MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 27 FEBRUARY 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Kirsten Wise
Helen Francis (from 1.10pm)
Apology:
In Attendance:
Kevin Snee (Chief Executive)
Andrew Lesperance (General Manager Planning and Performance)
Warrick Frater (Chief Operating Officer)
Tim Evans (Chief Financial Officer)
Members of the Executive Management Team
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
DECLARATIONS OF INTEREST
There was one amendment noted to the Conflicts of Interest Register.
Member David Davidson advised his contract with Cranford had concluded and asked that
reference be removed from the Register.
Action
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 19 December 2012, were confirmed as a true and
correct record of the meeting.
Moved:
Barbara Arnott
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 1: Conflicts of Interest was an agenda item at the meeting and would be removed from
the actions
Item 2: Personal care versus nursing home cost differentials, a report would be provided to
the March Board Meeting
Item 3: A report on Safe Sleep would be provided to the Board in March.
Item 4: Reports to be emailed to board members early, noted and the action removed.
March 2013
Section 1
1
CONFIRMATION OF MINUTES OF EMAIL RESOLUTION
Consent to Issue of Class B Shares in HBL
On 27 December 2012, a Board Report entitled “Consent to Issue of Class B Shares in
Health Benefits Limited” was distributed to board members by email as there was insufficient
time to call a meeting. By 8 January 2013, unanimous support had been received and the
recommendation/resolution was deemed to be carried. The Chief Executive duly signed the
consent form by due date.
“The Board:
• Consents to becoming the holder of 2,504,000 Class B Shares to be issued to it by
Health Benefits Limited
Once consent is obtained, that the Board:
• Delegates authority to the Chief Executive (or in his absence the Company Secretary)
to sign the relevant consent form on the Board’s behalf.”
Carried
BOARD WORK PLAN
The Board Work Plan for March 2013 was noted with the Central Hawke’s Bay Service
Model, Urgent Acute Unplanned Care and also the Regional Services Plan being provided to
the next meeting.
The Board had agreed to workshop on a strategic issue at future meetings. It had been
envisaged this would commence in April, however in the interim the topic would be discussed
amongst board members, together with the procedural aspects.
Action Chair
ACCOUNTABILITY PLANNING TIMELINE
Timelines provided by Planning & Performance were progressing well and noted.
CHAIR’S REPORT
Retirements
The Chair advised the meeting of those retiring or about to retire. Letters would be sent to all,
conveying the board’s wishes and thanks for the years of extended service.
Name
Job Title
Service
Ian Bunny
Orderly
Facilities & Operational Support (38 years)
Albert Dyer
Pharmacy Asst
Integrated Care Services (10 Years)
Sigi Ziegler
Interpreting Services Co-ordinator
Facilities & Operational Support (15 years)
Kaye Palmer
Registered Nurse
Acute & Medical (34 years)
The Chair provided a verbal update of communications received as summarised below:
• The Letter of Expectation for DHBs and subsidiary entities for 2013/14 year had been
received just prior to Christmas, with the government continuing to expect better, sooner,
more convenient healthcare for patients and communities within constrained funding
increases.
It had been noted that good progress on patient access targets had been made, however
more effort was needed on preventative targets.
The minister noted the need for care close to home as vital for better management of
long term conditions, mental health, an ageing population and patients in general.
For health of older people, the need for integrated services that support continued safe,
independent living at home.
Regional collaboration was integral as was implementing Regional Service Plans and
DHBs living within agreed financial plans.
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• A copy of the National Health Targets for Quarter 2 had been received and the Minister
had congratulated Hawke’s Bay on our position in the table.
• A letter had been received from the Minister relating to the B Class Share resolution with
him advising he had consented to the issuing of shares and for the DHBs to hold such
shares (reflected by funding put into the project).
• A “submission” had been received from NZ Nursing Organisation regarding the Business
Case for parking charges at HB Hospital.
• Mr Brian Roche, Chairman of the First World War Centenary Panel was encouraging the
HBDHB to consider how we could commemorate New Zealand’s involvement in the 1st
World War in 2018. The Chair saw this as an opportunity to dig into our past to discover
stories about how the war touched Hawke’s Bay, the hospital and its people and
suggested a workplan be developed on how we could participate in the commemoration.
Action Executive Team
• The Audit New Zealand Report for year ended 30 June 2012 would be issued to FRAC
members.
Actioned
CHIEF EXECUTIVE OFFICER’S REPORT
The CEO welcomed Liz Stockley to the meeting who was recently appointed as Chief
Executive of Health Hawke’s Bay. He congratulated Liz on her appointment and looked
forward to working with her.
The Chief Executive’s Report to 18 February 2013 was received and noted with the following
points summarised:
Some difficulties with performance, however there were expectations that throughput in the
Emergency Department (ED) would improve. A team were looking at performance aspects
to ensure patients with primary care conditions were seen by the right people and not
congesting ED. These, as well as waiting times for surgery were expected to improve over
the coming months.
Health Hawke’s Bay (PHO) were working hard with various campaigns, including heart and
diabetes checks. An improvement had already been seen in people scanned.
The financial position had seen an improvement for the month of January, with intense focus
on achieving an end of year surplus.
Primary Care initiatives - Better Sooner More Convenient:
• The CEO had been appointed as the national lead for Pharmacy Services which included
managing a complex national contract with nearly 1000 providers.
• Pharmacy Services appear to be working well locally, with Hawke’s Bay recognised as
one of the better performers nationally.
• HBDHB now have a number of General Practice Relationship Managers to provide a
single point of contact for a primary care provider; to support the development of
integrated service programmes and ensure good communication between HBDHB and
the GP practices and care providers.
This initiative, the first nationally, was more about solving nuisances the DHB create and
how we can change DHB workforce culture to be more responsive to the needs of
primary care.
Four senior managers were also aligned also, to provide greater resource to manage the
interface to ensure we work firmly in tandem with Health Hawke’s Bay.
The Relationship Managers held regular meetings to ensure consistency. Concern was
expressed that there appeared to be another layer of management. In response, this
was more about putting resources into a neglected area of need. This was not a
bureaucratic move but purely aimed to streamline processes and costs. Presently there
were monthly interactions with GPs. GPs often had limited understanding and the
interaction was focused on communication and problem solving.
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• In summary some key problems areas receiving attention were waiting times for surgery
and waiting times for acute admission to hospital (ie the 6 hour target). Financial control
also remains a high priority.
FINANCIAL PERFORMANCE REPORT FOR MONTH ENDED JANUARY 2013
The Chief Financial Officer presented his report for the seventh month of the financial year
2012/13, revealing an adverse variance to the end of January of $799k. The report was
taken as read.
The main negative areas were: IDF Outflows and Medical staffing and locums.
• The drop in home help hours was noted and assumed to be the result of work done in
this area. Feedback received from those receiving home help was they were happy with
the questions and it was pleasing to note that no complaints had been received.
• Inter District Flows (IDFs) was discussed with the three components which make up the
costs. This is all relative to facility service and expertise and requires a multifaceted
approach. In reality IDFs is work going off to a specialty where the skills, rather than the
capacity is not available in HB (to the level required). Another aspect of IDFs is the costs
incurred by our DHB from Hawke’s Bay residents visiting other regions that require care,
for which we have no control.
.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 13 February 2013
Drs John Gommans / Chris McKenna were in attendance.
The Board were advised, with Dr Peter Foley on extended leave for the next few months, Dr
Mark Peterson had been appointed Acting Chief Medical Officer Primary Care; and Chris
McKenna (Director of Nursing) would be acting co-chair of Council.
The following summarised the outcomes and discussions at the Council Meeting:
• Council fully endorsed the concepts proposed to Improve Maternity Services in Hawke’s
Bay.
• The introduction of Care Pathways to help integrate what we do in primary and
secondary care was thought to be an easy decision initially. However our region was
tending to go in different directions. This topic would be further discussed at the next
Council Meeting in March and a way forward developed.
• Other topics discussed included the Regional Health Plan 2013/16; Priorities for Annual
Plan 2013/14; National Health Quality and Safety Indicators; Patient Safety campaign
• Quality Indicators for quarter two, highlighted triage compliance rates. There was a
project on acute unplanned care which ED was one part of which would address this.
• HB Laboratory Committee (a sub-committee of Council) reported they had refined a
labelling process/pathway which would assist understanding and curb errors.
DECISION
Improving Maternity Services in Hawke’s Bay – Maternity Consultation Recommendations
Warrick Frater (COO), Emma Foster, Dr Phil Moore, Rika Hentschel and Lisa Jones were in
attendance for this paper which had been endorsed by Clinical Council several weeks prior.
This had been to the Board previously with the purpose on this occasion to update where the
process was at and seek approval to prepare a business case.
The Board understood there had been low attendance at consultation meetings held across
the region and asked if this was of concern. Dr Moore advised it was more likely the result of
acceptance that rationalisation was required. Those who had attended the consultation
4
meetings were very appreciative with good feedback received. Wairoa in particular
appreciated the opportunity according to board member Denise Eaglesome.
The loss of beds in Napier was of concern to some, however they generally accepted it was
more about the ‘model of care’ provided, rather than location.
The Terms of Reference was being developed and the group in attendance were asked to
establish timelines, with specific emphasis to have a Business Case available within the
Board’s current term.
Action
In summary, the consultation process had endorsed the preferred option, although not as
many people participated as first thought, it appeared the community were generally happy.
The resolution was duly carried.
RESOLUTION
That the Board:
1.
Note the summarised feedback from the public consultation, “Improving Maternity
Services in Hawke’s Bay – A summary of submissions” (December 2012).
2.
Endorse that management publish the document “Improving Maternity Services in
Hawke’s Bay – A summary of submissions” (December 2012) onto the HBDHB website
and advise those submitters that requested follow-up of this publication.
3.
Recommend that the raw public feedback is reviewed throughout the implementation
phase of all recommendations, to ensure that there is ongoing recognition from the
public consultation into the model of care, where appropriate.
4.
Recommend that a full Business Case is developed, that includes:
a) The development of a Parenting and Maternity Support Centre, in conjunction with
the public, in Central Hawke’s Bay, and clear integration with the IFHS network.
b) A purpose built Primary Birthing Facility “Hub” is co-located to current maternity
services on the Hawke’s Bay Regional Hospital site.
c) The development of a Parenting and Maternity Support Centre is developed, in
conjunction with the community and key stakeholders in Napier, preferably
separate from Napier Health Centre.
d) Enhanced Wairoa hospital maternity care and clear integration with the IFHC and
IFHS network.
5.
Endorse management to lead a process of reviewing pregnancy and parenting
education in its totality, across the HBDHB district.
Moved: Denise Eaglesome
Seconded: David Davidson
Carried
Paid Parking Implementation – Business Case
Warrick Frater (COO), Tony McKee (Facilities Manager),Andrea Beattie (Property and
Contracts Service Manager) and Peter Kennedy (Finance) were in attendance for this item.
The COO outlined the parking difficulties, the need for more car parks, and ongoing costs
with the current system which were funded from existing resources.
The proposal before the Board was to install an organised parking system including a levied
charge for the parking solution provision and sought approval to take this to the next stage.
• It was considered feasible by those presenting, to implement a paid parking system.
• Paid parking was not a new concept for the health sector, as operations were already in
place in other DHB’s including: Auckland DHB’s, Waitemata, Counties-Manukau, Waikato
5
Hospital, Hutt Hospital, Wellington Hospital, Palmerston North Hospital and Canterbury
DHB.
• The preliminary Business Case to implement paid parking had been considered by the
Board in October 2012.
• Wilson Parking (WGNZ) had been identified as the preferred external provider, and
offered the equipment on a lease back arrangement, with ‘on the ground management’
backed by their wealth of experience in this type of work.
It was pointed out that Section 7 addressed prior queries from the Board.
Summarised comments from board members and presenters follow:
• Discussion around the majority of those paying parking fees being staff (ie., 70% utilised
by staff and 30% by patients) and the difficulties that posed.
• If the process was implemented, there was a blanket parking rate proposed, which was
not based on earnings. This concerned some board members.
• If the plan was implemented, there was no guarantee it would alleviate congestion at the
end of the day shift change at the Hospital.
• Concern around using health dollars to improve car parking which was an allocation of
scare resource.
• Consideration around not being able to park where they work had safety implications.
• For every DHB who had implemented a paid parking system there had been a drop off in
the first year, predominately due to staff not wanting to pay. From patients and visitors
perspective there had been no drop off.
• A board member advised a lot of services provided on the HBDHB site could be provided
in another location, alleviating the existing parking problem and asked whether that had
been looked at.
• There was a need for a wider transportation strategy (50 years plus), not just a car
parking policy. More work was required and it was too early to introduce paid parking.
• It was suggest that management approach the HB Regional Council to seal additional
carparks
Action CEO
• Hawke’s Bay DHB needed to find in excess of $10m of efficiencies each year, to ensure
health related projects were carried out. Staff engagement and retaining good staff was
crucial.
• The Deputy Chair did not support the case advising those who come with compassion
already pay taxes for services and the community were already over policed. The
likelihood of being punished for not paying fees was an issue also, as Wilsons’ were
known to be unforgiving in this area.
Following extensive discussion, the Board did not approve the implementation of paid
parking on the HB Hospital campus, HBDHB corporate office carpark or the Napier Health
Centre site.
The Chair felt the decision was the right one. Goodwill was necessary, staff morale was
crucial especially in the tight financial environment we work within. He fully supported
management to ensure further development of a Transport Strategy and look at all other
options.
Action. The team were thanked for their preparation and presentation.
Establishment of HBDHB Consumer Council
Ken Foote (Company Secretary) provided the background on a number of factors that had
combined necessitating a need to review how we engage with consumers at an
organisational level within HBDHB. These factors included: the existing consumer group
committee’s effectiveness; international research; Consumer and Provider Partnerships for
Improved Health Quality and Safety; a recent HBDHB Whole of Board performance
appraisal; the effectiveness of the HBDHB Clinical Council model and the effectiveness of
the Consumer Council structure set up by Canterbury DHB.
6
Following a positive discussion amongst the board and CEO, the following resolution was
adopted.
RESOLUTION
That the Board approve the establishment of the proposed HBDHB Consumer Council and
the attached Draft Terms of Reference
Mover
David Barry
Seconder
Barbara Arnott
Carried
Interests / Conflicts of Interests Registers
Ken Foote spoke to the paper prepared which was focused on streamlining formats and
procedures.
The advantage of the new format provided:
• Balance and extended the legal and ethical dimension into “best practice”;
• It was “principles based” rather than ‘rules based”;
• It was more complete in that it required the nature of any conflict to be described;
• It was simpler and easier to follow and fill out.
Agreement was reached and the following recommendation was adopted
RECOMMENDATION
That the Board:
• Note the contents of this report
• Reviews the current “Interests” and “Conflicts of Interests” registers for the Board and
Committees and amend /complete as appropriate.
• Approves the introduction of the proposed new “Declaration of Interests/Conflicts of
Interest Form”.
Adopted
MONITORING
Human Resource KPIs for Quarter 2 (October – December 2012)
John McKeefry GM Human Resources provided an overview of the paper which was taken
as read.
The staff engagement survey would commence in March and results would be provided to
the Board in May.
Maori Workforce in the health sector: There is an opportunity in nursing, and concern was
expressed that this was not being taken up by Maori. The Deputy Chair asked how Iwi could
better support. It was advised the Maori Director of Health (Tracee TeHuia) was working
with a team in this area.
Four students exposed to “Incubator” in Hawke’s Bay schools, had come through to the
DHB. There was a need to focus on better links ie. processes from the programme in
schools back to HBDHB. It was difficult to track students through EIT and other institutions
who had actually embarked on study through exposure to “Incubator”. An issue realised by
some students wanting to study (particularly Maori), was their lack of science qualifications
when embarking on a nursing or clinical career.
7
Performance Framework for Quarter 2 (October – December 2012)
Andrew Lesperance, GM Planning & Performance and Rebecca Kaye (Business Analyst)
was present for this paper which was taken as read. This would be the last report prepared
by Rebecca who was complimented for an outstanding job.
