MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 26 FEBRUARY 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.04 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Barbara Arnott
Heather Skipworth
Andrew Blair
Apology:
Ngahiwi Tomoana and Jacoby Poulain
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
Members of the public
‘Put Patients First’ supporters
Television and media
Minutes
Brenda Crēne
KARAKIA
Tracee Te Huia, General Manager of Maori Health, opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
Andrew Blair and Diana Kirton advised of changes to Interest register directly.
No member had any interest to declare associated with the papers on the agenda.
DEPUTATION
A welcome was extended to those in attendance including members of ‘Put Patients First’
supporting a presentation around the General Practitioners Specialised Interest (GPSI)
Diabetes Services, specifically the cessation of the contract between Dr Janet Titchener and
HBDHB.
Guidelines around deputations had been provided prior to the meeting and were briefly
conveyed prior the commencement of an audio visual presentation.
Henare O’Keefe and Erena Tomoana each spoke passionately in support of the continuation
of funding for the service as important to approximately 100 patients serviced by Dr
Titchener.
In response the Chairman of the Board was grateful for the insight which emphasised how
important it was to develop clinical care pathways for diabetes so it met patients needs
across the whole health sector in Hawke’s Bay which is where the DHB’s focus must be.
March 2014
Section 1
1
The community must be reassured that the Diabetes Service in Hawke’s Bay was already
among the best in New Zealand and this will improve further with the planned implementation
of “clinical pathways”. In reality there were 8,000 diabetics in Hawke’s Bay and probably
another 2,000 un-diagnosed and HBDHB were well aware of the crippling costs, if not
managed well into the future.
Clinical Care Pathways follows international best practice and is a valuable component of
care being delivered through General Practices throughout the region.
The Chair urged the Put Patients First group to engage with the Hawke’s Bay Health
Consumer Council whilst the clinical care pathway was developed for diabetes care. This
pathway would be fast tracked with a target for completion at the end of April 2014 (originally
being June 2014).
Henare O’Keefe stressed the need to open up the channels of communication around this
without any hidden agendas.
This was acknowledged and the group were thanked for their attendance but should remain
confident that the development of clinical pathways would alleviate their perceived fears.
Those attending were asked to stay on when the Clinical Care Pathways Business Case was
reviewed. Many left the meeting at this point.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 18 December 2013, were confirmed as a correct
record of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Action 1: Patient stories would be included on the March Agenda
Action 2: Maternity Services Project/Build would remain as an action for further update.
Action 3: Interests Register – further changes relayed (by Andrew and Diana) would be
actioned.
Action 4: Transform and sustain – the development of a five year programme remains an
action.
Action 5: Long Term Strategy for Pharmacies and Licensing would be included as an action,
from 18 December minutes, page 6.
BOARD WORK PLAN
The Board Work Plan for March 2014 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.
Years of
Name
Job Title
Service
Tessa Davidson
Registered Nurse
25
Monica Wilde
Registered Nurse
39
Pip Rutherford
Nurse Practitioner
28
An update of communications received since the last meeting were summarised.
2
• A letter had been received from Totara Health offering support to assist in training of
general practices in support of diabetes care and share experiences and ideas.
• In December the Regional Governance Board had reached agreement around the Crisp
Project, it was pleasing to note all six DHBs had since signed in support of completing the
project within the original budget.
• A letter received from the HB Rescue Helicopter Trust advised under the new Trust Deed
that the six Trustees would be appointed ‘at large’ with no representative Trustees. Detail
around appointment criteria was also clarified.
• An invitation had been extended to the Board to visit the HB Rescue Helicopter Hangar to
better understand operations and have lunch. This would be noted as a
future action which would mean commencing the FRAC meeting early to allow sufficient time.
• The national health targets for quarter two had been received with positive results for
Hawke’s Bay in Short waits for Cancer Treatment, Immunisation and Better Help for
Smokers to Quit.
• The PHO Performance Report for quarter one had also been received for the 36 PHOs in
NZ.
• Central TAS Board advised they were keen to visit and have discussions with HBDHB.
This had been agreed and was included on the workplan for the April Board meeting.
• Minister Ryall provided a letter of Expectations for DHBs and subsidiary entities for
2014/15, including commentary on: Better Public Services (results for New Zealanders);
National Health Targets; Care Closer to Home; Health of Older People; Regional and
National Collaboration; and Living Within our Means.
• Minister Ryall had also advised in the 2014/15 Annual Planning Package, the 62-day
faster cancer treatment indicator would replace the current Shorter waits for cancer
treatment health target during 2014/15 (referring to those referred urgently with high
suspicion cancer).
• The Minister had announced on 29 January that $10m more would be spent on Elective
Surgery. Hawke’s Bay will be in line to receive $1.0m of that which would be an
enormous benefit to the community, if we can deliver to contract.
• An email had been received from Hutt Valley DHB, advising that CTAS changes to the
Constitution proposed within the papers had not been approved by their Board. Under
the Constitution all six Central DHBs need to agree unanimously. This was further
discussed under item 15 on the agenda.
CHIEF EXECUTIVE OFFICER’S REPORT
The report from the CEO was taken as read with commentary summarised as follows:
• We experienced the highest number ever (158 people) through the Emergency
Department (ED) in one day which put an amazing amount of pressure on everyone
concerned.
The ED Steering Group has been re-formed, taking a fresh look and now calling the
transit through to a destination “Patient Flows”.
The earlier Project had not changed behaviours in a sustainable way and that will be the
focus. In reality we have improved a great deal from where we started (moving from 74%
and stalling at around 93-94%). If there had not been greater numbers of people coming
through ED we would be running at 97%. We need to focus on how we run acute patient
flows and how we management the process.
• Finance: we are moving towards a 4th year of surpluses because we have managed our
resources well and made some difficult decisions along the way.
• Transform and Sustain work was preceding with focus in the following areas:
Transforming engagement with Maori; Transforming Multi-Agency Work; Patient
Experience through Better Clinical Pathways; Integration of Rural Services; Transforming
Primary Care; Transforming Out-of-Hours Inpatient Care; and Health Promotion and
Literacy.
3
• Heart and diabetes check work would be fast tracked. There was a program with general
practice to ascertain the position and also work with practices to ensure they have the
resources to cope if patients have a bad outlook.
• Virtual CVD assessments was another area being worked through in the community.
• There was a lot of work going on through the Cancer Network Group plus the faster
cancer treatment programme, as well as the development of Cancer Pathways.
• HBDHB were fairly confident in utilising the additional $1.0m of MOH funding for
electives.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JANUARY 2014
The Chief Financial Officer presented his report advising of a favourable variance of $277
thousand in January with cumulative favourable variance of $298 thousand year to date.
Points of discussion were summarised:
• The $3.0m surplus was being maintained and HBDHB were on target to achieve by
financial year end.
• Chair of FRAC advised the projected surplus excludes the $5m revenue banking in
reserve to be used in future years.
• The new Mental Health Unit Development was proceeding well. More capital had been
required as the development was running ahead of schedule.
• A Budget presentation had been provided by the Chief Financial Officer to the Finance
Risk and Audit Committee (prior) and this presentation would be distributed to members.
Action
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 12 February 2014
Chris McKenna and Dr John Gommans (co-chairs) were in attendance with the report taken
as read, with discussion around:
• Integrated Urgent Care in HB and the recommendation to support option 3 endorsed,
closely followed closely by option 4 ie moving towards full integration. The steps flow on
from each other however the most important aspect was bringing general practice along.
This significant change would affect the whole of the health sector.
• The business case for Clinical Pathways was fully supported, including the purchase of
the Map of Medicine (as the appropriate Tool), endorsing also the continuous
development of the clinical care pathways by GPs. We create time and the reward
system to get us over the line.
Other topics discussed included the: Health of Older People Strategy (HOPSI); Did not
Attend (DNA) Rates; Immunisation Policy Update; Clinical Indicators Q2, with a correction
noted around specimen labelling.
The Board Chair asked that Clinical Council assume responsibility of the Hospital (and
related services) monitoring role of the Hospital Advisory Committee (HAC), now that HAC
had no scheduled meetings. He asked that Council specifically look at elective services
performance, including waiting times and provide the Board with advice and
recommendations on that monitoring and assessment.
Action
Hawke’s Bay Health Consumer Council – 13 February 2014
Chair, Graeme Norton provided an overview of the Consumer Meeting held.
Consumer members now have portfolios areas of responsibility in a variety of health areas.
This allows Council to be visible in a variety projects and networks.
4
Clinical Pathways were supported, however the cost was queried. Presentations were also
received on Integrated Urgent Care (with support for option 3); Very Low Cost Access;
Elective Surgery Waiting Lists.
Particular areas of focus and interest for Consumer Council relate to Did Not Attend Rates in
Hawke’s Bay as well as using Consumer Stories to improve quality of care. The steering
group for Consumer Stories will be HB Health Consumer Council.
A representative from Mid Central attended HB Consumer Council’s February meeting and
their feedback was they should be braver and position either Consumer Council higher, to be
effective. Our position has the consumer council mirroring clinical with leadership a crucial
element in both areas.
A meeting had been held recently with a CTAS representative around a Consumer Forum
and its positioning.
Pacifika Health Leadership Group
Barbara Arnott attended the second meeting of this newly formed Group on Monday 24
February, and spoke of their passion and commitment to improve the health of Pacifika
peoples in Hawke’s Bay. Co-Chairs had been appointed to better manage commitments
across the region.
The group reviewed the Pacific Health Action Plan and were generally happy with the
content which was pleasingly simplistic. The Group made a suggestion around the need for
additional resource to deliver against the plan.
The final Pacifika Health Action Plan would be provided to the Board in March.
DECISIONS
Integrated Urgent Care in Hawke’s Bay
Tim Evans (CFO) and Carleine Receveur provided a presentation with discussion
summarised as follows:
• Milestones and feedback on the change process was crucial as was the need for the
Board to maintain visibility with the Alliance team, once appointed.
• The Board needed assurance the project would progress against clear milestones
through a change process. There was some discussion around including a monthly
update in the CEO’s report to the Board.
• A question around the involvement of pharmacies was raised?
• A consultation plan would be provided to the Board in March
Action. • It was advised this project was not occurring in isolation. There were projects happening
in Primary Care also which focused on high needs patients, ensuring they were not left
until the last minute with the need to turn up at ED.
RECOMMENDATION
That the Board
1.
Note the endorsements from Clinical Council, Consumer Council and the Urgent
Care Steering Group, and their view on preferred option.
2.
Establish an Urgent Care Service Level Alliance Team for the Hawke’s Bay Health
System.
3.
Endorse in principle the preferred Option (Option 3) for consultation with the public
and key stakeholders, ( It was expected that this would lead to the implementation of
option 4 in time).
Adopted
5
Clinical Pathways Business Case
Kieran McCann (GM Integrated Care Services) and Belinda Sleight (Project Manager)
attended to overview and answer questions. It was acknowledged support had been received
from Clinical and Consumer Councils.
Three Clinical Pathway tools were presently being used in New Zealand. All tools were
different, yet the same in providing an end result with updates against worldwide best
practice.
It was explained pilots had been developed and tested and the desire was to continue on
with this work. Clinical Pathways was the key tool to integration as a one system approach
which would greatly benefit patients. It was inevitable there would be some challenging
conversations as they had already come up early in the pilot phase. By working strategically
with our partners in the Central Region, there will be benefits.
The question was asked, was there adequate consumer representation on the Steering
Group?
Action
RESOLUTION
That the Board :
• Support and endorse the Business Case
• Support the procurement of Map of Medicine
• Support clinicians continuing to develop clinical pathways in the interim.
Moved
Peter Dunkerley
Seconded
Dan Druzianic
Carried
Changes to Central Regions Technical Advisory Services Constitution
Agreement was sought from the five Central DHBs as A Class shareholders, to amend the
Constitution of Central Region’s Technical Advisory Services Limited (CTAS).
The changes were outlined and had been discussed with the Regional Governance Group of
the joint CTAS Board/RGG Meeting (2 December 2013). Agreement by all six DHBs was
required and recent advice had been received that Hutt Valley DHB had not endorsed the
changes.
As unanimous support was required, this matter would now go back to the RGG’s March
meeting. Hawke’s Bay would defer any decision until the matter had been further discussed.
This would also be raised with CTAS when they visited Hawke’s Bay in April.
Te Matau a Maui Health Trust
Given it had been nearly three years since HBDHB first appointed Trustees to the Te Matau
a Maui Health Trust in accordance with clause 9.5 of the Trust Deed, it was now time to
consider reappointment/replacement for those initially appointed.
Given Kevin Atkinson and Leigh White had offered themselves for reappointment and there
was a need to appoint a representative from Wairoa, the following Recommendation was
agreed.
6
RESOLUTION
That the Board
(in accordance with the Trust Deed) reappoint Kevin Atkinson and Leigh
White and appoint Denise Eaglesome as Trustees of Te Matau a Maui Health Trust.
Moved
Barbara Arnott
Seconded
Diana Kirton
Carried
It was noted that Kevin Atkinson and Denise Eaglesome abstained from voting.
Governance Training and Development
Ken Foote provided an overview, with the Chair supportive and in agreement that Board
undertake training and development with the Institute of Directors (IoD) “Governance
Essentials” workshop, with the following changes noted:
• Utilise the whole of board review undertaken previously with a suggestion that some
aspects could be incorporated.
• Tailor the program to suit and ensure was not too simplistic – IoD need to work hard!
• Need to align attendees to preferably within the same industry.
• Suggestion to have several Consumer council members in attendance?
• The timeframe agreed was, a Wednesday in April/May.
Action: The Company Secretary would work with IoD to develop a suitable and challenging
programme considering the feedback provided.
Maori Relationship Board (MRB) Membership Appointment
A background paper had been received recommending the Board appoint nominees in
accordance with the Maori Relationship Board Terms of Reference.
RESOLUTION
The Board appointed the following people to the Maori Relationship Board (MRB), in
accordance with the attached Terms of Reference:
• Tatiana Cowan Greening
• George Mackey
• Trish Giddens
• Patrick LeGeyt
• Kerri Nuku
• Na Raihania
• Lynlee Aitcheson, and
• Des Ratima
Moved
Dan Druzianic
Seconded
Andrew Blair
Carried
Ngati Kahungunu Iwi Inc would be advised of the Board’s endorsement of their nominations
and members would be advised accordingly.
Action
Board member appointees to MRB advised at the 18 December board meeting included:
Ngahiwi Tomoana (Chair), Denise Eaglesome, Diana Kirton, Helen Francis and Heather
Skipworth.
7
MONITORING
Human Resource KPIs Q2 (Sept-Dec 2013)
John McKeefry spoke to the tabled report, including updated December comparisons.
Sick leave at HBDHB reflected 3rd lowest cf 20 DHBs, 1st lowest out of 6 mid central DHBs.
Staff Turnover had Hawke’s Bay placed 7th lowest cf 20 DHBs, 5th lowest out of 6 mid central
DHBs.
Accrued Annual Leave showed we were 6th lowest cf 20 DHBs, 1st lowest out of 6 mid central
DHBs.
The Staff Ethnicity gap had been reduced from 51 employed in 30 June 2013 to 39 at the
end of December 2013.
Maori Workforce KPIs
The first of the Tu Mai Ra KPI reports to the Board was taken as read.
It was noted there was a huge focus on attracting and recruiting those identifying as Maori
into nursing and medical profession. It was particularly pleasing to see the progress made in
the January 2014 intake, with 32% of successful candidates identifying as Maori.
There was some discussion around the “Incubator Programme” and the need for more
promotion, especially for Wairoa College eg. videos, staff talking to students about their
respect roles with encouragement provided.
Promotion of health careers was very important as was funding and scholarships for study.
This was seen as crucial and Treaty Claimants must be made aware and plan for incentives
to be put in place to encourage Maori to aim high with their career aspirations.
Actions:
a) John McKeefry would relay comments made to the providers of the Incubator
programme.
b) Of places on Incubator in one local HB school, 7 students applied with only 5 places.
This would also be followed up by John.
Performance Framework Exceptions Q2 (Sept-Dec 2013)
Recently issued Performance Framework Results compared with MOH rankings for Quarter
two, were reviewed and discussed.
A summary of discussion around the report provided in the board papers follows:
• Technical issue around data recording in the Mental Health relapse prevention area was
being reviewed.
• More relevant diabetes KPIs were required and this was being looked into
• CT scanner bedding in issues were noted.
• A drop in Green Prescriptions page 146 was noted. Discussions were being held with
providers to lift this result.
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
8
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
22.
Confirmation of Minutes of Board Meeting dated 18 December 2013
- Public Excluded
23.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
24.
Board Approval of Actions exceeding limits delegated by CEO
25.
Chair’s Report
- Regional Governance Group Meeting 3 February 2014
- HBL Chairs Update 18 February 2014
Reports and Recommendations from Committee Chairs
26.
Finance Risk and Audit Committee – 26 February 2014
27.
Immunisation Policy (Verbal Update)
Moved:
Dan Druzianic
Seconded:
Helen Francis
Carried
The meeting closed at 4.00 pm
Signed:
Chair
Date:
9
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 26 MARCH 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.06 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana (joined the meeting at 1.30pm)
Dan Druzianic
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Barbara Arnott
Heather Skipworth
Andrew Blair
Jacoby Poulain
Apology:
-
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
John Gommans (Co-Chair Clinical Council)
Members of the public
Members of the media
Minutes
Brenda Crēne
KARAKIA
Heather Skipworth opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
No member had any interest in the agenda items discussed.
Denise Eaglesome’s appointment to Te Matau a Maui may need to be included on the
register.
Action
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 26 February 2014, were confirmed as a correct
record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Action 1: Patient Stories – work in progress
Action 2: Maternity Services Build Project – The timeframe has been brought forward by
twelve months with the expected completion date now 1 July 2016.
April 2014
Section 1
1
Action 4: Transform and Sustain five year programme – work in progress
Action 5: Long Term Strategy for Pharmacies and Licensing – Take action forward.
Action Action 6: Visit to HB Rescue Helicopter Hangar to review operations will be held on 30 April
at 11.30am. FRAC Meeting to commence at 9.00am
Action 7: CTAS Constitution changes – Take action forward.
Action
Action 9: Elective Services performance and waiting times had been referred to Clinical
Council - work in progress
Action 12: Institute of Directors (IoD) Training – awaiting feedback and proposal from the
Institute. Have requested a Facilitator with “health” experience. Ongoing
Action 14: HBDHB Incubator Programme: Actioned. Discussions have been held between
the parties and with Wairoa College. Remove from actions.
BOARD WORK PLAN
The Board Work Plan for April 2014 was noted.
CHAIR’S REPORT
The Chair advised of the following retirements, with a letter being sent conveying the Board’s
best wishes and thanks for their extended service.
Years of
Name
Job Title
Service
Lavinia Waihape
Cook
12
Rosemary Ormsby
Registered Nurse
48
Kathy Morley
Booking Co-ordinator
22
Gwen Arnold
Medical Secretary
23
An update of communications received since the last meeting were summarised.
• The PHO’s performance for the first half of the financial year showed a significant
increase in immunisation (3rd of 20 DHBs compared to 15th prior to July 2013). Better
health indicators had moved from 6th to 11th and more heart and diabetes checks from
18th to 20th which was of concern. The DHB were working with the PHO to improve these
target areas.
• Murray Milner (Chair of the Regional Governance Group for the central region) who was
to retire at the end of February had his contract extended until May 2014.
