AGENDA PACK BOARD - Auckland District Health Board

 Board Meeting Wednesday 19 February 2014 2.00pm Marion Davis Library Building 43 Auckland City Hospital Grafton Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare Karakia E te Kaihanga e te Wahingaro E mihi ana mo te ha o to koutou oranga Kia kotahi ai o matou whakaaro i roto i te tu waatea. Kia U ai matou ki te pono me te tika I runga i to ingoa tapu Kia haumie kia huie Taiki eee. Creator and Spirit of life To the ancient realms of the Creator Thank you for the life we each breathe to help us be of one mind As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware Of the need to be fair and transparent in all we do. We ask this in the name of Creation and the Living Earth. Well Being to All. Agenda
Meeting of the Board
19 February 2014
Venue: Marion Davis Library, Building 43, Auckland City Hospital, Grafton ADHB Board Members Dr Lester Levy (Chair) Jo Agnew Peter Aitken Doug Armstrong Judith Bassett Dr Chris Chambers Dr Lee Mathias (Deputy Chair) Robyn Northey Morris Pita Gwen Tepania‐Palmer Ian Ward Apologies Time: 2.00pm
ADHB Management Ailsa Claire Simon Bowen Chief Executive Officer Director of Health Outcomes – Auckland and Waitemata District Health Boards Margaret Dotchin Chief Nursing Officer Fionnagh Dougan Director Provider Services Dr Debbie Holdsworth Director Funding – Auckland and Waitemata District Health Boards Dr Andrew Old Chief Strategy, Participation and Innovation Rosalie Percival Chief Financial Officer Vivienne Rawlings Chief Human Resources Officer Linda Wakeling Chief of Intelligence and Informatics Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer ADHB Senior Staff Lita Foliaki Pacific Planning & Funding Manager Naida Glavish GM Maori Health & Chief Advisor Tikanga Bruce Levi Acting Pacific General Manager for Hospital Services – Waitemata and Auckland Auxilia Nyangoni Deputy Chief Financial Officer Marlene Skelton Corporate Business Manager Director Communications Gilbert Wong (Other staff members who attend for a particular item are named at the start of the minute for that item) Margaret Wilsher Register of Interests Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda? Agenda Please note that agenda item times are estimates only 2.00pm 1 KARAKIA 2 ATTENDANCE AND APOLOGIES 3 CONFLICTS OF INTEREST 2:05pm 4 CONFIRMATION OF MINUTES 11 December 2013 1 CONFIRMATION OF MINUTES OF SPECIAL BOARD MEETING 11 December 2013 15 2:10pm 5 ACTION POINTS 11 December 2013 21 6 CHAIRMAN’S REPORT – VERBAL 25 2:15pm 7 CHIEF EXECUTIVE’S REPORT 27 7.1 MoH Speech at the Association of Salaried Medical Specialists Annual Conference 43 2:30pm 8 8.1 PRESENTATION Stroke All Ages Progress Update February 2014 – Sue Waters, Tim Denison, Alan Barber 53 55 2:45pm 9 9.1 9.2 LIFT THE HEALTH OF PEOPLE IN AUCKLAND CITY CPHAC Recommendations ‐ Nil Maori Health Gain Advisory Committee Maori Health Plan 2014/15 71 73 75 2:50pm 10 10.1 10.2 LIVE WITHIN OUR MEANS Finance Report Authorised Banking Signatories 89 91 101 11 GENERAL BUSINESS 109 RESOLUTION TO EXCLUDE THE PUBLIC 111 12 Next Meeting Wednesday 2 April 2014 at 2.00pm Marion Davis Library, Building 43, Auckland City Hospital, Grafton Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare Auckland District Health Board Meeting of the Board 19 February 2014 Attendance at Auckland District Health Board Meetings 19 February 2014 2 April 2014 14 May 2014 25 June 2014 6 August 2014 17 September 2014 29 October 2014 10 December 2014 Attendees Dr Lester Levy (Chair) Jo Agnew Peter Aitken Doug Armstrong Judith Bassett Dr Chris Chambers Dr Lee Mathias (Deputy Chair) Robyn Northey Morris Pita Gwen Tepania‐Palmer Ian Ward x absent # leave of absence 11 December 2013 1 1 1 1 1 1 1 1 1 1 1 Conflicts of Interest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge. An “interest” can include, but is not limited to: 
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Being a party to, or deriving a financial benefit from, a transaction Having a financial interest in another party to a transaction Being a director, member, official, partner or trustee of another party to a transaction or a person who will or may derive a financial benefit from it Being the parent, child, spouse or partner of another person or party who will or may derive a financial benefit from the transaction Being otherwise directly or indirectly interested in the transaction If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out duties under the Act then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a Board member and are unlikely to be appropriate in any circumstances. 