GENERAL BUSINESS
There being no further general business the meeting moved to Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
19.
Confirmation of Minutes of Board Meeting dated 19 December 2012
- Public Excluded
20.
Matters Arising from the Minutes of Board Meeting dated 19 December 2012
- Public Excluded
21.
Board Approval of Actions exceeding limits delegated by CEO
22.
Confirmation of Whole of Board Performance Appraisal Report
23.
Whole of Board Appraisal Report Action Plan
Reports and Recommendations from Committee Chairs
24.
Finance Risk and Audit Committee – 27 February 2013 (tabled)
25.
Hawke’s Bay Clinical Council – 13 February 2013
26.
Mental Health Inpatient Unit Business Case
27.
Paid Parking Implementation – Commercially Sensitive
28.
Governance Committee Meetings
29.
Replacement Trustee on Te Matua A Maui Health Trust
30.
Draft Budget (Presentation)
Draft Capital Plan 2013-16
Moved:
Helen Francis
Seconded:
David Barry
Carried
The meeting closed at 3.00pm
Signed:
Kevin Atkinson, Chair
Date:
8
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 27 MARCH 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.08 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Apology:
Kirsten Wise
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
DECLARATIONS OF INTEREST
A change was notified to the Interest Register. Diana Kirton advised the Turuki Research
Project was now complete and should be removed and replaced with an EIT representative
on the Turuki Steering Committee.
Actioned by Board Administrator
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 27 February 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Dan Druzianic
Seconded:
Helen Francis
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 1: Options for Older Peoples Care was included on the Agenda for March
Item 2: A Safe Sleep Project Update would be provided in May 2013
Item 3: A meeting with committee chairs and management would be held on 5 April to agree
the topic(s) for the Strategic Committee Workshops in May and August.
Item 4: Following on the First World War Centenary and HBDHB’s involvement, this was
being co-ordinated by the Company Secretary, and the national body would be
advised.
Actioned
Item 5: Maternity Services in HB Business Case would be provided to the Board in their
current term. Action removed.
April 2013
Section 1
1
Item 6: The Chair would approach the HB Regional Council about car parking at the hospital.
Action
Item 7: The Site Development Strategy (over 50 years) which included transport and parking,
would need to be reviewed/updated, taking into account potential service changes
and availability of funding.
BOARD WORK PLAN
The Board Work Plan for April 2013 was noted. This included a Board Workshop in the
public excluded section of the meeting.
ACCOUNTABILITY PLANNING TIMELINE
Timelines provided by Planning & Performance were progressing well and noted.
CHAIR’S REPORT
Retirements
The Chair advised the following retirement, with a letter being sent conveying the Board’s
wishes and thanks for her years of extended service.
Name
Job Title
Service
Katherine Rawstron
Care Associate
Women Children & Youth (15 Years)
A verbal update of communications received is summarised below:
• A letter had been received from the Chair of Mid Central and Wanganui DHBs. The
purpose was to seek a collaborative working relationship with HBDHB and invited our
CEO and Chair to meet and to discuss a closer working relationship. This would be
progressed when the Chair and CEO were next in their area.
The CEO expressed concern that work at a sub regional level could/would detract from
the regional work required within the central region.
• The summary of the “Whole of Board” component of the IOD “BetterBoards” appraisal
process undertaken by the Board in 2012, as approved in February was sent to the
Ministry of Health. Advice was received from the Ministry that the Report had been
forward on to the Manager of the Governance and Crown Entities team, with a message
advising their gratitude as they did not often receive such an appraisal.
CHIEF EXECUTIVE OFFICER’S REPORT
The financial position was improving and tracking well through focused activity to contain
costs. Good performance was being maintained in most key target areas. There was a need
to focus on delivery of Emergency Department performance and waiting times. There was
also continued focus on development and improvements as we work towards integrated
care.
• The CEO provided an overview of his report to the Board including: Pharmacy led care;
Clinical Facilitators (Pharmacy & Diagnostics); More Heart & Diabetes Checks; Shorter
Stays In ED - Free Access To After-Hours Care For Under Sixes; Options for integrated
health services in Central Hawke’s Bay (CHB); Population Health initiatives including Tu
Mai Ra with good progress being made.
• It was acknowledged some pleasing work was being achieved in relation to delivery of
services in the community in an integrated way in partnership with the PHO.
2
FINANCIAL PERFORMANCE REPORT FOR MONTH ENDED FEBRUARY 2013
The Chief Financial Officer presented his report for the eighth month of the financial year
2012/13, revealing a year to date adverse variance to the end of February of $605k.
The $605k unfavourable was mainly attributed to IDF outflows, Medical staffing (locum costs)
which were fairly volatile, together with efficiencies not achieved. The YTD contingency had
been used for the year.
With $605k under plan achieved, this related to an accumulation of $2,064 thousand surplus,
compared to plan at end of February 2013 of $2,669k. Huge swings have been observed;
however the plan is to achieve an end of year surplus of $3.0m (less the $1.2 technical
adjustment reported last month).
The report was taken as read.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS13 March 2013
Hawke’s Bay Clinical Council
Chris McKenna (Co-Chair) of Clinical Council was in attendance and summarised discussion
at the 13 March 2013 meeting. Topics included: Clinical Pathways; Clinical Council
Research Committee; the Prioritisation Framework; a 5 Year Planning Update; Clinical
Indicators Report; Nursing/Midwifery Shared Governance Committee; Consumer Report
Quarter Two and Event Report Quarter Two.
The report was taken as read with the following comments made:
• Clinical Pathways: as several models were being used or considered, a regional
approach was required. It was not possible to have different models working within the
region. As a regional approach would take time, Hawke’s Bay would move forward with
background work utilising those keen and willing to participate noting this needs to be led
by General Practice/Primary Care.
Liz Stockley (CEO of Health HB) advised buy in from primary care was crucial. They
need to be involved from as they are an integral part of the success of a Clinical
Pathways model for Hawke’s Bay.
• A Clinical Council Research Committee would be set up around research in the public
health sector. There was a large body of work that required better co-ordination not to
mention the wealth of knowledge be gained from the research undertaken. The
Committee’s TOR would be refined and put out for consultation. It was noted this does
not include “ethics” which is managed independently.
DECISION
Governance Committee Meeting
The report prepared by Company Secretary, Ken Foote was taken as read with the following
recommendation adopted.
RECOMMENDATION
That the Board:
• Approve revised meeting schedule for 2013.
• Approve amended “Member” section of the Terms of Reference for the Maori
Relationship Board
Adopted
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FOR INFORMATION AND DISCUSSION
Draft Regional Services Plan 2013-16
Mary Wills (acting for GM Planning and Performance) was in attendance. The plan was
taken as read with a comment made by the Board to only include what was achievable.
Following some discussion the following recommendation was adopted.
RECOMMENDATION
That the Board
1.
Note timeline for finalising the Regional Services Plan 2013-16.
2.
Endorse Draft Regional Services Plan 2013-16.
3.
Provide comments as applicable for feedback to the plan developers.
Adopted
• The next step would be to receive National Health Board (NHB) feedback, amendments
and negotiate during April.
• The Final would be submitted to the NHB on 17 May 2013.
5 Year Health System Strategic Framework
This paper sought Board endorsement on the content of the overview of the 5-year Health
System Strategic Framework that can be used widely as a “ready reference” when
considering Hawke’s Bay DHB planning.
Three, one page formats were provided as appendices 1-3 which had been designed to be
used in different ways to aid communication. Clinical Council had provided positive feedback
and suggestions which had been incorporated into the Board’s copy.
Following some discussion the recommendation below was adopted with the Board generally
indicating preference for option 3.
RECOMMENDATION
That the Board:
Endorse the strategic one-page overview, with preference for option 3.
Adopted
Hawke’s Bay District Health Board Draft Annual Plan 2013/14
The draft Annual Plan 2013/14 had been provided to the Board to illustrate how priorities
identified had been put into context within the plan, and structured to meet legislative and
reporting obligations.
During discussion the following comments were noted:
• The Chair wondered whether “average length of stay” should be included as a key
contributor to operate our hospital services. Considerable savings would be recognised
if we there was an average half a day reduction (per stay) in this area.
• The Chair queried whether the right indicators had been included eg., preventing people
arriving inappropriately at the Emergency Department; Improving general health across
the region; plus reducing the amount of time processing patients. All of the above would
have a significant impact on running the hospital.
• Diana Kirton advised an amendment to page 4 of the Plan specifically the “Board
advised by 6 committees” needed to be changed to “7” committees.
4
Timelines were noted as: 3 May NHB feedback; 18 May Final Draft submitted to NHB; 30
May Board approval of the Final Draft; 15 June Approval or change requirements advised by
NHB; 30 June Final date for Minister’s approval.
With the comments above noted, the Board adopted the recommendation.
RECOMMENDATION
That the Board:
1.
Note the DRAFT nature of the Annual Plan (version 1.6.) included with this report.
2.
Note the DRAFT Annual Plan is a “work in progress” and version 1.6 may not be the
most up-to-date version when the Board does meet.
3.
Note the purpose, structure and intentions as per version 1.6.
4.
Note the timeline for finalisation of the Annual Plan.
5.
Note the improved alignment with other key plans.
6.
Endorse the direction indicated by the planning to-date as per version 1.6.
Adopted
GENERAL BUSINESS
There being no further general business the meeting moved to Public Excluded.
RESOLUTION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
16.
Confirmation of Minutes of Board Meeting dated 27 February 2013
- Public Excluded
17.
Matters Arising from the Minutes of Board Meeting dated 27 February 2013
- Public Excluded
18.
Board Approval of Actions exceeding limits delegated by CEO (nil)
19.
Action Plan – Whole of Board Performance Appraisal
Reports and Recommendations from Committee Chairs
20.
Finance Risk and Audit Committee – 27 March 2013 (tabled)
21.
Hawke’s Bay Clinical Council – 13 March 2013
22.
Towards Integrated Health Services in Central Hawke’s Bay
23.
Advisory Committee Membership
24.
Options for Older Peoples Care
25.
Draft Annual Plan - Financials
26.
Transformation and Sustainability Presentations
Moved:
David Davidson
Seconded:
Ngahiwi Tomoana
Carried
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The meeting closed at 2.10pm
Signed:
Kevin Atkinson, Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 24 APRIL 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.04 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Kirsten Wise
Apology:
Helen Francis
In Attendance:
Kevin Snee (Chief Executive)
Ken Foote (Company Secretary)
Members of the Executive Management Team
Nicola Ehau, Head of Health Services, Health Hawke’s Bay
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
DECLARATIONS OF INTEREST
David Barry asked that his interest as a Consultant Paediatrician be removed from the
Register.
Actioned
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 27 March 2013, were confirmed as a true and
correct record of the meeting.
Moved:
David Barry
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 1: Safe Sleep Update would be provided in May.
Item 2: Improving Maternity Services in Hawke’s Bay – ongoing, timelines to be advised.
Item 3: Hospital Car Parking would be shared in confidence in the public excluded section.
Item 4: Site Development Strategy – ongoing, timelines to be determined.
BOARD WORK PLAN
The Board Work Plan for May 2013 was noted.
May 2013
Section 1
1
ACCOUNTABILITY PLANNING TIMELINE
Timelines provided by Planning & Performance were progressing with one query to be
confirmed outside the meeting as to whether the draft SOI had been sent to Audit NZ for
comment.
Action
The CEO advised feedback had been received and points which had been highlighted
related to the lack of measures included. This was due to those measures being under
review by HBDHB.
CHAIR’S REPORT
The Chair advised the meeting there were no retirements for the month.
A very special heartfelt acknowledgment of the passing of Dr Peter Foley was conveyed.
Peter had been Chief Medical Officer (Primary Care), Clinical Council co-chair, a member of
the Executive Management team and had held numerous other highly respected roles locally
and nationally. Peter was a very special man, a compassionate doctor and was held in very
high regard by those he came in contact with. The Board recorded their sympathy to the
family and colleagues, noting the huge contribution he had made to health in Hawke’s Bay. A
very moving ceremony had been held for Peter the prior week and it was acknowledged how
very difficult he would be to replace.
An update of communications received since the last meeting were summarised.
• Quoting from the Health Hawke’s Bay (HHB) Newsletter, the Chair was pleased to see of
the 17 programmes monitored for the 20 PHOs nationally, HHB was is in top 10 in 15 of
the 17 indicators and in the top 5 in 10 of the 17 indicators. This was an outstanding
result. In several areas HHB were first in NZ and in others they were 2nd and 3rd
respectively. The clinicians who supported the programs deserve the praise for
achieving such an excellent result for the region.
• The Health and Disability Commission (HDC) had released the “Complaints to HDC
involving District Health Boards” providing a Report and Analysis for Hawke’s Bay (HB)
period July to December 2012. The Chair reported that HB performed well with only 5
complaints during that period all of which were considered relatively minor and led to no
investigations. Compared to the national ranking, HBDHB was 2nd with 29.11 complaints
per 100,000 discharges. The best in NZ was 25.96 complaints per 100,000 discharges.
The average across the country was 63.07complaints per 100,000 discharges.
• During the month the Chair had a phone call from Janet Wilson, CEO of the Health
Quality and Safety Commission, and was asked if he would sign a pledge on behalf of
the Board to support the National Patient Safety Campaign. Board members provided the
Chair with approval to sign that pledge.
• The Chair had met with Phil Ryan, Chair of Springhill Addiction Centre Trust, and was
encouraged by the facility rebuild progress. The cost to build the new accommodation
facility was $850k, and to remove the upper floor of the existing building would be a
further $250k. Donations to date totalled $500k, with a commitment from another funder
for a further $250k loan. The balance required for the project to proceed is $350k and the
Trust are actively seeking donations from significant Hawke’s Bay businesses and
benefactors.
CHIEF EXECUTIVE OFFICER’S REPORT
In summary our financial performance continues to improve through tight control and focus.
• Six hour ED performance had deteriorated slightly in March resulting in poor performance
of 93.1% for the quarter. That had improved and as at 17 April was 94.5%. The positive
aspect was the variation is less than in the past.
• Fragility existed within elective surgery management. Capability was receiving
considerable focus with a number of mitigations being worked through within each
specialty. The target was to have most specialties aligned by 30 June.
2
The Chair advised he had received a call from the Minister who was concerned about
elective performance across the country and the additional focus required by all DHBs in
this area.
The Board was pleased to hear that more was being done to educate/communicate with
the community regarding “waiting lists” ie, 1st specialist assessments and access to
surgery.
• Greater Pharmacy-Led Care – it was encouraging to note that Hawke’s Bay pharmacies
were working hard to adjust their work and business practices around the new model.
• A draft of the National Dementia Care Pathway Framework (March 2013) developed by
the Ministry of Health would be adopted to improve the acceptance, support and care of
people with dementia nationally. Implementation would occur 2013/14.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF MARCH 2013
The Chief Financial Officer presented his report for the ninth month of the financial year
2012/13, revealing an adverse cumulative variance to the end of March of $386k. This was
$220k away from plan and related to an accumulated surplus of $3,875k, compared to a
planned surplus of $4,261k.
Favourable and unfavourable shifts were noted to what had been a good but volatile month.
Members were made aware that all financial contingencies had been released to bring up to
target. It was noted there was good balance in the Capital forecast noted near the end of the
financial report.
The report was taken as read.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 10 April 2013
Co-chairs Dr John Gommans and Chris McKenna were in attendance.
Dr Gommans advised Council had further discussed the Transform and Sustain topic from
the HB Health Sector Forum Workshop (as presented by the CEO). Other topics included a
review of the draft Cancer Services Plan; Tū Mai Rā Implementation Plan 2013-14; Tū Mai
Rā Dashboard Q2 (Oct-Dec 2012); Falls Minimisation Committee Update; and the monthly
Clinical Indicators Report.
Council were looking forward to the formation of the Consumer Council and developing a
mutually beneficial relationship with them.