• A letter had been received from the Trucking for HB Child Cancer Charitable Trust who
own and operate Little Elms. The Trust wished to discuss a potential opportunity to work
with the DHB on another venture.
Action: EMT to consider and advise the Board of their recommendation to the April
Board Meeting.
CHIEF EXECUTIVE OFFICER’S REPORT
The report from the CEO was taken as read with commentary summarised as follows:
• Performance problems continue with the Hospital being under increasing pressure over
the past 4-6 weeks with very high attendances at ED.
• An Elective Surgery plan has been put in place with additional work implemented, with
anticipated improvement towards 105% by financial year end.
• Financial performance was good for the month and the year.
2
• Health Equity -
Did Not Attend (DNA) rates are high nationally however Hawke’s Bay
was making this a priority focus.
Action CFO: How are DNA percentages calculated and reported. As an example - was
a person advising non attendance the morning of the clinic/visit counted as a DNA?
Action CFO: Denise Eaglesome requested Wairoa DNA statistics be provided to enable
her to mobilise initiatives in Wairoa, to assist.
Action CFO: DNA report(s) would be provided to Jacoby Poulain to enable better
understanding around past initiatives.
For consideration: The suggestion that Pasifika people could be used in a trial for DNA
improvement techniques. If successful, a refined model could be rolled out to other areas.
Texting was an efficient and well accepted reminder method used by many businesses,
and further rollout within HBDHB was expected. A lengthy time delay until a patient’s
next appointment was raised as being easily forgotten, if not included followed up.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JANUARY 2014
The Chief Financial Officer presented his report advising of a favourable variance of $20
thousand in February with cumulative favourable variance of $317 thousand year to date.
Following an overview of the report and noting the continued expectation of a surplus, the
Board expressed appreciation of the work undertaken. It was especially pleasing to note
progress with plans to meet the “Electives” target for year end.
The following write-off of uncollectable debts was considered and adopted as follows:
Action CFO: The CFO would provide detail around the HBL write off of $4,200 on page 23
of the finance report.
Ngahiwi Tomoana joined the meeting.
RECOMMENDATION
That the Board:
Approve the write-off of $415,030 of debtor balances considered to be uncollectable, and
fully provided for.
Adopted
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 12 March 2014
Dr John Gommans (co-chair) was in attendance with the report taken as read, with
summarised discussion around the following:
• Clinical Council had taken on formal oversight of the elective services programme as
directed by the Board. A draft report had been prepared to provide Council with some
context.
• A gap had been identified on Clinical Council’s Membership around representation on
Council from the electives area.
• All papers which had received full endorsement by Council at the 12 March meeting, was
a reflection on having Council’s early involvement in the topic/papers development. This
has ensured and will continue to ensure smooth flow through to the Board with no
surprises.
3
• The formation of the Clinical Research Committee was discussed and their wish and the
Board agreed to promote an “Excellence in Health Research” Award at the 2015 Health
Awards.
Action The Committee had also decided to develop an Annual Report.
Hawke’s Bay Health Consumer Council – 13 March 2014
Chair, Graeme Norton (Chair) provided an overview to members on the following topics:
• The Pasifika Health Action Plan resulted in a lively discussion with members keen to see
improved health outcomes for pacific people.
• Gastroenterology Model of Care was fully endorsed with some very interesting dialogue
between consumer members, the doctors and Service Director at the heart of this
development.
• Senior Health Quality and Safety Commission representatives who attended the
Consumer Council meeting provided affirmative feedback advising this was the only
Consumer forum in NZ they had observed which interacts with doctors and it is across
the sector. They described this as a dream come true!
• Diabetes Clinical Pathways: Three consumer representatives were in the pathways
development group with the challenge to ensure the patient’s perspective is built into the
process. Graeme suggested a simple formula for achieving success with Consumer was
Empathy + Engagement + Education = Empowerment.
Empathy
(my experience, how I think, how I might struggle)
Engagement (with me and my whanau, whoever is around me - needs to be involved)
Education
(eating, exercise, efficacy (meds))
Empowered (the end result of getting it right and achieving the goal)
Maori Relationship Board – 19 March 2014
Ngahiwi Tomoana (Chair) provided an overview of the report tabled to members and
highlighted: Recruitment of New Maori Nurse Graduates ● Tu Tururiki (Maori Workforce
Development) ● Integrated Urgent Care in HB with support for Option 4 ● Maori Health
Strategy 2014-19 (the new version MAI was about taking responsibility for ourselves which
was endorsed, and would be presented to NKII this week) plus there was a review of Annual
Maori Health Plan 2014-17.
MRB’s discussion around Did Not Attends sought better clarification of what constitutes a
DNA and wondered if a better definition should be applied.
DECISIONS
Gastroenterology Model of Care
Warrick Frater (COO) and Pip Stewart (Service Director for Acute and Medical)
presented the paper. The Model of Care (MOC) was developed following the Business case
approved in principle in August 2012. The MOC had been through a number of iterations with
the involvement of Clinical Council and more recently the Consumer Council who were
thanked for their input.
• The challenge or drivers for change came from the present gridlocked facility in the
Hospital which was unable to cope with demographic growth, or the potential rollout of
the national bowel screening service in due course.
• A “one stop shop” single focussed facility would work extremely efficiently, based on
international best practice and design.
• Rapid turnover is the efficient Model of Care. We cannot continue in the current theatre
model which does not work for patients or clinicians.
• The assumptions for anticipated volumes made in the 2012 Business Case to the Board
aligns with the Waitemata Pilot presently being run.
4
HBDHB need to do something to meet increasing demand, how we afford this was through
continuing to achieve planned surpluses through which capital projects are funded. Savings
achieved should not necessarily be seen as cut backs, as improving quality often costs less.
We are striving for quality instead of continuing with an inefficient system.
Key issues raised during discussion included:
•
The probability of the bowel screening programme being rolled out.
•
Lessons learned from the Theatre 7 Project.
•
Potential costs involved in developing detailed design.
•
Value engineering opportunities
•
Potential for alternative funding sources.
RESOLUTION
That the Board:
•
Continue to support the Business Case in Principle
•
Approve the Model of Care on the assumption the bowel screening programme will
be rolled out.
•
Request management continue to refine the business case, with specific inclusion
of:
-
Time and costs involved in detailed design phase.
-
Value engineering opportunities and consequential cost savings.
-
Potential alternatives for funding.
Moved
Helen Francis
Seconded
Peter Dunkerley
Carried
Helen Francis left the meeting.
Pasifika Health Action Plan
Talalelei Taufale (Pacific Health Development Manager) provided an overview of the paper
and the process followed to get to this point. Feedback received had been fully supported by
Clinical Council with Consumer Council being very focused on the need to include more
detailed actions to improve the health of pacific people.
The best way to achieve the improved health goals was through building relationships,
having conversations and sharing information around better health versus just being told.
The priority was to bring everyone along the journey together.
Action Director Population Health: a) A Pasifika Health Leadership Group Report would be provided to the Board following
PHLG meetings and included on the Board Workplan.
b) Indicators were being reviewed and considered for inclusion in Pasifika Framework.
The board acknowledged the good work around relationships building and work with church
groups and it was nice to see the goal of maternal health and wellbeing being put into action.
The board endorsed the Pasifika Health Action Plan.
RECOMMENDATION
That the Board:
Endorsed Pasifika Health Action Plan
Adopted
5
Mai Maori Health Strategy 2014-2019
The Board received a presentation and overview of the work to date, advising the Maori
Health Strategy Dashboard would be presented to Clinical Council in May.
MRB endorsement of the Strategy, along with Clinical and Consumer Councils, was noted.
RESOLUTION
That the Board:
Endorse the Mai Māori Health Strategy 2014-2019.
Moved
Ngahiwi Tomoana
Seconded
Heather Skipworth
Carried
Integrated Urgent Care Consultation Plan
Tim Evans (CFO) provided a follow up to the February Board paper and noted the discussion
had by FRAC earlier in the day.
A major concern raised was that the intended consultation should be led and owned by the
proposed Service Level Alliance Team, to have the best chance at effecting change. MRB,
Clinical Council and Consumer Council also needed to be fully engaged in the process.
So as not to lose momentum, a range of actions could be undertaken while the Alliance was
being established. It was generally agreed to wait and have everyone move forward together.
RECOMMENDATION
That the Board:
• Approve the principle of public consultation but defer the process pending the formation
and consideration of the process by the proposed Service Level Alliance Team.
• That clinicians in particular continue to be engaged in the interim.
Adopted
DISCUSSION AND FEEDBACK
Draft Annual Plan 2014/15 and Statement of Intent 2014-18
The plan provided was noted and the direction indicated was endorsed.
Draft Regional Services Plan
Tim Evans advised the detail provided was consistent with HBDHB’s strategies. The
document was noted with no feedback provided for plan developers.
MONITORING
Tu Mai Ra 2013-14 Q2 (Sept-Dec 2013)
The board noted the simple, refined document which focused on the issues, performance to
date and the challenges ahead. Inequalities and the Treaty of Waitangi Responsiveness
would be included in future.
Ngahiwi Tomoana was very passionate about services and indicators relating to cancer
screening as they were in the hearts and minds of his people.
6
KHW Status Update
The programmes were currently being reviewed against performance with the focus being on
revitalising them going forward.
The Board endorsed the steps outlined in this report for revitalising the Kahungunu Hikoi
Whenua programme.
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:
22.
Confirmation of Minutes of Board Meeting dated 26 February 2014
- Public Excluded
23.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
24.
Board Approval of Actions exceeding limits delegated by CEO (nil)
25.
Chair’s Report
- Regional Governance Group Meeting 5 March 2014
Reports and Recommendations from Committee Chairs
26.
Finance Risk and Audit Committee – 26 March 2014
Maori Relationship Board Meeting – 19 March 2014
27.
Update Suicides in Hawke’s Bay
28.
Annual Plan Financials
Moved:
Dan Druzianic
Seconded:
Andrew Blair
Carried
The meeting closed at 4.32pm
Signed:
Chair
Date:
7
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 30 APRIL 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Barbara Arnott
Heather Skipworth
Andrew Blair
Jacoby Poulain
Apology:
Nil
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair Consumer Council)
Chris McKenna (Co-Chair Clinical Council)
Members of the public
Members of the media
Minutes
Brenda Crēne
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
No member had any interest in the agenda items discussed.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 26 March 2014, were confirmed as a correct
record of the meeting.
Moved:
Barbara Arnott
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Action 1: Patient Stories, remains on actions as work in progress.
Action 2: Transform and Sustain Five Year Programme – report to the Board in May
Action 3: Long Term Strategy for Pharmacies and Licensing – timeline to be determined
May 2014
Section 1
1
Action 4: CTAS Constitution Changes – Regional Governance Group meet in early May, and
the CTAS Board to visit Hawke’s Bay on 28 June.
Action 5: Elective Services performance and waiting times – discussed by FRAC, work in
progress.
Action 6: Integrated Urgent Care – advised working with professionals to ascertain their
interest in being part of the Service Level Alliance Team.
Action 7: Institute of Directors (IoD) Training and Development Programme – arranged for
8.30am Wednesday 23 July 2014 with facilitator Professor Dr Jens Mueller.
Nominations from within the health sector in Hawke’s Bay would be sought to
attend in addition there was an expectation that all HBDHB Board members would
be in attendance.
Action: Other experienced outside directors (3-4) would be sought to attend later
in the day for a panel discussion. Suggestions would be provided to the Chair
outside the meeting.
A further Training Day around finance and risk would be run by the IoD later in the
year.
Action 8: Did Not Attend (DNA) Health Equity: Information had been provided by email to
board members in response to queries from the prior meeting.
It was advised the HBDHB DNA Project Team led by Tracee TeHuia (GM Maori
Health) had been formed. The work undertaken would be align with work
nationally as this issue was wide spread amongst DHBs.
Action 9: The HBL write off of $4,200 on page 23 of the February Finance Report noted last
month, was confirmed as a technical write off due to an incorrect accrual.
BOARD WORK PLAN
The Board Work Plan for May 2014 was noted. Detail around the Health Benefits Limited
visit on the 28th May (the next Board Meeting day) was in hand. The FRAC meeting would be
brought forward to 9am that day.
CHAIR’S REPORT
The Chair advised of the following retirement, with a letter being sent conveying the Board’s
wishes and thanks for her extended service.
Years of
Name
Job Title
Area
Service
Rhonda Kitching
Registered Nurse
Acute & Medical
40
An update of communications received since the last meeting were summarised.
• Gwen Arnold had provided a response to the Chair acknowledging her retirement.
• The Chair of Health Benefits Limited had written providing an outline of food, linen and
laundry services, advising of meetings planned with boards in near future.
• The CEO of Health Benefits Ltd, Nigel Wilkinson had resigned from his role.
• Advice had been received that David Wood would take over as interim CEO of Health
Benefits Ltd.
• A letter had been received from the MoH advising an agreement had been reached with
Microsoft to provide continued support to the government sector as the April deadline to
upgrade, from earlier Microsoft Operating systems, had not been met. This arrangement
provides coverage for six months whilst DHBs continue with their software upgrades.
• The half yearly report from Health and Disability Commissioner noted 30 complaints had
been received from Hawke’s Bay equating to 77.74 complaints per 100,000 discharges.
2
Chair, HB Health Consumer Council
The fine work undertaken by Graeme Norton as Chair of the Consumer Council was
acknowledged by the Board Chair. With the interim term of one year now complete there
was no hesitation to reappoint Graeme for an extended term. The Board congratulated
Graeme on his achievements to date.
Recommendation
That the Board reappoint Graeme Norton as Chair of the Hawke’s Bay Health Consumer
Council for a further term expiring 31 March 2017
Adopted
CHIEF EXECUTIVE OFFICER’S REPORT
The report from the CEO was taken as read with commentary around the challenges
experienced to deliver elective discharge numbers and reduce the time spent in the
Emergency Department (patient flow). Intense work is being undertaken in both areas with
improvements expected to meet June 30 MoH expectations success meaning the receipt of
an additional $1.0m.
Clinical Pharmacist Facilitators Business Case to provide pharmacists facilitators (funded by
the DHB) to work within General Practices would be a positive move for health in Hawke’s
Bay. This initiative would be a first for NZ, with evidence from other countries showing
positive improvements for all stakeholders, especially GPs and their patients.
Following the establishment of the Health Equity Champion in 2013, the Board would expect
a Health Equity Annual Report later in the year. This would be an independent report not
bounded by organisational concerns but representing the broader community.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF MARCH 2014
The Chief Financial Officer advised of a favourable variance of $32 thousand in March, with
a cumulative favourable variance of $350 thousand year to date, with the forecast result for
financial year end remaining at $3.0m.
Generally costs savings have been through good management and a focus on systematic
changes in many areas including some in the community.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 9 April 2014
Chris McKenna (co-chair) presented the report and advised a new member Dr Kiri Bird had
been welcomed to Council as a GP member, replacing the vacant position left by Dr Tipene
Leach.
The report was taken as read with strong support by Council for the Clinical Pharmacist
Facilitators Business Case advised.
Clinical Council had set aside part of their quarterly Meeting in May to focus on Elective
Services with clinicians and senior staff invited to contribute. Council would be holding a
Workshop
Hawke’s Bay Health Consumer Council – 10 April 2014
Chair, Graeme Norton provided commentary on the meeting held with the report taken as
read.
General discussion followed around Mental Health Service Redesign and the approach by
mental health consumers to be more involved. This should be seen as an opportunity as it
3
appears that consumers had been left behind and the system had not responded to their
requests in a timely manner. In the absence of real engagement, mental health consumers
were at a loss and accordingly misconceptions have formed. We need some enlightened
actions out of this as consumer expectations are realistic, they just wish to be heard and
appropriate care to result. Consumer Council have been working with the parties and a
meeting was imminent.
DECISION PAPERS
Clinical Pharmacist Facilitators Working in General Practice – Proposed Expansion of
Service across Hawke’s Bay
The report was taken as read. It was noted Clinical and Consumer Councils had provided
their full support for the Business Case. Kieran McCann (GM Integrated Care Services), Billy
Allan (Chief Pharmacist) and Sue Ward were in attendance for this discussion.
A trial undertaken since 2010 had achieved very positive results and had met all three
components of the “Triple Aim”. The subsequent evaluation of the trial resulted in this
Business Case being put forward to implement/roll out clinical facilitators within general
practice throughout Hawke’s Bay to enhance services. This programme of investment would
be self funding in the first instance – as there is an expectation that medicine costs (drugs
and cost of supply) would reduce and be captured as savings against the DHB Community
Pharmacy budget.
The eight clinical facilitator pharmacist roles would be advertised, and depending whether a
number of suitable applicants presented, it was agreed they would be taken on and the
programme fast tracked if candidates became available. Peter Dunkerley was particularly
enthusiastic as this concept would use pharmacists in the way they are trained.
The goal was a whole of system approach which would improve pharmaceutical quality,
provide better service for consumers and bring the pharmacy spend down through vigilance.
This was at the start of the pharmacist journey to see how pharmacists will add value to
General Practice and the journey will grow and mature over time but facilitators would remain
as part of business as usual.
RESOLUTION
That the Board
1.
Note this Business Case has been endorsed by the HB Clinical Council, HB Health
Consumer Council and the Clinical Quality Advisory Committee – Health Hawke’s
Bay
2.
Note the content of the Executive Summary which summarises the key intentions
3.
Note the preferred service model/configuration is based on eight Clinical Pharmacist
Facilitators working across eight geographic practice ‘clusters’
4.
Note a phased rollout and service development over two to three years is
supported, this recognising that experienced Clinical Pharmacists may be a scarce
resource
5.
Approve an additional investment of $432,000 Year 1 (2014/15) and $368,000 Year
2 (2015/16).
6.
Note Year 1 is to be funded from the projected reduction in HBDHB community
pharmacy expenditure indicated by the latest PHARMAC forecast, and an additional
$104k further savings for anticipated savings associated with the implementation of
new roles
7.
Note total DHB funding to support the programme once fully implemented will be
approximately $950,000 per annum
8.
Note the greatest risk to full and timely implementation is the availability of
4
appropriately qualified and experienced clinical pharmacists. With this in mind:
9.
Support an opportunistic approach to securing suitable staff early, should they
present.
Moved:
Peter Dunkerley
Seconded:
Ngahiwi Tomoana
Maori Health Plan 2013/14 – Report from the Target Champion for Diabetes
Nicola Ehau, Head of Health Services for Health Hawke’s Bay, was in attendance for Liz
Stockley (CEO Health Hawke’s Bay Ltd)
Due to the slow pace in progress on some Maori health indicators, this was the first report
from the Diabetes Champion advising work was underway to develop better quality indicators
to provide a better reflection of the Hawke’s Bay population. We presently struggle with data
sources and back office breakdowns for specific reporting, including ethnicity.
In discussion it was acknowledged as important to capture the rate of improvement in
diabetic conditions. Through programmes including Kahungunu Hikoi Whenua and also Iron
Maori, people were increasingly becoming more aware and taking responsibility for their own
health. We need to capture and demonstrate the outcomes of such programmes.
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:
14.
Confirmation of Minutes of Board Meeting dated 26 March 2014
- Public Excluded
15.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
16.
Board Approval of Actions exceeding limits delegated by CEO (nil)
17.
Chair’s Report
- Regional Governance Group Meeting 7 April 2014
- HBL Chairs Update 16 April 2014
Reports and Recommendations from Committee Chairs
18.
