AW169s for all IHTs.
2.
That Auckland DHB take the necessary steps to reverse its tasking
Yes/No
protocol for national IHT which currently only utilises Whangārei based
assets.
3.
That NASO, NRHL and northern DHBs implement the recommendations
Yes/No
of both the Assurance Review Report and the incident investigation
report.
4.
That a governance group consisting of senior Ministry, ACC and DHB
Yes/No
representatives be established to work alongside NASO and key
stakeholders to oversee the recommendations from this memo, the
assurance review report and the 6 November 2019 incident review
report. It is intended that this group governs the next steps to provide
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the boards of Auckland and Northland DHBs with the assurance that
national and regional IHT services have air ambulance rotary wing assets
available to them in a safe and timely fashion. Governance group
members to meet weekly by teleconference from the week starting
6 January 2020.
7
5.
That NASO support 2PIFR for all flights in the northern region for the
Yes/No
duration of the current contract term, to facilitate the use of the
AW169s for IHTs.
6.
That NASO vary the contract, including pricing, to facilitate 2PIFR
Yes/No
operations and increase the crewing configuration within NRHL. It is
anticipated that this pricing increase will be funded within the Ministry’s
ambulance appropriation.
s 9(2)(b)(ii)
8.
That the Ministry and ACC work actively with the DHB to capture the IHT
Yes/No
data to inform an urgent modelling exercise to ensure sufficient regional
capacity.
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9.
That subject to modelling, contracted capacity is adjusted to meet need.
Yes/No
10.
That NASO commence a co-design project to develop a centralised
Yes/No
tasking and coordination service incorporating prehospital and IHTs for
the northern region, to be overseen by the joint governance group
proposed in recommendation 3 of this memo.
INFORMATION
Signature: Date:
_____________________________ _____________________________
Keriana Brooking Graham Dyer
Deputy Director-General of Health Strategic Advisor, ACC
Page 7-8 recommendations endorsed by:
Signature: Date:
_____________________________ _____________________________
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Name:
Position:
Organisation:
8
Appendix A: Questions raised by Auckland DHB
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Use of AW169s for IHT missions
11 December 2019
Current situation
•
AW169s being utilised for pre-hospital missions but not for IHTs.
•
AW169s are certified for use in IHT missions and all up-front pilot/clinical staff training complete (accepting this will be an ongoing requirement due to staff
turnover).
INFORMATION
•
Auckland DHB are tasking Northland based helicopters as a priority for national IHTs.
Issues to be resolved
The list of issues to be resolved to enable the use of AW169s in IHT missions, as agreed with Auckland DHB, is outlined in the below table.
The status column represents the Ministry/ACC/NASO position in response to these issues.
Targeted date of
Issue
Description
Status
Lead
resolution
Investigation into
NASO led investigation into delayed
Draft investigation report shared with northern region
Carleine Receveur 16 December 2019 for
6 November 2019
time critical IHT, as reported by
DHBs on Friday 29 November 2019 for comment. DHB
(NASO) with
completion of
delayed retrieval
Auckland DHB
written feedback provided on 3 and 4 December 2019
assistance from
investigation report
and a face to face discussion took place on 5 December
Rose Laloli (TAS)
2019. The final report attached as Appendix C to this
memo
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9
Targeted date of
Issue
Description
Status
Lead
resolution
It is proposed that implementation of the
recommendations be overseen by a governance group
consisting of Ministry, ACC and DHB representatives
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Operational
Information on payload, range and
Performance spreadsheet compiled by Heliport Design
Considered to be closed
information
speed of AW169s
Group using flight manual information and users of the
relating to AW169s
aircraft types in question to provide realistic data.
to inform DHB
Included a comparison to the S76C++. Provided to
tasking guidelines
Auckland DHB on 4 December 2019. Auckland DHB
responded by requested analysis based on “real world”
scenarios (clinical crew numbers, patient weight, NZ
weather conditions).