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When a disclosure is made the Board member concerned must not take part in any deliberation or decision of the Board relating to the transaction, or be included in any quorum or decision, or sign any documents related to the transaction. The disclosure must be recorded in the minutes of the next meeting and entered into the interests register. The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if the majority of other members of the Board permit the member to do so. If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned. IMPORTANT If in doubt – declare. Ensure the full nature of the interest is disclosed, not just the existence of the interest. This sheet provides summary information only ‐ refer to clause 36, schedule 3 of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information (available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public Entities” (www.oag.govt.nz ). Register of Interests – Board Board Member Organisation Lester LEVY (Chair) Chairman ‐ Waitemata District Health Board Chairman ‐ Auckland Transport Independent Chairman ‐ Tonkin & Taylor Deputy Chairman – Health Benefits Ltd Chief Executive ‐ New Zealand Leadership Institute Professor (Adjunct) of Leadership ‐ University of Auckland Business School Professional Teaching Fellow ‐ School of Nursing, Auckland University Casual Staff Nurse ‐ ADHB Pharmacy Locum ‐ Pharmacist Shareholder/ Director, Consultant ‐ Pharmacy Care Systems Ltd Shareholder/ Director ‐ Pharmacy New Lynn Medical Centre Daughter is a partner – Russell McVeagh Lawyers Nil Employee ‐ ADHB Wife is an employee ‐ Starship Trauma Service Clinical Senior Lecturer in Anaesthesia ‐ Auckland Clinical School Member – Association of Salaried Medical Specialists Associate ‐ Epsom Anaesthetic Group Shareholder ‐ Ormiston Surgical Managing Director ‐ Lee Mathias Limited Shareholder/Director ‐ Pictor Limited Director ‐ John Seabrook Holdings Limited Chair – Counties Manukau District Health Board Chair ‐ Health Promotion Agency Chair ‐ iAC IP Limited Governance Advisor ‐ AuPairlink Limited Governance Advisor/Chair – Company of Women Ltd Self‐employed Contractor ‐ Project management, service review, planning etc. Board Member ‐ Hope Foundation Trustee ‐ A+ Charitable Trust Member – Waitemata District Health Board Shareholder – Turuki Pharmacy, South Auckland Owner and operator with wife ‐ Shea Pita & Associates Ltd Wife is member of Northland District Health Board Wife provides advice to Maori health organisations Board Member ‐ Waitemata District Health Board Board Member ‐ Manaia PHO Chair ‐ Ngati Hine Health Trust Committee Member ‐ Te Taitokerau Whanau Ora Committee Member ‐ Lottery Northland Community Committee Board Member ‐ NZ Blood Service Advisor ‐ Francis Group Consulting Jo AGNEW Peter AITKEN Doug ARMSTRONG Judith BASSETT Dr Chris CHAMBERS Lee MATHIAS Robyn NORTHEY Morris PITA Gwen TEPANIA‐
PALMER Ian WARD Latest Disclosure 6 Dec 2014 15 Jan 2014 17 Jan 2014 3 Dec 2013 15 Jan 2014 26 Jan 2014 15 Jan 2014 20 June 2012 13 Dec 2013 11 Mar 2013 15 Jan 2014 4 CONFIRMATION OF MINUTES WEDNESDAY 11 DECEMBER 2013 CONFIRMATION OF MINUTES OF SPECIAL BOARD MEETING WEDNESDAY 11 DECEMBER 2013 1
4.0 Confirmation of Minutes 11 December 2013 3
Minutes
Meeting of the Board
11 December 2013
Minutes of the Auckland District Health Board meeting held on Wednesday, 11 December 2013 in the Marion Davis Library, Building 43, Auckland City Hospital, Grafton commencing at 2:00pm ADHB Board Members Present Dr Lester Levy (Chair) Jo Agnew Peter Aitken Doug Armstrong Judith Bassett Dr Chris Chambers Dr Lee Mathias (Deputy Chair) Robyn Northey Morris Pita Gwen Tepania‐Palmer Ian Ward ADHB Management Present Ailsa Claire Chief Executive Officer Greg Balla Director Performance and Improvement Simon Bowen Director of Health Outcomes – Waitemata and Auckland Margaret Dotchin Chief Nursing Officer Fionnagh Dougan Director Provider Services Debbie Holdsworth Chief Planning and Funding Officer Andrew Old Interim Chief Strategy, Participation and Innovation Rosalie Percival Chief Financial Officer Linda Wakeling Chief of Intelligence and Informatics Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer ADHB Senior Staff Marlene Skelton Corporate Business Manager Gilbert Wong Director Communications (Other staff members who attended for a particular item are named at the start of the minute for that item) Lester Levy (Board Chair) welcomed new Board Members Doug Armstrong and Morris Pita to the meeting. He advised that on behalf of the Board that he had thanked outgoing members Susan Buckland and Rob Cooper for their service over the last term. He acknowledged the contribution of Greg Balla, Director of Performance and Improvement, who would be leaving the District Health Board in the new year. 1 KARAKIA Morris Pita led the Karakia. 2 ATTENDANCE AND APOLOGIES There were no apologies. 3 CONFLICTS OF INTEREST It was noted that there had been no time to incorporate interests for the new members into the register. This will be done for the next meeting. Returning members expressed the wish for the opportunity to also review and update the interests register in light of new appointments. Lester Levy advised that his title at the New Zealand Leadership Institute had changed. Action: The Corporate Business Manager to circulate by email to each member the existing 5