Finance Risk and Audit Committee – 30 April 2014
19.
Transformational Management and Leadership Development Programme
Presentation
Moved:
Diana Kirton
Seconded:
Denise Eaglesome
Carried
5
The meeting closed at 2.24pm
Signed:
Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 25 JUNE 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.07 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Denise Eaglesome
Diana Kirton
Helen Francis
Barbara Arnott
Heather Skipworth
Andrew Blair
Jacoby Poulain
Apology:
Denise Eaglesome
In Attendance:
Members of the Executive Management Team
Graeme Norton (Chair, HB Health Consumer Council)
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Members of the public
Members of the media
Minutes
Brenda Crene
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance. Board member Heather
Skipworth was congratulated on receiving her Queen Service Medal (QSM) announced in
the Queen’s Birthday honours list in early June.
DECLARATIONS OF INTEREST
Helen Francis had advised (prior to the meeting) that she was now the Patron and a Life
Member of the Alzheimer’s Society.
Peter Dunkerley advised he had been reappointed as a Trustee of the HB Rescue Helicopter
Trust.
DEPUTATION
A request to speak had been received on behalf of parties on the topic of “Institutional Elder
Abuse”. A welcome was extended to those attending to support the deputation.
Cressida Sing and Annette Burgan (Health Care Assistants) spoke as representatives of the
elderly on their experiences within an aged care facility. Their key concern were for those
living and working in an environment where they felt safety was being compromised, due to
reductions in clinical staffing number (hours) and the lack of proper training provided to care
assistants. They felt the DHB should do more to ensure such facilities maintained clinical and
quality standards and reduce this increasing risk.
July 2014
Section 1
1
In response, the Chair advised the first step was to communicate the perceived safety risk,
ensuring important incidents were well documented and brought to the attention of
management of the facility, prior to having the DHB involved.
If safety was still of concern, a “complaint” should be lodged with the HBDHB’s CEO. The
DHB are able to conduct spot audits without notice, under existing contracts. The CEO could
also refer matters of concern to the HB Health Consumer Council and HB Clinical Council.
If all else failed a complaint could be lodged with the Health and Disability Commissioner.
Those in attendance for this item, left the meeting.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 28 May 2014, were confirmed as a correct record
of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Item 1:
The Board will receive an update on Integrated Urgent Care in July
Item 2:
Actioned
Item 3:
The Oral Health Plan has been included on the Board’s August agenda.
BOARD WORK PLAN
The Board Work Plan for July 2014 was noted.
Institute of Directors Board Training will be held on 23 July – attendance had been confirmed
from all board members in attendance, with one outstanding to be followed up.
The HB Health Sector Leadership Forum will be held 15 October at the Te Taiwhenua o
Heretaunga
The KHW Update was to be revised with the next paper due to the Board in September.
CHAIR’S REPORT
The Chair advised of the following retirement, with a letter being sent conveying the Board’s
wishes and thanks for her extended years of devoted service which included 29 years as a
dental nurse.
Years of
Name
Job Title
Area
Service
Lorraine Arrowsmith
Sterile Services Manager
Surgical Services
40 years
An update of communications received since the last meeting were summarised.
• Consent had been received from the Minister of Health to dispose of three properties
(210 Nelson Street South, Hastings; 307 Omahu Road, Hastings and 59 Kennedy Road,
Napier) with several conditions imposed.
• A letter had been received from Ngahiwi Tomoana on behalf of the Ngati Kahungunu
Board approving the Mai Māori Health Strategy
• A letter of thanks had been received from a Hawke’s Bay couple who had moved to
Tauranga, praising the high level of specialist care they had received for which they were
most appreciative.
2
• “How my PHO is performing” in quarter three had been received with Hawke’s Bay 6/36
for immunisation. Better health for smokers to quit was not tracking well at 74%, 15/36,
Liz Stockley CEO of Health HB was present and advised that campaigns did not change
behaviour and a resource had been employed to work directly with general practices
from mid July to improve the result.
Heart and diabetes check sitting at 79%, 22/36, and the next quarter would be very close
to target.
• A letter had been received from the DHB Dietician Leadership Group (representing the
20 DHBs), advising that whilst they were involved in discussions around national food
contract – they were now no longer involved in dialogue and as key stakeholders they
would like to be informed of the proposal when received so that they can provide
individual DHB’s with advice on the proposed solution. The Chair agreed that this advice
was essential before the Board made any decision on the any HBL proposal.
• Two letters were received from the Napier Community regarding overnight care at
Napier Health Centre. Unfortunately many are misinformed as the decision has not yet
been made and wider consultation was still to be carried out.
CHIEF EXECUTIVE OFFICER’S REPORT
The report from the CEO was presented by the Acting CEO Tim Evans.
Thanks were extended to the efforts of our elective services teams, and to securing the
additional elective surgery to improve elective surgical discharges. In month eleven we have
achieved 96.3% of planned discharges and, as focus continues through to the end of June,
we anticipate meeting our elective discharge target of 100%, plus 200 discharges for the
year.
We have not met our “Shorter Stays in ED” target even with our very best efforts however
this patient flow system issue is receiving a great deal of focus. The increase in electives has
impacted not only on ED but has created bed space issues in the Hospital, with the higher
patient inflow due to the winter ills cycle.
The Transform and Sustain Projects update which was brought to the Board in May, will be
issued quarterly with the next provided in August.
More meaningful cardiovascular indicators focusing on the continuum versus the speed of
service access were being developed.
“Obesity” was a major driver of poor health nationally, with a staggering 51% of the Māori
adult population being classified as obese in Hawke’s Bay. There was general discussion
around ways to address the rising obesity statistics with suggestions:
• To run a “Top Town” promotion/competition and build on current initiatives.
• Focus learnings from those who participate in “Iron Māori” through auditing.
• It was agreed an “integrated” approach to curb obesity in the region should be
developed. This was about inspiring people to take responsibility for themselves (buy in)
rather than just advising them on what they should and should not do.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF MAY 2014
Dan Druzianic, Chair of the Finance Audit and Risk (FRAC) Committee advised they had
endorsed the resolution and recommended the Board approve the write off noted on page 25
of the Finance report.
RESOLUTION
That the Board:
Approve the write-off of $177,630 of debtor balances considered to be uncollectable.
Moved
Ngahiwi Tomoana
Seconded
Diana Kirton Carried
3
The Acting Chief Financial Officer, Peter Kennedy advised of an adverse variance of $322
thousand in May. This brings us to a cumulative favourable variance of $19 thousand for the
year to date, with the forecast result remaining at $3.0m.
Additional costs were incurred due to the focus on elective surgery and combined with high
bed occupancy rates.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
The report on the Clinical Council meeting held on 11 June 2014 was noted and summarised
as follows:
• Clinical Dashboard Champions will provide better consistency for more informed
commentary on the Clinical Indicators in future.
• Being mindful the Board had requested Council to focus on Electives, timing for full
involvement has been difficult, given that staff have been extremely busy focusing on
achieving the year end result for electives.
• Consumer and adverse event reports provided were scrutinised by Council and found to
provide only part of the story (data) and not outcomes.
• In Council’s clinical governance role there has been a focus on specimens and labelling
errors.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
Consumer Council meeting held on 12 June 2014, noting in particular:
• Diabetes clinical pathways process was moving forward with good participation.
• The Medical Director of Mental Health and Addictions, Dr Simon Shaw had been very
open to consumer involvement in the redesign of the Mental Health Service. Special
thanks were expressed and Kieran McCann would ensure the positive feedback was
relayed to Dr Shaw and his team. Board members endorsed this feedback.
Action
• Graeme had attended a Workshop on Design and Co-Design which provides for a lot of
opportunities going forward. It was important to get the models of care right but just as
important was getting the approach to care right also. This was not about bringing
consumers in once, it was more about consumer input and guidance being sought on an
ongoing basis.
Māori Relationship Board (MRB)
Ngahiwi Tomoana, Chair of MRB provided an update on the meeting held 18 June 2014, with
the prepared report emailed to board members prior to the meeting. The MRB meeting had
been very positive.
There had been discussion around the frequency and length of meetings and it was
suggested by MRB that NKII may host four additional meetings per year.
Requests were made to focus on the following:
• An acceleration of Cultural perspectives training for all staff; and
• The Patient Experience Survey by ethnicity.
It was noted board members received an email on 30 June, from the MoH for online Māori
Health Governance Training.
MRB were pleased to see the development of a “Nursing and Midwifery Strategic Plan for
2014-2019” and were keen ensure that nursing services were culturally appropriate.
4
The Oral Health KPI presentation highlighted a move to quadruple enrolment for oral health
with a particular focus on difficult to contact whānau. MRB support this approach.
Concern was raised that bariatric surgery, as a local indicator had been dropped and it had
been requested this be reinstated. Obesity was of real concern to MRB and must be
prioritised as a local indicator.
Cultural competency at GP level was also raised.
The Board agreed with the Chair of MRB’s suggestion that he would arrange to incorporate a
cultural flavour to the next HB Health Sector Leadership Forum being held on 15 October at
the Te Taiwhenua o Heretaunga facility.
Action
From the National Chairs Forum, it was noted there would likely be a surplus of doctors in the
foreseeable future. Following general discussion it was advised with graduates coming
through they were not just needed in the districts but having doctors focus on specialties was
also important. There appeared to be a good level of interest of graduates moving into
general practice.
MONITORING PAPER
Tu Mai Ra Quarter 3 Report (Jan-Mar 2014)
Tracee Te Huia (General Manager Māori Health) was in attendance and was very
appreciative to the Board for monitoring Māori Health KPIs in Hawke’s Bay. In a Newsletter
for Māori Health the improvements seen were quite phenomenal. It was great to see the
respective KPI Champions taking ownership and developing plans to ensure their respective
targets were moving in the right direction.
A copy of the new “Māori Health Plan Dashboard” was provided and discussed. Nationally
commentary was provided on the 11 KPIs with no commentary on our eight local KPIs. The
Board Chair felt there should be strong focus on a relatively small number of important areas
(KPIs) with focused resourcing to make a difference. It was understood that many KPIs
were driven by external societal factors nationally, however it was suggested that MRB look
at the ones that can be driven outside of that plan.
Action MRB would look into this and
feed back to the Board.
FOR ENDORSEMENT
Final Regional Services Plan 2014/15 and
Final Annual Plan and Statement of Intent
Paul Malan provided a verbal update as both reports were at the Ministers Office awaiting
approval.
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
5
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
17.
Confirmation of Minutes of Board Meeting dated 28 May 2014
- 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
- HBL Chairs Update for June (unavailable)
Reports and Recommendations from Committee Chairs
21.
Finance Risk and Audit Committee – 25 June 2014
22.
Hawke’s Bay Clinical Council – 11 June 2014
23.
Integrated Pathology Services
Laboratory Services Partnership Update and future contracting options
24.
New Mental Health Facility - Letting Construction Contract
Moved:
Dan Druzianic
Seconded:
Barbara Arnott
Carried
The meeting closed at 2.50pm
Signed:
Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 28 MAY 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.07 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Denise Eaglesome (departed at 3.10pm)
Diana Kirton
Helen Francis
Barbara Arnott
Heather Skipworth
Andrew Blair
Jacoby Poulain
Apology:
Nil
In Attendance:
Kevin Snee (Chief Executive)
Members of the Executive Management Team
Graeme Norton (Chair, HB Health Consumer Council)
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Members of the public
Members of the media
Minutes
Annie Quinlivan
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
Following the Karakia, Ngahiwi Tomoana congratulated the Chairman on his
acknowledgement at the recent 2014 Hawke’s Bay Sports Awards where he was officially
recognised for his generous support of sport in the region.
WELCOME
The Chair opened the meeting and welcomed those in attendance. He also advised that
Denise Eaglesome would be departing the meeting at 3pm.
DECLARATIONS OF INTEREST
Peter Dunkerley advised he had been reinstated as a Trustee of the Hawke’s Bay Helicopter
Rescue Trust on 15 May 2014.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 30 April 2014, were confirmed as a correct record
of the meeting.
Moved:
Peter Dunkerley
Seconded:
Dan Druzianic
Carried
June 2014
Section 1
1
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Action 1:
Patient Stories now in project – to be brought to Board in August 2014. On
workplan.
Action 3:
Long Term Strategy for Pharmacies and Licensing – June 2014. (Later
amended to July 2014). On workplan
Action 4:
CTAS Constitution Changes – Regional Governance Group meet in early May,
and the CTAS Board to visit Hawke’s Bay on 28 June.
Action 6:
Integrated Urgent Care – advised working with professionals to ascertain their
interest in being part of the Service Level Alliance Team.
Action 7:
Institute of Directors (IoD) Training and Development Programme – working
through a process to change the facilitator.
BOARD WORK PLAN
The Board Work Plan for June 2014 was noted.
CHAIR’S REPORT
The Chair advised of the following retirement, with a letter being sent conveying the Board’s
wishes and thanks for her extended service.
Name
Job Title
Area
Years of Service
Adeline Teoh
Registered Nurse
Surgical Services
25
An update of communications received since the last meeting were summarised.
•
Release of the 2014 Budget by the Government which had allocated an extra $1.8
billion over four years to the health sector. This was made up of $1.39 billion of new
money and $412 million of savings. This included additional funding in the following
areas:
$275m per year for DHB demographics and cost pressures
$200m new NDE capital for DHBs
$90m for free prescriptions and GP visit for under 13s starting 1 July 2015
$110m over four years for elective surgery, including $10m for bariatric
surgery
$40m over four years for aged care and dementia
$6.3m over four years for bilateral cochlear implants
$32.7m for cancer services, including psychologist and support workers
•
Programme director of the CRISP Project Paul Roberts had recently resigned.
•
The Chair advised that both he and the CEO had been exploring the possibility of
getting the air link between Hawke’s Bay and the Chatham Islands reinstated.
Currently Air Chathams flew out of Wellington and Christchurch. Preliminary
discussions with the owner of Air Chathams look promising. The CEO and the Chair
would soon be meeting with Air Chathams management and the Chair implied that
there would be benefits not only for the health sector but also for education (public
and private schooling), tourism for Napier/Hastings and the wider region, and with the
bigger plane used by Air Chathams, the increase in freight being between HB and the
Chathams would be a positive effect.
•
The Chair also said that it was disappointing that Hawke’s Bay was at the bottom of
the performance table for elective surgery. HB ranked 20th nationally for improved
access to elective surgery, achieving 95% of its target. It was noted however that
performance has significantly improved over recent months and it is expected that
year end targets will be achieved.
2
•
The Chair advised that he had received a letter from the Chairman of Allied Laundry
advising that the forecast end of year profit was estimated to be $160,000 despite the
company incurring significant costs on the HBL process.
CHIEF EXECUTIVE OFFICER’S REPORT
The report from the CEO was taken as read with commentary around the following
Napier Health Centre – Night Nursing: The CEO was disappointed around the recent
advertisements being placed in local newspapers regarding the night nursing at the
Napier Health Centre. He reiterated that no decision had been made and to suggest
that a decision has been made is misleading. Any decision would involve and include
the best clinical advice and the proposal would be ratified by the Board after rigorous
public consultation.
As referred to in the Chair’s report, the CEO advised it was disappointing to see
HBDHB was not doing well in the national performance tables for elective surgery.
However with the proposed changes to productivity in the theatres and with the new
clinical leadership being initiated, he believed there would be improvement in the next
reporting cycle.
The building of better capacity ie., with the recent recruitment of a vascular surgeon,
breast surgeon and colorectal surgeon, the CEO believed it was an encouraging sign
to increase capacity, These three surgeons were all committed to the region and this
would be Hawke’s Bay in a great position in relation to general surgery.
There had been a reduction in people waiting for outpatients appointments beyond
four months – this had gone from 191 to 43 as well as 43 down to 9 people waiting for
surgery.
The CEO referred to the introduction of fluoride in Wairoa. Discussion was had at the
meeting and in particular Board member Denise Eaglesome gave some local content
around what is going on and the opinions in Wairoa around fluoridation. The CEO
advised that a presentation which Ms Eaglesome could use to assist and support her
lobbying for fluoridation for Wairoa was currently being prepared.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF APRIL 2014
The Chief Financial Officer (CFO) advised of a small unfavourable variance of $11 thousand
in April. This brings us to a cumulative favourable variance of $339,000 for the year to date.
The CFO requested that the Board approve the increase in delegated authority to approve
expenditure from special funds up to $200k for the CEO and $100k for the COO. It was also
suggested at the meeting that a strategy be prepared to illustrate and identify the areas, with
the assistance of clinicians how that $300k could be best spent. This would go through
FRAC then on through to the Board.
Action
RESOLUTION
That the Board:
Temporarily Increase the CEO’s delegated authority to approve expenditure from special
funds up to $200,000 and for the Chief Operating Office up to $100,000, for the 2013/14
financial year.
Moved:
Barbara Arnott
Seconded:
Andrew Blair
Carried
3
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council – 14 May 2014
The report on the Clinical Council meeting held on 14 May 2014 was noted. Dr John
Gommans spoke to the meeting regarding a sub-committee that had been set up to address
the issue of incorrect labelling of specimens – either handwritten or printed. The
subcommittee were revising some studies and benchmarking around the best process for
this and options were being developed for a business case of going forward targeting ED.
Hawke’s Bay Health Consumer Council – 15 May 2014
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
Consumer Council meeting held on 15 May 2014, noting in particular:
The Consumer Council had been reviewing the mental health redesign. A meeting
had been held recently with attendances by staff from the mental health service and
consumers and was moving ahead effectively.
The Consumer Council was celebrating its 12 month anniversary next month and Mr
Norton advised the Board to expect the Council to be more proactive as “delegates”
of HB consumers and to expect increased innovation from the Council.
There was a process underway regarding replacements on the Consumer Council
and this would be confirmed at next month’s Board meeting.
Pasifika Health Leadership Group – 19 May 2014
Barbara Arnott on behalf of the Pasifika Health Leadership Group gave a progress update.
In summary the group were preparing a workplan. It was evident that the PHLG had the
passion and contacts in the community to make a difference in terms of the uptake of health
education and services from the Pasifika community. The workplan will focus on the areas
that have previously been identified as gaps for the Pasifika people one specifically being the
DNA’s (Do Not Attends).
In addition, the Group wanted to meet more regularly than four times a year which had been
initially agreed upon. It was considered that once the workplan had been finalised, that to
ensure the objectives in the workplan could be achieved the group would have to meet more
than once every three months, at least over the next year or so to gain some momentum.
The group were scheduled to meet again in July 2014.
DECISION PAPERS
Enhanced Community Services for Frail Older People – Business Case
Kieran McCann (General Manager Integrated Care Services), Allison Stevenson (Service
Director), Mary Wills (Service Re-design Manager) were in attendance at the meeting and
presented the above Business Case to the Board.
It was noted that the Consumer Council and Clinical Council were both supportive of this
business case.
RESOLUTION
That the Board:
Approve the Business Case and investment in Option 2, (ie. that there be a staged roll out to
Napier, then to Hastings and Havelock North implemented over the period May 2014 through
to December 2015).
Moved:
Denise Eaglesome
Seconded:
Helen Francis
Carried
4
Transforming Primary and Community Health Care in Hawke’s Bay
Nicola Ehau (Health HB) and Andrea Jopling (Service Redesign Manager) along with Liz
Stockley (CEO Health HB) presented this paper to the Board.