The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published
on Wednesday 6 February 2013. The merit of reading the full report was discussed. The
report recited appalling clinical practice and governance and was a reminder regarding the
key aspects of good clinical governance. It was noted that many of the key findings and
learnings raised in that report were already in place or formed part of HBDHB’s framework.
The report had been reviewed and discussed internationally and was available on the
internet
http://www.midstaffspublicinquiry.com/report. It was felt reading the “executive
summary” of the Mid Staffordshire Report could be of value to board members.
The Chair noted learnings from the Mid Staffordshire Report maybe a discussion topic at a
future Workshop.
Māori Relationship Board – 17 April 2013
Chair Ngahiwi Tomoana provided an overview of the meeting held the week prior. A copy of
the report which had been emailed to Board members was also tabled.
The prospect of $900k being cut from the Tū Mai Rā project had been discussed at the
meeting. On 22nd April a selected panel met and held a series of interviews with Māori health
providers. A report on the meetings held would be issued to the Board in the public excluded
section of the meeting.
3
Workforce Development: It was highlighted to members there was a positive drive from the
HBDHB with an increasing number of Māori ethnicity staff being employed in the health
sector. Of 17 Māori nurse graduates, 8 were placed immediately.
It was noted that MRB would be keeping constant eye on diabetes to improve outcomes and
supported the development of physical activity and nutrition programmes for you people in
secondary schools.
A review of the Memorandum of Understanding between the HBDHB and Ngati Kahungunu
Iwi Incorporated (NKII) had being initiated (the current MOU had been signed in 2006). NKII
had indicated they would prefer a more ambitious Agreement. A process was currently under
way for sign off by the respective chairs’.
MONITORING
Tū Mai Rā Dashboard Q2 (Oct-Dec 2012)
Tracee Te Huia and Shayne Walker (Programme Manager, Māori Health) were in attendance
with the report taken as read. The Board were very pleased with progress made.
GENERAL BUSINESS
There being no discussion the Chair moved into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
14.
Confirmation of Minutes of Board Meeting dated 27 March 2013
- Public Excluded
15.
Matters Arising from the Minutes of Board Meeting dated 27 March 2013
- Public Excluded
16.
Board Approval of Actions exceeding limits delegated by CEO
Reports and Recommendations from Committee Chairs
17.
Finance Risk and Audit Committee – 24 April 2013 (tabled)
18.
Hawke’s Bay Clinical Council – 10 April 2013
Māori Relationship Board – 17 April 2013 (tabled)
19..
Integrated Urgent Care
20.
Transform and Sustain Strategic Workshop
Moved:
Dan Druzianic
Seconded:
Diana Kirton
Carried
The meeting closed at 1.43pm
Signed:
Kevin Atkinson, Chair
Date:
4
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 26 JUNE 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Kirsten Wise
Helen Francis
Apology:
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair, HBDHB Consumer Council)
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
Liz Stockley CEO of Health HB and Graeme Norton the Chair of the new Consumer Council
were welcomed to the meeting.
DECLARATIONS OF INTEREST Nil
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 29 May 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Diana Kirton
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 1: Improving Maternity Services in Hawke’s Bay – dates required for the Board to review
the business case in their current term.
Item 2: Site Development Strategy ongoing, with timelines yet to be determined.
Item 3: Statement of Intent - completed.
Item 4: Health and Safety Commission Pledge – Clinical Council Report provided detail and
the Pledge would be signed on the proviso.
Item 5: Population Health – EMT considering strategies for the July Board Meeting.
Item 6: Fluoridation Referendum wording finalised, recommended wording included in CEOs
report.
July 2013
Section 1
1
BOARD WORK PLAN
The Board Work Plan for July 2013 was noted with the Cancer Plan Review moved to the
September meeting.
CHAIR’S REPORT
On behalf of the Board, the Chair acknowledged it was Andrew Lesperance (GM Planning
and Performance’s) last week at HBDHB, and he thanked him sincerely for his contribution
over the past three years. The Chair acknowledged Andrew’s dedication, wishing him well for
the future.
An update of communications received since the last meeting were summarised.
• A letter had been received from Kevin Woods (MOH), reporting on Primary Health Care
performance against targets, advising that Hawke’s Bay were No.1 in New Zealand for
“Smoking Brief Advice and or Cessation”; 8th for increased immunisation at 8 months and
12th for “More Heart and Diabetes Checks”. An outstanding effort in the Smoking Advice
area was acknowledged.
• A letter received from the MOH and copied to the Chair provided feedback on
achievements against health targets with no unexpected comments. Liz Stockley CEO of
the HHB commented the Heart and Diabetes target would be met by year end.
• Tony Ryall provided a letter regarding the achievement quality and safety standards in
Aged Residential and Mental Health areas.
This was in hand. DHB CEOs were gathering to discuss. This would be brought back to
the July Board Meeting.
Action
• The Chair thanked Dan Druzianic and Peter Dunkerley for their attendance in support of
the submission provided by HBDHB to the Regional Council on Car Parking. The
outcome was not known at this time.
• Deputy Chair Ngahiwi Tomoana had attended the Regional Governance Group on the
Chair’s behalf and provided an overview of that meeting.
• Public meetings on Fluoridation were being arranged by HBDHB and once the dates
were finalised Board Members would be advised.
Action
• Board member inductions into their roles: nationally it had been proposed to hold these in
two streams, one for “new members” and the other for more “experienced members” and
to continue with the one day induction.
Retirements: The Chair advised the following retirements, with a letter being sent conveying
the Board’s wishes and thanks for their years of extended service.
Years of
Service
Margaret Dalton
Immunisation Coordinator Healthy Populations
27
Judith Jarvis
Registered Nurse
Elective & Surgical
35
2013 Local Body Elections –Electoral Officer: The Chair advised Hastings District
Council’s Electoral Officer Peter Woodroffe had resigned recently. Peter was also HBDHB’s
Electoral Officer. The Board considered a replacement and duly appointed Richard Palmer
(HDC’s Democratic Support Manager) who was suitably qualified to undertake the role.
RESOLUTION
That the Board
• Appoint Richard Neil Palmer as HBDHB Electoral Officer pending his appointment as
Electoral Officer for Hastings District Council on 27 June 2013.
Moved
Kevin Atkinson
Seconded
Barbara Arnott
Carried
•
2
CHIEF EXECUTIVE OFFICER’S REPORT
• Three appendices were provided with the CEO’s report including a Regional Services
Plan update (April 2013) update, a Consumer Council membership selection
recommendation, and wording submitted by HBDHB for
the Referendum on Fluoridation.
• The wait in the Emergency Department remains a concern with a lot of work occurring to
deliver this target. Improved access to Elective Surgery to end of May at 113% was
inflated due to a number of small procedures. This will be altered to provide a better
understanding and focus on services where we could be more productive.
• Waiting list more than 5-6months, the CEO advised there was now no one waiting longer
than 5 months and the first specialist appointment target had been met.
• Financial performance had shifted and showed improvement, being on track to achieve a
surplus.
• Relationship manager appointments advised earlier in the year were working well liaising
with Primary Care and bringing problems for review.
• An update on Clinical Pathways would be brought to the Board in due course.
• Managing needs for diabetes was of concern for Pacific peoples in particular and this
would receive attention.
• The CEO advised the main focus going forward would be how we transform services and
put quality and safety at the forefront.
A query regarding sexually transmitted diseases and support services in HB was raised. In
response it was advised Ann Robertson (of Mid Central DHB) had been assisting in the
development of the service, to make it more available than in the past (ie, through
“Directions” or free GP visits). More funding had been provided in this area.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF MAY 2013
The Chief Financial Officer presented his report for the eleventh month of the financial year
2012/13, revealing favourable result for the month of May of $134 thousand, moving
cumulative adverse variance to the end of May to $564 thousand. We are on track to deliver
an end of year surplus of $1,800 thousand (with all contingencies used).
Health of Older people cost increases had slowed following a service review earlier in the
year. The service had been aligned to other DHBs.
The financial result although short by $1,200 thousand of a $3,000 thousand surplus
targeted, was a good effort and FRAC were pleased.
Good work on the part of all teams within the DHB.
The unknown related to IDFs which would not be known until the end of July.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 12 June 2013
Co-chairs Dr John Gommans and Chris McKenna were in attendance. The report was taken
as read with the following comments.
• Establishment of Consumer Council – the co-chairs and Leigh White had met with
Consumer Council Chair Graeme Norton regarding the best way forward and the close
working relationship both Councils had. Input had been most useful with strong signal of
partnership going forward. Graeme had attended his first Clinical Council meeting in
June.
• The request for DHB input into the Quality and Safety Framework had been received by
Clinical Council 5 days prior to their June meeting. A fair amount of time was dedicated
to this topic and a paper was being developed for review by both Council’s (Clinical and
Consumer) in July. Two messages were welcomed:
3
- A renewed focus on Quality and Safety patient focus/care
- A partnership with our people and consumers
• The National Patient Safety Campaign Pledge was fully supported with additional health
equity statement being included to enhance understanding. This was a timing issue, with
the statement to be provided to members at the next meeting.
The Pledge would be signed at the July Board Meeting
Action
HBDHB Consumer Council – 20 June 2013
Chair Graeme Norton provided an overview of the inaugural meeting held on Thursday 20th
June. He had received a great welcome and was looking forward to working with all to
achieve the consumer voice required.
• Consumer Council would be joining with Clinical Council providing monthly reports to the
Board.
• Bios for Consumer Council members were in hand with a rich range of consumer voices
around the table.
• Graeme was looking forward to a fruitful relationship and collaboration.
GENERAL BUSINESS
There being no discussion the Chair moved into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
12.
Confirmation of Minutes of Board Meeting dated 29 May 2013
- Public Excluded
13.
Matters Arising from the Minutes of Board Meeting dated 29 May 2013
- Public Excluded
14.
Board Approval of Actions exceeding limits delegated by CEO
15.
Chair’s Report
Reports and Recommendations from Committee Chairs
16.
Hawke’s Bay Clinical Council – 12 June 2013
17.
Finance Risk and Audit Committee – 29 June 2013 (tabled)
18.
Regional Services Plan
Moved:
Helen Francis
Seconded:
David Davidson
Carried
The meeting closed at 1.50pm
Signed:
Kevin Atkinson, Chair
Date:
4
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 29 MAY 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.05 PM
Present:
Kevin Atkinson (Chair)
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Kirsten Wise
Helen Francis
Apology:
Ngahiwi Tomoana
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Members of the public and media
Minutes
Annie Quinlivan
KARAKIA
Tracee Te Huia, Director Maori Health opened the meeting with a Karakia.
WELCOME
The Chairman welcomed Patrick O’Sullivan, Health Reporter from Hawke’s Bay Today.
DECLARATIONS OF INTEREST
David Barry requested that his conflict of interest register be updated to reflect that he no
longer worked as a consultant paediatrician.
Action
Helen Francis had advised the Board Administrator of a change in her conflict of interest
register and this would be amended accordingly.
Action
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 24 April 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Safe Sleep Update – presentation included on the May Agenda
June 2013
Section 1
1
Item 1: Improving Maternity Services in Hawke’s Bay – progressing, timelines to be
advised.
Item 2: Hospital Car Parking – actioned
Item 3: Site Development Strategy – on-going, timelines to be determined.
Item 5: Accountability Planning Timeline – the draft SOI was sent to Audit NZ for comment
but as yet no feedback has been received as yet.
BOARD WORK PLAN
The Board Work Plan for June 2013 was noted.
The Chair requested that the actual date of the Board meeting be included in the “month”
column of the Board workplan.
Action A question was raised as to where the recommendations from the Board Strategic Workshop
would be forwarded to. The Chair advised that a report from David Barry from the Combined
Advisory Committee Strategic meeting held on 15 May 2013 would be presented later in the
meeting and that this question would be discussed at that point.
CHAIR’S REPORT
Retirements
The Chair advised the following retirements, with a letter being sent conveying the Board’s
wishes and thanks for their years of extended service:
Alison Luscombe – Elective & Surgical ................... 12 years of service
Pat Andrew – Oral, Rural & Community Health ...... 47 years of service
2013 Budget
The Chair commented on the Governments budget. $1.6bn would be going to health over
the next four years – the largest budget increase. $250m will go directly to DHBs to meet
population and inflation pressures. This will increase total health spending to $14.7 billion in
2013/14 the highest ever.
Mental Health Unit – Business Case
A letter had been received from the Minister of Health, Hon Tony Ryall approving the
business case for the Mental Health facility. There were 13 approval conditions in this notice
letter - around that notice letter. A number of them were straightforward however two of the
conditions were brought to the Boards attention. Namely,
(a)
The project is not to exceed $22m excluded GST, and
(b)
At the completion of the project, the HBDHB is to complete a project evaluation.
Hospital Car Parking
Further to the April Board meeting, the Chair advised that a submission on behalf of the
HBDHB had been lodged with the HBRC for their draft annual plan process. The submission
requested support from the Regional Council for the development of 120 car parks at the
hospital at a cost of $400k. Notice had been advised that the HBDHB would be presenting
their submission on 11 June 2013 and as the Chair would be overseas on that date he had
requested Dan Druzianic to be his designate.
The Chair also commented that there had been reaction from the community to the issue of
car parking at the hospital, the most common one being why the DHB had sold the property
opposite the hospital along Omahu Road. That decision had been made in 1995/96 and as
the Chair understood it, that land was sold as part of the funding arrangements for the
regionalisation of hospital services within Hawke’s Bay.
2
Correspondence Received
An update of communications received since the last meeting were summarised.
• The Ministry of Health targets (released 28 May) showed that that Hawke’s Bay District
Health Board was one of the top five performing DHB’s in the country. The Chair
congratulated staff on the impressive result. In summary results for HBDHB were as
follows:
Elective surgery – 5th in the country
Immunisations – 2nd equal nationwide
Better Help for Smokers to Quit – 1st in the country
Heart and Diabetes Checks – 5th nationwide
Shorter Stays in Emergency Departments – ranked 15th in the country
• A letter had been received from the Health & Safety Commission (HQSC) requesting
that all DHB Chairs and CEOs sign a pledge document on behalf of their respective
DHBs. Before signing this, the Chair suggested that both the Clinical Council and EMT
review the pledge and provide feedback on the wording. Once all suggestions and
improvements had been made to the pledge this would then be brought back to the
Board for ratification at the June Board meeting.
Action
• As a member of the Regional Governance Group (RGG), the Chair advised that an
alternate was required in his absence. The Chair had approached Ngahiwi Tomoana
and he was comfortable being Kevin Atkinson’s alternate. Therefore, the Chair
requested that the Board concur with this appointment.
Adopted
• The Minister of Health had recently advised that he was eager that all DHB’s deliver on
their elective performance that being, by 30 June no one had been on the waiting list
more than 5 months and that decrease to 4 months in the following year. The Chair
advised that both the CEO and COO believed that this target goal could be achieved.
• The Minister had also brought up the issue with the Chair around the $3m surplus
expectation of the HBDHB. Discussion on how this would be managed moving forward
would be discussed by the Board in the item “Approve the Annual Plan 2013/14” in the
Public Excluded section of the meeting.
CHIEF EXECUTIVE OFFICER’S REPORT
The CEO provided an overview of his report to 20 May which was taken as read.
• ED performance had been better as reported and also there are still issues to be
addressed within ED, he suggested that the DHB were in a lot better position compared
to two years.
• Elective Surgery was significantly ahead of plan.
• In relation to waiting times - that figure had come down significantly since this report had
been produced and the CEO was confident that the HBDHB would be where it needed to
be at the end of the year.
• Cancer has been uniformly good for a long time now.
• Immunisations as earlier reported, was one of the best in the country.
• The “star performer” was “Better Help for Smokers to Quit”. A letter had been received
from the Manager of the PHO requesting that thanks be noted to Ana Apatu and the
Smoke Free Team in enabling this fantastic result.