INFORMATION
Advice received from Heliport Design Group and the
provider is that there are numerous variables that come
into play relating to variable weather conditions, holding
patterns etc leading to endless scenarios. It is up to the
provider to define the most appropriate asset and crew
response to a tasking request and this in-depth scenario
modelling goes beyond what is required for clinical
decision making
A related request for information on refuelling
requirements for common destinations under 6
scenarios is being actioned (see below)
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Targeted date of
Issue
Description
Status
Lead
resolution
Operational questions
Item 4 to be progressed
as part of the
1. What specifically were the safety
The provider reports that during the course of training,
implementation of 6
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concerns, raised by the flight nurses, clinical staff asked a range of questions about the
November incident
about the AW169? Where did these operational capability of the AW196s. The provider
investigation findings
concerns come from and to whom
characterised these as being routine in nature and were
were they reported?
responded to by ARHT staff as part of the training
Remainder of items
session.
considered closed
2. What specifically were the concerns The provider reports that any questions about vibration
raised by the flight nurses about the that were raised by clinical staff during training sessions
vibration level of the AW169?
were in response to the description of the active
INFORMATION
Where did these concerns come
antivibration system which is not a feature in the BK117s.
from and to whom were they
In addition, the assurance review looked into the
reported?
vibration matter by conducting a test flight, talking to
operators and conducting literature searches and
concluded that there was no evidence for concern
3. What back up arrangements have
The BK117 HKZ is being retained as a back up helicopter
you for scheduled and unscheduled
for the next 3 years. As per current practice, both NASO
maintenance of the AW169’s? How
and DHBs will be advised anytime there is a scheduled or
will this information be passed on
unscheduled maintenance event on any NRHL aircraft
to ADHB?
4. When will you provide NZAAS with
NRHL’s position is that the AW169s will be loaded on
NASO
Investigation report
TracPlus access for the AW169s?
TracPlus once they are able to be tasked for IHT missions.
(minus appendices) to
Access is needed now as the pilots
be shared with the
flying the AW169s are the same
A recommendation of the 6 November incident report is
provider on 17
pilots who would fly the BK117s for
that NZAAS Flight Coordinators have full visibility of air
December 2019
IHT. Therefore if they are out on a
ambulance helicopter missions via TracPlus. This
mission in the AW169s the BK117
recommendation will be shared and discussed with the
cannot be tasked for an IHT.
provider
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Targeted date of
Issue
Description
Status
Lead
resolution
Refuelling requirements for common
Provider has completed the table provided, see below.
NASO
Considered closed
destinations under 6 scenarios
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Staffing
Considered closed
1. Can you please confirm that both
Contract states that 2 pilot IFR
may be required.
However, the provider has committed to providing 2
AW169’s will be crewed and staffed
pilot IFR for one 24/7 asset. It is proposed that NASO
as per the NASO contract for 2 pilots
facilitate the secondary asset to be crewed 2 pilot IFR
IFR?
also
2. What are the hours of the second 10
Currently operational hours are 1030-2130. This
INFORMATION
hour AW169?
information is held by Air Desk, which receives regular
updates
3. Will you be providing shift by shift
The use of the BK117 HKZ is for a backup asset in the
information on the pilots on whether
event that the primary and secondary asset is not
they are HKZ rated?
available (for example maintenance). There is no
contractual expectation that the BK asset is crewed over
and above the AW169s.
General items
Considered closed
1. Can you please confirm that you will
There are no plans to base an asset in the Coromandel
not be basing an aircraft in the
over the summer period
Coromandel over the summer
period?
2. Has there been an increase in pre
NASO’s data for the period April to November 2018
hospital tasking since April 1st when
compared to the same period in 2019 shows a 5%
reduction in pre-hospital missions for ARHT
the HEMS team became 24/7?
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12
Targeted date of
Issue
Description
Status
Lead
resolution
3. Has there been an increase in tasking This information is produced annually by calendar year
and will be available end of January 2020.
31 January 2020
outside of the traditional ARHT
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destinations (excluding
Coromandel)?
Safety concerns
CAA investigation into reported safety
CAA are not in a position to provide a definitive
CAA
Considered closed for
concerns with AW169s
timeframe for completion of this investigation, but have
the purposes of use of
advised that the allegations do not warrant any
AW169s for IHT missions
immediate action or operational limitation i.e. there are
no safety barriers to the use of the AW169s for IHT
missions
INFORMATION
Working
Comments made by ARHT Chief Pilot at
There is significant tension between NRHL and Auckland
Governance
Closed
relationship
weekly key milestones meeting on 3
DHB and one example is the certification meeting also
group
between ARHT and December are suggestive of an attitude
attended by NASO on 3rd Dec 2019 where parties came
DHBs
issue that presents a barrier to pilots
away with different interpretations of the content.
and clinical staff working together as an
Please see NASO file note 8/12/19 on the following page.
effective team
This reflects a relationship that needs significant effort
from all parties to become more productive.