The result of this paper had been reached through engagement with stakeholders including
every governance group within PHO and DHB as well as reference groups speaking about
the challenges and potential solutions. Scores of providers and GPs involved in the
engagement had resulted in significant consensus around the establishment of community
cluster/networks and the use of multidisciplinary teams.
It was presented to the Board to agree the plan and the model approach to co-ordinating an
implementing the framework.
It was noted that the Consumer Council and Clinical Council were both supportive of this
strategic framework.
RESOLUTION
That the Board:
1.
Note the content of the paper entitled Transforming Primary & Community Health Care
in Hawke’s Bay 2013 – 2018 – A Strategic Framework.
2.
Agree to the vision,
goals and priority plan of the Framework.
3.
Agree to a community cluster model approach to co-ordinating and implementing
the Framework.
Moved:
Barbara Arnott
Seconded:
Peter Dunkerley
Carried
Transform and Sustain Overview
The CFO advised the Board that the Transform and Sustain strategy was being managed
and implemented through the Project Management framework. Progress Reporting and
performance was focussed through the Executive Management Team and the Finance Risk
and Audit Committee.
The paper proposed to add a high level report which would give all DHB Board members an
at-a-glance overview of Transform & Sustain implementation.
RECOMMENDATION
That the Board:
1.
Note the context and purpose of the proposed Transform & Sustain overview
2.
Approve the format of the report
Adopted
5
Board Code of Conduct and Ethics Review
The Board Code of Conduct and Ethics forms Schedule 4 of the HBDHB Governance
Manual. Given the current Code was last reviewed and adopted in 2010, the Board were
requested to once again review and update it where appropriate.
The Company Secretary specifically advised that recently an issue arose that appeared not
to be covered within the Code so an addition to the Code has been drafted for Board
consideration and approval. The addition was in the section “Complaints Procedure” and the
addition is shown below in
bold italics:
“Complaints Procedure
Board members will respect their role in providing a community voice to the activities
of the District Health Board. Equally, however, board members will recognise that the
organisation through the mandate of the board will have processes in place to seek
public consultation, prioritise resources, establish waiting lists and times and respond
to consumer complaints etc. To that end board members will:
•
Advise residents/health consumers, who desire personal matters to be brought
to the attention of the District Health Board, to follow the proper procedure for
raising issues and registering complaints;
•
Not advocate on behalf of an individual beyond advising them of the complaints
procedure and later checking that the matter has been addressed satisfactorily
by the organisation. (‘Satisfactorily’ refers to the procedures followed by the
organisation in addressing the matter, not necessarily whether the outcome is
as the individual would wish.) Should board members become aware of a
matter of real significance and/or urgency however, this shall be raised
immediately with the Chief Executive who will discuss/agree/advise (as
appropriate) how the matter will be addressed, and the board member advised
of the outcome (with the Chair being kept informed of the whole process);
and
•
Not make commitments for board related work or expenditure which have not
been previously approved by the District Health Board, nor create any liability
for the District Health Board beyond authorised delegations.
No further deletions, additions or amendments were identified.
RECOMMENDATION
That the Board adopt the Board Code of Conduct and Ethics” as amended above.
Adopted
MONITORING
Performance Framework Exceptions Q3 Jan-Mar 2014
The Chief Financial Officer advised that the purpose of this paper was to provide the Board
with exception reporting on the Hawke’s Bay District Health Board’s performance on the
Statement of Intent (SOI) and the District Annual Plan (DAP).
Achievements
• Health Targets - exceeded target in January to March 2014 quarter 3 for shorter waits for
cancer treatment, increased immunisation and better help for smokers to quit – hospital.
6
• ‘Percentage of accepted referrals that receive their CT scans within 42 days’ has seen
further improvement and remains favourable at 94.1%.
Areas of Progress
• Progress in the More Heart and Diabetes Checks Health Target compared to last quarter
and currently sits at 79.1%, this is still below the target of 90%.
• There was further improvement in ‘Percentage of cancelled elective cases as a result of
prioritised acute demand’ in this quarter compared with the previous quarter.
Areas of Focus
Continued to focus efforts in order to make gains with particular emphasis in the following
areas:
• Elective Surgery – currently at 95.4% for quarter 3, this is below the target of 100%.
• ED – a slight decrease in the ED Health Target compared to last quarter and it is
currently 93%, this is below the target of 95%.
• Better help for smokers to quit – Primary Care, have seen a decrease compared to the
previous quarter at 73.5%, this is below the target of 90%.
Human Resource KPIs Q3 Jan-Mar 2014
Kate Shambler Senior HB Advisor provided an update for the Board. In summary, the
following points were highlighted:
Accrued Annual leave – focus on getting staff with 2 years accumulated leave to take
leave . HBDHB is the best performed mid-sized DHB for this KPI and the 5th best
overall.
Staff Ethnicity – this was a measure for the number of positions at HBDHB where the
incumbents identify themselves as Maori. The gap to the target has reduced from 51
at 30/6/13 to 32 at 31/3/14.
As advised at the FRAC meeting, there was one serious harm incident notified the
Ministry of Business Innovation and Employment – a slight increase but nothing of
significance.
Oral Health KPI (Te Ara Whakawairoa)
This report was presented by Kieran McCann, Champion for the Oral Health Indicators –
2013/14 Maori Health Plan. In summary, points highlighted to the Board included the
following:
Maori 0–4 enrolment status for 2013: The result for 2013 is 36.7% which is a slight
increase from the previous years ie., 2011 at 34.9% and 2012 at 36.2%
Statistics showed that Maori in fluoridated areas have a better caries free status in
comparison to Maori who live in non fluoridated areas. This continues to validate the
recent community discussions and subsequent decisions about fluoridation.
There is room for improvement in both the ongoing relationship and sharing of
information between providers and the School Dental Service (SDS) are to progress
this.
The Board requested that a plan be developed to promote parents to enrol their pre-
schoolers with a dental service.
Action Kieran McCann would prepare this plan within three
months.
7
Ambulatory Sensitive Hospitalisation (ASH) Rates KPI (Te Ara Whakawairoa)
On behalf of Dr Mark Peterson, Champion for the ASH 0-4 indicators, Julia Haydon-Carr
presented the report.
While ensuring and improving early access to primary care is accepted as being of
considerable value in reducing ASH, it is also acknowledged that ASH is an indicator of socio
economic disparity and this indicator would not show improvement soon while the other
determinants of health were under pressure.
DISCUSSION AND FEEDBACK
Draft Regional Services Plan 2014/15
The purpose of this paper was to acknowledge the distribution to Board members of a FINAL
draft of the Regional Services Plan (RSP) and to confirm Hawke’s Bay DHB’s approval of
and participation in the plan.
The RSP has been developed by Central TAS on behalf of the six Central Region DHBs to
provide an overarching framework for future planning. The RSP provides an overview of
work being undertaken across the region in regional services, clinical networks and in sub-
regional groupings. The RSP is aligned with the DHB Annual Plan in order to provide
integration across common priorities and workplans.
Finalisation of the Draft RSP is aligned to the Annual Plan review process. The final Draft
was submitted to the National Health Board on 26 May 2014.
RESOLUTION
That the Board:
Endorse the FINAL RSP Draft that was circulated previously.
Note the FINAL RSP Draft was submitted to the National Health Board on 26 May 2014
as ‘not yet board approved’.
Approve the finalisation process
Delegate authority to the Chairman of the Board and the Chief Executive to sign the
final Plan on behalf of Hawke’s Bay District Health Board
Moved:
Ngahiwi Tomoana
Seconded:
Helen Francis
Carried
Draft Annual Plan and Statement of Intent
Paul Malan provided a draft copy of the changes and amendments to the Plan and requested
that the Board endorse the final draft.
The Annual Plan combines the Statement of Intent (SOI) and the former District Annual Plan
(DAP) into one document.
8
RESOLUTION
That the Board:
1.
Endorse the FINAL Draft Annual Plan tabled at the meeting
2.
Note the Annual Plan has been submitted to the National Health Board on 26 May
2014 as ‘not yet board approved’.
3.
Approve the process for finalising the plan
4.
Delegate authority to two named members of the Board to sign the Executive Summary
as required by section 141(3) of the Crown Entities Act 2004
5.
Delegate authority to Chairman of the Board and to the Chief Executive Officer to sign
the Annual Plan on behalf of Hawke’s Bay District Health Board as required in terms of
section 9(2) of New Zealand Public Health and Disability (Planning) Regulations 2011
Moved:
Ngahiwi Tomoana
Seconded:
Dan Druzianic
Carried
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:
23.
Confirmation of Minutes of Board Meeting dated 30 April 2014
- Public Excluded
24.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
25.
Board Approval of Actions exceeding limits delegated by CEO (nil)
26.
Chair’s Report
- Regional Governance Group Meeting 5 May 2014
Reports and Recommendations from Committee Chairs
27.
Hawke’s Bay Clinical Council – 14 May 2014
28.
Finance Risk and Audit Committee – 28 May 2014
29.
Draft Annual Plan Financials
Moved:
Jacoby Poulain
Seconded:
Helen Francis
Carried
The meeting closed at 3.38pm
Signed:
Chair
Date:
9
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 30 JULY 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana (arrived 2.00pm)
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis (arrived 1.20pm)
Barbara Arnott
Heather Skipworth
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Apology:
Nil
In Attendance:
Members of the Executive Management Team
Graeme Norton (Chair, HB Health Consumer Council)
John Gommans (Chair Clinical Council) and David Warrington (acting
Chief Nursing Officer)
Members of the public
Members of the media
Minutes
Brenda Crene
KARAKIA
Heather Skipworth opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
Diana Kirton had advised changes to the interest register which had been incorporated.
Andrew Blair had also advised an addition to the register since the board papers were
issued.
No members had an interest in any items to be discussed on the agenda.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 25 June 2014, were confirmed as a correct record
of the meeting.
Moved:
Peter Dunkerley
Seconded:
Dan Druzianic
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Item 1:
Integrated Urgent Care – Service Level Alliance - actioned
July 2014
Section 1
1
Item 2:
Oral Health KPI – August workplan – remove action
Item 3:
Feedback to Medical Director of Mental Health and Addictions – actioned
Item 4:
HB Health Sector Leadership Forum – work in progress remove action
Item 5:
Maori Health Plan Dashboard - ongoing
Item 6:
MRB Meetings action approved
Item 7:
Cultural Perspectives Training in hand for staff. GP training outstanding TBC
BOARD WORK PLAN
The Board Work Plan for August 2014 was noted.
The Institute of Directors Workshop held on Wednesday 23 July was very well received with
further training being considered this calendar year.
Action
CHAIR’S REPORT
The following resolution was passed regarding appointments to the HB Medical Research
Foundation who would be advised accordingly.
RESOLUTION
That the Board:
Appoint Diana Kirton and Helen Francis as DHB representatives on the HB Medical
Research Foundation, as Kevin Atkinson wished to step down from the role.
Moved
Kevin Atkinson
Seconded
Denise Eaglesome
Carried
An update of communications received since the last meeting were summarised.
• It was pleasing to receive a copy of the Hawke’s Bay District Health Board Annual Plan
2014/15 with the Statement of Intent and Statement of Performance Exceptions signed
off by Minister Ryall in July.
• Sally Webb, Chair of the Bay of Plenty District Health Board had recently been appointed
as Chair of the Regional Governance Group to replace Murray Milner who had been in
this position for some time but was stepping down. Murray’s exceptional contribution in
this role was noted.
• Learn Online Maori Health Governance: Further to an email issued in June by the
Ministry, all board members are encouraged to undertake this on-line module as it
reinforces learnings.
Action: the
Online Maori Health Governance detail will be re-issued to board
members who are asked to advise Brenda once they have completed the modules as
this forms part of training records.
• The Ministry of Health had recently contacted the regions to ascertain the level of
training undertaken since the local body elections in 2013. Advice had since been
received from TAS advising board training would occur on 23 September 2014.
HBDHB have rigorously pursued governance training to date and board members polled
during the meeting, felt further regional training was unnecessary at this time. The Chair
would advise TAS of this outcome.
• Diabetes GPSI Service: A letter had been received from the Ombudsmen advising since
no response had been received by Dr Janet Titchener, to his letter of 11 July, work has
now ceased, with the opinion that any further investigation into this matter was
unnecessary.
2
• Regional Sports Park Trust: The Chair had been advised the DHB were able to appoint a
member to the Appointments and Advisory Panel for the HB Regional Sports Park Trust.
In the interim Kevin Atkinson would attend to obtain an understanding of requirements.
The Chair advised of the following retirements, with a letter being sent conveying the Board’s
best wishes and thanks for extended years of devoted service.
Years of
Name
Job Title
Area
Service
Facilities & Operational
Kelvin Loveridge
Orderly Supervisor
Support
50
Older Persons & Mental
Marguerite Iles
Registered Nurse
Health
13
Recognition was made regarding Chris Styles who had worked in a variety of areas during
her time with Health Services and had retired on 15 August 2013, after 33 years of service.
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee provided an overview of his report summarised as follows:
• There had been a significant improvement in performance of electives with no person in
Hawke’s Bay waiting more than four months for elective surgery. A lot of hard work had
been undertaken by many to surpass the MoH contracted target. We need to ensure
continued focus on electives going forward.
• Patient flows through the Hospital continue to receive a lot of focus. Changes are
proposed to ensure better performance around the clock. An implementation plan will be
provided to the Board on this shortly.
• Financial performance was very satisfactory achieving target, with a $3.2 million surplus
for reinvestment envisaged. This was the 4th consecutive year of surplus.
• Some general discussion around the
“Smokers to Quit” target and the difference
between the Primary Care and Hospital target was had, the latter being easier to achieve
given the ‘controlled’ environment.
The key measure was a reduction in prevalence of smoking. It was noted that a lot of
young smokers never go to a GP.
We are also consistently seeing a high number of pregnant women smoking (with 50%
of those women being Maori) which is really concerning. Was a tick box type
questionnaire adequate for smoking mothers? It was advised the Smoke Free Team do
work with midwives and do offer interventions.
Dr Gommans advised we are currently monitoring that advice is given about quitting
smoking - not measuring that advice was being followed which was more difficult.
Consistency of the message is crucial. Over time it does have an impact.
Through recent feedback (in Wairoa), youth advised they do not receive, or see the
“
hard ugly facts about smoking”. Board member Denise Eaglesome was of the
opinion more education in schools to target children early would be very extremely
worthwhile. It was acknowledged that 15-20 year olds have extremely powerful voices in
their families which filter the messages through their whanau.
The CEO advised a “
Health Equity Annual Report” will be provided to the Board in
September. Board members asked for this report to include smoking age bands
hopefully by ethnicity. This will be included on the board’s workplan.
Action
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JUNE 2014
Chief Financial Officer, Tim Evans advised a favourable variance of $205 thousand in June.
This takes us to a cumulative favourable variance of $222 thousand year to date, with an
unaudited $3.2m surplus for the financial year end.
3
Continued additional costs incurred due to the focus on elective surgery, combined with high
bed occupancy rates.
• Not an easy year, with a great deal of hard work undertaken to move the cost base down
which has been challenging.
• Work was ahead of plan on the Mental Health Inpatient Unit. Work was a little slower on
the new Maternity build and the Napier Health Centre upgrade.
• $14.2m of targeted savings were achieved and the Board congratulated everyone
sincerely for their efforts. These savings were on top of $12.0m of efficiencies achieved
the year prior (y/e 30 June 2013).
As Board approval is required for purchases from special funds over $50 thousand per
item, following consideration the resolution was carried.
RESOLUTION
That the Board:
Approve the expenditure of $75 thousand from the Cardiac fund as a contribution towards
the purchase of the Vivid E9 Expert Cardiac Echo Ultrasound.
Moved
Helen Francis
Seconded
Diana Kirton
Carried
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
Dr John Gommans (co-Chair of Clinical Council) introduced David Warrington who was in
attendance as Acting Chief Nursing Officer in Chris McKenna’s absence.
The report on the Clinical Council meeting held on 9 July 2014 was noted.
When providing a presentation in the South Island recently, Dr Gommans advised it was
evident that the Hawke’s Bay Clinical and Consumer Council’s were being recognised
around the country for their effective leadership roles. Clinicians in particular have been quite
intrigued and were keen to duplicate the model in their area(s).
Following the formation of the HB Clinical Research Committee earlier in the year, a Forum
had recently been held for clinical researchers (approximately 35) to share their research
findings. This was very positively received as supporting researchers and sharing/learning
from findings is the Committee’s goals.
Next month signals the 4th year of HB Clinical Council has been in existence. An AGM would
be held on 13 August, and there would likely be changes recommended to the medical
membership composition.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update from the Consumer
Council meeting held on 10 July 2014, noting in particular:
• The response to challenges around Mental Health service and redesign matters raised
by a local group of consumers has been very positive, as indicated last month. A Terms
of Reference was being drafted for the formation of a Mental Health Advisory Group,
with Nicki Lishman (a Hawke’s Bay Health Consumer Council Member) as Chair.
• “Person Centred Care” focused on “how care was delivered” which was particularly
relevant in implementing Clinical Pathways (currently being developed), as well as
invaluable in the delivery of care across all health services. A draft Project Terms of
Reference for Person Centred Care had been prepared and Consumer Council would
4
workshop this at their August Meeting.
Action: A paper on “Person Centred Care”
would be presented to Clinical Council and the Board in due course.
• Hawke’s Bay Health Consumer Council Membership:
Council seek a consumer representative to fill a vacancy brought about by the
resignation of an existing member. It was acknowledged that nominations for positions
on Council would be sought from the community when vacancies occur through
rotation/termination.
The report circulated recommended endorsement by the Board for appointment of
Rachel Ritchie, noting approval for the appointment had been received from the CEOs of
Health Hawke’s Bay Limited and HBDHB.
The Chairman of the Board felt Rachel would make an excellent contribution to
Consumer Council.
RECOMMENDATION
That the Board endorse the appointment of Rachel Ritchie to the HB Health Consumer
Council, to replace Rob Lutter.
Adopted
DECISION
Integrated Urgent Care Service Level Alliance
Carleine Receveur, Project lead, summarised activity to date as outlined in the report
provided.
Following consultation with Key stakeholders around the formation of the Service Level
Alliance Team, agreement had been reached for the team’s make up as presented.
The challenge however was to design a system going forward and although the DHB and
PHO had given considerable thought to this and had indicated a desired intention, they did
not want to be seen as predetermining the “how”.
Board members noted the high level of tension particularly in Napier with hundreds signing
petitions – without any decisions on the matter having been made.
This was all about “equal accessibility to medical care across the region” and to see the
Terms of Reference signed off was a significant milestone in the process. The formation of
the Service Level Alliance Team was the first step towards what will become a community
solution.
The term “Urgent Care” relates to the “urgency of your (personal) need” as opposed to
planned. The words “out of hours” were irrelevant.
This work will continue to be supported by both Clinical and Consumer Councils, noting the
terminology IUC SLAT should be looked at by the team appointed.
RECOMMENDATION
That the Board:
Note the process followed and feedback received concerning the Integrated Urgent
Care Service Level Alliance
Approve the Terms of Reference for the Integrated Urgent Care Service Alliance (IUC
SLAT) which identifies the Clinical Council as the body in which the IUC SLAT is
accountable to.
Adopted
5
MONITORING
Did Not Attend (DNA) Specialist Appointments KPI Report:
DNA Champion and Chief Operating Officer, Warrick Frater introduced the report. This was
the first report back to the board following a significant amount of work following consultation
with a number of people and included a policy update; the rollout of text services to all
specialties; clearer literacy and community levels of engagement, the establishment of two
positions (from 1 September 2014) and an independent clinical assessor to work with the
focus teams.