3
FINANCIAL PERFORMANCE REPORT FOR MONTH OF APRIL 2013
The Chief Financial Officer presented his report for the tenth month of the financial year
2012/13, revealing an adverse variance for the month of April of $312k. The surplus for the
ten months to 30 April was $2,441 thousand compared to a budgeted surplus of $3,139
thousand, $698 thousand unfavourable which was mainly contributed to by IDF outflows and
non-achievement of efficiencies.
• Chair of FRAC Dan Druzianic, commented on the issue of IDF’s and how it would no
doubt emerge as a continuing issue over the next few months. FRAC would devise a
framework around work to be done on the IDF trend and this would be a focus over the
few months.
• The Chair also advised that it was encouraging to see that pharmacy volumes were
down and below budget. He also questioned as to why the table showed that the figures
were three months behind the current date and the GM Planning & Performance advised
that this was due to Pharmac allowing 90 days to make a claim.
The report was taken as read.
PRESENTATION - SUDDEN UNEXPLAINED DEATH IN INFANCY (SUDI)
Dr David Tipene-Leach and Roisin Van Onselen provided a presentation to the Board on the
project around SUDI in Hawke’s Bay. A copy of these slides would be provided to the Board.
Action
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 8 May 2013
Dr Mark Peterson (CMO Primary Care) presented in the absence of co-chairs Dr John
Gommans and Chris McKenna. In summary the reported covered the following points:
• Apologies were offered from Dr John Gommans and Chris McKenna. The Clinical
Council meeting held on the 8th May 2013, was in fact the first meeting since the passing
of Peter Foley and this was acknowledged and recognised at that meeting.
• The presentation which David Tipene-Leach had just presented to the Board was also
given at the Clinical Council May meeting and congratulations was given to David and
his team as the progress that had been made was obviously making a significant
difference.
• The draft Regional Services Plan was presented at the meeting.
• The Nursing Midwifery Shared Governance Committee had submitted a consultation
response to the Registered Nurse Prescribing. In addition International Nurses and
Midwives Day had been held on 10 May 2013 and awards were presented in HB.
• An overview of the Maternity Quality and Safety Programme was given at the Clinical
Council meeting and figures showed that Hawke’s Bay were very much in the middle in
terms of the indicators.
• An update on the Clinical Quality Advisory Committee (CQAC) held on 18 April 2013
was provided by the Committee Chair Dr Andrew Heslop.
The Chair of the Board requested that the Clinical Council review the wording on the
pledge document from the Health Quality and Safety Commission.
Action
Combined Committees Strategic Workshop – 15 May 2013
Dr David Barry spoke on behalf of the combined Chairs of HAC, CPHAC and DSAC and
tabled a paper containing strategic issues for the Board’s consideration and request for a
Management response with population health program options regarding an:
4
1.
Increase in the total budget for Population Health
2.
Within Population Health direct more resources to the "Child Wellness" program.
3.
Increase Health literacy in the health workforce, the community and individuals.
All of these measures would contribute to advancing The NZ Triple Aim.
The Board were asked to adopt these strategies with the corollary that there must be an
urgent Management response with population health program options. Anything less would
leave the Strategies hanging in the air. A monitored action plan was required.
Action
After some discussion the Chairman of the Board requested that the CEO take these
strategies to EMT for consideration and that there be a report brought back to the Board on
how these issues may be advanced. The challenge was how the DHB was going to “do it”.
Action: July Board meeting
DECISION
Local Body Elections 2013
Company Secretary, Ken Foote provided some background, together with detail issued by
the Ministry of Health for the forthcoming elections.
The Election timeline follows:
26 July
Candidate nominations open
23 August
Candidate nominations close (noon)
20 September
Voting document delivered, voting commences, special votes issued and
early processing of votes begins
12 October
Election Day – end of voting (noon) followed by announcement of
preliminary results
9 December
Newly elected DHB board members take office
The Chair suggested that any new incoming Board members needed to understand how the
Board operated so there would be no surprises once they officially joined the Board.
The question was also raised on the wording for the fluoridation Referendum. Apparently the
wording had been finalised however it was requested that Caroline McElnay clarify that.
Action
RESOLUTION
That the Board
• Confirms the appointment of Peter Woodroffe as HBDHB Electoral Officer.
• Confirms the names of candidates on the voting documents be arranged in alphabetic
order of surname.
• Authorises the Electoral Officer to begin processing votes during the three week voting
period.
• Requests the DHB elections communications programme includes the promotion of
nominations as well as encouragement to vote.
• Advertises and conducts “Information Evenings” for potential candidates (in Hastings
and Napier) prior to nominations being opened.
Moved
David Davidson
Seconded David Barry
Carried
5
MONITORING
Human Resource KPIs Q3 (Jan-Mar 2013)
Kate Shambler deputised for GM Human Resources and provided an overview of the report
provided.
Staff Engagement Survey 2013
A presentation provided on the recently completed staff engagement survey was noted.
Performance Framework Exceptions Q3 (Jan-Mar 2013)
Andrew Lesperance (GM Planning and Performance) provided an overview of the paper
provided.
GENERAL BUSINESS
There being no general business discussed, the Chair moved into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
16.
Confirmation of Minutes of Board Meeting dated 24 April 2013
- Public Excluded
17.
Matters Arising from the Minutes of Board Meeting dated 24 April 2013
- Public Excluded
18.
Board Approval of Actions exceeding limits delegated by CEO (nil)
19.
Chair’s Report
-
Allied Laundry
-
Regional Governance Group Report
Reports and Recommendations from Committee Chairs
20.
Hawke’s Bay Clinical Council – 8 May 2013
21.
Finance Risk and Audit Committee – 29 May 2013 (tabled)
For Decision
22.
Regional Services Plan
23.
Approve Annual Plan 2013/14
Presentation
24.
Budget 2013/14 Update
Moved:
Barbara Arnott
Seconded:
Diana Kirton
Carried
The meeting closed at 3.12pm
Signed:
Kevin Atkinson, Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 31 JULY 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.05 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana (arrived at 1.35pm)
Barbara Arnott
Dan Druzianic
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Kirsten Wise
Helen Francis
Apology:
In Attendance:
Kevin Snee (Chief Executive)
Ken Foote (Company Secretary)
Tim Evans (Chief Financial Officer)
Tracee TeHuia (Director of Maori Health)
Liz Stockley (CEO Health Hawke’s Bay)
Karen Molloy (acting GM Human Resources)
Graeme Norton (Chair, Consumer Council)
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Tracee TeHuia opened the meeting with a Karakia.
It was advised Ngahiwi Tomoana (Deputy Chair) would arrive around 1.30pm
DECLARATIONS OF INTEREST
Peter Dunkerley requested to have his affiliation with HB Helicopter Rescue Trust removed
from the Register due to him no longer being a Trustee.
Diana Kirton advised of a potential conflict of interest, now her husband was head of the
Cancer Society Trust for the Central Region (Diana to provide detail in email to Brenda).
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 26 June 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 3: Health and Safety Committee Pledge was covered later in the meeting.
Item 4: Population Health Action Plan to be provided to the Board’s August Meeting
August 2013
Section 1
1
Item 5: Achievement of Quality and Safety Standards in Aged Residential Care and Mental
Health was carried over to the August Board Meeting.
Item 6: Public Meetings on Fluoride were advised to the Board via email and provided to the
meeting.
BOARD WORK PLAN
The Board Work Plan for August 2013 was noted.
The Chair advised he would not be attending the August and September 2013 Board
Meetings and the Deputy Chair would be available for one, if not both meetings.
NATIONAL PATIENT SAFETY CAMPAIGN PLEDGE
Following the desire of the Health and Quality Safety Commission (HQSC) and Ministry for
all DHBs to adopt a patient safety pledge, the Executive Management Team and Hawke’s
Bay Clinical Council considered the points provided.
Clinical Council were fully supportive but did request the inclusion of bullet point 2 (as
included on page 9):
“working across sectors promoting equitable health outcomes for all”.
This has been a key theme for Hawke’s Bay and the inclusion was agreed by the Health and
Quality Safety Commission.
The Board discussed and passed the following resolution.
RESOLUTION That the Board approve the revised version provided and authorise the Chair and CEO to
sign the pledge on the Board’s behalf.
Moved
Helen Francis
Seconded
David Davidson
Carried
A media release would be prepared for the signing which will provide the community with
clear guidance around HBDHB’s expectations.
CHAIR’S REPORT
The Chair advised of the following retirement, with a letter being sent conveying the Board’s
wishes and thanks for Margaret’s years of extended service.
Years of Service
Margaret Pack
Registered Nurse
Older Persons, Mental
38
Health and Allied Health
An update of communications received since the last meeting were summarised.
• A letter had been received from the Minister of Health advising of a rise in board member
remuneration. The rates effective from 1 July 2013 for the Chair to $42,000 per year,
Deputy Chair to $25,500 and board members to $20,400.
• A letter dated 29 July, had been received from the Minister approving HB District Health
Board’s 2013/14 Annual Plan for the next three years. He had conveyed his thanks and
appreciation to those concerned for this significant piece of work.
• The Chair (under delegation) had signed a resolution for the Regional Governance Group
for the Central Region’s District Health Boards, appointing new directors and removing
existing directors from Central Region’s Technical Advisory Services Limited (TAS). This
process had resulted in the appointment of an independent Board and Chair.
The changes included the appointment of Jan White (Chair of TAS) as a director; Deryck
Shaw (Chair of Lakes DHB), plus two other independent Directors with appropriate
technical expertise being Elaine McCaw and Murray Bain. Mary Bonner (CEO of Capital
and Coast) would continue as the Central Region representative.
2
• An email had been received from Kevin Wood, Director General of Health and CEO
Ministry of Health (from 2011), advising he would not be accepting the State Service
Commissioner’s offer to renew his contract (for family reasons). The Chair advised Kevin
Wood had achieved a great deal during his time in the role.
• A letter had been received from the Hawke’s Bay Regional Council (HBRC) Chairperson
advising the Council did not see merit in the submission seeking $400k towards providing
additional parking on the hospital site. Instead HBRC offered involvement in a Workplace
Travel Plan for the site.
Action: The appropriate DHB Manager to contact the HBRC Sustainable travel
Coordinator to discuss and prepare a Workplace Travel Plan for the hospital site.
• A number of letters had been received around Chaplaincy services, supporting and
seeking a financial increase from $9k to $50k. A business case claimed HBDHB were
out of line with other DHBs.
Action: Management consider the Business case for HBDHB Support for the “The
HB Ecumenical Chaplaincy Association Incorporated”.
• Rural Women NZ, (RWNZ), had written with concerns around how various
recommendations regarding mechanisms to align pay parity and fair travel policy matters
which were being responded to.
Action: Anna Kirk to prepare a response from the Chair to the letter from RWNZ.
• DHB elections: An information session had been held for potential candidates in
Hastings during the month. Two candidates (in addition to board members) attended. A
further evening would be held at the Napier Health Centre on 1st August.
CHIEF EXECUTIVE OFFICER’S REPORT
In summary our financial performance resulted in a $3.0 million surplus, our third consecutive
year of surplus enabling the continuation of investment plans.
Performance targets were relatively stable; however the Emergency Department remains
under a lot of pressure especially with the peak “winter ills” period upon us. A lot of focus
has been placed on this area recently.
Transform and Sustain, our strategic proposal for service change and organisational
restructure was progressing.
The Better Sooner More Convenient update included Community Pharmacy Service (stage 3
implementation) nationally, Community initiatives and future reporting. Peter Dunkerley was
very complimentary on how the substantial pharmacy changes were being managed as they
have been well accepted by pharmacists.
Diana Kirton provided positive comments around access to sexual health which was working
in a very user friendly way. This had been a joint venture between HBDHB and the PHO with
support from Mid Central DHB.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JUNE 2013
The Chief Financial Officer presented his report for the final month of the financial year
2012/13, revealing a favourable cumulative variance to the end of June of $33 thousand
delivering a year end surplus of $3.033 million. This reflected a lot of effort by all to deliver
the surplus achieved. The Chair of the Finance Risk and Audit Committee conveyed his
congratulations to the, CEO, CFO, Executive Team and staff, to get to this point.
Although adjustments both technical and inter district flow wash ups would not be known for
some time, the Board Chari commented on the remarkable result.
3
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 10 July 2013
Co-chair of Council, Dr John Gommans was in attendance and provided an overview of the
report provided.
Clinical Pathways formed a big part of the integration of quality care and patient experiences.
The ideal was for the Central Region to align and adopt a common tool but with limited
progress. Hawke’s Bay, in the interim, would move forward with this crucial piece of work
which needs to be led by Primary Care with full support from secondary.
Other areas progressing were the formation of a Research Committee in Hawke’s Bay and
the Quality and Safety Framework.
The National Patient Safety Campaign Pledge incorporating additional wording had been
finalised.
HBDHB Consumer Council– 11 July 2013
Chair Graeme Norton provided an overview of the second Consumer Council Meeting
acknowledging the work ahead but being mindful the opportunities for consumer
engagement were many. It was mentioned the new members were faced with terminologies
which were foreign to them (including acronyms), but they were up for the challenge.
The Chair provided an overview of the report provided including: Transform and Sustain,
Compliments and Complaints Review and the Quality and Safety Framework which was
ongoing. Since the meeting some Council members had been sought for input into the
Integrated Urgent Care project.
Maori Relationship Board Meeting – 17 July 2013
Chair, Ngahiwi Tomoana provided an update of the meeting held earlier in the month.
Favourable comments from Maori Health providers had been received following the recent
funding review. They felt the process was well managed in an open and friendly way allowing
providers to take some responsibility for their own outcomes. A good process all round with
thanks to the DHB’s Chief Financial Officer.
The CEO advised it was very important to work with Iwi in a transparent way, to ensure
better health outcomes for Maori.
Suicide prevention data was discussed. It was noted that Police utilise a different set of data
than the DHB, the latter data being old (although it was validated). Work however was
progressing well in suicide prevention areas.
It had been recommended by MRB that the HR KPI become a KPI of the CEO. For MRB this
would raise the profile relating to staff ethnicity percentage levels within the DHB.
The board chair responded that this had been noted and may form part of the CEO’s
performance appraisal due shortly.
MONITORING
Tu Mai Ra Q3 (Jan-Mar 2013)
Tracee TeHuia (Director of Maori Health and Shayne Walker (Programme Manager Maori
Health) were in attendance.
Comments noted in discussion included:
•
Maori health had picked up regionally and nationally.
•
At a local level, traction was being gained in primary care.
•
Looking at monitoring of services against funding and next three year plan.
•
Infant mortality rates were discussed with concern that 2010 data had been used. It was
explained that data was constrained because of the coroner’s office. The CEO did not
4
accept that suitably anonomysed data could not be shared in the public domain. This
would be looked into
. Action Tracee TeHuia.
•
Referring to the Maternal Health data table on page 59, a review of this data set was
required as “fully breastfed up to 6 months” was not normal practice. Infants were
introduced to solids from 4 months on, therefore the fully breast feed babies at six months
should in fact be zero.
Action Tracee TeHuia.
•
The IS team would assist in the development of a revised dashboard.
•
Alcohol intervention and inebriated young people was raised by Denise Eaglesome, who
was interested to hear the DHB and Iwi were involved in discussions with Councils on the
issues for safer communities. “Drinking devastates communities” and she queried
whether this included those drinking at home, and whether this was being targeted
through Maori providers and linking into the community (particularly Wairoa). It was
agreed this would be checked
Action Tracee TeHuia.
FOR INFORMATION AND DISCUSSION
Update Napier Health Centre Concept Design
Kieran McCann (GM Integrated Care) and Wietske Cloo (Napier Health Centre Manager &
project manager) were in attendance providing an overview of the project. The proposed
changes would increase service delivery out of the Napier Health Centre, incorporating a
upgrade to the facility in Wellesley Road, Napier. As part of the building lease negotiation
package, the owners had offered $1m towards the refit.
Dr Gommans (Chair of Clinical Council) advised he had toured the Napier facility recently
and the building upgrade and service changes would encourage better services for the
people of Napier.
