This documentation includes the Taranaki DHB Annual Plan 2014/15 and

This documentation includes the
Taranaki DHB Annual Plan 2014/15
and
Te Matakite
Māori Health Plan 2014/15
1
This document presents our Annual Plan 2014/15 (referred to as the Plan). The Plan is broken into a
number of modules that can be extracted for different purposes including presentation of our
Statement of Intent 2013/2016. Central to understanding this Plan, is our performance story which
sets out our key outcomes (what we are trying to achieve), our impacts (our shorter term contribution
to an outcome), our outputs (goods and services supplied), and our inputs (resources).
This Plan should be read in conjunction with the Taranaki District Health Board Maori Health Plan and
the Midland DHB Regional Services Plan.
Published by Taranaki District Health Board
Private Bag 2016, NEW PLYMOUTH 4342
This document is available on the Taranaki District Health Board website: www.tdhb.org.nz
2
TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................................................ 3
EXECUTIVE SUMMARY ...................................................................................................................................... 7
MINISTER’S LETTER OF APPROVAL ................................................................................................................ 9
MODULE 1: INTRODUCTION AND STRATEGIC INTENTIONS ....................................................................... 14
1.1
CONTEXT ................................................................................................................................................. 14
1.2
PERFORMANCE STORY .......................................................................................................................... 15
1.3
NATIONAL OPERATING ENVIRONMENT .............................................................................................. 17
1.3.1
Treaty of Waitangi ........................................................................................................................ 17
1.3.2
Health Sector Challenges and Pressures .................................................................................. 17
1.4
REGIONAL OPERATING ENVIRONMENT .............................................................................................. 18
1.5
LOCAL OPERATING ENVIRONMENT ..................................................................................................... 18
1.5.1
Our Geography and Population ................................................................................................. 18
1.5.2
Health Profile ................................................................................................................................ 20
1.6
NATURE AND SCOPE OF FUNCTIONS ................................................................................................... 20
1.7
STRATEGIC INTENTIONS ....................................................................................................................... 21
1.7.1
Our Vision ...................................................................................................................................... 21
1.7.2
National Context ........................................................................................................................... 21
1.7.3
Regional Context........................................................................................................................... 24
1.7.4
Local Context ................................................................................................................................. 25
1.8
KEY RISKS AND OPPORTUNITIES ......................................................................................................... 26
1.8.1
Health Inequalities ....................................................................................................................... 26
1.8.2
Living Within Our Means ............................................................................................................ 27
1.8.3
Health System Workforce Shortages ........................................................................................ 27
1.8.4
System Integration ....................................................................................................................... 27
1.8.5
Regional Integration .................................................................................................................... 27
1.9
KEY MEASURES OF PERFORMANCE ..................................................................................................... 27
1.9.1
Outcome 1 – People are Supported to Take Greater Responsibility for their Health ..... 27
1.9.2
Outcome 2 - People Stay Well in Their Homes and Communities ....................................... 30
1.9.3
Outcome 3 - People Receive Timely and Appropriate Specialist Care ............................... 33
MODULE 2: DELIVERING ON PRIORITIES AND TARGETS ............................................................................ 38
2.1
HEALTH TARGETS .................................................................................................................................. 39
2.1.1
Shorter Stays in Emergency Departments ............................................................................... 39
2.1.2
Improved Access to Elective Services ....................................................................................... 41
2.1.3
Shorter Waits for Cancer Treatment / Transitioning to Faster Cancer Treatment......... 43
2.1.4
Increased Immunisation ............................................................................................................. 44
2.1.5
Better Help for Smokers to Quit ................................................................................................ 46
2.1.6
More Heart and Diabetes Checks .............................................................................................. 50
2.2
BETTER PUBLIC HEALTH SERVICES ..................................................................................................... 51
2.2.1
Reducing Rheumatic Fever ......................................................................................................... 51
2.2.2
Prime Minister’s Youth Mental Health Project ....................................................................... 52
2.2.3
Children’s Action Plan ................................................................................................................. 55
2.2.4
Whānau Ora ................................................................................................................................... 57
2.3
SYSTEM INTEGRATION .......................................................................................................................... 59
2.3.1
Long Term Conditions ................................................................................................................. 59
3
2.3.2
2.4.2
2.4.3
2.4.4
2.4.5
2.4.6
2.4.7
2.4.8
2.4.9
Stroke ............................................................................................................................................. 61
Acute Coronary Syndrome .......................................................................................................... 62
Improved Access to Diagnostics ................................................................................................ 64
Shorter Waits for Cancer Treatment/Faster Cancer Treatment ......................................... 65
Cardiac – Secondary Services ..................................................................................................... 68
Primary Care ................................................................................................................................. 69
Health of Older People ................................................................................................................ 71
Mental Health Service Development Plan ............................................................................... 74
Maternal and Child Health .......................................................................................................... 77
2.5
NATIONAL ENTITY INITIATIVES ........................................................................................................... 82
2.5.1
Our Approach ................................................................................................................................ 82
2.5.2
Linkages ......................................................................................................................................... 82
2.5.3
Action Plan ..................................................................................................................................... 82
2.6
IMPROVING QUALITY............................................................................................................................. 91
2.6.1 Our Approach ..................................................................................................................................... 91
2.6.2 Linkages .............................................................................................................................................. 92
2.6.3 Action Plan.......................................................................................................................................... 92
2.7
LIVING WITHIN OUR MEANS ................................................................................................................. 94
2.7.1 Our Approach ..................................................................................................................................... 94
2.7.2 Linkages .............................................................................................................................................. 95
2.7.3 Action Plan.......................................................................................................................................... 95
2.8
SUPPORTING DELIVERY OF REGIONAL PRIORITIES .......................................................................... 96
2.8.1 Our Approach ..................................................................................................................................... 96
2.8.2 Linkages .............................................................................................................................................. 96
2.8.3 Action Plan.......................................................................................................................................... 96
MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS ................................................................. 100
3.1
OUTPUT CLASSES .................................................................................................................................100
3.2
GUIDE TO READING THE STATEMENT OF PERFORMANCE EXPECTATIONS ................................100
3.3
PEOPLE ARE SUPPORTED TO TAKE GREATER RESPONSIBILITY FOR THEIR HEALTH ..............101
3.3.1
Fewer People Smoke..................................................................................................................101
3.3.2
Reduction in Vaccine Preventable Diseases .........................................................................102
3.3.3
Improving Health Behaviours ..................................................................................................102
3.4
PEOPLE STAY WELL IN THEIR HOMES AND COMMUNITIES ...........................................................103
3.4.1
An Improvement in Childhood Oral Health ...........................................................................103
3.4.2
Long-Term Conditions are Detected Early and Managed Well ..........................................103
3.4.3
Fewer People are admitted to Hospital for Avoidable Conditions ...................................104
3.4.4
More People Maintain their Functional Independence ......................................................105
3.5
PEOPLE RECEIVE TIMELY AND APPROPRIATE CARE ......................................................................105
3.5.1
People Receive Prompt and Appropriate Acute and Arranged Care ................................105
3.5.2
People Have Appropriate Access to Elective Services .........................................................106
3.5.3
Improved Health Status for those with Severe Mental Illness and/or Addictions ........107
3.5.4
More People With End Stage Conditions are Supported Appropriately ..........................107
3.6
SUPPORT SERVICES ..............................................................................................................................108
MODULE 4: FINANCIAL PERFORMANCE ..................................................................................................... 110
4.1
KEY POINTS FROM THE BUDGETED FINANCIALS 2014-18.............................................................111
4.2
KEY RISKS ..............................................................................................................................................112
4.2.1
Taranaki DHB’s Funder Operations .......................................................................................112
4.2.2
Taranaki DHB’s Hospital Provider Operations ....................................................................113
4.3
KEY FINANCIAL ASSUMPTIONS ..........................................................................................................114
4.3.1
Application of New Zealand Equivalents to International Financial Reporting
Standards (NZ IFRS) ....................................................................................................................................114
4
4.3.2
4.3.3
Equity and Borrowing ...............................................................................................................114
Operating Expenditure assumptions: ....................................................................................115
4.4
TDHB FUNDER – “RING FENCE PRINCIPLE” AND APPLICATION OF SURPLUS/DEFICITS ...........115
4.4.1
Mental Health Services ..............................................................................................................115
4.4.2
Interest Rates ..............................................................................................................................115
4.4.3
Asset Revaluation and its Impact ............................................................................................116
4.4.4
Depreciation ................................................................................................................................116
4.4.5
Capital Charge .............................................................................................................................116
4.4.6
Leasing..........................................................................................................................................116
4.4.7
Financial Covenants and Ratios ...............................................................................................117
4.4.8
Changes in Accounting Policies ...............................................................................................117
4.4.9
Capital Investment .....................................................................................................................117
4.4.10
Capital Divestment .....................................................................................................................118
4.4.11
Personnel .....................................................................................................................................118
4.5
CAPITAL EXPENDITURE 2014/15 (STRATEGIC) ..............................................................................119
4.5.1
Base Hospital Inpatient Facilities Development Programme ...........................................119
4.6
COST AND EFFICIENCY INITIATIVES ..................................................................................................120
4.7
DEBT AND EQUITY ...............................................................................................................................121
4.8
SENSITIVITY ANALYSIS: PLAN 2014/15 ............................................................................................122
4.9
STATEMENT OF COMPREHENSIVE INCOME ......................................................................................123
4.10
CONSOLIDATED STATEMENT OF FINANCIAL POSITION .................................................................125
4.11
CONSOLIDATED STATEMENT OF CASHFLOWS .................................................................................126
4.12
CONSOLIDATED STATEMENT OF MOVEMENT IN EQUITY ..............................................................127
MODULE 5: STEWARDSHIP.......................................................................................................................... 130
5.1
MANAGING OUR BUSINESS ..................................................................................................................130
5.1.1
Our People ...................................................................................................................................130
5.1.2
Organisational Performance Management ...........................................................................130
5.1.3
Funding and Financial Management ......................................................................................131
5.1.4
National Health Sector Agencies .............................................................................................132
5.1.5
Risk Management .......................................................................................................................132
5.1.6
Performance and Management of Assets...............................................................................132
5.1.7
Shared Decision-making ...........................................................................................................133
5.2
BUILDING CAPABILITY ........................................................................................................................134
5.2.1
HealthShare Limited ..................................................................................................................134
5.2.2
Information Communications Technology ............................................................................136
5.2.3
Integrated Contracting ..............................................................................................................136
5.2.4
Capital and Infrastructure Development ...............................................................................136
5.2.5
Collaboration ..............................................................................................................................137
5.2.6
Long Term Demand Forecasting .............................................................................................138
5.3
WORKFORCE .........................................................................................................................................139
5.3.1 Managing Our Workforce within Fiscal Restraints ...................................................................139
5.3.2 Strengthening Our Workforce .......................................................................................................139
5.3.3 Safe and Competent Workforce .....................................................................................................141
5.3.4 Child Protection Policies .................................................................................................................142
5.3.5 Children’s Worker Safety Checking ...............................................................................................142
5.4
ORGANISATIONAL HEALTH .................................................................................................................143
5.4.2
Providing Health and Disability Services ..............................................................................143
5.4.3
Planning and Funding Health and Disability Services ........................................................144
5.5
REPORTING AND CONSULTATION......................................................................................................145
5.5.1
Consultation with the Minister and the Ministry of Health ................................................145
5.5.2
External Reporting .....................................................................................................................146
5
MODULE 6: SERVICE CONFIGURATION ...................................................................................................... 148
6.1
SERVICE COVERAGE .............................................................................................................................148
6.2
SERVICE CHANGE ..................................................................................................................................148
6.3
SERVICE ISSUES ....................................................................................................................................148
MODULE 7: NON-FINANCIAL PERFORMANCE MEASURES ........................................................................ 152
MODULE 8: APPENDICES.............................................................................................................................. 158
8.1
GLOSSARY OF TERMS ...........................................................................................................................158
8.2
OUTPUT CLASS DEFINITIONS .............................................................................................................162
8.3
OUTPUT CLASS REVENUE AND EXPENDITURE .................................................................................168
8.4
OUTPUT MEASURE RATIONALE .........................................................................................................169
6
EXECUTIVE SUMMARY
The Taranaki District Health Board is ready to meet the significant challenges of 2014/15 onwards.
We remain focused upon improving performance, meeting national health targets, living within our
means and ensuring access to high quality services for the people of Taranaki.
Our plans and activities for 2014/15 concentrate on supporting service integration and achieving
greater efficiency across all health care providers. Planning involves using a range of information,
(demographic, long-term demand projections and epidemiological information) to help us determine
the needs of our population over the three years and beyond, and to inform the planning and
development of the services that will best meet those needs.
DHBs rely heavily on census data to support the planning function, and so the timing of the release of
this data (mid April 2014) has impacted on some of the information contained in this planning
document and our ability to show the most up to date data at this point in time.
A driving priority for Taranaki DHB is the health of Maori. We must improve health outcomes and
reduce disparity by addressing priority needs first.
We will continue to advance service integration between the services delivered by the DHB and services
delivered by our key primary care partners the Te Kawau Maro Strategic Alliance and the Midland
Health Network. Our PHO partners have jointly developed and agreed with all the relevant sections of
this plan as it relates to their service delivery.
The health environment is constantly changing. New technologies, changes in models of care, work
practices, clinical practice, a changing demographic (particularly an ageing population) and increases in
demand and community expectations require our health care system to be both adaptable and
responsive.
If we are to respond to change there will need to be developments in the way we support new models
of service delivery, including information systems, embedding the benefits of recent facility redesign,
and workforce capacity. Underpinning change these must always be a commitment to provision of
quality in health care delivery, and of course to sustainability. To this end we support the New Zealand
Triple Aim:
A greater emphasis on care in the community will see more support for those with long term
conditions, a greater emphasis on self-care, primary options to deliver short term acute care in the
community, and better use of our valued health professionals who work within the community.
7
Already a new community pharmacy model has capitalised on the clinical expertise of our pharmacists
in the area of medicines adherence for those with long term conditions.
This Annual Plan is supported by a Maori Health Plan, in line with Te Kawau Maro (Taranaki Maori
Health Strategy), developed together with the Maori Health Sector and Te Whare Punanga Korero, our
Iwi relationship board. The Plan has been informed by the 2012 Whānau Ora Health Needs Assessment
on Maori living in Taranaki. It sets challenging and practical steps to be taken in the years ahead to
improve the health status of Taranaki Maori.
All of this work will be done sensitively, with the benefit of working together with others as we treat
people with trust, respect and compassion – as we continue to strive for Taranaki Together, a Healthy
Community – Taranaki Whanui He Rohe Oranga.
8
MINISTER’S LETTER OF APPROVAL
9
10
11
12
13
MODULE 1: INTRODUCTION AND STRATEGIC INTENTIONS
1.1
CONTEXT
Taranaki DHB was established on 1 January 2001 by the New Zealand Public Health and Disability Act
2000 (NZPHD) and is one of 20 DHBs in New Zealand. DHBs were established as vehicles for the public
funding and provision of personal health services, public health services and disability support services
for a geographically defined population. Each DHB is a Crown Entity and is accountable to the Minister
of Health.
This Plan sets out the activities we will undertake in terms of national, regional and local priorities. It
describes to Parliament and to the New Zealand public what we intend to achieve in 2014/15, to
improve the health of the Taranaki DHB population and to reduce or eliminate health inequalities.
We are part of the Midland DHB region, and have worked together to improve regional consistency
across our plans. This collaboration is reflected throughout this Plan.
We receive funding from Government to undertake our role. The amount of funding is determined by
the size of our population, as well as the population’s age, gender, ethnicity and socio-economic status
characteristics. We are both a funder and provider of health services. In 2014/15 the Funder has a
planned expenditure of $309,753,347 in order to pay for services to improve the health of our
community. This includes most personal health (services to improve the health of individuals), mental
health and addictions, Maori health and health of older people services for the Taranaki DHB
population.
The Hospital and Specialist Services, our Provider division (which includes Governance costs), will
receive approximately $161,686,344 (52.2%) of this funding with $111,523,999 (36.0%) being utilised to
fund services including those provided by non-government organisations (NGOs), primary care,
pharmacy and laboratories. The remaining $36,518,532 (11.8%) is allocated to fund services that are
provided by other DHBs on behalf of Taranaki (inter-District Flows).
The Ministry of Health and National Health Board also have a role in the planning and funding of some
services. Some services are funded and contracted nationally, for example public health services,
breast and cervical screening as well as the provision of disability support services for people aged less
than 65 years.
We are socially responsible and uphold the ethical and quality standards commonly expected of
providers of services and public sector organisations. We are responsible for monitoring and evaluating
service delivery, including audits of the services we fund.
The costs of providing services to people living outside of our district are met by the DHB of the patient
and are referred to as ‘inter-district’ services or Inter-District Flows (IDFs). Likewise, where we do not
provide the service, we have funding arrangements in place enabling our district residents to travel
outside the district. We also deliver against service delivery contracts with external funders, such as the
Accident Compensation Commission (ACC). We closely monitor IDFs and ACC volumes to ensure our
ability to provide for our own population is not adversely affected by demand from outside the district.
In order to achieve the planned outputs, impacts and outcomes as outlined in this Annual Plan, we may,
pursuant to section 25 of the New Zealand Public Health and Disability Act 2000, negotiate and enter
into, or vary any current agreement for the provision or procurement of any health and disability
support service. These agreements (or variations) may contain any terms or conditions acceptable to
the DHB.
14
1.2
PERFORMANCE STORY
The diagrams presented on the following pages provide a high level summary of our performance story
and demonstrate the link between our outcomes and our stewardship areas. The right hand column of
the diagram indicates the relevant module of this Plan for further details.
The outputs section of the service performance diagram contains examples of measures contained in
Module Three.
Diagram: Our Performance Story
All New Zealanders lead longer, healthier and
more independent lives
The health system is cost effective and supports a
productive economy
Module 1
Overarching Health &
Health Sector Disability
Goals
System
Outcomes
National Performance Story
Better, Sooner, More Convenient Health Services for all New Zealanders
Regional
Midland
Strategic
Outcomes
Objectives
All residents of Midland District Health Boards lead longer, healthier and more independent lives
To improve the health of our population
To build the
workforce
Systems integration
across the
continuum of care
Module 1
Midland
Vision
Midland DHBs’ Regional Performance Story
To reduce or eliminate health inequalities
To improve
quality access
across agreed
regional services
To improve
clinical
information
systems
To improve Maori health
outcomes
By focusing on these objectives we will be able to drive change that enables us to live within our means
15
Our
Outcomes
To improve the health of our population
Health Targets
To reduce or eliminate health inequalities
Maori Health/Disparities
greater responsibility for their
Health of Older
People
Primary Health
People stay well in their homes
People receive timely and
and communities
appropriate care
health


An improvement in
Intermediate Impacts
Fewer people smoke

Reduction in vaccine
preventable diseases

Improving health

arranged care

detected early and
managed well

behaviours
People have appropriate
access to elective services

Improved health status for
Fewer people are
people with a severe
admitted to hospital for
mental health illness
avoidable conditions

More people maintain their
and/or addiction

functional independence
More people with endstage conditions are
appropriately supported


are seen by a health
dental services

practitioner in public
hospitals are offered brief
enrolled with a PHO

Percentage of rest home
advice and support to quit
residents receiving vitamin
smoking
D supplement from their
Percentage of eight
GP
months olds who will have

Percentage of population

Percentage of older
their primary course of
people receiving long-term
immunisation on time
home support who have
Number of people referred
had a comprehensive
to the Green Prescription
clinical assessment and a
programmes
completed care plan in the

Acute re-admission rate

Elective and arranged day
surgery rate

Improving the percentage
of long-term clients with up
Module 2

Percentage of children (04) enrolled in DHB funded
Percentage of hospitalised
patients who smoke and
Outputs
Long-term conditions are
People receive prompt
and appropriate acute and
childhood oral health

Wellness/Chronic
Conditions
Module 1
People are supported to take
Long Term
Impacts
Our
Strategic
Priorities
Vision: Taranaki Together, a healthy Community – Taranaki Whanui He Rohe Oranga
Mission: Improving Promoting, Protecting and caring for the health and wellbeing of the people of Taranaki
Module 1
Our Vision
and Mission
Taranaki DHBs Performance Story
to date relapse
prevention/treatment plans
last 12 months
16
Output
Classes
Intensive treatment and
Rehabilitation and support
Services
management services
assessment
services
Workforce
1.3
Performance
Management
Collaboration/Partnerships
Information
Module 5
Stewardship
Early detection and
Module 3
Prevention
NATIONAL OPERATING ENVIRONMENT
The Minister of Health with Cabinet and the Government develops policy for the health and disability
sector. The Minister is supported by the Ministry of Health and its business units, advised by the
Ministry, the National Health Board, Health Workforce New Zealand, the National Health Committee
and other Ministerial Advisory Committees. Accident services are funded by the Accident
Compensation Corporation (ACC). Health and Disability Services in New Zealand are delivered by a
complex network of organisations and people. Each has their role in working with others across the
system to achieve better, sooner, more convenient services for all New Zealanders. The network of
organisations is linked through a series of funding and accountability arrangements to ensure
performance and service delivery across the health and disability system.
1.3.1 Treaty of Waitangi
The Treaty of Waitangi (Te Tiriti o Waitangi) is New Zealand’s founding constitutional document and is
often referred to in overarching strategies and plans throughout all sectors. Taranaki DHB values the
importance of the Treaty. Central to the Treaty relationship and implementation of Treaty principles is
a shared understanding that health is a ‘taonga’ (treasure).
1.3.2 Health Sector Challenges and Pressures
Major, long-term systematic pressures are shaping the way health services will be delivered in the
future. These pressures not only impact on New Zealand, but on a majority of health systems across
the world, with:







A changing population – urban growth, rural decline, increasing diversity, an ageing population
and evolving family structure
An increasing burden of chronic conditions
A reducing rate of funding growth
Substantial inequalities in health status persisting
Workforce shortages are worsening
Multiple new technologies being developed
Public expectations rising
17
1.4
REGIONAL OPERATING ENVIRONMENT
Taranaki DHB is one of five DHBs that make up the Midland Region. In 2014/15 all five Midland DHBs
will continue to progress activities towards regional cooperation in a planned manner. Our region has
worked together to develop a Midland DHB Regional Services Plan (RSP) which is available from:
www.healthshare.health.nz
By actively participating in planning across the Midland DHB Region, we will:




1.5
Reduce duplication of effort
Enable the Midland DHBs to collectively develop more sustainable solutions
Identify efficiencies
Ensure that specialist skills, services and input remain available at a local level
LOCAL OPERATING ENVIRONMENT
We are responsible for the provision (or funding the provision) of the majority of health services in our
district. These services in our district include:









1.5.1
Two hospital sites
One mental health inpatient facility
Five community bases
Six community mental health residential facilities
29 aged related residential care facilities (rest homes)
25 pharmacies
36 GP practices
One preferred Maori provider
Two primary health organisations
Our Geography and Population
Our DHB serves a population of 109,608 (from the 2013 Census) and covers a geographic area of
723,610 hectares. It stretches from Mokau River in the north to Waitotara River in the south.
Our district takes in the major population centres of New Plymouth and Hawera. A detailed breakdown
of our population is presented in the following table 1.
Ethnic group (grouped total responses) 1 Taranaki Region usually
resident population count- 2013 Census
European
Māori
Pacific Peoples
Asian
Middle Eastern/Latin American/African 2
Other Ethnicity 3
89,802
18,150
1,701
3,594
447
2,112
86.2%
17.4%
1.6%
3.5%
0.4%
2.0%
Source: Statistics New Zealand
1 Includes all people who stated each ethnic group, whether as their only ethnic group or as one of several. Where a person reported more
than one ethnic group, they were counted in each applicable group.
2 Middle Eastern, Latin American, and African was introduced as a new category for the 2006
Census.
3 Previously Middle Eastern, Latin American, and African responses were allocated to the 'other
ethnicity' category.
18
Table: Taranaki DHB population by age and ethnicity – 2013 Census
Age Group
Ethnicity
Maori
Other
Total
00 – 24
9,450
26,610
36,060
25 – 44
4,422
22,167
26,589
45 – 64
3,273
25,878
29,151
65 – 74
672
8,925
9,597
75+
333
7,872
8,205
18,150
91,458
109,608
Total
Taranaki DHB Map
19
A large proportion of our population live outside the main urban areas. Our large rural population
presents diverse challenges in service delivery and ensuring access to health services.
The two main population centres are New Plymouth and Hawera. There are a large number of more
rural towns and settlements including Urenui, Waitara, Inglewood, Stratford, Eltham, Opunake, Manaia,
Patea and Waverley. Taranaki District Health Board areas reach from Mokau in the north to Waitotara
in the south. The geographic boundaries of Taranaki District Health Board cover the council areas of
Taranaki Regional Council, New Plymouth District Council, Stratford District Council and South Taranaki
District Council.
1.5.2 Health Profile
Understanding our health profile plays an important part in our decision making processes. This
information helps us focus on where we can make the greatest gains in terms of our strategic
outcomes, as well as for planning and prioritisation of programmes at an operational level. Key points
of interest in terms of the health profile of the population are:

Around 60% of Taranaki population live in NZDEP2006 Decile 6, 7, and 8 compared to 30%
nationally.
Non-Maori are over-represented in the wealthiest socio-economic deciles and
Maori are over-represented in the lowest socio-economic deciles.

Within Taranaki, 28% of Maori live in the most deprived 20% of areas compared to 10% of nonMaori. In contrast, 4.2 % of Maori live in 20% of the most affluent areas compared to 12.2% of
non-Maori.

Maori in Taranaki experience a shorter life expectancy than non-Maori. Based on the 2011/12
HNA1, Maori females have a life expectancy of 75.5 years compared to 82.5 years for nonMaori, a difference of 6.9 years.

Based on the 2011/12 HNA Maori males have a life expectancy of 72.4 years compared to 79.0
years for non-Maori, a difference of 6.6 years. This difference is less than that for the general
New Zealand population at 7.7 years for females and 7.9 years for males.

The leading causes of avoidable mortality in Taranaki DHB for non-Maori are ischaemic heart
disease, cerebro-vascular disease and chronic obstructive pulmonary disease (COPD) and lung
cancer. For Maori in the Taranaki District, the leading causes of avoidable mortality are
ischaemic heart disease, lung cancer, diabetes and chronic obstructive pulmonary disease
(COPD).
In 2011/12 Taranaki DHB completed a Whānau Ora Health Needs Assessment on the Maori Population
in the Taranaki Areas. The following areas were identified as priorities in terms of protective and risk
factors and preventative care: smoking, alcohol and drug issues, breastfeeding, immunisation, breast
screening and cervical screening. Priority health conditions identified were; diabetes, cardiovascular
disease, lung cancer, breast cancer, respiratory disease (i.e. COPD and asthma), oral health, mental
health and disability.
1.6
NATURE AND SCOPE OF FUNCTIONS
As a DHB we will:
 Plan in partnership with key stakeholders, the strategic direction for health and disability
services
 Plan regional and national work in collaboration with the National Health Board and other DHBs
1
Taranaki DHB’s Whānau Ora Health Needs Assessment† (Ratima and Jenkins, 2012)
20



Fund the provision of the majority of the public health and disability services in our district,
through the agreements we have with providers
Provide hospital and specialist services primarily for our population and also for people referred
from other DHBs
Promote, protect and improve our population’s health and wellbeing through health
promotion, health protection, health education and the provision of evidence-based public
health initiatives
1.7
STRATEGIC INTENTIONS
1.7.1
Our Vision
Our Shared Vision - Te Matakite
Taranaki Together, A Healthy Community
Taranaki Whanui He Rohe Oranga
Our Mission – Te Kaupapa
Improving, promoting, protecting and caring for the health and wellbeing of the people of Taranaki
Our Aims
 To promote healthy lifestyles and self-responsibility
 To have the people and infrastructure to meet changing health needs
 To have people as healthy as they can be through promotion, prevention, early intervention
and rehabilitation
 To have services that are people-centred and accessible where the health sector works as one
 To have a multi-agency approach to health
 To improve the health of Maori and groups with poor health status
 To lead and support the health and disability sector and provide stability throughout change
 To make the best use of the resources available
Our Values
How We Work Together With Others – Ngā Tikanga
The actions and behaviours described below are how we aim to contribute to all our relationships
including those with our patients, clients, Whānau, funded agencies, staff and members of the public.
Therefore, we will work together by:
 Treating people with trust, respect and compassion
 Communicating openly, honestly and acting with integrity
 Enabling professional and organisational standards to be met
 Supporting achievement and acknowledging successes
 Creating healthy and safe environments
 Welcoming new ideas
1.7.2 National Context
There are two identified health system outcomes for New Zealand2 as detailed in our performance
story diagram. Further detail relating to these outcomes can be found in the Ministry of Health
Statement of Intent 2013 to 2016.
The outcomes are:
1. New Zealanders live longer, healthier, more independent lives
2. The health system is cost effective and supports a productive economy
2
Sourced from: Statement of Intent 2013 to 2016 – Ministry of Health
21
The Ministry of Health and DHBs are charged with giving effect to the overarching goal for the health
sector of Better, Sooner, More Convenient Health Services for all New Zealanders.
1.7.2.1 Minister’s Letter of Expectations
The Minister of Health has outlined his expectations for the 2014/15 year, which enables us to plan and
prioritise activity for the year. The expectations reinforce the Government’s commitment to a public
health system that delivers better, sooner, more convenient health services to all New Zealanders
within constrained funding increases.
The areas of priority focus are:
Better Public Services: Results for New Zealanders
Of the Prime Minister’s 10 whole-of-government key result areas, DHBs are expected to actively engage
and invest in increased infant immunisation, reduced incidence of rheumatic fever, and reduced
assaults on children.
National Health Targets
We acknowledge the national health targets have proven very successful at driving major
improvements for patients: more elective surgery, faster access to emergency and cancer care, and
better prevention. How we will continue to achieve national health targets is a focus in this Annual
Plan.
The Minister expects that we will undertake particular work to achieve the three preventive targets,
demonstrating appropriate performance management arrangements for PHOs.
We will help patients by meeting our objectives of shorter waiting times for surgery, diagnostics,
cardiac and cancer care as per the Minister’s expectations.
Care Closer to Home
Taranaki DHB will focus on clinical integration – providing joined-up care across primary and secondary
services to ensure patients get their care sooner and closer to home.
We will continue to focus strongly on service integration across the health system, primary care direct
referral for diagnostics, clinical pathways (Map of Medicine) and will look at ways to promote the
sharing of patient controlled health records.
Health of Older People
Our DHB will continue working with primary and community care to deliver integrated services for
older people to support their continued safe, independent living at home. Avoiding a hospital admission
and care after a hospital discharge are key focus areas.
Regional and National Collaboration
Progress will continue to implement Regional Service Plans including workforce, IT and capital
objectives. We acknowledge and support the implementation of the key Health Benefits Ltd savings
programmes. Further gains in quality, efficiency and cost control will also come from our work with
Pharmac, Health Workforce NZ and the Health Quality and Safety Commission. Strong clinical
leadership and engagement is important and remains essential.
Living within Our Means
The Minister expects that to support New Zealand’s recovery, Taranaki DHB must keep to budget. We
must have detailed and effective plans to improve financial performance year on year. Equity and
capital remain constrained. As agents of the Crown Taranaki DHB supported by its Board must have in
place the appropriate clinical and executive leadership to deliver on the Government’s objectives. Our
Board will monitor and hold our CE accountable against these expectations.
22
1.7.2.2 Nation-Wide Health Targets
Improving performance across the sector is fundamental to the goal of Better, Sooner, More
Convenient Health Services for all New Zealanders. One of the mechanisms used to monitor our
performance is the nation-wide health targets. The following table outlines our target levels for each of
the six health targets.
Table: Taranaki DHB Health Targets 2014/15
Health Target
Long Term Target
Taranaki DHB Target
95 per cent of patients will be admitted, discharged,
or transferred from an Emergency Department (ED)
within six hours.
95 per cent
The volume of elective surgery will be increased
nationally by at least 4,000 discharges per year.
4,369 total elective surgical
All patients ready for treatment, wait less than four
weeks for radiotherapy or chemotherapy.
100 per cent
discharges
The 62-day Faster Cancer Treatment (FCT) indicator
will become the next cancer Health target during
2014/15.
85 percent of patients referred with a high suspicion
of cancer wait 62 days or less to receive their first
treatment (or other management) to be achieved by
July 2016)
95 per cent of eight months olds will have their
primary course of immunisation (six weeks, three
months and five months immunisation events) on
time.
Total
95 per cent
95 per cent of patients who smoke and are seen by a
health practitioner in public hospitals and
Total
95 per cent
90 per cent of enrolled patients who smoke and are
seen by a health practitioner in primary care are
offered brief advice and support to quit smoking.
Total
90 per cent
Total
90 per cent
Within the target a specialised identified group will
include: Progress towards 90 percent of pregnant
women who identify as smokers at the time of
confirmation of pregnancy in general practice or
booking with Lead Maternity Carer are offered advice
and support to quit.
90 percent of the eligible population will have had
their cardiovascular risk assessed in the last five years.
23
1.7.2.3 Better Public Services (including Social Sector Trials)
New Zealand's State Sector, (which includes DHBs), faces increasing expectations for better public
services in the context of prolonged financial constraints compounded by the global financial crisis. The
key to doing more with less lies in productivity, innovation, and increased agility to provide services.
Agencies need to change, develop new business models, work more closely with others and harness
new technologies in order to meet emerging challenges.
The area that health is taking a major role in is the results around supporting vulnerable children3,
which are:
Result 2:
Result 3:
Result 4:
Increase participation in early childhood education
Increase infant immunisation rates and reduce the incidence of rheumatic fever
Reduce the number of assaults on children
The Social Sector Trials (SSTs) involve Education, Health, Justice and Social Development, and the New
Zealand Police working together to change the way that social services are delivered4. They test what
happens when a local organisation or individual directs cross-agency resources, as well as local
organisations and government agencies to deliver collaborative social services. There is one SST in our
district in South Taranaki.
The Social Sector Trial in South Taranaki covers five distinct community areas, Hawera, Patea, Manaia,
Eltham and Opunake all with quite different needs. Health, Justice, Ministry of Social Development,
Education and Police are collectively working together in the region to:
 Reduce offending
 Reduce truancy
 Reduce young people’s use of alcohol and other drugs
 Increase the number of young people in education, training and employment; and
 Support co-ordination and collaboration and community.
Taranaki DHB will continue to offer workforce development and training opportunities to our agency
partner’s which provides consistency in tools being used in the community. Health is also working
closely with the schools in South Taranaki and in 2014/15 in schools we will provide additional clinical
psychology support and Alcohol and Drug group work and one on one intervention. Health will also be
an active part of the truancy forums and actively working with the five communities and iwi be more
responsive to specific needs of the distinct communities.
1.7.2.4 Non-financial Monitoring Framework
Another mechanism used to monitor performance is the DHB non-financial monitoring framework. It is
a key tool to provide assurance that DHBs deliver5 in terms of the legislative requirements, and in terms
of Government priorities. A summary of the monitoring framework, including our targets (where
appropriate) has been included in Module 7 of the Annual Plan.
1.7.3 Regional Context
The Midland DHBs have produced an RSP, which describes the strategic intent for the Midland DHB
Region. The strategic outcomes and objectives for the region are outlined in our performance story
diagram (see section 1.2) and further information is provided in the Midland DHBs Regional Services
Plan 2014/15.
3
4
5
For further information please see http://www.ssc.govt.nz/bps-supporting-vulnerable-children
For further information please see http://www.msd.govt.nz/about-msd-and-our-work/work-programmes/initiatives/social-sector-trials/
“to the extent they are reasonably achievable within the funds provided” (NZPH&D Act 2000 S3(2)
24
Our DHB is committed to being an active participant in our regional planning process. This is evidenced
by both clinical and management representatives from our DHB being part of the various forums and
networks that have been established to guide RSP implementation activities as well as directly funding
regional work and positions. HealthShare6 is tasked with co-ordinating the delivery of regional planning
and implementation on behalf of the Midland DHB region.
1.7.4 Local Context
To contribute to achieving the outcomes at a national and regional level, we have identified our local
strategic intent for 2014/15. Our strategic intent represents a continuation from previous years, as the
challenges we face are not short term issues easily resolved within a 12 month period. Our local
strategic outcomes listed below align directly to the regional strategic outcomes outlined in the
Regional services Plan (RSP).
1. To improve the health of the Taranaki DHB population
2. To reduce or eliminate health inequalities
Strategic Priority
Maori Health/Disparities
Description
Improving Maori health and enabling a Whānau Ora approach to
the health and welling being of Maori living in Taranaki, are
priorities for the Taranaki DHB.
Understanding of the implications of the Whānau Ora Health
Needs Assessment was considered necessary in order to
determine the priority areas for service planning for Maori. This
in turn will lead to improved health outcomes and reduced
inequalities in health.
Meeting and maintaining Health Taranaki DHB is committed to meeting the Health Targets.
Targets
Improving our performance requires a ‘whole of system’
approach with a combination of focused attention, clinical
leadership and system integration.
Financial Performance
Ensuring delivery on agreed financial forecasts and the ability to
live within our means, while delivering national, regional and
local initiatives.
Mama Pepi Tamariki
This is a focus on all children having the best start in life.
Delivering on the Children’s Action Plan, Health Beginnings and
the Well Child Tamariki Ora Quality Improvement Framework
are a priority for Taranaki DHB. The approach involves working
closely with our agency partners, recognising the important
contribution and accountability all agencies have in improving
outcomes for all Taranaki children.
Youth
We will continue to implement the Taranaki Taiohi Health
Strategy, Prime Ministers Youth Mental Health Project
objectives and use the Social Sector Trial site as the platform to
do things differently for Taranaki Taiohi.
Health of Older Persons
We will continue working with primary and community care to
deliver integrated services for older people to support their
continued safe, independent living at home. Particularly
important are avoiding hospital admission and care after a
hospital discharge.
6
Further detail on HealthShare is presented in Section 5.2
25
We are also working with the Ministry to implement our
commitment to improving home care, stroke services and
dementia care pathways.
Mental Health
We will continue with the redesign of the Mental Health and
Addictions Services with an emphasis on achieving and aligning
to align to the objectives of the Service Development Plan,
Rising to the Challenge. The sector recognises the importance of
robust early intervention strategies to maintain wellness for
those experiencing Mental Health and Addictions issues. Service
development takes into consideration a whole of life and whole
of system approach. We also see our Primary Care partners as
important for service integration. Work in this area will focus on
Perinatal, Infant and children.
Service Integration and redesign This will involve many stakeholders working together to
of non-acute services
redesign the Taranaki Integrated Health System.
A key to this will be the collective effort of local providers and
communities, together with lessons from elsewhere developing
new ways and potentially new locations for services to be
delivered within the resources available.
The local priorities have been included in our overall performance story to ensure items important to us
that are not explicitly covered in the regional strategic intent are included within this Annual Plan.
1.8
KEY RISKS AND OPPORTUNITIES
By its nature, the health sector is complex and challenging. We have identified the following risks and
opportunities as being particularly relevant for 2014/15.
1.8.1 Health Inequalities
We are committed to reducing or eliminating the effects of health disparities through, firstly,
identifying them and, secondly, through funding and providing universal programmes which include a
focus on reducing disparities as well as specific programmes that target disparities and improve access
to services. It should be noted that long term conditions, particularly those that are exacerbated by
tobacco use, and maternal smoking (particularly in the third trimester) are significant contributors to
health disparity. A challenge for DHBs in this region is to configure health service delivery in a way that
takes account of the complex relationships between the key social determinants of health inequalities
(e.g. housing quality and employment), while recognising that a number of public and private agencies
influence health outcomes.
The approach we intend to take includes:










Implementing Te Matakite 2014/15 (our Māori Health Plan)
Promoting screening services to hard to reach groups to increase early detection of disease
Implementing services that target communities with identified health inequalities
Setting targets by ethnicity or by high needs
Supporting kaupapa Māori services where appropriate
Increasing the capability of the Māori and Pacific workforce across our district
Using an equity lens as part of decision-making processes
Engaging with our Disability Support Advisory Committee to provide advice and inform decision
making
Engaging with Iwi Governance bodies to provide advice and inform decision making
Engaging with community health forums and expert advisory groups to provide and receive
advice – this will include alliance mechanisms and Service Level Alliance Teams (ALTs)
representing community/primary/DHB perspectives.
26
1.8.2 Living Within Our Means
The ongoing pressure of the financial environment is driving a need to improve efficiency, reduce waste
and improve healthcare. This, together with the Government’s goal of returning to surplus in 2014/15
has created a strong focus on improving fiscal management.
1.8.3 Health System Workforce Shortages
Workforce shortages, particularly in rural and provincial areas, are a key threat to the health system’s
ability to provide a full range of accessible, high-quality health services.
Between 2001 and 2021 there is a projected to be a 47 percent increase in demand for registered
health professionals in New Zealand; over the same period it is anticipated that there will be a 12
percent projected increase in supply7.
We will work to strengthen the Taranaki health workforce through collaboration with:
 Health Workforce New Zealand
 Midland Regional Training Network
 Local partners, e.g. Western Institute of Technology, the Whakatipuranga Rima Rau Trust and
other Government agencies
1.8.4 System Integration
A growing commitment to the achievement of more effective system integration in partnership with
primary care and other appropriate stakeholders is fundamental to strengthening our healthcare
system. We will use clinical leadership to drive improved system integration and Better Public Services.
Evidence shows that integrating primary care with other parts of the health system is vital for better
management of long term conditions, responding to the pressure of an ageing population and in
managing acute demand. Hospital demand is growing at a rapid rate, and as more hospital admissions
occur due to preventable causes, we need to examine what could be improved in regard to how we
deliver our services.
Alliance Leadership Teams and Service Level Alliance Teams have a key role to play in the development
of the 2014/15 DHB Annual Plans for Primary Care (including Rural Health) and Youth Health.
1.8.5 Regional Integration
Integration between regional DHBs is important for both financial and clinical reasons. Clinical
Networks provide a platform from which to deliver clinically-led innovation and best practice
approaches, and these are supported by integration initiatives in other areas (pharmacy, home-based
support services, information systems and so on). The over-arching driver for such developments is
improved service quality, and ultimately better health outcomes. The Midlands DHBs have also
articulated the services and activities intended to be addressed through the Regional Services Plan
(RSP).
1.9
KEY MEASURES OF PERFORMANCE
The following outcomes and impacts described below set out what we expect to see occurring in
response to the outputs we deliver over time. Local actions in relation to our services are recorded,
along with deliverables and timing, in Module 1 (Strategic Intentions - priorities and targets), Module 3
(Statement of Performance Expectations) and Module 5 (Stewardship) of this Plan.
1.9.1 Outcome 1 – People are Supported to Take Greater Responsibility for their Health
Expectation
Population health and prevention programmes ensure people are better protected from harm, more
informed of the signs and symptoms of ill health and supported to reduce risk behaviours and modify
lifestyles in order to maintain good health. These programmes create health-promoting physical and
social environments which support people to take more responsibility for their own health and make
healthier choices.
7
Source: Trends in Service Design and New Models of Care: A Review, Ministry of Health 2010
27
Why is this outcome a priority?
New Zealand is experiencing a growing
prevalence of long-term conditions such as
diabetes and cardiovascular disease, which
are major causes of poor health and account
for a significant number of presentations in
primary care and admissions to hospital and
specialist services. We are more likely to
develop long-term conditions as we age, and
with an ageing population, the burden of
long-term conditions will increase. The
World Health Organisation (WHO) estimates
more than 70 percent of all health funding is
spent on long-term conditions.
Figure 1 - Percentage of Year 10 high school students how have indicated they
have never smoked, not even a puff in the annual ASH survey. ASH New Zealand
2013. Report for the Ministry of Health, Health Sponsorship Council and Action
on Smoking and Health: Auckland, New Zealand.
Tobacco smoking, inactivity, poor nutrition and rising obesity rates are major and common contributors
to a number of the most prevalent long-term conditions. These are avoidable risk factors, preventable
through a supportive environment, improved awareness and personal responsibility for health and
wellbeing. Supporting people to make healthy choices will enable our population to attain a higher
quality of life and to avoid, delay or reduce the impact of long-term conditions.
1.9.1.1 Fewer People Smoke
Why is this important?
Smoking is a major contributor to preventable illness and long term conditions, such as cancer,
respiratory disease, heart disease and strokes. Cancer is the leading cause of death in New Zealand
(29.8 percent), and is a major cause of hospitalisation and driver of cost. Cancer also highlights
continuing inequalities, with Maori experiencing a higher incidence (20 percent +), higher mortality and
higher stage at presentation. In some communities, a sizeable portion of household income is spent on
tobacco, resulting in less money being available for necessities such as nutrition, education and health.
Supporting our population to say “no” to tobacco smoking is our foremost opportunity to target
improvements in the health of our population and to reduce health inequalities for Maori.
Key findings from the 2009 NZ Tobacco Use Survey identify that one in five adults aged 15-64 years (21
percent) and around one in five (18 percent) youth aged 15-19 years are current smokers. While
nationally, we are seeing a decline in smoking rates, we want to reduce the incidence even further.
Notably, 80 percent of current smokers aged 15-64 years said “they would not smoke if they had their
life over again”.
How will we know we are succeeding?
In order to have the greatest impact, we will prevent people from taking up smoking in the first place
(Year 10 students), working our way through the continuum from prevention, to detection (identifying
adults who smoke and offering them cessation advice – see Health Targets), and ultimately reducing
the number of people who smoke.
Fewer People Smoke
Percentage of Year 10 Students who have never
smoked
Actual
Target
Target
Target
2013
2014
2015
2016
73.1%
>73.1%
Improve
28
1.9.1.2 Reduction in Vaccine Preventable
Diseases
Why is this important?
Immunisation can prevent a number of diseases and is
a
very
cost-effective
health
intervention.
Immunisation provides protection not only for
individuals, but for the whole population by reducing
the incidence of diseases and preventing them from
spreading to vulnerable people or population groups.
Population benefits only arise with high immunisation
rates, and New Zealand’s current rates are low by
international standards and insufficient to prevent or
reduce the impact of preventable diseases such as
measles or pertussis (whooping cough).
These
diseases are entirely preventable. See Health Targets.
Figure 2 - 3 Year average Crude Rate per 100,000 of vaccine
preventable diseases in hospitalised 0-14 year old
How will we know we are succeeding?
We will know we have succeeded by reducing our admissions for vaccine preventable diseases.
Reduction in vaccine preventable diseases
Actual
Target
Target
Target
10/11 to
12/13
12/13 to
14/15
13/14 to
15/16
14/15 to
16/17
7.36
<7.36
3 Year average Crude Rate per 100,000 of vaccine
preventable diseases in hospitalised 0-14 year old
Decrease
1.9.1.3 Improving Health Behaviours
Why is this important?
Good nutrition is fundamental to health
and to the prevention of disease and
disability. Nutrition-related risk factors
(such as high cholesterol, high blood
pressure and obesity) jointly contribute to
two out of every five deaths in New Zealand
each year.
How will we know we are succeeding?
By seeing a reduction in obesity, a proxy
measure of successful health promotion
and engagement and a change in the social
and environmental factors that influence
people to make healthier choices.
Improving health behaviours
Figure 3 - 2011/12 New Zealand Health Survey.
Note - Obesity is defined as a body mass index (BMI) of 30 or more (calculated by
dividing a person’s weight in kilograms by the square of their height in metres).
Survey interviewers measured respondents’ height and weight, from which BMI
could be calculated.
Actual
Target
% Obese of New Zealand 5 -14 years population
11/12
10.7
2016/17
reduce rate of increase
% Obese of New Zealand 15+ years population
27.8
reduce rate of increase
29
1.9.2
Outcome 2 - People Stay Well in Their Homes and Communities
Expectation
Primary and community services support people to stay well by providing earlier intervention,
diagnostics and treatment and better managing their illness or long-term conditions. These services
assist people to detect health conditions and risk factors earlier, making treatment and interventions
easier and reducing the complications of injury and illness. They also support people to regain their
functionality after illness and to remain healthy and independent.
Why is this outcome a priority?
For most people, their general practice team is their first point of contact with health services. Primary
care can deliver services sooner and closer to home and prevent disease through education, screening,
early detection and timely provision of treatment. Primary care is also vital as a point of continuity and
effective coordination across the continuum of care, particularly in improving the management of care
for people with long-term conditions.
Supporting primary care are a range of other health professionals including midwives, community
nurses, social workers, aged residential care providers, personal health providers and pharmacists.
These providers have prevention and early intervention perspectives that link people with other health
and social services and support them to stay well. Studies show countries with strong primary and
community care systems have lower rates of death from heart disease, cancer and stroke, and achieve
better health outcomes for lower cost than countries with systems that focus on specialist level care.
With an ageing population, the Midland Region will require a strong base of primary care and
community support, including residential care, respite and home-based support. If long-term conditions
are managed effectively, crises and deterioration can be reduced and health outcomes improved. Even
where returning to full health is not possible, access to responsive, needs-based services helps people
to maximise function with the least restriction and dependence.
If people are well they need fewer hospital-level or long-stay interventions and, those who do, have a
greater chance of returning to a state of good health or slowing the progression of disease. This is not
only a better health outcome for our population, but it reduces the rate of acute and unplanned
hospital admissions and frees up health resources.
1.9.2.1 Children and Adolescents Have Better Oral Health
Why is this important?
Good oral health demonstrates early contact
with health promotion and prevention services
and reduced risk factors, such as poor diet,
which has lasting benefits in terms of
improved nutrition and healthier body
weights. Oral health is also an integral
component of lifelong health and impacts a
person’s comfort in eating (and ability to
maintain good nutrition in old age), selfesteem and quality of life.
Maori children are three times more likely to
have decayed, missing or filled teeth, and
improved oral health is a proxy measure of
equity of access and the effectiveness of
mainstream services in targeting those most
in need.
Figure 4 – Diseased, Missing and Filled Teeth (DMFT) for year 8 students in
Taranaki DHB, Midland Region and New Zealand. Data Source PLANNING
FOR 2013/14 DISTRICT HEALTH BOARDS' ORAL HEALTH PERFORMANCE
MEASURES
30
How will we know we are succeeding?
With the continued decrease in the DMFT score of year 8 children. Mean Diseased, Missing or Filled
Teeth (DMFT) for permanent teeth. DMFT is a count of Diseased, Missing or Filled Teeth in permanent
dentition (permanent teeth) in a person’s mouth. By Year 8, children’s teeth should be their permanent
teeth and any damage at this stage is life long, so the lower a child’s DMFT, the more likely that their
teeth will last a life time.
Children and
adolescents have better
oral health
Mean DFMT Year 8
Actual
Target
Target
Target
2012
2014
2015
2016
0.96
<0.96
reduce
1.9.2.2 Long-Term Conditions are Detected
Early and Managed Well
Why is this important?
If we are to empower people to take greater
responsibility for their health, to improve the health
of our population and if we are to “contain costs”
we have a significant opportunity by detecting
conditions early. Early detection will lead to either
successful treatment, or delaying or reducing the
need for secondary and specialist care, enabling
more people to stay well in their homes and
communities for longer. Our greatest
Figure 5 - Female Cervical Cancer mortality in New Zealand 1948
opportunity to do this is to manage
to 2010. Ministry of Health. 2013.
Cardiovascular Disease (CVD or heart disease). It
is one of the largest causes of death in New
Zealand, and disproportionately higher for Maori. Often by the time heart problems are detected, the
underlying cause of atherosclerosis (arterial disease) is usually well advanced. Our aim is to either
prevent the disease by modifying risk factors such as healthy eating, exercise and avoiding smoking, or
early detection and management. See also Health Targets.
How will we know we are succeeding?
Screening is one of the most effective methods to reduce the incidence and impact of some cancers. By
catching cancers when they are small screening programmes offer the best chance of success. Also by
increasing the proportion of people with well managed diabetes, we will reduce avoidable
complications that require hospital-level intervention, such as amputation, kidney failure and blindness,
and will improve people’s quality of life, allowing more people to stay well in their homes and
communities for longer.
Cervical Cancer mortality in New Zealand
Aged Standardised rate for NZ
Actual
Target
Target
Target
2010
2014
2015
2016
1.7
Decrease
31
1.9.2.3 Fewer People are Admitted to Hospital for Avoidable Conditions
Why is this important?
There are a number of admissions to hospital for
conditions which are seen as avoidable through
appropriate early intervention and a reduction in
risk factors. As such, these admissions provide an
indication of the effectiveness of screening, early
intervention and community-based care.
A reduction in these admissions will reflect better
management and treatment of people across the
whole system, will free up hospital resources for
more complex and urgent cases and deliver on the
Government’s priority of “better, sooner, more
convenient” healthcare.
Figure 6 – Rate of Ambulatory Sensitive Hospitalisations,
Ministry of Health, Ash summary by DHB, Q1 2014
The key factor in reducing avoidable hospital
admissions is an improved interface between
primary and secondary services.
Improving
people’s access to, and the effectiveness of, primary care will facilitate early interventions, particularly
among Maori and Pacific people, which supports improving our population’s health outcomes and
reducing health inequalities for Maori.
How will we know we are succeeding?
When we reduce the ratio of actual to expected avoidable hospital admissions for our population (Total
and Maori)?
Fewer people are admitted to hospital for
avoidable conditions
Taranaki DHB 0-74 year olds
Actual
Target
2013
2014
1,688
<1,688
Target
2015
Target
2016
decrease
1.9.2.4 People Maintain Functional Independence
Why is this important?
If we are to deliver on our twin goals of improving
health outcomes, and reducing or eliminating
health inequalities, for our older population, we
aim to support people to maintain functional
independence. With an increasing and ageing
population, as this cohort increases, so does
demand on our constrained funding. Aged
Residential Care (ARC) is a specialist, high cost,
and scarce resource. We are looking to manage
the expected growth in demand, through an
ageing population, by improved models of care
that support people to remain independent for as
long as possible.
Figure 7 – Average age at entry to residential care facilities in each of
the last 4 years for people under the Health of Older People funding
stream. Data sourced from Client Claims Processing System (CCPS).
32
How will we know we are succeeding?
Ideally, we would like to promote a model of care that reduces the proportional length of time an older
person requires ARC. As we do not currently capture this information, our best proxy indicator is to
increase the average age at which an older person enters ARC.
Average Age of Entry to Aged Related
Residential Care
Actual
Target
Target
Target
12/13
14/15
15/16
16/17
Rest Home
84.04
Increase
Dementia
82.50
Increase
Hospital
84.07
Increase
1.9.3 Outcome 3 - People Receive Timely and Appropriate Specialist Care
Expectation
Secondary-level hospital and specialist services meet people’s complex health needs, are responsive to
episodic events and support community-based care providers. By providing appropriate and timely
access to high quality complex services, people’s health outcomes and quality of life can be improved.
Why is this outcome a priority?
Clinicians, in cooperation with patients and their families, make decisions with regards to complex
treatment and care. Not all decisions result in interventions to prolong life, but may focus on patient
care such as pain management or palliative services to improve the quality of life. For those who do
need a higher level of intervention, timely access to high quality complex care improves health
outcomes by restoring functionality, slowing the progression of illness and disease and improving the
quality of life.
The timeliness and availability of complex treatment and care is crucial in supporting people to recover
from illness and/or maximise their quality of life. Shorter waiting lists and wait times are also indicative
of a well-functioning system that matches capacity with demand by managing the flow of patients
through services and reducing demand by moving the point of intervention earlier in the path of illness.
As providers of hospital and specialist services, DHBs are operating under increasing demand and
workforce pressures, and Government is concerned that patients wait too long for diagnostic tests,
cancer treatment and elective surgery. The expectations around reducing waiting times, coupled with
the current fiscal situation, mean DHBs need to develop innovative ways of treating more people and
reducing waiting times with limited resources.
This goal reflects the importance of ensuring that
hospital and specialist services are sustainable
and that the Midland Region has the capacity to
provide for the complex needs of its population
now and into the future.
1.9.3.1 People
Receive
Prompt
Appropriate Acute Care
and
Why is this important?
Long stays in Emergency Departments (EDs) are
linked to overcrowding of the ED, negative
clinical outcomes and compromised standards of
privacy and dignity for patients. Less time spent
waiting and receiving treatment in an ED
improves the health services DHBs are able to
provide.
33
The duration of stay in ED is influenced by services provided in the community to reduce inappropriate
ED presentations, the effectiveness of services provided in ED and the hospital and community services
provided following exit from ED. Reduced waiting time in ED is indicative of a coordinated ‘whole of
system’ response to the urgent needs of the population.
Figure 8 – Emergency Department Waiting times
How will we know we are succeeding?
When we see an increase in the percentage of people who visit our ED are admitted, discharged or
transferred within six hours.
Improved performance against this measure will not only improve outcomes for our population, but
will improve the public’s confidence in being able to access services when they need to.
Percentage of patients admitted, discharged or transferred
from emergency departments within 6 hours
Actual
Target
Target
Target
12/13
14/15
15/16
16/17
95%
>95%
>95%
>95%
1.9.3.2 People Have Appropriate Access to Elective Services
Why is this important?
Elective services are an important part of the
health system, as they improve a patient’s
quality of life by reducing pain or discomfort
and improving independence and wellbeing.
The Government wants more New Zealanders
to have access to elective surgical services
(see Health Targets). Improved performance
against this measure is also indicative of
improved hospital productivity to ensure the
most effective use of resources so that wait
times can be minimised and year-on-year
growth is achieved.
How will we know we are succeeding?
To meet the appropriate level of access, we
want to ensure that our Standard Intervention
Rates (SIRs) meet national expectations for
elective procedures.
Figure 9 – Ministry of Health Year Ended June 2013 Standardised Discharge
Rates per 10,000 for Publicly Funded Cardiac Surgery Discharges for
patients with 95% Confidence Intervals
Actual DHB performance (12/13)
Elective
service
standardised
intervention
rates (per
10,000)
Target 14/15
Target 15/16
Target 16/17
Major joint replacement
20.2
21
Maintain
Maintain
Cataract procedures
31.4
27
Maintain
Maintain
Cardiac surgery
7.94
6.5
Maintain
Maintain
Percutaneous revascularisation
7.82
12.5
Maintain
Maintain
Coronary angiography services
45.33
34.7
Maintain
Maintain
34
1.9.3.3 Improved Access to Mental Health Services
Why is this important?
It is estimated that at any one time, 20
percent of the New Zealand population will
have a mental illness or addiction, and 3
percent are severely affected by mental
illness. With high suicide rates in some of our
communities, we are working to reduce this
rate and support our communities with
Whanau Ora initiatives (see Module 3). There
is also a high prevalence of depression with
the economic downturn and other pressures.
The World Health Organisation (WHO)
predicts that depression will be the second
leading cause of disability by 2020. We have
an ageing population, which places increased
demand from people over 65 for mental
health services appropriate to their life stage.
The prevalence of mental illness in the
population increases with age, and older
people have different patterns of mental
illness, often accompanied by loneliness,
frailty or physical illness.
Figure 10 – Data from PRIMHD showing the percentage of mental health
patient admissions who are readmitted to hospital within 28 days of a previous
discharge
How will we know we are succeeding?
Access is the key to improving health status for people with a severe mental illness. Our goal is to build
on our existing, and well established intersectoral cooperation between primary / community and
secondary services, by offering programmes to individuals and groups from a broad range of ages –
children and youth, adults and older people.
If we improve access, and providing we provide services to people at the right time, and in the right
place, and can expect to see a reduction in our 28 day readmission rate. This will, in turn, assist in
reducing pressure on our hospital services.
35
28 day acute re-admission rates
Actual
Target
Target
Target
12/13
14/15
15/16
16/17
14%
≤15 %
Decrease
1.9.3.4 More People with End-Stage Conditions are Appropriately Supported
Why is this important?
For people in our population who have end stage conditions, it is important that they, their family and
whanau are supported to cope with the situation. Our focus is on ensuring that the patient is able to
live comfortably, without undue pain or suffering. Early identification and recognition of end-of-life
choices heavily influence the quality of life an individual experiences during the dying process.
Rehabilitation and Support Services contribute to this impact. Programmes include palliative care, aged
residential care, respite care and home based support services.
How will we know we are succeeding?
Palliative care is being accessed, but we want to target those with greatest need. The Palliative Care
Council has identified inequalities of access to palliative care based on diagnosis (evidence of underutilisation by those with non-malignant conditions), with a lack of suitable service provision for children
and young people. We would like to see an increase in palliative support for this group.
The Palliative Care Council in its 2010 position statement identified a lack of data on the need for
palliative care for New Zealand and monitoring on the implementation New Zealand Palliative Care
Strategy. Over the next 12 months we hope to work towards identifying and reporting on an impact
measure.
36
37
MODULE 2: DELIVERING ON PRIORITIES AND TARGETS
This module presents the actions we are planning to deliver in 2014/15. Implementation of the actions
outlined in this plan is expected to enable us to positively contribute to local, regional and national
outcomes as well as the goal of Better, Sooner, More Convenient Health Services for all New
Zealanders. The actions and measures presented in this module show:



How we are implementing Government priorities
How we are contributing to the activities in the Midland Region Service Plan
How we plan to improve performance in terms of our local priorities
Sections of this module have been developed in collaboration with key stakeholders both internal to
the health sector and external. This helps us to ensure service planning is not done in silos. The
methods we utilise include:








An alliancing approach to service planning with our primary care partners
Active engagement of clinical leaders / champions
Working with other DHBs from the Midland region
A collaborative cross-sector approach to working with vulnerable children and their families
where information, services, resources are coordinated and shared to improve outcomes
Working with NGOs with a view to including them in alliance arrangements in the future
Utilising the expertise of community clinicians working across the service continuum with an
educative and capacity building focus
Expanding implementation of clinical pathways via Map of Medicine across the region to
promote regional clinical collaboration and consistency
Participating in the social sector trials work streams with cross agency partners
The narrative and tables in this module are clustered into the following topics:



Health Targets
- Shorter Stays in Emergency Departments
- Improved Access to Elective Surgery
- Shorter Waits for Cancer Treatment (transitioning to Faster Cancer Treatment)
- Increased Immunisation
- Better Help for Smokers to Quit
- More Heart and Diabetes Checks
Better Public Health Services (including Social Sector Trials)
- Reducing Rheumatic Fever
- Prime Minister’s Youth Mental Health Project
- Children’s Action Plan
- Whānau Ora
System Integration
- Diabetes and Long Term Conditions
- Stroke
- Acute Coronary Syndrome
- Improved Access to Diagnostics
- Faster Cancer Treatment
- Cardiac – Secondary Services
- Primary Care
- Health of Older People
- Mental Health Service Development Plan
- Maternal and Child Health
38




National Entity Priority Initiatives
Improving Quality
Actions to Support Regional Delivery of Regional Priorities
Living Within Our Means
2.1
HEALTH TARGETS
2.1.1
Shorter Stays in Emergency Departments
2.1.1.1 Our Approach
Better Sooner More Convenient Health Services for New Zealanders in relation to Emergency
Departments means all New Zealanders can easily access the best services, in a timely way to improve
overall health outcomes. A health system that functions well for people with acute care needs is one
that:
•
Delivers and coordinates acute care services in the hospital and community
•
Improves the public’s confidence in being able to access services when they need to
•
Sees less time spent waiting and receiving treatment in the ED
•
Moves patients efficiently between phase of care
•
Makes the best use of available resources
In a constrained system with limited capacity, our approach to managing patient flow becomes even
more important. If we are to continue to deliver care, we will need to ensure that our capacity is
matched to demand and the right care is delivered rapidly and responsively to reduce the risk of
Emergency Department attendance and avoidable hospital admission. Increasing Emergency
Department presentations and unplanned (acute) admissions to our hospitals consume resources and
place pressure on clinical care, diminishing the effectiveness of hospital activity.
Activities that will contribute to achieving our target include:
 Working with primary care services to reduce demand for unplanned care
 Integrated and improved long term health conditions care and management across the health
system
 An effective functioning Emergency Department
 Ensuring hospital flow, reducing gridlock and improving community based discharge services
and rehabilitation
Also the Midland Regional Trauma System is a clinical programme outlined in our RSP, as a regional
activity that links multiple services across the region with a common goal: to provide the best care
leading to the best outcomes for trauma patients and their families.
2.1.1.2




Linkages
Minister’s Letter of Expectations
Health Target – Shorter stays in Emergency Departments
Midland DHBs Regional Services Plan 2014/15
Our Performance Story Impact: People receive timely and appropriate specialist care
2.1.1.3 Action Plan
Objective
Shorter Stays
in Emergency
Departments:

Actions to Deliver Improved
Performance
Diagnostic/analysis work to
identify the main factors
impacting on ED length of stay
Measure

95% of patients will be admitted,
discharged, or transferred from an
Emergency Department within six
hours.
Reporting
Quarterly
39
Objective
Support the
education
campaign
with Midlands
Regional
Health
Network
Charitable
Trust (MHN)
to ensure only
those
who
need E.D. care
present there,
and
that
General
Practices and
others offer
care
as
appropriate
that enables
patients
to
avoid
the
need
to
attend ED.
Sustainable
Services for
Unplanned
and
Acute
Care
Actions to Deliver Improved
Performance

TDHB ED will align its quality
activities to the ED Quality
Framework
Measure



All mandatory measures will be
audited and reported as per
guidelines
Non-mandatory measures will be
included where relevant
95% of patients will be admitted,
discharged, or transferred from an
Emergency Department within six
hours.
Senior clinicians and managers
continue working in partnership
to enhance pathways through
the ED

Whole of organisation focus,
with demonstrable support from
senior managers and clinicians.
ED Quality framework is utilised
to monitor and support ED
activity
Key activities include:
 Ongoing diagnostic/analysis of
patients with extended length of
stay
to
ensure
service
development continues.
 Work collaboratively with MHN
to develop across sector
processes to manage growth in
the ED
 Focus
on
non-urgent
ED
presentations including analysis
of why patients are attending the
ED for non-emergency reasons
 Embed the ED CNS service at
Taranaki Base Hospital and
Hawera Hospital
 Appropriate resources placed on
the most significant bottlenecks
and constraints identified in the
diagnostic analysis work
 Actions spanning the whole
system – pre ED, within the ED,
and post-ED
 Whole of organisation focus,
with demonstrable support from
senior managers and clinicians
 Funding has been allocated to
enhance access to GP service for
under sixes after hours

Quality measures established and
reported against as per the ED
Quality Framework

Reduced rate of admissions

Number of patients seen and
discharged by ED CNS Service –
create baseline




PHOs to report annual utilisation
of services provided to under sixes
after
hours
to
measure
effectiveness in reducing demand
for ED services
Implemented by 1 December 2014
Quarterly Reports showing a
reduction in Primary Health Care
ED presentations in both Hawera
and New Plymouth

Midlands Health Network and
the Taranaki DHB will implement
a programme to manage
overflow at ED across Taranaki.
This will include implementation
of Primary Options in Taranaki
Reporting
Quarterly
Performance
against the
health
target
Quarterly
Performance
against the
health
target
Quarterly
reporting re
progress on
specific
actions
Quarterly
Quarterly
40
2.1.2 Improved Access to Elective Services
Better Sooner More Convenient Health Services in relation to electives means improved and timelier
access to elective services for our population. There is an increasing demand for elective services. It is
important for wellbeing of our population that we meet as much of this elective demand as possible,
ensure our population receives equitable access to services and minimises the demand for unplanned
(acute) care.
2.1.2.1 Our Approach
Managing patient length of stay is important to sustaining our elective service in terms of capacity. It is
also important for good patient health outcomes; high length of stay is a quality issue and usually linked
to high surgical infection rates. Reducing length of stay is critical to providing an efficient optimal use of
our health budget.
We are working regionally with other Midland DHBs and moving towards greater integration of each
DHBs elective services. Purchasing appropriate regional volumes will allow sustainable service
improvement. Service improvement will be supported by regional referral pathways, clinical networks
and consistently applied access criteria.
2.1.2.2




Linkages
Minister’s Letter of Expectation
Health Target – Improved Access to Elective Services
Midland DHBs Regional Services Plan 2014/15
Our Performance Story Impact: People receive timely and appropriate specialist care
2.1.2.3 Action Plan
Objective
Improved
Access
Elective
Surgery

to



Actions to Deliver Improved
Performance
Delivery against TDHB agreed
volume schedule, including
elective surgical discharges, to
deliver the Electives Health
Target
Electives funding will be
allocated to support increased
levels of elective surgery,
specialist
assessment,
diagnostics, and alternative
models of care
Standardised intervention rates
and/or other mechanisms (such
as demand analysis) will be
used to assess areas of need for
improved equity of access
Patient flow management will
be improved to achieve further
reductions in waiting times for
electives. No patient will wait
longer than five months during
2014, and waiting times are
reduced to a maximum of four
months by the end of December
2014
Measure
Reporting

Delivery against agreed volume
schedule, including a minimum of
4,369 elective surgical discharges
in 2014/15 towards the Electives
Health Target (will be provided in
electives funding advice)
Quarterly
reporting

Reported against non-financial
reporting to MoH (Please see SI4):
Elective services standardised
intervention rates
Quarterly
reporting

Elective Services Patient Flow
Indicators expectations are met,
and all patients wait four months
or less for first specialist
assessment and treatment from
January 2015
Quarterly
reporting
41
Objective





Actions to Deliver Improved
Performance
Implementation of the National
Patient Flow Project, Phase One
completed December 2014
Actions
to
support
improvements in electives
access, quality of care, patient
flow management, or that
maximise available capacity and
resources:
o Design
of
Enhanced
Recovery (ERAS) Pathway
for orthopaedic patients
admitted with fracture
Neck Of Femurs (NOF)
o Maintenance,
development and audit of
standards with existing
ERAS
pathways
for
elective orthopaedic hip
and
knee
joint
replacement patients and
for
patients
having
colorectal surgery
o Development
of
a
perioperative
anaemia
pathway
o Design
and
implementation
of
demand and capacity
management tools for
planning
of
patient
bookings
o Production plans in place
for all surgical specialties
Participate in regional planning
with regard to Elective Surgery
delivery ensuring equity of
access across the region
Patients will be prioritised for
treatment using national, or
nationally recognised, tools,
and treatment will be in
accordance
with
assigned
priority and waiting time
Regional Alignment: TDHB will
participate in regional activities
that support the delivery of
elective services across the
Midlands region. The three
regional focus areas for elective
services are: Chronic Pain,
Increasing
endoscopy
and
Ophthalmology
Measure


Patient level data for referrals for
FSA are reporting into new
collection
See
Non-financial
reporting
framework - Ownership Dimension
performance
measures
for
Inpatient Length of Stay (OS3)
Reporting
Quarterly
reporting

Average time to theatre for
appropriate orthopaedic patients
with fracture NOF will be less than
36 hours by January 2015

Average length of stay for elective
hip and knee procedures will be
reduced to four days by January
2015


Reduced transfusion rates for
patients
who
would
have
previously had them for anaemia
management – baseline to be
established
Tools in place by December 2014

In place by December 2014

Increased uptake of latest national
CPAC tools to improve consistency
in prioritisation decisions
Quarterly
reporting

Implementation
of
National
Scoring tool for ORL by December
2014
Implementation
of
National
Scoring Tool for Gynaecology by
December 2014
Increase endoscopy capacity to
reduce waiting times as per
Ministry of Health guidelines by
June 2015.
Continue with
introduction of GRS tools to
enhance productivity and quality
measures
Quarterly
reporting


Quarterly
reporting
42
2.1.3 Shorter Waits for Cancer Treatment / Transitioning to Faster Cancer Treatment
Better Sooner More Convenient Health Services for New Zealanders in relation to cancer means all New
Zealanders can easily access the best services, in a timely way to improve overall cancer outcomes.
Cancer is the country’s leading cause of death (29 per cent) and a major cause of hospitalisation. Most
New Zealanders will have some experience of cancer, either personally or through a relative or friend.
The incidence of cancer is 20 percent higher for Maori than for non-Maori, but cancer mortality is
nearly 80 percent higher for Maori. Maori are also more likely than non-Maori to have their cancer
detected at a later stage of disease spread.
Residents of more socioeconomically deprived areas are more likely to develop cancer, less likely to
have their cancer detected early, and have poorer survival than residents of less deprived areas.
While the overall risk of developing cancer in New Zealand is decreasing, New Zealand has an increasing
number of people who are developing cancer, mainly because of population growth and ageing. The
total number of cancer registrations is projected to increase by approximately 21 percent from 2006 to
2016. In addition, once people are diagnosed with cancer they are now less likely to die from it. This
means that people are surviving longer, and being treated for longer periods of time, with different
treatments.
2.1.3.1 Our Approach
Taranaki DHB maintains a clinical relationship with the Central Cancer Network for care and treatment
of our cancer clients. The Central Cancer Network area includes Capital and Coast, Hutt Valley,
Wairarapa, MidCentral, Whanganui, Hawkes Bay and Taranaki DHBs. Cancer is an area of high need
which can only be effectively met through regional and inter-regional collaboration and cooperation. In
the Central Region there are strong clinical networks which provide for essential collegial support in the
provision of cancer services to mitigate the risks to a potentially vulnerable service.
A health system that functions well for cancer is one that ensures all:




People get timely services across the whole cancer pathway (screening, detection, diagnosis,
treatment and management, palliative care)
People have access to services that maintain good health and independence
People receive excellent services wherever they are
Services make the best use of available resources
Health system success is measured by five year survival rates, cancer incidence and cancer mortality
data. The focus of the regional work programme covers the following areas:




2.1.3.2






Continuing to ensure timely and improved access to radiotherapy and chemotherapy services
Building knowledge and capacity to ensure timely and improved access to diagnosis and cancer
treatment services via the Faster Cancer Treatment programme of work
Improving colonoscopy wait times and quality of services
Improving system integration and service collaboration
Linkages
Minister’s Letter of Expectations
National Cancer Programme Work Programme
Midland DHBs Regional Services Plan 2014/15
Central Cancer Network Strategic Plan
Taranaki Palliative Care Plan 2013-16
Hei Pā Harakeke Action Plan
43


Health Target – Shorter Waits for Cancer Treatment
Our Performance Story Impact: People receive timely and appropriate specialist care
2.1.3.3 Action Plan
Objective
Shorter Waits
for Cancer
Treatment






2.1.4
Actions to Deliver Improved
Performance
Maintain performance against the
radiotherapy and chemotherapy
wait time targets by investing in
workforce and capacity as
required
Report against the shorter waits
for cancer treatment target on a
monthly basis
Work with CCN to implement
priority areas for the year
identified in the regional radiation
oncology capital and service plans
(plan to be developed by June
2014)
Work with CCN to continue
implementation of the priority
areas for each year identified in
the National Medical Oncology
Models of Care Implementation
Plan 2012/13, including:
o Support the implementation
of e-prescribing into both
cancer centres ensuring
process appropriate for TDHB
site
o Implement SMO workforce
priorities as identified by the
national plan
To work with CCN to submit a joint
proposal for service improvement
initiatives along the patient cancer
pathway
that
support
achievement of the 62 day DCT
indicator and/or implementation
of the provisional
tumour
standards.
The new Health target to be
achieved by July 2016 is 85
percent of patients referred with a
high suspicion of cancer wait 62
days or less to receive their first
treatment (or other management)
Measure
Reporting

100% of patients, ready for
treatment, wait less than four
weeks for radiotherapy or
chemotherapy

Monthly reports submitted
Monthly

Implementation
priorities
identified by July 2014. Priorities
completed by June 2015
Quarterly

Implementation
priorities
identified by July 2014. Priorities
completed by June 2015
Quarterly

Joint proposal developed and
submitted
Quarterly
Increased Immunisation
2.1.4.1 Our Approach
During 2014/15 we will continue our focus on increasing immunisation in our district. There are many
stakeholders from across the sector whose individual work forms part of the ‘greater whole’ in terms of
the approach to supporting children in this district. The results against the target and initiatives
planned for our district will reflect the combined effort of all these stakeholders.
We will be working with our primary care partners to make progress against this priority.
44
2.1.4.2 Linkages
 Our Performance Story Impact: People take greater responsibility for their health
 Better Public Services: Supporting vulnerable children
2.1.4.3 Action Plan
Objective
Increased
Infant
Immunisation
Actions to Deliver Improved
Performance
Support and strengthen relationships
between immunisation stakeholders
and other relevant agencies by:
1. Maintaining the Taranaki
Immunisation
Steering
Group (TISG) that includes
all the relevant stakeholders
for the DHB’s immunisation
services including the Public
Health Unit
2. Participation in regional and
national forums as required
3. The TISG will meet quarterly
to review, monitor and
implement
actions
as
identified
through
the
Taranaki
Immunisation
Action Plan
4. Support
activities
for
Immunisation Week
5. Through the TISG identify
and develop relationships
with
other
relevant
agencies. Including actions
that support the increase
immunisation rates
Actively monitor and evaluate
immunisation coverage at DHB, PHO
and
practice,
and
Outreach
Immunisation level.
1. Targeting
of
specific
populations groups where
gaps in immunisation are
identified
2. Monitoring of the DHB
Monthly dashboard and
follow-up on indicators
where gaps are identified
3. Ensure effective Outreach
Immunisation Services
4. That
the
immunisation
status of all patients
receiving care is checked on
or soon after admission and
the number of opportunistic
immunisations increases as a
result of this
5. Maintain process between
NIR and ED for children
presenting Department who
Measure

National Health Target – 95% of 8
months children vaccinated

Reporting against DHB Quarterly
Reporting through to MoH

Evidence of Immunisation Week
activities through Narrative report
on DHB and interagency activities
to promote immunisation week
(April 2015)

Increase the number opportunistic
immunisations as a result of
Paediatric Ward admissions

Increase the % of Outreach
Immunisations referrals that have
completed immunisation
Reporting
Quarterly
Quarterly
45
Objective
Actions to Deliver Improved
Performance
are due or over-due for
immunisation.
Ensuring
follow-up with OIS where
appropriate
Work with primary care partners to
monitor to increase immunisation
rates
1. Through the Taranaki WCTO
QIF – Access Indicator 1 –
New-born’s are enrolled
with a PHO by two weeks of
age. Work towards 100%
enrolment
2. In collaboration with primary
care stakeholders monitor
systems
for
seamless
handover of mother and child
as they move from: maternity
care services to general
practice and WCTO services
3. Primary Care will monitor the
performance
of
their
immunisation rates through
Best Practice Intelligence
Tools
Measure
Reporting
Quarterly

Increase new-born enrolments
from 66% to 88% by December
2014 at 2 weeks of age

Maintaining the current handover
to WCTO and Primary Care of 99%

PHO Quarterly reporting
activities and monitoring
on
2.1.5 Better Help for Smokers to Quit
Better Sooner More Convenient Health Services for New Zealanders in relation to tobacco means more
smokers make more quit attempts, leading to more successful quit attempts and a reduction in
smoking prevalence. A renewed impetus is required in order to achieve the Government’s aspirational
goal of a Smokefree New Zealand by 2025. Increased integration into all other aspects of health is
critical to achieving Smokefree Aotearoa 2025. Supporting smokers to quit needs to be integrated into
all primary, secondary and maternity health services and DHBs have a leading role.
2.1.5.1 Our Approach
Our children and tamariki need to grow up free of the risk of becoming addicted to tobacco and the
effects of second-hand smoke. We recognise that actions we take at a regional and local level will link
with the actions driven at a national level to contribute to the achievement of the goal of a Smokefree
New Zealand by 2025.
A renewed impetus is required in order to achieve the Government’s aspirational goal of a Smokefree
New Zealand by 2025. Increased integration into all other aspects of health is critical to achieving
Smokefree Aotearoa 2025. Supporting smokers to quit needs to be integrated into all primary,
secondary and maternity health services and DHBs have a leading role.
We are active participants in the regional smokefree network and will be implementing the actions
from our current Tobacco Control Plan. This plan has a focus on achieving the national health targets.
We will continue to engage regularly with our primary care partners and share information about the
health target as well as monitoring actual performance against planned performance.
Our focus on smoking during pregnancy is part of our Maternity Quality and Safety (MQSP) programme.
46
We will be working with our primary care partners to make progress against the primary care portion of
this priority.
2.1.5.2 Linkages
 Minister’s Letter of Expectations
 Health Target – Better Help for Smokers to Quit
 Parts of this section have been developed and agreed with our primary care partners
 Our Performance Story Impact: People stay well in their homes and communities
 Our Performance Story Impact: People receive timely and appropriate specialist care
2.1.5.3 Action Plan
Objective
Better Support
for Smokers to
Quit
in
Secondary Care





Actions to Deliver Improved
Performance
TDHB is committed to sustain
performance
against
the secondary Care target
o Current unit procedures
support ongoing process to
ensure all patients who
smoke are asked about their
smoking status, given brief
advice to stop smoking and
are offered/given effective
smoking cessation support
for hospital based services
To promote and monitor the use
and
access
of
Nicotine
Replacement
Therapy
and
Smoking Cessation medicines
within the hospital
o Determine a baseline by 31
September 2014
To improve and monitor the
number of patients/clients to
the Quitline and Specialist
Smoking Cessation Providers
o Determine a baseline by 31
September 2014
Continue to strengthen systems
and linkages between Secondary
and Primary Care
To implement the National
Smokefree
Mental
Health
Project within the hospital
Measure

Maintain 95% of hospitalised
patients who smoke and are
seen by a health practitioner are
offered brief advice and support
to quit smoking
Maintain 95% of hospitalised
Maori patients who smoke are
seen by a health practitioner are
offered brief advice and support
to quit smoking
Quarterly

Increase
percentage
of
hospitalised smokers receiving
pharmacotherapy medicine by
June 2015
Quarterly

Increase of direct referral
numbers to Quitline and
specialist smoking cessation
providers by June 2015
Quarterly

On-going work

Implementation of National
Smokefree
Mental
Health
guidelines and resources within
the hospital by June 2015
Smokefree Aotearoa 2025 logo
and messages included across
Smokefree
projects,
communication and resources
Quarterly
90% of patients who smoke aged
15 years and over and are seen
in General Practice by a health
practitioner are offered brief
advice and support to quit
smoking
Quarterly


Better Support to
Quit in Primary
Care (PHOs)
General Practice

Reporting
To promote and raise the
awareness and knowledge of a
Smokefree Aotearoa 2025 goal

Continue to fund the Primary
Care Midland Regional Health
Network to deliver agreed local
activities to support the
achievement of the Tobacco
Health Target

47
Objective

Actions to Deliver Improved
Performance
Ensure all patients who smoke
are asked about their smoking
status, given brief advice to stop
smoking and are offered/given
effective smoking cessation
support
o MHN Network Liaison Team
to provide quarterly reports
to all practices on their
performance against the
Annual Quality Plan targets
for Smoking
o Network Liaison team when
required to
support
practices to
implement
their smoking cessation
plans to ensure a patient
centred practice based on
ABC service model
o To
provide
a
MHN
centralised practice support
approach for identified
practices
that
require
support for those smokers
not contacted in 12 months
o MHN will monitor utilisation
of Patient Prompt and BPI
reporting tools to record
and report on smoking
status and feedback to
practices via the quarterly
Network Liaison Team visits
o

Better Support
for
Pregnant
Women to Quit


PHO exploring additional,
linkages, pathways
and
feedback loops for referrals
to NGO’s for specialised
cessation support
Explore options for a range of
dedicated smoking cessation
support in the Primary Care
Setting
Ensure all patients who smoke
are asked about their smoking
status, given brief advice to stop
smoking and are offered/given
effective smoking cessation
support for hospital based
maternity services
o To communicate Taranaki
DHB quarterly results from
Ministry of Health to local
Midwifes and LMCs
To monitor the use and access of
Nicotine Replacement Therapy
and
Smoking
Cessation
medicines within hospital based
Measure
Reporting

Make progress toward 90% of
pregnant women who identify as
smokers at the time of
confirmation of pregnant in
general practice are offered
advice and support to quit
Quarterly

Increase of direct referral
numbers to Quitline and
specialist smoking cessation
providers by June 2015
Quarterly

Agree with MRHN a evidence
based model to best support
General
Practice
by
30
September 2014
Progress towards 90% of
pregnant women who identify as
smokers at the time of
confirmation of pregnancy in
General Practice or booking with
Lead Maternity Carer are offered
advice and support to quit.


Quarterly
Increase
percentage
of
hospitalised Pregnant smokers
receiving
pharmacotherapy
medicine by June 2015
48
Objective







Actions to Deliver Improved
Performance
maternity services
o Determine a baseline by 31
September 2014
To monitor the number of
pregnant smokers to Mana
Wahine Hapu and Specialist
Smoking Cessation services
o Determine a baseline by 31
September 2014
TDHB Hospital Service to work
with Te Kawau Maro (Smoking
in Pregnancy Services) and PHOs
to inform ways in which the
Hospital Services can improve its
cessation advice and referral
service for pregnant women
Actions refer to Section 2.4.9
Maternal & Child Health
Professional Mana Wahine Hapu
community
champions to
deliver promotional sessions to
health
and
community
professionals
Five
Mana Wahine Hapu
Whanau Champion trainers to
recruit and provide training
support packages
Whanau champions to deliver
Smokefree
pregnancy
conversations
Provide smoking cessation /
behavioural
support
group
interventions
to
pregnant
women
and
their
partners/Whanau
Measure

Increase of direct referral
numbers to Mana Wahine Hapu
and specialist smoking cessation
providers by June 2015

Measures refer to Section 2.4.9
Maternal & Child Health
Quarterly

To deliver Mana Wahine Hapu
promotional sessions reaching
250 health and community
professionals by 31 March 2015
Quarterly

40 whanau champions recruited
and trained by 31 March 2015
Quarterly

400
smokefree
pregnancy
conversations recorded by 31
March 2015
125 women received three
facilitated
group
support
sessions (partners included
based on ration 85% women
15% partners) by 31 March 2015
100 pregnant women enrolled in
SmokeChange
telephone
support by 31 March 2015
Taranaki Tobacco Action Plan
2014-16 completed by 30
September 2014
Smokefree/Auahi Kore logo and
messages included across all
projects, communications and
resources
Quarterly


Regional
Collaboration –
Implement the
2014-15 Actions
in the Midland
Smokefree 2025
Five
Year
Programme
of
Action 2010-15

Develop a Taranaki Tobacco
Action Plan 2014-16


To align and implement agreed
local actions and priority groups
from Regional and National
Smokefree
Aotearoa
2025
Action Plans
To promote and raise the
awareness and knowledge of a
Smokefree Aotearoa 2025 goal
Representation
on
the
Smokefree Midlands and Maori
Caucus Advisory Group



Reporting

Quarterly
Annually by
June 2015
Ongoing attendance at Regional
meetings
49
2.1.6
More Heart and Diabetes Checks
2.1.6.1 Our Approach
We will continue to work with our primary care partners to reduce the impact of long term conditions
like cardiovascular disease. We provide funding to our primary care partners to enable implementation
of their respective long term conditions programmes (which include a focus on the More Heart and
Diabetes Checks Health Target). Our primary care partners use the allocated funding to support and
incentivise performance of their practices. This approach is intended to contribute to the achievement
of our outcomes of improving the health status of our population and reducing or eliminating health
inequalities.
We are part of a sub-regional8 approach (overseen by an Alliance Leadership Team) to the funding
allocation of our primary care partners, the Midlands Health Network. This approach focuses on
enabling implementation of their Long Term Conditions programme using funding from an agreed
flexible funding pool to support and incentivise practices. This funding is allocated to practices through
a funding allocation model which covers inputs, outputs and outcomes:



2.1.6.2




Capacity funding - calculated in year one based on high needs; year 2 based on numbers in
stratified risk categories with different categories buying different levels of intervention
Coverage funding - as practices achieve agreed coverage targets in three bands in year one and
then active care plans for year two; then the funding is adjusted to reflect that the harder to
reach are being actively managed.
Quality funding - year one coverage targets and some outcome; year two moving to less
coverage and greater outcome
Linkages
Minister’s Letter of Expectation
Health Target – More Heart and Diabetes Checks
Section developed and agreed with our primary care partners
Our Performance Story Impact: People stay well in their homes and communities
2.1.6.3 Action Plan
Objective
More Heart and
Diabetes Checks
8

Actions to Deliver Improved
Performance
Using PHO resource, identify and
target missed opportunities by:
o Enhancing
current
reporting capability to
provide more specific and
timely analysis on network,
locality
and
practice
performance
o Providing
analysis
to
network liaison team to
actively manage general
practices
where
performance needs to be
improved
o Systematically reviewing
performance at a network,
locality
and
general
practice level to ensure
each practice is using the
tools and reports to review
Measure
Quarter
Reporting
Minimum Percentage Coverage to be
achieved in the Taranaki DHB district by
the end of Quarter (expressed as a
percentage of the Eligible Population)
Maori
Pacific
Other
Total
Jul-Sep
2014
90%
90%
90%
90%
Oct-Dec
2014
90%
90%
90%
90%
Jan-Mar
2015
90%
90%
90%
90%
Apr-Jun
2015
90%
90%
90%
90%
Jul-Sep
2015
90%
90%
90%
90%
Sub-region in this case refers to the geographic areas covered by Lakes DHB, Tairawhiti District Health, Taranaki DHB and Waikato DHB
50
Objective


2.2
Actions to Deliver Improved
Performance
missed opportunities and
initiate active follow up
o Providing an incentive for
general
practices
to
achieve their targets
Using NGO resource, identify
and target missed opportunities
by implementing systems to
capture activity undertaken
outside of the general practice
environment
Fully integrate catch up and
coordination services for key
health targets including the
utilisation of telephone catch up
services
Measure
Reporting
BETTER PUBLIC HEALTH SERVICES
2.2.1 Reducing Rheumatic Fever
Rheumatic Fever left untreated can damage the heart leading to life-long heart problems. Working to
reduce and eliminate rheumatic fever can reduce the incidence of heart disease and/or related
complications.
2.2.1.1 Our Approach
During 2013/14 we developed our Rheumatic Fever Prevention Plan. While the incidence of Rheumatic
Fever is low in Taranaki (less than 1 per 100,000 population) we expect to reduce both the incidence
and impact of Rheumatic Fever across our district.
Our plan includes sections on:





2.2.1.2



Overarching actions to reduce the incidence of Rheumatic Fever
Investment in reducing Rheumatic Fever
Actions preventing the transmission of Group A Streptococcal throat infections
Actions to treat Group A Streptococcal throat infections quickly and effectively
Actions facilitating the effective follow-up of identified Rheumatic Fever cases
Linkages
Our Performance Story Impact: Fewer people admitted to hospital for avoidable conditions
Better Public Services: Supporting vulnerable children
Rheumatic Fever Prevention Plan 2013-2017
2.2.1.3 Action Plan
Objective
Reduce
the
Incidence
of
Rheumatic Fever

Actions to Deliver Improved
Performance
Implement the Rheumatic Fever
Prevention Plan appropriate to
the level of intervention
required
Measure

2014/15 Rheumatic Fever
target – number and rate
reductions, 40% below 3-year
average (by ethnicity)
Reporting
Quarterly
51
Objective






Actions to Deliver Improved
Performance
Ensuring that primary care
providers and other health
professionals likely to see high
risk children follow the National
Heart Foundation Sore Throat
Management Guidelines
Ensuring people with Group A
streptococcal infections are
treated appropriately within 7
days of developing symptoms
Ensuring that all cases of acute
rheumatic fever are notified to
the Medical Officer of Health
within 7 days of hospital
admission
Reviewing all cases of Rheumatic
Fever to identify any identifiable
risk factors and system failure
points
Ensuring patients with a past
history of Rheumatic Fever
receive monthly antibiotics not
more than 5 days after due date
Undertake a root cause analysis
of every Rheumatic Fever case
and identify systems failures
Measure
Reporting

The Taranaki DHB Rheumatic
Fever Prevention Plan has
been operational since the
start of October 2013
Quarterly

There was only one case
notified in 2013 – a 10 year old
Maori child in June. This gives
a notification rate of 0.9 per
100,000
The activities in “What we are
planning to do to achieve it”
are reviewed annually
An intersectoral project team
then reviews the annual report
and
epidemiology
of
Rheumatic Fever in Taranaki
over the previous year and
decides on actions which are
consistent with the level of
need
Quarterly



Quarterly
Provide a report on the lessons
learned and actions taken
following the root cause
analysis to the Ministry each
quarter
2.2.2 Prime Minister’s Youth Mental Health Project
The Department of the Prime Minister and Cabinet developed a cross agency project looking at
improving services for young people with, or at risk of, mild to moderate mental health disorders. The
52
project is designed to build on existing successful interventions and to trial new initiatives for young
people aged 12-19 years (inclusive) in settings in which young people live their lives: schools, the health
system, their families and community, and online.
2.2.2.1 Our Approach
We will be working with our primary care partners to make progress against this priority. Our activities
in this priority area are expected to mean young people will be able to access the services they require
before their condition escalates to being a severe mental health disorder.
2.2.2.2



Linkages
Minister’s Letter of Expectation
PP25 - Delivery of the Prime Minister’s youth mental health initiative
Our Performance Story Impact – People stay well in their homes and communities
2.2.2.3 Action Plan
Objective
Prime Minister’s
Youth
Mental
Health Project
Actions to Deliver Improved
Performance
Development of Taranaki Youth
Health Teams (YHT’s) as per Taranaki
Taiohi Health Strategy 2013-2016.
1. Identification
of
key
agencies/organisations
to
partner
with
for
the
development of YHT’s
2. Establishment of Service
Level Alliance Team with key
agencies/stakeholders for the
purpose of designing the
teams
3. Undertake a service design
process for YHT’s
Improving access and service options
for youth.
1. Roll out of (C)HEADSSS
assessment tool to school
counsellors,
and
other
professionals working with
youth
2.
3.
4.
Expanding the use of standing
orders and prescribing by
Public Health Nurses in
schools, alternative education
and similar environments.
Enabling Nurses to manage
patients
promptly
and
efficiently
PHN pathway for linking
youth with General Practice
documented
Embed the Primary Mental
Health Initiative for Youth
voucher
access
through
General Practice, School
Counsellors, Public Health
Nurses and Social Sector Trial
Measure
Reporting

Monthly progress updates to
Taranaki DHB Board
Monthly

By
December
2014,
establishment of the Service
Level Alliance Team
Quarterly

By June 2015 the service
design process and action plan
completed
Quarterly

By July 2014 60 professional
working with youth would
have undertaken the training
(PMHI Reporting)
Number
of
(C)HEADSSS
assessments completed
Quarterly