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13
NASO File note 08/12/19
In follow up to the Certification and Equipment meet that was held as a regular weekly operational meeting, Shay McGuinness, requested via email, on the
3/12 to Barry Woodmass, that the minutes convey what Shay believed that Roger (Chief Pilot ARHT) had stated. The interpretation of the NASO team is
somewhat different to what Shay heard.
ACT 1982
Please see below further details for your reference:
The four points made by Shay were:
1. They will not give us access to Tracplus until we commit in writing to using the 169s
2. They won’t provide the range etc information to us because there is no requirement for them to do so in the contract
3. They don’t believe they have anything further to discuss with ADHB because their contract is with NASO
4. They have enough work anyway so don’t really care if they do IHTs or not
INFORMATION
Peter and Barry have commented below to each point on what they believe their interpretation of the conversation was.
1. They will not give us access to Tracplus until we commit in writing to using the 169s:
• ARHT confirmed safety would not be compromised
• ARHT commented that they will provide TracPlus visibility following confirmation in writing from ADHB regarding commencing use of AW169 for
IHT.
2. They won’t provide the range etc information to us because there is no requirement for them to do so in the contract:
• ARHT indicated they have already provided range and specification details to ADHB.
3. They don’t believe they have anything further to discuss with ADHB because their contract is with NASO
• ADHB commented a meeting with ARHT had been cancelled the previous week due to the Assurance team visit and was seeking to reschedule the
meeting.
• ARHT indicated another meeting is not required at this time.
4. They have enough work anyway so don’t really care if they do IHTs or not.
• ARHT commented that they would reassign AW169 assets to pre hospital and "other jobs" if not used for IHT.
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14
Full ECMO
Full PICU team (2-3
Full ECMO team (
team,
Clinicians) family
AW169 Performance
4 Clinicians) and
equipment and
member and
equipment
a patient of
equipment
140Kgs ACT 1982
This table illustrates the proportion (as a %) of missions you
Destination
VFR
IFR
VFR
IFR
VFR
IFR
would expect the AW169 to be able to complete without
100%
100%
100%
100%
100%
100%
refuelling provided that:
Rotorua
100%
100%
100%
100%
100%
100%
-
Aircraft refuel at each destination
Gisborne
100%
100%
100%
100%
100%
100%
-
Weather conditions are:
Hastings
nil wind
100%
100%
100%
100%
100%
100%
INFORMATION
nil fog
Taranaki
nil icing enroute
100%
100%
100%
100%
100%
100%
Taupo
-
no delays with air traffic control
New Plymouth 100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
-
not allowing for instrument Departure or Inst approach
Wanganui
Palmerston
100%
100%
80 kg patient
80 kg
100%
100%
-
nil IFR alternate required for destination aerodromes or
North
100%
patient
140 kg patient 100%
hospital helipads
refuel enroute 140 kg
patient
-
PICU stretcher – 2 clinicians
refuel
enroute
-
All pax at 80 kg average
Hutt (Avalon) Need to refuel
Need to Need to refuel Need to
100%
100%
NZWN
enroute
refuel
enroute
refuel
enroute
enroute
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15
s 9(2)(f)(iv)
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ADELAIDE BANK HELICOPTER SERVICE
REVISED STATEMENT OF REQUIREMENTS
Document 7B
Mission Tasking - IHT
Notes: Here is a copy of the range details for the AW 169, it also compares the S76 C&&. The speed chosen we believe is reasonable although it is slightly generous for the
S76 (perhaps 5 – 10 knots slower with external equipment). The AW169 is listed as red at a weight of 4814 kgs which is 14 kg over maximum take off weight, the reality is that
the starting fuel, flight to ADHB and loading time is about 60 to 80 kg fuel. After this point they would pick up the medical crew and extra equipment, allowing them to have
maximum fuel from Ardmore.