It was heartening to see statistics improving as in Hawke’s Bay we have around 1,100 first
specialist appointments each month.
The bulk of the DNAs have occurred within the nine specialties selected. For those in
Wairoa several service appointments on one day (in Napier) were extremely helpful, however
travel was an issue. It was more the impact of failing to attend appointments by those
individuals with chronic health issues that was of concern.
DNAs are receiving focus nationally at present.
The Board thanked the team for the work reflected in the report.
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:
14.
Confirmation of Minutes of Board Meeting dated 25 June 2014
- Public Excluded
15.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
16.
Board Approval of Actions exceeding limits delegated by CEO (tabled)
17.
Chair’s Report
- Regional Governance Group (nil)
- HBL Chairs Update (nil)
Reports and Recommendations from Committee Chairs
18.
Finance Risk and Audit Committee – 30 July 2014
19.
Hawke’s Bay Clinical Council – 9 July 2014
Moved:
Helen Francis
Seconded:
Barbara Arnott
Carried
The meeting closed at 2.45pm
Signed:
Chair
Date:
6
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 27 AUGUST 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.08 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis
Heather Skipworth
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Apology:
Barbara Arnott
In Attendance:
Members of the Executive Management Team
Graeme Norton (Chair, HB Health Consumer Council)
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Members of the public
Members of the media
Minutes
Brenda Crene
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
Changes to the interest register were noted with Diana Kirton and Helen Francis included as
members of the HB Medical Research Foundation, and Kevin Atkinson was no longer a
member. Andrew Blair had been appointed Chairman of Cancer Control New Zealand which
had been noted, and Jacoby Poulain was no longer a columnist for HB Today.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 30 July 2014, were confirmed as a correct record
of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Item 1:
Maori Health Plan Dashboard in hand – remove action
Item 2:
Cultural Perspectives progressing – remove action
September 2014
Section 1
1
Item 3:
The Strategy Training session date was discussed with members in favour of
Tuesday 11 November - remove action
The Central Region training day in September was cancelled with a two day
Symposium planned in Palmerston North for 13 and 14 November. Peter
Dunkerley advised he could attend on the Chair’s behalf. The purpose is thought to
be a team building and bonding session.
Item 4:
On-line “Maori Health Governance Training” progressing - remove action.
Item 5:
Health Equity Annual Report underway - remove action.
Item 6:
Person and Whanau Centred Care – has been included on the Workplan - remove
action.
BOARD WORK PLAN
The Board Work Plan for September 2014 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 years of devoted service
Years of
Name
Job Title
Area
Service
Ray Turner
Electrician
Facilities & Operational Support
27
Robert Willis
Senior Orthotist
Older Persons & Mental Health
19
Sarah Atley
Social Worker
Older Persons & Mental Health
14
Shona Tomlins
Secretary
Facilities & Operational Support
18
An update of communications received since the last meeting were summarised.
• A letter had been received from Tony Ryall MoH advising approval of the 2014/15
Central Regional Services Plan with one condition and appreciation for the significant
work involved in the plans development. MoH expected to receive a fully prioritised and
costed regional Information Technology (IT) plan, with milestones covering the next
three years by 30 September 2014.
• Quarter 4 results for HBDHB for the six target areas were compared with all (20) DHBs
nationally and was seen as patchy with: Shorter stays in ED was 18/20 for the quarter
ended June 2014; Improved access to Elective Surgery 13/20; Shorter waits for Cancer
Treatment at 100%; Increased Immunisation 3/20; Better help for smokers to quit 13/20
and Heart and Diabetes Checks at 14/20.
• Quarter 4 results for the PHO compared with the 36 national organisations were:
Increased Immunisation 10/36 for the quarter; Better help for smokers to quit 21/36; and
More heart and diabetes checks 22/36.
• A letter had been received from Annette King the Opposition Spokesperson for Health,
who advised that should Labour lead the next government, they would be cancelling the
HBL hospital food proposal.
• An Open letter to all DHB board members from lobby group “End Seclusion Now” had
been received. This group were working to bring about a prompt and decisive end to the
use of seclusion in all New Zealand hospitals.
David Warrington (Nurse Director, Mental Health and Older Persons) was in attendance
providing an overview for Hawke’s Bay, highlighting a number of areas which had been
addressed to reduce or eliminate seclusion. Between 2011 and 2013 seclusion had
actively been reduced in Hawke’s Bay by 25%. He advised the new Mental Health Unit
had been designed to maximise an individual’s recovery and will have more quiet areas
and specifically designed sensory modulation areas. Furthermore the layout of the new
2
unit will mean there will no longer be two distinctive wards, and staff will be more readily
available.
In May 2014, the Office of the Ombudsman undertook an unannounced visit looking at
mental health services nationally to ensure no cruel, inhumane or degrading treatment or
punishment was taking place. The Office provided a positive review for HBDHB.
HBDHB wish that seclusion was not necessary however there are times when
individuals are at such an imminent risk (to themselves or others) that seclusion is the
only appropriate intervention to keep them safe. Alternatives such as long episodes of
manual or mechanical restraint or heavy pharmacological sedation often carry increased
risks both physically and mentally/emotionally. The DHB are engaging well with service
users, and consumers are already involved in the development of the new unit and its
services.
Action: The Chair requested management (EMT) draft a suitable response to the
lobby group.
• The Chair reminded members of the forthcoming HB Health Sector Leadership Forum
on 15 October and the “Strategy Day” planned for November, date to be confirmed.
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee, CEO provided an overview of the report and commentary summarised as
follows:
• A notable achievement was the large reduction in those waiting for First Specialist
Assessments and for Elective Surgery. This has been the result of a lot of focused effort
over recent months.
• Support was being provided to the PHO to lift better help for smokers to quit in Primary
care target, as well as more heart and diabetes checks.
• The financial position for the first month of the financial year was on target.
• Other areas raised included deferral of the Strategy for Community Pharmacy Services;
Health Equity Update including nutrition and smoking.
• All areas of the hospital have been under a great deal of pressure around patient flow
with gridlocks and backlogs occurring for varying reasons. There is need for change to
ensure we provide the right care at the right place at the right time.
A Hospital After of Hours discussion paper was provided to FRAC. Another important
area to be progressed will be the Urgent Care after hours project to be overseen by an
Alliance Leadership team.
Dr Gommans (on behalf of all staff) was thanked by the Chair for the delivery of good
results considering the difficult circumstances under which they were achieved.
It was advised that some reallocation of funds and additional management resource to
ensure the issues are dealt with quickly was important with staff under such pressure.
Action: Dr John Gommans would pass on the Board’s appreciation on to staff.
They wished to express their sincere thanks and understanding of the
pressures staff are under in the Hospital at this time.
• HBDHB’s Workforce Ethnicity was noted as 5th of the 20 DHBs for the employment of
Maori staff. A good result.
• It was felt there should be zero smoking rate targets for students. Presently MoH targets
focus on asking people about smoking versus the “outcome”, hence the target of 10%.
The Health Equity Annual Report being released soon will tackle this area. Hawke’s Bay
was presently at 18% heading towards a smoke free NZ by 2025.
3
FINANCIAL PERFORMANCE REPORT FOR MONTH OF JULY 2014
Chief Financial Officer, Tim Evans advised of a favourable variance of $19 thousand for July
(being the first month of the financial year) with no contingency used.
This being the first report for the financial year, patterns has not yet emerged. The new
Mental Health Unit development is receiving major focus.
The Board was complimentary on the new financial reporting format.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
The report on the Clinical Council meeting held on 13 August 2014 was noted and
summarised as follows by Dr John Gommans (Chair):
• Council will mark its 4th year of operation in October 2014 and at the August annual
meeting the survey undertaken noted significant improvements from the prior year.
Clinical Council papers can be viewed on the HBDHB website.
• The topic of “prioritisation” was raised during the survey discussion. As Council deal
with a lot of large cost items on a month by month basis Council has not had the
opportunity to make comparisons between papers or projects to truly prioritise
resourcing decisions. Council need to be reassured about these prioritising decisions
and requested an update.
• The current Council Chair’s (Dr John Gommans and Chris McKenna) will continue, with
a further three members at the end of their terms. There will be new members to confirm
at the September Board meeting.
• “Clinical Indicators” now have Clinical Council owners/champions to ensure clinical input
is included to strengthen information and relationships in the sector – achieving more
consistency.
Labelling errors were briefly discussed with hospital and community labelling quite different.
Most are low level with progress being made on the high risk sub-group.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
meeting held on 14 August 2014.
• The Consumer footprint has been ever increasing and it is challenging on how to report
– whether it be from the meeting or the state of play. The Chair agreed to take the
broader view.
• Consumer Council is a lively, passionate and productive group with a lot of work going
on between meetings.
• It was noted there is a perception the Napier Health Centre is closed with a group in
Napier stirring the pot.
Management felt clear communication had been provided to the Napier community.
However following discussion there was agreement to hold an open day as the best way
to showcase the upgrades and the quality of service.
Action: An Open Day would be held at the Napier Health Centre once completed to
highlight the upgrades and what was now occurring at the Centre.
4
Hawke’s Bay Health Alliance Leadership Team Agreement
Adri Isbister, Chair of the HB Health Alliance Leadership Team (ALT) joined the meeting and
provided an overview of the meeting of the ALT meeting held on 22 July 2014 on the
progress with formation of the Alliance which was mandated by the MoH (nationally) to
ensure DHBs worked with PHOs (and others as appropriate). On reflection there has been a
very good relationship between the HBDHB and Health Hawke’s Bay (PHO) for a long time
with a common sector wide vision, however it was felt we would create added value by
promoting the ALT.
There was clear agreement the ALT would utilise clinical expertise through the well
established Hawke’s Bay Clinical Council, for clinical decision making. The added value of
the HB Health Sector Leadership Forum twice per year was also acknowledged.
The Board noted the report and thanked Adri and the ALT for the work completed to date.
Hawke’s Bay Health Alliance Agreement
Since formation, the ALT has had a number of discussions about formalising an Alliance
Agreement. Given the standard Alliance Agreement template was required to be used (by
the MoH), it has taken some time to develop a meaningful document that reflected both the
current environment and future intent of the Parties (DHB and PHO), whilst preserving the
format/structure and intent of the template. Such a document was now being presented to
both Boards for approval and execution.
Following discussion there was general agreement with the content.
RESOLUTION
That the Board
• Note the contents of this report
• Note the amended Alliance Agreement meets both national and local requirements.
• Approve the agreement for execution.
Moved Diana Kirton
Seconded Denise Eaglesome
Action: One typo on page 17 of the Agreement was noted and would be amended
before signing.
The Health Hawke’s Bay Board would consider the Hawke’s Bay Health Alliance Agreement
the week commencing 1 September 2014.
DECISION
Capital Plan 2014-17
The plan provided showed a source and application statement for the Capital programme for
the three financial years from 2014-17; an allocation of block spends (clinical equipment,
facilities, IS, and minor projects) included in the plan; and a breakdown of total spend on
local strategic programmes.
• CRISP and the HBL programme were included as separate spends.
Costs for parking was raised with a comment it was hard to prioritise health spending for
parking. As services move closer to the communities they serve, it will reduce the need for
parking on the hospital site.
• The Deputy Chair queried where the Mortuary spend was included being advised it was
a sub-set spread across years under facilities.
5
RECOMMENDATION
That the Board:
Endorses the Capital Plan for 2014-17.
Adopted
Using Consumer Stories to Improve Quality of Care
Emma Foster, Service Quality Improvement Manager and Graeme Norton, Chair of Hawke’s
Bay Health Consumer Council introduced the paper which had been a collaborative effort
over past months, with the Board viewing the detail for the first time.
• It was acknowledge the “Patient Story” document had been developed by Hutt Valley
was approved as appropriate for use in Hawke’s Bay. The letters and feedback
brochure had been produced in consultation and the Tool Kit had been endorsed by
HQSC.
• Why capture consumer stories?
We need to understand the consumer journey to enable us to make systematic changes
to the provision of services to our community. This was about changing the way we do
things by putting consumers at the centre.
• We must ensure stories are used with integrity and respect for the patient, whanau and
carer. Feedback from clinical areas has been very positive. Some stories (with
agreement) will be utilised for staff inductions and training. This is a key tool to enable us
to understand why things need to change. We are not replacing feedback systems
already in place – this is seen as one of the avenues.
• The Feedback Brochure would be used within the health sector in Hawke’s Bay,
however it would be introduced slowly at the outset. Posters, in time will be placed
within the community. We do need to get the most vulnerable people within our
community to share their stories.
Action: Heather Skipworth requested this work be provided to the Maori
Relationship Board for their information.
• How will the Board know that changes have been made and the stories are working to
ensure real change? Change will occur by addressing themes through analysis. Using
complaints and compliments system in conjunction with the patient stories.
Following general discussion this very worthwhile project was endorsed by the Board.
RECOMMENDATION
That the Board:
1
Note that Clinical and Consumer Council have endorsed the process taken and detail
provided.
2
Approve the package (toolkit, consent form and background information sheet) to
support the collection of consumer stories
3
Approve the HBDHB feedback brochure
Adopted
MONITORING
Transform and Sustain Projects Overview
Tim Evans, Chief Financial Officer summarised the snapshot report provided which was
underpinned by a lot of additional detail. There was some discussion around the delay in the
installation of Windows 8.1 and Office 2013. The use of Video conferencing technology was
queried. It had been utilised and agreed to have clinical services use them in certain
situations, however it was not practical in many situations.
6
Performance Framework Exceptions Q4 Apr-Jun 2014
The Board Chair noted work was required in problem areas and was hopeful to see
improvements in the next quarter.
The tabled A3 document including updated national detail would be placed on the website
Action.
HR KPIs Q4
Kate Shambler (acting General Manager Human Resources) was in attendance and provided
a summary of the report. In the areas of sick leave and staff turnover we had performed well
at national level. However we were struggling with excessive annual leave owing. A more
proactive approach was planned to reduce this over the next few months. Excellent progress
was being made with the Maori staff target.
Child Health KPI (Maori Health Plan)
Caroline McElnay (Director Population Health) was joined by Julia Haydon Carr (the report
writer) and Jules Arthur (Midwifery Director) to discuss the report with the Board and
summarised as follows:
• There were some improvements however inequities were evident. The Lead Maternity
Carer (LMC) target was an area where we could do better.
• The fully breastfed at 6 months target had been changed by the MoH, originally in place
to meet WHO standards not recognising ‘partially breastfed’.
• A GP visit by an expectant mother was not often captured for follow through. What
happens after the GP visit is where differences can be made through
better linkages
with LMCs
• There was some discussion around the detail provided to expectant mothers at the
outset of their pregnancy and how this could be improved to ensure they had awareness
on how to navigate the system and what to expect. There was a need also to focus on
‘health literacy’.
Action: Jacoby Poulain and Jules Arthur to further discuss outside the meeting.
The Deputy Chair felt the overall statistics in this area for Maori were disappointing. How do
we promote better in the community? KHW were building on better models. Tarawhiti DHB
had good results in this area.
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
7
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
20.
Confirmation of Minutes of Board Meeting dated 30 July 2014
- Public Excluded
21.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
22.
Board Approval of Actions exceeding limits delegated by CEO (nil)
23.
Chair’s Report
- Regional Governance Group (nil)
- HBL Chairs Update (nil)
Reports and Recommendations from Committee Chairs
24.
Finance Risk and Audit Committee – 27 August 2014 (tabled)
25.
Hawke’s Bay Clinical Council – 13 August 2014
26.
Hawke’s Bay Health Consumer Council – 14 August 2014
27.
Consumer Story
Moved Diana Kirton
Seconded Peter Dunkerley
The meeting closed at 3.30pm
Signed:
Chair
Date:
8
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 24 SEPTEMBER 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.08 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis
Heather Skipworth
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Barbara Arnott
Apology:
-
In Attendance:
Members of the Executive Management Team
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Graeme Norton (Chair, HB Health Consumer Council)
Members of the public
Members of the media
Minutes
Brenda Crene
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance.
DECLARATIONS OF INTEREST
Heather Skipworth advised the TeTimatanga Ararau Trust she is a trustee of is currently
negotiating a contract for Green Prescription.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 27 August 2014, were confirmed as a correct
record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Jacoby Poulain
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Item 1:
The Governance Strategy Training session confirmed 19 November.
Item 2:
Appreciation conveyed.
Item 3:
Napier Health Centre Open Day - planning is underway.
Item 4:
Consumer Stories provided to MRB, remove action.
October 2014
Section 1
1
Item 5:
Child Health KPI: A meeting was to be held between Jacoby Poulain and Jules
Arthur. Remove action.
Item 6:
End Seclusion Now lobby Group response provided.
BOARD WORK PLAN
The Board Work Plan for October 2014 was noted.
Board members have been invited to attend the Tū Kaha 2014 Pōwhiri and lunch at the HB
Racing Centre in between the FRAC Meeting and Board Meeting on Wednesday 29 October.
Transport will be provided. An apology was received from Helen Francis for the Pōwhiri.
Action:
The October Board meeting will include a Workshop on “Strategic
Relationships”. Ken Foote would prepare a background paper for
members.
CHAIR’S REPORT
The Chair advised there were no retirements to note on this occasion.
An update of communications received since the last meeting were summarised.
• A letter had been received from Basil LeProu expressing concern over the lack of public
parking available at the Hospital, identifying an area adjacent to the main car park which
could provide up to 22 parks. A copy of the detail provided would be passed on to
Facilities for consideration.
Action: Transport and parking will be included on the Board agenda at a future
date (timing to be determined).
• The National Health Board (NHB) will be holding their Board meeting in Hastings and
incorporate meetings with Board and Executive team members on 17-18 November.
Action: An outline of the NHB programme for November 17 and 18 will be
provided to Board members when available.
It will be ascertained whether the NHB Board meeting is able to be
attended by HBDHB board members?
• The Chapel: As part of the World War One (WWI) Centenary commemorations in April
2015, a significant amount of time and effort has gone into a plan and associated
funding proposal to refurbish and rededicate the “Chapel” near the main entrance to the
Hospital.
Agreement has also been reached with the Hastings RSA to revert to the original name
given to the hospital in 1927 being “Hawke’s Bay Fallen Soldiers’ Memorial Hospital”.
Action: Appropriate Maori wording would be provided by the Deputy Chair to
Ken Foote for inclusion on the new hospital signage.
• A half yearly report (Jan-June 2014) had been received from the Health and Disability
Advocacy Service on complaints nationwide. Hawke’s Bay rated 9th of the 20 DHBs for
the “rate of complaints to Advocacy per 100,000 discharges”. This was not too
inconsistent with previous years. Of the 22 complaints received: 80% were low level,
with resolution or partial resolution achieved; 8% had been withdrawn with 8% referred
to the HDC. Of the reported complaints, two related to “respect”; 11 to “appropriate
standards”; 7 “effective communication” and 2 “not kept fully informed”.
• A letter received from MoH on PHO Health Target Performance for quarter four
compared with the same quarter the prior year saw a slight reduction in the achievement
of indicators for increased immunisation down 1% to 94% compared to the prior year Q4
result); and Better help for smokers to quit down 3% to 77%. A good result was
achieved for More heart and Diabetes checks which were up 12% to 84%.
2
• A complimentary letter from the Ministry of Health had been received; however this did
exclude EDs turnaround.