Increase numbers
prescribing
and
orders in clinics
Quarterly

By December 2014,
documentation completed
Quarterly

Increase in the numbers of
Youth accessing Primary
Mental Health Initiative (PMHI
Reporting)
Quarterly

of PHN
standing
53
Objective
Actions to Deliver Improved
Performance
Implementation of the 2014/15
workforce development and training,
PMHI and PHO.
1. Delivery of workshops aimed
to build skills/capacity and
confidence in working with
young people in supporting
and
understanding
of
interventions
for
youth
experiencing poor mental
health
2. Enhance
electronic
tools/resources available to
general practice to include
care planning and selfmanagement
3. Workforce education and
training to support the
utilisation of stepped care
model is available
3.1 Access to increased
specialist services for
advice/training.
3.2 Launch policy as part of
annual education.
4. Identify Map of Medicine
pathways to better support
treatment processes and
improve access
5. Introduction of a Child
protection policy and Family
Violence policy for general
practice
and
identify
education opportunities

Explore group programmes for
working with youth 12-19 years
Review and improve the follow-up
care for those discharged from
CAMHS and Youth AOD services:
 Consistently follow process of
completing care plans in letters
to GP to be sent within 7 days of
discharge
Measure
Reporting

75% of General Practices have
participated in the training by
June 2015 (PMHI Reporting).
Quarterly

Information
relating
to
electronic tools/ resources are
included in quarterly narrative
reporting. Monitoring via PHO
quarterly reporting
Quarterly

Framework to be agreed by
September 2014
Deliverables
agreed
by
September 2014
Reporting
through
PHO
Quarterly reporting
Quarterly



Reporting
through
Quarterly reporting
PHO

Reporting
through
Quarterly reporting
PHO

The percentage of care plans
will increase

The percentage of care plans
included
in
discharge
summaries to GPs from
CAMHS & Youth AoD will
increase to 75% by June 2015

An internal audit of the current
status will be done in July as a
baseline and to inform our
confirmed target


Improve follow-up in primary
care of youth aged 12-19 years
discharged from secondary
mental health and addiction
services by providing follow-up
care plans to primary care
providers. The follow-up care
plans should be provided with
the expectation that they are
activated by the primary care
54
Objective
Actions to Deliver Improved
Performance
provider within three weeks of
discharge
Measure
Reporting

Consistently follow process of
completing care plans in letters
to GP to be sent within seven
days of discharge
 Ensure services are culturallycompetent and provided to
meet the health needs of Māori
and Pacific populations
 TDHB will ensure services are
culturally-competent
and
provided to meet the health
needs of Māori and Pacific
populations through offering a
range of services and training
staff
Improve access to CAMHS and
Youth AOD services through wait
times targets and integrated case
management:
 Implement agreed action to
meet the waiting time targets
that by 2015 will enable: 80% of
youth to access services within
three weeks; 955 to access
services within eight weeks

TDHB will change the model of
service through role redesign in
order to complete initial
assessments within three weeks
of referrals


All new staff will attend
TDHB’s Tikanga Best Practice
Training
Existing staff will attend
refreshers as required

Delivery against target

Measured through PP-8 being
the MOH Measurement of
MH&A waiting times. Targets
being to achieve by June 2015

80% of service users to be seen
within three weeks of referral
and 95% within eight weeks
2.2.3 Children’s Action Plan
Supporting vulnerable children contributes to the Government’s overall priorities by improving services
and reducing avoidable expenditure in the justice, health and welfare systems – helping to deliver
better public services within financial constraints and helping to build more competitive and productive
economy.
2.2.3.1 Our Approach
National Child Health Information Programme (NCHIP).
Initially Catch 18 was a programme instigated by the Midlands Health Network who sought a
partnership with the four Midland DHBs, Waikato, Lakes, Taranaki and Tairawhiti. These DHBs
contributed $400,000 over a two year period to fund the programme that would establish a pathway
for a regional and ultimately a national solution for child and youth health. Subsequently the Ministry
of Health and the National IT Board joined the team as the owner of the national programme, (renamed
NCHIP) the goal of which was to develop as proof of concept, a child and youth health platform and coordination service.
The programme will create greater visibility of child health information and improve collaboration and
standardisation in the delivery of health services of child health providers. It will also assist in the
achievement of DHB health targets for immunisation, B4 Schools and obesity reduction. Registrations
55
of Interest were sought from appropriate IT vendors via a closed tender process. Following the
selection of a preferred vendor, pricing discussions and modelling of national roll out costs have
occurred. Good progress is being made on the project which now includes Bay of Plenty and Auckland
DHBs.
2.2.3.2 Linkages
 Minister’s Letter of Expectation
 Health Target – Increased Immunisation
 Better Public Services: Result 2: Increase participation in quality early childhood
 education
 Better Public Services: Results 3: Increase infant immunisation rates and reduce the incidence of
Rheumatic Fever
 Better Public Services: Result 4: Reduce the number of assaults on children
 Our Performance Story Impact: People take greater responsibility for their health
2.2.3.3 Action Plan
Objective
Implementation
of the White
Paper for
Vulnerable
Children –
Establishment of
Children’s Teams
Reducing the
Number of
Assaults on
Children
Actions to Deliver Improved
Performance
Describe DHB actions to support
establishment of Children’s Teams
including:
 Participation in regional
Children’s Team governance and
leadership involvement by DHB
and non-DHB employed health
professionals
 Collaboration with other
agencies to plan, test and
monitor assessment processes
to support early response
systems, assessment processes
and delivery of coordinated
services for vulnerable children
 Work to develop effective
referral pathways to/from
Children’s Teams and primary
and secondary health services
 Enabling health professionals to
attend necessary training to
support Children’s Teams

DHBs to develop and evaluate
VIP programmes

MHN introduction of a Child
protection policy and Family
Violence policy for general
practice and identify education
opportunities
Measure
Reporting
• DHBs support establishment of
multi-disciplinary Children’s
Teams
• All DHBs achieve audit scores of
70/100 for each of the child and
partner abuse components of
their VIP programmes
• All DHBs implement NCPAS by
30 June 2015
DHB has internal
governance/engagement
arrangements within the DHB and
with primary and community
partners to provide services for:
 Vulnerable children and their
families/whānau
 Pregnant women with complex
needs
 Children referred to Gateway
 All DHBs achieve audit scores
of 70/100 for each of the child
and partner abuse components
of their VIP programmes
 Policy will be launched as part
of the annual education plan
and will be reported via
quarterly narrative report
Progress
update In Q1
report
Progress
update in Q2
report
Progress
update in Q3
and 4 reports.
Establish key
steps to be
included in
the 2014/15
planning
Quarterly
Quarterly
56
Objective






2.2.4
Actions to Deliver Improved
Performance
TDHB will increase Family
Violence screening of women
over 16 years of age who
receive any TDHB service for FV,
to enable measuring of this
within the DHB
TDHB will code and audit
screening results and continue
with appropriate care plan
implementation for women who
have a positive screening
Actions
taken
to
plan,
implement and/or maintain
their National Child Protection
Alerts System
To ensure that interagency
collaboration continues and that
internal processes support the
National Child Alert systems
being maintained
DHBs to confirm provision of
Ministry-accredited training for
health
professionals
to
recognise signs of abuse and
maltreatment in designated
services
To continue the FVIP training,
increasing the numbers of staff
in all areas who have attended
Measure
Reporting
 To increase the numbers of
patients who are screened
whilst being patients at TDHB –
establish baseline and aim to
increase screening rate to 50%
by end June 2015
 Audit scores of 70/100 for each
child and partner abuse
component
of
the
VIP
programme
 To increase the numbers of
patients who are screened
whilst being patients at TDHB –
establish baseline and aim to
increase screening rate to 50%
by end June 2015
 Audit positive screenings and
associated care plans – aim for
100% by end June 2015
 Implement NCPAS by 30 June
2015
Quarterly
 FVIP training to be rolled out to
all areas and numbers of staff
attending to be monitored and
increased
Quarterly
Quarterly
Quarterly
Whānau Ora
2.2.4.1 Our Approach
The vision for Taranaki Maori is “Whānau Ora – whānau supported to achieve their maximum health
and wellbeing”.
The Whānau Ora philosophy articulated by the Whānau Ora Taskforce, as it relates to health, provides
the philosophical base for the TDHBs approach to Whānau Ora. The characteristics of the philosophy
that give Whānau Ora definition and distinctiveness are as follows:

Recognises a collective entity (whānau). Whānau Ora is not simply about the sum total of
collective measures, but is primarily concerned with the ways in which the group functions as a
whole to achieve health and wellbeing for its people.
57





Endorses a group capacity for self-management and self-determination. Whānau Ora activities
will transfer knowledge and skills to whānau so that the group develops critical awareness and
are best able to manage their own health and wellbeing.
Has an intergenerational dynamic. That is, Whānau Ora is about ongoing intergenerational
transfers towards the goal of increasing sustainability of improved health outcomes. For
example, in managing diabetes health services may immediately treat the problems but will
also support knowledge transfer and prevention activities among the next generation in order
to avoid the development of diabetes among descendants.
Is built on a Māori cultural foundation. Wellbeing is closely linked to Māori cultural identity and
the expression of Māori values.
Asserts a positive role for whānau within society. Health institutions should have the capacity
to respond positively to whānau, and whānau should be able to negotiate freely with these
institutions to achieve the best results.
Can be applied across a wide range of social and economic sectors. Whānau Ora is equally
concerned with socio-economic wellbeing, and cultural and environmental integrity. Therefore,
the Health and Disability Sector should actively participate, and in some instances lead in
intersectoral activities that contribute to Whānau Ora.
The implication for Taranaki DHB is that every service offered should contribute to the generation of
self-management knowledge and skills that are owned by whānau.
The philosophical underpinning described above is supported by He Korowai Oranga, National Maori
Health Strategy, as a framework for Whānau Ora implementation. Within this framework and at the
core of the Taranaki DHB’s approach is to support whānau ownership over their own development. The
transfer of knowledge and skills to enable this to happen is a key function of Whānau Ora health service
provision.
The Taranaki DHB is committed to taking a whānau-centred approach by aligning activities to the
whānau context described above.
2.2.4.2 Linkages
 Minister’s Letter of Expectations
 Our Performance Story Impact: People stay well in their homes and communities
2.2.4.3 Action Plan
Objective
Whānau Ora

Being Outcomes
Focused

Actions to Deliver Improved
Performance
Building capacity and capability:
build on the investment Te Puni
Kōkiri (TPK) has made to
strengthen both the capacity
and capability of the provider
collectives
across
the
governance, management and
service delivery levels
Continue implementation and
refinement
of
integrated
contracting processes, focused
on outcomes; and to work with
the Ministry to support GP
providers, who are part of
Whānau
Ora
provider
collectives, to use their practice
management systems to report
on Whānau outcomes
Measure
Reporting

Work with the Taranaki Ora
Collective to identify and agree
areas where the DHB can
support capacity and capability
building of the collective
Annually
Q2

Work with the relevant parts
of the Taranaki Ora collective
(Tui Ora Ltd) to support
alignment of its GP client
management systems to be
able
to
satisfy
MOH
requirements for reporting on
Whānau outcomes
Six-monthly
Q2 & Q4
58
Objective
Implementing
Programmes of
Action

Supporting
Strategic Change

Changes to the
Future Direction
of Whānau Ora
2.3

Actions to Deliver Improved
Performance
Support the provider collectives
in the planned activities for
implementation in 2014/15; and
substantive engagement with
provider collectives
Strategic planning with the DHB
includes participation of the
Whānau
Ora
provider
collectives;
building
and
maintaining relationships with
agencies implementing Whānau
Ora; and support for Whānau
Ora across all levels of the DHB,
including at Board and Planning
and Funding level
Minister
Turia
announced
changes on the future direction
of Whānau Ora in July. A key
feature of the announcement is
the establishment of three NGO
Commissioning Agencies. It is
not yet clear what the
commissioning agencies will look
like and what will be required of
DHBs. Te Puni Kōkiri aim to
complete the procurement
process and be in a position to
announce the selected agencies
by the end of this year
Measure




Reporting
Establish processes to facilitate
access by the Taranaki Ora
collective, to the skills and
services offered by the
Taranaki DHB
Taranaki
Ora
collective
participates in at least one
TDHB strategic planning forum
TDHB participates / leads /
facilitates at least one strategic
funder forum involving local
agencies
involved
in
implementing Whānau Ora
Six-monthly
Q2 & Q4
Develop and implement a
programme across all levels of
the TDHB to socialise Whānau
Ora and whānau-centred
practice as an approach
Six-monthly
Q2 & Q4
Annually
Q2
SYSTEM INTEGRATION
2.3.1 Long Term Conditions
Long term conditions account for a significant number of potentially preventable presentations at
emergency department and admissions to hospital. With an ageing population this burden will
increase. Improving care for people with long term conditions can best be achieved through whole of
the health system approach.
2.3.1.1 Our Approach
We will continue to work with our primary care partners to reduce the impact of long term conditions.
There will be a focus on ensuring the care of people with long term conditions takes place in the most
appropriate setting (particularly community and primary settings), with primary care nurses and allied
health professionals taking wider responsibility for helping people manage their ongoing health needs.
2.3.1.2



Linkages
Midland DHBs Regional Services Plan 2014/15
Our Performance Story Impact: People stay well in their homes and communities
Our Performance Story Impact: People receive timely and appropriate specialist care
59
2.3.1.3 Action Plan
Objective
Diabetes
Long-term
Conditions
and
Actions to Deliver Improved
Performance
Taranaki DHB, in collaboration with
our primary care alliance partners,
have identified actions to reduce the
impact of long terms conditions that
are driving demand upwards in our
district
Measure

Linkage
with
Ambulatory
Sensitive Admissions to Hospital
(ASH) rates
Measurement of improved
diabetes outcomes using a set of
clinical
indicators
to
be
developed
100% of MHN general practices
have
access
to
eligible
population list via the risk
stratification process
Information
pertaining
to
resources is demonstrated via
quarterly reporting narrative
Quarterly

90% of the diabetic eligible
population (total and high need)
have
personal
health
assessment
and
planning
available by 30 June 2015
Quarterly

10% of the diabetic eligible
population (total and high need)
have accessed personal health
assessment and planning 30
June 2015
Volumes – 210 face-to-face
contacts (Clinical Pharmacist);
2525
face-to-face
contacts
(Dietician/Social Worker)
Information
pertaining
to
resources is demonstrated via
quarterly reporting narrative
Education calendar for 14/15
still being finalised
Information
pertaining
to
funding
strategy
is
demonstrated via quarterly
reporting narrative


Each practice has access to a list
of
their
diabetic
eligible
population


Further resources developed
within the LTCMP website ‘tool
kit’ so General Practice can best
utilise their funding and
resources
Enhance and extend the
electronic tools and systems to
provide
standardised
assessment, care planning and
clinical reviews using the MHN
Personal health assessment and
planning process
Increased use of MDT for
diabetes and CVD

Enhance
the
electronic
tools/resources available to
general practice to include selfmanagement
Workforce
education
and
training in the delivery of LTCMP










Enhancement of existing funding
strategy to further encourage
general practices to deliver
quality care and management
and to best target resources
Via
the
MHN
quality
programme, a set of indicators
and targets for the LTCMP
including
progress
toward
Smokefree by 2025
Continuation of the LTCMP
evaluation
and
monitoring
framework
Reporting

Quarterly
Quarterly
Quarterly

Quality indicators and targets
still being finalised – IPIF and
MOH diabetes clinical indicator
dependant
Quarterly

Information
pertaining
to
evaluation
and
monitoring
framework is demonstrated via
quarterly reporting narrative
Quarterly
60
Objective


2.3.2
Actions to Deliver Improved
Performance
TDHB ensures complex LTC
inpatients are managed by
specialist
interdisciplinary
teams.
o Evaluation
of
current
pathway Q1
o Recommendations
for
enhancements Q2
Q1 - Evaluation of the pathway
from inpatients to primary care
is evaluated and enhancements
made to ensure support of
complex patients back to
primary care post discharge
Measure
Reporting
Quarterly
Quarterly
Stroke
2.3.2.1 Our Approach
Stroke Services are identified as a priority area in our Regional Services Plan (RSP) (see Integration
across continuums of care – 2014/15 RSP). HealthShare through the Midland Stroke Action Group are
leading the development and implementation of regional actions.
2.3.2.2



Linkages
Midland DHBs Regional Services Plan 2014/15
Our Performance Story Impact: People stay well in their homes and communities
Our Performance Story Impact: People receive timely and appropriate specialist care
2.3.2.3 Action Plan
Objective
Stroke Services


Actions to Deliver Improved
Performance
Stroke thrombolysis quality
assurance procedures will be
developed, including processes
for staff training and audit
 Workforce
training
to
support thrombolysis, care
pathways developed for
thrombolysis,
workforce
allocation to support all
DHBs in region having
access to thrombolysis, for
those DHBs not able to
provide
thrombolysis
transport
options
to
regional provider in place
Continue to provide workforce
training to support the delivery
of thrombolysis
- 80 % of staff involved in
stroke care will attend a
credentialling Study Day
Planned (Nursing and Allied
health Staff. This will be
held x2 per year. Day to
include general overview of
Measure





6% of potentially eligible stroke
patients thrombolysed
80% of stroke patients admitted
to a stroke unit or organised
stroke
service
with
demonstrated stroke pathway
Annual Refresher Education
regarding
stroke
pathway
presented at Nursing Annual
Clinical Refresher
Three educations sessions per
year by the stroke CNS to
include Stroke pathway, Stroke
Care/ inclusive of thrombolysis
management
Quarterly
Attendance
at
Midland
Stroke
Network
meeting by lead stroke clinician
and Stroke CNS
Reporting
Quarterly
61
Objective
Actions to Deliver Improved
Performance
Stroke,
swallow,
positioning, thrombolysis,
assessing cognition, Dietary,
Physical assessment and
monitoring
- On commencement into the
Stroke Unit, new staff will
be required to undertake
the Stroke Self Learning
Package- This will be
coordinated by the Stroke
Clinical Nurse Specialist
- Monthly in-service stroke
education held in the stroke
unit- Coordinated by the
Stroke
Clinical
Nurse
Specialist
- Embedding of the FIM
Assessment tool to be used
on all stroke patients- 100%
of staff already trained in
FIM use to be recertified
- 100 % - Acute Stroke team
required to present a topic
at monthly in-service
 Continue to utilise care pathways
for thrombolysis
 Provide dedicated stroke units
or areas for management of
people
with
stroke,
thrombolysis, and transient
ischaemic
attack
services
supported by ongoing education
and training for interdisciplinary
teams
 Maintenance
of
dedicated
stroke unit for management of
people with stroke, thrombolysis
and TIA
 Participation in national and
regional clinical stroke networks
to support implementation and
maintenance of stroke and
thrombolysis services
 Support national and regional
clinical stroke networks to
implement actions to improve
stroke services
Measure
Reporting
Quarterly
Quarterly
Quarterly
Quarterly
2.4.2 Acute Coronary Syndrome
Cardiac services are a national priority service area in our RSP. Disparate access issues and workforce
vulnerabilities exist, but an opportunity exists to make a difference to population health outcomes and
inequalities through a cardiology pathway that is strongly entrenched across the continuum of care
from prevention through to specialist care, and cardiac rehabilitation. The affordability of ever62
emerging new technologies will require focused attention to prioritisation in the future. Development
of the acute coronary syndrome (ACS) pilot is a major focus area for the network.
2.4.2.1 Our Approach
HealthShare through the Midland Action Group are leading the development and implementation of
regional actions.
In 2014/15 we will be continuing the work around the acute coronary syndrome (ACS) project, which is
a major focus for our region. We will continue to engage with our primary care partners in the planning
and implementation activities that occur in this area.
2.4.2.2 Linkages
 Minister’s Letter of Expectations
 Midland DHBs Regional Services Plan 2014/15
 Our Performance Story Impact: People receive timely and appropriate specialist care
2.4.2.3 Action Plan
Objective
Acute Coronary
Syndrome





Actions to Deliver Improved
Performance
The Cardiac ANZACS-QI register
enables reporting measures of
ACS risk stratification and time
to appropriate intervention
Implement the Cardiac Surgical
register that in conjunction with
the ANZACS-QI register will give
full reporting measures to
intervention
Develop processes, protocols
and systems to enable local risk
stratification and timely transfer
of appropriate high risk ACS
patients.
Risk
stratification
enables
angiography to be completed
locally
where
clinically
appropriate
Active participation in regional
cardiac networks to develop
processes,
protocols
and
systems across the region
ensuring timely access to
assessment and intervention.
The regional network will
develop and implement an
agreed acute chest pain
pathway
Measure

Reporting
70% of high-risk patients will
receive an angiogram within
three days of admission. (‘Day
of Admission’ being ‘Day 0’)
Reporting measures will be
available that track through to
intervention
Quarterly

Over 95% of patients presenting
with ACS who undergo coronary
angiography have completion of
ANZACS-QI ACS and Cath/PCI
registry data collection within
30 days
Quarterly

70% of high risk patients will
receive an angiogram within
three days of admission. (‘Day
of Admission’ being ‘Day 0’)
Quarterly

Quarterly
63
2.4.3
Improved Access to Diagnostics
2.4.3.1 Our Approach
Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times
for diagnostics can reduce delays to a patient’s episode of care and improve DHB demand and capacity
management.
We have a number of initiatives underway in terms of diagnostic services. It is planned that these
initiatives will enable an improvement in waiting times.
2.4.3.2 Linkages
 Our Performance Story Impact: People receive timely and appropriate care
 Improved Access to Elective Services
2.4.3.3 Action Plan
Objective
Improved
Access
Diagnostics

to
Actions to Deliver Improved
Performance
Improving diagnostic waiting
times has been identified a
policy priority area for 2014/15.
As a consequence, diagnostic
waiting time indicators are
shifting from a developmental
status to full DHB accountability
measures in 2014/15.
This
means formal performance
targets will be set against the
indicators for 2014/15
Measure






We will work to achieve
identified waiting time targets
by more efficient use of existing
resources;
making
improvements
to
referral
management
and
patient
pathways; and investing in
workforce and capacity as
required
Participate in activity relating to
development
and
implementation of the National
Patient Flow (NPF) system,
including
adapting
data
Coronary angiography – 90% of
accepted referrals for elective
coronary
angiography
will
receive their procedure within 3
months (90 days)
CT and MRI – 90% of accepted
referrals for CT scans, and 80%
of accepted referrals for MRI
scans will receive their scan
within six weeks (42 days)
Diagnostic colonoscopy – 75% of
people accepted for an urgent
diagnostic colonoscopy will
receive their procedure within
two weeks (14 days); and 60%
of people accepted for a
diagnostic colonoscopy will
receive their procedure within
six weeks (42 days)
Surveillance colonoscopy – 60%
of people waiting for a
surveillance
or
follow-up
colonoscopy will wait no longer
than 12 weeks (84 days) beyond
the planned date
Reporting
Quarterly
Quarterly
Quarterly
64
Objective




2.4.4
Actions to Deliver Improved
Performance
collection and submission to
allow reporting to the NPF as
required
Work with regional and national
clinical groups to contribute to
development of improvement
programmes
Work with the Midland Regional
Radiology Group to:
o Scope and implement ereferrals and orders
o Utilise
regional
benchmarking
for
performance improvement
Measure
Reporting
Quarterly
Above indicators are expected for all
DHBs for CT, MRI and colonoscopy.
For coronary angiography, indicators
are expected where those services
are locally provided
 Representation, attendance and
participation in national and
regional clinical group activities
 Agreed system changes are
implemented
Quarterly
Quarterly
Monitor and improve on the
MOH CT and MRI waiting time
indicators
Implement the Global Rating
Scale for Endoscopy with the
support
of
the
National
Endoscopy team
Quarterly
Shorter Waits for Cancer Treatment/Faster Cancer Treatment
2.4.4.1 Our Approach
There is a large amount of work underway around the faster cancer treatment targets including the
appointment of additional nursing staff to co-ordinate the patient journey. A comprehensive database
designed to monitor the timelines of each patient’s care, access to each of the multiple services
involved in cancer care has been created. General Practitioners now flag all referrals for patients with a
high suspicion of cancer and the patients are actively followed up wherever they are in their journey
through the hospital system. The Multidisciplinary Care Coordinators help facilitate this journey for
patients.
2.4.4.2






Linkages
Minister’s Letter of Expectations
National Cancer Programme Work Programme
Midland DHBs Regional Services Plan 2014/15
Central Cancer Network Strategic Plan
Health Target – Shorter Waits for Cancer Treatment
Our Performance Story Impact: People receive timely and appropriate specialist care
2.4.4.3 Action Plan
Objective
Faster Cancer
Treatment
Actions to Deliver Improved
Performance
FCT Indicators
Work with CCN to ensure a
coordinated approach to identifying
Measure

% of patients (by DHB and
ethnicity) referred urgently with
a high suspicion of cancer who
receive their first cancer
Reporting
Quarterly
65
Objective
Actions to Deliver Improved
Performance
and implementing actions to
improve faster cancer treatment
data-collection systems, including:
 DHB FCT IT project implemented
 FCT trackers identify and
implement processes to make
FCT
data
collection
systems/processes
part
of
Business as Usual
MDM Development
Complete phased implementation of
the
regional
Multidisciplinary
Meeting (MDM) Implementation
Plan within allocated funds. Priority
activities:
 Review current MDMs against
the National MDM Standards
 Review MDM access criteria
against nationally developed
criteria and adjust as required
Tumour Standards
Work with CCN to undertake the
following actions to support use of
the tumour standards:
 Analyse the DHBs review of three
tumour standards (different
tumour types to the review
undertaken in 2013-14) to inform
regional service improvement
initiatives
 Implement the regional service
improvement initiatives that
were identified by the review of
the tumour standards in 2013-14
 Work with CCN to develop a
coordinated approach to cancer
pathway development via Map of
Medicine / Health Pathways
projects
Care Coordination
 Support
implementation
of
cancer
nurse
coordinators’
professional development plan,
including attendance at national
and regional training and
mentoring forums
 Continue to work with CCN to
support active patient tracking
Measure


Reporting
treatments
(or
other
management) within 62 days
Baseline - At 30 June 2013 62% for the CCN region
Target – 85%
% of patients referred urgently
with a high suspicion of cancer
who have their first specialist
assessment within 14 days
% of patients with a confirmed
diagnosis of cancer who receive
their first cancer treatment (or
other management) within 31
days
Quarterly
 Reviews completed by June 2015
(Baseline – 2013/14 data) (PP24)
 No. of patients accessing MDMs
for the most common tumour
streams (Baseline - 2013/14
data) – PP24
 Target – to be defined by
National Tumour Standards
Groups by May 2014
 Identification of the three
prioritised tumour standards
for review by Aug 2014
 Reviews completed by June
2015





Implementation
priorities
identified by August 2014
Priorities completed by June
2015
Reviews updated quarterly
Approach developed by Aug
2014
Cancer Nurse Coordinator to
attend National Forum by June
Quarterly
Quarterly
66
Objective
Improved
Waiting Times
for Diagnostic
Services
(Colonoscopy)
Improving
Palliative Care
Actions to Deliver Improved
Performance
aligned to CRISP and national
patient flow
Primary Care
Work with CCN to coordinate a focus
on the front end of the process in
primary care identification of high
suspicion of cancer (HSC), including:
 Implementing
nationally
developed e-referral criteria for
referral of patients with HSC
from primary care as enabled by
CRISP 3.0
TDHB will take a coordinated
approach to identifying actions to
improve waiting times and quality of
endoscopy / colonoscopy services,
including:
 Implementing the Endoscopy
Quality Improvement (EQI)
programme
 identifying and implementing
improvements to colonoscopy
services
 Monitoring waiting times for
diagnostic
and
surveillance/follow
up
colonoscopy
 Undertaking
a
regionally
coordinated
approach
to
implementing
Provation
(endoscopy reporting system)
 Undertaking
a
regionally
coordinated
approach
to
implementing
Provation
(endoscopy reporting system)
Implementation of the Taranaki
Palliative Care Plan (2013-16):
 Implementation of a formal
partnership
model
with
Midlands Health Network (MHN)
to support the provision of
primary palliative care to
patients living in the community


TDHB to formally contract the
in-reach Palliative Care Services
provided by Hospice Taranaki to
Taranaki Base Hospital, and
extend to Hawera Hospital, in
alignment with the Draft
Specialist Palliative Care Service
Specifications
Review the current model of
specialist assessment and care
Measure

Reporting
2015
Number of patients referred to
Cancer Nurse Coordinator per
quarter
Quarterly

E-referral processes in place by
June 2015
ProVation implemented by Jun 2015
Diagnostic colonoscopy:
 75% of people accepted for an
urgent colonoscopy will receive
their procedure within two
weeks (14 days) (PP29)
Quarterly

60% of people accepted for a
diagnostic colonoscopy will
receive their procedure within
six weeks (42 days) (PP29)
Quarterly

% of MHN GPs engaged in MHN
Palliative
Care
Scheme
(establish baseline in 2014/15))
% of MHN GPs who have
completed specialist palliative
care training by Hospice
Taranaki (establish baseline in
2014/15)
Formal partnership document
between Taranaki DHB and
Hospice Taranaki is agreed and
signed by 30 December 2014
Quarterly
Review
undertaken
and
completed by 30 December
Quarterly



Quarterly
67
Objective


2.4.5
Actions to Deliver Improved
Performance
coordination for patients with
complex needs who receive
nursing services from District
Nursing Services in Inglewood
and Mokau
Undertake a Taranaki wide
needs assessment for palliative
care training and develop a
training plan for generalist
palliative care providers
Develop a directory of services
available to those with palliative
care needs (exploring potential
opportunities to utilize the
existing CCN Cancer Directory in
the first instance)
Measure
Reporting
2014



Needs assessment undertaken
and completed by 30 Dec 2014
Palliative Care Training Plan
developed by 31 March 2015
Quarterly
Service Directory developed by
30 June 2014
Quarterly
Cardiac – Secondary Services
HealthShare through the Midland Cardiac Network are leading the development and implementation of
regional actions. Disparate access issues and workforce vulnerabilities exist, but an opportunity exists
to make a difference to population health outcomes and inequalities through a cardiology pathway that
is strongly entrenched across the continuum of care from prevention through to specialist care, and
cardiac rehabilitation. The affordability of ever-emerging new technologies will require focused
attention to prioritisation in the future. Development of the acute coronary syndrome (ACS) pilot is a
major focus area for the network.
2.4.5.1 Our Approach
In 2014/15 we will be continuing the work around the acute coronary syndrome (ACS) project, which is
a major focus for our region. We will continue to engage with our primary care partners in the planning
and implementation activities that occur in this area.
2.4.5.2 Linkages
 Our Performance Story Impact: People receive timely and appropriate specialist care
 Midland District Health Boards Regional Services Plan 2014/15
2.4.5.3 Action Plan
Objective
Cardiac Services



Actions to Deliver Improved
Performance
Intervention rate for cardiac
surgery is set in conjunction
with the National Cardiac
Surgery Clinical Network, to
improve equity of access
Improve access to cardiac
diagnostics
to
facilitate
appropriate treatment referrals,
including
angiography,
echocardiograms,
exercise
tolerance tests, etc
Manage waiting times for
cardiac services, so that no
patient waits longer than five
months for first specialist
assessment
or
treatment.
Measure
Reporting

Agreement to and provision of a
minimum of 84 total cardiac
surgery discharges for local
population in 2014/15
Quarterly

Refer PP29: Improved access to
diagnostics. 90% of people will
receive
elective
coronary
angiograms within 90 days
Quarterly

Elective Services Patient Flow
Indicators: all patients wait four
months or less for first specialist
assessment and treatment from
January 2014
Monthly
68
Objective



Acute Coronary
Syndrome
2.4.6

Actions to Deliver Improved
Performance
Reduce waiting times to a
maximum of four months by the
end of December 2014
Undertake initiatives locally to
ensure population access to
cardiac
services
is
not
significantly below the agreed
rates.
This includes cardiac
surgery,
percutaneous
revascularisation and coronary
angiography
Participation
in
regional
cardiology network activities
Implementation
of
local
cardiology
project
recommendations
Taranaki DHB will Implement the
Cardiac ANZACS-QI and Cardiac
Surgical registers to enable
reporting measures of ACS risk
stratification and time to
appropriate intervention

Taranaki DHB will develop
processes,
protocols
and
systems to enable local risk
stratification and transfer of
appropriate high risk ACS
patients

Taranaki DHB will work with the
midland region, to improve
outcomes for high risk ACS
patients

Embed processes to increase
number of acute angiograms
completed locally

TDHB cardiologists continue to
meet with regional group to
develop regional guidelines
Measure



Reporting
Refer SI4:
Standardised
Intervention Rates
Cardiac surgery: 6.5 per 10,000
of population
Percutaneous revascularisation:
12.5 per 10,000 of population

Coronary angiography: 34.7 per
10,000 of population
Quarterly

Indicator 1. >70% of high risk
Acute
Coronary
Syndrome
patients accepted for coronary
angiography having it within 3
days of admission (Day of
admission=Day
0)
(TDHB
baseline currently 60%.)
Indicator 2 >95% of patients
presenting with Acute Coronary
Syndrome
who
undergo
coronary angiography have
completion of ANZACS Q1 ACS
and Cath/PCI registry data
collection within 30 days
Performance
reported
against
health
target

Performance
reported
against
health
target
Performance
reported
against
health
target
Performance
reported
against
health
target
Performance
reported
against
health
target
Primary Care
2.4.6.1 Our Approach
We will work with our primary care partners.
In addition, DHBs are expected to use their Alliance Leadership Team and any Service Level Alliance
Teams to jointly develop 2014/15 DHB Annual Plans for the following in 2014/15:
69


2.4.6.2



Primary Care (including Rural Health) , and
Prime Minister’s Youth Mental Health Project – Youth Services.
Linkages
Performance Story Impact: People stay well in their homes and communities
Prime Minister’s Youth Mental Health Project – Youth Services.
Strong linkages exist to other primary care focused services such as:
o Shorter Stays in ED
o Increased Immunisations
o Better Help for smokers to quit
o More Heart and Diabetes checks
o Long Term conditions
o Improved Access to Diagnostics
o Maternal and Child Health
2.4.6.3 Action Plan
Objective
Primary Care

Actions to Deliver Improved
Performance
Work programme as agreed by
the Taranaki Alliance Leadership
Team
Measure

Work programme agreed by 30
June 2014
Taranaki
Primary
Options
programme
available
in
Taranaki from 1 July 2014.
Estimated volume 750
30 localised pathways published
by 30 June 2015

Implementation of
Options programme
Primary


Continuation of the localisation
of the Map of Medicine
programme
Supporting the advancement of
the Taranaki Health – Integrated
System programme


Working with general practice to
introduce an improved primary
care overflow and out of hours
service


Rural Service Level Alliance
Team established and a plan for
distribution of the Rural Primary
Care funding developed and
implemented





Primary
access
services
Care
to

TDHB continues to introduce
locally agreed clinical pathways
through the Map of Medicine to
support improved access to
services for primary care.
Including maintenance of direct
GP access to:
1. gastroscopy
2. minor operations list

Work programme to be agreed
by the Taranaki Alliance
Leadership Team by 30 July
2014
100% of Taranaki general
practices using the shared
electronic health record provide
an after-hours summary to ED
by 30 September 2014
Option selected from 13/14
development
work
implemented by 30 September
2014
8% decrease in primary care
presentation in hours to ED
department
Team established and plan
completed by 30 September
2014
Active
Specialist
services
pathways reported
Reporting
Quarterly
70
Objective


2.4.7
Actions to Deliver Improved
Performance
TDHB will maintain and support
specialist advice services for GPs
in their management of patients
in
the
primary
care
environment. These services are
Mental Health and Paediatrics.
Resources for increased access
to community radiology was
provided for last financial year
and TDHB commits to the
maintenance of that funding
level into the 2014/15 year with
an expectation of an additional
3250 RVUs of general radiology
being delivered above the
baseline delivery as identified in
2012/13.
Measure
Reporting

Specialist services pathways
implemented by Quarter 2,
2014.
Quarterly

Primary access to radiology
increased by 3250 RVU’s above
2012/13 baseline of 31,897
RVUs
Quarterly
Health of Older People
2.4.7.1 Our Approach
During 2014/15 we will continue to work with our primary care partners and regional DHBs to develop
and refine integrated services that will address the needs of older people - from those with basic needs
to those whose needs have a greater complexity, working towards a restorative outcome wherever
possible.
During 2014/15 we will continue our focus on establishing a regional approach to the delivery of Home
and Community Support Services. The Midland DHB region will participate in the development of the
national Health of Older People Steering Group’s national framework and on the cost implications of
quality care. Where applicable we will use the framework to inform decision-making about the
implementation of a Midland DHB regional approach.
2.4.7.2



Linkages
Our Performance Story Impact: People receive timely and appropriate specialist care
Midland District Health Boards Regional Services Plan 2014/15
Midlands Health of Older People Clinical Action Network Action Plan
2.4.7.3 Action Plan
Objective
Health of Older
People
Actions to Deliver Improved
Performance
Rapid response and discharge
management services (wrap around
services) (PP23)
Measure
Reporting
Quarterly

TDHB will implement an ED
Rapid Response Service aimed at
identifying elderly with complex
comorbidities and optimising
their management to maintain
functional independence and
reduce avoidable readmission to



Appointment of 1.0FTE Clinical
Nurse Specialist by 1 July 2014
Number of over 65’s who
undergo initial assessment by
the Clinical Nurse Specialist
(establish baseline in 2014/15)
Reduction in over 75s ASH rates
71
Objective
Actions to Deliver Improved
Performance
ED and hospital through the
appointment of 1FTE Clinical
Nurse Specialist who proactively
identifies cases presenting in ED
Home and Community Support
Services for Older People (PP23)
 TDHB will appoint an additional
1FTE Care Manager (an increase
from 7FTE to 8FTE) to work with
older people identified as having
high and complex needs to
ensure timely and effective
assessment using InterRAI Home
Care
 TDHB will use the quality
measures for HCSS as identified
by the DHB HOP Steering Group
 Use of Budget 2013 funding for
home and community support
services
 Use of quality measures for
Home and Community Support
Services identified by the DHB
HOP Steering Group
Dementia Care Pathways (PP23)
Measure

Reduced ED re-presentation for
over 75s

Appointment of 1 FTE Care
Manager by 1 July 2014
An additional 2500 hours/visits
per year of HCSS will be
delivered
above
2013-14
baseline (actual hours delivered
in 2013/14)
Evidence of DHB using interRAI
quality measure to progress and
compare performance with
other DHBs (to be finalised by
HOP Steering Group)


Reporting
Quarterly
Quarterly
Local Dementia Pathway initiatives:
 Continued development and
implementation of the Taranaki
dementia care pathway
 Deliver Living Well Groups
aimed at people recently
diagnosed with dementia and
their carers
 Ongoing education to the
primary care sector on use of
the dementia care pathway
 Continued development and
implementation of Taranaki
dementia care pathway
Local Dementia Pathway initiatives:
Regional
Dementia
Pathway
initiatives
 Work with Midland DHBs to
implement region-wide Primary
Dementia Education Programme
including dementia workshop,
education
and
resource
development to support use of
the Map of Medicine dementia
pathway across the Midlands
Region
Regional
Dementia
Pathway
initiatives):
 Map of Medicine hits per GP
practice
 Map of Medicine hits per GP
 Referrals to Alzheimers New
Zealand



Dementia care pathway in place
1 July 2014
2 Living Well Groups by end
June 2015
10 GP practices have dementia
care pathway packs in place and
have received education
72
Objective
Actions to Deliver Improved
Performance
Fracture Liaison Service (PP23)


TDHB will recruit 0.5 FTE
Fracture Nurse Coordinator to
establish and manage the
fracture liaison service from 1
July 2014
Full operation of a fracture
liaison service
Measure
Quarterly





0.5FTE
Fracture
Nurse
Coordinator is appointed by 1
July 2014
Number of over 65s identified
as having fragility fractures
referred for assessment by the
fracture
liaison
nurse
coordinator (establish baseline
in 2014/15)
Number of over 65s assessed by
the Fracture Liaison Nurse and
referred for bone density scans
(establish baseline in 2014/15)
Number of over 65s assessed by
the Fracture Liaison Nurse and
treated
with
appropriate
medication in line with pathway
(establish baseline in 2014/15)
Reduction in current number of
fractures NOF for over 65s as
measured
against
12-13
baseline data (currently 102 in
2013/14)
Comprehensive Clinical Assessment
in Residential Care (interRAI) (PP23)




TDHB will provide ongoing
support to the InterRAI long
term care facility training
programme
through
the
provision of TDHB training
facilities and support from the
TDHB lead practitioner as
required
TDHB will continue to actively
support aged care facilities to
take up InterRAI training
Facilities trained or engaged in
training in the use of interRAI
DHBs supporting the uptake of
interRAI training
Quarterly




All aged residential facilities in
DHB area using, or training their
nurses to use, the interRAI LTCF
assessment tool
Evidence of how the DHB has
supported the uptake of
interRAI training (e.g. provision
of training facilities at no cost,
provision of support through
TDHB Lead Practitioners)
100% of aged residential care
facilities in TDHB area are using
the InterRAI LTCF assessment
tool by June 2015
Narrative
report
outlining
actions TDHB has taken to
support update of InterRAI LTCF
training
HOP Specialists (PP23)


Proactive use of DHB specialist
Health of Older People Services
(geriatricians, gerontology nurse
specialists) to advise and train
health professionals in primary
care and aged residential care
TDHB will continue the proactive
use of DHB specialist HOP
Reporting
Quarterly

The DHB has increased the
number of hours that specialist
HOP services consult with health
professionals in primary care
and aged residential care
(‘maintain’ rather than increase
if already at an optimal level) or
used another relevant measure
to show an increase or
73
Objective
Actions to Deliver Improved
Performance
services
(Geriatricians,
Gerontology Nurse Specialist) to
advise
and
train
Health
Professionals in primary care
and aged residential care
 TDHB has reviewed the role of
the current Aged Care Nurse
Consultant. This role will now
be expanded to become a
Gerontology Nurse Specialist
role that provides practical,
hands on clinical support and
advice to aged residential care
facilities caring for residents
with high and complex needs
with the aim of reducing
avoidable ED and hospital
admissions. Referrals will come
via ED and following hospital
discharge, or via TDHB Care
Managers/Geriatricians
following reassessment within
an aged residential care facility
Regional Alignment:

2.4.8
Continue to engage with
Midland DHBs in development
of the new service model and
funding model for restorative
home support
Measure
Reporting
maintenance at optimal level
(eg using FTEs rather than
hours)

Maintain the number of hours
that specialist HOP services
consult
with
health
professionals in primary care
and aged residential care at 250
hours per quarter

Employment
of
1
FTE
Gerontology Nurse Specialist to
work with complex clients in
aged residential care
Number of clients care managed
by Gerontology Nurse Specialist
– establish baseline
Reduction in presentation rates
to ED from aged residential care


Quarterly

New service and funding model
implemented 30 June 2015.
TBC at regional level
Mental Health Service Development Plan
2.4.8.1 Our Approach
A number of the planned actions in this area have been developed in association with the other four
DHBs in our region.
2.4.8.2



Linkages
Our Performance Story Impact: People receive timely and appropriate specialist care
Midland District Health Boards Regional Services Plan 2014/15
Mental Health and Addiction Service Development Plan
2.4.8.3 Action Plan
Objective
Mental Health
Service
Development
Plan
Actions to Deliver Improved
Performance
1. Make better use of
resources/value for money

Continued participation in Adult
and Child and Youth Key
Performance Indicator Forum –
The adult KPI forum will focus on
the agreed national KPIs for
improvement. KPI data used to
improve performance
Measure
See Module 7 – non-financial
performance measures. Measures
no: PP6, PP7,PP8 ,PP26 & OS10
 Improving the health status of
people with severe mental
illness PP6
Reporting
Quarterly
74
Objective
Actions to Deliver Improved
Performance
Measure

December 2014 – Provider Arm,
NGO partners will attend KPI
forums and implement at least
1 quality improvement activity

Expand access and decrease
waiting times

Increasing number of patients
with relapse plans in place
through review of current plans
and completion of new plans
(excludes addictions)

60% of patients have relapse
plans by June 2015. Milestone
of 50% at end December 2014

Service redesign of adult intake
processes to decrease waiting
times and improve flow for
newly referred patients

Waiting
time
for
adult
outpatient services is reduced to
achieve the targets in PP8 by
June 2015. Milestone of 80%
being seen <= 3 weeks and 95%
being seen <= 8 weeks to be
achieved by end December 2014
Continue to monitor the existing
discharge delay codes within the
inpatient
unit
to
better
understand reasons for delayed
transfers of care
2. Improve integration between
primary and specialist services

Type and number of discharges
recorded to establish baseline

Quarterly

Implementation
of
project
outcomes
from
2013-2014
Midland Health Network and
Specialist Mental Health and
Addictions Services Primary
Secondary Integration – shared
care etc

Develop a project scope for
management of non-complex
Clozapine in primary care

Project scope completed by
September 2014. Aim for initial
patients to be managed in
primary care by June 2015
Provide education and training
for GPs on management of
patients with addiction through
day training event with open
invitation
3. Cementing and building on gains
in resilience and recovery with for
people
with
low-prevalence
conditions and/or high needs

Training content decided by
September 2014 and training
completed end June 2015


By
July
2014
final
reconfiguration for Residential
services implemented
By December 2014 models of
care for redesign of nonresidential services complete

Implementation of new models
of care for residential services –
increasing the options of
services to enhance active
intensive rehabilitation and
recovery and ensuring resources
Reporting

75
Objective
Actions to Deliver Improved
Performance
are flexible and able to
transition with tangata whaiora
through their recovery journey
Measure

By June 2015 implementation of
service re-design for nonresidential services complete
TDHB will facilitate people’s
access to parenting support
programmes through improved
data collection and embedded
referral pathways. The data will
be collected through initial
assessment and development of
management plans
4. Deliver increased access for all
age groups

Audit of initial assessment for
data collection and audit of
management plans – baseline to
be established by December
2014 with aim of 50%
appropriate management plans
by June 2015

To reduce DNA rates through
range of activities including
exploring options for using the
‘Text To Remind’ system to send
a text message to service users
reminding them of their
appointment, surveying patients
to ask them why they do not
attend and looking at DNA rates
across teams

Review service entry and exit
criteria for community service
users against current client base
– review service users with subclinical HONOS scores for
potential discharge from service



Quarterly

Current DNA rate 8.75%. Aim to
reduce to 8.5% by December
2014 and less than 8% by June
2015
Current sub-clinical HONOSCa
= 9%.
Current
sub-clinical
HONOS = 8.5%. Aim to utilise
HONOS
sub-clinical
data
routinely to assist MDTs in
decision making regarding entry
and exit. Assess utility via
internal audit and report
acceptance of new referrals &
discharges across all services
monthly
Outcomes Champions Group to
establish agreed sub-clinical
reduction targets by December
2014 based on good clinical
practice in combination with
outcomes data such as HONOS
Implementation of the New Zealand
Suicide Prevention Strategy 20062016 and the New Zealand Suicide
Prevention Action Plan 2013-2016.
Submission of District Suicide
Prevention and Postvention Plans
for review in the second quarter
reporting




Annual ASIST training offered to
Primary Care, School Counsellors
and other health and non-health
professionals
working
with
young people
Establishment of a local interagency collective with other lead
agencies to implement the
Action Plan
TDHB’s Plans to be finalised to
include training health workers
to identify and support etc
Reporting


Quarter 2
Number of training sessions
offered. Numbers and types of
professionals taking up training
– reporting in accordance to the
PMHI quarterly reporting
Six monthly reporting from
agencies against milestones in
the plan
Plans in place December 2014
76
Objective