interests attributed to them for amendment. There were no declarations of conflicts of interest for any other items on the agenda. 4 CONFIRMATION OF MINUTES 30 OCTOBER 2013 (Pages 3‐12) Resolution: Moved Lee Mathias/Seconded Robyn Northey That the minutes of the Auckland District Health Board meeting held on 30 October 2013 be confirmed as a true and correct record. Carried 5 ACTION POINTS 30 OCTOBER 2013 (Page 15) That an amendment be made to the following action item: “To present an action plan on how to achieve a comprehensive co‐related all age stroke service” Replace the word, co‐related” with the word, co‐located”. 6 CHAIRMAN’S REPORT (Page 17) 6.1 Establishment of Executive Committee of the Board (Pages 21‐22) Lester Levy advised that this was a procedural necessity in order for the Board to continue to function during the Christmas and New Year recess. Resolution: Moved Doug Armstrong/Seconded Chris Chambers 1. That the Board approve the establishment of an Executive Committee (under schedule 3 clause 38 of the New Zealand Public Health and Disability Act 2000) to consider any matters that require the urgent attention of the Board during the Christmas and New Year Board recess. 2. That membership of the Committee is to comprise the Board Chair, the Deputy Board Chair (Lee Mathias), Judith Bassett, Gwen Tepania‐Palmer and Ian Ward, with a quorum of three members (the Chair needs to be one of the three members). 3. That the Executive Committee be given delegated authority to make decisions on the Board’s behalf relating to the urgent approval of business cases, leases and the awarding of contracts for facilities development, services and supplies and information services and on any other urgent recommendations from a Committee or the Chief Executive (same arrangements as last year). 4. That all decisions made by the Executive Committee be reported back to the Board at its meeting on 19 February 2014. 5. That the Executive Committee be dissolved as at 19 February 2014. Carried [Secretarial Note: This item was taken after item 8.2] 6
7 CHIEF EXECUTIVE’S REPORT (Pages 25‐42) The CEO highlighted and/or updated aspects of her report advising that: 
Seven ‘Staying Connected’ CE Briefings have taken place attended by approximately 800 staff. These sessions have been very successful with communication to the CEO increasing as a result. There are plans to video a further session for those staff that have not had the opportunity to attend. 
The Healthcare Excellence Awards took place on 28 November 2013. Details of the finalists and winners can be found in the Healthcare Excellence Booklet. Consideration is being given to how the concept can be expanded as there are a good group of very robust projects that deserve a much wider audience than they are currently getting. 
A fund raising page was setup for the Auckland District Health Board team to support those affected by Typhoon Haiyen. The process employed was very successful with more than $16,000 being raised to date. 
Auckland District Health Board published its Summary of Serious Adverse Events for the 2012‐13 year, the Annual Report 2012‐13 and its first set of Quality Accounts. 
25 people were nominated as local heroes during November and the local hero trophy was awarded to Amanda Rookes, Ward Clerk for Cardiovascular ICU. 
Auckland District Health Board anaesthetist and HQSC chair Professor Alan Merry has been awarded the 2013 Gluckman Medal, the University of Auckland Faculty of Medical and Health Sciences' premier recognition of research excellence. In addition, Professor Merry has recently been awarded honorary membership of the American Society of Anaesthesiology (ASA). Honorary ASA membership has been awarded only 34 times since 1935. 
The Health Innovation Hub which is in its second year of activity now has a full complement of staff. Business development across the ‘clinician innovator’ customer segment continues but with many projects at an early stage. revenue opportunities will not be realised quickly. The ‘industry’ customer segment engagement has been slower and somewhat disappointing. 
There is a changing composition within the registered nurses workforce and an across sector view is being undertaken to consider the current age profile, level of experience and skill mix. There are cost restraints within the Provider Arm as a result of holding this very experienced workforce and there is a need to bring in more graduates to reduce cost and prepare for replacement of retiring nurses. 
In October 2012, Auckland District Health Board and AUT’s Faculty of Design and Creative Technologies signed a Memorandum of Understanding (MoU) to explore opportunities for collaboration on health projects. AUT wanted to develop and apply its design research and teaching activity in the health and social sector and the Auckland District Health Board was interested in innovative solutions to population health, service planning and healthcare delivery issues. The collaboration has been valuable and in order 7
to realise that potential, the intent now is to create a virtual Design for Health and Wellbeing Lab to demonstrate how design can contribute to health and wellbeing. A two day design event was held recently to promote the collaboration. Board Members had the following questions or comments to make: 
In response to a question in regard to funding of the virtual design lab it was advised that to date there had been no financial outlay other than staff time. That should there be a financial cost once the Lab design was completed it would be put to the Board for approval. 
Disappointment was expressed at the widening gap in the DNA targets with Board Members being advised that there was no obvious attributable reason for the increase and that there was a more detailed report scheduled for February regarding the management of DNA. 