AIRCRAFT: Leonardo AW169
AIRCRAFT: Sikorsky S76C++
SPECIFICATIONS
Kg
Lb
Lts
SPECIFICATIONS
Kg
Lb
Lts
MTOW RUNWAY
4800
10579
MTOW RUNWAY
5307
11697
ZERO FUEL WEIGHT SP/IFR (Fixed Provisions)
3255
7174
ZERO FUEL WEIGHT SP/IFR (Fixed Provisions)
3484
7679
Equipped Empty Weight includes Neo Natal Cot
3518
7754
Equipped Empty Weight includes Neo Natal Cot
3747
8258
EMS / SAR Removable Equipment Weight
0
0
EMS / SAR Removable Equipment Weight
0
0
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Pilot
90
198
Pilot
90
198
Co-Pilot
90
198
Co-Pilot
90
198
Medical Personnel (2)
180
397
Medical Personnel (2)
180
397
Equipment
50
110
Equipment
50
110
MISSION WEIGHT OUTBOUND (ZERO FUEL)
3928
8657
MISSION WEIGHT OUTBOUND (ZERO FUEL)
4157
9162
CRUISE TAS
130
CRUISE TAS
140
CRUISE FUEL FLOW
300
661
375
CRUISE FUEL FLOW
320
705
400
ENDURANCE FUEL FLOW
273
602
341
ENDURANCE FUEL FLOW
280
617
350
FUEL CAPACITY STD
880
1940
1100
FUEL CAPACITY STD
850
1873
1063
FUEL AUX
0
0
FUEL AUX
0
0
FUEL TOTAL
880
1940
1100
FUEL TOTAL
850
1873
1063
DISTANCES
DISTANCES
TO POSITION
145
TO POSITION
137
INFORMATION
RETURN TO BASE
145
RETURN TO BASE
137
TOTAL DISTANCE
290
TOTAL DISTANCE
274
OUTBOUND to Incident
OUTBOUND to Incident
FLIGHT TIME (minutes)
67
FLIGHT TIME (minutes)
59
FLIGHT TIME (RTB)(minutes)
67
FLIGHT TIME (RTB)(minutes)
59
FLIGHT FUEL
335
738
418
FLIGHT FUEL
313
690
391
FLIGHT FUEL RTB
335
738
418
FLIGHT FUEL RTB
313
690
391
VARIABLE RESERVE @10%
67
148
84
VARIABLE RESERVE @10%
63
138
78
FIXED RESERVE @ 30 Min.
150
331
188
FIXED RESERVE @ 30 Min.
160
353
200
TOTAL FUEL REQUIRED
886
1953
1108
TOTAL FUEL REQUIRED
849
1871
1061
TAKEOFF WEIGHT OUTBOUND
4814
10611
TAKEOFF WEIGHT OUTBOUND
5006
11034
ADDITIONAL PAYLOAD OUTBOUND
-14
-31
ADDITIONAL PAYLOAD OUTBOUND
301
664
INBOUND from Incident
INBOUND from Incident
LANDING WEIGHT @ INCIDENT
4480
9873
LANDING WEIGHT @ INCIDENT
4693
10343
LOAD INFANT PATIENT
1
2
LOAD INFANT PATIENT
1
2
TAKEOFF WEIGHT
4481
9875
TAKEOFF WEIGHT
4694
10345
ADDITIONAL PAYLOAD AVAILABLE INBOUND
319
704
ADDITIONAL PAYLOAD AVAILABLE INBOUND
613
1352
Note:
This is a theoretical mathematical exercise only and does not consider temperature, wind and weather holding / alternate requirements.
Both aircraft are capable of flying Auckland District Hospital to Hastings a distance of 194nm.
The S76C++ based at Whangerai could pick up a medical crew at ADH enroute and fly to Hastings without refuelling.
Both aircraft would require refuel ing in Hastings before return.
The GREEN data boxes can be used to input scenarios for range and loading.
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Document 8
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"[email address]" <[email address]>,
"[email address]" <[email address]>,
"[email address]" <[email address]>, "[email address]"
<[email address]>, "Nick Chamberlain (NDHB)"
<[email address]>, "russel .[email address]"
<russel .[email address]>, "[email address]"
<[email address]>
Date:
31/01/2020 03:17 pm
Subject:
RE: Minutes - Governance Group Northern Region Air Ambulance Service
Thanks
I have a few comments on the minutes
ACT 1982
Ngā mihi
Ailsa Claire
Chief Executive
P: 09 - 6309943 extn 22342 M: s 9(2)(a)
From:
Peter Whisker/MOH
To:
[email address], Ashley Bloomfield/MOH@MOH, [email address], Kathy
Rex/MOH@MOH, [email address], russel .[email address],
Keriana Brooking/MOH@MOH
INFORMATION
Date:
31/01/2020 12:49 pm
Subject:
Minutes - Governance Group Northern Region Air Ambulance Service
Refer to ‘Document 8A’
Minutes - Northern Region Air Ambulance Governance Meeting 24th Jan 2020 1.0.docx
Kia ora
Please find attached minutes from the last Governance meeting for the Northern Region Air Ambulance
Service
Please advise if you have any agenda items for the next meeting.