Drivers of Crime
and Welfare
Reforms



2.4.9
Actions to Deliver Improved
Performance
Established working group with
the following local agencies who
are part of the Suicide
Prevention Action Plan – MSD
(CYF),
MYD,
MOE,
MOJ,
Corrections
Mental Health and Addiction
Service provision ring-fence will
be maintained as per MoH
expectations of 2013/14 Funder
expenditure plus CCP of 0.61%.
Continued delivery of the
actions and outcomes from the
South Taranaki Social Sector
Trial. Also refer Youth Mental
Health Section
Improving maternity and early
parenting support. Also refer
sections for Maternal and Child
Health and Children’s Action
Plan
o Implementation
of
identified actions from the
Phase II, Perinatal and
Infant
Mental
Health
Midlands Regional Project
Continue to proactively work
with other agency partners,
MSD including CYP, investing in
Services for Outcomes (ISO),
Education, Corrections, Policy, to
develop and embed a way of
working together that improves
outcomes for the population
that accesses multiple services.
Also refer Youth Mental Health
and Children’s Action Teams
Measure
Reporting

Plans in place December 2014

Financial expenditure records
increased expenditure

Monthly monitoring of actions
and milestones against the
Social Sector Trial Action Plan
Quarterly


Monthly reporting to the Board
Quarterly
Midland
Mental
Health and Addictions Regional
Network reporting
Quarterly

Quarterly reporting
interagency activity
Quarterly
against
Maternal and Child Health
2.4.9.1 Our Approach
We intend to undertake actions to improve the access that pregnant women, babies, children and
families have to services that maintain good health and independence through:



2.4.9.2



Supporting them to enrol with a GP and Well Child Tamariki Ora (WCTO) provider as early as
possible
Alerting health providers when a child or young person is due for a health milestone
Better informing all providers about the progress of a child or young person
Linkages
Our Performance Story Impact: People stay well in their homes and communities
Our Performance Story Impact: People take greater responsibility for their health
Midland District Health Boards Regional Services Plan 2014/15
77
2.4.9.3 Action Plan
Objective
Actions to Deliver Improved
Performance
Timely
Registration
with an LMC
Newborn
Enrolment

Measure
TDHB will increase the number
of women who register with an
LMC by week 12 of their
pregnancy by
o Monitoring numbers at the
MQSP Meetings
o Maintenance and update of
the ‘Find Your Midwife’
website
o Ensuring
midwife
availability is known
o GP education to have
patients
contact
the
Maternity Unit if they are
unable to find a Midwife
All newborn babies are enrolled with
a PHO and registered with a GP, Well
Child Tamariki Ora (WCTO) provider
and Community Oral Health Services
by:



Increase new-born enrolments
from 66% to 88% by December
2014 at 2 weeks of age

100% of new-borns are enrolled
with general practice by 6weeks,
measure B code uptake

Continuing to ensure all babies
are enrolled at discharge from
the Maternity Unit
o Education of parents and
written information given on
discharge to support this
o Monitor and audit use of the
discharge checklist to ensure
all relevant services are
discussed with the parents
and babies are enrolled
o Continue to work with Maori
Health to ensure babies are
registered for oral health
services at birth – opt out
system in place to gain
consent
for
contacting
parents for enrolment their
child later on
Through the Taranaki WCTO QIF
– Access Indicator 1 – New-borns
are enrolled with a PHO by two
weeks of age. Work towards
100% enrolment.
o Monitoring of the WCTO
Quality
Improvement
Framework
(QIF)
Implementation Plan for
Indicator 1 – new-borns are
enrolled with a PHO by three
months of age
At least 80% of women register
with an LMC by week 12 of their
pregnancy
Reporting
Quarterly
Quarterly

By December 2014 delivery
against identified actions in the
WCTO QIF Plan
78
Objective
B4
Checks
School
HPV
Oral Health
Actions to Deliver Improved
Performance
Measure
 Maintain B4 School Check
coverage to 90% of the eligible
population
 Providing additional B4 School
Check
Clinics
to
support
increased coverage
 Reducing the enrolment age
from 4.7 to 4.1 to enable more
time to capture the children
 Enrolments of preschool- Maori
children under 5 years of age will
increase from 59% in July 2014 to
70% by July 2015
Quarterly
 Monitoring of the following
indicators:
o % of parents who wish to
opt
out
from
being
contacted
around
enrolment
o % of children who are
enrolled but have never
attended an appointment
o Number
of
preschool
children newly enrolled
monthly
Quarterly
 At least 90% of children receive a
B4 School Check, including at
least 90% of children living in
high deprivation areas
 At least 70% of girls have
received dose one, 65% of girls
have received dose two and 60%
of girls have received dose three
– To be confirmed
Quarterly
 Routinely recalling all those who
DNA
 Combining VHT and B4 School
Checks in high needs areas to
reduce the number of visits for
patients
 TDHB will continue a school
based HPV programme starting
February 2014 via the Public
Health
Nurses
including
education, sessions for parents
and children
 Auditing of IT database Titanium
to match with DHB Patient
Management System to identify
and contact those currently not
enrolled
 Mobile dental units being
utilised more efficiently during
school holiday time
 Family based checks continue



Text to remind changing to a
local 0800 number to ensure
more texts are sent back
Implementation of the actions
from the Menemene Mai Oral
Health Project – aiming to
improve the oral health among
Maori children thus reducing the
disparity in oral health outcomes
between Maori and Non-Maori
Delivery against the Taranaki
WCTO QIF Indicator 16 –
Children are caries free at five
years of age
Reporting
Monthly &
Quarterly
 Monitoring 14/15 achievement
against targets as listed below
 PP10 Oral Health DMFT Score at
Year 8 is 0.9
 PP11 – 62% of five year olds
carried free
 PP12 - 85% adolescent utilisation
Quarterly
Quarterly
 PP13 - 85% of preschool enrolled
and 10% of children overdue for
their scheduled examination
Quarterly
 Increasing the numbers of Maori
children who are caries free at
five years of age from 35%
currently to 40% by December
2014
Quarterly
79
Objective
Actions to Deliver Improved
Performance
Services
for
Pregnant
Women,
Babies, Children
and Families
Services for pregnant women,
babies, children and families are of
high quality and are nationally
consistent:
 TDHB will provide services for
pregnant
women,
babies,
children and families that are of
high quality and are nationally
consistent by:
o Maternity
Quality
and
Safety programme (MQSP)
meeting regarding TDHB’s
care and clinical outcomes
with actions relating to
these occurring
o Mental health pathway for
pregnant
women
–
implementation
to
be
continued
o Continuing to work closely

with Maori health to
capture vulnerable women
and families to ensure
earlier
access
to
appropriate services
o Rollout of second phase of
the
Midland
Regional
Perinatal and Infant Mental
Health project. Working
across agencies
 To develop and establish a
referral process and pathway for
hospitalised pregnant smokers
to Mana Wahine Hapu and
specialist smoking cessations
services by December 2014
Links to Smoking Cessation Section
 By August 2014 development of
the training plan for Hospital
Midwives and LMC’s furthering
education and resources for
smoking cessation
 Reporting against WCTO QIF
Plan Outcome: Indicator 19 –
Mothers are smokefree at two
weeks postnatal
 Continue
to
implement
Maternity Quality and Safety
Programme,
identify
local
quality improvement priorities
that include addressing National
Maternity Monitoring Group
priorities, DHBs who are outliers
in the NZ Maternity Clinical
Indicators put programmes in
place to reduce unnecessary
variation in clinical practice
Maternity
Quality
Safety
&
Measure
Reporting
Quarterly
 Improved performance against
WCTO
Quality
Indicators
measuring access as agreed with
MoH
 Quarterly Regional and local
Reporting
against
project
milestones.
 Reporting against the MQSP
milestones
 Improved quality and safety of
maternity services including
improved access, outcomes and
consumer
satisfaction
as
measured by national and DHB
data analysis and surveys,
reduced
variation
in
performance against the NZ
Maternity Clinical Indicators
Quarterly
80
Objective
Gestational
Diabetes
Actions to Deliver Improved
Performance


Improving
Breastfeeding
Rates



Mama
Pepe
Hauora
Programme on
Improving
Maternal
Nutrition and
Breastfeeding
Implement
the
national
guidelines for the screening,
diagnosis and management of
gestational diabetes
TDHB awaits the national
guidelines for the screening,
diagnosis and management of
gestational diabetes and will
implement when appropriate to
improve the care for Taranaki
women (expected to be released
in early 2014)
Expand Breastfeeding Welcome
Here (BFWH) framework
Maintain the Baby Friendly
Community Initiative (BFCI)
Continue to deliver the Peer
Support Counselling Service
 Complete
the
Lactation
Consultant
Scholarship
Programme
 Reporting against WCTO QIF
Plan Outcome: Indicator 13 –
Infants are exclusively or fully
breastfed at three months of
age
To improve women’s health during
pregnancy and the post-natal period
through promotion of healthy eating
and physical activity :
 Supporting
five
priority
communities
to
develop,
implement, and evaluate at least
one new maternal and child
physical activity and nutrition
initiative in each community
 Promote healthy feeding of
babies including encouraging
and supporting breastfeeding
 Expanding the Breastfeeding
Welcome
Here
(BFWH)
framework to accredit a
minimum of two workplaces,
early childhood providers, or
other settings in each of the five
priority communities
 Maintaining accreditation and
expanding the content of the
Baby
Friendly
Community
Initiative (BFCI) with the existing
four providers to include
maternal and child physical
activity and nutrition
Measure
Reporting
 A nationally consistent approach
to the screening, diagnosis and
management of gestational
diabetes
 By July 2014 the four chosen
indicators with actions will be
and
targets
will
begin
implementation.
Monitoring
through quarterly reporting
Quarterly
 By December 2014 10 settings in
the community will be BFWH
accredited
 By June 2015 all three
organisations achieve
annual
BFCI education status
 By June 2015 120 New Peer
Support Referrals received
 All four recipients become
registered Lactation Consultants
by November 2014
 By December 2014 delivery
against identified actions in the
WCTO QIF Plan
6 Monthly
 By December 2014 Active
Movement
Training
in
a
minimum of 20 settings in the
five priority communities will be
delivered
 Five new initiatives planned,
implemented and evaluated by
June 2014
6 Monthly
 By July 2014 six new Peer
Support Counsellors are trained
6 Monthly
 By December 2014 10 settings in
the community will be BFWH
accredited
6 Monthly
 Each organisation will undertake
annual education (including
physical activity and nutrition) to
maintain BFCI standards to
achieve reaccreditation
6 Monthly
Quarterly
6 Monthly
6 Monthly
6 Monthly
6 Monthly
6 Monthly
81
Objective
Actions to Deliver Improved
Performance

2.5
Measure
To promote healthy feeding
(including the introduction of
healthy first foods) and physical
activity of children at pre-school
age
Reporting
 By December 2014, Mama Pepe
Hauora Toolkits delivered to 20
organisations/groups across five
priority communities
6 Monthly
NATIONAL ENTITY INITIATIVES
2.5.1 Our Approach
We are expected to align our planning with the planning intentions key national agencies. Each of
these national agencies has initiatives for the 2014/15 year, which will impact on our DHB. The
following table outlines the initiatives each agency has identified as a priority.
2.5.2


Linkages
Midland District Health Boards Regional Services Plan 2014/15
Module 4 – Financial Performance
2.5.3
Action Plan
Initiative
Brief Description
Summary of Strategic
Rationale
Key Actions Taranaki DHB
will undertake to
contribute to the initiative
HBL and DHBs are working
together to implement a
national
Finance,
Procurement and Supply
Chain
programme
to
combine their purchasing
power
through
standardising the ways
goods and services are
ordered, delivered, stored
and paid.
HBL and DHBs are currently
assessing options as part of
completing the detailed
business case for reducing
the costs of Food services.
It is a priority to improve the
overall quality of hospital
food service to ensure good
nutrition for all patients.
Detailed
business
case
forecasts saving of $538
million over ten years - from
an investment of $88 million
- with all the savings being
reinvested
back
into
supporting frontline health
services.
The DHB will commit
resources
to
the
implementation of HBL’s
FPSC initiative, and fully
factor in expected budget
benefit impacts.
The Indicative Case for
Change
identified
the
potential for savings of $10
million a year.
HBL and DHBs are currently
assessing options as part of
completing the detailed
business case for reducing
the costs of Linen & Laundry
services, while improving
service delivery quality.
The Indicative Case for
Change
identified
the
potential for savings of $7
million a year.
The DHB is committed to
working in partnership with
HBL to progress the Food
Services, Linen and Laundry
Services
and
National
Infrastructure
Platform
business cases. The DHB will
commit resources to the
decision reached in relation
to these Detailed Business
Cases.
As above.
Health Benefits
Ltd (HBL)
Finance,
Procurement &
Supply Chain
Food
Linen & Laundry
82
National
Infrastructure
Platform
Human Resources
Management
Information
Systems
Banking &
Insurance
The vision is for a national
infrastructure platform with
agreed
standards
and
policies and a single
governing
organisation,
delivered out of significantly
fewer than the 40-50
current
physical
data
centres. It will also align the
health
sector’s
infrastructure services with
the Government’s overall
Information
Communications
Technology
goal
of
harnessing technology to
deliver better, trusted public
services.
The Indicative Case for
Change for a staged
approach
to
seeking
improvements to Human
Resource
Management
Information Systems, not
payroll systems, is to be
shared with DHB CEOs in
early 2014. It focuses on
improved
workforce
management practices.
Collective
approach
to
national
banking
arrangements across 20
DHBs
for
transactional
banking
services,
cash
management and working
capital
facilities;
plus
collective
approach
to
insurance cover for DHB
assets.
Financial modelling in the
Indicative Case for Change
indicated that over the first
5 years (transition phase) a
range of $71.4 - $169.8m in
cost avoidance could be
achieved.
As above.
Improved
workforce
management practices are
expected to lead to cost
savings - which will be
confirmed as part of any
decision made to proceed to
a next stage.
The DHB will commit
resources to the decision
reached in relation to
progressing the Indicative
Case for Change for the
Human
Resources
Management Information
Systems initiative to the
next stage.
Case already approved and
actions underway. Actions
have led to avoided costs which are expected to
amount to around $4.5m for
banking in 2013/14 and
$11m for insurance in
2013/14
The DHB will continue to
support
the
collective
approach to banking and
insurance
to
ensure
maximum benefits are
realised.
Implementation
of
electronic reconciliation of
medicines on admission and
discharge from hospital.
Without
medicines
reconciliation, studies have
shown that there is up to a
50% error rate in the
patient's drug chart. eMR
reduces this rate to below
10%.
eMR enhances both patient
safety, the quality of clinical
decision-making and the
efficiency of managing the
patient's drug chart.
The DHB is aligned with the
NHIT
Board
and
is
committed to the agreed
implementation plan for the
pilot
of
eMedicines
Reconciliation (eMR).
National Health
Information
Technology
Board
eMedicines
Reconciliation
(eMR) with
eDischarge
Summary
In 2014/2015 the DHB will
upgrade
the
current
eMedicines Reconciliation
system to the latest version
and
progress
the
implementation as per the
programme.
83
Regional Clinical
Workstation (CWS)
and Clinical Data
Repository (CDR)
Implementation
of
a
regional
Clinical
Workstation
(Orion,
Concerto) and Clinical data
repository (mixed products).
The CWS is a web based
system, accessed via a single
sign-on
that
connects
multiple clinical applications
and data sources to provide
clinicians with secure access
to
patient
data.
Replacement of
Legacy Patient
Administration
Systems
National Patient
Flow
Self-Care Portal
A CDR is a database of
patient identifiable clinical
information
such
as
medications,
laboratory
results, radiology reports,
care plans, patient letters
and discharge summaries.
The 8 DHBs with legacy PAS
need
to
progress
implementation
of
a
supported system that is
aligned with the regional
plan.
The PAS supports and
manages the administrative
details of a patients
encounter with a hospital or
DHB service. It supports the
management of the hospital
resources used to provide
patient care such as clinical
staff, rooms, beds and
equipment.
National Patient Flow will
create a new national
collection that provides a
view of wait times, health
events and outcomes in a
patient’s journey through
secondary and tertiary care.
Portals are an on-line IT tool
that will enable individuals
to have access to their own
health information. It will
also allow hospital based
services, in particular, ED, to
have access to a summary
view of primary care
information.
Clinical Workstation and
Clinical Data Repository
allow a patient centric view
of clinical information from
a hospital (or community)
setting. It is the basis for a
regional electronic health
record and is the essential
platform enabling support
of
other
high
value
functionality
like
eMR,
electronic
orders,
and
results
sign-off.
It will also support a
person's on-line access to
their own health record
The deployment of CWS
(including the supporting
CDR) will be considered as
part
of
the
eSPACE
programme roadmap and
rolled out in line with
clinical
and
business
priorities
and
Midland
release planning.
Hospital
based
patient
administration systems are
a fundamental enabler to
support other high value
functionality, like Clinical
Workstation and National
Patient Flow. 8 DHB's need
to replace their obsolete
systems
The DHB is aligned with the
Regional
Patient
Administration
System
(PAS).
National Patient Flow aligns
with the vision of better
integrating care so that
patients can receive the
appropriate services, in the
right setting and in a timely
way to improve overall
health outcomes. Patients,
referrers and providers
need to better understand
demand for services and
waiting times.
This is an essential delivery
to achieve the IT Board's
vision of “a core set of
personal health information
available to [patients] and
their treatment providers
regardless
of
setting".
Portals will enable people to
take more control of their
The DHB commits to
collecting First Specialist
Assessment (FSA) referral
information,
including
outcomes of referrals, from
July 2014 (Phase 1); and to
collecting
Phase
2
information from July 2015.
Waikato and Lakes DHBs will
be the only Midland DHBs to
deploy in 2014/201515 and
further deployment at other
DHBs, will need to be
confirmed.
Note that Taranaki already
uses the Orion Concerto and
Sysmex Éclair products
locally.
The current PAS will be
upgraded to the latest
version during May/June
2014.
The
development
and
delivery of Self Care portals
will be considered as part of
the eSPACE programme
roadmap and rolled out in
line with clinical and
business priorities
and
Midland release planning.
84
In later phases, it will enable
patients to communicate
with their primary health
practitioners
and
add
information to their health
record.
Each of the General Practice
Patient
Management
System (PMS) vendors are
developing portals, and
Orion Health is developing a
portal in conjunction with
Canterbury DHB eSCRV
project.
own care. They will change
the way care is delivered
and save time for patients
and
practices.
Recent surveys indicate that
15 to 20% of patients are
interested in enrolling for
portal access.
DHB support for ongoing
hosting costs of the national
surveillance data warehouse
from July 2015.
Goal - Removal / reduction
in preventable patient harm
resulting from surgical site
infections throughout the
New Zealand Health and
disability sector
National and local surgical
site infection surveillance
system
to
generate
verifiable information that
drives practice change and
improvement
The DHB will commit to
meeting infection control
expectations in accordance
with Operational Policy
Framework - Section 9.8.
Patient
experience
indicators help measure and
report how consumers and
patients actually experience
the health system – what
happened to them and how
did it make them feel?
By
capturing
this
consistently and coherently
across New Zealand’s health
system, this information can
be used to make substantial
improvements to both the
experience and the actual
quality of care received.
The DHB commits to
surveying
patient
experience of the care they
received using the national
core survey, at least
quarterly.
Building sector capability
and clinical leadership and a
culture of quality and safety
improvement
The
DHB
will
meet
expectations in accordance
with Operational Policy
Framework Section 9.3 &
9.4.6.
Health Quality
and Safety
Commission
Surgical site
infection
programme (SSIP) National Infection
Surveillance Data
Warehouse
Surgical site
infection
programme (SSIP) DHB Infections
Management
systems (ICNet NG
system)
Patient experience
indicators
Capability and
Leadership
DHB adoption of ICNet NG
Infections Prevention and
Control Systems investment
and
implementation
including local integrations.
Both
Hospital
and
Community with National
hosting.
The Commission now holds
the licence for the use by
DHB's of Picker’s inpatient
survey questions. About 40
of these which have a close
relationship with the four
“domains”
of
patient
experience (communication,
partnership, co-ordination
and physical and emotional
support)
Programmes to support
improvement science and
increased clinical leadership.
The DHB will continue
development of infection
management systems at our
local DHB level.
85
E-medicine / E
prescribing
Joint work programme with
NHITB for an electronic
system to access patient
medication information
Improved
electronic
medication management
The DHB will continue to
commit resources to
support the current
ePrescribing and eMedicines
installation in place within
the agreed priority areas by
[date].
One of HWNZ’s priorities is
to have 100 diabetes nurse
prescribers either in training
or trained by July 2014. To
date
diabetes
nurse
prescribers have been in
secondary services. This
initiative could potentially
be rolled out to include
more
general
practice/community nurses
working
in
diabetes
management.
The
General
Practice
Education
Programme
(GPEP)
includes
opportunities for registrars
to complete the equivalent
of at least 120 days' training
alongside
a
doctor
registered in a vocational
scope other than general
practice.
Training
opportunities for the group
of registrars entering year 2
of their training need to be
available in DHB-funded
services from 1 December
2013.
The sonographer workforce
needs to grow by 300 full
time
equivalent
(FTE)
employees over the period
to 2023, more than double
the current FTE numbers, to
enable more timely delivery
of healthcare services, and
to meet increased demand
from demographic change
and growth of sonography
as a diagnostic tool.
Increasing the numbers of
Diabetes Nurse Prescribers
will contribute to improving
services being offered for
diabetes
enabling
healthcare to be delivered
closer to home. Increasing
the numbers of Diabetes
Nurse Prescribers will also
free up Diabetes Specialists
to
manage
complex
patients.
The DHB supports the
regional approach being
taken to addressing key
workforce requirements on
diabetes nurse prescribers.
GPs who have gained
knowledge and experience
from working with doctors
of other vocational scopes
will
have
enhanced
understanding of the work
of DHBs, will be able to
deliver improved patient
care, and are expected to
actively
reduce
acute
admissions.
The DHB supports the
regional approach being
taken to addressing key
workforce requirements on
GPEP 2 registrars.
Current
numbers
of
sonographers across both
the public and private
sectors are unable to meet
demand in many places and
without
workforce
development,
healthcare
services
will
be
compromised.
The DHB supports the
regional approach being
taken to addressing key
workforce requirements on
sonographers.
Health Workforce
NZ
100+ diabetes
mellitus nurse
prescribers either in
employment or in
training by 1 July
2014.
Implementation of
training
requirements for
GPEP2 registrars to
train with doctors
of other vocational
scopes.
Sonographer
workforce
86
Implementation of
the new 70/20/10
funding criteria for
post-entry training
in medical
disciplines,
effective from 1
January 2014
The funding model is part of
the DHBs' new medical
contract for post-entry
training agreement with
HWNZ that comes into
effect on 1 January 2014.
The new funding model
replaces the previous bulkfunding
approach
and
provides
a
more
transparent, inclusive and
fair process. The model was
developed by the HWNZ
Board and NHB and seeks to
clearly identify what training
HWNZ is purchasing.
The DHB will support the
growth of the medical
workforce
by
aligning
training funding to the
70/20/10 model to be
implemented by July 2015.
Burden of Disease
Review
Prioritise
future
work
programmes by undertaking
review burdens of disease
for two or three major
programme budget spends.
Likely to be musculoskeletal, endocrinology and
cancer. A second tier of
work will analyse specific
disease states for suitability
to
undertake
Health
Technology Assessments
The DHB will support the
NHC work programme by
engaging with and providing
advice on the burden of
disease documents.
Sector Referral
Round
Call for sector to refer
significant technology issues
to the NHC for assessment.
Development of
recommendations
and
implementation
strategies
Working
and
Advisory
groups to the NHC to
facilitate the development
of recommendations the
sector will be able to
consistently implement.
Ensure clinical outcomes are
improved and the cost curve
for health is bent by using a
programme
budget
to
identify large and fast
growing
health
sector
spends where there are
pathways of care which
deliver outcomes which can
be improved and there is a
reliance on technologies for
which the evidence is
untested.
Ensure clinical outcomes are
improved and the cost curve
for health is bent by
identifying
new
and
significantly
expanding
technology cost drivers for
the sector which are not
captured by the NHC
through the burden of
disease review process.
Consistent implementation
of recommendations is
essential to being able to
realise improved pathways
of care and notional savings.
National Health
Committee (NHC)
The DHB will support the
NHC work programme by
referring technologies that
are driving fast-growing
expenditure to the NHC for
prioritisation
and
assessment
where
appropriate.
The DHB will support the
NHC work programme by
providing expert clinical
opinion to working and
advisory groups on health
technology
assessments
where possible.
The DHB will not introduce
emerging
technologies
where
the
NHC
has
recommended that these
technologies should not be
introduced.
87
Identification of
notional savings
Working
and
Advisory
groups to the NHC to
facilitate the development
of recommendations the
sector will be able to realise
notional savings from.
Consistent implementation
of recommendations is
essential to being able to
realise improved pathways
of care and notional savings.
Health Innovation
Partnership
Trial promising technologies
outside business as usual
while evidence is gathered
for final recommendations.
Development of
regional
prioritisation
networks
Improve capability and
capacity for consistent
health
technology
prioritisation for issues
which are significant at a
regional level.
Hold technologies, which
may be useful, but for which
there
is
insufficient
evidence, out of business as
usual while the evidence is
gathered in a standardised
manner
Ensure clinical outcomes are
improved and the cost curve
for health is bent by
identifying
new
and
significantly
expanding
technology cost drivers for
the sector which are not
sufficiently material at a
national
level
to
be
captured by the NHC
through the burden of
disease review and referral
round process.
The DHB will support the
NHC work programme by
providing expert business
opinion to working and
advisory groups on health
technology
assessments
where possible.
The DHB will support the
NHC work programme by
providing clinical research
time to design and run field
evaluations where possible.
The DHB will support the
NHC work programme by
referring technologies that
are driving fast-growing
expenditure and that have
not been prioritised for
assessment at a national
level, to the Regional
Prioritisation
Network
where appropriate.
Health Promotion
Agency
Health
target
promotional
activities
Alcohol and
pregnancy
HPA is often requested to
undertake national health
promotion activities to
support the achievement of
Government health targets.
Our draft objectives for this
work programme are to
make
significant
contribution toward the
prevention of children being
born with Fetal Alcohol
Spectrum Disorder (FASD)
by: 1.reducing the number
of
women
consuming
alcohol while they are
aware they are pregnant or
planning
to
become
pregnant 2.increasing public
awareness of the risk
associated with alcohol
consumption
during
pregnancy 3. supporting
health
professionals
(particularly
GPs,
obstetricians,
midwives,
well-child nurses, and other
primary care providers) to
respond in a routine
This aligns to Government
health priorities, health
outcome
impacts,
and
health system enabler
The DHB will support
national health promotion
activities around the health
targets.
Aligns with Government
priorities,
particularly
around the child health
action
plan
and
the
recommendations by the
Health Select Committee
The DHB will support work
undertaken by the Health
Promotion
Agency
on
preventing Fetal Alcohol
Spectrum Disorder.
88
effective and consistent way
to women who are drinking
while pregnant or planning
to become pregnant
Implementation of
alcohol law reform
Sale and Supply of Alcohol
Act (2012) requires Medical
Officers of Health to work
more collaboratively with
regulatory agencies and
have more involvement in
the
licensing
process.
Medical Officers of Health
will require ongoing support
to maximise opportunities
through the law changes.
Give effect to Government
law,
contributes
to
objectives of the Act
including reduction in local
alcohol harm
The DHB will comply with
the requirements of the Sale
and Supply of Alcohol Act
2012, including enabling the
Medical Officer of Health to
comply with their specific
responsibilities and duties
outlined under the Act.
The
interim
national
procurement of medical
devices will seek to obtain
'quick
wins'
from
procurement of certain
types of medical devices in
advance
of
the
full
establishment
of
the
standard
financial
management information
system for all 20 DHBs (as
part
of
HBL's
FPSC
implementation).
Reflects transition from
interim activity to steady
state - which includes
assessment of new devices,
health
technology
assessment, active category
management,
category
reviews and tendering.
Reflects
Cabinet
requirement for PHARMAC
to assume this role. The
2013/14 SOI notes expect
net savings of $4.33m in
2014/15 and $14.76m in
2015/16.
The DHB will support
PHARMAC in commencing
its interim procurement role
for hospital medical devices,
including committing to
implement new national
medical device contracts,
when appropriate.
Cabinet
above.
By
2017/18,
expect
PHARMAC
to
assume
responsibility for full budget
management of hospital
medical devices.
Cabinet requirement - as
above.
While hospital medical
devices
category
management establishment
has been identified as a
national entity priority
initiative, the DHB and the
Ministry do not expect this
to have an impact on the
2014/15 planning.
While hospital medical
devices interim budget
management has been
identified as a national
entity priority initiative, the
DHB and the Ministry do not
expect this to have an
impact on the 2014/15
planning.
PHARMAC
Hospital medical
devices interim
procurement
Hospital medical
devices category
management
establishment
Hospital medical
devices interim
budget
management
requirement-
as
89
Hospital
pharmaceuticals
management
Development of hospital
pharmaceuticals schedule
for DHBs.
Reflects
Cabinet
requirement for PHARMAC
to assume this role. This is
expected to materially bend
the cost curve down over
time.
Hospital
pharmaceuticals
budget
management
Completing work towards
full budget management of
hospital
pharmaceuticals
(per
community
pharmaceuticals
budget
management).
Cabinet requirement - as
above.
The DHB will support
PHARMAC in progressing its
hospital
pharmaceuticals
management function. Note
– as no data is available on
growth within the existing
medicines usage, the DHB
will need to use local cost
forecasting
to
identify
changes that may result.
While
hospital
pharmaceuticals
budget
management has been
identified as a national
entity priority initiative, the
DHB and the Ministry do not
expect this to have an
impact on the 2014/15
planning.
The following table describes the planned funding allocated to the National Entities initiatives for the
2014/15 year:
2014/15
Plan Year One
Inclusions in 2014/15 DHB Annual Plan 2014/15 Year One
Capital
Costs
$'000's
HBL
Core funding- incremental costs to core funding of $6m pa
Finance, Procurement & Supply Chain
Food
Linen & Laundry
National Infrastructure Platform
IT Procurement
Human Resource Management Information Systems
Banking & Insurance- incremental costs to current budget of $0.36m in
2013/14
NH IT Board
eMedicines Reconciliation (eMR) with eDischarge Summary
Regional Clinical Workstation (CWS) and Clinical Data Repository (CDR)
Replacement of Legacy Patient Administration Systems
National Patient Flow
MoH contribution to National Patient Flow
Self-Care Portal
HQSC
Surgical site infection programme (SSIP) - National Infection Surveillance
Data Warehouse
SSIP - DHB Infections Management systems (ICNet NG system)
Patient experience indicators
Capability and Leadership
E-medicine / E prescribing
PHARMAC
Hospital medical baseline shift from DHBs to PAHRMAC
Total Impact for Taranaki DHB
2014 / 15
Core funding- non-incremental costs share core funding of $6m pa
Operating Costs
One-Off
Ongoing
$'000's
$'000's
(67)
(12)
Operating
Benefits
$'000's
(85)
(41)
Net
Operating
$'000's
0
(97)
0
0
0
0
(41)
0
(20)
(20)
0
0
(139)
0
(132)
(139)
(132)
0
0
(15)
0
0
(15)
0
(67)
(324)
(35)
(163)
(85)
(444)
(163)
90
2.6
IMPROVING QUALITY
Quality and patient safety are a top priority with many initiatives successfully in place and others
underway. But there is always more to do. Staff want to make a difference for our patients and their
ongoing actions are critical to patient safety.
2.6.1 Our Approach
The Taranaki DHB is committed to the delivery and funding of quality services by all health and
disability provider within the district. Quality assurance systems and procedures are in place to ensure
services undergo performance measurements (usually focused on service content, delivery
specifications and patient/client outcomes). Continuous quality improvement is the response to this
quality activity and supports the mission of the Board – Taranaki Together, a Health Community.
Improvements in patient and staff safety, practice service delivery and risk mitigation are supported by
the Taranaki DHB, recognising that there needs to be a balance maintained between achieving the
necessary improvements, mitigating risk and the costs of doing so. The tension and challenge lies in
finding this balance. We continue to broaden our quality and risk management approach from the
Taranaki DHB Hospital Provider as our key point of reference, to an approach that involves the entire
health and disability sector in Taranaki, particularly engaging with clinicians and clinical services.
Our Strategic Quality and Risk Plan facilitates the progressive achievement of the DHB’s vision by
assisting us to meet the challenge of continuously improving service provision and quality of care by
ensuring patient safety and robust systems and processes. The Strategic Plan outlines the Taranaki
DHB’s:
 Quality and risk framework
 Strategic objectives
 Dimensions of quality and our associated goals
 Quality and risk committee structure
 Staff responsibilities
 Links into the Health Quality and Safety Commission’s areas of focus identified in their
Statement of Intent
We are committed to implementing the initiatives specified by the Health Quality and Safety
Commission including the National Patient Safety ‘Open for Better Care’ Campaign focuses that
commenced in May 2013 and goes through to June 2015.
The key work areas are:
 Continuing to keep our patients safe by participating in the national patient safety campaign:
o reducing falls resulting in harm led by the Falls Prevention Steering Group
o reducing surgical site infection led by the Infection Control Committee
o reducing peri-operative harm (including safety in theatres and Venous
Thromboembolism prevention) via the Productive Operating Theatre programme,
the Venous Thromboembolism working party
o reducing medication errors led by the Safe Medication and Pharmacology and
Therapeutics Committees
- Improving our hand hygiene compliance
- Reducing the number of patients who develop a pressure injury whilst in hospital
- Minimising seclusion practice in mental health
 Continuing to improve the quality of end of life care for our patients
 Continue to work to improve our escalation process when a patient’s condition deteriorates
 Improve our customer care and responsiveness to patient/client needs
 Increase patient/client/family/whanau participation
 Implement a Midland DHB integrated electronic quality and risk management system
91
These areas were chosen because of the common themes identified from our monitoring processes
including but not limited to audit, serious events and patient/client complaints received.
Our first Taranaki DHB Quality Accounts document was very much a ‘beginning’ document that
provided a snapshot of the many quality improvement and patient safety initiatives being undertaken
and identified where improvement is still required. The 2014/15 Quality Accounts document will better
reflect the DHB has a whole and will be informed by the Health Quality and Safety Commission’s
guidance once this is provided.
2.6.2






2.6.3
Linkages
Taranaki DHB Strategic Quality & Risk Plan 2012-2015
Quality & Safety Markers
Serious and Sentinel Event processes including reporting, review, corrective action
implementation and evaluation
Patient/Client satisfaction
Taranaki DHB Patient and Family/Whanau Centred Care Framework
Taranaki DHB Quality Annual Report
Action Plan
Objective
Improving
Quality
Actions to Deliver Improved
Performance
HQSC priorities for 2014/15 are subject
to
confirmation
following
the
conclusion of the Health Sector Forum
led prioritisation process
Identify actions to support projects
that make a difference to improving
the quality of care, reducing patient
harm (Quality & Safety Markers) and
contribute to the national patient
safety campaign ‘Open for better care’.
 Falls Risk Assessment. Continue
with:
o
Raising staff awareness
o
Real time auditing and
feedback
o
Improving our post falls
review process
o
Analysing
contributing
factors (patients not seeking
assistance, patient safety
and privacy)
o
The feasibility of a Taranaki
Integrated Falls Prevention
Service in conjunction with
ACC is investigated and
implemented if considered
feasible.
 Hand Hygiene. Continue with:
o
Staff education particularly
targeting
Health
Care
Assistants
o
Regular organisation wide
good
hand
hygiene
awareness activities
Measure
 100% of older patients are given a
falls risk assessment
Reporting
Quarterly
 90% compliance with good hand
hygiene practice
92
Objective





Actions to Deliver Improved
Performance
o
Actions to Increase our pool
of Gold Auditors from 2 to 5
o
Continue
our
auditing
activities expanding focus
areas and moments audited
as auditing resource is
realised
Surgical Safety Checklist
o
Explore options to increase
compliance (with particular
focus on the third part) as
part of the perioperative
harm campaign programme
o
Continue with our auditing
and feedback to staff
programme
Prophylactic Cephazolin for hip
and knee replacements
o
Negotiate
with
our
Orthopaedic Surgeons to
increase
prophylactic
Cephazolin from 1g to ≥ 2g
for all total hip and knee
replacements and not those
patients who weigh more
than 8okg
o
Continue with our auditing
and feedback to staff
programme
Skin Preparation. Continue with:
o
The use of appropriate skin
preparation.
o
Clipping and not shaving
o
Our auditing and feedback to
staff programme
Medication Safety. Continue with:
o
Our auditing, monitoring and
reporting activities, including
use of the Medication
Trigger
Tool
and
participating
in
the
Commission’s
medication
safety focus on the national
patient safety campaign
o The review of the national
short stay patient medication
chart and whether adoption is
appropriate.
o The implementation our epharmacy programme locally
and regionally
Identify and implement actions to
support the reduction of patient
pressure injury development while
in hospital
Measure
Reporting
 All three parts of the surgical safety
checklist used 100% of the time
 100% of hip and knee replacement
patients receive Cephazolin ≥ 2g as
surgical prophylaxis
 100% of hip and knee replacement
patients have appropriate skin
preparation

Meeting/exceeding the targets as
outlined in our medication safety
project documents.

The National short stay patient
medication chart is successfully
implemented if appropriate.
 Decreased incidence of inpatient
pressure injury development as
identified through reporting and
monitoring processes
Quarterly
93
Objective
Actions to Deliver Improved
Performance
 Identify and implement actions to
support the minimisation of
seclusion practice in mental health
 Identify and implement actions to
support an improved experience
through increased patient, client,
family, whanau involvement in
decision making (at all levels), and
the introduction of national survey
questions as part of DHB systems
for
capturing
patient/client
feedback
 Identify and implement actions to
improve quality of end of life care

Identify actions to improve our
escalation process when a
patient’s condition deteriorates
 Identify actions to support
continued implementation of an
improved, representative and
value-added Quality Accounts
document
 Implementation of a Midland DHB
integrated electronic quality and
risk management system
2.7
Measure
 Monitoring of seclusion practice
within mental health shows a
decrease over time
 Patient
and
Family/Whānau
Centred
Care
Framework
implemented
 Increased
patient/
client
satisfaction levels over the 2014-15
year as identified from survey.
 Increased
patient/client
participation across the
DHB
defined through defined evaluation
processes associated with the
Patient
and
Family/Whānau
Centred Care Framework
 Action Plan formulated and
delivered according to timeframes
assigned. This includes linking into
the National Working Group, policy
review/redevelopment, review of
advanced care plans and care
directives and use of the Map of
Medicine
 Regular audit shows steady
improvement in relation to the
timely identification of a patient’s
deteriorating
condition
and
treatment
 The 2014-15 Quality Accounts
document builds on the 2013-14
document to better reflect the
evaluation of the DHB’s DAP
measures, Quality & Risk Strategic
Plan dimensions of Quality and
better reflect the whole of the
DHB rather that a Hospital and
Specialist Services focus
 Successful implementation of an
integrated system that results in
improved effectiveness, efficiency
and ultimately patient safety
Reporting
Quarterly
Quarterly
Quarterly
Six monthly
Quarterly
Six monthly
December
2015
June 2015
LIVING WITHIN OUR MEANS
Current and projected constraints on government funds mean the health and disability system must
focus strongly on maximising value from a limited set of resources. If we live within our means we
won’t be distracted by short-term cost reduction measures when we want to be focused on the
delivery of better, sooner, more convenient health care, improving the health status of the local and
regional population and reducing or eliminating health inequalities.
2.7.1 Our Approach
Taranaki DHB recognises it faces significant challenges in delivering services within available resources.
We have outlined in Module 4 our financial forecast to 2017/18. In order to achieve those targets this
Annual Plan contains cost containment strategies that align with our targets of a $1.436m deficit in
2014/15, $0.750m deficit in 2015/16 and a return to breakeven/surplus in 2016/17 and beyond.
94
Our DHB has well developed budgetary control systems to manage operating and capital expenditure.
The major financial risks faced by the DHB are those relating to cost increases in our provider arm. We
provide regular financial information to our Board and the MoH/NHB.
We will be focusing on the following initiatives to enable us to live within our means:


Working with Health Benefits Limited (to support and advance their initiatives to achieving
savings and efficiencies for non-clinical initiatives)
Productive Wards, Communities and Radiology Programmes (engages front line staff in
improving quality and productivity through redesign and streamlining the working environment
and daily processes)
These initiatives will all have a role to play in ensuring we operate in a financially responsible manner
(which means ensuring delivery on agreed financial forecasts within available funding). This is
important for the health of the organisation generally and to meet the significant demands that arise
from our building programme.
2.7.2


Linkages
Stewardship Module
Midland District Health Boards Regional Services Plan 2014/15
2.7.3
Action Plan
Objective
Living Within
Our Means






Actions to Deliver Improved
Performance
Operate within agreed financial
plans (and fund capital investment
from internal sources)
Appropriate clinical and executive
leadership
Continued development of the
Allied Response Teams (ART)
utilisation within ED to assist in
reducing unnecessary admission
and inpatient length of stay. The
team will also contribute to
management plans for patients
who present to ED on a regular
basis. Patients who are admitted
via the ART will be started on the
correct clinical pathway earlier
TDHB will continue to work on
strategies to increase the number
of appropriate surgical procedures
that are completed as day cases
TDHB will continue to redesign
Mental Health services to ensure
the right place for treatment and a
reduction in seclusion rates
IDF flow will be monitored with
the aim of reducing outflow by
bringing appropriately trained
clinicians to TDHB to complete
procedures within the hospital
Measure

System Integration 3: Ensuring
delivery of Service Coverage

Ownership OS3: Inpatient Length
of Stay
Ownership OS8: Reducing Acute
Readmissions to Hospital
Output 1: Output Delivery Against
Plan
Reduction
in
number
of
presentations to ED
Day surgery rates to increase to
85% of appropriate cases
Seclusion rates reduce







Reporting
Quarterly
IDF outflow rates to reduce
Theatre utilisation rates to reach
85% by end June 2015
95
Objective
Actions to Deliver Improved
Performance
The Paediatric model of care will
continue to be reviewed in order
to ensure patients are treated
appropriately across the primarysecondary care continuum
TDHB will launch a Project to look
at improving management of
frailty for admitted patients
TDHB will continue to run
initiatives such as Releasing Time
To Care and a Theatre User Group
to realise operational efficiencies
in measures such as LOS,
readmission rate, and theatre
utilisation
TDHB will review the opportunity
for further efficiencies from
Laboratories




2.8
Measure

Reporting
Measures for frailty management
to be agreed by project team
SUPPORTING DELIVERY OF REGIONAL PRIORITIES
2.8.1 Our Approach
Workforce and training plans illustrate the collaborative work of the Regional Director of Training and
General Managers of Human Resources building whole of health solutions and also working alongside
the Clinical Networks to meet some of their key deliverables that pertain to workforce and training.
Within the Midland Regional Plan we aim to develop the principles of culture, capability, capacity and
change leadership. We recognised that there are longstanding gaps and weaknesses in our knowledge
around the current workforce, particularly relating to the capability and capacity.
In 2014/15 the overarching imperative for TDHB to meet our goals, are collaboration and
connectedness locally, regionally and nationally.
2.8.2
Linkages
 Stewardship Module
 Midland District Health Boards Regional Services Plan 2014/15
2.8.3
Action Plan
Objective
Actions
Support
Delivery
Regional
Priorities
to

of



Actions to Deliver Improved
Performance
TDHB will participate in the
Regional Trauma Team MDTs and
in the regional training network
TDHB will provide scenario
training for ED staff to ensure staff
competency in the event of major
trauma
TDHB will continue to provide a
dedicated Trauma Nurse
TDHB will utilised the Westmead
Scale for the assessment of post
traumatic amnesia and head
injury
Measure
Reporting
 Attendance at regional trauma
meetings
Quarterly
 Number of scenario training
sessions delivered to ED staff
 Westmead scale being utilised
where clinically appropriate with
procedures in place by December
2014
96
Objective
Growing the
Health
Workforce
through
Strengthening
Recruitment,
Retention and
Repatriation
Strengthening
Health
Workforce
Intelligence
Shaping the
Future
Workforce
through
Transformative
Change
Building and
Expanding the
Capability of
the Health
Workforce
Delivery of
Regional IT
Priorities

Actions to Deliver Improved
Performance
Retention
and
recruitment
strategies for rural and primary
care workforces

TDHB will support the provision of
a demographic information and
forecasting
model
for
all
workforces identified by the
Clinical Networks and some base
line
intelligence
to
target
vulnerable, hard to recruit, new &
emerging workforces
 Identify the potential capacity and
capability of the ageing workforce
and model how this cohort will
continue
to
contribute
to
healthcare delivery within the
Midland Region
 Develop a Midland Region
platform and suite of e-Learning
programmes for the health
workforce

A current focus is on regional
deployment the CSC ePharmacy
application that will provide the
underpinning for the regional
deployment of the medication
management pilot

The other programme currently
under review is the deployment of
the Orion CWS application within
the Midland region. This will
require significant reprioritisation
of current activities at both a local
and regional level to enable this to
be brought forward

Further information is available in
the Midland DHBs RSP for
2014/15

TDHB will contribute to and
actively participate in the
regionally agreed objectives and
initiatives
Measure
Reporting
 Establish ‘warm welcome here’
sites in each DHB in order to
recruit, orient and socialise new
health professionals to rural areas
and to facilitate collegiality within
the sector
Quarter 4
 Participation and contribution to
workforce planning to:
- Improve our understanding of
current demographics
- Enable us to model workforces
for future needs
Quarter 4
 Feasibility to introduce:
- Flexible work arrangements
- Phased retirement options
- Third age (post retirement)
employment
Quarter 4
 Develop a business case that
proposes the future model of the
Managed
Virtual
Learning
environment (MVLE)
Quarter 1
 Successful introduction of the
ePharmacy application
Quarterly
 Quarterly reporting against RSP
activities
97
98
99
MODULE 3: STATEMENT OF PERFORMANCE EXPECTATIONS
We have worked with other DHBs in the Midland region, our primary care partners as well as other key
stakeholders to develop this Statement of Performance Expectations (SPE) in which we provide
measures and forecast standards of our output delivery performance. The actual results against these
measures and standards will be presented in our Annual Report 2014/15. The performance measures
chosen are not an exhaustive list of all of our activity, but they do reflect a good representation of the
full range of outputs that we fund and / or provide. They also have been chosen to show the outputs
which contribute to the achievement of national, regional and local outcomes (see modules 1 and 2).
Where possible, we have included with each measure past performance as baseline data.
Activity not mentioned in this module will continue to be planned, funded and/or provided to a high
standard. We do report quarterly to the Ministry of Health and / or our Board on our performance
related to this activity.
3.1
OUTPUT CLASSES
DHBs must provide measures and standards of output delivery performance under aggregated output
classes. Outputs are goods and services that are supplied to someone outside our DHB. Output classes
are an aggregation of outputs, or groups of similar outputs of a similar nature. The output classes used
in our statement of forecast service performance are also reflected in our financial measures and are
described in Module 8.3. The four output classes that have been agreed nationally are defined in
Module 8.2. They represent a continuum of care, as follows:
3.2
GUIDE TO READING THE STATEMENT OF PERFORMANCE
EXPECTATIONS
The following points provided should be kept in mind when reading the rest of this module:




Further detail of the performance story logic and rationale is contained in Module 1
Baseline and National/Regional Result figures for the output performance measures are for the
2012/13 financial year unless otherwise stated (measures introduced in 2013/14 use latest
available data for a baseline)
In the performance measures table and where available the average column presents the
national or regional average for the output performance measure
Most measures have been adopted regionally
100





Term
Impacts
3.3.1
People are supported to take greater responsibility for their health
Impact
Long
PEOPLE ARE SUPPORTED TO TAKE GREATER RESPONSIBILITY FOR
THEIR HEALTH
Intermediate
3.3
Some measures fall across more than one impact. Where this is the case they have only been
included once
Measurement type key: qn = Quantity t = Timeliness ql = Quality
There are some services we provide that support the rest of the health system so we have
included these in a “Support Services” section of our performance story
Detailed information about various programme definitions and rationale for each output
measure is provided in Module 8.4
National data collections will be occurring during 2014/15 through the Quality and Safety
Commission’s National patient Safety Campaign. Further baseline data for future quality
markers will be available for the 2014/15 Annual Plan and TDHBs Quality Programme Outcomes
will be presented in our 2014/15 Quality Account Report


Fewer people smoke

Reduction in vaccine
preventable diseases
Improving health
behaviours
Fewer People Smoke
Output
Class
Measure
Type
Percentage of hospitalised smokers offered
advice to quit (Health Target & MHP)
Maori
Non-Maori
Total
1
qn/t
Percentage of Primary Health Organisations
enrolled smokers offered advice to quit
(Health Target & MHP)
1
Outputs
Baseline
Target
2014/15
National/Regional
Result
National Regional
95%
96%
95%
95%
95%
95%
96%
95%
95%
96%
96%
96%
qn/t
National Regional
71%
90%
67%
68%
High Needs
Total
Percentage of pregnant women who
identify as smokers at the time of
confirmation of pregnancy in general
practice or booking with Lead Maternity
Carer are offered advice and support to
quit (Health Target and MHP)
Maori
Non-Maori
Total
1
qn/t
Progress
towards
New Measure
90%
90%
90%
New Measure
101
3.3.2
Reduction in Vaccine Preventable Diseases
Output
Class
Measure
Type
Percentage of eight month olds fully
immunised (Health Target & MHP)
Maori
Non-Maori
Total
1
qn/t
Percentage of the population >65 years
who have received the seasonal influenza
immunisation (PHO Performance
Programme & Maori Health Plan)
High Needs
Total
1
Outputs
3.3.3
Baseline
Target
2014/15
National/Regional
Result
National Regional
89%
89%
89%
95%
95%
95%
88%
92%
91%
85%
90%
88%
qn/t
National
69%
70%
75%
75%
68%
69%
Improving Health Behaviours
Output
Class
Measure
Type
Percentage of infants who are fully or
exclusively breastfed at 6 months (Maori
Health Plan)
Maori
Non-Maori
Total
1
qn/t
The number of referrals to the GRx (Green
Prescription) programmes (Local Contract)
Adult
Children
1
Reduce the teen birth rate per 10,000
Maori
Non-Maori
Total
1
Reduce the rate of teenage terminations of
pregnancy per 10,000
Maori
Non-Maori
Total
1
Outputs
Baseline
Target
2014/15
National/Regional
Result
National
11%
24%
21%
27%
27%
27%
qn/t
16%
27%
25%
Regional Average
1132
96*
1490
35
350
144
195
<350
<144
<195
1987
67
National Regional
qn/t
qn/t
380
108
167
390
125
218
National Regional
163
120
131
<163
<120
<131
133
71
84
124
100
109
* GRx Active Families programme numbers boosted by Taranaki DHB’s Whanau Pakari research.
102
Impact
Term
PEOPLE STAY WELL IN THEIR HOMES AND COMMUNITIES
People stay well in their homes and communities

Impacts
Intermediate
Long
3.4
3.4.1
An


Long-term
improvement
in childhood
oral health
Fewer people
conditions are
are admitted
detected early
to hospital for
and managed
avoidable
well
conditions

More people
maintain their
functional
independence
An Improvement in Childhood Oral Health
Output
Class
Measure
Type
Percentage of children (0-4) enrolled in
DHB funded dental services (Policy Priority
13)
Maori
Non-Maori
Total
2
qn
Percentage of enrolled pre-school and
primary school children (0-12) overdue for
their scheduled dental examination (Policy
Priority 12)
2
Percentage of adolescent utilisation of DHB
funded dental services (Policy Priority12)
2
Outputs
Baseline
Target
2014/15
National/Regional
Result
National Regional
59%
82%
75%
85%
85%
85%
qn/t
55%
74%
70%
56%
74%
69%
National Regional
9%
10%
12%
9%
National Regional
3.4.2
qn
77%
85%
72%
70%
Long-Term Conditions are Detected Early and Managed Well
Output
Class
Measure
Type
Percentage of population enrolled with a
PHO (Maori Health Plan)
Maori
Non-Maori
Total
2
qn
Percent of the eligible population will have
had their cardiovascular risk assessed in the
last five years (Health Target & Maori
Health Plan)
Maori
Non-Maori
Total
2
Outputs
Baseline
Target
2014/15
National/Regional
Result
National Regional
85%
97%
95%
96%
96%
96%
89%
96%
95%
94%
98%
97%
qn
National Regional
63%
75%
73%
90%
90%
90%
63%
68%
67%
60%
74%
71%
103
Output
Class
Outputs
Maintain or improve appropriate
management of microalbuminuria or overt
nephropathy in patients with diabetes
(Policy Priority 20)
Maori
Non-Maori
Total
2
Percentage of eligible women (20-69) have
a cervical cancer screen every 3 years
(Maori Health Plan)
Maori
Non-Maori
Total
1
Percentage of eligible women (50-69) have
a breast screen in the last 3 years (Maori
Health Plan)
Maori
Non-Maori
Total
1
Increase the number of packages of care
available to youth under the Primary
Mental Health Initiative
Maori
Non-Maori
Total
2
3.4.3
Measure
Type
Baseline
Target
2014/15
National/Regional
Result
70%
82%
80%
>70%
>82%
>80%
Not Available
qn/t
National Regional
72%
87%
85%
80%
80%
80%
63%
79%
77%
66%
83%
80%
qn/t
National Regional
63%
77%
76%
70%
70%
70%
66%
73%
72%
59%
68%
67%
New Measure
82
247
329
New Measure
Fewer People are admitted to Hospital for Avoidable Conditions
Outputs
Output
Class
Measure
Type
4
qn
Baseline
Target
2014/15
National/Regional
Result
National Regional
Percentage of Rest Home residents
receiving vitamin D supplement from their
GP
75%
70%
N/A
74%
National Regional
Triage level 4 & 5s presenting to the
Emergency Department as a percentage of
the total population
Percentage of eligible population who have
had their B4 school checks completed
High Needs
Total
2&3
qn
1
qn/t
25%
<23%
11%
16%
National Regional
86%
88%
90%
90%
80%
80%
83%
82%
104
3.4.4
More People Maintain their Functional Independence
Output
Class
Measure
Type
Percentage of older people receiving longterm home support who have had a
comprehensive clinical assessment and a
completed care plan in the last 12 months
(Policy Priority 18)
4
qn/t
For those with aged related and chronic
health conditions we aim to reduce the rate
of rest home level of residential care to
home based support and respite funding
4
Outputs
4
41%
95%
Not Available
ARRC:HBSS/
Respite
2.34:1
2.40:1
Not Available
156
>156
Not Available
91%
100%
Not available
ql
PEOPLE RECEIVE TIMELY AND APPROPRIATE CARE
People receive timely and appropriate care

Intermediate Impacts
National/Regional
Result
qn
3
Impact
Long Term
3.5
Target
2014/15
qn
Increased number of clients accessing
respite services
Percentage of patients aged 75 and over
(Maori and Pacific Islanders 55 and over)
that are given a falls risk assessment
Baseline

People receive
prompt and

status for
People have
appropriate
appropriate
access to
acute and
elective services
arranged care
Improved health

More people
people with a
with end-stage
severe mental
conditions are
health illness
appropriately
and/or
supported
addiction
3.5.1
People Receive Prompt and Appropriate Acute and Arranged Care
Output
Class
Measure
Type
Baseline
Target
2014/15
National/Regional
Result
Acute Re-admission rate (Ownership
Dimension 8)
3
qn/t/ql
5.49%
≤5.22%
National Regional
8.11%
7.40%
Acute Re-admission rate 75+ years
(Ownership Dimension 8)
3
qn/t/ql
8.90%
≤8.66%
National Regional
11.49%
10.37%
4.07 days
National
3.99 days
Outputs
Acute inpatient average length of stay
(Ownership Dimension 3)
3
qn/t
4.07 days
105
Output
Class
Measure
Type
Proportion of patients referred with a high
suspicion of cancer who receives their first
cancer treatment with 62 days (Health
Target))
3
qn/t
Proportion of patients with a confirmed
diagnosis of cancer who receives their first
cancer treatment with 31 days (Policy
Priority 30)
3
Arranged Caesarean deliveries without
catastrophic or severe complication as a %
of total primary and secondary deliveries
Percentage of operations where venous
thromboembolism (blood clot) was
considered as part of the surgical checklist
3
ql
3
ql
Outputs
3.5.2
Baseline
Target
2014/15
National/Regional
Result
Redefined
TBC
Not Available
Redefined
TBC
Not Available
qn
National Regional
20%
<18%
18%
17%
91%
100%
Not available
Target
2014/15
National/Regional
Result
People Have Appropriate Access to Elective Services
Output
Class
Measure
Type
Percentage of patients waiting longer than
five months for their first specialist
assessment (Elective Service Performance
Indicator 2) ) then four months by 1 January
2015
3
qn/t
Number of surgical discharges under the
elective initiative (Health Target)
3
Elective inpatient length of stay (Ownership
Dimension 3)
Did-not-attend percentage for outpatient
services (Maori Health Plan)
Maori
Non-Maori
Total
Outputs
Baseline
Regional
0.11%
0%
1.5%
qn
4,660*
4,369
N/A
3
qn/t
3.21 days
3.18 days
National
3.36 days
3
qn/t
National Regional
19%
7%
9%
<9%
<9%
<9%
13%
5%
6%
15%
6%
8%
*The number of surgical discharges performed during 2012-13 was greater than Plan. We expect that during 2014-15 we will manage the
volumes to meet the Plan live within our means.
106
3.5.3
Improved Health Status for those with Severe Mental Illness and/or Addictions
Output
Class
Measure
Type
Percentage of people referred for nonurgent mental health or addiction services
are seen within 3 weeks (Policy Priority 8)
Mental Health
0-19 yr olds
20-64 yr olds
65+ yr olds
Addictions
0-19 yr olds
20-64 yr olds
65+ yr olds
3
qn/t
Percentage of clients discharged with a
transition (discharge) plan. (Policy Priority 7)
<20 yr olds
Maori
Non-Maori
Total
20+ yr olds
Maori
Non-Maori
Total
3
Average length of acute inpatient stays (KPI
8)
3
Rates of post-discharge community care (KPI
19)
3
Outputs
3.5.4
Baseline
Target
2014/15
National/Regional
Result
National Regional
61%
80%
87%
80%
80%
80%
67%
84%
82%
63%
77%
83%
86%
76%
83%
80%
70%
70%
80%
84%
83%
73%
64%
76%
qn/t/ql
National Regional
100%
97%
97%
95%
95%
95%
80%
85%
84%
82%
87%
86%
99%
99%
99%
95%
95%
95%
92%
92%
92%
90%
83%
86%
qn/t/ql
15 days
14-21 days
Not Available
qn/t/ql
53%
90-100%
Not Available
More People With End Stage Conditions are Supported Appropriately
Outputs
A reduction in the percentage of palliative
care clients who have had an Emergency
Department presentation
Output
Class
Measure
Type
Baseline
Target
2014/15
National/Regional
Result
11%
≤11%
Not Available
3
107
3.6
SUPPORT SERVICES
Outputs
Improved wait times for diagnostic services accepted referrals receive their scan within
42 days (PP29)
Output
Class
Baseline
Target
2014/14
77%
44%
90%
80%
95%
95%
90%
90%
90%
90%
National/Regional
Result
2
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Non-urgent community laboratory tests are
completed and communicated to
practitioners within the relevant category
timeframes:
Category 1: Within 24 hours
Category 2: Within 96 hours
Category 3: Within 72 hours
Measure
Type
Not Available
2
Not Available
108
109
MODULE 4: FINANCIAL PERFORMANCE
The consolidated financial summary below includes the Hospital Provider (Personal Health, Mental
Health, Public Health and DSS), DHB Governance & Funding Administration, and the DHB Funder
operations.
Hospital Provider +
Governance Funding
(including other income)
179,571
Year 0
2013/14
Forecast
175,666
Non Hospital Provider
Funding (NGO)
147,173
156,695
158,067
160,489
162,911
165,336
TOTAL FUNDING
Hospital Provider +
Governance Operating
Expenses
326,744
189,389
332,361
189,119
338,170
191,038
342,660
192,019
348,152
194,241
353,821
194,985
Payments to Non Hospital
Providers (NGO)
137,348
146,695
148,067
150,489
153,861
158,336
TOTAL OPERATING
EXPENSES & PAYMENTS
326,737
335,814
339,105
342,508
348,102
353,321
-9,818
-13,453
-10,935
-9,848
-9,000
-6500
9,825
10,000
10,000
10,000
9,050
7,000
7
-3,453
-935
152
50
500
($’000)
2012/13
audited
Hospital Provider +
Governance Operating
Deficit
TDHB Funder surplus
CONSOLIDATED FINANCIAL
RESULT
Year 1
2014/15
plan
180,103
Year 2
Year3
2015/16 2016/17
plan
plan
182,171
185,241
Year4
2017/18
plan
188,485
The net consolidated financial projection for the planning period 2014-18 is:




2014-15: Deficit $ 0.94M
2015-16: Surplus $ 0.15M
2016-17: Surplus $ 0.05M
2017-18: Surplus $ 0.50M
These financial projections are to be read with the accompanying notes and assumptions.
110
4.1














KEY POINTS FROM THE BUDGETED FINANCIALS 2014-18
The Board has planned for a consolidated financial deficit for Year 1 of the planning period
2014-18, with a financial breakeven targeted for Year 2, Year 3 and Year 4.
These financial projections reflect a common trend across the entire planning period 2014-18,
clearly indicating that cost growth in the hospital provider operations is significantly in excess of
funding received, leaving residual operating deficits. The relatively better consolidated financial
result is solely on account of surpluses generated in the Funder operations during each of the
fiscal periods under consideration, which is not sustainable.
Stage 1 of the hospital redevelopment programme (Project Maunga) is scheduled for
completion in April 2014, bringing the $ 80M project to completion.
The hospital provider (and consolidated) financial result in Year 1 is materially influenced by the
cost impacts of Project Maunga. Increased depreciation ($ 3.10M), cost of borrowing ($ 2.02M)
, loss of interest income on deposits ($ 1.30M) and increased cost of utilities ($ 0.40M) has
resulted in $ 6.82M addition to operating expenditure in 2014-15.
The hospital provider budget for Year 1 (2014-15) has a target of $ 4.30M in new savings
required from a number of cost reduction and efficiency initiatives, besides the savings plan
already in place to realise savings for the current 2013-14 year. These savings are being sought
from improved service level management, monitoring of contracted volumes, targeted cost
reduction initiatives, reduced staffing costs and service reconfigurations amongst a range of
other initiatives that are in the process of being explored. (Please refer to the “Cost & efficiency
initiatives” section for details).
In addition to the targeted $ 4.30M in new savings to be delivered by the hospital provider in
Year 1, there is an expenditure to revenue gap of $ 0.50M in Year 1 and $ 0.90M in year 2 that
are yet to be identified against initiatives and savings.
Likewise, the DHB Funder operations is planning to reprioritise funding and drive initiatives to
enable the DHB Funder operations to manage its costs down and deliver the operating surplus
planned for 2014/15 and years following.
It is difficult to estimate with certainty the likely costs and benefits to this DHB from Health
Benefit Limited (HBL) driven business cases as these are in various stages of delivery. Outgoings
in capital investment and contribution to HBL’s operating expenditure have been recognised
based on estimates made available.
Indicative savings through reduced pricing from collective procurement projects, All of
Government (AOG) initiatives and other collaborative efforts have been factored into clinical
supply and consumable costs over the plan period. Likewise, operating expenditure outflow to
support these national initiatives has been recognised.
TDHB’s share in supporting the Midland regional projects and contribution to HealthShare (the
regional shared services entity) has been recognised.
The total cost provided by TDHB towards supporting regional and national service agencies
(HBL, Health Share, and other National entities) and contributions to business cases planned for
2014-15 is circa $ 1.70M.
The operating budget is severely limited to absorb these new (and increasing) costs arising on
different fronts.
The Hospital Provider Arm is facing a significant cost to funding gap resulting in operating
deficits in each year covered by this plan. This gap could increase if other identified risks and
associated costs (estimated at $3.20M) were to materialise fully. With the residual risk at
$2.08M, the resultant financial gap could be in the region of $13.50M. Likewise, the DHB
Funder is also faced with exposure estimated at around $5.60M for 2014/15, with a residual
risk equating to about $2.40M. (Please refer the “Sensitivity Analysis” section for details).
These risks are in addition to the expenditure to revenue gap of $ 0.50M in Year 1 and $
0.90M in year 2 that are yet to be identified against initiatives and savings.
The Board recognises that the operating cost to funding gap in the Hospital Provider
operations will need to be addressed through options that will result in significant changes to
111

models of care, service configurations and re-alignment of services within funding available. It
acknowledges these changes are essential if the Hospital Services arm is to remain financially
viable when faced with increased costs on several fronts, in particular Project Maunga.
In is expected that the gains from Project Maunga will materialise in 2014-15 and future
periods. Consolidation of specialist services and improved models of care and pathways will
result in more efficient use of clinical resources and thereby reduction in core operating costs.
The redevelopment will pave the way for a recovery plan for Hospital Services to align itself
more efficiently – both clinical and financial.
In the final analysis, the Board is faced with:
1. A continuing deficit in the Hospital Provider operations in each of the plan years.
2. Additional financial exposure in its expense budgets which could materialise in part or full.
3. The need to make radical changes and re-align service configurations in its hospital service
operations to reduce the current deficit.
4. The financial recovery for its Hospital Provider operations being largely dependent on cost
reductions incidental to services rationalisation, capacity and work force management for
the current plan period, and efficiencies arising from the redevelopment of the hospital
facilities in the years following.
5. Its Funder operations having to significantly reduce investment in additional services during
the period the hospital operation is going through this transition.
Recognising that additional risks continue to be carried both within and outside the financial budget,
with reliance on timely outcomes from service changes and initiatives, Taranaki District Health Board’s
financial risk assessment of the current District Annual Plan is rated “medium to high” risk under the
assumptions and risks as stated.
4.2
KEY RISKS
4.2.1
Taranaki DHB’s Funder Operations
1. Taranaki DHB’s increase in funding from the Funding Envelope for 2014/15 is $5.02 million,
comprising a $1.82 million (0.61%) contribution to cost pressures and $3.20 million (1.08%,)
demographics.
2. Whilst the level of funding for Taranaki DHB is equitable when compared to the proposed increases
for other DHBs, the level of increase is considerably lower than the cost and service pressures faced
by the DHB Funder and Provider Arm
3. The Government has made no decision on out-year funding. To ensure consistency across all DHBs,
Taranaki DHB has prepared the Annual Plan using the planning assumption that funding increases in
out-years will be of the same nominal value as stated in the planning guidance.
4. Taranaki DHB’s population based funding share (PBFF) share is reducing over time. Taranaki DHB’s
PBFF share in 2012/13 was 2.74%, this reduces to 2.73% in 2013/14 and in 2014/15 to 2.72%. The
relative growth of the Taranaki DHB population is less than other parts of New Zealand but services
still need to be planned for an absolute increase in the population numbers as demonstrated in
Census Population Projections
5. The Funding Envelope advice indicates that there may be some further additional funding made
available to DHB’s from non-devolved funding held by the Ministry of Health for 2014/15. Further
advice on devolution of funding is awaited. However, it is assumed that any funding would already
112
be committed to contracts currently held by the Ministry and which would be transferred to
DHB’s.
6. General hospital and specialist services delivered by the DHB’s own Provider Arm will be paid in a
composite of National IDF prices and local prices acknowledging affordability and capacity issues.
Mental health services delivered by the DHB’s Provider Arm are funded by a local price
mechanism. Significant reconfiguration of the DHB’s hospital and specialist services is planned over
the next three years to bring the cost of service delivery closer to the funding available.
7. In order to offset planned deficits in the Provider Arm, whilst service reconfiguration is undertaken
to a lower cost base, the Funder is required to achieve significant surpluses. In 2014/15 the
planned Funder surplus is $10 million this present a significant challenge for the Funder.
8. The key risks associated with achievement of this surplus include

Achievement of planned deficits in the Provider Arm

Growth in Inter District Flows

Absence of a risk reserve will severely limit the Funder’s ability to fund transition costs of new
models of care and respond to unexpected demands in year.

Containment of Growth in pharmaceuticals
9. In order to deliver a net Funder $10 million surplus the DHB will plans to deliver further service
configuration. These changes are transformational in nature and it is believed will deliver the same
or better health outcomes for less cost.
4.2.2
Taranaki DHB’s Hospital Provider Operations
1. The funding contribution for cost pressure in 2014/15 is 0.61%. However, the real cost growth in
hospital provider services is well in excess of this adjustor. The year on year cost movements across
several expenditure lines are on an average between 3% and 5%. This gap between funding and
real cost growth has resulted in a budgetary deficit of $10.94M after considering all current
efficiencies and cost savings, including new costs totalling $ 6.82M related to Project Maunga.
2. Cost pressures are particularly evident in the following areas:
a.
b.
c.
d.
e.
f.
g.
Clinical staff costs – primarily nursing
Outsourced clinical staff – primarily locum doctors and psychiatrists
Diagnostics – primarily radiology
Acute services such as cardiology, mental health inpatient services, emergency services.
Increasing cost impacts of statutory compliances, quality and accreditation deficits and
numerous legislative requirements
Information and communication technology (ICT) capital investment and increased
operating costs for network infrastructure and software licences.
Operating cost contributions, capital investment and participation in national and
regional initiatives and business cases.
Overall, the Hospital Provider’s financial plan for the planning period is highly geared and has no
flexibility to accommodate unplanned cost movements. Its operating budget carries financial risks
and it is highly dependent on the realisation of targeted savings within planned timelines to meet
its 2014/15 and out year financial targets.
113
3. In applying the budgetary assumptions we have recognised ongoing quality improvements and
those compliance costs of which TDHB has been aware. The financial budget is vulnerable to small
movements in costs over stated assumptions or increased costs resulting from clinical compliance
expectations and legislative changes.
4. The Hospital Services Provider is dependent on sustainable revenue streams. With about 92% of its
revenue derived from health funding (via DHB Funder and the Ministry of Health), the Hospital
Provider has few alternate income streams for revenue growth. There is a marginal increase (+$
0.32M) in ACC revenues planned for 2014/15 arising from increased theatre capacity post Project
Maunga. Miscellaneous income also assumes $ 2.50M to be raised through community donations.

In view of the increasing cost pressures, the financial budget for the Provider Arm continues to
hinge on a number of efficiency initiatives, which have to generate $4.30M of reduced
operating costs during 2014/15. (Please refer to the “Cost & Efficiency initiatives “section for
details). In addition there is an expenditure to revenue gap of $ 0.50M in Year 1 that is yet to
be identified against initiatives and savings.
5. During the plan period 2014-18, baseline capital expenditure will be contained within depreciation
provisions, so that additional equity injection or borrowing is not required despite operating
deficits.
In summary, the gap between funding and the realistic cost model for services + the cost impact of
Project Maunga has resulted in a very sensitive financial budget for the planning period 2014/15
and out years. Due to funding constraints, the hospital provider will have to bridge this budgetary
gap in a decisive and time sensitive manner through a range of initiatives comprising rationalisation
of services, workforce management, regional co-operations and realisation of gains from ongoing
projects. These measures will have to be undertaken in order to exit costs and reduce the deficit in
a planned manner to realistic funding levels. From a realistic view point, the quantum of cost
savings required from the hospital services will likely span a 3 year planning horizon – if existing
services and levels are to be maintained.
4.3
KEY FINANCIAL ASSUMPTIONS
The following key assumptions have been employed in the preparation of the financial statements for
the three-year planning period 2014-18.
4.3.1
Application of New Zealand Equivalents to International Financial Reporting
Standards (NZ IFRS)
The DAP financial template for the plan period 2014-18 and comparative years has been prepared in
accordance with NZ GAAP. They comply with the NZ equivalent to International Financial Reporting
Standards (NZIFRS), and other applicable Financial Reporting Standards , as appropriate for public
benefit entities.
4.3.2
Equity and Borrowing
a) The District Annual Plan 2014-18 has not assumed any additional Crown equity.
b) Term borrowing of $ 45M from the Crown Health Financing Agency (DMO/MOH) to fund the
first stage of the capital redevelopment programme has been included in the DAP 2014-18. The
project is scheduled for completion in April 2014.
114
c) Base line capital expenditure is expected to be contained within the level of depreciation for
2014/15 and the three years following.
d) Taranaki DHB was moved from “intensive monitoring” to “performance watch” status on the
performance monitoring scale in December 2013.
4.3.3
Operating Expenditure assumptions:
a) Wage costs: in principle, wage budgets for employee groups covered by national MECA
settlements are essentially in accordance with the agreement(s) and in line with collective DAP
assumptions agreed nationally.
b) Clinical supplies: average around 2.5% for 2014/15 + estimated on increased activity levels +
reduced for local efficiencies and procurement gains.
c) General operating expenditure (excluding depreciation and interest): average 2.5% for 2014/15
+ confirmed outflows + reduced for local efficiencies and procurement gains.
d) Value for Money (VFM) impacts: Cost reductions and gains likely to ensue from the collective
procurement contracts undertaken by HBL/ National VFM programmes have been recognised
in the DAP financials. Equally, costs related to implementation have been considered to the
extent information is available. Due to indicative timelines and budgetary constraints some of
these will have to be managed within existing budgets, and as and when they occur. Gains from
local initiatives and projects have been built into the relevant expense budgets.
e) Other expenditure reductions: the 2014/15 expense budget assumes efficiencies and cost
reductions arising from the following:
 Prioritised service levels
 Length of stay and patient throughput
 FTE management + reduced staffing costs
 Contract tracking + monitoring.
 Demand and capacity management
4.4
TDHB FUNDER – “RING FENCE PRINCIPLE” AND APPLICATION OF
SURPLUS/DEFICITS
4.4.1
Mental Health Services
In keeping with the guidelines on treatment of “Mental Health Ring fence surplus” the amount of any
under-expenditure carried forward from previous accounting periods has been reported as a surplus in
Taranaki DHB’s Statement of Financial Performance in the year the surplus is generated. The ring
fenced surpluses as at the beginning of FY 2014/15 have been fully applied to Mental Health Services
either in the Hospital Provider or community during the year. Based on expenditure to date and
forecasts, no material surplus is likely to remain on 30 June 2014. No surpluses from Mental Health
services are envisaged during the 2014-18 plan period and, if any surpluses do eventuate, these will be
ring fenced and expended in the year(s) following.
4.4.2
Interest Rates
Interest rates have been assumed along current monetary indicators and commitments and averaged
as appropriate over the mix of funding streams and options as follows. Interest on DMO/MOH loans are
as per the loan drawdown schedule.
115
Overdraft
DMO/MOH
Loans
(existing)
DMO/MOH
Loans
(new)
Deposits
Equity
Year 1 (2014/15)
Year 2 (2015/16)
Year 3 (2016/17)
6.00%
6.50%
7.50%
7.02%
-
3.73%
4.15%
4.15%
5.50%
6.00%
7.00%
8.00%
8.00%
8.00%
Year 4 (2017/18)
7.50%
-
4.15%
7.00%
8.00%
Notes:
1.
2.
4.4.3
DMO/MOH total approved facility is $74M (inclusive of $ 29M of earlier loans), with the full limit having
been drawn down with the completion of Project Maunga in April 2014. This is inclusive of the $45M new
term debt from DMO/MOH approved for Stage 1 of the Base Hospital redevelopment project.
TDHB is in the DHB collective banking & transactional arrangement with West Pac. Monthly closing cash
balances are mostly positive, on odd occasions dipping into over draft for limited periods during certain
month ends.
Asset Revaluation and its Impact
Under the provisions of FRS3, TDHB is required to undertake an asset revaluation exercise as at 30 June
each year, and recognise any material increase in land and building values, and also its impact on
depreciation and capital charge.
No provision has been made in the 2014/15 financials arising from any impacts of asset revaluation as
on 30 June 2014. A detailed revaluation exercise was completed on 30 June 2013, and updated upon
completion of the new build (Project Maunga) in early 2014. It is therefore assumed that there will be
no material movements requiring an adjustment to the current asset base. The impact of the new
hospital redevelopment on current building values has been factored in the recent revaluations and
treated appropriately. Conversely, should there be a material movement, it is assumed that any related
capital charge increase will be funded/base line adjusted in accordance with current Treasury
guidelines.
4.4.4
Depreciation
Depreciation has been calculated on a straight line method for all existing assets, less disposals and
recognising additions.
4.4.5
Capital Charge
Capital charge have been calculated in line with existing methodology, adjusted for donations and
monthly movements in operating results and closing balance of shareholders funds.
4.4.6
Leasing
The District Annual Plan assumes certain items of plant and equipment will be leased after evaluation
on a case-by-case basis. The Plan also assumes that operating leases will be explored for capital plant
and equipment which have a short economic life or are prone to rapid changes in technology.
Operating leases will adhere to current guidelines and tests to clearly differentiate these from finance
leases.
116
4.4.7
Financial Covenants and Ratios
There are no specific financial covenants stipulated by the DMO/MOH for its term lending to TDHB. No
financial covenants have been stipulated by Westpac for transactional banking.
The following are some key financial ratios as derived from the consolidated financial statements for
the period 2014-18.
Financial ratios
1
2
3
4
5
Revenue to net funds employed
Operating margin to revenue
Operating return on net funds employed
Interest cover ratio
Debt to debt equity ratio
4.4.8
TDHB
2013/14
forecast
2.08
3%
7%
5.50
46%
Year1
2014/15
plan
2.14
5%
11%
5.62
47%
Year2
2015/16
plan
2.20
6%
12%
5.84
48%
Year3
2016/17
plan
2.24
6%
12%
6.09
48%
Year4
2017/18
plan
2.28
6%
13%
6.23
48%
Changes in Accounting Policies
There have been no changes from the accounting policies adopted in the last audited financial
statements other than any changes brought about by the adoption of NZIFRS in the financial
statements. All policies have been applied on a basis consistent with the previous period. These are
detailed in the Statement of Intent for 2014/15.
4.4.9
Capital Investment
The capital investment planned during the Business Plan period and the proposed funding lines to
finance the investment are as follows:
Year 1
(2014/15)
Year 2
(2015/16)
Year 3
(2016/17)
Year 4
(2017/18)
Total
(2014/2018)
Clinical Equipment
Other Equipment
Motor Vehicles
Minor Site Redevelopment
(excluding prior year WIP)
5,000
450
70
3,500
450
-
3,000
450
-
3,000
450
-
14,500
1,800
70
1,500
1,000
750
550
3,800
Information Technology
4,980
6,050
6,800
7,000
24,830
TOTAL
12,000
11,000
11,000
11,000
45,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
GRAND TOTAL
12,000
11,000
11,000
11,000
45,000
Sources of Funding
Crown Equity
Bank Borrowing
DMO/MOH Term Loans
Internal Cash Accruals
0
0
0
12,000
0
0
0
11,000
0
0
0
11,000
0
0
0
11,000
0
0
0
45,000
Capital Outlay ($‘000)
Operating
Strategic
Community Oral Health Project
Base Hospital redevelopment
project
TOTAL
117
4.4.10 Capital Divestment
A: The disposal of surplus assets proposed during the period 2014-18 is as follows:
Book value
($)
Realisable
Value ($)
Gain/(loss)
On sale ($)
Timing
* Miscellaneous equipment
(discarded/obsolete)
0
Not material
0
2014/18
* Surplus land
0
0
0
n/a
* Vehicles
0
Not Material
0
2014/18
Total
0
0
0
Asset
Taranaki DHB will ensure that disposal of any land transferred to, or vested in it pursuant to the Health Sector
(Transfers) Act 1993 will be subject to approval by the Minister of Health. Taranaki DHB will work closely with
the Office of Treaty Settlements to ensure the relevant protection mechanisms that address the Crown’s
obligations under the Treaty of Waitangi and any processes relating to the Crown’s good governance
obligations to Māori sites of significance are addressed.
4.4.11 Personnel
a) Paid / Contracted / Core FTEs:
The movement of “contracted/worked FTE” numbers across the Annual Plan period is assumed along the
following lines:
CONTRACTED
PROVIDER
Medical Personnel
Nursing Personnel
Allied Health Personnel
Support Personnel
Management & Administration
GOVERNANCE
TOTAL
Forecast
2013-14
Yr 1
2014-15
Yr 2
2015-16
Yr 3
2016-17
Yr 4
2017-18
142
545
242
80
270
1,279
153
539
248
81
270
1,291
154
530
245
81
270
1,280
156
525
240
82
270
1,273
158
525
240
82
270
1275
17
17
17
17
17
1,296
1,308
1,297
1,290
1292
The average “worked FTE” numbers for the four-year plan period are expected to be managed within the core
staffing numbers indicated above.


Project Whakapai – the initiative/project has become entrenched into the hospital services
operations utilising proprietary workforce allocation and real-time monitoring software to actively
manage supplementary staff costs arising from use of casuals, backfills, overtime and locums
continue to provide the framework for management and budgeting of FTEs. This interactive
workforce management tool has inbuilt levels of authority and decision matrixes with a centralised
allocations unit. Project Whakapai promotes a significant change in the traditional methods of
workforce allocation and management with resultant slowing down of the annual wage bill and
optimised allocation of available workforce.
Medical FTE count will increase on the assumption that vacancies are likely to be filled over the
coming period in lieu of locum cover (with corresponding drop in locum costs). Nursing staff are
expected to stabilise over the 4 year plan period due to more efficient management of staffing
118


(Project Whakapai) and efficiencies from services reconfigurations and changing models of care
within the hospital and mental health services. Movements in Allied Health and support staff are
likely to remain steady, whilst Management and Administration staff are also expected to remain at
current levels, with possible reduction in back office and administration staff arising from efficiency
reviews and reduction in staff managed through attrition. Capping FTE growth with improved
productivity and more efficient and smarter workflows is a key goal for Taranaki DHB to manage the
cost growth and the deficit.
Taranaki DHB is currently tracking below the Ministerial cap set for Management and Administration
staff having made significant reductions over the recent period through internal reviews and
restructures, and is expected to remain below the cap over the plan period.
In principle, the personnel budget has not planned for net FTE increases – other than FTEs required
to deliver new projects and nationally driven initiatives. There will be the impacts from changes to
services and models of care incidental to the hospital redevelopment project. The overall strategy is
to cap FTE growth, however it is acknowledged that there will be demand for clinical resources due
to increase in activity levels – both acute and elective. Additionally, as recent period statistics
indicate, there has been an increase in specialling patients (one-on-one care) in ICU and Mental
Health inpatient admissions. With introduction of management tools, TDHB will continue to
aggressively pursue measures and initiatives to increase productivity of existing staff and reduce the
demand for locums and casual staff within the hospital and specialist services.
b) Accrued FTEs:
The corresponding average “Accrued FTE” count for the four year plan period is as below:
ACCRUED
PROVIDER
Medical Personnel
Nursing Personnel
Allied Health Personnel
Support Personnel
Management & Administration
GOVERNANCE
TOTAL
Forecast
2013-14
Yr 1
2014-15
Yr 2
2015-16
Yr 3
2016-17
Yr 4
2017-18
145
569
242
82
275
1,313
156
563
248
83
275
1,325
157
553
245
83
275
1,313
159
548
240
84
275
1,306
161
548
240
84
275
1308
17
17
18
17
17
1,330
1,342
1,330
1,323
1325
4.5
CAPITAL EXPENDITURE 2014/15 (STRATEGIC)
4.5.1
Base Hospital Inpatient Facilities Development Programme
Project Maunga – the Stage 1 of the redevelopment of the Base Hospital inpatient facilities with
theatres and inpatient wards is scheduled for completion in April 2014. Total capital outlay is $ 80M.
The primary focus of this project is to generate efficiencies and improvements to prevalent models of
care through consolidation of hospital services and systems into a more compact footprint, which will
lend more flexibility and efficiency to operations both in the immediate and long term. In doing so, it
will also provide a more user friendly hospital and wellness environment to patients, staff and public.
119
The Master Plan envisages a 3 Stage redevelopment of the Base Hospital core inpatient facilities and
support systems, such that it is both financially and operationally feasible over a defined timeline. The
components of the programme are as follows:
Stages
Comprising
Estimated
Cost
Construction Timeline
Status
1 STAGE 1
Theatres, Ambulatory,
Inpatient wards
$80M
Start: Aug 2011
Finish: April 2014
Completion in April 2014.
2 STAGE 2
Maternity,
ED
$37M
Tentative: 2018-19
Supplementary business
case to be progressed.
3 STAGE 3
OPD, Laboratory,
Administration
$28M
Tentative : 2020-2021
Supplementary business
case to be progressed.
$145M
2011 – 2021
TOTAL
Neonatal,
Notes:
1.
2.
3.
Stages 2 and 3 are discrete components of the overall Master Plan for the redevelopment of inpatient
facilities at the Base Hospital.
Once Stage 1 is completed it is envisaged that supplementary business cases will be developed for each of the
remaining stages and forwarded to National Capital Committee for approval and funding.
In short, each of the stages can be visualised as standalone projects, yet forming part of one coherent
facilities redevelopment programme for the Base Hospital in New Plymouth, thus enabling affordability to
both Taranaki DHB and the National Health capital budget.
An updated Schedule of Capital Intentions has been submitted.
4.6
COST AND EFFICIENCY INITIATIVES
Taranaki DHB is faced with the challenge of managing its service delivery within a defined fiscal
envelope. In addition, it has to balance its long-term strategies with short-term objectives while
continuing to provide a clinically safe and quality service. Under this capped environment, with
increasing operating costs and demand for services, the Hospital Provider Arm will need to achieve
sustainability – both clinical and financial. Taranaki DHB recognises the need for continuous service
improvements and efficiency gains while it attempts to re-position itself continually to meet the
challenge.
The strategy is to continuously progress short term initiatives and service reviews to provide immediate
gains, while progressing a series of more strategic service changes in conjunction with regional services
planning to achieve longer term sustainability. The latter is needed to rationalise the growth in demand
for services and operating costs, besides the need to arrest and reduce the hospital provider financial
deficit.
The following key initiatives are being considered within the Hospital Provider operations to generate
efficiency gains, and contain or reduce operating costs.
120
Initiatives
Campus wide cost management
strategies including service
efficiencies and prioritisation.
Proposal
Potential
Est. ($)
Impact
Savings targets of 5% across specific
expenditure lines to be managed at
a Unit and Service level across all
cost centres; and further initiatives
to be identified.
Review and Management of
contracted services, with a view to
reducing utilisation and cost.
$2.60M
Reduce operating
costs
$0.80M
Reduce outsourced
service costs.
Service configuration
Review configuration of services for
improved cost management.
$0.45M
Reduce supply costs
and personnel
efficiencies
Management of staffing costs
Use of alternative staffing models,
where clinically appropriate.
$0.45M
Reduce service costs
Management of contracted
services costs.
TOTAL
$4.30M
The DAP 2014-15 has identified a cost to funding gap of $ 4.30M, which has to be bridged by a range of
saving initiatives and cost reduction plans as outlined. The services initiatives commenced in 2013-14
will also generate cost savings in future periods, and have been recognised in out years.
Other miscellaneous gains from local initiatives and cost reduction measures have been built into the
relevant expense budgets.
Faced with a gap in its operating budget, the Hospital Provider Arm will continue to explore all practical
options with the aim of reducing its overall cost of services delivery, whilst improving productivity and
efficiency of operations. This financial recovery plan is an ongoing process, will involve partnering with
primary sector providers and is expected to span more than one fiscal year in view of their strategic
components and broader implications.
In parallel, the immediate focus post Project Maunga is to generate efficiencies and improvements to
prevalent models of care through consolidation of hospital services and systems into a more compact
footprint. This will in turn lend more flexibility and efficiency to operations. Overall, the project should
generate permanent and sustainable benefits post 2013-14.
4.7
DEBT AND EQUITY
The debt profile of Taranaki DHB as @ 01 July 2014 will be term loans of $74M with the Debt
Management Office (DMO)/MOH, fully drawn down against the approved loan limit of $74M. The
primary assumptions carried in the financial plan 2014/15 are:
a) Overdraft facilities (as per OPF guidelines) are assumed to be available under the DHB collective
banking arrangement with West Pac.
b) No additional equity or deficit support is envisaged. It is expected that base line capital
expenditure will be contained within the level of depreciation for 2014/15 and out years.
121
4.8
SENSITIVITY ANALYSIS: PLAN 2014/15
The District Annual Plan has outlined some key financial risks and while it is difficult to quantify all these
risks with accuracy, the likely impacts on the bottom line if these were to materialise is factored below:
DHB Hospital Provider Operations – key risks
Unbudgeted
financial risk
Est. risk
($M)
FTE + wage budget
Timing of gains from initiatives
Diagnostic costs
0.30
0.30
Clinical supplies
General overheads
Likely impact on 2014/15 planned
financial result
0.40
1.50
0.400.30
0.30
0.60
$3.20M
75% risk
($M)
50% risk
($M)
25% risk
($M)
0.30
1.13
0.20
0.22
0.45
0.20
0.75
0.20
0.15
0.30
0.10
0.37
0.10
0.08
0.15
$2.30M
$1.60M
$0.80M
Probability
factor
(% risk)
75%
75%
0.10 75%
50%
50%
0.10
$2.08M
The analysis estimates an overall exposure of circa $3.20M for 2014/15, which could arise from a
combination of cost drivers as identified above. The overall probability factor is estimated to be around
65% leaving a residual risk equating to about $2.08M. The risk is expected to be managed through a mix
of:





Internal cost controls
Management of FTEs,
Operational savings in discretionary expense lines through capped budgets
Gains from National procurement programmes and initiatives
Achievement of internal efficiency projects and service reviews
DHB Funder Operations – Key Risks
Unbudgeted financial risk
Estimated
risk
($’M)
75% risk
50% risk
25% risk
($’M)
($’M)
($’M)
Probability
factor
(% risk)
Pharmaceuticals
0.60
0.45
0.30
0.15
25%
IDF outflows
2.00
1.50
1.00
0.50
50%
Provider Arm expenditure
2.00
1.50
1.00
0.50
50%
Older Peoples Service
1.00
0.75
0.50
0.25
25%
5.60M
4.20M
2.80M
1.40M
2.40M
Potential impact on 2014/15
planned financial result
The overall exposure is estimated at around $5.60M for 2014/15, while the probability factor is
estimated to be around 40% leaving a residual risk equating to about $2.40M.
These risks are expected to be managed through contract monitoring and efficiency gains from current
NGO contracts.
122
0.10
4.9
STATEMENT OF COMPREHENSIVE INCOME
TARANAKI DISTRICT HEALTH BOARD
STATEMENT OF COMPREHENSIVE INCOME
DISTRICT ANNUAL PLAN 2014-18
($'000)
Year -1
FORECAST
Year 0
Consolidated
Audited
2012/13
Hosp+Gov Funder
Forecast
Forecast
2013/14
2013/14
Consolidated
Forecast
2013/14
Year 1
Provider Governan:
Plan
Plan
2014/15
2014/15
Hosp+Gov
Plan
2014/15
Funder
Plan
2014/15
Consolidated
Plan
2014/15
REVENUE
* MOH funding
* Funding & Governance
159641
147173
161954
2597
2040
152446
* ACC Revenue
4201
4256
* CTA revenue
2137
1506
* Other revenue
TOTAL REVENUE
75
161954
152446
165039
0
165039
2040
0
2466
2466
4331
4579
0
4579
1506
2060
0
2060
153998
165039
153998
2466
80
4659
2060
10995
5910
4174
10084
5959
0
5959
3989
9948
326744
175666
156695
332361
177637
2466
180103
158067
338170
28574
43428
15487
4071
19538
28865
42836
15634
4305
18104
28865
42836
15634
4305
18104
29467
42610
16530
4022
16002
0
0
0
0
1375
29467
42610
16530
4022
17377
111098
109744
109744
108631
1375
110006
18687
3033
17724
2333
17724
2333
16378
2115
0
0
16378
2115
21720
20057
20057
18493
0
18493
8615
1307
936
987
2443
3994
3508
8126
1358
1309
1083
2549
4267
4183
8126
1358
1309
1083
2549
4267
4183
7711
1240
1182
1082
2234
3931
4342
0
0
0
0
0
0
0
7711
1240
1182
1082
2234
3931
4342
0
21790
22875
22875
21722
0
21722
3160
3665
857
3843
2097
-2989
285
11662
1832
0
3149
4082
828
4122
2637
-304
285
12545
2020
0
3149
4082
828
4122
2637
-304
285
12545
2020
0
2953
4177
695
4485
2218
211
7
16032
3158
-501
1
0
30
0
413
329
315
0
0
0
2954
4177
725
4485
2631
540
322
16032
3158
-501
EXPENDITURE
Personnel costs
- medical
- nursing
- allied health
- support
- mgt & admin
total
0
29467
42610
16530
4022
17377
0
110006
Outsourced services
- clinical services
- other outsourced
total
0
16378
2115
0
18493
Clinical supplies
-
treatment disposables
diagnostic supplies
instruments & equip
patient appliances
implants & prostheses
pharmaceuticals
other clinical & client costs
total
0
7711
1240
1182
1082
2234
3931
4342
0
21722
Infrastructure & other op.costs
-
hotel services & laundry
facilities
transport
IT systems & telecom
professional fees
other op.expenses
democracy
depreciation
interest
cost & efficiency initiatives
Payment to - NGO providers
- personal health
- mental health
- disability support services
- public health
- maori health
- IDF's
total
60288
8623
34918
370
2650
35090
166351
TOTAL OPERATING EXPENSES
320959
5785
SURPLUS before capital charge
- Capital charge
29364
63298
9536
35344
745
2750
35022
146695
63298
9536
35344
745
2750
35022
176059
33435
1088
182040
146695
328735
182281
2463
-6374
10000
3626
-4644
3
7079
6294
0
6294
10000
-3453
-10938
3
-10935
2954
4177
725
4485
2631
540
322
16032
3158
-501
34523
62859
9740
35166
921
2838
36543
148067
62859
9740
35166
921
2838
36543
182590
184744
148067
332811
-4641
10000
5359
5778
7079
7
-13453
15544
0
0
0
0
0
0
0
0
0
0
0
0
0
Total Other Comprehensive Income
15544
0
0
0
0
0
0
0
0
TOTAL COMPREHENSIVE INCOME
FOR THE YEAR
15551
-13453
10000
-3453
-10938
3
-10935
10000
-935
Interest Cover ratio
15.85
NET SURPLUS/(DEFICIT)
6294
10000
-935
OTHER COMPREHENSIVE INCOME
* Gain/(Loss) on asset revaluation
*Gain/(Loss) on sale of assets
*Share of surplus/(loss) from associates
Revenue to Net Funds employed
5.50
5.78
2.00
1.10
2.08
1.12
Operating margin to Revenue ratio
9%
1%
3%
5%
2.14
6%
Op. return on Net Funds employed
18%
1%
7%
5%
12%
123
TARANAKI DISTRICT HEALTH BOARD
STATEMENT OF COMPREHENSIVE INCOME
DISTRICT ANNUAL PLAN 2014-18
Year 2
Provider Governan: Funder
Plan
Plan
Plan
2015/16 2015/16 2015/16
Year 3
Consolidated
Plan
2015/16
Provider Governan: Funder
Plan
Plan
Plan
2016/17 2016/17 2016/17
Year 4
Consolidated
Plan
2016/17
Provider Governan: Funder
Plan
Plan
Plan
2017/18 2017/18 2017/18
Consolidated
Plan
0
REVENUE
* MOH funding
167717
156329
* Funding & Governance
2507
* ACC Revenue
4904
* CTA revenue
2070
* Other revenue
4973
TOTAL REVENUE
179664
2507
167717
156329
170396
158658
2507
2549
82
4986
5229
2070
2080
4078
9051
4987
160489
342660
182692
29761
43036
16696
4062
17550
30057
43466
16863
4103
16324
1401
111105
110813
1401
16460
2126
16542
2137
18586
18679
7750
1246
1188
1087
2245
3951
4364
7789
1252
1194
1092
2256
3971
4386
21831
21940
2969
4198
728
4507
2644
660
324
16032
3158
-902
2983
4219
701
4530
2240
318
7
16032
3158
173074
160988
2549
84
2549
170396
158658
2591
5313
5729
2591
86
2080
2090
4169
9156
5001
162911
348152
185894
30057
43466
16863
4103
17725
30267
43867
17027
4144
16487
1414
112214
111792
1414
16542
2137
16402
2120
18679
18522
7789
1252
1194
1092
2256
3971
4386
7747
1243
1192
1084
2240
3964
4376
21940
21846
2984
4219
731
4530
2657
652
326
16032
3158
0
2976
4225
700
4537
2243
307
7
16032
3158
173074
160988
5815
2090
2591
4262
9263
165336
353821
EXPENDITURE
Personnel costs
- medical
- nursing
- allied health
- support
- mgt & admin
total
29761
43036
16696
4062
16162
1388
109717
1388
0
0
30267
43867
17027
4144
17901
0
113206
Outsourced services
- clinical services
- other outsourced
total
16460
2126
18586
0
0
0
0
16402
2120
0
0
18522
Clinical supplies
- treatment disposables
- diagnostic supplies
- instruments & equip
- patient appliances
- implants & prostheses
- pharmaceuticals
- other clinical & client costs
total
7750
1246
1188
1087
2245
3951
4364
21831
0
0
0
0
7747
1243
1192
1084
2240
3964
4376
0
0
21846
Infrastructure & other op.costs
- hotel services & laundry
- facilities
- transport
- IT systems & telecom
- professional fees
- other op.expenses
- democracy
- depreciation
- interest
- cost & efficiency initiatives
- Payment to - NGO providers
- personal health
- mental health
- disability support services
- public health
- maori health
- IDF's
total
TOTAL OPERATING EXPENSES
SURPLUS before capital charge
- Capital charge
NET SURPLUS/(DEFICIT)
2968
4198
698
4507
2229
329
7
16032
3158
-902
1
30
415
331
317
417
334
319
33224
1094
63517
9916
36044
944
2909
37159
150489
34188
1101
65105
10079
36944
967
2983
37783
153861
183358
2482
150489
336329
185620
2502
153861
341983
-3694
25
10000
6331
-2928
47
9050
6169
-451
6179
6119
6119
6119
152
-9047
50
-6570
6179
-9873
25
10000
63517
9916
36044
944
2909
37159
184807
1
30
47
9050
65105
10079
36944
967
2983
37783
189150
34185
186345
1
2977
4225
730
4537
2662
643
328
16032
3158
0
30
419
336
321
1107
67758
10242
37867
992
3058
38419
158336
67758
10242
37867
992
3058
38419
193628
2521
158336
347202
70
7000
6619
70
7000
6119
500
OTHER COMPREHENSIVE INCOME
* Gain/(Loss) on asset revaluation
0
0
0
0
0
*Gain/(Loss) on sale of assets
*Share of surplus/(loss) from associates
0
0
0
0
0
0
0
0
0
0
Total Other Comprehensive Income
0
0
0
0
0
0
0
0
0
0
0
0
-9873
25
10000
152
-9047
47
9050
50
-6570
70
7000
500
TOTAL COMPREHENSIVE INCOME
FOR THE YEAR
Interest Cover ratio
Revenue to Net Funds employed
6.12
6.09
0
0
0
6.23
1.14
2.18
1.17
2.22
1.19
Operating margin to Revenue ratio
5%
6%
6%
6%
7%
2.26
6%
Op. return on Net Funds employed
6%
12%
6%
12%
8%
13%
124
4.10 CONSOLIDATED STATEMENT OF FINANCIAL POSITION
TARANAKI DISTRICT HEALTH BOARD
DISTRICT ANNUAL PLAN 2014-18
CONSOLIDATED STATEMENT OF FINANCIAL POSITION
($'000)
2012/13
audited
2013/14
forecast
2014/15
plan
2015/16
plan
2016/17
plan
2017/18
plan
CURRENT ASSETS
*
*
*
*
Bank Account
Prepayments +ST investments
Debtors (net of provision)
Inventory
4752
11530
6562
2513
4005
3640
6650
2575
4505
3640
7200
2775
4755
3640
7575
2875
5755
3640
7950
3000
6755
3640
8325
3125
25357
16870
18120
18845
20345
21845
29662
0
21598
25155
0
20977
24342
0
20862
19817
0
21812
17119
0
21812
13571
0
22212
51260
46132
45204
41629
38931
35783
-25903
-29262
-27084
-22784
-18586
-13938
* Net Fixed Assets
* Investments
* Trust funds
187335
1297
702
189334
187318
1297
701
189316
183286
1297
701
185284
178254
1297
701
180252
173222
1297
701
175220
168190
1297
701
170188
NET FUNDS EMPLOYED
163431
160054
158200
157468
156634
156250
720
980
72000
735
0
74000
775
0
74000
850
0
74000
925
0
74000
1000
0
74000
73700
74735
74775
74850
74925
75000
25083
68150
-3502
24124
68150
-6955
23165
68150
-7890
22206
68150
-7738
21247
68150
-7688
20288
68150
-7188
89731
85319
83425
82618
81709
81250
163431
160054
158200
157468
156634
156250
45%
46%
47%
47%
48%
48%
CURRENT LIABILITIES
* Creditors & other payables
* Term Loans (current portion)
* Provisions
WORKING CAPITAL
NON CURRENT ASSETS
NON CURRENT LIABILITIES
* Provisions - non current
* Retentions
* Term Loans
CROWN EQUITY
* Crown Equity
* Reserves
* Retained earnings
NET FUNDS EMPLOYED
Debt: Debt equity ratio
125
4.11 CONSOLIDATED STATEMENT OF CASHFLOWS
TARANAKI DISTRICT HEALTH BOARD
DISTRICT ANNUAL PLAN 2014-18
CONSOLIDATED STATEMENT OF CASHFLOWS
($'000)
2012/13
audited
2013/14
forecast
2014/15
plan
2015/16
plan
2016/17
plan
2017/18
plan
OPERATING ACTIVITIES
* MOH funding
* Other revenue
314737
13509
317612
13784
323020
14040
328428
13297
333308
13909
338368
14518
total receipts
328246
331396
337060
341725
347217
352886
* Payment of salaries & operating exp.
* Payment to providers & DHB's
167695
143797
181034
147337
175782
148379
176364
153712
177859
156959
178603
161884
total payments
311492
328371
324161
330076
334818
340487
16754
3025
12899
11649
12399
12399
1370
584
560
560
560
560
7
0
0
0
0
0
21887
8111
0
0
0
0
* Capital expenditure
-53528
-12528
-12000
-11000
-11000
-11000
NET CASHFLOW FROM INVESTING
-30264
-3833
-11440
-10440
-10440
-10440
-959
-959
-959
-959
-959
-959
15200
2000
0
0
0
0
588
-980
0
0
0
0
14829
61
-959
-959
-959
-959
343075
-341756
331457
-332204
336101
-335601
340766
-340516
346258
-345258
351927
-350927
NET CASHFLOW
1319
-747
500
250
1000
1000
Add: Cash (opening)
3433
4752
4005
4505
4755
5755
CASH (CLOSING)
4752
4005
4505
4755
5755
6755
NET CASHFLOW FROM OPERATIONS
INVESTING ACTIVITIES
* Interest & Dividends Received
* Sale of fixed assets etc
* (Increase) / decrease in investments
FINANCING ACTIVITIES
* Equity injections / repayments
* Borrowings
* Payment of debts
NET CASHFLOW FROM FINANCING
Total cash in
Total cashout
126
4.12 CONSOLIDATED STATEMENT OF MOVEMENT IN EQUITY
TARANAKI DISTRICT HEALTH BOARD
DISTRICT ANNUAL PLAN 2014-18
CONSOLIDATED STATEMENT OF MOVEMENT IN EQUITY
2013/14
forecast
2014/15
plan
2015/16
plan
2016/17
plan
2017/18
plan
EQUITY AT THE BEGINNING OF PERIOD
89731
85319
83425
82618
81709
*
*
*
*
-3453
0
-959
0
-935
0
-959
0
152
0
-959
0
50
0
-959
0
500
0
-959
0
85319
83425
82618
81709
81250
Net results for the period
Revaluation of Fixed assets
Equity Injections / (repayments)
Other
EQUITY AT THE END OF THE PERIOD
127
128
129
MODULE 5: STEWARDSHIP
5.1
MANAGING OUR BUSINESS
Ability to adapt in a changing environment is critical if we are to provide effective, sustainable services.
This module describes Taranaki DHB’s stewardship as owner, provider and funder of our assets,
workforce, and infrastructure to build, adapt and maintain organisational capacity in order to perform
the functions and conduct the operations that will deliver the outputs and impacts we seek. It provides
further detail on the stewardship portion of our performance story.
5.1.1 Our People
The central part of our capability is our people. Providing health and disability services now and into
the future depends on having a workforce that is well matched to the health needs of the community
and appropriately skilled and located.
Key points of note about our workforce (as at 31 December 2013) are:






We employed 1,215.33 FTE of staff
81% of staff were female
We have a multi-cultural workforce with 37 different ethnicities working together to provide
health services in many settings
The Maori workforce made up around 7.7% of the overall staffing numbers with 33% in support
roles (non-health support, administration, management) and 67% in clinical roles (medical,
nursing, allied)
New Zealand non-Maori make up the largest single ethnic group of employees (68%)
59% of our workforce is over the age of 45 years
As at 31 December 2013, Taranaki DHB’s workforce was broken down as follows:
Workforce
Medical
Nursing
Allied
Non Health Support
Management/ Administration
Total
Subgroup
SMO
RMO
FTE
74.55
64.50
500.12
235.80
77.43
262.94
1,215.33
5.1.2 Organisational Performance Management
Our performance is assessed on both non-financial and financial measures. The table in Section 5.5.2 of
this module provides an overview of the external reporting. Our overall planned performance as a
funder and provider of health services for 2014/15 is outlined in this plan and will be reported to our
senior management, Board and the Ministry of Health on a regular basis.
130
5.1.2.1 Non-financial Performance Reporting
Non-financial performance, which relates to volume and performance expectations for health service
provision (by Taranaki DHB Provider Arm, PHOs and the NGO’s we fund), is monitored regularly. It is
one of the tools we use to identify issues and inform decision-making to improve our performance.
As a funder we monitor the agreements we have with providers through effective portfolio
management which includes regular performance reports and data analysis. We also monitor the
quality of services provided through reporting of adverse incidents, routine audits, service reviews and
issues-based audits.
We report quarterly to the Ministry of Health on the required measures in the DHB Non-Financial
Monitoring Framework and regularly feed into benchmarking and quality programmes to compare our
performance with other providers. We support the national expectation that the public should be
informed about health system performance by publishing our performance against the national health
targets.
We report to our Board through our regular narrative reporting process on performance against this
Annual Plan. These reports are provided and discussed in Board Meetings and are available to the
public as part of the relevant Board agenda.
5.1.2.2 Financial Performance Reporting
As part of our annual planning process we submit a set of financial templates to the Ministry of Health.
The templates inform the tables and narrative presented in Module 4. We report monthly to the
Ministry of Health against the financial templates. We report on our financial performance monthly to
our Board. This report includes commentary and financials as well as actions planned to improve
financial performance.
As part of our financial reporting we include full time equivalent (FTE) reporting. This covers areas like:
 Accrued FTE
 Management / Administration FTE Cap
 Clinical FTE
 Out Sourced Services FTE
The information on our financial performance is one of the tools used by the organisation to identify
issues and inform decision-making to improve our performance.
5.1.3
Funding and Financial Management
The following table sets out our key financial indicators:
Revenue (after adjustments)
Net Surplus/(Deficit)
Total Fixed Assets
2012/13
2013/14
2014/15
2015/16
2016/17
2017/18
$M
$M
$M
$M
$M
$M
ACTUAL
FORECAST
PLANNED
PLANNED
PLANNED
PLANNED
326.744
332.361
338.170
342.660
348.152
353.821
0.007
(3.453)
(0.935)
(0.150)
0.005
0.500
187.335
187.318
183.286
178.254
173.222
168.190
Net Assets
89.731
85.319
83.425
82.618
81.709
81.250
Term Borrowings and
73.700
74.735
74.775
74.850
74.925
75.000
Provisions
131
5.1.4 National Health Sector Agencies
We are expected to align our planning with the planning intentions key national agencies. Each of
these national agencies has initiatives for the 2014/15 year, which will impact on our DHB. The national
agencies are:
 Health Benefits Limited (HBL)
 National Health Information Technology Board
 Health Workforce New Zealand
 PHARMAC
 Health Quality and Safety Commission
 National Health Committee
See Module 2, section 2.5 for activities we will undertake to support the work of these National
Agencies.
5.1.5 Risk Management
Taranaki DHB manages risk using AS/NZS ISO 31000:2009, a nationally accepted standard. We utilise a
top down, bottom up enterprise-wise risk management process that is co-ordinated through the
Quality and Risk team. The Executive Team own the Emergent Risk Register which is updated and
reported to the Board on a monthly basis. Risk information is utilised to inform and drive organisation
wide and service improvement and auditing activities.
A subcommittee of the Board – The Audit, Finance and Compliance Committee review risks on a regular
basis. Internal and external mechanisms are in place for evaluation of contracted providers; these are
done on a planned and on an ad-hoc basis as required.
Sector Services also provide a range of routine and special audits on behalf of Taranaki DHB with
respect to primary care services and Fee for Service Agreements (including pharmacy, dental, homebased support services and aged care).
All DHBs face pressure to meet additional expenditure which must be managed within allocated
funding. There is pressure to devolve services to the primary area seen as a “lower cost platform” and
to increased tertiary level interventions such as cardio-thoracic surgery and cardiology procedures. This
creates increasing challenges for the viability of secondary services, particularly for provincial DHBs.
In employment negotiations there will be a focus on increased workforce flexibility, increased
productivity and wage increases that are affordable. The DHB will have to manage staff numbers to
appropriate levels and may implement changes to service configuration. These efforts will have to be
prioritised within the DHB’s service priorities and demographics.
5.1.6 Performance and Management of Assets
Local: Taranaki DHB has a significant investment in fixed assets which are essential to enabling the DHB
to deliver sustainable health services. The DHB is committed to the effective planning and
management of its assets for efficient and effective use. The strategic planning for assets is undertaken
through an asset management planning process which encapsulates future demand for assets flowing
out of regional and local clinical services plans. The asset management process also covers the long
term maintenance and refurbishment of assets.
The DHB ensures capital expenditure is prioritised and affordable through a rigorous approval process.
Business cases are produced for new asset purchases and performance indicators such as return on
investment analysed to ensure the asset contributes positively to the organisation.
132
Regional: In line with national expectations we will participate in the provision of a regional
commentary to sit alongside the midland DHB region Asset Management Plans. The regional
commentary will take into account the long term direction on service delivery settings and clinical and
economic sustainability.
5.1.7
Shared Decision-making
5.1.7.1 Clinical Governance
A commitment to quality and patient safety places responsibility on the DHB to have effective
mechanisms in place for planning, monitoring and managing the quality of clinical provided.
Attempting to make the fundamental changes to the health system for the sector to “live within its
means” will require strong clinical engagement and leadership. TDHB is driven by clinical engagement
commitments through a range of initiatives.
Clinical input into decision making is facilitated by a model of shared management and clinician
leadership at all levels within the DHB. Our Clinical Directors are formally part of the TDHB leadership
team and fully involved in the financial and clinical management of their services. The TDHB Clinical
Board is a multidisciplinary clinical forum, whose membership includes representatives from the
primary, secondary and community sectors, and the Clinical Board is chaired by the Chief Medical
Officer. The Clinical Board oversees the DHB’s clinical activity, provides advice to the Chief Executive
and Board on clinical issues and takes a proactive role in setting clinical policy and standards,
encouraging best practice and innovation. Members support and influence the DHB’s vision and values
and play an important clinical leadership role, leading by example to raise the standard of patient care.
5.1.7.2 Māori Participation
We have a governance relationship, through a memorandum of understanding, with local Iwi/Māori
represented by Te Whare Punanga Korero (TWPK) Iwi relationship Board. TWPK has representatives
from each of the eight Iwi within Taranaki.
The memorandum of understanding underpins a “good faith” relationship between the parties by
recognising the legitimacy of the TWPK Board to represent the interests of Māori, as well as the
legitimacy of the Board as the statutory body charged with the determination, prioritisation and
funding of health and disability services.
We have a number of established mechanisms to enable Māori to participate in and contribute to
strategies for Māori health gain. These include:
 TWPK (as above)
 Partnership and contract with preferred Maori Health Provider - Te Kawau Maro Alliance
 Maori Health Team relationships within the community and provider networks
5.1.7.2 Primary Health Alliance Leadership Teams
An Alliance Leadership Team (ALT) has been established across the Midland region with our primary
care partners, the Midlands Health Network. The ALT is populated by clinical leaders and managers
from across primary and secondary care.
The purpose of the ALT is to lead and guide our Alliances as they improve health outcomes for our
population. The aim of the ALT is to provide the direction to enable the provision of increasingly
integrated and co-ordinated health services through clinically-led service development and its
implementation within a “best for patient, best for system” framework.
133
5.1.7.3 Community input
We regularly engage with a number of advisory groups, working groups, consumer groups and
community health forums. Their advice and input assists in the development of DHB strategies and
plans.
Community Health Forums are made up of local people representing specific geographical regions.
They support and advise us about local health issues, activities and priorities for their community. They
are also mechanisms for ensuring communities are kept involved in and informed of DHB activities and
issues.
5.2
BUILDING CAPABILITY
This section outlines the capabilities we will need in the next three to five years as well as touching on
the approach in the short term to work towards developing these.
5.2.1 HealthShare Limited
HealthShare (HSL), established in 2001, is a regional Shared Services Agency jointly owned by Waikato,
Bay of Plenty, Lakes, Taranaki, and Tairawhiti District Health Boards. From August 2011 HSL has taken
on an expanded role as a regional provider of non-clinical service and now provides operational support
in a number of areas identified as benefiting from a regional solution.
The Midland region DHBs determine the services that HSL will provide, and the level of these services,
on an annual basis. These determinations are made through the Regional Services Plan (RSP) and
regional business case processes.
Categories of possible regional service delivery include:
 Activities that support future regional direction and change through the development of
regional plans
 Facilitating the development of clinical service initiatives undertaken by regional clinical
networks and regional action groups that support clinical service change
 Key functions that support and enable change through the ongoing development of the region’s
workforce and information systems
 Back office service provision that can drive efficiencies at a regional level, alongside new
national back office shared services.
The annually agreed regional services form the basis for HSL’s Business Plan which specifies the
company’s performance framework; the services to be provided; and the associated performance
measures. HealthShare’s Business Plan also details, at a service level, the activities that have been
purchased by the shareholding DHBs.
HSL has multiple planning and reporting relationships within the Midland region and to national
agencies as depicted in the diagram:
134
Serving the Midland DHBs through network coordination and support excellence
National
Health
Board
Minister & Ministry of Health
Annual Report
Funding contracts
& reporting
Regional
Services Plan
& reporting
Business plan &
reporting
Midland
CEs Group
HealthShare
Board
Regional
Contracts
Service level
agreements
DHB
Shareholders
Midland DHBs
Taranaki
DHB
Lakes
DHB
Waikato
DHB
Bop
DHB
Tairawhiti
DHB
The following regional services are expected to be provided from HSL in 2014/15:

Regional planning and reporting facilitation

Regional Service Networks
 Midland Cancer Network
 Midland Mental Health and Addictions

Regional Clinical Networks and Regional Action Groups including:
 Cardiac Network
 Child Health Action Group
 Elective Services Action Group
 Health of Older People Action Group
 Midland Maternity Action Group
 Midland Region Trauma System
 Radiology Network
 Stroke Network
 Regional Emergency Departments Services*
 Renal Action Group*
 Rheumatic Fever Action Group *

Midland Region Training Network

Workforce development and intelligence support

Regional Information Services

Shared services including:
 Third party provider Audit and Assurance Service*
 Regional Internal Audit Service (Waikato, Lakes, Taranaki, Tairawhiti)*
 Midland recruitment and selection service
 Midland Smokefree programme.
* These areas are not included in the 2014/15 Regional Services Plan
135
5.2.2 Information Communications Technology
The Midland Regional IS service will implement the Midland Region Information Services Plan and
advance National Health IT Board priorities, specifically the implementation of the National Health IT
Plan priority areas. Work in this area is done within the context of the affordability envelope of the
Midland DHBs.
The process of prioritising the ICT work effort is done via the IS executive group with is comprised of
clinical leaders and business leaders from each of the Midland DHBs. This group reviews the
programmes of work and provides recommendations to the regional capital committee for funding
decisions.
A current focus is on regional deployment the CSC ePharmacy application that will provide the
underpinning for the regional deployment of the medication management pilot.
The other programme currently under review is the deployment of the Orion CWS application within
the Midland region. This will require significant reprioritisation of current activities at both a local and
regional level to enable this to be brought forward.
Further information is available in the Midland DHBs RSP for 2014/15 and see also section 2.5.3 re the
National IT Board initiatives that TDHB is committed to working on.
5.2.3 Integrated Contracting
We have been working with our local Preferred Provider of Maori Health Services (Te Kawau Maro
Alliance) to progress a Whānau ora service delivery model within the contracting framework. This
involves ensuring our current services are responsive and quality focused and sustainable. We (the
DHB and its primary care partners) are also utilising the Results Based Accountability framework in
order to assist in identifying the appropriate population and performance indicators that we can use to
ensure that changes made are actually helping improve the health and well-being of our people.
We will look to take up integration opportunities as appropriate.
integration, considerations we will take into account are:
 Consistent population coverage
 Position in the continuum of health services
 History of service / contract delivery
 Integrating agreements will not result in service gaps
When making decisions on
5.2.4 Capital and Infrastructure Development
Capital expenditure is planned and prioritised at both a Midland regional and local level. DHBs capital
intentions, which span 10 years, are consolidated to form a regional view. Large clinical investments
are collaborated with the aim of achieving best fit for the region.
The Midland region capital committee meets regularly to consider and approve business cases requiring
regional sign-off. Business cases are prepared and approved at a local Board level before submission to
the regional capital committee for approval.
At a local level, our long term financial model provides a high level view on capital affordability of ‘big
ticket items’. For the items identified as ‘non big ticket’, there is a rolling three year process. As part of
this process a comprehensive annual prioritisation exercise is undertaken, which includes a quarterly
review to identify any potential need for re-prioritisation.
136
5.2.5 Collaboration
We collaborate with other health and disability organisations, stakeholders and our community, to
decide what health and disability services are needed and how to best use the funding we receive from
Government. These collaborative partnerships also allow us to share resources and reduce duplication,
variation and waste across the whole of the health system to achieve the best health outcomes for our
community.
5.2.5.1 Regional Collaboration
In addition to the work happening regionally around our RSP development and implementation, there
is work occurring in other areas. An example of such an area is Public Health. There are four Public
Health Units in the Midland Region:




Toi Te Ora Public Health Service servicing the Bay of Plenty and Lakes DHBs
Te Puna Waiora, Tairawhiti District Health
Public Health Unit, Taranaki DHB
Population Health, Waikato DHB
Midland DHBs Public Health Units have identified a number of areas where collaboration could be
strengthened. In 2014/15 the Public Health Units will continue to develop collaborative working
relationships by maintaining and developing regional linkages and contacts, sharing information,
contributing to the National Public Health Clinical Network and collaborating on relevant regional
projects.
In line with national direction, the Public Health Units in the Midland Region have established the
Midland Regional Public Health Network. The Network will provide leadership for and strengthen the
performance and sustainability of Public Health Units. The Network will also develop and maintain
relationships with the Midland Regional Services Planning Groups.
The goals of the Network are to:


Enhance the consistency, co-ordination and quality of public health service delivery across the
Region
Plan together where there are benefits in doing so
The Network’s specific areas of focus for 2014/15 are outlined in the following table.
Area of Focus
Workforce development and retention
Specific Areas of Work
Collaborative approach across the Midland Region for
general
public
health
workforce
professional
development
Midland Public Health Clinical Network
Communication and actions as required to support
national Public Health Clinical Network
Maintaining and developing regional Regular public health regional teleconferences and
linkages and contacts
forums for staff groups
Communicable disease protocols
Develop regional protocols for an identified list of
communicable diseases
Information sharing and knowledge Explore opportunities to collaborate in the areas of
management
health intelligence and health needs analysis
137
Taranaki DHB Public Health Unit also maintains key linkages with the Central North Island Drinking
Water Assessment Unit (CNIDWU) for drinking water assessment and continues to participate in
developing the network.
5.2.5.2 Local Collaboration
We work with other agencies (for example Ministry of Education, Ministry of Justice, Ministry of Social
Development, Police, Tertiary Education Commission, Housing NZ as well as other central government
agencies and local government) to improve the determinants of health.
Whakatipuranga Rima Rau Trust (WRR) is an inter-agency trust established by Taranaki District Health
Board, Ministry of Social Development, Te Puni Kokiri and Te Whare Punanga Korero. WRR was created
to build an integrated approach focusing on the common objective of up-skilling and developing the
Maori Health and Disability workforce in Taranaki. This is an innovative multi agency and multi funder
model which introduces a range of initiatives to address Maori workforce development through
collaboration.
Other examples of intersectoral collaboration include:
 Whānau Ora Integrated Contracts
 Long-term Community Council Plans
 Strengthening Families
 Accident Compensation Corporation and DHB relationship
 Healthy Homes initiatives
5.2.6 Long Term Demand Forecasting
We are experiencing an increasing mismatch of health service demand, supply and affordability. The
health sector cannot continue to operate in the same way as it has been if we expect to be clinically and
financially sustainable into the future.
Long term demand forecasting is one of the tools we must use to inform decisions around reforming
health sector configurations and related models of care if we are to move forward with a sustainable,
affordable and fit for purpose health sector. These reforms have already begun in the shape of:




Programmes like the better, sooner, more convenient health care initiatives
expectations for closer integration of services across the care continuum to improve
convenience for patients and reduce pressure on hospitals
Regional service planning
Facility Change Management – supporting staff in lean process redesign and change
management for the completion of Project Maunga (New Plymouth Base Hospital campus
redevelopment)
We will continue to participate in demand forecasting work as well as exploring the use of modelling
and simulation techniques to assist in shaping services. These techniques can improve both efficiency
and quality of services through a range of applications including:





Waiting time reduction
Scheduling
Bed capacity management
Workforce planning
Commissioning
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5.3
WORKFORCE
The health and disability sector continues to face increased demand for services along with rising public
expectations as to how services are delivered. There is also a strong requirement for simpler, more
standardised ways of doing things to release resources for better use elsewhere and build a platform to
develop a workforce with more generic skills that is flexible and able to work in integrated service
models across hospital and community settings.
5.3.1 Managing Our Workforce within Fiscal Restraints
We continue to operate in a changing environment within a large and complex workforce. This requires
sound strategic planning in order to meet our current obligations however this must be delivered within
fiscal constraints.
Given the impact of affordability and availability factors, New Zealand faces a critical challenge in
maintaining a clinically skilled health workforce. Improving supply within the health workforce is only
part of the answer. To find enduring solutions service providers will need to strengthen innovation,
explore new ways of working, and to develop workforces that are sustainable into the future.
Staff engagement and organisational health is central to ensure the provision of high quality and
effective services that meet the health needs of our community. TDHB engages staff and unions in
forums in change management, transformational initiatives and policy development. Staff involvement
is important to achieve productivity gains and foster continuous improvement.
Collaboration and connectedness locally, regionally and nationally is imperative for TDHB to continue to
attract and retain people to Taranaki with emphasis on supporting the national Kiwi Health Jobs brand
and leading the regional recruitment work plan.
By working closely with our union partners, we will ensure organisational improvement, continuous
improvement and productivity enhancements. In return we will ensure the terms and conditions of our
peoples employment are in line with the state sector expectations.
The fostering of a performance culture ensures that the aims and objectives of the organisation are
being met at all levels within the organisation.
5.3.2 Strengthening Our Workforce
Health Workforce New Zealand (HWNZ) has overall responsibility for planning and development of the
health workforce. It aims to ensure that New Zealand has a fit-for-purpose, high quality and motivated
health workforce, keeping pace with clinical innovations and the growing needs and expectations of
service users and the public.
The regional and local workforce and training plans recognise the emerging national collaboration
between District Health Board – Shared Services and Health Workforce New Zealand. This collaboration
will support collection and collation of workforce intelligence and training data. This will enable the
ability to extract and critique credible and reliable data around its workforce, funded training positions
and support development of health practitioner workforces to deliver new models of care.
139
Regional
The DHBs in the Midland Region have established the Midland Regional Training Network9 (MRTN) as a
platform to support coordination and optimal solutions for post entry education and training of the
health workforce. The MRTN is a cooperative system of interacting roles and functions. The
components operate autonomously in a virtual and adaptive model. A number of factors shape the
network such as national direction, policies, strategies, and plans. The network provides an interface
for relationships with local stakeholders and health training stakeholders more generally.
The following list identifies activities we intend undertaking over 2014/15. Further detail is provided in
the Regional Services Plan 2014/15 and also identified in section 2.8.3 earlier in this document:






Recruitment and retention strategies for rural workforces
Kia Ora Hauora – promotion of Maori Health as a career
Strategies to achieve a sustainable supply for vulnerable, hard to recruit to and emerging
workforces
Strategies around the management of the ageing workforce
Implementation of the Midland Training Network action plan focussing on e-Learning
Development of the care assistant roles (health care assistance, orderlies, therapy assistants)
Workforce is identified as a key enabler both within the DHB Annual Planning Priorities and the
Regional Services Plan (RSP) Guidelines for 2014/15. Within the Midland Regional Workforce and
Training Plan, that provides a framework for the five Midland DHBs, we aim to develop the principles of
culture, capability, capacity and change leadership. We recognise that there are longstanding gaps and
weaknesses in our knowledge around the current workforce, particularly relating to the capability and
capacity. Critically evaluating the workforce as a number (headcount / FTE) does not provide sufficient
evidence to enable clinical networks to develop new models of healthcare delivery.
This workforce and training plan illustrates the collaborative work of the Regional Director of Training
and General Managers of Human Resources building whole of health solutions and connectedness
working alongside the Clinical Networks to meet some of their key deliverables that pertain to
workforce and training.
The DHBs have revised how regional workforce programmes are delivered. Regional workforce projects
will be completed by the DHBs using a collaborative model. The collaboration process involves each
DHB agreeing to a common approach for each project area first and then one DHB commits internal
resource to develop the products for each DHB to select from. The decision about the strategy was
made early to reduce the likelihood of redundant work and duplication. It also allows for the fact that
each DHB has evolved to respond to its unique situation which has resulted in differences in the nature
of services delivered, systems, processes, policies etc. The factors which have resulted in these
differences remain today.
We will support and actively participate and contribute to the regional approach to address key
workforce requirements specifically the following:
 Diabetes prescribers
 GPEP 2 Registrars
 Sonographers and
 Career advice and planning for all HWNZ funded trainees
140
Local
Change continues to be driven by workforce shortages and an ageing workforce, and ensuring that the
DHB has an engaged and committed workforce. As agent for the Crown, the Minister of Health has
highlighted the expectation for DHBs to have in place the appropriate clinical and executive leadership
to deliver the Government’s objectives. This requires an improved retention of permanent clinical staff,
a reduction of vacancy rates and strengthening clinical leadership and networks.
Capability and capacity will be addressed by the implementation of initiatives that include supporting
new service models across within the hospital setting with senior leadership roles, the delivery of the
Long Term Conditions contracts that will enhance the interface between primary and secondary
settings, and management of employment and cost growth and use of the workforce.
Organisational culture features in 2014/15 and we will continue to strengthen TDHB’s “Behaviours in
the Workplace” initiative that was introduced as collaboration with unions. A culture of learning is
critical to building capability and capacity. We will work with staff on the development of their career
and supporting them through a wide range of development opportunities aligned to their career.
We have a continued commitment to:
 High quality clinical leadership and the development of strong, high performing
clinical/management partnerships. This will drive engagement and accountability at all levels
as we strive to live within fiscal constraints and to manage change.
 Progression of the Care Capacity Demand Management project system along with the
“Releasing Time to Care” project, which drives the way we work. This provides a whole of
organisation view to meeting service demand with quality care, providing a healthy and safe
work environment, and delivering service efficiencies.
 Meet or exceed it good employer obligations by maintaining a safe, supportive ad healthy
environment for staff, where a strong culture of leadership, accountability, health, safety and
wellbeing is fostered.
 Building on our strong “Grow Our Own” programme targeting graduates, opportunities to
attract vocational trainees back to Taranaki and a well-known health education scholarship
programme.
To achieve workforce equity for Maori, TDHB will continue to work closely with the Whakatipuranga
Rima Rau Trust (WRR) to expose rangatahi Maori to career opportunities in the health sector. Priorities
for Maori workforce development in 2014/15 is to embed Science Taster programmes for Year 9, 10
and 11 students, and Science Academies targeting Year 7 and 8 students. Our goal is to increase Maori
participation in our workforce up to 9%.
5.3.3 Safe and Competent Workforce
Local
In order to provide a safe and competent workforce, Taranaki DHB will undertake the following
initiatives to both strengthen and support vulnerable areas within our workforce.
Staff will be able to contribute through forums and project groups in the development of the following
workforce initiatives for 2014/2015:
Initiatives
Regionally, develop and implement a future focused Managed
Virtual Learning Environment (MVLE).
Develop and implement a Workplace Assessor model to assist
the attainment of qualifications by employees in the nonregulated workforce.
“Grow our Own” nurses by employing a minimum of 90% of
Measure
Quarter 1
Quarter 1
Quarter 2
141
Initiatives
NETP graduates.
We will continue to develop as an attractive employer using
regional e-recruitment technology to connect new employees
to the organisation in the shortest possible time by
introducing an e-On Boarding solution.
Measure
Quarter 3
Promoting opportunities where there are known workforce
gaps and reliance on overseas trained health professionals in;
 Rural hospital medicine – increase number of vocational Quarter 3
trainees
 Emergency medicine – increase FACEM qualified specialists Quarter 4
Increase the Maori workforce up to 9% of all employees.
Quarter 4
Continue to progress an initiative to investigate the feasibility
to establish in partnership with the University of Auckland
Medical School a 5th Year programme that focuses on rural and
GP immersion to meet the future workforce needs in these
areas.
Quarter 4
5.3.4 Child Protection Policies
The Vulnerable Children’s Bill is currently progressing through the house. A number of Government
Departments are affected by this. Once the Bill completes the process (expected to be in June, 2014)
DHBs will be notified of any implications for Human Resource practice and policies.
Taranaki DHB seeks to achieve a safe, supportive and healthy environment for staff, patients and their
family/whanau. The Vulnerable Children’s Bill requirements will be implemented using current and
proposed policy and procedures.
To strengthen our procedures we will:
 Review candidate assessment processes for qualifications and police vetting;
 Develop a 3 Yearly Review cycle for all employees;
 Develop a Child Protection Policy.
5.3.5 Children’s Worker Safety Checking
TDHB commits to the implementation of the requirements as identified under the Vulnerable Childrens
Bill. This includes:
 Recruitment policies will include all aspects of safety checking the core children’s workforce
 Safety checking information will be available to provide to the Director General (s38) to meet
the requirements in the Vulnerable Children’s legislation.
Current TDHB policy states all new employees, students, volunteers and contractors must undergo a
police vetting procedure, and organisational pre-screening questions informs all candidates of this
requirement.
TDHB intends to implement the requirements of the Vulnerable Children’s Bill once confirmed as
statute, and will work with the General Managers of Human Resources national forum to develop
guidelines for all 20 DHBs. This will provide a consistent framework that all DHBs will implement.
Guidelines will be developed and implemented
142
5.4
ORGANISATIONAL HEALTH
We need to make sure that we have the people, relationships, and processes that will enable us to
achieve our outcomes, impacts, and outputs. We cannot be successful without well-qualified and
motivated staff, sound management of resources and an effective working relationship between staff
and stakeholders.
5.4.1 Governance
We have an established governance structure based on the requirements of the NZPHD Act 2000,
through which the DHB functions. Governance plays a key role in determining what we need to do to
maximise the impact on our outcomes.
Our Board assumes the governance role and is responsible to the Minister of Health for the overall
performance and management of the DHB. Its core responsibilities are to set the strategic direction for
the DHB and to develop policy that is consistent with Government objectives and improves health
outcomes for our population. The Board ensures compliance with legal and accountability
requirements and maintains relationships with the Minister of Health, Parliament and our community.
The normal composition of the board is 11 members, seven elected and four appointed by the Minister
of Health. As required, the Board has two Maori members.
Three statutory (mandatory) advisory committees and three non-statutory committees have been
established to assist the Board to meet its responsibilities. The membership of these committees is
comprised of a mix of Board members and community representatives who meet regularly throughout
the year. It includes both clinical and Maori members who contribute clinical and cultural experience
and understanding to decision making.
The Board has not approved delegations to committees. All matters are recommended to the Board
through the minutes of the relevant committee.
The public is welcome to attend meetings of the Board and its three statutory committees. However,
for some items during a meeting the Board or committee may exclude the public. The Official
Information Act states the grounds on which the public may be excluded. Such items are clearly noted
on the agenda in question. Details of the meetings are publicly available on our website:
www.tdhb.org.nz
While responsibility for our DHB’s overall performance rests with the Board, operational and
management matters have been delegated to the chief executive. This delegation is made on such
terms and conditions as the Board thinks fit. The Chief Executive is supported by his direct reports, who
are:






General Manager Finance and Corporate Services
General Manager, Planning, Funding and Population Health
Chief Operating Officer & Chief Nursing Advisor
Quality and Risk Manager
Chief Advisor Maori Health
Chief Medical Advisor
5.4.2 Providing Health and Disability Services
As well as being responsible for planning and funding the health and disability services that will be
delivered in the Taranaki region, we also provide a significant share of those services as the ‘owner’ of
143
hospital and specialist services. These services are provided through our Provider Arm Division from
two key facilities being New Plymouth and Hawera Hospitals, supported by various clinics and facilities
across the province.
Hospital services comprise services that are delivered by a range of secondary, tertiary and quaternary
providers using public funds. These services are usually integrated with ‘facilities’ classified as hospitals
to enable co-location of clinical expertise and specialised equipment. These services are generally
complex and provided by health care professionals that work closely together.
They include:



Ambulatory services (including outpatient, district nursing and day services) across the range of
secondary preventive, diagnostic, therapeutic and rehabilitative services.
Inpatient services (acute and elective streams) including diagnostic, therapeutic and
rehabilitative services.
Emergency Department services including triage, diagnostic, therapeutic and disposition
services.
Taranaki DHB provides Hospital Services in New Plymouth and Hawera. New Plymouth Base Hospital is
generally a Level 4 facility, providing a full range of services medical, surgical, paediatrics, obstetrics,
gynaecology and mental health. It is also a base for a range of associated clinical support services and
allied health such as rehabilitation, speech therapy, physiotherapy, stroke and cardiac support, district
nursing and drug and alcohol programmes.
Hawera Hospital is a Level 2 facility providing emergency, medical and obstetric services. Hawera
Hospital delivers a range of associated outpatient, allied and community clinical support services such
as rehabilitation, physiotherapy, stroke and cardiac support and district nursing.
There are a total of 237 beds at New Plymouth Base Hospital, including the Special Care Baby Unit,
Maternity and Mental Health. Of these, approximately 153 in-patient beds are available for medical
and surgical patients (including critical care and coronary care) and 10 for day stays (surgical/medical),
with a further 22 for children and older people. 27 beds are designated for mental health patients.
There are 26 beds available for maternity, including 8 for the special care baby unit.
Taranaki DHB is currently undergoing facility redevelopment (Project Maunga) to better enable the DHB
to provide health services to match population demand and expectations.
The primary focus of this project is to generate efficiencies and improvements to prevalent models of
care through consolidation of hospital services and systems into a more compact footprint, which will
lend more flexibility and efficiency to operations both in the immediate and long term. In doing so, it
will also provide a more user friendly hospital and wellness environment to patients, staff and public.
Taranaki DHB will ensure that both Hospitals provide the amount of elective operations, procedures
and assessments agreed to with the Ministry of Health. We will review the key operations we perform
to ensure we are delivering the right level of service for the people in our region. We will demonstrate
innovative strategies, or alternative delivery options aimed at increasing elective capacity, including
initiatives across the primary/secondary interface.
5.4.3
Planning and Funding Health and Disability Services
The Planning and Funding Division of our DHB is responsible for planning and funding health and
disability services across our district. The core responsibilities are:


Assessing our population’s current and future health needs
Determining the best mix and range of services to be purchased
144






Building partnerships with service providers, Government agencies and other DHBs
Engaging with our stakeholders and community through participatory consultation
Leading the development of new service plans and strategies in health priority areas
Prioritising and implementing national health and disability policies and strategies in relation to
local need
Undertaking and managing contractual agreements with service providers
Monitoring, auditing and evaluating service delivery
The Planning and Funding Division contracts services from a wide range of non-government
organisation (NGO) providers, as well as other DHBs who often provide more specialist services.
Planning and Funding is responsible for oversight of the total funding package for our DHB and linking
on this with the Ministry of Health. Planning and Funding role incorporates ensuring equitable
acceptable and effective spending of health funds and ensuring that all services funded are delivered in
line with expectations. It acts for the DHB in local and national technical and strategic forums working
on the development of funding and pricing as well as service and purchasing frameworks.
In order to live within the available funding whilst maintaining sustainable services it is essential to
ensure that services are funded at appropriate levels and that value from health expenditure is
maximised in terms of both health gain and the DHBs priorities. Additional focus in these areas will be
required given the fiscal constraints and the need for DHBs to make decisions based on information and
analysis.
Planning is an integral part of purchasing and providing healthcare services. Planning is undertaken in
partnership with key stakeholders, including:












5.5
Ministry of Health
National Health Board
Midland DHBs
Other DHBs
Clinical leaders
Primary Health Organisations
Our primary care alliance partners
Iwi / Maori
Non-Government Organisations
Clinical advisory groups
Expert advisory groups
Community health forums
REPORTING AND CONSULTATION
5.5.1 Consultation with the Minister and the Ministry of Health
When making decisions, we follow an appropriate planning and consultation processes to avoid adverse
financial, resource and clinical impacts on the affected population(s) and avoid unnecessary service
instability. A well-managed process provides the confidence that:
 A robust process is followed
 There are sufficient controls in place to avoid unnecessary service instability
 The change is clinically appropriate and public confidence is managed
145
There are a range of matters that we must consult / notify the Minister of Health, the National Health
Board and Ministry of Health. These matters are:





Proposed service changes
Acquisition of shares or other interests
Entry into joint ventures and / or collaborative or cooperative agreements / arrangements
Capital expenditure if required by policy and / or legislation
Otherwise as required by legislation, regulation or contract
5.5.2 External Reporting
The Ministry of Health monitors our performance on behalf of the Minister. The mechanisms currently
in place to achieve this are outlined in the following table.
Table: External Reporting Framework
Reporting
Frequency
Information requests
Ad hoc
Financial reporting
Monthly
National data collections
Monthly
Risk reporting
Quarterly
Health target reporting
Quarterly
Crown funding agreement non-financial reporting
Quarterly
DHB Non-financial monitoring framework
Quarterly
Annual Report and audited accounts
Annual
146
147
MODULE 6: SERVICE CONFIGURATION
6.1
SERVICE COVERAGE
Taranaki DHB acknowledges that it has responsibility to fund other services outside the district, and will
do so accordingly. The impact of this responsibility in the 2014/15 funding environment will largely be
limited to:
 Determining alternative levels of services purchased from those indicated by Ministry of Health
forecasts where there have been indications that volumes need to be increased or decreased in
line with need and prioritisation
 Funding any additional acute inpatient activity to meet demand
 Purchasing services from outside the region (IDF outflows) where the DHB is unable to provide
services locally
 Purchasing services previously provided within the district from outside the district should local
provision be disrupted - to enable continuance of service coverage until longer term solutions
are put in place.
Services not directly funded or provided by us include, but are not limited to:
 Well Child services through Plunket, health camps etc
 National contracts (Organ transplants and new services purchased nationally)
 Emergency ambulance services
 Strengthening Families
 Family Start
 Primary response in medical emergencies (PRIME)
We have little influence in these areas in respect of service coverage. We will, however, seek to engage
with the relevant providers as appropriate. There are also services such as Public Health and Disability
support services for people under 65 years of age which are directly purchased by the Ministry of
Health where the DHB along with other providers may deliver the services. In these areas the DHB will
seek to engage and work collaboratively however decisions in relation to services purchased lie with the
Ministry of Health.
6.2
SERVICE CHANGE
Service coverage exceptions and service changes must be formally approved before they are included in
Annual Plans. The DHB had not signaled any significant proposed service changes for the 2014/15 year
prior to the deadline established by the Ministry of Health of February 2014.
6.3
SERVICE ISSUES
The following table identifies emerging service issues other than what is already covered this plan or
described within the context of the Midland Regional Service Plan. TDHB wishes to signal its intention
to review and/or evaluate these in the coming year.
It has yet to be determined that there is a proven need for all changes to take place. Should the DHB
consider in due course that a change is warranted, a formal service change process as outlined under
the Operating Policy Framework (OPF) will be followed to ensure service coverage and the Minister’s
and the Ministry’s requirements are met.
148
Table: Approved Service Issues 2014/15
Type of Change
Midland Regional
Clinical Services
Plan
Reconfiguration
Description of Change
As part of the Regional
Clinical Services planning
process clinical action
groups or networks have
been established for
identified areas.


Home
and
Community Support
Services
Consolidation
of
Residential Mental
Health Services
Benefits of Change

Reduce duplication of effort
enabling DHBs to collectively
develop sustainable solutions.

Develop integrated approach
to recruitment and retention
within the global marketplace.