Proposed timeline for facility changes
September 2013
Develop design
October 2013
Tender process
November 2013 to April 2014
Construction
April-May 2014
Handover back to Napier Health Centre
The board were positive and provided favourable comments on the process and layout of the
facility. Congratulations were extended to the team regarding the consultation undertaken
around this project.
RESOLUTION
That the Board:
1. Approve the concept design of the facility changes at Napier Health Centre
recommended and supported by the Steering Group, EMT and Clinical Council.
2. Note the planned milestones in 2013 - 2014.
3.
Note progress to date.
Moved
Helen Francis
Seconded
Diana Kirton
Action Kieran McCann: The Chair requested regular updates on as the Napier Health
Centre Upgrade as it progresses.
GENERAL BUSINESS
There was no General Business.
5
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
16.
Confirmation of Minutes of Board Meeting dated 26 June 2013
- Public Excluded
17.
Matters Arising from the Minutes of Board Meeting dated 26 June 2013
- Public Excluded
18.
Board Approval of Actions exceeding limits delegated by CEO
19.
Chair’s Report
- Regional Governance Group Report
- HBL Chair’s Update
Reports and Recommendations from Committee Chairs
20.
Hawke’s Bay Clinical Council – 10 July 2013
21.
Finance Risk and Audit Committee – 31 July 2013 (tabled)
22.
Capital Plan 2013-14
23.
Pacific Health Leadership Group
24.
Quality and Safety Framework
Moved
Peter Dunkerley
Seconded
Diana Kirton
The meeting closed at 2.34 pm
Signed:
Kevin Atkinson, Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 28 AUGUST 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Dan Druzianic (Chair)
Barbara Arnott (left at 2.20pm)
David Barry
David Davidson
Peter Dunkerley
Diana Kirton
Kirsten Wise
Helen Francis
Apologies:
Kevin Atkinson, Ngahiwi Tomoana and Denise Eaglesome
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
Lewis Ratapu (Maori Health Service)
Liz Stockley (from 2.00pm)
Members of the public and media
Minutes
Brenda Crene
KARAKIA
Lewis Ratapu opened the meeting with a Karakia.
WELCOME
Chair, Dan Druzianic welcomed everyone to the meeting.
DECLARATIONS OF INTEREST
Nil
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 31 July 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Barbara Arnott
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
Item 1: Site Development Strategy: 10-20 year plan would be provided next year (by Warrick
Frater) and a Travel Plan would be developed in conjunction with the Regional Council (by
John McKeefry) as part of this strategy. This item would be included on the workplan for
March 2014 and the action removed.
Item 2: Population Health Action Plan had been included as agenda item 16.
September 2013
Section 1
1
Item 3: Achievement of Quality and Safety standards: this item related to discussions at a
national level and ties into the development of a Quality and Safety Framework and Quality
Accounts. This was work in progress with a draft of the Framework provided to the Board in
November. Item to be removed from the action list.
Item 4: Workplace Travel plan would be removed and incorporated into the site
development plan (item 1).
Item 5: Chaplaincy Services: Warrick Frater advised he had met with the Chaplaincy
Committee and all issues had been resolved. The group appeared pleased with the outcome
which include a small increment provided for in next years budget. Remove from actions.
Item 6: Actioned
Item 7: Tu Mai Ra Data/Dashboard review reflecting on items raised around Maternal Health,
Infant Mortality, and Alcohol Intervention.
a) A response prepared was circulated to the board with further discussion around the data
“fully breast fed up to 6 months”. The MOH would be asked to clarify the phrasing of the
question and the criteria around data collection (across all ethnicities). This item would
remain as an action.
b) Infant Mortality rates and the need for them to be more up to date vs using old 2010 data
because of the coroner’s office, was being investigated by a health intelligence analyst
with the outcome to be advised in due course.
c)
Alcohol intervention in the home and inebriated young people in Wairoa. A copy of the
response to this question would be provided to absent members who were particularly
interested in this action.
Item 8: Napier Health Centre Project was on track with regular updates sought by the board
and would continue as an action.
BOARD WORK PLAN
The Board Work Plan for September 2013 was noted.
CHAIR’S REPORT
The Chair advised there were no retirements this month and no communications to note.
The MOH national targets had been released and Hawke’s Bay had fared well in all areas
except one.
Second in the country for “Improved access to elective surgery”, “Increased immunisation”
and “Better help for smokers to quit”.
Eighth in the country for Heart and Diabetes Checks (but only by a very small margin)
A great result for “Shorter waits for cancer treatment” also, however “Shorter stays in ED”
was not as good with Hawke’s Bay in 13th place.
CHIEF EXECUTIVE OFFICER’S REPORT
In summary
Service and Financial Performance
• Shorter stays in ED – disappointing performance in July but improving in August.
• Waiting lists – meeting five month target and well on the way to next years four month
target.
• Pleasing financial performance for the first month of the new financial year - but is early
days
• Focus on personnel costs with a strong reign on the FTE count.
• Transform and Sustain areas highlighted.
2
Strong focus on Transform and Sustain includes: Transforming our Engagement with Ngati
Kahungunu Iwi Inc; Transforming Multi-Agency Work; Transforming Primary Care;
Transforming through Integration of Rural Services; Transforming Health Promotion and
Health Literacy.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JULY 2013
The Chief Financial Officer presented his report advising a favourable result of $2k for the
month being marginally better than planned. Other points highlighted included:
• Bedding in budget, no obvious problems.
• No contingency used to date.
• Insurance costs – redistribution in our favour this year
• Page 30-31 capital expenditure plan – shows source of funds, block allocations and big
initiatives, including contribution to CRISP and Health Benefits Ltd.
• Depreciation higher than expected – look to bring that down.
• New Mental Health Unit – project progress report illustrated proposed reporting process
for all future capital projects of significance.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 14 August 2013
Co-chairs Dr John Gommans and Chris McKenna were in attendance.
HB Clinical Research Committee
Dr Gommans advised of the intent to produce a publication annually.
The committee would also assist with promoting a culture of clinical research which in turn
could assist with attracting clinicians to come and work here.
Principles for developing GPSI service
It was generally noted that these services provide good value and incentivise GP’s to do
more, acknowledging that issues of credentialing and scopes of practice still need to be
finalised.
HBDHB Consumer Council
Chair, Graeme Norton provided an overview of the third Consumer Meeting held on 15
August.
Of particular interest were current discussions about the potential to expand the mandate of
the Consumer Council to be HB Health sector wide. Health Hawke’s Bay would be reviewing
this proposal at the next meeting. This will also then further highlight the need to ensure the
consumer voice was heard at all levels within the sector with the Consumer Council providing
a co-ordination function for this.
Combined Committees Strategic Meeting 21st August 2013
Barbara Arnott (Chair) provided an overview of the meeting held, with a paper prepared by
Andrea Jopling tabled for members information.
At the workshop, the groups were asked to consider the three themes that had emerged from
other Primary Health Care Strategy development meetings, namely:
Knowing Our Communities
Accessibility, Affordability, Acceptability
Integration
The groups were then asked to identify practical steps or initiatives that could be progressed
as well as enablers to progress.
3
Common ideas/initiatives that emerged from the groups included:
Improving Health Literacy – people being supported to take responsibility for their own
health
Information – needs to be appropriate and well communicated to patients
Shared health plans and patient information
Funding – should better targeted to reduce inequalities and follow the patient
Flexible Funding and gain share arrangements should be sought
Clinical guidelines should be seen as a vehicle for integration
Enablers noted include:
Common health record and/or and IS system that promotes integration and seamless
service provision
Trust based relationships and contracting arrangements
Intersectoral collaboration
Next steps:
The feedback from the session will be used, along with feedback from other workshops, to
progress the development of the Primary Health Care Strategy. The DHB and PHO
management are meeting with a large number of sector groups and organisations over the
coming weeks. A working draft of the Strategy will be presented to the HBDHB Board in
November.
DECISION
Health and Safety Policy Statement
John McKeefry, GM Human Resources provided an overview as a follow up to
recommendations approved by FRAC in July.
RESOLUTION
That the Board:
Approve the Health and Safety Policy Statement.
Moved
Diana Kirton
Seconded
David Davidson
Carried MONITORING
Human Resource KPIs (Q4) 2012/13
John McKeefry, GM Human Resources worked through the report provided, providing
additional information/comments as required.
Significant issues noted included:
• Staff within the two GP practices in Wairoa acquired during the year were included in the
FTE increase
• Staff turnover in support staff quite high but no particular reason other than this group
tend to be highly mobile and there are some concerns over the current HBL processes.
• Achieving good results with accrued annual leave but still further improvement required.
• Still not achieving target for Maori staff. Subject now to significant focus.
4
Performance Framework Exceptions (Q4) 2012/13
Tim Evans, Chief Financial Officer was in attendance for this report providing the Board with
exception reporting on the Statement of Intent and Annual Plan. In addition the HBDHB
Performance Framework Results for Qtr 4 2012/13 Dashboard were tabled.
Significant issues discussed included:
Achievements:
• Health targets and ambulatory sensitive hospital admissions
Progress
• ED health target and triage 2
• More heart and diabetes checks
• Adolescent oral health utilisation rate
• 50-59 year old women receiving breast screening
Areas of Focus
• DNA
• Diabetes management
FOR INFORMATION AND DISCUSSION
Response to Combined Strategic Committees
Caroline McElnay, Director Population Health and Health Equity Champion spoke to her
report.
General discussion acknowledged:
• Additional funding going in to child wellness programmes
• Value of increasing support to enable people to take more responsibility for their own
health
• Improving population health a long term investment
• Population health messages need to be incorporated into Primary Care Strategy.
PRESENTATION
Health Hawke’s Bay Annual Plan
Liz Stockley, CEO Health Hawke’s Bay was in attendance and presented the Health Hawke’s
Bay Annual Plan 2013/14.
The presentation covered:
• Achievements 2012/13
Majority of targets achieved
One of the best performing PHO’s in New Zealand
• Strategic Goals
Population Health
Improving Health Outcomes for Maori, Pacific and high needs people
Capability and capacity
Sustainability for our people
Maintaining a relationship with HBDHB
• Population Health
Demographics
2013/14 projects
• Supporting High Needs
2013/14 Projects
• Capability and Capacity
Activities and projects
• Business Sustainability
Staff resources and structure
2013/14 projects
5
• Sector Relationship
Planning
Governance
Activity
GENERAL BUSINESS
There being no discussion the Chair moved into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
18.
Confirmation of Minutes of Board Meeting dated 31 July 2013
- Public Excluded
19.
Matters Arising from the Minutes of Board Meeting dated 31 July 2013
- Public Excluded
20.
Board Approval of Actions exceeding limits delegated by CEO (nil)
21.
Chair’s Report
- Regional Governance Group Report
- HBL Chair’s Update
Reports and Recommendations from Committee Chairs
22.
Hawke’s Bay Clinical Council – 14 August 2013
23.
Finance Risk and Audit Committee – 28 August 2013
24.
Restorative Home Based Support
25.
CT Scanner Replacement – Business Case
Moved:
Peter Dunkerley
Seconded:
Diana Kirton
Carried
The meeting closed at 2.38pm
Signed:
Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 25 SEPTEMBER 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Dan Druzianic (Chair)
Ngahiwi Tomoana (co-Chair, left the meeting at 1.20pm)
Barbara Arnott
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome (via video conference)
Diana Kirton
Kirsten Wise
Helen Francis
Apologies:
Kevin Atkinson
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
David Ritchie (Director Allied Laundry)
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
A welcome was extended to those present including Denise Eaglesome via Video
Conference from the new Wairoa Health Centre.
Ngahiwi Tomoana advised he would depart early and Dan Druzianic would continue as
Chair.
DECLARATIONS OF INTEREST
Nil
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 28 August 2013, were confirmed as a true and
correct record of the meeting.
Moved:
Diana Kirton
Seconded:
Barbara Arnott
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted with the following comments:
October 2013
Section 1
1
Item 1: Tu Mai Ra Data / Dashboard
Following earlier discussions on the relevance of the “fully breastfed up to 6 months”
Ministry target, Tracee TeHuia (Director of Maori Health) provided a further update to
members. She advised the Ministry were going through a series of reviews and
agreed with HBDHB that the indicator was no longer meaningful/relevant in its
present form. A new indicator would take effect in the New Year. Present reporting
would continue until that time.
Out of date Infant Mortality Rate reporting remains a problem with the data remaining
unofficial for an 18 month period, until signed off by the coroner.
Both actions would be removed.
Item 2: A Napier Health Centre Project update was provided by Kieran McCann (GM
Integrated Care Services). It was noted the “detailed design” was virtually complete
and would be presented to the Board in November. Work had already commenced in
the Reception area of the Health Centre. Issues which had been raised and were in
hand included: the landlord of the building would provide seismic report, and there
had been some further discussion around clinical corridor lighting at the Centre.
BOARD WORK PLAN
The Board Work Plan for October 2013 was noted.
CHAIR’S REPORT
The Chair advised there had been one retirement during the month with a letter being sent
conveying the Board’s wishes and thanks to Margaret Boyce (Anaesthetist Technician) for
her years of extended service.
Several letters of complaint had been received by the Chair, from anti fluoride campaigners
which had been responded to. These followed a public meeting held in Havelock North. The
Board fully supports continued fluoridation of Hastings water supply and also supports the
CEO and other senior staff in their efforts to ensure the community was fully and reliably
informed on this issue
The Chair Ngahiwi Tomoana, conveyed his best wishes to fellow board members for the
elections. There would be two further meetings with the current Board before any new Board
members take office on 9 December 2013.
Ngahiwi left the meeting at 1.20pm
CHIEF EXECUTIVE OFFICER’S REPORT
A good month financially, however difficulties had been experienced in relation to meeting
Ministry targets for shorter stays in ED and in elective surgery, the latter in response to acute
demand over past months.
On Fluoridation the CEO advised he was not just passionate about the issue but passionate
about reducing inequities (especially in the lower socio economic areas) who would miss out
if fluoride was taken out of the water. He was disappointed and saddened by the promotion
of incorrect data/detail by a small minority group!
CRISP Programme scope change: The Central Region DHBs have been provided with an
opportunity to make significant savings by purchasing a comprehensive licensing and service
support package than originally intended as part of the CRISP Programme Phase 1. The
Regional Governance Group recommendation was approved by the CEO, with all supporting
detail provided to members for their information.
Health Informatics: Following an overview and brief discussion (with full detail provided at
appendix II), the board approved the following recommendation.
2
RECOMMENDATION
The Regional Governance Group recommends that the Hawke’s Bay District Health Board:
1.
Note the critical need for a regional ICT strategy if government policy and ministerial
expectation is to be met in the Central Region.
2.
Note the critical need for a regional ICT service provider if the benefits of the current
CRISP are to be realised for patients, clinicians and communities across the central
region.
3.
Agree in principle to the adoption of the Central Region Health Informatics Strategy as
presented.
4.
Agree that the Board Chair and the Chief Executive provide Hawke’s Bay District Health
Board’s agreement to the strategy subject to there being no material changes through the
Central Region Boards’ deliberations.
Moved
Dan Druzianic
Seconded
Peter Dunkerley
Carried
Transform and Sustain: Work has been progressing in the following areas Transforming our
engagement with NKII; Transforming multi-agency work; Primary Care; Health Promotion
and Health Literacy; Unplanned care; and Business Models. The programme of
transformational change was moving forward and would gather speed once the revised
strategy was published following a tremendous amount of consultation. This would result in
more patient centred care and a more productive health service/sector going forward,
encompassing the whole of Hawke’s Bay.
Specific equity reports would be provided to future board meetings through Dr Caroline
McElnay as “Equity Champion”.
Other associated projects were discussed including housing insulation and funding thereof.
HB Power Consumers Trust had recently increased their funding in this area.
There had been a large number of home insulations undertaken in the past 2 years in HB,
however there was concern there were still many who were vulnerable, including those in
rental accommodation.
The HB Regional Council had been approached by Denise Eaglesome to ascertain funding
availability for Wairoa residents. There were options and it did appear there was a lack of
understanding as to what was available.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF AUGUST 2013
The Chief Financial Officer presented his report advising a favourable result of $4k for the
month without requiring any of the contingency budget and without recognising the $500k
lower than budgeted insurance cost.