• A further letter had been received from the Platform Charitable Trust. We have
responded to this organisation in the past and the response would likely remain the
same.
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee, CEO provided an overview of the report of 16 September with commentary
summarised as follows:
• Patient flow through the hospital remains our most significant problem and while there
had been some improvement in August it was only slight.
To address Service Performance an Acute Inpatient Management (AIM 24/7) project had
been recently implemented to expedite patient flow problems. An Ambulatory Care
Centre is being looked at to centralise medical day procedures away from ED to assist
flow and care significantly.
• Performance results were reviewed as well as other detail covered in the Board Report.
• Meeting Smoking targets within GP Practices: PHO have funded attention on achieving
this target through their performance programme and were hopeful the target would
soon be met. Unfortunately our IT systems will not let us know when this has been
achieved until after the fact as Dr Info and DHB shared services systems are not linked.
• A significant report on Inequity in Hawke’s Bay will be brought to the Board in October to
allow more time for the report to be appropriately completed and targeted in the right
way to maximise its impact with release planned for the HB Health Sector Leadership
Forum on 15 October.
• It is pleasing to note that members of the Intersector Leadership Forum will be in
attendance at the Health Sector Forum.
• Enrolling newborns within three months. Last quarter a gap of 150 babies not enrolled
resulting in our PHO being 31/36 in NZ. This was thought to be related to BK coding
and a programme was underway to ensure enrolment occurred within several weeks.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF AUGUST 2014
Chief Financial Officer, Tim Evans advised of some financial pressures during August
resulting in an adverse variance of 57 thousand.
• The biggest cost pressure was in Health of Older People however this was not a major
concern at this time.
• No contingency had been used year to date and employee numbers were close to that
budgeted.
• Case weighted discharges slightly under but not alarmingly so.
• The new Mental Health Unit Development report had been included with the build
proceeding to plan.
• Preparation of the Annual report was advanced with the unaudited year end result at
$3.22m. Finalised accounts were available and a draft set of unaudited accounts had
been emailed to board members on the day of the meeting (24 September).
The CFO apologised for the delay and advised the Annual Report financials would need
to be signed by Tuesday 28 October, the day prior to the next Board Meeting.
3
RESOLUTION
That the Board:
• Note that the Annual Report is draft at this stage
• Request that members read the unaudited financial accounts and provide feedback to
the Chief Financial Officer.
• Delegate authority for two board members to sign off the accounts to ensure they are
lodged by due date of 28 October 2014.
Moved
Barbara Arnott
Seconded
Dan Druzianic
Carried
Action:
A query was raised by the Deputy Chair, regarding the length of stay in the
Emergency Department. Advised there did not appear to be any
correlation/pressure effect on our vulnerable population. The CFO would
check and report back to the next meeting.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
The report on the Clinical Council meeting held on 10 September 2014 was noted and
summarised as follows by Chris McKenna (co-Chair):
• Significant work was being undertaken to ensure correct labelling of specimen samples
across the health sector.
• Collaborative Clinical Pathways programme was progressing with a launch tentatively
planned for 12 November. This is being led by primary care with oversight by Clinical
Council. A lot of training had occurred to facilitate the pathways program.
• A number of monitoring reports were reviewed including Tu Mai Ra (the final with a
program review nearing completion) and Te Ara Whakawaiora: Cardiovascular Disease;
Data Quality of KPIs and Child Health KPIs had been presented by executive
champions.
• The first meeting of the newly formed HB Radiology Committee would be held on 30
September.
• A recent review of the Council’s Terms of Reference to take into account the wider
mandate requested/approved by Health Hawke’s Bay Ltd and the Hawke’s Bay Health
Alliance had been completed and appended to the report.
• Recently three vacancies on Council were advertised. The recommendation for board
endorsement was submitted with one Clinical Director/Head of Department yet to be
appointed.
RECOMMENDATION
That the Board
1. Notes the contents of this report.
2. Endorse the re-appointment of Robyn O’Dwyer (Senior Nurse (Primary Care) and
appointment of Dr Malcolm Arnold (Medical Director / Head of Department) to the HB
Clinical Council
3. Approve the Updated Terms of Reference.
Adopted
4
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
meeting held on 11 September 2014.
• The deferral of “Patient and Whanau Centred Care” will ensure more clarity is achieved
as this piece of work will mean significant change. Clinicians and consumers need to
discuss this further.
• Difficulties encountered by people trying to navigate their way through health services is
an ongoing concern and further conversations around this will be had by Consumer
Council.
• A successful partnership has developed between community users of mental health
services and Mental Health staff regarding service redesign. A good outcome is being
achieved for all parties.
Maori Relationship Board (MRB)
Ngahiwi Tomoana, Chair of the MRB provided an update from their meeting held on 17
September 2014.
• It was pleasing to see the focused response by executive team as the Maori Indicator
Champions. Having the system in place now ensures KPIs contained within the
“Dashboard” on page 53 receives focus.
Ambitious targets have been set to drive for better results. The work undertaken by all
concerned was most appreciated.
• The descriptor around the second indicator on page 54 appeared wordy and medically
focussed. Was there better terminology that could be used? It was explained ACS was
a national indicator but good point.
• Follow up for those who participate in wellbeing programmes eg., obese teenagers in
Wairoa was raised. Was there an opportunity to provide a dietician to ensure follow
through?
Action:
Following up wellbeing programmes in the Community: Shayne
Walker to look at the item raised by Denise Eaglesome relating to
Wairoa and the need for a dietician.
It was conveyed that the key to long term success was to build capability and leadership
within our communities to ensure long term sustainability, without relying on service
providers.
Pasifika Health Leadership Group (PHLG)
Barbara Arnott (Chair of CPHAC) provided an update on the meeting held 22nd September.
PHLG members were very pleased to receive an invitation to attend the HB Health Sector
Leadership Forum.
Following the resignation of Iakopo Faafuta in July, the Group sought to replace one member
with two to ensure wider representation of the Pasifika community.
RESOLUTION
That Michelle Iosefo and Vaeluaga Iosefa be appointed to the Pasifika Health Leadership
Group.
Moved Barbara Arnott
Seconded Heather Skipworth
Carried
5
Pacific Health update noted achievements since July 2014 particularly in suicide prevention,
workforce development and Did Not Attend (first specialist appointments).
The PHLG’s workplan was under development and would be further considered at their
meeting in December.
DECISION
Memorandum of Understanding between NKII and HBDHB
Tracee TeHuia (GM Maori Health) was in attendance and acknowledged the significant
engagement and efforts of Ken Foote and Jenny Smith of NKII and Tatiana Greening, to
review the current Memorandum of Understanding (MOU).
Following a summary of the work undertaken the Board Chair acknowledged this excellent
result with thanks to those involved.
Action:
The Board requested an update six monthly and this would be programmed
into the Workplan with the first update due in April 2015
Following discussion it was agreed
Action:
The MOU would be signed at the HB Health Sector Leadership Forum and
owned all.
RESOLUTION
That the Board
Approve the attached Memorandum of Understanding between Ngāti Kahungunu Iwi Inc and
Hawke’s Bay District Health Board including the updated Terms of Reference for the Maori
Relationship Board.
Moved
Helen Francis
Seconded Dan Druzianic
Carried
Action:
The Board would be keen to understand how many other MOU’s and
Charters there are and their status.
Increasing Enrolled 0-5 year olds into Community Dental Service
Dr Robin Whyman (Clinical Director for Oral Health) and Claire Caddie (Service Manager,
Oral, Rural and Community Health) were in attendance for this discussion.
It was evident a lot of activity underway to have children enrolled early, through “Quadruple
Enrolment” being led by Population Health. Good relationships exist with providers who are
now undertaking a more proactive role which was working well.
Reflection on the
Nuka whole health care system created, managed and owned by Alaska
Native People. Wairoa could be seen as candidate for such a system.
Linking with partners eg the Ministry of Social Development “health team” was
acknowledged. To have a successful preventative programme we need to look at all
partners.
The real challenges were children in high decay risk groups with the need for checks and
fluoride varnishes every six months. 0-13 year olds in Hawke’s Bay numbered 25,000 with
30% of that group who need to be seen six monthly (at a Clinic, mobile facility or in own
homes).
A national campaign marketing plan was/had been developed by the MoH plan and HB will
be part of that national initiative, once the Minister of Health is appointed.
6
RECOMMENDATION
That the Board:
• Note the contents of the report.
• Endorse deferring the implementation of local Hawke’s Bay marketing for preschool oral
health until it is known what the national oral health promotion marketing programme will
involve, how it will be implemented and when it will commence.
Adopted
MONITORING
Tū Mai Rā Plan Q4 (Apr-Jun 2014)
Tracee TeHuia (General Manager of Maori Health) and Shayne Walker (Programme
Manager Maori Health) were in attendance. This was the final report under the Tū Mai Rā
programme with the “Mai” programme having commenced with Q1 results due in December.
• Overall good work with a slow start in establishing data collection improvements.
• The stand-out for the duration of the programme has been increased immunisation rates.
• The baseline has improved overall and with the continuing Te Ara Whakawaiora
reporting, further improvements will become evident.
• An independent assessment of the programme is due out soon and a presentation to the
Board will follow.
Action: This will be placed on the workplan.
• Zero DNAs were achieved for the Paediatric Unit for the first three weeks. In the past
there has been a 20% average. The focus on DNAs has been a whole of system
approach.
All teams are dedicated and focussed. Key is monitoring and oversight from Executive team
and improved communication. A great result.
Action: A discussion would occur outside the meeting with Denise Eaglesome
around a suicide matter in Wairoa.
Te Ara Whakawaiora / Quality of Data
Tim Evans (Chief Financial Officer) and Quality of Data Champion discussed the report
provided including commentary as follows:
• Detail was being provided to the HB Health Consumer Council further clarifying home
based support, residential and palliative care data for Maori. This also includes a
definition of “disability”.
• Overall we have made considerable progress in the quality of data within the
organisation.
• A query from Helen Francis related to detail contained on page 59 under the heading
“Maintaining accuracy of ethnicity reporting in PHO registers” advising the definition may
be misunderstood or required further clarification.
PHO targets: Should PHO data collection be based on every “enrolled” patient
within a practice OR every patient that visits their GP or a doctor? Trying to get
to ALL patients enrolled with a practice noting some enrolled rarely visit their
doctor as they are likely to be in good health appears to be an unrealistic ask?
What do other DHBs base their data on?
Action Tim Evans to verify and circulate to all board members.
The new set of Te Ara Whakawaiora KPIs for the remainder of 2014 and 2015 have been
added into future workplans.
7
Te Ara Whakawaiora / Cardiovascular Disease
Dr John Gommans (Chief Medical Officer – Hospital) and Champion for Cardiovasular
Disease provided an overview of his report highlighting that:
• Cardiovascular Disease was the number one killer in all ethnicities in NZ. Premature
death rates were high and that is where the problem arises for those under 75 years.
The graph highlighted in the CEO’s report and also on page 81 of the board report
shows whilst there is an improvement in more recent years, issues with obesity and
smoking will slow the curve.
• It was noted that the Central region as a whole do less cardiac surgery compared to the
whole of NZ. Wellington advises they do not have significant waiting lists for
cardiovascular surgery. This poses the question why?
• NZ guidelines recommend cardio risk assessments should be undertaken in women
from the age of 55, and in men from 45. Maori risk assessments however should occur
10 years earlier at age 45 for women and 35 for men with yearly checks.
• Stopping smoking and stamping out obesity is the key.
• Social messaging and role modelling is also a key by having children tell their family
members they want them around. Billboards send a strong message.
• The Deputy Chair advised that Marae’s are now: alcohol, sugar, fast food free and
smoke free.
.
Kahungunu Hīkoi Whenua (KHW) Update
Shayne Walker spoke to the paper with an overview of the revitalised programme including
partnering with organisations. If we develop leaders and build the capability of our providers
in the community we obtain better traction overall.
Following queries around KHW and its revitalisation around physical activity, nutrition and
smoke free, it was felt better communication was required.
Action:
Consider the need to raise awareness and educate the community(s) about
changes to KHW and promotion of the programme.
Should billboards be used more in a general sense to motivate and provide
messaging with pictures?
The MoH changed the model.
• KWH is face to face, listening to communities.
• The old system did not work with examples provided.
There have been changes to Green Prescription delivery as part of KHW. This programme
was originally delivered by Sport Hawke’s Bay however another provider has not been
contracted.
Several appropriately trained Senior EIT students are involved with the programme however
that could be expanded.
KHW quarterly updates have been included on the workplan for the Board’s future
information.
GENERAL BUSINESS
There being no discussion the Chair accepted a motion to move into Public Excluded.
8
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
20.
Confirmation of Minutes of Board Meeting dated 27 August 2014
- Public Excluded
21.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
22.
Board Approval of Actions exceeding limits delegated by CEO (nil)
23.
Chair’s Report
- Central TAS Quarterly Report
Reports and Recommendations from Committee Chairs
24.
Finance Risk and Audit Committee – 24 September 2014 (tabled)
Moved Peter Dunkerley
Seconded Barbara Arnott
Carried
The meeting closed at 3.34pm
Signed:
Chair
Date:
9
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 29 OCTOBER 2014, IN THE TE WAIORA ROOM,
DHBADMINISTRATIONBUILDING, MCLEOD STREET, HASTINGS
AT 1.30 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Barbara Arnott
Heather Skipworth
Apology:
Ngahiwi Tomoana
In Attendance:
Chief Executive Officer
Members of the Executive Management Team
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Graeme Norton (Chair, HB Health Consumer Council)
Members of the public
Members of the media
Minutes
Brenda Crene
KARAKIA
Denise Eaglesome opened the meeting with a Karakia.
WELCOME
The Chair opened the meeting and welcomed those in attendance advising an apology from
Ngahiwi Tomoana as he was attending Tū Kaha 2014 (the biennial conference for Māori health
in the Central DHB Region).
DECLARATIONS OF INTEREST
No changes to the Interest Register was advised.
There were no interests advised in any of the items to be discussed on the days agenda.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 24 September 2014, were confirmed as a correct
record of the meeting.
Moved:
Dan Druzianic
Seconded:
Peter Dunkerley
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Item 1:
Strategic Relationships – included on workplan, remove action
November 2014
Section 1
1
Item 2:
Transport and Parking – include “Transport Strategy” on workplan in 2015 and
remove action
Item 3:
National Health Board occurring 17&18 November. Awaiting agenda to ascertain
HBDHB Board involvement. Also advice whether NHB Board Meeting can be
attended by HBDHB members?
Item 4:
HB Fallen Soldiers’ Memorial Hospital – progressing – Māori wording. This will be
followed up.
Item 5:
Length of Stay in ED – members were happy with the clarification provided.
Remove action.
Item 6:
KHW programme – noted and included in the next update. Remove action.
Item 7:
MOU NKII and HBDHB – signature obtained from DHB Chair. Ngahiwi Tomoana’s
signature would be obtained outside the meeting. Remove action.
Item 8:
Other MOU’s and Charters – this will be provided at the November meeting.
Item 9:
The Tū Mai Rā Programme Assessment will be provided at the November meeting
and has been included on the Workplan. Remove action.
Item 10: Smoking Advice clarification provided with no discussion. Remove action
Item 11: KHW - communication plan being developed. Remove action.
BOARD WORK PLAN
The Board Work Plan for November 2014:
13 and 14 November: Central Region Combined Boards Symposium (Masterton)
14 and 15 November: Napier Health Centre “Open Day”
17 and 18 November: National Health Board
19 November: Governance Strategic Planning Workshop
The programme for the Central Region Combined Board Symposium had been received.
There was some discussion around the level of activity highlighted above and other timing
commitments of members. Peter Dunkerley advised he would attend one day (13th
November) and this would be conveyed to Central TAS,
Action.
CHAIR’S REPORT
The Chair advised there were no retirements during October.
Members were advised the Chair of national chairs group, Tony Norman had resigned from
the position after two years in the role. A new chair will be selected in due course.
Ngahiwi Tomoana had attended the RGG meeting in October on the Chair’s absence and had
advised it was a good meeting.
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee, CEO provided an overview of the report of 22 October with commentary
summarised:
• As advised the prior month Dr Snee had resigned from the role of Chair of DHB CEO’s.
He noted Rob Dunham (of Lakes DHB) had been appointed to the role and would take up
his position shortly.
• Improvements in patient flow to relieve ED has shown improved performance.
• Moving the location of inpatient dialysis beds will see a medical ambulatory care centre
opened up in mid-November in the area previously occupied by the dialysis unit.
• Elective surgery appeared in reporting as below plan, however delays in coding reveal we
are running very close to plan.
2
• The Health Equity Report being presented later in the meeting was introduced by the CEO,
outlining some areas identified in the report:
- One third of our children live in poverty
- The rate of serious assaults resulting in injury in HB is twice the NZ average
- People living in areas like Camberley are three times more likely to die from an
avoidable cause of death than people who live in Havelock North
- 62% of 15-24 year old males’ drink hazardously compared to 34% nationally, with
women at 36% compared to 18% nationally. That is double the rate for both
genders compared to the rest of NZ
- The high rate of smoking amongst pregnant Māori women is a public health crisis.
- Three out of four Māori die before their 75th birthday compared to one in three
European. One in four Māori will die before their 50th birthday compared to one in
twenty European.
Recognising and identifying the issues contained in the Health Equity report will help
reduce the inequity gap but the health system alone cannot solve inequity. A multi-
sectoral group of agencies, politicians and civic leaders have been briefed on the
findings of the Health Equity Report. The next stage will be to develop an ambitious
plan and follow through with decisive action, as this must be tackled collectively and
is a community responsibility.
Denise Eaglesome agreed on the intersector approach however felt it all started with
education. Children must embrace education then health and justice will fall into place.
In the meantime HB faces a very real challenge.
• The significant turnaround is PHO targets was noted and commented on and
congratulations conveyed to Liz Stockley.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF SEPTEMBER 2014
Chief Financial Officer, Tim Evans advised a favourable variance of $168 thousand for the
third month of the financial year, with a cumulative favourable variance of $111 thousand to
the end of September.
• Noted it was encouraging that no contingency had been used to date.
• The health of older people costs referred to the prior month were seasonal in nature and
not persistent.
• Spend on the new Mental Health Unit fell behind slightly compared to higher spends in
prior months.
• Inter District Flows (IDFs) had achieved savings, however this was offset by other
outsourcing activities.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
The report on the Clinical Council meeting held on 8 October 2014 was noted and summarised
as follows by Dr John Gommans (co-Chair):
• Clinical Council champions were now aligned to individual clinical indicators assuring
intelligence input into the respective targets.
• A presentation had been well received on “Prioritisation”, setting the scene for an extended
discussion at the November meeting.
• Other matters discussed at the meeting included: Laboratory specimen labelling; and
favourable comments around the new Integrated Performance and Incentive Framework
(IPIF) for PHO reporting.
3
• There was some discussion around the replacement of the CQAC representative on
Council.
• An update was provided on the Central Region Health Safety and Quality Alliance for
which Dr John Gommans had been nominated the Regional CMO representative.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
meeting held on 9 October 2014.
Requests for Consumer Council representation continues to flow in for time and input into
various projects. The challenge remains to have the resources balanced and to build with a
suggested broad base of consumer resource to support. Seeking consumer engagement early
in projects remains part of the learning process for many.
Other areas discussed/presented included: Quality Accounts first draft; Person and Whānau
Centred Care; Consumer Council Annual Plan 2014/15; Mental Health Partnership Advisory
Group (good engagement and well received); and Advanced Care Planning.