Standardised
planning,
evaluation and procurement of
new technology solutions
within a clinical environment.
Implementation of new Service
Specification
Regional approach
Sustainability of services
Greater
sustainability
of
services
Facilitates demand for and
from DHB inpatient facility
Reduced
proportion
of
expenditure on overheads
Clinical sustainability
Improved cost effectiveness
Fewer women delivering who
are not registered with an LMC

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

Explore
most
appropriate model
of
maternity
services for rural
Taranaki
Expansion
of
intermediate care
for older people
New options for
acute demand and
urgent primary care









Taranaki
Integrated Health
System
Ongoing the redesign of
non-acute services. This
will involve many
stakeholders working
together to redesign the
Taranaki Integrated
Health System.

Reduced inpatient LOS
Reduced proportion of older
people entering permanent
rest home care
Care closer to home
Support achievement of ED
Health Target
Increase options available in
primary care after hours
Increased
enrolment
of
patients with PHOs
Developing new ways and
potentially new locations for
services to be delivered within
the resources available
Link to
Lower
Funding
Path
Yes
Change Due to Local,
Regional, or National
Reasons
This work is consistent
with the national
expectation of an
increased focus on
regional approaches,
and with the strong
focus on
regionalisation agreed
across the Midland
DHBs.
Yes
Regional
Yes
Local
Yes
Local
Yes
Local
Yes
Local
Yes
Local
A key to this will be the
collective effort of local
providers and
communities, together
with lessons from
elsewhere
149
150
151
MODULE 7: NON-FINANCIAL PERFORMANCE MEASURES
The DHB monitoring framework aims to provide the Minister with a rounded view of performance using
a range of performance markers. Four dimensions are identified that reflect DHBs functions as owners,
funders and providers of health and disability services. The four identified dimensions of DHB
performance cover:
•
•
•
•
Achieving Government’s priority goals/objectives and targets or ‘Policy priorities’
Meeting service coverage requirements and Supporting sector inter-connectedness or ‘System
Integration’
Providing quality services efficiently or ‘Ownership’
Purchasing the right mix and level of services within acceptable financial performance or
‘Outputs’.
It is intended that the structure of the framework and associated reports assists stakeholders to ‘see at
a glance’ how well DHBs are performing across the breadth of their activity, including in relation to
legislative requirements, but with the balance of measures focused on government priorities. Each
performance measure has a nomenclature to assist with classification as follows:
Code
PP
SI
OP
OS
DV
Dimension
Policy Priorities
System Integration
Outputs
Ownership
Developmental – Establishment of baseline (no target/performance expectation is set)
Performance Measure
2014/15 Performance Expectation/Target
Age 0-19
PP6: Improving the health status of people with
severe mental illness through improved access
PP7: Improving mental health services using
transition (discharge) planning and employment
Age 20-64
Total
3.78%
Maori
3.78%
Total
4.02%
Maori
5.34%
Age 65+
3.46%
Long term clients
Provide a report as
specified
Child and Youth with a
Transition (discharge) plan
At least 95% of clients
discharged will have a
transition (discharge)
plan.
Mental Health Provider Arm
PP8: Shorter waits for non-urgent mental health
and addiction services for 0-19 year olds
Age
<= 3 weeks
<=8 weeks
0-19
80%
95%
Addictions (Provider Arm and NGO)
Age
<= 3 weeks
<=8 weeks
0-19
80%
95%
PP10: Oral Health- Mean DMFT score at
Ratio year 1
0.9
Year 8
Ratio year 2
0.9
Ratio year 1
62%
Ratio year 2
64%
% year 1
85%
PP11: Children caries-free at five years of age
PP12: Utilisation of DHB-funded dental services by
152
adolescents (School Year 9 up to and including age
17 years)
PP13: Improving the number of children enrolled in
DHB funded dental services
% year 2
85%
0-4 years - % year 1
85%
0-4 years - % year 2
90%
Children not examined 0-12
years
10%
% year 1
Children not examined 0-12
years
8%
% year 2
PP18: Improving community support to maintain
the independence of older people
PP20: improved management for long term
conditions (CVD, diabetes and Stroke)
Focus area 1:
Long term conditions
Focus area 2:
Diabetes Management
(HbA1c) Improve or, where high, maintain
the proportion of patients with good or
acceptable glycaemic control
Focus area 3:
Acute coronary
syndrome services
The % of older people receiving
long-term home support who
have a comprehensive clinical
assessment and an individual
care plan
95%
Report on delivery of the actions and milestones
identified in the Annual Plan.
Improve or, where high,
maintain the proportion of
patients with good or acceptable
glycaemic
control
70 percent of high-risk patients
will receive an angiogram within
3 days of admission. (‘Day of
Admission’ being ‘Day 0’)
Over 95 percent of patients
presenting with ACS who
undergo coronary angiography
have completion of ANZACS QI
ACS and Cath/PCI registry data
collection within 30 days.
Improve or maintain
70%
95%
6 percent of potentially eligible
stroke patients thrombolysed
6%
80 percent of stroke patients
admitted to a stroke unit or
organised stroke service with
demonstrated stroke pathway
80%
PP21: Immunisation coverage (previous health
target)
Percentage of two year olds
fully immunised
95%
PP22: Improving system integration
Report on delivery of the actions and milestones
identified in the Annual Plan.
PP23: Improving Wrap Around Services – Health of
Older People
Report on delivery of the actions and milestones
identified in the Annual Plan.
PP24: Improving Waiting
Multidisciplinary Meetings
Report on delivery of the actions and milestones
identified in the Annual Plan.
Focus area 4: Stroke Services
Times
–
Cancer
PP25: Prime Minister’s youth mental health project
Provide quarterly narrative progress reports against the
local alliance Service Level Agreement plan to implement
named initiatives/actions to improve primary care
responsiveness to youth. Include progress on named
153
actions, milestones and measures.
PP26: The Mental Health & Addiction Service
Development Plan
Report on the status of quarterly milestones for a
minimum of eight actions to be completed in 2014/15
and for any actions which are in progress/ongoing in
2014/15.
PP27: Delivery of the children’s action plan
Report on delivery of the actions and milestones
identified in the Annual Plan.
As a low incidence DHB, TDHB will provide an exception
report only against DHBs’ rheumatic fever prevention
plan
PP28: Reducing Rheumatic fever
Hospitalisation rates (per
100,000 DHB total population)
for acute rheumatic fever are
40% lower than the average
over the last 3 years
1.
2.
3.
a.
PP29: Improving waiting times for diagnostic
services
b.
Coronary angiography –
90% of accepted referrals
for elective coronary
angiography will receive
their procedure within 3
months (90 days)
CT and MRI – 90% of
accepted referrals for CT
scans, and 80% of accepted
referrals for MRI scans will
receive their scan within
than 6 weeks (42 days)
0.5 per 100,000
90%
90% CT
80% MRI
Diagnostic colonoscopy –
75% of people accepted
for an urgent diagnostic
colonoscopy will receive
their procedure within
two weeks (14 days) and
60% of people accepted
for a diagnostic
colonoscopy will receive
their procedure within six
weeks (42 days)
75% Urgent
60% Non-urgent
Surveillance colonoscopy
c.
60% of people waiting for
a surveillance
colonoscopy will wait no
longer than twelve weeks
(84 days) beyond the
planned date
60%
Part A: Faster cancer treatment
– 62 day indicator
PP30: Faster cancer treatment (details of
expectations to be confirmed)
This indicator will be included
within PP30 for quarter one
2014/15 only
85%.
From quarter two 2014/15 this
indicator will become a health
target.
Part B: Faster cancer treatment
– 31 day indicator
< 10 % of the records
submitted by the DHB
154
This indicator will be included
within PP30 for all quarters of
2014/15.
Part C: Shorter waits for cancer
treatment
– radiotherapy and
chemotherapy
This indicator will be included
within PP30 from quarter two
2014/15 (transitioning from
health target).
SI1: Ambulatory sensitive (avoidable) hospital
admissions
are declined.
All patients ready-fortreatment receive
treatment within four
weeks from decisionto-treat.
Age 0-4
95%
Age 45-64
95%
Age 0-74
95%
SI2: Delivery of Regional Service Plans
Provision of a single progress report on behalf of the
region agreed by all DHBs within that region ( the report
includes local DHB actions that support delivery of
regional objectives
SI3: Ensuring delivery of Service Coverage
Report progress achieved during the quarter towards
resolution of exceptions to service coverage identified in
the Annual Plan , and not approved as long term
exceptions, and any other gaps in service coverage
SI4: Standardised Intervention Rates (SIRs)
SI5: Delivery of Whānau Ora
OS3: Inpatient Length of Stay
OS8: Reducing Acute Readmissions to Hospital
major joint replacement
21.0 per 10,000
cataract procedures
27.0 per 10,000
cardiac surgery
6.5 per 10,000
percutaneous revascularization
12.5 per 10,000
coronary angiography services
34.7 per 10,000
Report progress on planned activities with providers to
improve service delivery and develop mature providers.
Elective LOS
3.18 days
Acute LOS
4.07 days
total pop
≤6.9%
75 plus
≤10.9%
New NHI registration in error
A. Greater than 2% and less
than or equal to 4%
OS10: Improving the quality of identity data within
the National Health Index (NHI) and data submitted
to National Collections
Focus area 1:
identity data
Improving the quality of
B. Greater than 1% and less
than or equal to 3%
>1% ≤3%
C. Greater than 1.5% and less
than or equal to 6%
Recording of non-specific
ethnicity
Greater than 0.5% and less than
or equal to 2%
Update of specific ethnicity
value in existing NHI record with
>0.5% ≤2%
>0.5% ≤2%
155
a non-specific value
Greater than 0.5% and less than
or equal to 2%
Validated addresses unknown
Greater than 76% and less than
or equal to 85%
Invalid NHI data updates
causing identity confusion
>76% ≤85%
%tbc
%tbc
NBRS links to NNPAC and NMDS
Greater than or equal to 97%
and less than 99.5%
National collections file load
success
Focus area 2:
Improving the quality of
data submitted to National Collections
Greater than or equal to 98%
and less than 99.5%
>97% ≤99.5%
>98% ≤99.5%
Standard vs edited descriptors
Greater than or equal to 75%
and less than 90%
>75% ≤90%
NNPAC timeliness
Greater than or equal to 95%
and less than 98%
Focus area 3:
Improving the quality of
the programme for Integration of mental
health data (PRIMHD)
>95% ≤98%
PRIMHD File Success RateGreater than 95%
>95%
PRIMHD data quality
Routine audits
undertaken
with
appropriate
actions where
required
Volume delivery for specialist Mental Health and
Addiction services is within:
a) five percent variance (+/-) of planned volumes
for services measured by FTE,
Output 1: Mental health output Delivery Against
Plan
b) five percent variance (+/-) of a clinically safe
occupancy rate of 85% for inpatient services
measured by available bed day, and
c) actual expenditure on the delivery of
programmes or places is within 5% (+/-) of the
year-to-date plan
Developmental
experience
measure
DV4:
Improving
patient
No performance target set
156
157
MODULE 8: APPENDICES
8.1
GLOSSARY OF TERMS
TERM
MEANING
Activity
What an agency does to convert inputs to Outputs.
Capability
What an organisation needs (in terms of access to people, resources, systems,
structures, culture and relationships), to efficiently deliver the outputs required
to achieve the Government's goals.
Cost Containment
Reducing costs or cost growth in general, whether through improved efficiency,
or other means such as contract negotiation/consolidation, changes to budget
management, changes in structure etc.
Crown Agent
A Crown entity that must give effect to government policy when directed by the
responsible Minister. One of the three types of statutory entities (see also
Crown entity; autonomous Crown entity and independent Crown entity)
Crown Entity
A generic term for a diverse range of entities within one of the five categories
referred to in section 7(1) of the Crown Entities Act 2004, namely: statutory
entities, Crown entity companies, Crown entity subsidiaries, school boards of
trustees, and tertiary education institutions. Crown entities are legally separate
from the Crown and operate at arm’s length from the responsible or
shareholding Minister(s); they are included in the annual financial statements of
the Government.
Crown Entity
Subsidiary
A crown company is a company that is incorporated under the Companies Act
1993 that are controlled by Crown entities and that are: (a) a subsidiary of
another Crown entity under sections 5 to 8 of the Companies Act 1993; or (b) a
multi-parent subsidiary of 2 or more Crown entities New CE Act 2013 s7 1(c)
Efficiency
Reducing the cost of inputs relative to the value of outputs.
Effectiveness
The extent to which objectives are being achieved. Effectiveness is determined
by the relationship between an organisation and its external environment.
Effectiveness indicators relate outputs to impacts and to outcomes. They can
measure the steps along the way to achieving an overall objective or an
Outcome and test whether outputs have the characteristics required for
achieving a desired objective or government outcome.
Impact
Means the contribution made to an outcome by a specified set of goods and
services (outputs), or actions, or both. It normally describes results that are
directly attributable to the activity of an agency. E.g., the change in the life
expectancy of infants at birth and age one as a direct result of the increased
uptake of immunisations. (Public Finance Act 1989)
Impact Measures
Impact measures are attributed to agency (DHBs) outputs in a credible way.
Impact measures represent near-term results expected from the goods and
services you deliver; can be measured after delivery, promoting timely decisions;
reveal specific ways in which managers can remedy performance shortfalls.
Input
The resources such as labour, materials, money, people, information technology
used by departments to produce outputs, that will achieve the Government's
158
stated outcomes.
Intervention
An action or activity intended to enhance outcomes or otherwise benefit an
agency or group.
Intervention Logic
Model
A framework for describing the relationships between resources, activities and
results. It provides a common approach for integrating planning,
implementation, evaluation and reporting. Intervention logic also focuses on
being accountable for what matters – impacts and outcomes
(Refer State Services Commission ‘Performance Measurement – Advice and
examples on how to develop effective frameworks: www.ssc.govt.nz)
Intermediate
Outcome
See Outcomes
Living within Means
Providing the expected level of outputs within a break even budget or NHB
agreed deficit step toward break even by a specific time.
Management
Systems
Are the supporting systems and policies used by the DHB in conducting its
business.
Measure
A measure identifies the focus for measurement: it specifies what is to be
measured
Multi-Parent
Subsidiary
A company (incorporated under the Act) is a multi-parent if, under sections
5 to 8 of the Companies Act 1993,—

(a) the company is not a subsidiary of any one Crown entity; but
(b) if 2 or more Crown entities were treated as 1 entity (a combined entity), with
their rights, entitlements, and interests in relation to the company taken
together, the company would be a subsidiary of the combined entity (New CE
Act s7(1 – 2)
Objectives
Is not defined in the legislation. The use of this term recognises that not all
outputs and activities are intended to achieve “outputs”. E.g., Increasing the
take-up of programmes; improving the retention of key staff; Improving
performance; improving Governance…etc are ‘internal to the organisation and
enable the achievement of ‘outputs’.
Outcome
Outcomes are the impacts on or the consequences for, the community of the
outputs or activities of government. In common usage, however, the term
'outcomes' is often used more generally to mean results, regardless of whether
they are produced by government action or other means. An intermediate
outcome is expected to lead to an end outcome, but, in itself, is not the desired
result. An end outcome is the final result desired from delivering outputs. An
output may have more than one end outcome; or several outputs may
contribute to a single end outcome.
A state or condition of society, the economy or the environment and includes a
change in that state or condition. (Public Finance Act 1989).
Output Agreement
Output agreement/output plan - See Purchase Agreement
An output agreement is to assist a Minister and a Crown entity (DHB) to clarify,
align, and manage their respective expectations and responsibilities in relation
159
to the funding and production of certain outputs, including the particular
standards, terms, and conditions under which the Crown entity will deliver and
be paid for the specified outputs. Responsible Minister may set standards, terms,
and conditions in respect of certain classes of outputs.
Output Classes
An aggregation of outputs. (Public Finance Act 1989)
Outputs can be grouped if they are of a similar nature. The output classes
selected in your non-financial measures must also be reflected in your financial
measures (s 142 (2) (b) CE Act 2004). Are groups of similar outputs (Public
Finance Act 1989).
Outputs
Are final goods and services, that is, they are supplied to someone outside the
entity. They should not be confused with goods and services produced entirely
for consumption within the DHB group (Crown Entities Act 2004).
Ownership
The Crown's core interests as 'owner' can be thought of as:
Strategy - the Crown's interest is that each state sector organisation contributes
to the public policy objectives recognised by the Crown;
Capability - the Crown's interest is that each state sector organisation has, or is
able to access, the appropriate combination of resources, systems and structures
necessary to deliver the organisation's outputs to customer specified levels of
performance on an ongoing basis into the future;
Performance - the Crown's interest is that each organisation is delivering
products and services (outputs) that achieve the intended results (outcomes),
and that in doing so, each organisation complies with its legislative mandate and
obligations, including those arising from the Crown's obligations under the
Treaty of Waitangi, and operates fairly, ethically and responsively.
Performance
Measures
Selected measures must align with the DHBs Regional Service Plan and Annual
Plan. Four or five key outcomes with associated outputs for non-financial
forecast service performance are considered adequate. Appropriate measures
should be selected and should consider quality, quantity, effectiveness and
timeliness. These measures should cover three years beginning with targets for
the first financial year (2014/15) and show intended results for the three
subsequent financial years.
Priorities
Statements of medium term policy priorities.
Productivity
Increasing outputs relative to inputs (i.e.: either more outputs produced with the
same inputs, or the same output produced using fewer inputs)
Purchase Agreement
A purchase agreement is a documented arrangement between a Minister and a
department, or other organisation, for the supply of outputs.
Regional
Collaboration
Regional collaboration refers to DHBs across geographical ‘regions’ for the
purposes of planning and delivering services (clinical and non-clinical) together.
Four regions exist.
Northern:
Northland DHB, Auckland DHB, Waitemata DHB and Counties
Manukau DHB
Midland:
Bay of Plenty DHB, Lakes DHB, Tairawhiti DHB, Taranaki DHB and
Waikato DHB
160
Central:
Capital and Coast DHB, Hawkes Bay DHB, Hutt Valley DHB,
MidCentral DHB, Waitemata DHB and Whanganui DHB
Southern:
Canterbury DHB, Nelson Marlborough DHB, South Canterbury
DHB, Southern DHB and West Coast DHB
Regional collaboration for some clinical networks may vary slightly. For example
Central Cancer Network contains eight DHBs, Taranaki DHB and Tairawhiti DHB
in addition to the Central Region DHBs.
Results
Sometimes used as a synonym for 'Outcomes'; sometimes to denote the degree
to which an organisation successfully delivers its outputs; and sometimes with
both meanings at once.
Standards of Service
Measures
Measures of the quality of service to clients focus on aspects such as client
satisfaction with the way they are treated; comparison of current standards of
service with past standards; and appropriateness of the standard of service to
client needs.
Statement of
Performance
Expectations (SPE)
Government departments and Crown entities are required to include audited
statements of objectives and statements of performance expectations with their
financial statements. These statements report whether the organisation has met
its service objectives for the year.
Statement of Service
Performance (SSP)
Government departments, and those Crown entities from which the
Government purchases a significant quantity of goods and services, are required
to include audited statements of objectives and statements of service
performance with their financial statements. These statements report whether
the organisation has met its service objectives for the year.
Strategy
See Ownership
Sub Regional
Collaboration
Sub regional collaboration refers to DHBs working together in a smaller grouping
to the regional grouping. Typically this is groupings of two or three DHBs and
may be formalised with an agreement e.g., Memorandum of Understanding.
Examples include DHBs in the Auckland Metropolitan area, MidCentral and
Whanganui DHBs (central Alliance), Capital and Coast, Hutt Valley and Wairarapa
DHBs and Canterbury and West Coast DHBs.
Targets
Targets are agreed levels of performance to be achieved within a specified
period of time. Targets are usually specified in terms of the actual quantitative
results to be achieved or in terms of productivity, service volume, service-quality
levels or cost effectiveness gains. Agencies are expected to assess progress and
manage performance against targets. A target can also be in the form of a
standard or a benchmark.
Values
The collectively shared principles that guide judgment about what is good and
proper. The standards of integrity and conduct expected of public sector
officials in concrete situations are often derived from a nation's core values
which, in turn, tend to be drawn from social norms, democratic principles and
professional ethos.
Value for Money
The assessment of benefits relative to cost, in determining whether specific
current or future investments/expenditures are the best use of available
resource.
161
8.2
OUTPUT CLASS DEFINITIONS
Output Class
1
Category of Output Class
Prevention
1
Health Promotion and Education
Preventative services are publicly
These services inform people about risks, encourage them to self-
funded services that protect and
manage, become healthier and, as a result, live longer. Success is
promote
whole
measured by a continuum from awareness and engagement,
sub-
reinforcing the message by specific programmes and support, through
health
population
populations
or
the
identifiable
comprising
designed to enhance the health
status of the population as distinct
from
treatment
to seeing behaviours changing for the better.
services
services
2
These services sustainably manage environments to support people
which
and communities to make healthier choices and maintain health and
repair/support health and disability
safety. They include: compliance monitoring with liquor licensing and
dysfunction. Preventative services
smoke free environment legislation, assurance of safe drinking water,
address individual behaviours by
proper
targeting population-wide physical
and
social
environments
3
substances
and
effective
Success is measured by
or (b) conditions at an earlier stage. They include breast and cervical
are reduced; statutorily mandated
cancer screening and antenatal HIV screening. Success is measured
health protection services to protect
by high coverage rates.
the public from toxic environmental
risk and communicable diseases;
and, population health protection
Population Based Screening
Screening Unit and help to identify either (a) people at risk of illness;
prevented and unequal outcomes
4
Immunisation
These services reduce the transmission and impact of vaccine-
services such as immunisation and
preventable diseases. The DHB works with primary care and allied
screening services. High need and
health professionals to improve the rate of immunisations across all
at risk population groups are also
age groups, both routinely and in response to specific risk. Success is
more likely to engage in risky
live
hazardous
These services are mostly funded and provided through the National
promotion to ensure that illness is
to
of
compliance with legislation.
Preventative services include health
and
management
quarantine and bio-security procedures.
to
influence health and wellbeing.
behaviours
Statutory Regulation
measured by a high coverage rate.
in
environments less conducive to
5
Well Child Services
choices.
These services are aimed at our most vulnerable group – our children.
Prevention services represent our
Services and programmes targeted towards our children today will
best
target
significantly impact upon our adult population of tomorrow. Success is
improvements in the health of high
measured by (a) a comprehensive range of services, including
need populations and to reduce
immunisation, assessment of children before they start school and (b)
inequalities in health status and
services provided to a broad range of children, including a focus on
health outcomes.
Māori and those children of high deprivation, to reduce health
making
healthier
opportunity
to
disparities.
162
Output Class
2
Category of Output Class
Early Detection and Management
6
Primary Healthcare and GP Services
Early detection and management
These services are offered in local community settings by teams of
services are delivered by a range of
general practitioners (GPs), registered nurses, nurse practitioners and
health
health
other primary healthcare professionals, aimed at delivering Better,
professionals in various private, not-
Sooner and More Convenient services and improving, maintaining or
for-profit and government service
restoring our population’s health. Success is measured by high levels
settings, including general practice,
of enrolment with our PHOs (Primary Health Organisations) as it
community
indicates engagement, accessibility and responsiveness of primary
services,
and
and
allied
Māori
Pharmacist
health
healthcare services.
services,
Community Pharmaceuticals (the
Schedule), child and adolescent
7
Oral Health Services
These services are provided by registered oral health professionals to
oral health and dental services.
assist people in maintaining healthy teeth and gums.
While high
levels of enrolment, timely access and treatment are important,
These services are by their nature
ultimately success is measured by results – children who are caries-
more generalist, usually accessible
free, and reducing the number of decayed, missing or filled teeth.
from multiple health providers and
from a number of different locations
within the DHB. On a continuum of
care
these
services
8
are
Primary Community Care Programmes
These services are offered in local community settings by teams of
preventative and treatment services
healthcare professionals (other than general practitioners (GPs),
focused on individuals and smaller
registered nurses, nurse practitioners) aimed at delivering Better,
groups of individuals.
Sooner and More Convenient services and improving, maintaining or
restoring our population’s health. Success is measured by rates of
participation.
9
Pharmacy Services
These services include the provision and dispensing of medicines and
are demand-driven, i.e. by patients and prescribers (nurse specialists,
GPs and specialists).
As long term conditions become more
prevalent, we are likely to see an increased dispensing of medicines.
Success is measured by (a) medication management for people on
multiple medications to reduce potential negative interactive effects
and (b) maintaining or reduction the level of prescribed medicines.
163
Output Class
Category of Output Class
10
Community Referred Testing and Diagnosis
These are services to which a health professional may refer a patient
to help diagnose a health condition, or as part of treatment. They are
provided by health personnel such as laboratory technicians, medical
radiation technologists and nurses. Success is measured by timely
access to diagnostics to improve clinical referral processes and
decision-making.
11
Mental Health Services
These services are provided to people who are affected by mental
illness or addictions. They include assessment, diagnosis, treatment
and rehabilitation, as well as crisis response when needed. Success
is measured by timely access to services, particularly for our children
and youth, so that we can eliminate, or reduce the severity of, mental
health conditions and addictions.
3
Intensive
Assessment
and
12
Treatment
Specialist Mental Health Services
These services are provided to people who are most severely affected
and
by mental illness or addictions. They include assessment, diagnosis,
treatment services are delivered by
treatment and rehabilitation, as well as crisis response when needed.
a range of secondary, tertiary and
Success is measured by (a) timely access to services, particularly for
quaternary providers using public
our children and youth, so that we can eliminate, or reduce the
funds. These services are usually
severity of, mental health conditions and addictions; and (b) a
integrated into facilities that enable
reduction in relapses.
Intensive
assessment
co-location of clinical expertise and
specialized equipment such as a
‘hospital’.
These
services are
generally complex, more costly and
provided
professionals
by
that
health
care
work
closely
together.
13
Elective (inpatient/outpatient) Services
These are assessment and treatment services that are provided to
people who do not need immediate hospital treatment and who
require booked or arranged services. This includes elective surgery,
but also non surgical interventions (such as coronary angioplasty) and
specialist assessments (either first assessments, follow-ups or pre-
They include:
admission assessments).
Success is measured by (a) timely
services; (b) services that are provided in an effective and efficient

Ambulatory services (including
way and (c) that we make the best use of our resources.
1
1
While the OAG has indicated a preference for patient satisfaction survey results to be included as a qualitative
measure, the Midland DHBs have elected not to include them because there are some questions regarding the reliability
164
Output Class



outpatient, district nursing and
day services across the range of
secondary
preventive,
diagnostic , therapeutic, and
rehabilitative services
Category of Output Class
14
These are services that have an abrupt onset, are often short in
duration and rapidly progressive, for which the need for care is urgent.
They may lead to a hospital admission.
Inpatient services (acute and
elective
streams)
including
diagnostic,
therapeutic
and
rehabilitative services
and intensive care services. Success is measured by (a) timeliness
(waiting times), (b) productivity (length of stay), (c) outcome measures
such as readmission rates, to indicate quality of service provision, and
(d) managing demand by either maintaining or reducing the number of
ED presentations, which is indicative of a strong primary/secondary
integration.
On a continuum of care these
treatment services and focused on
Hospital-based services
include Emergency Departments (ED), short-stay acute assessments
Emergency
Department
services
including
triage,
diagnostic,
therapeutic
and
disposition services
services are at the complex end of
Acute (Emergency Department/Inpatient/Outpatient) Services
15
Maternity Services
These services are provided to women and their families through pre-
individuals, rather than groups.
conception, pregnancy, childbirth and for the first months of a baby’s
life.
These services are provided in the home, community and
hospital settings by a range of health professionals, including
midwives, GPs and obstetricians and include specialist obstetric,
lactation, anaesthetic, paediatric and radiology services. Success is
measured by (a) ensuring that our proportion of caesarian deliveries
1
is consistent with the national average; and (b) that we maintain our
post natal length of stay (days).
16
Assessment Treatment and Rehabilitation
These are services provided to restore functional ability and enable
people to live as independently as possible. Services are delivered in
specialist inpatient units, outpatient clinics and also in home and work
environments.
Specialist geriatric and allied health expertise and
advice is also provided to GPs, home and community care providers,
aged residential care (ARC) facilities and voluntary groups.
Success
is measured by an increase in the rate of people discharged home
with support, rather than to ARC or hospital environments (where
appropriate).
1
While some caesarians are necessary on either an arranged or acute basis, overall we want to see as many babies
delivered with no surgical intervention as possible, particularly as surgery introduces an element of risk to either the
mother or her baby.
165
Output Class
4
Category of Output Class
Rehabilitation and Support
17
Needs Assessment and Service Coordination
These are services that determine a person’s eligibility and need for
Rehabilitation and support services
publicly-funded support services and then assist the person to
are delivered following a ‘needs
assessment’
process
coordination
input
Assessment
by
and
determine the best mix of support services, based on their strengths,
and
resources and goals. The support is delivered by an integrated team
Needs
in the person’s own home or community. Success is measured by (a)
Service
increasing the number of assessments completed using a clinically
Coordination (NASC) Services for a
accepted assessment tool, (b) providing timely assessments and (c)
range of services including palliative
increasing the number of assessments provided to those who are
care services, home-based support
services
and
residential
most likely to require an assessment (i.e. people 65+ and people who
care
have entered ARC).
services.
On a continuum of care these
services
individuals
provide
following
support
a
18
Palliative Care Services
These are services that improve the quality of life of patients and their
for
families facing the problems associated with life-threatening or long
health-
term conditions, through the relief of suffering by early intervention,
related event.
assessment, treatment of pain and other supports.
Success is
measured by providing timely and appropriate palliative care that is
patient-driven, and avoids unnecessary and/or painful treatment which
does not positively impact on either the patient’s quality or length of
life.
19
Rehabilitation Services
These are services that restore or maximise people’s health or
functional ability, following a health-related event.
They include
mental health community support, physical or occupational therapy,
treatment of pain or inflammation and retraining to compensate for
specific lost functions.
Success is measured through increased
referral of the right people to the right service.
20
Aged Related Residential Care (ARC) Services
These services are provided to meet the needs of a person who has
been assessed as requiring long term residential care in a hospital or
rest home indefinitely. Success is measured, particularly with our
ageing population and a decrease in the number of subsidised bed
days, by (a) more people being successfully supported to continue
living in their own homes, (b) balancing our level of home-based
support (see below) and (c) the quality of ARC.
166
Output Class
Category of Output Class
21
Home Based Support Services
These are services designed to support people to continue living in
their own homes and to restore functional independence. They may
be short or longer-term in nature.
Success is measured by (a) an
increase in the number of people being supported as indicative of an
increased capacity in the system (b) a decreased or delayed entry into
ARC or hospital services.
22
Life Long Disability
These are services designed to support people who have a lifelong
disability to continue living in their own homes and to retain as much
independence as possible.
Success is measured by an increase in
the number of people being supported as indicative of an increased
capacity in the system.
23
Respite Care and Day Care Services
These services provide people who suffer from dementia or a long
term condition with a break, so that a crisis can be averted or so that a
specific health need can be addressed.
Services are provided by
specialised organisations and are usually short-term in nature. They
may also include support and respite for families, caregivers and
others affected. Success is measured by an increase in the level of
services provided over time, so that more people are supported and
able to remain in their own homes.
167
8.3
OUTPUT CLASS REVENUE AND EXPENDITURE
The following table outlines the funding and expenditure associated with the allocation of the output
classes described above:
Table: Output Class Revenue and Expenditure
Prevention
Planned Revenue
($000s)*
11,508
Planned Expenditure
($000s)*
11,557
Early Detection and Management
81,198
81,543
Intensive Assessment and Treatment Services
200,698
201,550
Rehabilitation and Support
44,766
44,956
TOTAL
338,170
339,606
Output Class
168
8.4
OUTPUT MEASURE RATIONALE
Measure
Rationale
Output class / Category
Dimension of
Performance
Percent of patients who
smoke and are seen by a
health practitioner in public
hospitals are offered brief
advice and support to quit
smoking
Percent of patients who
smoke and are seen by a
health practitioner in primary
care are offered brief advice
and support to quit smoking
Percentage of pregnant
women who identify as
smokers at the time of
confirmation of pregnancy in
general practice or booking
with Lead Maternity Carer
are offered advice and
support to quit
Percentage of eight month
olds fully immunised
Providing brief advice to smokers is shown to
increase the chance of smokers making a quit
attempt
Prevention Services/Health
Promotion and Education
Quantity
Providing brief advice to smokers is shown to
increase the chance of smokers making a quit
attempt
Prevention Services/Health
Promotion and Education
Quantity
Pregnancy is a period during which women are
motivated to quit smoking, and evidencebased tobacco cessation programmes can
significantly increase the likelihood of this.
Reducing smoking in pregnancy would be well
supported by New Zealanders, is easy to
understand and leads to significant positive
outcomes across the whole of life span
Immunisation can protect against harmful
infections, which can cause serious
complications, including death. It is one of the
most effective, and cost-effective medical
interventions to prevent disease
Prevention Services/Health
Promotion and Education
Quantity
Prevention Services/
Immunisation
Prevention Services/
Immunisation/Well Child
Prevention Services/
Immunisation/Well Child
Quantity
Breastfeeding is the unequalled way of
providing ideal food for the healthy growth
and development of infants and toddlers. This
measure supports the sector to get ahead of
the chronic disease burden.
A Green Prescription (GRx) is a health
professional’s written advice to a patient to be
physically active, as part of the patient’s health
management. Research published in the New
Zealand Medical Journal indicates that a Green
Prescription is an inexpensive way of
increasing activity.
Having babies at a very young age can increase
maternal risk factors such as high blood
pressure and preeclampsia. There is also the
increased likelihood of those without
parental/guardian support receiving less prenatal support.
Teenage pregnancy is associated with
difficulties in psychological, sexual and overall
health. We also want to measure both teen
pregnancy and termination rates to ensure
that one does not increase while the other
decreases.
Research shows that improving oral health in
childhood and adolescence has benefits over a
lifetime.
Prevention Services / Health
Promotion and Education
Quantity/
Timeliness
Prevention Services / Health
Promotion and Education
Quantity
Prevention Services/Health
Promotion and Education
Quantity
Prevention Services/Health
Promotion and Education
Quantity
Early Detection and
Management Services/Oral
Health
Quantity
Percentage of population
over 65 years who are
immunised against influenza
Percentage of infants fully
and exclusively breastfeed at
six months
The number of referrals to
the GRx (Green Prescription)
programmes
Reduce the teen birth rate
Reduce the rate of teenage
terminations of pregnancy
Percentage of children under
five years of age (i.e. aged 0 –
4 years of age inclusive) who
are enrolled with DHB-funded
oral health services
Percentage of pre-school and
primary school children (0 –
12 years) who are overdue
for their planned recall period
Percentage of adolescents
Quantity/
Timeliness
Quantity/
Timeliness
Quantity
Quantity
169
Measure
accessing DHB funded oral
health services
Percentage of population
enrolled with a primary
health organisation
Percentage of people who
are enrolled with a primary
health organisation and have
had their cardiovascular risk
assessed in the last five years
Maintain or improve
appropriate management of
microalbuminuria or overt
nephropathy in patients with
diabetes
Percentage of eligible women
(20-69) have a cervical cancer
screen every 3 years
Percentage of eligible women
(50-69) have a breast screen
in the last 3 years
Increase the number of
packages of care available to
youth under the Primary
Mental Health Initiative
Percentage of Rest Home
residents receiving vitamin D
supplement from their GP
Percentage of all Emergency
Department presentations
who are triaged at levels 4&5
Percentage of eligible
children have their B4 School
Checks completed
Hospitalisation rates per
100,000 for acute rheumatic
fever
Percentage of older people
receiving long-term home
support who have had a
comprehensive clinical
assessment and a completed
care plan in the last 12
months
For those with aged related
and chronic health conditions
we aim to reduce the rate of
rest home level of residential
care to home based support
and respite funding
Increased number of clients
accessing respite services
Rationale
Output class / Category
Dimension of
Performance
Access to primary care has been shown to have
positive benefits in maintaining good health. It
can reduce the economic cost of ill health by
intervening early.
By increasing the percentage of people being
checked for long-term conditions ensures
these are identified early and managed
appropriately, and aid in the promotion and
protection of good health and independence.
Early Detection and
Management Services/
Primary Healthcare
Quantity
Early Detection and
Management Services/
Primary Healthcare
Quantity
Cervical cancer is one of the most preventable
of all cancers. Having regular cervical smears
can reduce a woman’s risk of developing
cervical cancer by 90 percent
Breast screening is a proven way for finding
breast cancers early to reduce the risk of dying
of breast cancer
Primary mental health initiative is funded to
increase the availability of services in Primary
Health Organisations for patients with mild to
moderate mental health issues. In line with our
Taiohi Health Strategy and the Prime Minister’s
Youth Mental Health project we are expecting
the actions in our Annual Plan will result in an
increase in youth accessing these services.
Vitamin D supplementation has been
demonstrated to improve mineral bone
density and reduce falls.
Emergency department services utilise a scale
of one to five triage, with one being the most
urgent. Triage category four and five may
more appropriately be seen in primary care.
A nationwide programme offering a health and
development check for four year olds
Prevention Services/
Population Based Screening
Quantity
Prevention Services/
Population Based Screening
Quantity
Early Detection and
Management Services/
Primary Mental Health and
Addictions
Quantity
Prevention Services/Health
Promotion and Education
Quantity
Intensive Assessment and
Treatment Services/Acute
Services
Quantity
Prevention Services/
Well Child
Quantity
Rheumatic fever arises as a result of a throat
infection with Group A Streptococcal bacteria.
It predominantly affects children between 5
and 14 years of age. In New Zealand, evidence
points to poorer housing conditions (especially
overcrowding) and general social deprivation
as risk factors for rheumatic fever.
More consistent and comprehensive
assessment of the older person which enables
determination of service capacity and service
planning information
Prevention Services/
Well Child
Quantity
Rehabilitation and Support
Services/Needs Assessment
and Service Coordination
Quantity
By focusing the models of care in community
services such as home based support and
respite services to have a more restorative
approach we expect that the proportion of
funding required to allocate to rest home
residential care to comparatively reduce.
In line with community services for older
people having a more restorative approach
Rehabilitation and Support
Services / Age Related
Residential Care Services
Rehabilitation and Support
Services
Quantity
Quantity
170
Measure
Percentage of patients aged
75 and over (Maori and
Pacific Islanders 55 and over)
that are given a falls risk
assessment
Acute re-admission rate
Average length of inpatient
stay
Percentage of patients who
require radiation or
chemotherapy are treated
with 4 weeks
Faster Cancer Treatment –
Proportion of patients with a
confirmed diagnosis of cancer
who receives their first
cancer treatment with 31
days
Arranged Caesarean
deliveries without
catastrophic or severe
complication as a % of total
deliveries
Percentage of operations
where venous
thromboembolism (blood
clot) was considered as part
of the surgical checklist
Rationale
and a focus on meeting the needs of informal
carers we expect the number of clients
accessing respite services will increase.
Falls in the elderly contribute to a reduction in
the quality of life including loss of
independence, early entry into Rest Home
residence and premature death. To ensure that
the risk of inpatient falls in the elderly is
minimised we aim to provide a risk assessment
to all eligible patients.
Unplanned readmissions will usually present to
emergency departments, and may result in
admission to hospital for further treatment.
This puts pressure on emergency departments
and inpatient hospital capacity, efficiency and
productivity.
An unplanned acute hospital readmission may
often (though not always) occur as a result of
the care provided to the patient by the health
system. Reducing unplanned acute admissions
can therefore be interpreted as an indication
of improving quality of acute care, in the
hospital and/or the community, ensuring that
people receive better health and disability
services.
By shortening hospital length of stay, while
ensuring patients receive sufficient care to
avoid readmission, we will positively impact
hospital productivity through freeing up beds
and other resources so it can provide more
elective surgery, reduce waiting times in the
emergency department or make savings.
Supporting patients to return home sooner
may, in part, be achieved by reducing the rate
of patient complications and better use of the
time clinical staff spend with patients. Patients
will also be less at risk of contracting
nosocomal infections.
Specialist cancer treatment and symptom
control is essential in reducing the impact of
cancer
Implementation of Faster cancer treatment
supports the overarching goal of Better,
Sooner, More Convenient Health Services for
New Zealanders. The key 2013/14 (strategic)
planning considerations of integration,
regionalisation and value for money are all
supported by implementation of these
indicators.
The longer-term aim is to reduce the risks
associated with an unnecessary Caesarean
section, reduce the number of women at risk
of a subsequent Caesarean section and reduce
the number of women who experience
difficulties with their second and subsequent
births as a consequence of a primary
Caesarean section.
Venous thromboembolism can cause long term
debilitating damage so the assessment and
appropriate preventative actions to all surgical
patients will increase not only the overall
quality of life but also reduce the toll of long
term ill health or even death.
Output class / Category
Dimension of
Performance
Intensive treatment and
assessment.
Quality
Intensive Assessment and
Treatment Services/Acute
Services
Quality
Intensive Assessment and
Treatment Services/Elective
Services and Acute Services
Quality
Intensive Assessment and
Treatment Services/Elective
Services and Acute Services
Quantity
Intensive Assessment and
Treatment Services/Elective
Services
Quantity
Intensive Assessment and
Treatment Services/Elective
Services
Quantity
Intensive Assessment and
Treatment Services Acute/
Elective Services
Quality
171
Measure
Rationale
Output class / Category
Dimension of
Performance
Percentage of patients
waiting longer than five
months for their first
specialist assessment
Patients have a much better chance of
recovering and getting on with their lives
where they are diagnosed and treated and
returned home in a timely way.
Intensive Assessment and
Treatment Services/Elective
Services
Quantity/
Timeliness
Number of surgical
discharges under the elective
initiative
Elective surgery reduces pain or discomfort,
and improves independence and wellbeing.
Increasing delivery should will improve access
and reduce waiting times.
Reducing did not attends is a key objective in
terms of removing waste in the system
Intensive Assessment and
Treatment Services/Elective
Services
Quantity
Intensive Assessment and
Treatment Services/Elective
Services and Acute Services
Quantity
Access and shorter waits are very important to
patients. Earlier treatment in the progression
of illness links to better outcomes as evidenced
in international literature. Timeliness is also a
key quality indicator in calls for improvement
to the health care system.
Intensive Assessment and
Treatment Services/Specialist
Mental Health and Addiction
Services
Timeliness/
Quality
When long term clients with serious mental
illness have agreed relapse prevention plans
that enable them to better co-produce their
mental health and well-being outcomes
Mental health and addiction services seek to
support service users in the least restrictive
environment. Performance on this indicator
provides some information about the extent to
which this is being achieved.
Intensive Assessment and
Treatment Services/Specialist
Mental Health and Addiction
Services
Intensive Assessment and
Treatment Services/Specialist
Mental Health and Addiction
Services
Quantity
Intensive Assessment and
Treatment Services/Specialist
Mental Health and Addiction
Services
Quality
Percentage of people who did
not attend (DNA) their
schedule appointment for an
outpatient service
Percentage of people
referred for non-urgent
mental health services are
seen within three weeks
Improving the percentage of
long-term clients with up to
date relapse
prevention/treatment plans
Average length of stay in an
adult mental health and
addiction inpatient unit
Quantity
Length of stay is the main driver of variation in
inpatient episode cost and reflects differences
between mental health service organisations
resources, service practices and service user
case-mix.
Rates of post-discharge
community care
A reduction in the percentage
of palliative care clients who
have had an Emergency
Department presentation
Improved wait times for
This indicator, alongside others promotes a
more complete understanding off an
organisation’s overall model of service
delivery.
A responsive community support system for
people who have experienced an acute
psychiatric episode requiring hospitalisation is
essential to maintain clinical and functional
stability and to minimise the need for hospital
readmission. Service users leaving hospital
after an admission with a formal discharge plan
involving linkages with community services and
supports are less likely to need early
readmission. Research indicates that service
users have increased vulnerability immediately
following discharge, including higher risk for
suicide.
The Taranaki Palliative Care Strategy
highlighted the need for an increase in the
generalist workforce who are trained and
supported by our Specialist Palliative Care
Provider to provide quality palliative care
underpinned by Advanced Care Planning. We
expect that delivery of enhanced palliative care
pathways, particularly in aged residential care,
will lead to a reduction in the percentage of
palliative care patients who present to our
Emergency Departments.
Diagnostics are a vital step in the pathway to
Intensive Assessment and
Treatment Services
Intensive Assessment and
Quantity/
172
Measure
Rationale
Output class / Category
Dimension of
Performance
diagnostic services –
accepted referrals for CT and
MRI receive their scan within
6 weeks (Developmental
Measure 2)
Non urgent community
laboratory tests are
completed and
communicated to
practitioners within the
relevant category timeframes
Number of community
pharmacy prescriptions
access appropriate treatment. Improving
waiting times for diagnostics can reduce delays
to a patient’s episode of care and improve DHB
demand and capacity management.
Treatment Services/Elective
Services
Timeliness
The new Community Pharmacy contract will
encourage greater efficiency and a more
patient focused service. We expect volume of
prescriptions to decrease overall
Early detection and
management/Pharmacy
Services
Quantity
173
Table of Contents
Overview
03
Summary of Indicators
04
Abbreviations
05
Population Profile
06
Māori Health Needs Assessment
07
Māori Community Development - Te Ara Tuatahi Pathway One
Participation and Leadership - Te Ara Tuarua Pathway Two
Health System Performance - Te Ara Tuatoru Pathway Three
Social Determinants - Te Ara Tuawha Pathway Four
07
07
08
08
Improvements Under Way
08
Priorities and Indicators
09
National Priorities
10
N1- Data Quality
N2.1- Access to Care, PHO Enrolments
N2.2- Access to Care, ASH
N3- Child Health
N4.1- Cardiovascular Disease, Tertiary Cardiac Interventions
N4.2- Cardiovascular Disease, CVD Risk Assessment
N4.3 - Cardiovascular Disease, Presenting with ACS
N5.1- Cancer, Breast screening
N5.2- Cancer, Cervical screening
N6.1- Smoking, Hospital
N6.2- Smoking, Primary Care
N7.1- Immunisation, 8 months
N7.2- Immunisation, Seasonal Influenza
N8- Rheumatic Fever
N9 - Oral Health
N10 - Mental Health
Local Priorities
L1 - Access to Services DNA's
L2 - Primary Mental Health
References
10
10
11
13
14
15
15
16
17
18
19
20
21
22
23
23
24
24
25
26
Page 2 of 26
OVERVIEW
This Plan describes the Taranaki District Health Board’s (TDHB) priorities in Māori health for 2014-2015. The plan
represents the TDHB’s main response to its obligations under the New Zealand Public Health and Disability Act (2000)
which requires DHB’s to reduce disparities and improve Māori health outcomes. It aligns to the TDHB’s strategic
framework that aims to achieve the vision of “Taranaki whanui, he rohe oranga” as well as the wider aspirations of
Whānau ora as described in He Korowai Oranga, national Māori Health Strategy and Te Kawau Mārō, Taranaki Māori
Health Strategy. The format of this plan and the indicators included follow the 2014-2015 Operational Policy
Framework guidelines.
In 2014-15, in addition to the national priorities, we will continue to focus on two local priorities identified in the TDHB’s
2012 Whānau Ora Health Needs Assessment of Māori living in Taranaki*, namely DNA rate for outpatient appointments
and access by taiohi Māori to primary mental health services. The Sudden Unexplained Death of Infants (SUDI)
priority made mandatory by the Ministry of Health in previous years, is no longer mandatory and is therefore excluded
this year. The focus in previous years on children’s oral health has now become a national priority and will continue to
be progressed as such, the relevant indicator being pre-school dental enrolments.
The Māori Health Plan gives a one-year subset of actions and aspirational targets related to Māori health priorities and
indicators. Longer term activities (2 – 5 years) to improve health for Māori and non-Māori are described in the 20142015 TDHB Annual Plan with which this Plan aligns.
Four national Māori Health Plan indicators identified in this Plan are prioritised in the Midland Regional Services Plan to
bring about regional focus on addressing these priority issues – Cancer screening, Breast feeding, Immunisation at 8
months and Cardiovascular Risk Assessments.
Quarterly performance results for the Māori Health Plan indicators will be disseminated to key audiences. First, results
will be submitted to a joint meeting of the TDHB and Te Whare Punanga Korero Iwi relationship Boards along with
senior managers, to monitor progress against the Plan. Second, quarterly performance reports will be disseminated for
review by the Midland Health Network as well as the Māori Health Services alliance Te Kawau Mārō Alliance
Leadership Teams. These groups represent key governance and operational audiences which are directly engaged in
delivery against the Plan. Finally the DHB’s Māori Health Plan performance will be presented in the DHB’s Annual
Report.
*
Whānau Ora Health Needs Assessment, Māori Living in Taranaki, Dr M Ratima and B Jenkins, Taranaki DHB, 2012
Page 3 of 26
1.
SUMMARY OF INDICATORS
Health Issue
Indicator(s)Target
Target
Baseline TDHB
Māori
Non-Māori
National Priorities
1
N1
Data Quality
2
N2.1
Access to care
3
N2.2
Accuracy of ethnicity reporting in PHO registers as measured by
Primary Care Ethnicity Data Audit Toolkit
1.
Percentage of Māori enrolled in PHOs
98%
85.3%
97.3%
2.
Ambulatory Sensitive Hospitalisations rates per 100,000 for the age
groups
0-4 yrs
95%
68%
54%
59%
90%
117%
5,300
168%
3,835
156%
3,110
56%
34%
9%
73%
56%
2,555
73%
1,677
73%
1,458
68%
54%
23%
83%
70%
25%
50%
95%
100%
94%
70%
65%
79%
80%
73%
89%
95%
90%
98%
71%
96%
72%
95%
75%
89%
67%
89%
70% Total
4
5
6
7
N3.1
N3.2
N3.3
N4.1
Child Health
8
N4.2
2.
9
N4.3
3.
10
N5.1
11
N5.2
Cardiovascular
disease
Cancer
Audit tool to be implemented or PHO
enrolments as proxy
1.
1.
2.
12
13
N6.1
N6.2
Smoking
1.
2.
14
15
N7.1
N7.2
Immunisation
1
2
16
N8
17
18
N9
N10
Rheumatic
Fever
Oral Health
Mental Health
45-64 yrs
95%
0-74 yrs
95%
Exclusive breastfeeding at 6 weeks
3 months
6 months
Percentage of the eligible population who have had their CVD risk
assessed within the past five years (ht)
70 percent of high-risk patients will receive an angiogram within 3 days
of admission. (‘Day of Admission’ being ‘Day 0’)
Over 95 percent of patients presenting with ACS who undergo coronary
angiography have completed ANZACS QI ACS and Cath/PCI registry
data collection within 30 days
Breast Screening, 70% of eligible women will have a BSA mammogram
every two years
Cervical Screening, percentage of women (Statistics NZ Census
projection adjusted for prevalence of hysterectomies) aged 25-69 who
have had a cervical screen in the past 36 months (by ethnicity)
Hospitalised smokers provided with advice and help to quit (ht)
Current smokers enrolled in a PHO and provided with advice and help
to quit
Percentage of infants fully immunised by eight months of age (ht)
Seasonal influenza immunisation rates in the eligible population (65
years and over)
2014/2015 rheumatic fever target is 0.5 per 100,000 and a 40%
reduction from baseline (3 year average 2009/10 – 2010/11)
Preschool Enrolments
Mental health Act: Section 29 Community Treatment Order indefinites
comparing Māori rates with other (as per reporting to the Office of the
Director of Mental Health)
High needs
0.5/100,000
0.9
85%
59%
82%
Improve on
baseline
102/100,000
54/100,00
5%
19%
7%
Improve on
baseline
17%
49%
Local Priorities
19
L1
Access to
Services
Did-Not-Attend (DNA) rate for outpatient appointments
20
L2
Primary Mental
Health
Access by Taiohi Māori to packages of primary mental health Care
Page 4 of 26
ABBREVIATIONS
ABC
An approach to smoking cessation requiring health staff to ask, give brief
advice, and facilitate cessation support.
ALT
Alliance Leadership Team
ASH
Ambulatory Sensitive Hospitalisation
BFCI
Breastfeeding Friendly Community Initiative
BOPDHB
Bay of Plenty District Health Board
COL
Colposcopy
COPD
Chronic Obstructive Pulmonary Disease
CVD
Cardiovascular disease
CVD-IHD
Cardiovascular disease – Ischaemic heart disease
DEN
Dental
DHB
District Health Board
DIA
Diabetes
dmf
Decayed, missing, or filled primary teeth
DMFT
Decayed, Missing, or Filled Teeth (permanent)
dmft
Decayed, missing, or filled teeth (deciduous)
DNA
Did not attend (used in the measurement of outpatient clinic attendance)
ENT
Ear, Nose and Throat
KARO
Knowledge, Actions, Results, Opportunity – reporting database through MOH
MHN
Midland Health Network
MOH
Ministry of Health
MSD
Ministry of Social Development
NGO
Non-Government Organisation
NHC
National Hauora Coalition
PHO
Primary Health Organisation
PM
Portfolio Manager
PHN
Public Health Nurse
PMHI
Primary Mental Health Indicator
RFP
Request for Proposal
RS
Respiratory
SUDI
Sudden Unexplained Death of Infants
TDHB
Taranaki District Health Board
TLA
Territorial Local Authority
Page 5 of 26
POPULATION PROFILE
1.1. Taranaki DHB serves 3.03% of the Māori population of New Zealand. At the 2013 Census, 18,165 Māori were resident
in Taranaki; this represents the 15th highest number of Māori serviced by any of the DHB’s. However Māori make up
16.6% of the total Taranaki DHB population which is slightly higher than the national of 14.1%.
1.2. In the regional context Taranaki DHB has the lowest number and lowest proportion of Māori living in its service area of
all the Midland DHB’s. The highest proportion of Māori live in the Midland region.
Age Distribution
1.3. The Māori population in Taranaki is very young compared to the overall population as shown in Figure 4 below. For
Māori, 35.9% of the population resident in Taranaki is under 15 years of age compared to 21.8% for the total
population. The difference is even more marked for older Māori, with 4.7% of the Māori population resident in Taranaki
aged over 65 years compared to 14.8% for the total population. This is, in part, a reflection of the lower Māori life
expectancy relative to non-Māori.
Figure 4
Age Structure of Taranaki DHB, 2010
Māori Population (Black line) and Total Taranaki Population (Gray Shadow)
85+
Female
Male
80-84
75-79
70-74
65-69
60-64
55-59
Age
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
8%
6%
4%
2%
0%
2%
4%
6%
8%
% Population
Source: Statistics NZ, Estimated Territorial Local Authority Population of TLA population June 2010.
Iwi
1.4. As at the 2013 Census the following was the population makeup of the iwi of Taranaki:
IWI
Ngati Tama
Ngati Mutunga
Te Atiawa
Ngati Maru
Taranaki
Ngaruahinerangi
Ngati Ruanui
Ngaa Rauru Kiitahi
Tangahoe
Pakakohe
Other – Not Defined
TOTAL
Māori: non-Taranaki iwi
Total Māori Population
TOTAL IWI
POPULATION
1,338
2,514
15,273
852
6,087
4,803
7,260
4,176
246
351
120
43,020
IWI POPULATION
RESIDENT IN
TARANAKI
387
759
3,828
291
1,689
1,779
1,827
717
96
144
21
11,538
6,627
18,165
% IN
TARANAKI
28.92%
30.19%
25.06%
34.15%
27.75%
37.04%
25.17%
17.17%
39.02%
41.03%
17.50%
26.82%
Geographic Distribution
1.5. TDHB comprises three territorial authorities. In 2013 the majority of the population was based in the New Plymouth
District Council catchment (9369) while the largest proportion was based in the South Taranaki District (22.6%).
Total Population
Māori (%)
South Taranaki
District
26,580
22.8%
Stratford District
8,991
11.2%
New Plymouth
District
74,184
14.9%
Page 6 of 26
Population Growth
1.6. The Māori population in Taranaki is growing much faster than the non-Māori population, which is projected to decline.
The Taranaki population is projected to increase from 109,608 in 2013 to 111,400 by 2031, an increase of 1.6%.
1.7. At the time of writing this Plan, Māori population projections based on the 2013 census were not available. However
based on the 2006 census the Māori population is expected to increase to 22,800 by 2026, an increase of 44%. This
means that, by 2026, Māori are expected to account for around 20.7% of the region’s population compared to 15.2% in
2006. The Māori population in the region will increase faster in the younger age groups. Based again on 2006
projections by 2026, Māori are expected to account for 36.7% (27.3% in 2008) of those aged under 15, and 33.6%
(23.9% in 2008) of those aged between 15 and 24.
1.8. Māori who whakapapa to Taranaki iwi account for 63.5% of the local Māori population or 11,538 people, while almost
36.5% percent whakapapa to iwi outside of Taranaki. Around 26% of the 43,000 Taranaki uri live in the Taranaki
region.
Deprivation
1.9. Taranaki had a higher proportion of people living in deciles 6 to 10. Māori make up a significantly higher proportion of
Taranaki residents in deprivation deciles 8 and 9 and a much higher proportion of Māori in decile 10. Conversely in
deciles 1 to 4, the proportion of non-Māori is much higher.
2.
MĀORI HEALTH NEEDS ASSESSMENT
Leading Causes of Avoidable Mortality and Hospitalisation
The leading causes of avoidable death and hospitalisation are ranked below. Similar issues ranked highly for Māori
and non-Māori locally and nationally:
Avoidable Mortality
TDHB
Māori
Other
CVD-IHD
Lung cancer
Diabetes
COPD
Cerebrovascular diseases
CVD-IHD
Cerebrovascular diseases
COPD
Lung cancer
Colorectal cancer
NZ
CVD-IHD
Lung cancer
Diabetes
COPD
Road Traffic injuries
CVD-IHD
Lung cancer
Colorectal cancer
Suicide & self harm
Road traffic injuries
Avoidable Hospitalisation
TDHB
NZ
Angina and chest pain
Respiratory infections
Asthma
Cellulitis
Dental conditions
Angina
Respiratory infections
COPD
COPD
Asthma
Angina and chest pain
Angina
Dental conditions
Respiratory infections
Cellulitis
Cellulitis
Skin cancers
Road traffic injuries
COPD
ENT infections
Health Needs Assessment
The health needs of Taranaki Māori and priorities for action are identified in the Taranaki DHB’s Whānau Ora Health
Needs Assessment (Ratima and Jenkins, 2012) and are summarised below:
**
a.
Te Ara Tuatahi Pathway One – ‘Development of Whānau, hapu, iwi and Māori communities’
The Māori community has a limited capacity to engage with work around Whānau Ora, and in this context Māori
community development at whānau, hapū, iwi levels was important. A need to engage whānau in preventative
and aspirational activities was identified. At the whānau level, work is required to strengthen whānau cohesion
so that whānau are better positioned to exercise the positive functions of whānau. Strengthening cultural
identity as a mechanism to achieve health gain was also identified. Whānau level development as a basis for
Whānau Ora is a priority area. The challenge for funders and providers is to identify ways in which they may
facilitate this development without taking leadership and risking engendering dependency.
b.
Māori Participation and Leadership - Te Ara Tuarua Pathway Two – ‘Māori participation in the Health and
Disability Sector’
Building the capacity and capability of the Māori sector is a priority. The sector currently consists of the
following components:
 Te Whare Punanga Korero Trust represents the eight iwi of Taranaki** and has a formal relationship
with the Taranaki DHB to jointly work at a strategic level to improve Māori health outcomes;
Ngati Tama, Ngati Mutunga, Te Atiawa, Ngati Maru, Taranaki, Ngaruahinerangi, Ngati Ruanui, Nga Rauru Kiitahi. Pakakohe and
Tangahoe were represented by Ngati Ruanui on original set up of the Trust.
Page 7 of 26

