28 July 2022

Harold

Īmēra / Email:  [FYI request #19525 email]

Kia ora / Dear Harold

RE Official information request ChChD 10925 / HNZ 1770

I refer to your email dated 31 May 2022 which we received on 7 July 2022 requesting the following
information under the Official Information Act from Waitaha Canterbury. Specifically:

•  I would like to make a request for a copy of the COVID-19 Southern Region Resilience Plan.

Please find attached as Appendix 1 the Southern Resilience Plan dated 21 October 2021.

I trust that this satisfies your interest in this matter.

Please note that this response, or an edited version of this response, may be published on the Waitaha
Canterbury website after your receipt of this response.

Ngā mihi / Yours sincerely,

Ralph La Salle
Senior Manager, OIAs
Waitaha Canterbury / Te Tai o Poutini West Coast.

Te Whatu Ora.govt.nz
PO Box 1600, Christchurch, Postcode 8011

Southern Regional Resilience Plan: update for Health Systems Readiness Steering Group
21st October 2021
Resilience Plan - Overview
The purpose of this plan is to provide advice to DHBs, Ministry of Health and Minister of Health and Associates on what wil
be required to build the resilience of the South Island healthcare system in anticipation of changes in pandemic management
strategy and Government policy settings.
A function is considered resilient if it has the capacity and capability to support sustainable responses to recurring
community resurgences of COVID-19, without limiting the ability to provide effective non-COVID related health care
services.
South Island
Key assumptions
Predicted regional numbers per week (in 2022)
Resilience
(from modelling by TAS)
Model
3,036
The “worst case scenario” model ing has been used
to inform resilience planning.
New cases
•
90% adult (16+) vaccination rate.
142
2,894
•
No vaccination of <12 year olds.
•
Loose public health controls.
Hospital admissions
In community
•
Loose border restrictions.
14
Deaths
RELEASED
Priorities to build resilience
Priority area
Recommendations by December-21
Estimated additional
funding required
(Detailed costings can be produced
UNDER
on request)
Increasing Māori and Pacific Service Providers’
• Offer flexible and sustained funding models for Māori and Pacifika Providers, to fund end-to-end COVID services.  Inclusive of:
capacity and capability to offer end-to-end care
• individual activities
inclusive of COVID support services to their
• testing,
communities sustainably.
• Vaccination,
THE
$40m
• welfare support for isolating households.
• Fund cultural y competent Training Providers to recruit, upskill and grow the available workforce pool.
• Increasing the Kaiawhina workforce.
OFFICIAL
• Providing funding security to al ow workforce growth within Providers beyond the health transition in July 2022. (note MoH support needed)
Enhance and establish systems and infrastructure  • Funding required specifically targeted towards improving access to care for COVID positive patients in rural communities and/or who have difficulty accessing
for sustainable service to rural and vulnerable
care.
$2m
communities.
• Comprehensive plan to incentivise recruitment of health care workers to rural communities.
Recruitment and Training
• Funding to enable networks of 24/7 Primary Care to COVID Cases in rural communities.
INFORMATION
$20m
• Develop networks with rural NGOs & communities to ensure connection and consideration of rural services is transparent to health.
Annual workforce Cost
• Extend digital or alternative connection to our rural isolated communities. (note MoH support needed)
• COVID core data set needs to include monitoring of rural COVID service delivery and response.
• Expediate the mobility of services across the whole system to support delivery of care to where it is needed.
Expand regional capacity for air and road
• Support regional and local connections to ensure urgent care transport is efficient and available across our rural and urban areas.
transport services especially to rural areas.
• National resourcing to coordinate approach. (note MoH support needed)
• Increase local based ability to respond, within clinically appropriate times, for the predicated increase in service demand.
$ 10m
Investment in St John as wel
ACT
Upgrading the facilities, infrastructure and
• Funding required to enable facility and infrastructure changes required across the five DHBs to sustain care for COVID patients and non-COVID activities.
equipment to ensure there is appropriate and
• Conduct rapid triage assessment for all community services to determine facility requirements.
sufficient availability of space to treat patients
• Conduct rapid review of space available for screening, testing and pre-triage of patients at al  health service entrance points–including standing up dedicated
$29m (one off)
who are COVID positive.
temporary space,  or changes to entrance points, and implement recommendations from findings.
• Support ICU capacity increase business case.
Workforce to meet the demand of COVID care.
• Increase the provision of sustainable services such as Māori and Pacifika workforce including Kaiawhina workforce and consider alternative workforce
solutions.
$2m
• Provision of a sustainable funding that enables capacity to manage predicted demand, such as:
Recruitment and training
• Extend IPC workforce.
$34m
• Optimise Workforce capacity requirements (Workplace bubbles, DNM after hours, pharmacy).
Annual workforce cost
• Build staff wel being response.
• Ensure H&S requirements are met for staff across sector (N95 fit testing).
• Extend Public Health workforce.
•
Build Mental Health to support capacity and accessibility
Offering a standardised Welfare package to
• Ensure that the appropriate agencies have a scalable and sustainable process that provides an immediate 48 hour Manaaki package to all families requiring to
enable families to safely self isolate with COVID.
self isolate, including procurement, storage and logistics arrangements. (note MoH support needed)
$50m
• Acquire equipment to allow self-monitoring of symptoms.
May include other agency
• Implement DHBs psycho-social responsibilities during care in the community programme of activity.
funding
Set up communication system and data and
• Increase communication resource for health workforce, unions and public/ community platforms.
information infrastructure.
• Enhance interoperability of information systems across the system (e.g. Secondary to Primary, NCTS access for Primary Care).
• Common Data analytics platform across the region enabling access to latest information and quick decision making.
$1m
• Knowledge management program to share models of care and other COVID related innovation.
Recruitment
• Fund a dedicated resource for media engagement.
$20m
• Hardware that enables workforce mobility, and so deliver care closest to the home.
Hardware and licensing costs
Develop and operationalise models of care that
• Implement telehealth to enable community outreach while supporting service capability and sustainability of BAU activity.
support rapid MDT review, supportive decision
• Support the development of local and regional pathways and decision making tools to enable seamless whole of system approach to care including the
making and treatment/care planning for COVID
enablement of our Kaiawhina approach to care in the community.
positive patients.
• Develop safe and efficient ways to manage the care pathways of asymptomatic COVID positive patients who require planned or urgent care unrelated to COVID
$6m
infection
Resource - telehealth
Community and Primary care
• National work and funding underway “ Care in the Community work Stream”
• Continue effective engagement and col aboration with primary and community providers