Ailsa Claire noted that the Public Health Action Plan had been drawn up in an interesting way. It was in the consultation phase and she felt it was worth Board Members looking at. That the Chief Executives report be received [Secretarial Note: This item was taken after item 8.2] 8 PRESENTATIONS [The presentations were heard immediately after consideration of item 5] 8.1 Rainbow Health (Pages 47‐80) Michael Stevens of Affinity Services Ltd addressed the Board in relation to key issues contained in a recently published report on the Rainbow community and associated health care provision. Michael advised that the term “Rainbow Community” placed a very broad umbrella over a group that was extremely difficult to define. It was calculated that 10% of New Zealand’s overall population fell within the Rainbow community and had health needs that were not currently being measured nor met. What unites the community is a shared sense of difference and of being marginalised. Many pass through the health system unnoticed and afraid to reveal details about themselves. Therefore, no data is collected on this group of people and the wider community remains unaware that this group of people have a distinct set of health needs. Michael advised that Gay men were the most powerful group within Rainbow but that they still felt marginalised and that did not auger well for other groups who felt they were in a less socially powerful position. Australian research showed that 40% of Gay men did not disclose to their General Practitioner that they were Gay. There was a strong sense of personal vulnerability. It could 8
be said that a legal change in law does not provide equality. The Rainbow community were over represented in smoking, obesity, suicide (five times over the national average), mental health issues, DNA abuse, certain forms of cancer and some STI’s. They have a wide set of needs and in an ideal world the government should be taking up this challenge but pragmatically the public health system approach is the only recourse available. Michael reiterated the recommendations from his report which were around equitable and culturally safe access to general and mental health services, enhancement of data collection and involvement and consultation over development and delivery of evaluation of appropriate policies, programmes and services. Board Members had the following questions or comments to make: 
Lester Levy reminded members that there was a need to be more wide ranging in their consideration of this group of people. 
Jo Agnew asked why this had not been taken up by other District Health Boards given the population base in the wider region. Michael advised that Auckland District Health Board had been the only one to express a real interest and actively work directly with Rainbow. He had had difficulty in getting others to have a conversation with him about these issues. 
In response to Robyn Northey asking whether this had permeated into the residential care environment Michael advised that the information had been made available but he was not sure how far it had gone nor the effect. Action: Lester Levy undertook to pass the report on to Waitemata District Health Board and Lee Mathias would make it available to Counties Manukau District Health Board. That the presentation by Michael Stevens of Affinity Services Ltd be received. 8.2 Ernest and Marion Davis Medical Library and Lecture Halls (Pages 83‐84) Richard Frith addressed the Board in relation to plans for the refurbishment of the Ernest and Marion Davis Medical Library and Lecture Halls. In attendance and in support were Jon Simcock and Gill Naden. Richard tabled a concept design report and advised that: 
There is a plan to redevelop the building including earthquake strengthening to current code, redevelopment of the kitchen facilities and ablutions, redevelopment of the display areas and the installation of a lift. 
The current estimate for these works is $1.5 million. The Marion Davis Trust contains sufficient funds to complete most if not all of the project. The work would occur in 9
2014 with a completion date in the second half of the year. 
The facility would complement the Clinical Education Centre and its proximity to Starship Hospital makes it an attractive venue for clinical and other meetings for Starship staff. It would be staffed and run in conjunction with the Clinical Education Centre and there was ongoing funding available for day to day running from the Marion Davis Trust. Matters covered in discussion of the presentation and in response to questions included: 
The Chief Financial Officer advising members that in context of the master site plan there is no building expansion contemplated in the immediate future (next 10 to 15 years) that would impact on this site. Resolution: Moved Lester Levy/Seconded Gwen Tepania‐Palmer That the presentation by Richard Frith in relation to the refurbishment of the Ernest and Marion Davis Medical Library and Lecture Halls be received. That the Board support the approach outlined which incorporates proceeding with detailed design, consent and construction. Carried [Secretarial Note: Item 6.1 was considered next] 9 LIFT THE HEALTH OF PEOPLE IN AUCKLAND CITY 9.1 Auckland District Health Board Child and Youth Mental Health and Addiction Direction 2013‐2023 (Pages 89‐190) Lester Levy advised that in future he would like to see recommendations attached to plans and strategies such as this; framed so that the economic effect was apparent. He was only prepared to approve this plan in principle subject to the adoption of a business case. Resolution: Moved Gwen Tepania‐Palmer/Seconded Jo Agnew That the Board agree in principle the Integrated Child and Youth Mental Health and Addictions Direction 2013‐2023. Carried 9.2 2014/2015 Annual Plan Approach (Pages 193‐200) Resolution: Moved Lee Mathias/Seconded Judith Bassett That the Board: a) Approve the approach to annual planning for 2014/15, including the longer term direction and timetable. b) Note the national planning guidance, including updates and changes. 10
Carried 10 LIVE WITHIN OUR MEANS 10.1 Finance Report (Pages 205‐212) The Chief Financial Officer asked that her report on the financial results for October 2013 be taken as read. Matters covered in discussion of the report and in response to questions included: 
Comment that the results were considered good in relation to the current pressure on finances although it was noted that the position would be better if the Board were not starting from a known negative position. 
The Chief Financial Officer explaining for the benefit of the new Board Members that the Board was not allowed to carry a deficit from one year to the next and that traditionally the last few months of the budget year were extremely difficult to manage. The last financial year was closed with only a $150,000 surplus. 
Robyn Northey asking whether the favourable base revenue of $1.8m due to devolvement of Primary Mental Health, Aged Nursing Care and Dementia Care, Late Effect Treatment, and Eating Disorders had been passed on and whether nurses had benefited. It was advised that it had been passed to the organisations but that there was no way of knowing, nor influencing an organisation in how the money was expended. An explanation being requested as to what was meant by, “Higher Research Grants $2.2m. Note that costs of this research are spread throughout the overspend categories year to date in the provider arm.” The Chief Financial Officer advised that it did not mean that this money was funding ordinary activities. It was agreed with the Board Chair that a more detailed explanation would be contained in the next financial report. 