HBL Memorandum of Understanding (MoU)
John McKeefry (GM Human Resources) provided an overview, noting the Shared Services
Council was set up by the 20 DHBs, with the intention to inform the decision making process
and provide representation and expertise across the shared service. The MoU ensures
stakeholders have a common understanding of the scope of the Shared Service Council and
HBL including deliverables, timeframes, resources and authority; and limits issues.
The Executive Management Team were in favour of the Board adopting and signing the MOU.
RECOMMENDATION
That the Board
That the Board agree to the Chair of the (Interim) Shared Services Council signing the 20
DHB Shared Services Council, Memorandum of Understanding with HBL.
Adopted
Allied Laundry Limited – Annual General Meeting
Shareholder representation at the AGM for Allied Laundry to be held 25 November was
outlined. Following some discussion agreement was reached.
RESOLUTION
That the Board:
•
Appoint Ken Foote as the HBDHB Shareholder representative to attend the Allied
Laundry Limited (Allied) Annual General Meeting (AGM) to be held on Tuesday 25
November 2013.
•
Approve the Allied Board recommendation:
“That the surplus funds of Allied Laundry Ltd for the 2013/14 year and the current
retained earnings are, due to the uncertainties around business continuity, retained by
Allied Laundry.
Moved
Andrew Blair
Seconded
Barbara Arnott
Carried
4
Report on Health Equity in Hawke’s Bay
A presentation on the key findings of the report on “Health Equity in Hawke’s Bay” was provided
by author Dr Caroline McElnay (Director of Population Health and Health Equity Champion).
The published report was tabled at the meeting.
Recognising and identifying the issues through this report will help us work to reduce the gap
but the health system alone cannot solve inequity as there are an array of determinants:
Within the report:
- 49 indicators of community health were examined
- All were avoidable
- The areas were structured by determinants of health – behaviours, healthcare and
social or economic factors
- Analysed by ethnicity
- Analysed by deprivation quintile
- Overlap between ethnicity and deprivation
Most indicators were improving.
In tackling “Health Inequity”, areas highlighted include: Smoking; Obesity; Primary care
access; Heart disease and diabetes management; Income, education and employment;
Housing; Road safety and Alcohol.
• One in three adults in Hawke’s Bay (HB) are obese.
• One in two Māori adults and two in three Pacific adults are obese
• One in every four adults in HB is a “hazardous drinker” meaning they are likely to harm
their own health or harm others through their behaviour.
• Smoking remains the biggest single cause of inequity in death rates in HB.
• High smoking rates amongst pregnant Māori women is a public health crisis.
• Social inequity is widening – more than half and over two thirds of our Māori and Pasifica
communities live in our most deprived areas.
• More Māori, more Pasifica and more people living in most deprived parts of HB are dying
at younger ages.
• Māori are twice as likely to die from an avoidable cause of death as non- Māori.
• A baby boy in HB who is Māori can expect to live eight fewer years than a baby boy who
is not Māori.
5
Dental Care: Nearly two-thirds (65%) of HB adults, 84% Māori and 83% of people living in
Quintile 5 areas, never visit a dental health worker or only visit for toothache.
Primary Care: One third of HB adults have difficulty accessing primary care when they need it
with cost being the main reason.
We grapple with dealing with things medically within the HB region when we need to deal with
it socially and economically first.
The lack of education is high. The tipping point will be changing the norm and influencing
behaviour.
Education Training and Employment: 30% of young Māori in HB (15-24 years) are not in
education; employment or training compared to 9.5% of European young people. HB is the
highest in NZ.
Health Behaviours and causes of premature death that are avoidable include (through
community focus) are: Ischaemic heart disease; lung cancer; diabetes; road traffic injuries;
breast cancer; colorectal cancer and suicide.
An example of a direct impact of a non-health issue causing a great deal of hardship is resulting
the recent change in government legislation around driving licensing rules/requirements.
Through a change of legislation making it more difficult and more expensive to get a full license.
Because of this change, hundreds of predominantly young people (in HB) are being
criminalised, highlighting the need to work together to achieve outcomes.
RECOMMENDATION
That the Board
Note the contents of the Equity Report provided and request that an action plan to address
these findings be developed and brought back to the Board by
December 2014. Action Adopted
Committee Structure and Meeting Schedule for 2015
Ken Foote (Company Secretary) provided background and sought feedback from the board on
the current structure. With agreement for the present structure to continue there was
discussion around the HB Health Sector Leadership Forums in 2015. Depending on the
structure of each Forum, a decision around the need for an outside facilitator would be
determined.
RECOMMENDATION
That the Board:
• Confirm the current governance committee structures and processes are meeting the
Board’s needs
• Approved meeting schedule provided for 2015
Adopted
GENERAL BUSINESS
There being no further 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:
16.
Confirmation of Minutes of Board Meeting dated 24 September 2014
- Public Excluded
17.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
18.
Board Approval of Actions exceeding limits delegated by CEO
19.
Chair’s Report
- Central Region Combined Boards Symposium 13 & 14 November
Reports and Recommendations from Committee Chairs
20.
Finance Risk and Audit Committee – 29 October 2014 (tabled)
21.
Hawke’s Bay Clinical Council – 8 October 2014
22.
Staff Engagement Survey
Moved Peter Dunkerley
Seconded Dan Druzianic
The meeting closed at 3.25pm
Signed:
Chair
Date:
7
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 26 NOVEMBER 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATIONBUILDING, MCLEOD STREET, HASTINGS
AT 1.00 PM
Present:
Kevin Atkinson (Chair)
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Barbara Arnott
Heather Skipworth
Apology:
Ngahiwi Tomoana
In Attendance:
Chief Executive Officer
Members of the Executive Management Team
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Graeme Norton (Chair, HB Health Consumer Council)
Members of the public
Minutes
Brenda Crene
KARAKIA
Denise Eaglesome opened the meeting with a Karakia.
DECLARATIONS OF INTEREST
Barbara Arnott advised one change to the interest register, due to her husband’s retirement.
Action. There were no interests advised in any of the items to be discussed on the day’s
agenda.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 29 October 2014, were confirmed as a correct
record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Heather Skipworth
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Items 1-5 had been actioned. Item 6 has been placed on the workplan for the December
Meeting.
BOARD WORK PLAN
The Board Work Plan for December 2014:
Tuesday 9 December:
Xmas staff BBQ breakfast from 6.30am (Zacs Courtyard)
Wednesday 17 December: 9.30am FRAC Meeting; 11.30am Worksafe NZ Presentation;
1.00pm Board Meeting; 4.30pm Christmas Function at Jarks
November 2014
Section 1
1
CHAIR’S REPORT
• HBDHB Performance for quarter July-September 2014:
First equal with 20 DHBs for cancer treatment.
Access to Elective Surgery 19th out of 20 DHBs
Shorter Stays in ED 19/20.
Increased Immunisation 4th out of 20 DHBs
Better Help for Smokers to quit 5/20.
More Heart and Diabetes checks 12/20.
• PHO’s Performance for the quarter July-September 2014:
Increased Immunisation 8th out of 36 PHOs
Better Help for Smokers to quit 9/36.
More Heart and Diabetes checks 20/36.
• A copy of a letter from the Acting National Director of the National Health Board (NHB)
sent to Tom Hemopo, Deputy Chair of the Ahuriri District Health (ADH) had been
received on 3 November 2014. The letter acknowledged negotiations had been ongoing
over the years and although close, no agreement for the provision of health services had
been reached between ADH and HBDHB. The NHB requested the funds (being held by
HBDHB to administer services in conjunction with ADH) be returned to the Ministry to
administer.
This overall result (following continue efforts) was a real disappointment to board
members, as the lack of agreement on administering health services under the WAI 692
settlement, had left many in Napier missing out on the provision of oral, community and
social health services for a number of years.
It was understood there were groups within Maori, working behind the scenes to facilitate
a solution.
• The Chair had received a summary of NZ regions population projection for the 2015/16
which feeds into ‘population based’ funding packages (PBFF) provided by the MoH. This
shows a projected positive increase in the Hawke’s Bay region’s population of 2.07%. In
part, this may well be a correction for estimations in previous years.
Board members queried whether this projected population increase was available in
demographic breakdown.
Action EMT
• A letter had been received from the Office of the Auditor-General advising the contract
for Audit NZ to complete the audit of HBDHB expired on completion of financial year
ended 30 June 2014. Arrangements need to be reviewed.
Action CFO.
• There were four retirements to be acknowledged with letters being issued from the
Chair.
Years of
Name
Job Title
Area
Service
Margaret Meikle
Kitchen Assistant
Facilities & Operational Support
12
Richard (John) Clough
Team Leader Wairoa
Oral Rural and Community
42
Jim Greenwood
Social Worker
Older Persons & Mental Health
14
Kathryn Willoughby
Enrolled Nurse
Surgical
28
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee, CEO provided an overview of the report of 19 November 2014
• Some of the key changes of
AIM 24/7 have been ongoing and Dr John Gommans
advised the structural changes are easy, the real secret is changing the Model of Care
and processes, which takes longer. Over the next two-three months there will be a
2
noticeable change. Staff are positive with many wanting changes made immediately,
however change often involves many others within the hospital.
• Victoria Speers of Health Hawke’s Bay provided an overview of
PHO performance and
the methods used to achieve targets, advising that although targets had been met it was
not sustainable from a cost perspective.
IT systems in the practices were queried? Dr Info was not that accurate. Some practices
were better than others at using the tool to support their processes.
•
Did Not Attend (DNA’s) for
First Specialist Appointment had been a significant issue for
the Hospital, however this was being dealt with holistically. With the DNA project
focusing on the issues under Champion Warrick Frater (COO), the rate at 19.1% was
significant, however this was now down to 5.9% for Maori. There were personal
approaches and this together with system changes was having a very positive effect.
• Dr Caroline McElnay, author of the
Health Equity Report had been presenting to
various forums and there was a great deal of interest with a number of conversations
occurring including outside of the health sector. No set of solutions as yet but activity
was encouraging.
A paper was expected at the December Board Meeting. It was advised this would be
from a Framework perspective to provide a direction, more than a set of actions.
The Multiagency Forum would discuss Inequity further and hopefully some solutions can
be captured and focused on.
•
Health Awards Event on Thursday 27 November has received some exceptional
submissions.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF OCTOBER 2014
Chief Financial Officer, Tim Evans advised a small favourable variance of $59 thousand for
the fourth month of the financial year, with a cumulative favourable variance of $170
thousand to the end of October.
In summary, a lot of unusual one-off issues including pressure on locum and home support
costs. Overall electives remain behind plan, more for outsourced activity to local providers
than in house, with recovery plans in place. IDFs need some analysis on coding and time
lags which is receiving some focus. Employee numbers were as planned and the Mental
Health Unit build was progressing to plan.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council (Quarterly)
The report on the Clinical Council meeting held on 12 November 2014 was noted and
summarised by the co-Chairs, led by Chris McKenna:
• A good discussion on Prioritisation leading to next year’s budget was had, with Council
seeking involvement in the process.
• Prioritisation of EOIs for Collaborative Clinical Pathways Development has been moving
along with the launch held on 12 November. This has taken longer as we are continually
learning. This is not about evidence based practice it is more about how the medical
profession work with consumers on implementation of the pathways.
• Next year Consumer and Clinical Council will come together on the Person and Whānau
Centred Care aspect (ie the “how” in the pathways process). Diabetes Pathways is work
in progress with Put Patients First being kept informed through Rachel Ritchie who is
also a member of Consumer Council.
• HB Radiology Services Committee TOR and membership were approved. Another
Committee reporting directly to HB Clinical Council.
3
• The draft Quality Accounts were reviewed and would be presented to the Board in
December for sign off.
• Te Ara Whakawaiora / Culturally Competent Workforce was also reviewed.
A query around IT issues was raised in relation to accessing radiology images.
Dr Gommans advised the DHB in-house system (Carestream) was now more stable.
Systems throughout the sector are all different and when referred back to the Hospital it has
not been possible to view and compare images. Due to concerns, Dr Gommans advised the
Steering Group had been re-engaged. Carestream advised they are currently working on
regional solutions after which they can focus on our internal issues. Clinicians are deeply
concerned about these delays.
Following the combined boards symposium in Masterton, Peter Dunkerley advised of a DHB
within the Central Region that had seen a drastic drop in their numbers through ED.
Information was to be provided. It was advised a similar turnaround had been experienced in
Northland. Dr Gommans advised the key enabler was communication with the right
information which includes ED sharing information with primary care. Care Pathways is an
enabler and presently Mid Central are training staff here in HB.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council provided an update to the Board from the
meeting held on 13 November 2014.
• An overview of Health Costs was provided by Liz Stockley (CEO of Health HB) which
included funding streams within the PHO. This assisted members understand and pose
some challenging questions around access and the cost of care.
• Consumer Council have been involved with an ever increasing number of projects and a
circle of supporters outside of Council has been actively encouraged to ease the burden.
• Feedback on improvements at Napier Health Centre have been positive. Further and
ongoing engagement with Consumer Council is being sought from the Napier Centre,
one around DNA issues they have been experiencing.
• Graeme Norton and Leigh White are now Central Region representatives on the National
Consumer Engagement Group.
• Counties Manukau requested a copy of Consumer Council’s Terms of Reference as they
are looking to /structure their Consumer Council along the lines of Hawke’s Bay.
Māori Relationship Board
Tracee TeHuia GM Maori Health spoke to the report in the absence of Ngahiwi Tomoana, for
the meeting held on 12 November 2014.
• Consumer engagement to improve health for Maori in terms of responsiveness had been
discussed at the meeting and was further discussed at EMT Day Out recently. It will
take time to work up a structure to move this forward.
• Tracee advised there were four Maori and one Pacific representative on the HB Health
Consumer Council who are very vocal and active, and confirmed that MRB were
definitely connecting in with Consumer Council representatives.
• Discussions around Health Equity and how MRB can support through driving and
engaging. MRB are planning to hold a special meeting to Workshop this topic in
December to discuss responsiveness for Maori as “what” is clear but the “how” was not
so clear.
The Board requested the following MRB recommendations be considered by EMT -
Action:
• To get a strengthened focus by the Nursing Director Māori position to provide additional
aid to the sector to resolve some of the issues around NETP and unsuccessful
candidates, and to look at whether the position FTE needs to be increased from 0.5 to 1
FTE (Chief Nursing Officer)
4
• A Patient Survey be undertaken that is adapted to gauge the effectiveness of services
being delivered to Māori patients.
• Expects concerted effort to increase the number of medical and support staff completing
cultural training by the next MRB meeting in February 2015
There was some further discussion around the Patient Survey aspect as this was a customer
service role and would take time to roll out. National survey information on-line has only a
small proportion of Maori responding. Maybe a closer working relationship between Maori
Health and Quality Improvement and Patient Safety (QIPS) should be pursued? Emails to
patients voluntarily again not achieving local responses. We are not getting good data.
Jacoby commented that MRB are talking about the whole health system and felt there were
other ways to obtain information without the use of surveys or steering groups. Te
Taiwhenua o Heretaunga has a very rich source of information that the DHB should tap into
and likely have feedback from surveys they have already undertaken.
Action
Central Region’s Technical Advisory Services (CTAS) Limited AGM
The CTAS AGM would be held on Monday 1 December. As a shareholder, the HBDHB
Board were required to formally appoint a representative with the following recommendation
agreed.
RESOLUTION
That the Board
Appoint Kevin Atkinson as the HBDHB shareholder representative to attend the TAS AGM
on 1 December 2014 and Dr Kevin Snee as his alternate.
Moved Denise Eaglesome
Seconded Peter Dunkerley
Carried
HB District Health Board Performance Framework Exceptions Q1 (July-Sept 2014)
The board noted the contents of the report with the following a summary of comments from
board members as follows:
• Referring to page 62 of the report around “shorter waits for mental health and addiction
services” noted a rising trend in waiting times for 2014. On the opposite page the MoH
CAPA (Choice and Partnership Approach) system working on motivation to accept
change and engage in therapy putting the onus on the client/Whānau to phone for an
appointment, could well be creating a barrier. It was agreed this could well be the case
and the same strategy as used for DNAs could work well here also.
The COO felt “Peer Support” may be more appropriate in this case. He would like to
raise this with the Mental Health Team and have them speak to this at the next
presentation of the Quarterly Result to the Board.
Action COO
• Denise Eaglesome asked whether there were any statistics on young Maori in Wairoa
accessing drug and alcohol services, as many seemed lost. What is accessibility for
services for Wairoa people as they really appear to be struggling in numbers?
Action
EMT
• The Chair enquired about MRI scans and was advised additional screening sessions
were being undertaken in the weekends and after hours. To improve the present service
more staff would be required. The results are not great nationally, however locally with
the AIM 24/7 project progressing well, processes were improving all the time.
5
Transform and Sustain Projects Overview
Tim Evans introduced the overview report to the Board. A question recently asked by
Consumer Council was how is this work tracking? A visual way to show this without
cluttering the report will be looked at. Overall a good report with one comment around
CRISP (now Regional IT Service) as being on track. This may be due to new management
with a revised conclusion date of December 2015.
Human Resource KPIs Q1 (July-Sept 2014)
Kate Shambler spoke to the report in John McKeefry (GM HR Services) absence:
• Highlighted sick leave at 3.03% compared to a target of 2.0%. Asked whether coding
the reason for sick leave ie for personal versus or for family member support would
assist. Members were advised that family member support makes up a very small
proportion. Hawke’s Bay did however rank well across all DHBs (2nd)
• Staff turnover was at 1.53% compared with the target of 2.5% being the 4th lowest
nationally and 3rd lowest regionally.
• Accrued Annual Leave has increased and there are multiple mechanisms in place to
rectify this. Staff can buy out leave as an option but this is not seen as desirable.
Reduced services over Christmas/new year period should assist. Nevertheless, HB
were the best performing mid-sized DHB for this target and 4th best overall.
• Occupational Health and Safety indicator showed staff related injuries was slightly above
average. Mostly minor or near misses and from serious harm perspective, very low.
• Serious Harm Injuries for an aging workforce have been static (around 20-30) for the
quarter. These have occurred for tripping more than back injuries through lifting. Chris
McKenna advised a lot of training was occurring in this area.
• Staff ethnicity covered next agenda item.
Te Ara Whakawaiora / Culturally Competent Workforce
Chris McKenna and Kate Shambler spoke to the report provided with comments
summarised:
• MRB earlier in the year had issues with having staff trained in cultural competencies. A
new facilitator has now been engaged with very active enrolments and excellent
feedback resulting with staff eager to attend.
• Increasing the rate of Maori in our workforce is behind with six months to go. The DHB
work closely with EIT, with a comment around issues with students not completing
courses. Look at closing the gap there.
• The Foundation Course at EIT was highly recommended prior to undertaking study.
• There is a gap however for nursing graduates that cannot find work in HB. Chris has an
ongoing relationship with EIT graduates.
• The Foundation Course at EIT is a very good for transitioning into first year study and
comes highly recommended not only for nursing studies but other vocations also.
Memorandums of Understanding
Tim Evans CFO summarised what had been provided in response to a Board query several
months prior. It was noted several were to be added to this list and kept live for future
reference: Those to add included: the Memorandum of Commitment with Ahuriri District
Health, Health Alliance, HBDHB/NKII MOU, EIT Bachelor of Nursing and Grey Power.
6
GENERAL BUSINESS
There being no further 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:
19.