Southern Regional Resilience Plan: update for Health Systems Readiness Steering Group
xxth October 2021
Scenario modelling overview
The below assumptions have been used to model the predicted impact of COVID in the South Island in 2022.
Key assumptions (Full assumptions available on request)
•
90% adult vaccination rate by Dec 2021.
•
Children ages 12-15 are vaccinated.
Over 2022 year
Average per week in 2022
•
0-11 year olds not vaccinated.
%
•
Borders are opened 1 Jan 2022.
SI DHB’s
Cases Hospitali
% cases  deaths  %
•
Restrictions remain on travel to some countries, but otherwise quarantine-
-sations Deaths % cases
M
P
m
deaths P Cases Hospitali
-sations Deaths
free travel is occurring.
NMDHB
21,200 1,100
120
12%
2%
x
x
408
21
2
•
Assume Delta variant is main issue, medium R0 = 4.5 per REF.
•
Assume variation in coverage by community around the average
WCDHB
4,400
240
30
12%
1%
x
x
85
5
1
vaccination coverages.
CDHB
78,200 3,500
340
11%
3%
x
x
1,503
67
7
•
Vaccine efficacy (Pfizer) against Delta = 88%, against severe disease 94%.
•
Assume severity proportions as per REF.
SCDHB
8,300
410
40
12%
1%
x
x
160
8
1
•
Vaccine reduction in transmission - 85%.
SDHB
45,900 2,100
210
12%
3%
x
x
883
40
4
•
No further community lockdowns, but case isolation and contact tracing
e.g. as measles is managed now, drops R0 44% [REF p11].
Total Regional 157,900 7,400
750
12%
3.5%
3036
142
14
•
Health care workers at 93% coverage - assume other groups slightly lower.
(Note, rounding may cause some variation in numbers reported)
•
M + P have 2.5 and 3x the rate of hospitalisation as European/Other.
RELEASED
Assumptions and notes
Priority area
Notes and assumptions
Estimated additional
funding required
UNDER
Enhance and establish systems and infrastructure  • Based on model ing approximately 43% of the south island population is classified as living outside of city centre.
for sustainable service to rural and vulnerable
• This requires service delivery remotely with a reliance on mobility/ technology and transport to access patients and services.
communities.
• The average travel time to a hospital for a rural patient is 2.5 -3 hrs and is highly weather dependant.
THE
• 24 additional FTE required to staff “Q@HomeHub” concept, with average salary of $100k per year.
• Note some Primary Care funding may be from already allocated streams.
$40m
OFFICIAL
Increasing Māori and PacificService roviders’
• Based on modelling, approx. 15.5% of new cases will be Māori or Pacifika ethnicities, with an estimated 470 cases per week in these communities.
capacity and capability to offer end-to-end care
• To accommodate the growth in cases within these communities, at least 100 additional FTE regionally will need to be trained and contracted by Providers.
$2m
inclusive of COVID support services to their
• An estimated training cost of $10k per person has been assumed based on current courses available.
Recruitment and Training
communities sustainably.
• An average salary of $100k per year has been used, with a 15% overhead margin.
$20m
• Funding also extends to Kaiawhina workforce and welfare support.
Annual workforce Cost
INFORMATION
Expand regional capacity for air and road
• The South Island has two tertiary hospitals with Canterbury being the hub for speciality services.
transport services especially to rural areas.
• Travel between the tertiary centres  being in excess of four hours and the average travel time between hospitals is 2.5 hours which is highly weather dependant.
$ 10m
• There is a significant increase in transpiration infrastructure including speciality configured vehicles,  and increased number of drivers.
Investment in St John as wel
• The impact on service availability of  St Johns will be further comprised with requirements of transporting COVID patients.