That the report of the Chief Financial Officer dated October 2013 be received. 10.2 Northern Region Health Plan 2013/2014 Quarter 1 Report (Pages 215‐280) Lester Levy noted for the information of new Board Members that the plan was well regarded and seen as functioning increasingly well for the Northern District Health Boards. The Chief Medical Officer advised that it was now in its third year and that there was an expectation that more consolidation would be seen. It was a clinically led plan and was extremely effective in bringing clinicians together to work on collaborative projects. The Board notes the Northern Region Health Plan 2013/14 Quarter 1 Report and the good progress that has been made against this plan 11
11 GENERAL BUSINESS There was no general business this month. 12 PUBLIC EXCLUSION (Pages 295‐286) Resolution: Moved Gwen Tepania‐Palmer/Seconded Jo Agnew That in accordance with the provisions of Clauses 32 and 33, Schedule 3, of the New Zealand Public Health and Disability Act 2000 (“Act”), the Auckland District Health Board resolve that the public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of each item to be considered: Reasons for passing this resolution in relation to each item: Ground(s) under Clause 32 for the passing of this resolution 12.1 Confirmation of the Public Excluded Minutes of the Auckland District Health Board Committee Meeting 30 October 2013 Confirmation of Minutes As per resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act 2000. That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.2 Community Laboratory Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] [Official Information Act 1982 S.9 (2) (j)] 12.3 Business Case and Request for Dispensation – Echo Machine – Level 4, Anaesthesia Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.4 Paediatric CT Bi‐plane Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12
That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.5 Installation of Cart Washer Equipment in CSSA Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.6 ACH Support Building Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.7 Perioperative Service Fleet Instruments Business Case Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.8 Natural Gas Contract Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.9 Medical and Allied Health Training Contract Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.10 Human Resources Report Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] 13
That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.11 Planning and Funding Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.12 Financial Report Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.13 Productivity Model Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] Carried The meeting closed at 3.55pm. Next Meeting The next ordinary scheduled meeting will be held: 2:00pm, Wednesday, 19 February 2014 Marion Davis Library, Building 43, Park Road, Auckland City Hospital, Grafton Signed as a true and correct record of the Auckland District Health Board meeting held on Wednesday, 11 December 2013. _____________________________________________ Chair ___________________________ Date Auckland District Health Board Meeting of the Board 11 December 2013 14
4.0 Confirmation of Minutes of Special Board Meeting 11 December 2013 15
Minutes
Special Meeting of the Board
11 December 2013
Minutes of the Special Auckland District Health Board meeting held on Wednesday, 11 December 2013 in
the Marion Davis Library, Building 43, Auckland City Hospital, Grafton commencing at 9:30am
ADHB Board Members Present Dr Lester Levy (Chair) Jo Agnew Peter Aitken Doug Armstrong Judith Bassett Dr Chris Chambers Dr Lee Mathias (Deputy Chair) Robyn Northey Morris Pita Gwen Tepania‐Palmer Ian Ward ADHB Management Present Ailsa Claire Chief Executive Officer ADHB Senior Staff Mark Fenwick Communications Manager Marlene Skelton Corporate Business Manager Gilbert Wong Director Communication 1 Karakia The Karakia was deferred and made at the full Board meeting held at 2pm. 2
Attendance and Apologies There were no apologies. 3
Welcome to Returning and New Members Lester Levy welcomed and introduced Doug Armstrong, a newly elected Board Member and Morris Pita a newly appointed Board Member. He welcomed back returning members. 4
Appointments to Committees Lester Levy referred to some of the challenges that would be faced by the Board and the difficulties that would be faced by the northern region in general over the coming three years. He stressed the requirement for the Board to display thoughtfulness and innovation when seeking solutions to these challenges. Lester Levy advised that Waitemata District Health Board membership on CPHAC, DSAC and Manawa Ora is subject to their Board’s decision to be made on 12th December 2013. External appointments are proposed and are subject to determination by the Board Chair and relevant Committee Chair in the new year. Resolution: Moved Gwen Tepania‐Palmer/Seconded Lee Mathias (A) That the Board approve the appointment of Board Members as Members and Chairs of Committees as set out as follows: 17