Page 33 showed sources of capital expenditure and where those were spent
A one pager on the new Mental Health Inpatient Unit had been provided in August and this
would be provided again with the CFO’s Finance Report in October. The September report
will be emailed to board members separately.
Action CFO.
It was advised the FRAC meeting held earlier in the day had been attended by an auditor
who was very pleased with budgeting and controls within the organisation.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 11 September 2013
Co-Chair Dr John Gommans was in attendance and provided a brief overview of the Clinical
Council meeting held on 11 September which included:
• Transformation – Resource Deployment which was supported by Council
3
• ‘Establishing the Balance’ Financial Report
• Quality Improvement and Patient Safety Action Plan.
• Developing the HBDHB Quality Accounts 2013 – work in progress
• PHO Performance Quarterly Report
• Event Report Q4 (April-June 2013) – problem with diagnostic testing would improve.
• The first HB Clinical Research Committee meeting would be held on 7 November with
appropriate reporting back to Clinical Council.
• Annual Plan and objectives for the year was also provided and briefly discussed.
• The profile of Clinical Council in the health sector had been discussed widely and by
opening up the Clinical Council meetings to the public should assist in this area. This was
also an area of focus for Council within their Annual Plan
Hawke’s Bay Consumer Council
Chair, Graeme Norton provided an overview of the Consumer Meeting held on 12
September.
The Terms of Reference for the recently formed Consumer Council had been revised.
Originally a HBDHB Consumer Council, the group has now expanded with the support and
endorsement of Health Hawke’s Bay Ltd (PHO) to “Hawke’s Bay Health Consumer Council”,
providing a consumer voice across the Bay’s health sector. This aligns well with the Hawke’s
Bay Clinical Council also being sector wide.
An Annual Plan and objectives document would be brought back to Council following
discussion with members on their areas of interest. By November this should be completed
showing full connections with the Hawke’s Bay health sector providing a consistent voice
across the sector and feeding back to the HBDHB and Health Hawke’s Bay Ltd.
There would be some Consumer Council presence at the HB Health Sector Leadership
Forum being held on 23 October.
RECOMMENDATION
That the Board:
Endorse the revised Terms of Reference for the Hawke’s Bay Health Consumer Council.
Moved
Barbara Arnott
Seconded
David Barry
Carried
DECISION
Transformation – Resource Deployment
Tim Evans, Chief Financial Officer was in attendance and spoke to his paper.
The aim is to develop agreed measures to monitor changes in front line resource deployment
in-line with the aims of “Transform and Sustain”. The categorisation of spend for Secondary
was changed to Hospital.
This is a proposed financial categorisation at a strategic level, which overlays the
financials, enabling a simple/effective way to measure/evaluate shifts through the
Transform and Sustain strategy presently being developed. This was simply a
way/means of measuring whether a shift in resources was actually following the strategic
intent to shift service delivery close to the consumer.
Following discussion and taking into account that Clinical Council had supported the
proposal, the Board agreed:
4
RECOMMENDATION
That the Board:
1. Approve categorisation and definitions proposed to measure and enable the targeting
of resource deployment with “Secondary” being amended to “Hospital”.
2. Note that that the DHB will:
• Report quarterly actual expenditure against planned deployment of resources with
2013/14 budget as the base year.
• Review the classification of specific services as part of the annual plan/budget cycle.
• Develop a policy in consultation with Clinical Council for a targeted and deliberate shift of
resources to more convenient care.
Moved
David Barry
Seconded
Barbara Arnott
Carried
With the categories agreed the CFO advised the finance department would refine and come
back in the New Year with some targets in each of these categories. This would be a flexible
process.
GENERAL BUSINESS
There being no discussion the Chair moved into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
18.
Confirmation of Minutes of Board Meeting dated 28 August 2013
- Public Excluded
19.
Matters Arising from the Minutes of Board Meeting dated 28 August 2013
- Public Excluded
20.
Board Approval of Actions exceeding limits delegated by CEO
21.
Chair’s Report
Reports and Recommendations from Committee Chairs
22.
Hawke’s Bay Clinical Council – 11 September 2013
23.
Finance Risk and Audit Committee – 25 September 2013
24.
Allied Laundry Services Limited
- Annual General Meeting and Approval of Major Transactions
Moved:
Peter Dunkerley
Seconded:
David Davidson
Carried
The meeting closed at 2.13 pm
Signed:
Chair
Date:
5
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 30 OCTOBER 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Ngahiwi Tomoana
Barbara Arnott
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Apology:
Kirsten Wise
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Heather Skipworth (pending Board Member)
Graeme Norton (Chair Consumer Council)
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance. Congratulations were
conveyed to those who were re-elected and a warm welcome was extended to Heather
Skipworth who was attending the meeting as an observer. The Chair advised the Minister
had not yet finalised the appointment process
DECLARATIONS OF INTEREST
The register would be amended accordingly with Barbara Arnott no longer the Mayor of
Napier.
Action
A business case being considered during the meeting entitled “Electronic Board and
Committee Papers” recommended the Company “Diligent” who was listed on the NZ Stock
Exchange. It was noted that Peter Dunkerley and Dan Druzianic, as shareholders of
Diligent, would abstain from voting or any decision relating to the company.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 25 September 2013, were confirmed as a correct
record of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
November 2013
Section 1
1
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted, with an update on the Napier Health Centre
project provided by Kieran McCann (GM Integrated Care Services).
Kieran advised new lighting was presently being trialled at the centre prior to final design.
Consumer Council had held their October Meeting at the facility and following a tour offered
to assist with internal signage (way finding). A more detailed plan will be provided to the
Board in November.
BOARD WORK PLAN
The Board Work Plan for November 2013 was noted.
Following discussion it was agreed to provide an update to Board members in December on
progress with the Mental Health Inpatient Unit Project.
Action
CHAIR’S REPORT
With no retirements noted for the month, the Chair advised he had received the following
correspondence.
• A standard six month report had been received from the Disability Commissioner on
complaints received by DHBs nationally. The key areas receiving focus were mental
health, public hospital care and surgery in the public sector. Over the past five years
HBDHB has had no complaints investigated, an outstanding result. Recently however,
one had been raised for investigation, with overall Hawke’s Bay sitting at number eight in
the ranking, with eight complaints received for 1,000 discharges (69%).
• A letter had been received from the Te Matau a Maui Voyaging Trust, advising that the
Waka would be available for the Board to utilise for 2-3 hours, if they so wish. The offer
was most appreciated and will be kept in mind.
CHIEF EXECUTIVE OFFICER’S REPORT
Kevin Snee advised of an eventful month including the fluoride referendum. He was
delighted the majority of the community had seen through the nonsense and realised the
science and will be keen to revisit this topic in future with Wairoa and Central Hawke’s Bay.
It was pleasing to have Heather Skipworth and Jacoby Poulain elected to the Board,
boosting Māori representation. Acknowledgement was conveyed for the long standing and
valued service to the community provided by David Barry and David Davidson, and the
dedication of Kirsten Wise – all of whom did not stand for re-election.
Service Performance figures were reasonable and overall tracking well with areas of concern
receiving focus.
Transform and Sustain work was progressing encompassing: patient involvement, multi-
agency work, clinical quality and clinical pathways, work with primary care and through the
integration of rural services, with health promotion and health literacy work (recently
commissioned).
There was some discussion around orthopaedics and their inclusion in the Clinical Pathways
work presently being undertaken. The COO advised this would ensure consistency in the
scoring mechanism (in all disciplines), resulting in a consistent and fair treatment pathway.
With high numbers continuing to present in ED some systems dynamics modelling would
take place there in the New Year. The model (utilised by other centres) would be applied to
our systems to see what possibilities there may be to cut across some of the duplication and
choking issues. This was all about finding different ways to deal with multiple choke points in
ED.
2
FINANCIAL PERFORMANCE REPORT FOR MONTH OF SEPTEMBER 2013
The Chief Financial Officer presented his report advising an unfavourable variance of $52
thousand after releasing contingency of $128 thousand. A small variance but satisfactory
considering such large totals. There are however some pressures in the system so we
cannot be complacent.
October was looking to improve overall again and financially we are a mile ahead of where
we were to budget in September 2012.
The report was taken as read with varying items highlighted to note.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 9 October 2013
Dr Caroline McElnay was in attendance on behalf of Clinical Council and the report was
taken as read. Of particular note was the progress with the Quality and Safety Framework
and Quality accounts.
Hawke’s Bay Health Consumer Council
Chair, Graeme Norton provided an overview of the Consumer Meeting held on 10 October
2013, noting in particular the Consumer Council Annual Plan 2013/14. This enables a
Consumer Council representative to be sourced by those in the health sector requiring
consumer engagement early on in a project.
Concern around elective surgery waiting lists, especially coronary was raised with the Board.
Council wanted to understand more about how the waiting list system worked. This was
about managing expectations within the Community, as many Consumer Council members
were connected to organisations with a health focus.
Discussion on this topic is summarised as follows:
• The COO noted a request for a representative from the Elective team to address
Consumer Council which would assist their understanding on how the present process
was managed.
• The community must understand the health system will never be able to fund all surgery
requirements, and there will always be a need for prioritisation. However it was crucial to
keep everyone informed about the process. Consumer input would be invaluable and
welcomed in this area.
• The CEO advised some services may need to be scaled up but that takes time and
needs the right people (through recruitment), with a transition period in the interim.
Doctors with several specialties were preferred and sharing skills within the region was
also preferred and occurring at present.
We need to get good consumer information into our system. We also need to deliver the
same message throughout the region and maybe through the CEO and Chair could evaluate
and see how our Consumer Council links through to regional. The status of the present
Regional Consumer Forum was under review.
Māori Relationship Board (MRB) – 16 October 2013
Chair, Ngahiwi Tomoana conveyed he was very pleased by the appointments of Heather and
Jacoby and was looking forward to them joining the Board.
3
An overview of the MRB meeting held in mid October was provided and the Board who were
happy to either note and/or implement the following recommendations:
RECOMMENDATION
That the Board
Māori Service Provision
1.
Note the performance on Māori health providers in the area of Tamariki Ora and the
great results being reported.
2.
Not agree to the reduction of any more funding from the Māori health portfolio but
that existing funding be redirected into key priority areas in Kaupapa service delivery
like Tamariki Ora.
On seeking clarification, it was confirmed this comment was about maintaining
the total level of funding that existed within the Maori portfolio at present.
Human Resource Key Performance Indicators Q4
3.
Note MRB’s support for the efforts being placed into meeting this KPI and the great
relationship between HR and Māori Health Services to lead this work.
4.
Continue to track and monitor the increase of Māori staff into the organisation and
challenge where there was no increase.
Adopted
Diana Kirton advised that EIT had observed a lack of Māori lecturers teaching nursing and
issued a challenge to encourage some of our exceptional Māori nurses to be involved in
teaching at EIT. She advised that EIT struggled to recruit and retain in this area.
To improve Māori employment within the health sector would take time, requiring the need to
double the current intake to meet the 1% increase targeted.
Denise Eaglesome advised a Māori Health strategy Group was meeting in Wairoa regarding
the lack of Māori in employment, advising it was all about whanau encouraging, assisting and
supporting.
DECISION
Electronic Board and Committee Papers – Business Case
Ken Foote (Company Secretary) outlined the report and introduced co-authors Alex Trathen
(Business Analyst) and Brenda Crene (Board Administrator). There were several queries
around the Windows 8 Tablet (device) and Windows 8.1 implementation which were
addressed by Alex.
Following discussion it was agreed to implement the system and be fully operational
(including training) for the March 2014 Board Meeting.
Dan Druzianic and Peter Dunkerley abstained from voting at this time (as outlined earlier).
It was noted that amplification of board members voices to those in the gallery would be
further investigated as part of the implementation process (through Bluetooth).
RESOLUTION
That the Board:
• Agree to the introduction of Diligent Boardbooks and appropriate training for the
Executive Management Team and incoming Board in March 2014.
4
• Agree to the purchase of 25 licenses for Board and Executive Management Team (EMT)
members and acceptance of the ongoing costs associated with such licences.
• Agree to the set up of two Administrators.
• Agree to the purchase of up to 25 devices to be loaned to board members and EMT
members as appropriate, with return of the devices to HBDHB on the cessation of their
respective terms or employment with HBDHB.
• Agree to the purchase of two devices for Administrators.
• Note the pricing included may vary due to the timing delay prior to implementation.
• Note and approve the IT recommendation (in the Addendum) to use Windows 8 Tablets
as the preferred device.
Moved
Ngahiwi Tomoana
Seconded
Helen Francis
Carried
Disposal of Mental Health Properties – Jacaranda House, Te Whare Aronui and Walnut
Grove
Kieran McCann, General Manager of Integrated Care Services was in attendance, providing
an overview of the direction outlined in the paper presented.
Following discussion several points were made:
• When transitioning to the new unit, plans were in place to ensure patient services were
managed well. This has been factored into the process.
• The new Model of Care sees a complete overhaul of how mental health is provided in
Hawke’s Bay in future.
RESOLUTION
That the Board:
• Formally declare the properties surplus to HBDHB requirements.
• Approve disposal of the properties in accordance with the Statutory Disposal Processes.
Moved
David Barry
Seconded
Diana Kirton
Carried
Board Induction/Development Programme
Ken Foote, Company Secretary, outlined the detail provided with discussion summarised as
follows:
• The induction package focused on new members and provided a refresher for existing
Board members.
• Discussion around the availability of IOD courses that may be suitable for Board
members being held in house.
• A National Board Induction program would be held in Wellington catering for the 33 new
members nationally. MoH had reviewed the induction provided in 2010.
• Existing members would be inducted regionally.
• With the IOD Board appraisal due for review in November 2014, a fund for any required
professional development of board members should be allowed for in the 2014/15
budget.
5
RECOMMENDATION
That the Board
• Note the Ministry of Health DHB Board Development Programme Update.
• Agree with the concepts, themes and content of the proposed Induction and
Board Member Development Programmes
Adopted
Update on Integrated Urgent Care Project
Tim Evans (Chief Financial Officer) and Carleine Receveur (Service Redesign Manager) provided
an update utilising the HBDHB website
http://www.hawkesbay.health.nz/page/pageid/2145882178
which contained an array of information for the public to view regarding the background,
consultation workshops held across Hawke’s Bay and an array of feedback provided by the
facilitators of those workshops.
Following the workshops, a survey was undertaken online and 75% of participants had found
the interaction extremely positive.
The project group were developing scoring criteria across the triple aim at present. This
would result in the development of two or three options for further consideration.
Integrated Urgent Care and the need for this, was a common theme across other DHBs who
were at varying stages in the process.
Tu Mai Ra Quarter 4 Result (2013) and Māori Health Strategy Review and Design
Ngahiwi Tomoana and Tracee TeHuia (Director of Māori Health) were in attendance to
review the report.
The main theme to come through was that everyone was sharing the Māori health problem
had now become everyone’s problem and this was being embraced across the whole sector.
Agencies were keen to work collaboratively on all issues both internally and externally and
there was fantastic leadership including that at Board level.
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
6
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
18.
Confirmation of Minutes of Board Meeting dated 25 September 2013
- Public Excluded
19.
Matters Arising from the Minutes of Board Meeting dated 25 September 2013
- Public Excluded
20.
Board Approval of Actions exceeding limits delegated by CEO
21.
Chair’s Report
Central Region’s Technical Advisory Services AGM
Reports and Recommendations from Committee Chairs
22.
Finance Risk and Audit Committee – 30 October 2013
24.
Transform and Sustain Update Draft
Moved:
Diana Kirton
Seconded:
Denise Eaglesome
Carried
The meeting closed at 2.55pm
Signed:
Chair
Date:
7
8
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 27 NOVEMBER 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.05 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Ngahiwi Tomoana
Barbara Arnott
David Barry
David Davidson
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Apology:
Kirsten Wise
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Jacoby Poulain (pending Board Member)
Graeme Norton (Chair Consumer Council)
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
A special welcome was extended to Jacoby Poulain for her outstanding polling result in the
elections. In response, Jacoby advised although she did not have a health background she
was looking forward to serving on the Board.