Upgrading the facilities, infrastructure and
• Note that some of these projects are already underway and retrospective funding wil  be required.
equipment to ensure there is appropriate and
• Note a business case is already progressing for approval to increase the number ICU capacity.
sufficient availability of space to treat patients
• Increasing Christchurch’s resourced ICU beds by 21 would bring Canterbury DHB’s beds per 100,000 population to 6.8 (currently 3.4), and raises national beds to
$29m (one off)
who are COVID positive.
5.4 (currently 5.0) per 100,000 population.
• Conduct rapid review of options to increase laboratory capacity
ACT
Workforce to meet the demand of COVID care.
• Develop a strengthened kaiawhina workforce model within the DHB and Māori Health providers to support our Pae Ora model of care. Includes recruitment,
orientation, education/training and leadership.
$2m
• The clinical expertise and skillsets in the primary care sector needs to better leveraged and supported to manage the evolving COVID-19 pandemic. This is
Recruitment and training
especially the case as the pandemic becomes endemic and part of everyday life and the shared care approach across primary care (general practice), telehealth
services, secondary care, Māori and Pacific health care services and other allied health workforces.
$34m
Annual workforce cost
Offering a standardised Welfare package to
• Based on modelling, around 2,900 cases per week will not require hospitalisation.
enable families to safely self isolate with COVID.
• Of these, we have assumed approx. 1 in 3 cases wil  require welfare support for their whānau, to enable safe self isolation.
$50m
• The average cost to provide essential welfare support (food, clothing, telecoms, medication and children’s items) has been $750 per whānau (from NRHCC
May include other agency
Welfare team), in addition we have estimated an additional $250 per whanau to cover additional costs associated with rurality and transport/ supply.
funding
• Providing this support to the estimated number of cases wil  require an additional $961k per week.
• Note this may be from other agencies budgets
Set up communication system and data and
• Central development of tools to allow many settings to self-manage exposure events without ARPHS involvement (e.g. schools, DHBs, Businesses) will release
information infrastructure.
ARPHS capacity and allow triage function to be established.
$1m
• Coordination of real-time view of ICU and hospital occupancy to enable planning of service delivery.
Recruitment
• Enhance ethnicity reporting, surveillance and analytical support to ensure data driven decision making and service delivery
$20m
Hardware and licensing costs
Develop and operationalise models of care that
• Providing frameworks for enabling MoC changes across:
support rapid MDT review, supportive decision
• General Practice virtual/telehealth consult (Person’s regular or alternative general practice provider)
making and treatment/care planning for COVID
• Workforce: GPs, Nurses, Public Health, translation services
positive patients.
• Decision-making framework: Adaptation of RPA Risk Stratification and Ontario model, Testing requirements for contacts who may be isolating with
$6m
cases.
Resource - telehealth
• Training / Guidance: COVID-19 Community HealthPathways, webinars, Clinician to Clinician line, 0800 COVID-19 Positive Line for cases
• IT: PMS integration with NCTS and BCMS
Community and Primary care
•
No funding required as assumed funding as part of the Care in the Community” programme.
• The community care, welfare, home and community, mental health and disability support needs of the household/whānau are organised alongside the COVID-
Funding from Care in
19 Primary Care Clinical Model
Community Workstream

Document Outline