Papers and agenda for the next meeting 7th Feb wil be issued in due course.
Kind regards Peter
Peter Whisker
Contract Manager
National Ambulance Sector Office
Primary Health Care System Improvement and Innovation
Health System Improvement and Innovation
Ministry of Health
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DDI: 048163639
Mobile: s 9(2)(a)
http://www.hiirc.org.nz
Visit the HIIRC today and register as a NZ health professional
mailto:[email address]
Document 8A
MINUTES
Governance Group - Northern Region Air Ambulance Service
Meeting Date:
Friday, 24 January 2020
Time:
8:30–9:00 am
Location:
s 9(2)(k)
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Meeting Room 3C.5 Ministry of Health
Chair:
Keriana Brooking
Attendees:
Ailsa Claire (Auckland DHB), Ashley Bloomfield (MoH), Graham Dyer (ACC),
Russel Simpson (Lead DHB CEO), Keriana Brooking (MoH), Kathy Rex
(MoH)
Apologies:
Nick Chamberlain (Northland DHB) INFORMATION
Item
Action
Who
1.
Previous Meeting
Action: 1
Include summary of the previous
Summary of Governance Group - Northern
meeting and distribute with the
Region Air Ambulance Service Meeting held minutes of this meeting.
10 January 2020
MoH
Terms of Reference (draft) for the group to
be developed and added to next meeting for
ratification.
Action 2
National Tasking and Coordination
Procurement for Additional Asset
Project to be scheduled and planned
It was agreed that this procurement would
as part of the Collaborative
be paused (neither cancelled or
Governance Group when
proceeding). During this period the Ministry appropriate.
wil work through their process to vary the
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contract in respect of increasing to a 2 Pilot
IFR and increased number of assets
available 24/7. This includes capacity
modelling and completion of investment
process as the cost of a new asset falls
outside the scope of its current
appropriation. Agreed the procurement of
a new asset was outside the scope of this
forum.
National Tasking and Coordination
Project General agreement that central
Document 8A
tasking should progress but not at the level
of urgency described in the report as there
is a significant change management
process that needs to accompany this
project. Agreed that a National Tasking and
Coordination Project was not within scope
of this group.
2.
Capacity - 2 Pilot IFR
Action:4
NASO
Further work is underway to support
Contract variation to be developed to
increasing the crewing capacity in the
support 2Pilot IFR for IHT.
northern region and provide a contract
variation so all IHT’s are 2Pilot IFR. This
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may be a different policy for other regions.
Which use single pilot IFR.
MoH/
Capacity - Increase Availability
DHBs
Currently availability of rotary aircraft is in
the contract specifies 2x assets 10 hours
and 2x assets 24 hours. Work is underway
to vary the contract to increase availability
to 3x24hours. John Becker has sent through
INFORMATION
data on IHT’s to support modelling capacity.
3.
MoH
Terms of Reference
DHBs request for a formal response to the
letter to MoH on 23rd Dec 2019 responding
Action: 5
to memo recommendations. The group
acknowledged that some of the same
MoH to send formal reply to letter
recommendations appear across both the
23rd December from DHBs.
issues report and the assurance report and
or the incident report and can be
Action: 6
consolidated and addressed in the work
Terms of Reference to include two
programme going forward.
new recommendations proposed by
the DHBs in the letter 23rd
December.
Action: 7
Update status report to reflect the
recomm
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scope.
Action: 8
Update ToR to include two additional
items. A) Incident Report or RASCII
B) Provider fortnightly performance
report.
Document 8A
4.
NASO
Incident Management
Action: 9
Provide progress update at next
Agreed incident management required
meeting on improvements to incident
improvement by all parties. January
management and include incident
incidents have been reported but have yet
register with status report.
to be received by NASO.
5.
Relationship Management
Action 10
NASO/
Noted that NASO have organised a visit to
Kathy Rex and NASO visit to
ADHB
meet with Jo Gibbs at ADHB in Auckland
Auckland
next month. Items for discussion include
Post meeting update Meeting
incident reporting and relationship and
Schedule 20 February
protocols.
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Seeking to make improvements to incident
management. This includes assigning
accountabilities for incident management.
Also, to have conversations with the
provider around progress in NRHL and
improvements to service.
INFORMATION
6.
DHBs
Clinical Directors
Action: 11
Briefing note to be developed around
clinical director roles. This includes
the Clinical Director for Pre-Hospital
of ARHT and the Clinical Director for
Skyline.