DECLARATIONS OF INTEREST
David Davidson advised he had been made a trustee of the Weem Trust recently and asked
this be noted. The Weem Trust had in 2004 provided the CT scanner ($1.6m) to the Hospital
for the people of Hawke’s Bay.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 30 October 2013, were confirmed as a correct
record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Helen Francis
Carried
December 2013
Section 1
1
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update on the Napier Health Centre
provided by Warrick Frater on behalf of Kieran McCann (GM Integrated Care Services)
BOARD WORK PLAN
The Board Work Plan for December 2013 was noted.
CHAIR’S REPORT
The Chair advised of the following retirements, with a letter being sent conveying the Board’s
wishes and thanks for their extended service.
Action
Years of Service
Isobel Saunders
Booking Co-ordinator
Facilities & Operational Support
13
Sonya Whale
Receptionist
Facilities & Operational Support
30
Liz Harvey
Registered Nurse
Acute & Medical
14
Janice Burnett
Booking Co-ordinator
Facilities & Operational Support
35
An update of communications received since the last meeting were summarised:
• Health Target Results for quarter one had been received showing we had come through
well in four of the six targets, however shorter stays in ED had deteriorated at the time
the snapshot had been taken. The difficult month in ED was acknowledged by the CEO.
The DHB’s elective performance has also dropped off the pace, management advised
that this was principally as a result of not including minor procedures in the data
submitted to the Ministry.
• Kevyn Moore of the Oliver Smales Trust had provided a biennial update of funds and
spending from the Trust to keep the DHB informed. As at the 30th June 2013 the Trust
capital funds stood at $168,000. Currently the Trust is raising funds to purchase a GE
portable ultrasound for Ata Rangi, which can also be used in outlying areas of the
HBDHB district.
• The Central Technical Advisory Service (CTAS) Board had advised they had appointed
Graham Smith to role of Chief Executive Officer (who would commence the role on 13
January 2014). It was acknowledged that interim CEO Julian Moore, had done an
outstanding job for the organisation.
• A letter from Eileen Page advised of her resignation from the Hospital Advisory
Committee (HAC). In her letter she acknowledged the high level of governance
leadership, including the new format for committees which were working well, in her
opinion.
• During the month the Chair and CEO had met with Ahuriri District Health Trust (ADH) and
Ministry of Health representatives. The Chair advised he was disappointed with progress
in agreeing to a contract to spend the $1.3m of the monies held by HBDHB for oral health
services in the Ahuriri district. The Chair said the trustees were struggling to bring this
together.
• A letter from NZ Police around suicides in the Flaxmere area had been received, asking
HBDHB to take a lead role to co-ordinate services community wide and suggesting a
prevention service be set up to manage the risk of suicides in region. The report was
confidential but the Chair was happy to share this with board members if they so wished.
• It was noted that Auditors reviewed Central Technical Advisory Service (CTAS) and
disagreed with the accounting treatment of the CRISP CAPEX. If not addressed, this
created obligations for directors that would be unacceptable. The Regional Governance
Group unanimously agreed to $3.2m of CAPEX being reallocated to OPEX and approved
an additional OPEX budget of $1.55m for CRISP in the 2012/13 financial year to enable
the increase in OPEX to be accommodated without breaching the CRISP budget for the
year.
2
CHIEF EXECUTIVE OFFICER’S REPORT
CEO, Kevin Snee commented on performance with ED and elective surgery targets showing
improvement in November.
Financial performance has been positive for the month of November, with no contingency
used. Savings of $14m had been generated over the past three years to make
improvements to health services in Hawke’s Bay. These improvements include the new
Wairoa Health Centre recently opened by Minister Tony Ryall, who had also visited the
Hastings Renal unit. It was noted 70 more patients were being treated through the Renal
Unit as a consequence of the upgrade.
The Transform and Sustain document had been revised but was not in final form. Key
intentions and demographic changes had been included and a final version would be
released in December.
Other areas summarised included Multiagency, Clinical Pathways programme and the Health
Alliance which would be discussed later in the meeting.
Good progress had been made with Tu Mai Ra which saw 17 of the 20 KPIs showing
improvement. The low indicators were problematic and the question was asked whether
they were the best measures for the future.
A Hui held on the Maori Health strategy recently with 60 in attendance. There was concern
that attendance was low, however members were assured this was not of concern due to
rigorous consultation that had occurred. This Strategy was being seen, not as a Maori
programme but more a Community programme.
There was discussion around births in Hawke’s Bay with 48% of being Maori, with 33% of
those births being teenagers. Teenage pregnancy was of real concern.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF OCTOBER 2013
The Chief Financial Officer presented his new format financial report, advising the changes
were made to make the document more user friendly.
In summary areas pointed out for note were:
• Bad and Doubtful debts of $580k - are we doing enough as the anomalies appear to
be more through acute patient admissions, who were not covered by the NZ health
system.
• Capital development work on the “Mental Health Unit” was progressing, with some
work undertaken ahead of timelines, resulting in spend against the budget being
slightly ahead of plan.
The new format was acknowledged as being much improved and the CFO was congratulated.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 13 November 2013
Dr John Gommans and Chris McKenna (co-chairs) were in attendance on behalf of Clinical
Council and the report was taken as read.
• Interim work has and will continue to be been undertaken with Council on Quality and
Patient Safety. This had been high level from which will flow a number of operational
actions.
• The Hawke’s Bay Clinical Research Committee had their inaugural meeting during
November. This was not an operational committee and does not replace the bodies
operating within the community. This sub-Committee of Clinical Council is chaired by Dr
John Gommans.
3
Ngahiwi asked how research gets to table and mentioned the issue of “post trauma”.
In response, the organisations operating have standard criteria which need to be met
when embarking on research. The goal of the Clinical Research Committee was to raise
awareness on what was happening and identify where there were gaps, as presently
many work in isolation.
Hawke’s Bay Health Consumer Council – 14 November 2013
Chair, Graeme Norton was in attendance and the report was taken as read.
Graeme commented there had been discussion, observations and suggestions made around
quality improvement and patients safety, stemming from the work recently worked through
with Consumer Council. From this work and on discussion with Tracee TeHuia (GM Maori
Health) the following was suggested to the Board:
•
Patient Stories: That 15 minutes be set aside at the beginning of each board meeting to
consider a patient story as this would remind us about what we are here for. From patient
stories you listen, learn and link services to the person, not the person to the services
. By listening and learning you sometimes realise the service required may not be in
health.
The board felt “patient stories” were an important part of healthcare with members
supporting the wish to start with a patient story for the new Board.
Action
•
Communication and Media Interaction. As consumer members become more
active/visible they need skills to ensure they respond appropriately, and also ensure they
are not replicating channels of communication that already exist.
DECISION
Hawke’s Bay Health Alliance
Kevin Snee and Liz Stockley outlined the report provided regarding the formation of a
Hawke’s Bay Health Alliance. This is a requirement of the Ministry and in line with the PHO
Contract with the DHB and is also in keeping with how we work with the PHO. The report
explained what we have achieved, how we work and the people involved. Respective
leaders continue to drive the change needed for integration of the health system in Hawke’s
Bay. This pulls the strands together noting there is a need to have a bias towards having
clinicians involved.
The Health Hawke’s Bay Board had approved the formation of the Health Alliance the week
prior advising representatives were: Andrew Heslop, Bayden Barber, Adri Ibister and Liz
Stockley.
Support was provided by the board with the following resolution adopted.
RESOLUTION
That the Board :
•
Approves the establishment of the Hawke’s Bay Health Alliance under the terms of the
Draft Foundation Document (Appendix 1).
•
Appoints Barbara Arnott as Board representative to the Alliance Leadership Team
•
Approves the appointment of the following to the Alliance Leadership Team:
-
CEO
-
Chair (or nominee) of:
Maori Relationship Board
Hawke’s Bay Clinical Council
Hawke’s Bay Health Consumer Council
Moved:
David Davidson
Seconded:
Denise Eaglesome
Carried
4
Maternity Services Business Plan
Warrick Frater, Chief Operating Officer provided a detailed overview and was supported by
Rika Hentschel (Service Director, Women, Children & Youth), Jules Arthur (Midwifery
Director) and Dr Philip Moore (Clinical Director)
There had been a significant period of consultation on a whole of Hawke’s Bay view for the
provision of maternity services in Hawke’s Bay. The concept of a primary birthing unit was
part of the consultation process, and the preferred option. The board were asked to accept
the recommendation to proceed to the next stage.
Discussion was summarised as follows:
• UK studies have demonstrated lower risk over a period of time, was the response to a
question about having a separate primary care unit and the envisaged drop off in
intervention rates.
• The demographic mix in Hawke’s Bay had changed and births by caesarean in the area
being one of the highest in the country.
• This was not just about establishing a new facility but would be a new way of interacting
with mothers. This will change the model of care to be service led.
• Wairoa mothers were being encouraged to birth in Wairoa with an upgraded service.
• The location of the primary birthing unit was selected for cost saving reasons, but it also
provided the opportunity to reshape service delivery to patients. Some car parking would
be removed in the build but they would be replaced.
• The CFO advised the increase of $1m above previous estimates would be funded
through the savings program.
• Timing of the project for completion at the end of 2017 was disappointing to some board
members who asked whether timing could be pulled forward. This would be discussed
by the Management team and be taken to the Finance, Risk and Audit Committee on 18
December
Action
RESOLUTION
That the Board :
•
Note there had been wide consultation with key stakeholders on the model of care
driving this proposal
•
Approve this Business Case.
•
Approve an estimated Capital Budget of $2.62m (excl GST)
Moved
David Barry
Seconded
David Davidson
Carried
Transform and Sustain
The Transform and Sustain document was issued in draft form to board members and would
be put on the website
Action
• The document included a clear statement on how the population was changing in
Hawke’s Bay (with growth in the Maori, Pacific, Asian populations as well as an increase
in the aged population).
• Case studies/patient stories were used to bring the document alive.
• Focusing on better ways to do things by better understanding the needs of our people.
5
• The detail will lie behind this document and linked into a Detailed Workplan.
• Rather than having the DHB logo incorporated into the document, the board felt the logo
representing Hawke’s Bay should be used to better reflect transformation and integration
of the health system. This was noted.
• The map included in the document would be amended.
Members were asked to spend some quality time on the document and provide feedback
through Kevin Snee and/or Anna Kirk.
Action
Members were very appreciative and supportive of commitment and amount work
undertaken. They look forward to receiving the final Transform and Sustain document at the
18 December Board meeting
Action.
MONITORING
Performance Framework Exceptions Q1 (July-Sept 2013)
Tim Evans (CFO) outlined the report provided and drew the board’s attention to the
Performance Highlights (on page 52). Areas where targets were not achieved included:
elective surgery, ED and better management of long term conditions. The latter having a
denominator change which was being validated.
The Chair noted three areas for further clarification being:
• Page 71 - MRI CT Scans – the drop in the last quarter was of concern with an
explanation sought.
It was advised that ACC had tightened their belt, whereas discharged patients requiring
scan in the past, had taken the pressure off by having their scans through private
providers and charged back to ACC directly. ACC no longer allowed this, ultimately
putting increased pressure on the numbers of people waiting for scans through the
hospital.
• “Did Not Attend” specialist appointments on page 75, showed steady progress at 17.9%
for the previous quarter. However for Quarter 1, this had risen to 20% “did not attends”
for Maori. This was unacceptable and if it further increased we have a real issue!
Ngahiwi agreed.
Action ?
• Page 79 – Needs Assessment and Service Co-ordination (NASC). The high staffing
demand due to online IT issue, was of concern.
Generally the report showed a lot of pleasing results.
HR KPIs Q1 (July-Sept 2013)
John McKeefrey spoke to the report provided, highlighting the following points:
• The final position around personal costs page 82. cf year ago reports an increase in staff
numbers, offset by decrease in administration etc.
• Sick leave was tracking at 3.0% which was the third lowest of 20 DHBs.
• Staff turnover had been around 18% and was now tracking at around 14%. Some staff
stay too long therefore a healthy turnover is seen as good/refreshing. Staff turnover at
8.0% is probably a little too low.
• Staff ethnicity (Maori employed in health) commenced the year with a gap of 51 which
had narrowed to 43. This area was receiving focus from Kahungunu and the Tu Tuki
Steering Group and it was noted would take a while to turn around.
• To have a comparison to measure against, HR have requested other DHBs to add
ethnicity to their reporting.
• Page 93 relayed the Occupational Health and Safety KPIs which had shown a drop.
6
• Lost time injury rates can be compared to other DHBs
• There had been three serious harm incidents (vigilant around reporting). Serious harm
set out in legislation (fractured arm can be serious harm).
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
17.
Confirmation of Minutes of Board Meeting dated 30 October 2013
- Public Excluded
18.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
19.
Board Approval of Actions exceeding limits delegated by CEO
20.
Chair’s Report
Regional Governance Group Meeting (November)
Reports and Recommendations from Committee Chairs
21.
Hawke’s Bay Clinical Council – 13 November 2013
22.
Finance Risk and Audit Committee – 27 November 2013
23.
Transform and Sustain Update Draft
Moved:
Barbara Arnott
Seconded:
Denise Eaglesome
Carried
The meeting closed at 3.10 pm
Signed:
Chair
Date:
7
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 18 DECEMBER 2013, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.05 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Ngahiwi Tomoana
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Jacoby Poulain
Heather Skipworth
Andrew Blair
Apology:
Barbara Arnott
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
Members of the public and media
Minutes
Brenda Crēne
KARAKIA
Deputy Chair, Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair welcomed those in attendance, extending a special official welcome to new Board
members Jacoby Poulain and Heather Skipworth and Andrew Blair.
As this was the first official meeting of the “new” Board, a welcome was also extended to
returning members. The Chair felt the Board was in good shape to move forward and take
up the challenges ahead.
It was noted that Kevin Atkinson and Ngahiwi Tomoana were appointed Chair and Deputy
Chair respectively for the current term. Peter Dunkerley acknowledged this was Kevin
Atkinson’s 5th term as Chairman of the Board and congratulations were in order. It was also
very pleasing to have Ngahiwi make himself available and return as Deputy Chair.
Committee appointments would be covered later in the agenda.
A change to the meeting agenda was conveyed with item 19 “Implementation of the Central
Region Health Informatics Strategy”, moved to the public section of the meeting as a
decision.
DECLARATIONS OF INTEREST
Andrew Blair’s interests had been included on the register provided.
Actions:
Jacoby Poulain and Heather Skipworth would provide interest details to the Board
Administrator.
Diana Kirton advised family members had been employed by the DHB with details to
be formally advised for the register to be updated accordingly.
February 2014
Section 1
1
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 27 November 2013, were confirmed as a correct
record of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Item 2:
Patient Stories would commence in February 2014, with a process to be put in
place to have these come through the Consumer Council and included on the
Agenda
Action
Item 3: The
Maternity Services Project was fully supported by the Board at the
November meeting with the suggestion at that time, to bring the facility build
forward (from 2017). This had been discussed by Management with some
concern expressed as to the logistics of bringing the build date forward with the
new Mental Health build occurring on site around the same time.
Action This would be further reviewed and an update provided to the Board
in February.
Item 5:
Did Not Attend (DNA) first specialist appointment. It was noted there was an
ongoing piece of work in progress and the COO advised he would bring this back
to the Board in due course.
The Deputy Chair referenced a letter from the NZ Police around suicides and asked whether
the DHB were taking a lead role? Dr McElnay responded that work was in progress and a
person was to be appointed into a co-ordination role.
BOARD WORK PLAN
The Board Work Plan for February 2014 was noted.
New board members were invited to attend induction training in Wellington 17/18th February.
It was noted the HB Health Sector Leadership Forum would be held the following day,
Wednesday 19th February.