Hospital Advisory Committee Chair: Judith Bassett Deputy Chair: Chris Chambers Board Members: Dr Lester Levy (Board Chair), Jo Agnew, Peter Aitken, Doug Armstrong, Dr Lee Mathias (Deputy Board Chair), Robyn Northey, Morris Pita, Gwen Tepania‐Palmer, Ian Ward. Audit and Finance Committee Chair: Ian Ward Deputy Chair: Norman Wong Board Members: Lester Levy, Doug Armstrong, Lee Mathias, Morris Pita and Peter Aitken. Proposed external appointment subject to determination by the Board Chair and Committee Chair: Norman Wong (Professor of Accounting and Finance, Head of the Department of Accounting and Finance, University of Auckland). Community and Public Health Advisory Committee Chair: Gwen Tepania‐Palmer (ADHB and WDHB) Deputy Chair: To be determined by Waitemata District Health Board Special Meeting to be held on 12 October 2013 Ex officio: Lester Levy (ADHB / WDHB) Auckland District Health Board Members: Jo Agnew, Peter Aitken, Judith Bassett, Chris Chambers, Lee Mathias and Robyn Northey Proposed Waitemata District Health Board Members: Max Abbott, Pat Booth, Sandra Coney, Warren Flaunty Christine Rankin, and Allison Roe Proposed external appointments subject to determination by the Board Chair and Committee Chair, suggested that they be up to five: one specialist clinician, one general practitioner, one member from the Maori community, one member from the Pacific community and one member from the Asian community. Disability Support Advisory Committee Chair: To be determined by Waitemata District Health Board Special Meeting held on 12 October 2013 Deputy Chair: Jo Agnew (ADHB) Ex officio: Lester Levy (ADHB/WDHB) Auckland District Health Board Members: Robyn Northey and Judith Bassett Proposed Waitemata District Health Board Members: Sandra Coney, Max Abbott and Pat Booth Proposed external appointments subject to determination by the Board Chair and Committee Chair: Dairne Kirton, Jan Moss, Dr Marie Hull‐Brown, Susan Sherrard and Russell Vickery 18
Manawa Ora (Maori Health Gain Advisory Committee) Chair: Gwen Tepania‐Palmer (ADHB/WDHB) Deputy Chair: Morris Pita (ADHB/WDHB) Ex officio: Lester Levy (ADHB/WDHB) Auckland District Health Board Members: Chris Chambers and Robyn Northey Proposed Waitemata District Health Board Members: James Le Fevre and one other (to be appointed by the Waitemata District Health Board). Proposed external appointments subject to determination by the Board Chair and Committee Chair: Dr Matire Harward, Eru Lyndon, Dr Mataroria Lyndon, Josie Smith and Tereki Stewart (b) That the other appointments as follows be approved: Starship Foundation Jo Agnew A+ Trust Robyn Northey Carried The meeting closed at 9.55am. Next Meeting The next ordinary scheduled meeting will be held: 2:00pm, Wednesday, 11 December 2013 Marion Davis Library, Building 43, Park Road, Auckland City Hospital, Grafton Signed as a true and correct record of the Auckland District Health Board meeting held on Wednesday, 11 December 2013. _____________________________________________ Chair ___________________________ Date Auckland District Health Board Meeting of the Board 11/12/13 19
5 ACTION POINTS WEDNESDAY 11 DECEMBER 2013 21
Action Points from Previous Board meetings As at Wednesday 11 December 2013 Meeting and Item 18/9/13 Item 8.3 Detail To present an action plan on how to achieve a comprehensive co‐located all age stroke service. 11/12/13 Circulate by email to each member the existing Item 3 interests attributed to them for amendment. 23
Designated to Action by Sue Waters In this agenda Corporate Business Manager Completed 6 CHAIRMAN’S REPORT 25
7 CHIEF EXECUTIVE’S REPORT 7.1 MoH Speech at the Association of Salaried Medical Specialists Annual Conference 27
Chief Executive’s Report Recommendation That the report is received. Prepared by: Ailsa Claire (Chief Executive) Glossary ACH AUT Kaupapa RDA RMO = = = = = Auckland City Hospital Auckland University of Technology plan of action created by Māori NZ Resident Doctors Association Registered Medical Officer 1. Introduction This report covers the period from 28 November, 2013 to 31 January, 2014. It includes an update on the management of the wider health system and is a summary of progress against the Board’s priorities to confirm that matters are being appropriately addressed. 2. Events and News Events/ Campaigns Effective implementation of the Summer Bed plan meant we exceeded the planned and budgeted number of summer bed closures. The 2013/14 target was to close an average of 71 beds out of a normal average of 660 beds. In December 2013, the target was met and in January it was exceeded by an average of 19 additional bed closures. This compares to the 2012/13 target when an average of 38 beds were closed. The flow performance remained in excess of 95 % over this period. The financial impact of the higher number of bed closures is estimated as a saving of $400k, which will be reflected in January and February accounts. The summer bed plan enabled the Auckland DHB staff to take necessary leave which allowed us to also record a significant decrease in the accrued leave balance of $3.6m from December to January.  Festive treats of mince pies were distributed to all Auckland DHB staff. Unfortunately there were quality issues with a small number of the mince pies and this received negative media attention. Overall staff gave positive feedback to the effort.  Staff generously contributed to the City Mission Christmas appeal throughout December  Gen‐I, the health technology providers, brought a full‐scale model of health in the home of the future into ACH  Staff and patients were entertained by the Centenary Methodist Church Choir from Suva, Fiji, supported by our own chaplains  Wards at Auckland City Hospital created a festive atmosphere for patients and staff over the holiday period. They competed with one another in this and the winner was Ward 42 (you can see photos on the Auckland DHB Facebook page)  We launched a collaboration between the Auckland DHB and the AUT Faculty of Design and Creative Technology on how design can improve health service delivery 29