Confirmation of Minutes of Board Meeting dated 29 October 2014
- Public Excluded
20.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
21.
Board Approval of Actions exceeding limits delegated by CEO (nil)
22.
Chair’s Report
Reports and Recommendations from Committee Chairs
23.
Finance Risk and Audit Committee – 26 November 2014 (tabled)
24.
Hawke’s Bay Clinical Council – 12 November 2014
Moved Barbara Arnott
Seconded Dan Druzianic
Carried
The meeting closed 2.50pm
Signed:
Chair
Date:
7
MINUTES OF THE BOARD MEETING
HELD ON WEDNESDAY 17 DECEMBER 2014, IN THE TE WAIORA ROOM,
DHB ADMINISTRATION BUILDING, MCLEOD STREET, HASTINGS
AT 1.15 PM
Present:
Kevin Atkinson (Chair)
Ngahiwi Tomoana
Dan Druzianic
Peter Dunkerley
Diana Kirton
Helen Francis
Andrew Blair
Jacoby Poulain
Denise Eaglesome
Barbara Arnott
Heather Skipworth
Apologies:
-
In Attendance:
Chief Executive Officer
Members of the Executive Management Team
John Gommans and Chris McKenna (Co-Chairs HB Clinical Council)
Graeme Norton (Chair, HB Health Consumer Council)
Members of the public
Minutes
Brenda Crene
KARAKIA
Ngahiwi Tomoana opened the meeting with a Karakia.
DECLARATIONS OF INTEREST
No changes to the Interest Register were advised and there were no interests advised in any
of the items to be discussed on the day’s agenda.
CONFIRMATION OF PREVIOUS MINUTES
The minutes of the Board meeting held on 26 November 2014, were confirmed as a correct
record of the meeting.
Moved:
Peter Dunkerley
Seconded:
Andrew Blair
Carried
MATTERS ARISING FROM PREVIOUS MINUTES
Actions from the previous meeting were noted and an update provided:
Items 1, 3 and 4 had been actioned with commentary summarised:
Item 2: Population Projection 2015/16: A summary of NZ regions population projection for
the 2015/16 which feeds into ‘population based’ funding packages (PBFF) had been
received from the MoH. This shows a projected positive increase in the Hawke’s Bay
region’s population of 2.07%. Board members queried whether this projected
population increase was available in demographic breakdown.
This demographic breakdown would be sought and when available would be
circulated to the Board, with a copy also sent to the Intersector Forum Group who
were also keen to receive this information.
November 2014
Section 1
1
Item 3:
Auditor General Letter: Advised this was routine business however it did not happen
last year until June. Trying to pull this forward. A letter of engagement was signed
for auditor (Audit NZ) recently by the Chair. Remove action.
Item 4: Performance Framework Q1 Report under Mental Health and Addiction Services:
The COO advised the CAPA system had been approved.
On discharge the process of community patients self-registering with the service
will continue, however in order not to take responsibility away from consumers, if
no word heard within 5 days of discharge - contact will be made.
Statistics for Wairoa - The COO advised of a number of organisations refer people
through for alcohol and drug services, with increased referrals compared to prior
year. There may well be more people affected in the community who are unknown
to services. Remove action.
BOARD WORK PLAN
The Board Work Plan for February 2015 was noted. The plan for 2015 has been prepared in
draft form.
The Gastroenterology paper which was to be considered this month was deferred until the
New Year.
CHAIR’S REPORT
There were two retirements to be acknowledged with letters being issued from the Chair.
Beverley Fullerton-Smith
Pharmacy Assistant
Pharmacy
20years service
Nicola Manning
Medical Secretary
Facilities & Operational Support
10years service
• The Minister of Health visited HBDHB on 5 December and the visit went very well. It was
pleasing to receive favourable feedback on the revised governance and advisory
committee structures which encourages active dialogue between governance,
management, clinicians and consumers.
• A letter of thanks was received from HQSC following the visit by Dr Janice Wilson CEO
and Bob Henderson (HQSC Board Member) on 26 November.
• Hawke’s Bay has achieved a high standard in Hand Hygiene performance sitting third
nationally (for Q1) at 82.9% with the average across DHBs sitting at 75.5%
• Congratulations were conveyed to the PHO for achieving all (5) targets it was noted that
three PHOs would receive additional funding for their efforts.
• Hawke’s Bay advised Central TAS of the preferred date for the Combined Board Meeting
as 16/17 July. Subsequent advice received, confirmed 17 July.
CHIEF EXECUTIVE OFFICER’S REPORT
Dr Kevin Snee, CEO provided an overview of the report of 10 December 2014, including:
• An overview of performance including changes to AAU which were assisting shorter stays
and increasing capacity within the hospital in crucial areas. It was anticipated the next
quarter would be in line with target.
• Improved access was achieving results at 92.4%
• Waiting times would be achieved end December/January.
• With the balance of indicators achieving or very close to target.
2
• At a recent Intersector Group Meeting the need for targets which were understood by the
general community were required. This work was handed to the CEOs of various
agencies, to further develop.
• From a Health Equity perspective the focus Te Ara Whakawaiora indicators for Maori
health are lifting through creative thinking and the need to make a real difference. Focus
on quality improvement is equally important.
• The Board were advised of Adri Isbister’s appointment as new Chair of Health Hawke’s
Bay Limited.
• Interviews have gone well for the senior positions advertised with appointments to be
made shortly.
FINANCIAL PERFORMANCE REPORT FOR MONTH OF NOVEMBER 2014
Chief Financial Officer, Tim Evans advised a favourable variance of $146 thousand for
November, with a cumulative favourable year to date variance of $315 thousand to the end of
November, with no contingency used.
An overview of the report was provided with particular note made around the sizeable lag time
in IDFs between an event occurring and the activity recorded in reporting. At month five the
detail of months one and two are now evident. The gap was reducing. Capital spend was also
behind for reasons explained.
REPORT AND RECOMMENDATIONS FROM COMMITTEE CHAIRS
Hawke’s Bay Clinical Council
A report was tabled for the Clinical Council meeting held on 10 December 2014 with an
overview provided by Dr John Gommans (co-Chair). In particular the following was noted:
• Progress on the development of Clinical Pathways: Following the launch to the sector in
November, we are now facing the reality to turn a “pilot” in to “business as usual” by 30
June 2015. We have learnt a lot about the “what” and now need to move into the “how”
and this will be worked through in the “Whānau and Patient Centred Care” project in 2015.
Presently Pathway approvals go through Clinical Council, with the plan for these to be
managed from 1 July 2015 through a Clinical Governance Group, reporting to Clinical
Council.
“Diabetes” was the first Pathway to be signed off.
• The relationship between Clinical and Consumer Council is very good and very robust with
the two groups planning to come together in the New Year to discuss various common
areas of interest.
• Council noted the stunning performance in the improvement of FSA DNAs area. There is
now particular interest amongst primary care members who advise they can learn a lot
from this relatively new process.
The Board were advised of Clinical Council’s support for the Quality Accounts and the Health
Equity Framework and Intersector Forum collaboration.
Hawke’s Bay Health Consumer Council
Graeme Norton, Chair of the Consumer Council tabled a report to the Board from the meeting
held on 11 December 2014.
• Whānau and Patient Centred Care: A sub-group of Clinical and Consumer Council
members will meet in January to ascertain what success looks like in Hawke’s Bay then
bring this back to a workshop between both Councils’. Graeme believes this work will
redefine relationships between clinicians, primary care and consumers.
3
• Monitoring papers received resulted in very interesting discussions, thoughts and
observations.
• Kevin Atkinson noted that we appear to be really struggling in the “Obesity” area which
ultimately impacts on the health system, if not addressed.
• The Stanford Model was explained as a structured programme that follows a ‘self-care’
methodology with the PHO funding courses and training trainers to train the public. The
second aspect will be an understanding of health literacy in primary care practices and
organisations.
• Health Literacy was raised as a good topic that could be taught in schools (through
NZCEA). Children need to learn more about health and how certain health issues can
affect their Whānau. Nice to see some initiative around intervention.
Council support for the Quality Accounts and Health Equity Framework was conveyed to the
Board.
Maori Relationship Board (MRB) Workshop held 16 December 2014
Ngahiwi Tomoana Chair provided a verbal update on the comprehensive report tabled:
•
Dr George Gray had undertaken a review of Tū Mai Rā 2011 to 2014 noting:
-
16 of the 31 indicators could not be reviewed because of data issues
-
Of the 15 indicators reviewed by Dr Gray, inequity had increased for 3 of the 15
indicators but had decreased for the balance, resulting in better outcomes for Maori.
-
Children caries free at 5 years and Oral health indicators showed increased gaps of
inequity. The Board acknowledged sincere disappointment that the Ahuriri District
Trust health funding remained sitting in the bank (through indecision) when it could
have made a huge difference in the oral health area.
With 31 indicators reviewed in Tū Mai Rā, it was acknowledged this was a high
administrative burden on HBDHB. It was acknowledged the number of indicators needed
to be reduced.
MRB were very positive and grateful for the significant health outcomes achieved in
Hawke’s Bay as a result of Tū Mai Rā. It was acknowledged the rates of inequity
decreased faster in HB than seen at a national level.
•
Achieving Health Equity in Hawke’s Bay – Solutions Framework
Acknowledging the 10 areas highlighted as priorities in the report it was pointed out
success could best be achieved through Whānau, in many areas by children relaying
various messaging to their parents (eg as has been done through the seat belt campaign
and recycling).
MRB felt significant inroads could be made by utilising the Whānau in many areas
including obesity (with learnings introduced in schools also). Iron Māori in schools would
be worthwhile considering also.
Investment in Whānau health should be explored further and used more extensively to
provide better health outcomes for communities and the DHB. It was felt there was need
for a different approach within the DHB.
The Iron Maori approach to curbing obesity is filled with positive messaging:
-
“Measure your waiora” - not your weight.
-
“We want to uplift your Mana”.
-
“What matters to you” instead of what is the matter with you?
-
Use of the word “partake” does not mean you need to be a participant.
-
Iron Maori is more than an “Event”, it is a “Journey” and is a significant vehicle for the
improvement of Māori health.
4
If KPIs are better targeted they are more likely to succeed.
The following recommendations were generally supported by the Board, but would be
considered in detail by the Executive Management Team who would report back to the
MRB and the Board:
1. One Annual Plan for the DHB that incorporates the Annual Māori Health Plan
2. Report by exception to reduce the burden of reporting
3. Continue Te Ara Whakawaiora program that focuses on areas of non-performance at
the Board and Executive levels of the DHB
4. Reduce the number of priorities within the Māori Health Annual Plan component.
5. Continue to report indicators by ethnicity ‘including the Other category’ to ensure we
understand the equity gap better
6. Identify a Whānau investment approach to good health using MRBs discussion points;
and consider additional investments into Māori Health Services for 2015-16 to enable
a navigated approach both clinically and culturally.
Pasifika Health Leadership Group (PHLG)
Barbara Arnott conveyed detail from the meeting held on 15 December, advising Victoria
Speers would attend future meetings as a representative of Health HB. It was conveyed the
group would like to feel more connected and was evident on the completion of their workplan
how very similar it was to MRB’s (even though people are a smaller portion of the population).
It was noted pacific people had the largest population growth since the prior census.
The group has now operated for over one year (meeting four times per year) and are very
hands on when it comes to making a difference.
RECOMMENDATION
That the Board
Agree to the request from the Pasifika Health Leadership Group to be provided a slot at
HBDHB board meetings twice per year (noting: the same request will be made to attend
Health HB board meetings). This attendance would be in addition to PHLG attendance at the
Leadership Forums Workshops.
Adopted
DECISION ITEM
Quality Accounts
Kate Shambler acting Director Quality Improvement and Patient Safety, spoke to the final
document presented with the guiding principles being: accountability and transparency; be
meaningful and relevant to whole of system outcomes; reflect continuous quality
improvements.
• There was a requirement for all DHBs to complete Quality Accounts annually and the
document needs to be with the MoH and HQSC by calendar year end 2014. It was noted
this document was still predominantly hospital focused and needed to be broader.
• The main audience for these accounts are the Community.
It was felt some may have difficulty with jargon (eg “intentional rounding”), complexity and
too much information.
• The document covers performance around MoH targets, national priorities and some
agreed local quality indicators. As we maintain performance against some of these
5
indicators we may drop some and include others. The document needs to be informative
and reflect continuous improvement.
• The document was endorsed by Clinical and Consumer Councils and other staff, having
gone through multiple iterations. A minor tweak on the graph on page 27 which was
missing some of the axis information, would be corrected.
• Appropriate to print from the website (if required), with no intention to produce a large
number of copies.
• The process and document will continue to evolve and success will depend on the
feedback we receive.
RECOMMENDATION
That the Board:
Endorse the Quality Accounts for the HB health sector and noted the next steps
Adopted
INFORMATION/DISCUSSION
Achieving Health Equity in Hawke’s Bay – Solutions Framework
Dr Caroline McElnay, author of the document, provided an overview of the next stage and the
analysis of issues leading to the 10 priority areas for a whole of community approach. The
emphasis is on what the issues are, not how to address them. There appeared to be nothing
new as the key drivers for health inequity have been presented before. There had been some
progress made but not at the desired pace, hence a need to do things differently as a
community.
This work was encouraged by the Intersector Group where active discussions have taken place
on “Inequity” with the CEO’s of respective organisations being tasked to look at this further and
come back with detail.
A general discussion followed with points summarised as follows:
• HBDHB are role models and have policies, we cannot forget the impact we have as an
organisation and employer.
• For the priority areas identified, several organisations were suggested that should take the
lead for Education, Employment, Road Safety and Alcohol.
It was noted that HBDHB take responsibility to report on health inequity and through
conversations, the Intersector Group need to identify themselves, their need to commit
and provide assistance in respective areas.
• All priority areas identified affect Maori. We need a different way to address these areas
with the most appropriate being the Whānau approach. Ngahiwi advised he was Chair of
the Maori Economic Group for the Government and long term sustainable growth comes
directly back to Whānau “education”.
In response a Whānau education plan from early childhood needs to be implemented into
Primary Schools where Whānau become partners with the providers by becoming
partners with schools.
MRB feel a dramatic change through a delivery model with more focused effort using
Whānau, does not necessarily mean using more money.
Action Dr Caroline McElnay: The Board look forward to regular updates factored into the
workplan (issue by issue).
6
MONITORING
Annual Māori Health Plan Q1 (July-September 2014)
Tracee Te Huia (GM Maori Health) and Shayne Walker were in attendance for this paper.
Following discuss the following actions were provided for consideration:
• It may be appropriate to include traffic lights on the A3 dashboard to assist those reviewing.
• A suggestion was made to consider whether
Tamariki Ora was promoted appropriately.
• Oral Health did need to be included in reporting, as the gap was widening.
The Board were advised that Shayne Walker (Programme Manager, Maori Health) had
resigned his position with the DHB effective Friday 19 December 2014. Shayne was thanked
sincerely for his contributions to health and was congratulated on his new role.
Te Ara Whakawaiora (TAW) First Specialist Appointment, Did Not Attend access rates
Warrick Frater (COO) as Champion of this KPI thanked Shayne Walker for his leadership, hard
work and advocacy which had been instrumental in the success of this KPI.
A key driver of TAW has been focus by the Executive Team and Board to drive change and
the achievement of positive results. The philosophy now is to do the best we can and
continuously improve in this area.
The two Kaitakawaenga’s were introduced to the Board with some very positive messages
relayed about the success of this initiative to drive change through interaction with Whānau
directly. This had resulted in feedback which has ultimately contributed to process changes
and better understanding across specialties. It was acknowledged there continue to be some
very real difficulties experienced by many in the community with health being a low priority.
Diana Kirton advised this was such a good model of engagement and may be a better way
than the CAPA system in the Mental Health/Addictions area. A follow up visit instead of a
phone call may well result in benefits longer term.
Some in primary care work through contracts specific to several targets. The next focus will be
at population level and look at vulnerable families and include social worker support through
LTAs for a more holistic approach to wellbeing.
Te Ara Whakawaiora / Access Obesity
Liz Stockley (CEO Health HB) as Champion supported by Shari Tidswell.
This was a challenging first stage to develop a strategy on obesity for action within the
region.
Are we doing all we can as an organisation by setting examples as this is a mind shift with
the following comments made:
• Sugar sweetened beverages have been removed from hospital catering and vending
areas, with alternatives for chips being looked at..
• A focus on increasing physical activity is important and a “Healthy at Work” paper will be
coming to the Board in March 2015.
• Lobbying Supermarkets (which are locally owned) to assist in the obesity area. It was
noted that TESCO in UK have new policies on obesity and the positioning of sugary
products on shelves.
• There are 5000 employed directly or indirectly in the Hawke’s Bay health sector. What
can we do to make a difference and how would that translate to the rest of the population?
• Maraes and Māori events in the community are all now smoke, alcohol, sugar and fast
food free. This has made a difference with Whānau taking a lead.
• Iron Māori is seen as the most successful phenomenon created for wellbeing. Clinicians
advise that nothing else comes close.
• The Minister of Health is very interested in addressing obesity.
7
Te Ara Whakawaiora / Access Health Literacy
Liz Stockley (CEO Health HB and member of EMT) as Champion provided an update on
PHO activity in this important area as part of Transform and Sustain.
• The Stanford Model had been explained under the Consumer Council update.
• The first meeting of the Steering Group will be held in the New Year to evaluate the Literacy
Programme before launch.
• The “Let’s PLAN” tool
(attached) had been shared with general practices which contains
questions patients would want to know about their condition or illness. This has been
provided to practices to think about in the.
• MRB had not considered this paper as yet as it is part of the Health Promotion Plan
managed through the PHO.
Te Ara Whakawaiora / Access Outreach Primary Screening
Liz Stockley as Champion supported by Victoria Speers, provided an overview of this initiative
focused on getting more people into general practices for screening and getting more services
conveniently to people who were not engaging.
• A question as to whether nurses undertaking screening in workplaces could be funded by
employers?
In response, by using this method there was a danger of duplication. Also the PHO was
not a service provider and had no intention in competing with general practice.
• General practices are rewarded for performance on the level of success.
Warrick Frater, Chief Operating Officer - Thank You
This would be Warrick Frater’s last Board Meeting in his capacity as COO, having advised of
his resignation earlier in the year.
Warrick was thanked sincerely by the Board for his contribution and passion towards the
organisation, his skills and constructive discussions over the years.
Warrick advised he came to HBDHB initially for a six month interim contract and stayed for
eight years. There had been some interesting times and learnings with the DHB in a very
different place today, saying we should be very proud of where we are at present.
The Board thanked and acknowledged Warrick’s part in the success.
GENERAL BUSINESS
There being no further discussion, the Chair accepted a motion to move into Public
Excluded.
8
RECOMMENDATION TO EXCLUDE THE PUBLIC
RESOLUTION
That the Board exclude the public from the following items:
20.
Confirmation of Minutes of Board Meeting dated 26 November 2014
- Public Excluded
21.
Matters Arising from the Minutes of Board Meeting
- Public Excluded
22.
Board Approval of Actions exceeding limits delegated by CEO (nil)
23.
Chair’s Report
Reports and Recommendations from Committee Chairs
24.
Finance Risk and Audit Committee – 17 December (tabled)
Moved Barbara Arnott
Seconded
Helen Francis
Carried
The meeting closed 3.30pm
Signed:
Chair
Date:
9
10
11
Document Outline