CHAIR’S REPORT
The Chair advised there were no retirements to acknowledge, or any significant items to
raise since the last meeting.
CHIEF EXECUTIVE OFFICER’S REPORT
Whilst steady progress had been made during 2013, we need to accelerate change in the
latter half of the financial year. As we end this calendar year we signal our intention to drive
change in a more transformational manner in order to ensure the needs of our population are
met more fully.
Financial performance continued slightly ahead of plan with a $3.0m surplus on track.
However looking ahead, HBDHB would receive $2.5m less funding in 2014/15. This had
been compounded by changes to the way tertiary hospitals were funded and the lower
population growth in Hawke’s Bay compared to other parts of the country.
An overview of the report followed on quality and safety markers as well as Transform and
Sustain progress in engagement with Maori; Clinical Quality through Clinical Governance;
Patient Experience through Better Clinical Pathways; Integration of Rural Services Update;
Primary Health Care
2
An equity update around child poverty had been recently released. Child poverty has ongoing
impacts and HBDHB has a major role in this area.
The formation of the HB Intersectoral Leadership Group had been initiated in 2013 with
membership representative from the five HB territorial authorities, MPs, NZ Police, Ministry of
Social Development, TPK, NKII, Ministry of Education etc. Although early days, the purpose
of the group is to work collaboratively to achieve clarity of vision for Hawke’s Bay, and ensure
effective working relationships on agreed priorities.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF NOVEMBER 2013
The Chief Financial Officer summarised the report provided, noting in particular:
• Overall an encouraging month’s performance with $119 thousand favourable.
• It was noted there were 30 more full time equivalents paid during November, than
planned. This related largely to nursing staff, where taking of annual leave and
implementation of summer rosters had not happened as planned. It is possible that
annual leave taken in the peak holiday period of December January will correct this.
There had been discussion around the financials at the Finance Risk and Audit Committee
Meeting held earlier in the day. The theme that came through was the forecast looks
comfortable, however next year looks to be quite challenging. PriceWaterhouseCoopers
were undertaking a project to help the DHB identify strategies, initiatives and opportunities to
be able to efficiently manage with less funds. This will come to the board in due course.
Following a brief discussion around signatories, the following was agreed:
RESOLUTION
That the Board
Note the contents of the report.
Delegates authority to the Chief Executive, Chief Financial Officer, and Finance Manager to
act as authorised signatories for changes to the Master Services Agreement between the
DHBs, HBL and Westpac.
Moved
Dan Druzianic
Seconded
Helen Francis
Carried
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 11 December 2013
Chris McKenna (co-chair) Chief Nursing Officer was in attendance on behalf of Clinical
Council and provided an overview of the report advising it had been a large agenda including
feedback on the following topics: Quality accounts; Health Passport and Clinical Indicators,
Gastroenterology Model of Care and Endoscopy Business Case.
Hawke’s Bay Health Consumer Council – 12 December 2013
Chair, Graeme Norton introduced himself to the new members advising the Consumer
Council (which focused on the needs of the consumer) had been in operation for six months.
Members were becoming increasingly active in projects where a consumer voice was crucial.
A topic high on Consumer Council’s agenda was access to GPs and low cost care. The PHO
were focussing in this area and were providing information to Consumer Council..
3
It was during a discussion on Clinical Indicators that Did Not Attends (DNAs) arose with a
suggestion that Consumer Council may consider looking at this with a fresh set of eyes in the
New Year.
Maori Relationship Board – Special Meeting – 17 December 2013
Denise Eaglesome provided an overview of the meeting held the day prior.
Tu Mai Ra Report Q1 (July-September) was reviewed with several missing commentaries
noted. Did Not Attend (first specialist appointments) had been discussed and noted that Paul
Malan would be providing a further report on DNAs. MRB advised they were to seek a status
review of the recommended actions from Paul’s 2012 DNA Report.
The Maternity Services in HB (Business Case) had been provided for information. The
Business Case had been reviewed by Consumer, Clinical Council and approved by the
Board in November, noting extensive consultation had been undertaken. MRB members did
raise several areas of concern, and in response the COO provided comment summarised as
follows: a midwife visits a mother and baby within 48 hours of discharge as this was a
statutory requirement; the new maternity facility was about the birthing experience; length of
stay issues were more related to secondary maternity service provision; the relationship
between the mother and the midwife around pre and post delivery was vital - with attendance
by mothers to these services paramount.
Ngahiwi Tomoana was concerned about the low attendance by Maori women to ante-natal
clinics (at 27%) and suggested the service provider send a reminder to whanau (using an
“auntie” system) to ensure pre and post natal attendance. Although this was seen as a good
idea, there were privacy and practicality issues to consider. The Deputy Chair would further
evaluate as this system had been very successful with native peoples internationally.
Any feedback or ideas would be directed to the Maternity Services Project team in the first
instance.
The focus of this special MRB meeting was to address the first draft of the Maori Health
Strategy (for the next three years) and following discussion it was agreed to reduce the size
of the document and simplify the strategy.
Pacific Health Leadership Group – 2 December 2013
Talalelei Taufale (Pacific Health Development Manager) spoke on behalf of Barbara Arnott,
who was a conduit for this newly formed Group reporting to the Community and Public Health
Advisory Committee.
Members showed a real willingness to roll up their sleeves to improve health issues in their
pacific communities. Meetings would be held quarterly and the Group would appoint a
Chairperson at their next meeting. It was anticipated that the Chairperson would join the HB
Health Sector Leadership Forum in 2014.
DECISION
Transform and Sustain
The bound Transform and Sustain document, in near final form was provided to members.
Feedback was very positive with some minor changes noted to page 6. The health system
logo introduced was for further discussion (within the sector) however feedback had
generally been positive.
The need for transformational change was real and the key intentions identified would
become part of the emerging strategy. With focus and determination we should see
ourselves in a very different place in five years time.
4
The Transform and Sustain document will be on the HBDHB website and continually
updated. The deployment graph included within the document will provide a snapshot to
monitor resources throughout the process of change.
Thanks and gratitude was expressed to those who had put an enormous amount of work in
to get to this point. It was pleasing to note a lot of activity had already occurred around the
intentions identified.
Following discussion the board passed the following resolution.
RESOLUTION
That the Board
Approve the Transform and Sustain document as the Hawke’s Bay health strategy for the
next five years.
Moved Denise Eaglesome
Seconded Helen Francis
Carried
Action: A Transform and Sustain five year program will be brought back to the Board
in the New Year.
Board Committee Structure and Meeting Schedule for 2014
Ken Foote (Company Secretary) relayed changes made to the Terms of References (TOR)
for the respective committees, along the lines discussed at the November Board Meeting.
The meeting schedule had been amended with the planning and combined strategic
committee meetings removed utilising as agreed, the HB Health Sector Leadership forum as
the more appropriate vehicle moving forward.
Changes to the Policy for Payment of Fees had been made to allow for payment to the HB
Health Consumer Council and the newly formed Pacific Health Leadership Group.
Nomination of the Chairs for the advisory committees (CPHAC, DSAC and HAC) even
though they may not meet was however a statutory requirement. The respective Chairs
would be familiar the TOR’s for their respective committees and have the ability to call
special meetings at any time.
Ken was thanked for the work he had put in and the following resolution was agreed:
RESOLUTION
That the Board:
Note the contents of this report.
Approve the “evolution” ideas
Approve the “Draft Amended Terms of Reference” for
- Community and Public Health Advisory Committee (CPHAC)
- Disability Support Advisory Committee (DSAC)
- Hospital Advisory Committee (HAC)
- Finance Risk and Audit Committee (FRAC)
- Maori Relationship Board (MRB)
- Hawke’s Bay Clinical Council
5
- Hawke’s Bay Health Consumer Council
- Hawke’s Bay Health Sector Leadership Forum
Approve the amended/updated Policy “Payment of Fees and Expenses”
Approve the Draft 2014 Meeting Schedule
Review these changes in November 2014 to ensure it is meeting our needs
Moved
Peter Dunkerley
Seconded
Ngahiwi Tomoana
Carried
Napier Health Centre Detailed Design Update
Kieran McCann (GM Integrated Care Services) updated the Board on progress with the
Napier Health Services design project. With the seismic report received, detailed design
completed and the project let for tender, the project was proceeding according to plan.
Tenders had since been received for review and it was noted that some preliminary work in
the Reception area had already been completed.
The design was user friendly, with good patient flow and signage. Appreciation was
expressed to Consumer Council for their input which had been very helpful. The demand for
extra space had been timely.
There was some discussion around the inclusion of a Pharmacy or a dispensing facility at the
complex. It was agreed this topic would be further discussed around a long term strategy for
pharmacies and licensing
Action
RECOMMENDATION
That the Board
• Note the progress on detailed design of the facilities changes at Napier Health Centre
• Note that HBDHB has received owner approval to proceed with planned facility changes.
• Note the Initial Seismic Assessment Report of Dec 2011 confirms the building is not
earthquake prone and has a New Building Score (NBS) of 60% at Importance Level 3,
placing it in the medium risk category (acceptable level is between 34-66 %). The
agreed detailed design has been assessed to only have minimal effect on this score and
therefore the works can proceed.
Adopted
Working in Partnership for Quality Healthcare in Hawke’s Bay
An introduction was made by John Gommans and Graeme Norton (co-Chair and Chair of the
respective Clinical and Consumer Councils) who had been working with their teams and
Emma Foster (Project Manager) on this for some time. This piece of work was triggered
when the Ministry of Health challenged DHBs across all services to ensure patient Safety.
Emma provided copies of the Framework document in bound form and followed up with a
presentation which was very well received and included a lot of positive well researched
messages.
6
Points summarised:
• To make changes in your organisation you need stories.
• Hawke’s Bay working together as one whole health system
• Five priority areas had been identified:
o
Implement information technology solutions to support quality improvement.
o
Ensure that our most vulnerable have all available resources needed to support their
health journey.
o
Improve process of gathering patient experience data, and how we share it.
o
Support ongoing professional development.
o
Develop consistent patient journeys through clinical pathways or individual pathways
for difference services.
• The next step includes the development of action plans to underpin the Framework.
• This will be a transparent process with website updates throughout.
• People will feel more confident providing feedback as we are doing something with
information and comment provided.
Those who put quality measures at the highest level as their financial measures must
succeed! We have good staff and the Framework to do this well.
There was no hesitation in adopting the following recommendation.
RECOMMENDATION
That the Board:
1.
Note the summarised feedback from the specific stakeholder engagement, “Working in
Partnership for Quality Health Care in Hawke’s Bay – A Summary of Feedback”
(December 2013).
2.
Endorse that “Working in Partnership for Quality Health Care in Hawke’s Bay – A
Quality Improvement and Safety Framework” (December 2013) as the strategic
framework for quality improvement and safety for the Hawke’s Bay health sector.
3.
Note the priority action areas identified throughout the stakeholder engagement
process.
Adopted
Quality Accounts
Dr Caroline McElnay presented the paper on Quality Accounts which started off initially as
optional for DHBs to complete. Subsequently the MOH advised all DHBs were required to
complete Quality Accounts from 2013 onwards.
The paper provided (which had been viewed by Clinical Council) was a pragmatic approach,
including comment next year on proposed enhancements for a mix of local measures (3)
being: Correct labelling of laboratory specimens: plans which reduce the risk of relapse in
people with mental illness; and Rheumatic Fever.
Nationally, in addition to the Health Targets there would be measures to: Reduce harm from
falls; Reduce harm from surgery; Reduce harm from medications and Reduce harm from
healthcare acquired infections.
Board feedback was sought, however it was recognised the timeframe was very tight for the
(prior year accounts y/e June 2013). The document provides the basis for next year’s
Quality Accounts and further minor changes would be made prior to submission.
7
RECOMMENDATION
That the Board approve the Quality Accounts which would be submitted subject to minor
changes.
Adopted
Implementation of the Central Region Health Informatics Strategy – from public
excluded section
The CEO provided an outline and stressed the need for the CRISP programme to move
forward as a region. Following some discussion the resolution was approved.
RESOLUTION
That the Board :
1. Note the critical need for a regional ICT strategy if government policy and ministerial
expectation is to be met in the central region.
2. Note the critical need for regional ICT service provision if the benefits of the current
CRISP are to be realised for patients, clinicians and communities across the central
region.
3. Agree to adopt the Central Region Health Informatics Strategy as
appended.
4. Approve
the Transition Plan as appended to guide the implementation of the
Strategy.
5. Note that the Transition Plan is not:
• Centralisation of all regional ICT staff into Wellington (or anywhere else).
• Regional ICT driving/determining DHB business goals and outcomes.
• One (or more) DHBs taking over the region at the expense of others.
• Regional ICT suppliers telling their customers what their problem is and how
they’ve solved it.
• A removal of sovereignty or control from any DHB over their business
• Hugely expensive.
6.
Note that the estimated costs are up to $495k pa (including upfront costs).
Moved
Diana Kirton
Seconded
Dan Druzianic
Carried
MONITORING
Mental Health Inpatient Unit Update
Kieran McCann (GM Integrated Care Services), Dr Simon Shaw (Clinical Director), David
Warrington (Nurse Director), Allison Stevenson (Service Director) and Amber Hone (Project
Manager) updated the Board on the project to date, and overviewed the developed design
plan which provided for flexibility with subtle design measures included.
Preparing the site for the build to commence had required some fairly extensive works to be
undertaken on and around the environs.
Change and transition is underpinned by the Model of Acute Care, with the Maori Cultural
Pathway of Care sitting underneath but linked. Other ethnicities cultural requirements would
occur in the same way, as required.
8
With change and transition comes a comprehensive set of activities and timelines to ensure
continuity of service. Frequently asked question (FAQ) sheets had been put in place to assist
with customer enquiries.
Following enquiries around the nature of services provided at the facility as well as the
inclusion of specific areas/items into the facility eg lounges, a Gym and therapeutic outdoor
spaces, the Board expressed their appreciation with how the project was progressing.
Tu Mai Ra Q1 (July-Sept 2013)
Tracee Te Huia (GM Maori Health) welcomed the new board and hoped they enjoyed
Powhiri (held earlier in the day). In introducing the Tu Mai Ra Report, Tracee noted in
particular the real strength in relationships that were being developed, which was very
pleasing. This included the rationalisation of Maori health providers from 12 down to five,
which was paying dividends.
On reviewing the Tu Mai Ra Report, there was support for fewer indicators over the next 3-5
years.
Reporting in age bands had been discussed at MRB and it was felt that age band reporting
may provide for better focus/structure of services for particular groups. Some were unsure
however whether that would be the best use of resources as it would not be desirable to
have four to five provider vehicles up the driveway of our more vulnerable families. The
focus should be to “contract for outcomes”.
There had been a huge improvement in reporting with many gains made, however we still
had a long way to go. The efforts put in by all were acknowledged.
The Chair expressed his interest in focussing on the generation of Maori born today to
ensure they have the same equitable health opportunities across the board, as their non-
Maori counterparts, and not the inequitable health status of older Maori today.
Other members agreed it was about prevention and education, with access to services not
occurring for a whole lot of reasons. There needed to be a focus on Did Not Attend first
specialist appointments (DNAs).
There was also a real challenge in the area of workforce development. As everything was so
tight, there was little flex for those workers to take time out to advance their education. It was
noted that EIT had stopped several programmes recently due to insufficient enrolments as a
result of students not able to be released, due to work pressures.
9
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
17.
Confirmation of Minutes of Board Meeting dated 27 November 2013
- Public Excluded
18.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
19.
Board Approval of Actions exceeding limits delegated by CEO (nil)
20.
Chair’s Report
- Regional Governance Group Report 2 December 2013
- HBL Chairs Update
- Committee Appointments
Reports and Recommendations from Committee Chairs
21.
Hawke’s Bay Clinical Council – 11 December 2013
22.
Finance Risk and Audit Committee – 18 December 2013
23.
Transform and Sustain Update Draft
Moved:
Diana Kirton
Seconded
Peter Dunkerley
Carried
The meeting closed at 4.40pm
Signed:
Chair
Date:
10
Document Outline