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Document 9
From:
"Ailsa Claire (ADHB)" <[email address]>
To:
"[email address]" <[email address]>,
"[email address]" <[email address]>
Cc:
"russel .[email address]" <russel .[email address]>, "Nick Chamberlain (NDHB)"
<[email address]>, "Margaret Wilsher (ADHB)" <[email address]>
Date:
07/02/2020 09:34 am
Subject:
Air ambulance
Kia ora
One of the issues I was going to raise at the meeting was the issue of air ambulance transfers for ECMO.
I include the briefing that has been done in relation to the potential need for additional capacity in our
ECMO service. The figures will give an idea of the likely increase in interhospital transfers which if it also
is ongoing over winter will cause quite a peak.
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I would like Marg to be able to work with the contractors on protocols given these patients will be
infectious.
What is the best way forward on this one?
Ngā mihi,
INFORMATION
Ailsa Claire
Chief Executive
(09) 630-9943 ext. 22342 | M: s 9(2)(a)
|
[email address]
Auckland District Health Board| Level 1| Building 37 | Auckland City Hospital
The information contained in this email and any attachments is confidential and intended for the named recipients
only. If you are not the intended recipient, please delete this email and notify the sender immediately. Auckland
DHB accepts no responsibility for changes made to this email or to any attachments after it has been sent.
Refer to ‘Document 9A’
Brief justification for two additional ECMO machines.docx
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Document 9A
Brief justification for two additional ECMO machines, ADHB
Prepared by Margaret Wilsher CMO
Endorsed by Ailsa Claire CE
February 5, 2020
Extracoporeal membrane oxygenation (ECMO) is a form of intensive cardiorespiratory support using
a modified heart-lung machine to allow for treatment and recovery from severe respiratory or heart
failure. ADHB provides a national service for adult and children who require such support, most
commonly patients with severe pneumonia or following heart/lung transplant or paediatric
congenital cardiac surgery. Patients who require ECMO cannot be supported with the usual intensive
care therapies including intubation and ventilation.
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In the 2009 H1N1 influenza pandemic, ADHB provided the national ECMO service for patients with
influenza pneumonia and severe respiratory failure. Approximately 10 patients had prolonged ICU
stay and received ECMO for H1N1 related respiratory failure. The maximal number of patients on
ECMO at any one time was 7 although these were not all H1N1 cases.
Early reports from China indicate around 17% of admitted coronavirus patients develop acute
respiratory distress syndrome, of whom 3% require invasive ventilation and 3% ECMO support
INFORMATION
(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext). This is
similar to that reported for the H1N1 outbreak. Thus, in the event of a coronavirus pandemic, New
Zealand will need to be prepared to provide ICU level services in the same way as planned for and
provided for the H1N1 pandemic. It is reported that ventilation times for novel coronavirus 2019
patients are shorter than H1N1 but little else is known of the outcomes of these patients.
In the decade since the H1N1 pandemic, the NZ population has grown by approximately 500,000. As
such we consider that ADHB will need two further ECMO machines to cover the possible demand at
peak incidence of the pandemic. It should be noted that indications for ECMO have generally grown
since 2009 and there is insufficient capacity to provide for the anticipated volumes of patients with
respiratory failure referred during a possible coronavirus pandemic. Although it is likely that ADHB
will need to cancel elective cardiac surgery during such time it will not be possible to stop urgent and
emergency cardiac surgery, transplant or access to ECMO for patients with other causes of
respiratory failure.
Two additional ECMO machines should allow both adult cardiac and paediatric intensive care
services to be able to provide sufficient capacity for predicted coronavirus cases and to have
equipment on standby for emergencies. Allowing for the possible lead time to peak incidence, then
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ADHB is accelerating the ECMO training programme to allow for sufficient nursing staff to provide
ECMO care during a pandemic.
It is recommended that the Ministry consider supplementary funding for two additional ECMO
machines at an estimated price of $ 130K per unit.
It is strongly recommended that an order is
placed as soon as practicable given predicted international demand for such equipment as the rest
of the world prepares for the coronavirus pandemic. ADHB also advises that the peak incidence of
a coronavirus pandemic is likely to occur at the same time as seasonal influenza and other
Document 9A
respiratory illnesses thus increasing the likelihood that ECMO capacity will be rapidly exceeded
unless additional ECMO machines are secured.
A full business case is in preparation and updated clinical and epidemiologic information will be
incorporated as it becomes available.
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INFORMATION
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