Te Kawau Mārō Alliance between Tui Ora Limited, Ngati Ruanui Tahua and Ngaruahine Iwi Health
Service. The alliance is the preferred provider of Māori-specific primary health care services in
Taranaki;

There is one PHO in Taranaki. Māori account for 15.57% of the Midlands Health Network PHO
enrolled population for Taranaki, or 16,419 of 105,437 as at February 2014;

Two public hospitals - Taranaki Base Hospital in New Plymouth with 152 inpatient, 23 inpatient
mental health, 21 emergency department, 18 maternity beds and 8 neonatal inpatient cots, and
Hawera Hospital with 10 inpatient, 6 emergency department beds and 4 maternity beds;

Whakatipuranga Rima Rau Trust is a joint venture project between Te Whare Punanga Korero Trust,
Ministry of Social Development (WINZ) and Taranaki DHB to increase the Māori health and disability
workforce over ten years. A staff of three under the leadership of a General Manager, develops and
delivers a range of programmes aimed at increasing the health and disability workforce supply;

Te Roopu Paharakeke Hauora is the Māori Health directorate of the Taranaki DHB. The unit is
headed by the Chief Advisor Māori Health, a member of the Taranaki DHB Executive Management
Team, and along with a small team, is responsible for influencing decision-making across the funder
and provider arms of the DHB to achieve improved outcomes for Māori.
In terms of the Māori health and disability workforce, there is a lack of reliable information available to assess
this currently. The Taranaki DHB regularly collects information on its workforce though accuracy of the data is
limited, while currently no mechanism exists for gathering NGO workforce data. As at January 2014, 7.7% of
Taranaki DHB staff or 132 from a total of 1,713 identified as being of Māori ethnicity.
c.
Health System Performance and - Te Ara Tuatoru Pathway Three – ‘Effective health and disability
services’
Increased access to health services at all levels, and particularly at the primary health care level are priorities
and include geographically equitable access to quality health care across the Taranaki Region and the
implementation of Whānau Ora oriented service provision.
The priorities in terms of protective and risk factors and preventative care are smoking, alcohol and drug issues,
breastfeeding, immunisation, breast screening and cervical screening.
Priority health conditions identified are diabetes, cardiovascular disease, lung cancer, breast cancer, respiratory
disease (i.e. COPD and asthma), oral health, mental health and disability.
d.
3.
Social Determinants and - Te Ara Tuawha Pathway Four – ‘Working across sectors’
It is well documented that there are systematic inequalities in access to social and economic determinants of
health for Māori and that socio-economic status is a key factor contributing to health outcome disparity between
Māori and non-Māori. There is clear evidence that Māori living in Taranaki have poor access to socio-economic
determinants of health, and this is reflected in high relative levels of deprivation, compared to non-Māori. It is
also reflected in barriers to health care and related needs (e.g. ability to pay for service provision and access to
transport) identified through community engagement. Addressing determinants of health through intersectoral
collaboration is therefore a priority area.
IMPROVEMENTS UNDER WAY
Good progress is being made in reducing health inequalities for Māori in Taranaki DHB in the areas of CVD risk
assessment, breast screening, help for smokers to quit in the hospital setting, and immunisations at 8 months old.
The system for addressing and monitoring Māori health improvement in Taranaki has been substantially strengthened
with the implementation of Te Ara Whakawaiora, framework for accelerating Māori health improvement developed by
Te Tumu Whakarae national DHB Māori Managers forum. Endorsed by the national CEO’s forum, the system makes
the whole DHB responsible and accountable for Māori Health improvement, through implementation, monitoring and
sharing of best practice models that address the priorities and indicators within the Māori Health Plan. Monitoring of
progress by the Iwi Relationship Board Te Whare Punanga Korero jointly with the Taranaki DHB Board and senior
DHB and PHO managers brings significant rigor to the focus on reducing Māori health inequalities.
In terms of Health Sector Performance good progress has been to consolidate the Māori health sector. The TDHB
preferred provider ‘Te Kawau Mārō’ alliance, a collective of Tui Ora and iwi providers evolved from an RFP process
seeking a single provider of services for Māori. An outcomes-based contract which commenced on 1 July 2013,
Page 8 of 26
merges 35 primary care contracts and $8.3M per annum, into a single 5-year contract. The formation of the alliance
and the move to outcomes-based contracting is expected to result in;
 Reduction in operational overheads to release more funding to front line services for whānau
 Greater scope and flexibility for the alliance to deploy resources in more innovative ways to achieve better
outcomes for whānau
 The burden of reporting being significantly reduced
 Clinical and cultural safety significantly strengthened
 The partners have committed to developing a common Whānau Ora system for Taranaki
4.
PRIORITIES AND INDICATORS
The following section of the plan presents Māori health priorities and indicators that have been selected as national and
local priorities. The national indicators are determined by the Ministry of Health and are priorities for all DHB’s. These
priorities are based on the leading causes of morbidity and mortality for Māori nationally and indeed reflect the priorities
for Taranaki. Local priorities are determined by the Taranaki DHB Whānau Ora Health Needs Assessment (Ratima
and Jenkins, 2012).
The national and local priorities are presented in tables in the following sections that summarise:







The outcome we want to achieve
What we are planning to do to achieve it
Who will be responsible
How we will know if we have been successful
Why this outcome is important
Where Māori are at now relative to non-Māori and the extent of the inequalities gap
Where we want to get to in the next year
The ‘inequalities box’ at the bottom right of the tables provides a snapshot of the extent of disparities between Māori
and non-Māori. The absolute measure of inequality provided is the ‘gap’ between Māori and non-Māori such as a
percentage difference. As well, the ‘inequalities box’ provides an indication of progress made in addressing
inequalities for Māori over time. Where data is available (data used to determine progress will be described in a
footnote), the progress measure will report on trends over a number of years using the following symbols already used
by TDHB in reporting progress on ethnic inequalities indicators.
Quarterly, six-monthly and/or annual (as relevant to each indicator) quantitative assessment of disparities between
Māori and non-Māori, where relevant, will be reported. The following symbols will be used to report progress on
inequalities indicators:
Symbol
Key

Progressing well
℗
Some progress

No progress or worsening
Ţ
Not yet sufficient time to judge
?
Further info or work required
↑
Increasing gap
↓
Decreasing gap
Page 9 of 26
5.
SECTION FIVE: NATIONAL PRIORITIES AND INDICATORS ACTION PLAN
National Indicator 1
DATA QUALITY
Who will be responsible: PM, Primary Care
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Improve and maintain the quality of data
collected locally and supplied to national
collections.
Continue to work with the Midland Health Network PHO to check,
improve and maintain the accuracy of ethnicity data submitted to
national collections by the PHO, by
 The MHN Alliance will review quarterly enrolment coverage
versus census 2013 population data, via the MHN Health
Intelligence reports, by March 2014
 Providing guidance on ethnicity data quality improvement
activities (ongoing)
Where gaps are identified the MHN and TDHB through the Taranaki
ALT will identify the appropriate mechanisms to work to support
higher enrolment and accuracy.
Accuracy of ethnicity reporting in PHO registers
acknowledging that ethnicity is self selected by
the patient.


98% of Māori will be enrolled in PHOs as a proxy for
reporting on Ethnicity Data accuracy.
Commentary on how the quality of ethnicity data is
improving.
Why is this outcome important:
Accurate ethnicity data is essential for tracking progress in Māori health outcomes. The accuracy of ethnicity data in
PHO databases is unknown at present.
Māori
Non-Māori
Progress
Gap (%)
Midland Health Network
PHO Enrolments
85.3%
97.3%

12%
National Indicator 2.1
Outcome we want to achieve
ACCESS TO CARE (PHO Enrolment)
What we are planning to do to achieve it
Who will be responsible: PM, Primary Care
How we will know if we have been successful
Increased access by Māori to primary health
care services
Working within the Alliance TDHB and MHN will review quarterly
access reports via the MHN Health Intelligence reports.
98% of Māori will be enrolled in PHOs.
Where gaps are identified and where capacity exists all parties will
work to support equity of access.
Why is this outcome important:
PHO enrolment facilitates easier access to preventative health care and early condition management.
PHO enrolment rates vary throughout the country.
Thursday 27 June 2014, V3.0 Final
Utilisation of services by Māori 1:1 or higher than non
Māori.
Māori
Non-Māori
Progress
Gap (%)
85.3%
97.3%

12%
Page 10 of 26
National Indicator 2.2
ACCESS TO CARE (ASH Rates)
Outcome we want to achieve
What we are planning to do to achieve it
Reduced ambulatory sensitive hospitalisation
(ASH) rates among all age groups:
0-4 years
45-64 years
0-74 years
1. Audit the most recent ASH data to identify the current leading
causes of ASH for Māori in the 0-4, 45-64, and 0-74 year age
groups by condition, domicile, NZDep, and hospital location.
DHB and MHN action by December 2014.
2. Develop evidence based interventions targeted at Māori, in
collaboration with all local stakeholders including MHN PHO, by
June 2015.
3. Develop performance indicators for new interventions for
agreement by the MHN Alliance and other interested
stakeholders and monitor quarterly. Report findings to the joint
TWPK/TDHB monitoring group and discuss successful and new
interventions with the MHN and TKM Alliance.
0-4 years
4. Maintain or improve B4 School Check coverage for tamariki
Māori, on-going to June 2015.
5. Work with the Midland Health Network Taranaki Alliance
Leadership Team to ensure tamariki under six years have
access to free after hours primary care, on-going to June 2015.
6. Continue to work with TDHB dental, maternity and child health
teams as well as primary care providers to support the
Menemene Mai project to enrol pre-school children in dental
services and to support whānau engagement with dental and
other pre-school service initiatives.
45-64 years
7. Taranaki DHB and the Midland Health Network continue to work
together to implement the Primary Options to Acute Care for
Taranaki and the GP/ED Overflow Clinic at Medicross Accident
and Medical.
8. Continue to support Midlands Health Network PHO to:
a. implement Diabetes Improvement packages of care in
Clinical Pharmacy, Social Work, Dietetics and Podiatry.
b. support GP Practices to increase checks for CVD and
Thursday 27 June 2014, V3.0 Final
Who will be responsible: PM, Primary Care and
Chief Advisor Māori Health
How we will know if we have been successful
ASH rates in all age groups will demonstrate movement
towards the national rate for the total population in that
age group. Over the 2014-15 year, ASH rates for Māori
will approach the targets derived from the Ministry of
Health ASH target formula as follows:
0-4 years:
95%
45-64 years: 95%
0-74 years: 95%
Page 11 of 26
Diabetes with the aim of meeting the 90% of the eligible
population having had a CVD Risk assessment.
c. upskill the Primary Health workforce in the care and
management of Diabetic patients and Insulin Initiation.
0-74 years
9. Continue to support the Taranaki Map of Medicine Clinical
Pathways Steering Group to localise the prioritised clinical
pathways. This piece of work will support Primary Options which
is being launched on 14 June 2014.
10. Continue to support implementation of outreach influenza
vaccination clinics to achieve increase access for the eligible
population.
Why is this outcome important:
Māori – TDHB
Non-Maori – TDHB
All – National
Effective primary care can reduce ASH rates and ethnic inequalities in ASH rates. ASH rates are a proxy measure for
access to primary care services, preventative management, and the quality of care delivered. Ambulatory sensitive
hospital admissions are preventable with the appropriate quantity and quality of primary care.
Thursday 27 June 2014, V3.0 Final
Progress
Inequalities Gap –
TDHB
0-4y
45-64
0-74
117%
5,300
56%
2,555
100%
4,532
168%
3,835
73%
1,677
100%
2,287
↑
95%
2,158
156%
3,110
73%
1,458
100%
1,988
↓
61%
2,745
Page 12 of 26
↓
83%
1,652
National Indicator 3
CHILD HEALTH (BREASTFEEDING)
Outcome we want to achieve
What we are planning to do to achieve it
Increase in breastfeeding rates for Māori and
reduce inequalities in breastfeeding rates
between Māori and non-Māori








Maintenance of BFHI status with 3 providers including TDHB,
TKM alliance partners.
Work with the TDHB Provider Arm, Māori health and Public
health teams, MHN PHO and TKM Alliance to review the
breastfeeding information given to Māori women, and support
associated education around breastfeeding.
Distribution of Mama Aroha Talk cards to LMC’s, WCTO
providers and PHO’s to support education antenatally and in
the community.
Audit Māori women coming through our service to establish
why more are not breastfeeding, audit to be completed by Dec
2014. Service Manager – TDHB Provider
Support the Mama and Pepi Hauora project delivered by TKM
to develop and deliver a toolkit to 5 priority communities to
improve skills, knowledge, behaviour and attitudes with respect
to nutrition, physical activity, and breastfeeding for mothers and
infants including Breastfeeding Welcome Here accreditation
and Active Movement training.
Link with existing Breastfeeding Peer Support and Community
Lactation Services to strengthen collaborative approaches
Support 4 Scholarship Recipients to successfully register as
Lactation Consultants by November 2014.
Monitor of breastfeeding data will take place quarterly by the
joint TWPK/TDHB monitoring group. Successful and new
interventions will be discussed with the provider arm, public
health and Māori health teams of the TDHB as well as the MHN
and TKM alliance.
Who will be responsible: PM, Population Health;
Service Manager, Child and Maternal Health
How we will know if we have been successful
Report on exclusive breastfeeding at 6 weeks, 3 months,
and 6 months. Service Manager – Provider
Māori infants will have attained breastfeeding rates
consistent with the age-related targets from the Well
Child Tamariki Ora Quality Improvement Framework of:
Exclusive and fully breastfed at 6 weeks
68%
Exclusive and fully breastfed at 3 months
54%
Exclusive, fully and partially breastfed at 6 months 59%
Why is this outcome important:
Breastfeeding contributes significantly to infant, maternal, and whānau health in both the short and long term. The
benefits of breastfeeding are unequivocal. In recent years breastfeeding rates in Taranaki have been declining, the
Breastfeeding Community Support Service is implementing strategies to improve rates of breastfeeding particularly for
Māori.
Thursday 27 June 2014, V3.0 Final
Māori
Non-Māori
Target
Progress (inequality)
Inequalities Gap (%)
6 wks
56%
68%
68%

12%
3 mths
34%
54%
54%

6 mths
9%
23%
59%

20%
14%
Page 13 of 26
National Indicator 4.1
CARDIOVASCULAR DISEASE (Risk Assessment)
Who will be responsible: PM, Primary Care
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Reduced mortality through improved
cardiovascular health
Working within the Alliance TDHB and MHN will review six monthly
performance against the agreed clinical targets.
Primary care will achieve agreed clinical targets
Where gaps are identified and where capacity exists the MHN PHO,
TKM alliance and TDHB will work to analyse and identify gaps,
develop and implement workable solutions support higher enrolment
and accuracy.
90% of the eligible population have had their CVD risk
assessed within the past five years (ht)
1. Using NGO resource, identify and target missed opportunities by
implementing systems to capture activity undertaken outside of
the general practice environment
2. Fully integrate catch up and coordination services for key health
targets including the utilisation of telephone catch up services
3. Increased use of MDT for diabetes & CVD
4. Enhance the electronic tools/resources available to general
practice to include self-management
5. Workforce education and training in the delivery of LTCMP
6. Enhancement of existing funding strategy to further encourage
general practices to deliver quality care and management and to
best target resources
Why is this outcome important:
CVD is the leading cause of death and the leading cause of avoidable hospitalisation for Taranaki Māori. Given the
extent of the burden of CVD and wide ethnic inequalities in cardiovascular health outcomes, access to risk assessment
and effective condition management are important interventions to improve outcomes.
CVD is substantially preventable with early identification, lifestyle advice and treatment.
Thursday 27 June 2014, V3.0 Final
Māori
Non-Māori
Progress
Gap (%)
73%
83%
?
10%
Page 14 of 26
National Indicator 4.2
CARDIOVASCULAR DISEASE
Outcome we want to achieve
What we are planning to do to achieve it
Reduced mortality through improved
cardiovascular health
1.
2.
The Cardiac ANZACS-QI register enables reporting measures
of ACS risk stratification and time to appropriate intervention
The data recorded in this registry enables patients level
information to be reviewed by ethnicity
Why is this outcome important:
CVD is the leading cause of death and the leading cause of avoidable hospitalisation for Taranaki Māori. Given the
extent of the burden of CVD and wide ethnic inequalities in cardiovascular health outcomes, access to risk assessment
and effective condition management are important interventions to improve outcomes.
CVD is substantially preventable with early identification, lifestyle advice and treatment.
National Indicator 4.3
CARDIOVASCULAR DISEASE
Outcome we want to achieve
What we are planning to do to achieve it
Reduced mortality through improved
cardiovascular health
On-going monitoring of existing procedures to maintain performance
on this indicator
Why is this outcome important:
CVD is the leading cause of death and the leading cause of avoidable hospitalisation for Taranaki Māori. Given the
extent of the burden of CVD and wide ethnic inequalities in cardiovascular health outcomes, recording and monitoring
the key data associated with these events will help ensure services are clinically appropriate and equitable services are
delivered to meet the needs of Taranaki Māori
Thursday 27 June 2014, V3.0 Final
Who will be responsible: Clinical Services Manager,
Medical
How we will know if we have been successful
70 percent of high-risk patients will receive an angiogram
within 3 days of admission. (‘Day of Admission’ being
‘Day 0’)
Māori
Non-Māori
Progress
Gap (%)
25%
50%
?
25%
Who will be responsible: Clinical Services Manager,
Medical
How we will know if we have been successful
Over 95 percent of patients presenting with ACS who
undergo coronary angiography have completion of
ANZACS QI ACS and Cath/PCI registry data collection
within 30 days
Māori
Non-Māori
Progress
Gap (%)
100%
94%

-6%
Page 15 of 26
National Indicator 5.1
CANCER (BREAST SCREENING)
Who will be responsible: PM, Cancer Services
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Reduced cancer mortality and morbidity
Continue to work with BreastScreen Aotearoa, PHOs and providers
to strengthen local reporting of breast screening rates by DHB and
ethnicity.
70% of eligible women will have a BSA mammogram
every two years.
Continue to work with BreastScreen Aotearoa, PHOs and Te Kawau
Mārō alliance to identify and implement effective interventions
tailored toward Taranaki Māori women.
Activities include:
 Continue to support the Māori Health subgroup of the Local
Cancer Network, with a focus on increasing screening rates
of Māori women across Taranaki
 Working with BreastScreen Coast to Coast to influence the
location of the mobile screening bus in 2014/15 to target
areas with a high Māori population
 Continue to identify opportunities for BSA to work with Te
Kawau Mārō alliance to expand delivery of the screening
outreach programme across Taranaki
 Monitor delivery against planned actions as well as sixmonthly monitoring of the overall coverage target
Why is this outcome important:
Māori
Non-Māori
Progress
The purpose of Breast Screening is to detect breast cancer at an early stage, in order to reduce breast cancer morbidity
and mortality. In Taranaki, the screening coverage rate among Māori women is lower than for other ethnicities.
Gap (%)
Achieving high rates of breast screening coverage for Māori women is important, given that according to national data,
Māori women are more likely to be diagnosed at a later stage of breast cancer spread than non-Māori and that for many
cancers at each stage Māori-specific mortality rates post diagnosis are higher.
Thursday 27 June 2014, V3.0 Final
65%
79%
℗
14%
Page 16 of 26
National Indicator 5.2
CANCER (CERVICAL SCREENING)
Who will be responsible: PM, Cancer Services
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Reduced cancer mortality and morbidity
Continue to work with the National Cervical Screening Unit,
PHOs and Te Kawau Mārō alliance to establish and deliver
six monthly reporting on rates for Māori and non-Māori in
Taranaki.
Work with the Taranaki Regional Screening Unit to
continue to work with the National Cervical Screening Unit,
PHOs and providers to develop and implement strategies
to improve cervical screening rates for Taranaki Māori
women
Health promotion activities continue to focus on Māori and
include for example
 WINZ youth service programme
 Pae Pae in the Park (Patea)
 Kaumatua at Te Roopu Pahake O Waitara
 Tui Ora Kaumatua group
80% Cervical Screening percentage of women (Statistics
NZ Census projection adjusted for prevalence of
hysterectomies) aged 25-69 who have had a cervical
screen in the past 36 months
The Taranaki region has a three year plan (July 2011 –
June 2014) with a strong focus on PHO/community
involvement. The next three year plan is currently being
rewritten collaboratively by the PHO and the Regional
Screening Unit. We have no evidence to gauge if recent
initiatives are working as there have been no Cervical
Screening statistics from the NSU since Dec 2013. We
continue to work closely with the PHO to increase
coverage with 85% of activities being completed by the
PHO. We also take advantage of any unplanned
opportunities that arise during the year.
Activities continue with kaimahi making direct phone
contacts for cervical screening with referrals from practice
nurses for our Outreach service. All sessions are
evaluated.
Why is this outcome important:
The cervical screening coverage for Māori women in Taranaki is lower than for non-Māori. The focus is on increasing
coverage for Māori women. Cancer is a leading cause of mortality for Māori in Taranaki. Cervical cancer is largely
preventable through regular three yearly cervical smear tests which can reduce a women’s risk of developing cervical
cancer by 90%.
Thursday 27 June 2014, V3.0 Final
Māori
Non-Māori
Progress
73%
89%
Gap (%)
16%
℗
Page 17 of 26
National Indicator 6.1
SMOKING (HOSPITAL)
Outcome we want to achieve
What we are planning to do to achieve it
Less people smoking
National Vision and Government Goal: Smokefree
Aotearoa 2025
 Our Tamariki and Rangatahi deserve a future
where smoking is history
Continue to work with TDHB provider arm to apply a focus
on Māori patients and their whānau to:
 Current unit procedures support ongoing process to
ensure all Māori patients who smoke are asked about
their smoking status, given brief advice to stop
smoking and are offered/given effective smoking
cessation support for hospital based and maternity
services
 To promote and monitor the use and access of
Pharmacotherapy medicine for hospitalised Māori
Smokers
o Determine a baseline by 31 September 2014
 To improve and monitor the number of referrals for
hospitalised Māori smokers to Quitline and specialised
smoking cessation services
 Maternity services to monitor the use and access of
Nicotine Replacement Therapy for hospitalised Māori
pregnant smokers
o Determine a baseline by 31 September 2014
 Maternity services to establish a referral process and
pathway for hospitalised Māori pregnant women
smokers to Mana Wahine Hapu and other specialist
smoking cessation services
o Determine a baseline by 31 September 2014
 To implement the recommendations from the National
Smokefree mental health project within the hospital
Why is this outcome important:
Smoking is a significant risk factor for Māori in the Taranaki Region. Māori have a higher prevalence of smoking than
other New Zealanders. Some 47% of Taranaki Māori females and 38% of Māori males are regular smokers, compared
to around 21% of New Zealand Europeans. The prevalence of regular smoking in Taranaki Māori females is also higher
than the national average. Smoking kills an estimated 5000 people in New Zealand every year and smoking-related
diseases are a significant opportunity cost to the health sector.
Thursday 27 June 2014, V3.0 Final
Who will be responsible: Clinical Services Manager,
Medical
How we will know if we have been successful
95% of hospitalised Māori patients who smoke and are
seen by a health practitioner are provided with brief
advice and support to quit smoking
Progress towards 90% of Māori pregnant women who
identify as smokers at the time of confirmation of
pregnancy in General Practice or booking with Lead
Maternity Carer are offered advice and support to quit

Increase percentage of Māori hospitalised smokers
receiving pharmacotherapy medicine by June 2025

Increase of Māori direct referrals numbers to Quitline
and specialist smoking cessation services by June
2015

Increase percentage of hospitalised pregnant
smokers receiving Pharmacotherapy medicine by
June 2015

Increase of direct referral numbers to Mana Wahine
Hapu and specialist smoking cessation providers by
June 2015
Implementation of National Smokefree Mental Health
guidelines and resources within the hospital by June
2015
Māori
Non-Māori
Progress
Gap (%)
98%
96%

2%
Page 18 of 26
National Indicator 6.2
SMOKING - PRIMARY CARE
Who will be responsible: PM, Population Health
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
New Zealanders living longer, healthier and more
independent lives
National Vision and Government Goal – Smokefree
Aotearoa 2025
 Our Tamariki and Rangatahi deserve a future
where smoking is history

PHO to ensure all Māori patients who smoke are
asked about their smoking status, given brief advice to
stop smoking and are offered/given effective smoking
cessation support
o MHN Network Liaison Team to provide quarterly
reports to all practices on their performance
against the Annual Quality Plan targets
o To provide a MHN centralised practice support
approach for identified practices that require
support for Māori smokers not contacted in 12
months
o Explore options for a range of dedicated smoking
cessation support in the Primary Care Setting







Smokefree Pregnancy
o Professional Mana Wahine Hapu community
champions to deliver promotional sessions to
health and community professionals
o 5 Mana Wahine Hapu Whānau champion trainers
to recruit and provide training support packages
o Whānau champions to deliver Smokefree
pregnancy conversations
o Mana Wahine Hapu service to provide smoking
cessation/behavioural support group interventions
to pregnant women and their partners/whānau



Taranaki representation on the Smokefree Midlands
Māori Caucus Group
Why is this outcome important:
Smoking is a significant risk factor for Māori in the Taranaki Region. Māori have a higher prevalence of smoking than
other New Zealanders. Some 47% of Taranaki Māori females and 38% of Māori males are regular smokers, compared
to around 21% of New Zealand Europeans. The prevalence of regular smoking in Taranaki Māori females is also higher
than the national average. Smoking kills an estimated 5000 people in New Zealand every year and smoking-related
diseases are a significant opportunity cost to the health sector
Thursday 27 June 2014, V3.0 Final

90% of Māori patients who smoke aged 15 years
and over and are seen in General Practice by a
health practitioner are offered brief advice and
support to quit smoking
Make progress towards 90% of pregnant women
who identify as smokers at the time of confirmation
of pregnant in general practice are offered advice
and support to quit
Agree with MRHN a evidence based model to best
support General Practice by 30 September 2014
To deliver Mana Wahine Hapu promotional sessions
reaching 250 health and community professionals by
31 March 2015
40 whānau champions recruited and trained by 31
March 2015
400 smokefree pregnancy conversations recorded
by 31 March 2015
125 women received three facilitated group support
sessions (partners included based on ratio 85%
women 15% partners) by 31 March 2015
100 pregnant women enrolled in Innov8 Smokefree
telephone support by 31 March 2015
Ongoing attendance at Regional meetings
Māori
Non-Māori
Progress
Gap (%)
71%
72%
?
1%
Page 19 of 26
National Indicator 7.1
IMMUNISATION
Who will be responsible: PM, Child & Youth
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Improved children’s health






Maintain an immunisation alliance steering group
that includes all the relevant stakeholders for the
DHB’s immunisation services including the Public
Health Unit; and that participates in regional and
national forums
Work with primary care partners to monitor and
increase new born enrolment rates to 100%
Monitor and evaluate immunisation coverage at
DHB, PHO and practice level, manage identified
service delivery gaps
Identify immunisation status of children presenting at
hospital and refer for immunisation if not up to date
In collaboration with primary care stakeholders
develop systems for seamless handover of mother
and child as they move from maternity care services
to general practice and WCTO services
In collaboration with NGOs and government
agencies, describe how the DHB is working across
agencies to increase immunisation coverage
Why is this outcome important:
•
•
Immunisation is linked to primary care access and management
Immunisation can prevent a number of diseases and is a cost-effective health intervention.
Thursday 27 June 2014, V3.0 Final
95% of infants are fully immunised by eight months of
age (ht)
Māori
Non-Māori
Progress
Gap (%)
89%
89%

0%
Page 20 of 26
National Indicator 7.2
IMMUNISATION
Who will be responsible: PM, Primary Care
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Reduced communicable disease
Continue to support the NGO sector through the DHB
Immunisation coordinator and the Taranaki Immunisation
Steering Group to provide opportunistic immunisations at
health promotion days on Marae and in the community.
Achieving the target for seasonal influenza immunisation
rates in the eligible population (65 years and over)
(by ethnicity)
Why is this outcome important:
The complications of influenza (more commonly known as ‘flu’) in elderly can be serious or life threatening. As a result,
the Government funds the cost of influenza vaccinations and their administration for people aged 65 and over and
Thursday 27 June 2014, V3.0 Final
Māori
Non-Māori
Total
Progress
Gap (%)
67% (High needs)
70%
℗
3%
Page 21 of 26
National Indicator 8
RHEUMATIC FEVER
Who will be responsible: PM, Population Health
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Reduce the incidence of Rheumatic Fever
Implement the TDHB Rheumatic Fever Prevention
Plan by:
o Ensuring that primary care providers and other
health professionals likely to see high risk children
follow the National Heart Foundation Sore Throat
Management Guidelines
o Ensuring people with Group A streptococcal
infections are treated appropriately within 7 days
of developing symptoms
o Ensuring that all cases of acute rheumatic fever
are notified to the Medical Officer of Health within
7 days of hospital admission
o Reviewing all cases of rheumatic fever to identify
any identifiable risk factors and system failure
points
o Ensuring patients with a past history of rheumatic
fever receive monthly antibiotics not more than 5
days after due date
Why is this outcome important:
Rheumatic Fever left untreated can damage the heart leading to life long heart problems. Working to reduce and
eliminate rheumatic fever can reduce the incidence of heart disease and/or related complications.
Thursday 27 June 2014, V3.0 Final
Rheumatic fever number and rate reductions are 40%
below the 3-year average (2009/10 – 2010/11), towards
a target of 0.5/100,000 (by ethnicity)
Māori
Non-Māori
Progress
Gap (%)
0.9 Total
℗
NA
Page 22 of 26
National Indicator 9
ORAL HEALTH
Who will be responsible: Service Manager, Child
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Improved dental health of Māori Children


and Maternal Health

Work with maternity services to ensure all children are
enrolled at birth with the dental service
Work with providers such as Tamariki Ora, Plunket
and PHO’s to ensure all pre-school children are
enrolled with the dental service.


Why is this outcome important:
There is disparity between Māori children and non-Māori children’s oral heath in Taranaki, this needs to be addressed to
aim for equal oral health outcomes for all children.
75% of preschool children are enrolled with
Dental Services. Audited quarterly with target
achieved by June 2015.
Children enrolled and ‘on our books’ earlier
enable us to track and trace them to
ensure/support oral health checks and treatment.
Working alongside Māori health workers and
community Māori health teams to locate children
and families easier if the child is enrolled already.
Māori
Non-Māori
Progress
Gap (%)
59%
82%
?
23%
Oral health reflects and impacts on general health and well being. Having healthy teeth as a child leads to healthy adult
teeth and less associated co-morbidities and health risks.
National Indicator 10
MENTAL HEALTH
Who will be responsible:
Outcome we want to achieve
What we are planning to do to achieve it
How we will know if we have been successful
Improved mental health outcomes for Māori
•
•
•
Reduction in the number and proportion of Community
Treatment Orders issued under Section 29 of the Mental
health Act for Māori.
Establish a baseline through data reporting
Identify emerging trends.
Develop a plan to address
Why is this outcome important:
Māori
102 per 100,000 of pop
Identify and address the disparity between Māori /Non Māori in relation to MHA/CTO rates.
 Establish baseline- as of July 2014/2015 this data will be part of the MH&A PRIMD data set to facilitate better
reporting.
 Monitor this data monthly via the MH&A business unit. Variations will be reported to the Service Manager.
Negative variations are to form part of the agenda for discussion at the Monthly Clinical Governance Forum –
with a view to establishing a plan for improvement.
Non-Māori
54 per 100,000 of pop
Progress
?
Gap
52 per 100,000 of pop (
equivalent of 9 clients for
TDHB population)
Thursday 27 June 2014, V3.0 Final
Page 23 of 26
LOCAL PRIORITIES AND INDICATORS ACTION PLANS
Local Indicator 1
ACCESS TO SERVICES – DNA’S
Outcome we want to achieve
What we are planning to do to achieve it
Who will be responsible: Clinical Services
Manager, Medical
How we will know if we have been successful
Improved access to secondary care
Complete the profile of Māori DNA FSA’s and follow up
appointments for CVD clinics
DNA rate for Outpatient appointments reduced to <9%
by July 2015
Review patient pathways including whānau feedback to
identify issues that need to be addressed
Drawing on successful experiences of other DHB’s,
develop and implement the action plan to reduce DNA
rates in the particular specialties examined
Establish a review process to regularly monitor progress
towards reducing DNA’s and make adjustments in
approach where needed
Look at implementing successful interventions across other
DNA specialties.
Why is this outcome important:
Māori
19%
Māori have double the DNA rate for first specialist outpatient appointments compared to “Other” ethnic groups in
Taranaki and around three times the DNA rate for follow-up appointments. While DNA rates for the Taranaki DHB
population are consistently lower than the national figures they have been increasing over the three year period and the
extent of ethnic inequalities between Māori and non-Māori is similar.
Higher disease burden coupled with higher DNA rates will result in ongoing unmet health need.
Non-Māori
7%
Progress
Gap (%)
↑
Thursday 27 June 2014, V3.0 Final
12%
Page 24 of 26
Local Indicator 2
PRIMARY MENTAL HEALTH
Outcome we want to achieve
What we are planning to do to achieve it
Taiohi are emotionally and mentally well and are
achieving their best possible educational outcomes
Increase the uptake of counselling vouchers for Māori
Taiohi – through schools and PHNs
Improve pathways for earlier intervention of young people
identified with mild to moderate mental health and
addictions issues.
Work with the social sector trial and increase the
interventions available to Youth.
Why is this outcome important:
At least 20% of young people experience emotional and mental health issues during the course of their adolescent
years. There are a number of risk factors which impact on a young person being able to maintain good mental health
including, family/whānau, cultural identity, peers and friendships, activities they are involved in, boredom and being
engaged with the education system. Utilisation of primary mental health interventions can significantly reduce
Young Māori are over represented in a range of statistics, including teenage birth rates being double the national
average at 92.0 per 1000 population. Māori are also more likely to present to hospital for self related harm. In 2011/12
38% of admissions for taiohi were for Māori.
School completion and educational attainment rates are 57% for Māori compared to 71% for non-Māori.
Thursday 27 June 2014, V3.0 Final
Who will be responsible: Portfolio Manager,
Mental Health & Addictions
How we will know if we have been successful
>=25% of vouchers for access to counselling are
available for Māori Taiohi under the Primary Mental
Health Initiative.
Number of referrals from mini HEADSSS and HEADSSS
assessments by PHN’s and School Counsellors for
Māori Taiohi. (access indicator)
The number of Māori youth accessing Social Sector Trial
interventions from base line of 0 in March 2014 to
>=25% of total contacts for Māori Taiohi by 30 June
2015
Māori
17%
Non-Māori
49%
Progress
?
Gap (%)
32%
Page 25 of 26
REFERENCES
1.
Whānau Ora Health Needs Assessment, Māori Living in Taranaki, Ratima and Jenkins, Taranaki District Health
Board, February 2012
2.
TDHB Māori Health Plan 2013-2014
3.
Te Kawau Mārō, Taranaki Māori Health Strategy 2009 – 2029
4.
Ministry of Health, 2014/15 Operational Policy Framework
5.
Statistics NZ, District Health Board Area summary tables, Statistics NZ 2013
Page 26 of 26
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