2.2 External and internal communications 2.2.1 External Auckland DHB made public statements about:  The launch of the collaboration between the Auckland DHB and the AUT Faculty of Design and Creative Technology  Nurses from the Philippines decorating wards with traditional decorations to continue awareness for fundraising for victims of Typhoon Haiyean  Dr Cathy Purdy, the 2013 winner of the Ray Hader award, for her pastoral care for contribution to the welfare of trainee anaesthetists  The Auckland DHB’s screening of 200 staff for exposure to tuberculosis after a staff member was diagnosed We received 162 requests for information, interviews or for access from media organisations in the period from 26 November to 24 January. Media enquiries included significant interest in:  A review of the care provided to mental patient Geoffrey Tampin  A new baby born to show the changing face of Auckland as recorded by the 2013 Census  The first baby born in Auckland Hospital for 2014 Apart from those noted, 63 % of the enquiries over the period were routine enquiries about the status of patients hospitalised following crimes or accidents or who were of interest because of their public profile. We reviewed 14 Official Information Act requests and provided responses. 2.2.2 Internal  Five blog posts were published by the CE  Four blog posts were published in Teamtalk, by Stephen Stewart, Charge Nurse in Orthopaedics; Margaret Colligan, Nurse Practitioner in ED; David Milne, Clinical Director Radiology and Emma Bowyer‐Warner, Sustainability Manager.  The December/January issue of Nova was published  31 news updates were published on the DHB intranet  Seven eNova (weekly electronic newsletters) were published  CE emails were issued about: o New Board appointments o New Directors appointed in the new structure o Health target results o Christmas message from Chief Executive.  The Chair’s Christmas message was distributed to all staff 2.2.3 Social Media Our social media channels engaged the following numbers of people:  Facebook ‐ 499  Twitter ‐ 421  Linkedin – 1,647 30
Most popular items of content in 2013 were:  Rheumatic Fever – post about the campaign with the Vodafone Warriors  Our People – recognitions, Local Heroes, Healthcare Excellence Awards  Cancer – Allied Health supporting Odd Shoe Day  Education – staff receiving Aniva Whitireia Pacific Nurse Leadership Programme  Facts – did you know facts about sites, services and more  Community – ward Christmas decorating photos, Warriors visit to Starship, Auckland DHB Typhoon Support  Emergency Preparedness – Get Ready Week display at GCC. 2.2 People  45 people were nominated as local heroes during November and December and the local hero awards have been presented to: o Jojo Lafaele, Orderly at Auckland City Hospital. Jojo was nominated for supporting colleagues to become healthier. Jojo made radical changes to his lifestyle and managed to lose more than 80kg. As a result of his own weight loss success, Jojo initiated the Biggest Loser Challenge, inspiring others to lose weight. o Mania Winder, Maori Midwife Specialist. Mahia was nominated for going the extra mile in the care she provides for vulnerable women with complex needs. Mahia regularly visits women and their babies in refuges, sometimes in her own time, to provide advice and care for women who may otherwise face barriers to accessing midwifery care.  New Year’s honours were awarded to two of Auckland DHB staff, Professor Stephen Munn and Professor Cynthia Farquhar. Stephen, who is the Clinical Director of the Intra‐abdominal Organ Transplant Services, was made Officer of the New Zealand Order of Merit (ONZM) for services to health. Cynthia, who is a consultant specialising in fertility and gynaecology, was made Companion of the New Zealand Order of Merit (CNZM) for her services to women’s health.  Dr Catherine Purdy, who until recently worked as an Auckland DHB clinician, has won the 2013 Ray Hader Award for Pastoral Care. The award is given by the Australian and New Zealand College of Anaesthetists to a fellow or trainee who has made a significant contribution to the welfare and wellbeing of their colleagues.  Dr Sarah Biller received the Robin Mitchell medal, for top Emergency Department (ED) trainee in the Auckland region. This award is given in honour of the late Dr Robin Mitchell, former emergency medicine specialist and director of training at Auckland City Hospital.  Arun Kulani and Andrew Wooding lead a team of clinical coders whose performance in the quarter to the end of December has been recorded as outstanding in three of six categories (all others were achieved). This work improves the quality of identity data in the National Health Index and data provided to the National Collection Systems (NCS). 31
3. Performance of the Wider Health System 3.1 National Health Targets Performance Summary Status Acute patient flow (ED 6 hr) Comment Dec 95 %, Target 95% Improved access to elective surgery Shorter waits for radiation therapy & chemotherapy Better help for smokers to quit 99% to plan for the year Dec 100%, Target 100%, Year to Date 100% Dec 96%, Target 95% Cardiac bypass surgery 74 patients on the waitlist which is less than the 100 target More heart & diabetes checks Sep Qtr 80%, Target 80% Increased immunisation 8 months Sep Qtr 94%, Target 90% Key: Proceeding to plan Issues being addressed Target unlikely to be met Commentary Better Help for Smokers to Quit We continue to perform well against all the National Health Targets with the exception of Better Help for Smokers to Quit in primary care. A consolidated DHB figure is not able to be reported this month but will be included in next month’s report. More heart and diabetes checks Preliminary Q2 results are now out and Auckland DHB is second in the country behind Wairarapa who are just 0.2 % ahead on 83.5 %. We are still the number one DHB for both our Māori and Pacific populations on 80.4 % and 85.4 % respectively. 3.2 Financial Performance For December we have recorded a year‐to‐date net deficit of $(0.8) m compared to the budgeted deficit of $(0.5) m. Income for the month was higher than budget by $1.1m, largely driven by higher base revenue. Expenditure for the month was higher than the budget by $(1.1) m. There were significant line variances in personnel, clinical supply and infrastructure cost lines. Each of these was offset by favourable variances in funder payments from the delay in strategic projects. Work is underway to resolve overspending with a full report on savings and mitigation strategies provided in the Hospital Advisory Committee agenda. 3.3 Clinical Governance Indicators The following landscape pages show scorecards for Patient Safety and Better Quality Care Auckland District Health Board Meeting of the 32
Auckland DHB Provider Scorecard For December 2013 Measure % AED patients seen within triage time ‐ triage category 2 (10 minutes) % CED patients seen within triage time ‐ triage category 2 (10 minutes) PR00
6 PR00
8 Patient Safety Reported adverse events causing harm (SAC PR08
1&2) per 1,000 bed days 4 Central line associated bacteraemia rate per 1,000 central line days * PR08
7 Healthcare‐associated Staphylococcus aureus bacteraemia per 1,000 bed days * PR08
8 33
Actual Target Prev. Period 85.6% >= 80% 82.6% 87.1% >= 80% 85.2% 0.18 <= 0.06 0.34 0 <= 1 0 0.38 <= 0.2 0.15 Commentary Target continues to be met by AED processes. On‐going good performance. Stable rate within control limits. Measure under review (may be better as absolute number) and target is inappropriate. There were no CLAB events in November The rate of HA‐STA bacteraemia has increased during November to 0.38/1000 patient days (up from 0.15 in Oct). This corresponds to a total of 10 cases (up from 4 in Oct). 9 out of 10 cases were due to central line related infections. The majority of these occurred outside the ICU setting. Services that appear to be particularly high risk appear due to case mix and other factors include adult renal and surgical services. The IPC service will be supporting these services in reviewing current practices aimed at minimising the risk of these infections. Actual Target Prev. Period Healthcare‐associated bloodstream infections per 1,000 bed days ‐ Adult * PR08
9 1.6 <= 1.6 1.34 Healthcare‐associated bloodstream infections per 1,000 bed days ‐ Child * PR09
0 1.33 <= 2.4 1.47 0.03 <= 0.09 0.15 5.9% <= 6% 6.8% 2.37 <= 4 4.55 74.9% >= 70% 75.1% Measure Falls with major harm per 1,000 bed days Nosocomial pressure injury point prevalence (% of in‐patients) Healthcare‐associated Clostridium difficile infection rate per 10,000 bed days Better Quality Care PR09
5 PR09
7 PR14
3 % Hand Hygiene Compliance * PR14
4 (MOH‐01) % All patients with ED stay < 6 hours % Inpatients on Older Peoples Health waiting list for 4 days or less PR01
7 PR02
3 HT2 Elective discharges cumulative variance PR03
34
95.3% >= 95% 95.3% 95.4% >= 80% 96.7% 0.99 >= 1 1.01 Commentary The rate of healthcare‐associated bloodstream infections in adult patients continues to fluctuate monthly and currently sits on target.(CS) The rate of healthcare‐associated bloodstream infections in paediatric patients remains stable and currently sits below target.(CS) This represents normal monthly variability. The rate for the first six months is currently sitting at 0.075 which is below the target. Target now includes Grade 1 pressure injuries Continues to fluctuate but sitting below target.(CS) ADHB HH compliance has seen an audited 25% increase in compliance rates across all national reporting wards and currently 75% and exceeds the QSM's set by the Commission. Target met Waiting list is under good control currently Discharges are back on track now, slightly Measure from target (ESPI‐2) Patients waiting longer that 5 months for their FSA * 5 PR03
8 (ESPI‐5) Patients given a commitment to PR03
treatment but not treated within 5 months * 9 Cardiac Bypass Surgery Waiting List % Accepted referrals for elective coronary angiography treated within 3 months % Urgent Diagnostic colonoscopy procedures treated < 14 days % Non‐urgent colonoscopy procedures treated < 42 days % Outpatients & community referred MRI completed < 6 weeks % Outpatients & community referred CT completed < 6 weeks Elective day of surgery admission (DOSA) rate PR04
2 PR04
3 PR04
4 PR04
5 PR04
6 PR04
7 PR04
8 35
Actual Target Prev. Period 0.1% 0% 0.1% 0.7% 0% 1% 74 <= 101 40 100% >= 85% 100% 32% >= 50% 59.4% 30.9% >= 50% 32.5% 66.3% >= 75% 72.3% 89% >= 85% 88.3% 61.4% >= 68% 67.2% Commentary ahead of plan. Issues are mostly in Orthopaedics. 26/28 Services are fully compliant or only moderately non‐compliant. Key issues are in Orthopaedics and Paediatric Surgery. 10/14 Services are fully compliant or only moderately non‐
compliant. Wait list remains within target range The service has now been 100% compliant in this measure for over six months Due to Xmas closure, 2 out of 3 patients waited > 14days Additional funding being sought from MoH for colonoscopy initiative Closure of private practise for outsourcing MR over Xmas/New Year period resulted in decrease in % Maintaining result DOSA cases stopped on Dec 20th due to Xmas slowdown, accounting for Measure PR05
% Day Surgery Rate 2 In‐house Elective WIES through theatre ‐ per PR05
day 3 % DNA rate for outpatient appointments ‐ PR05
All Ethnicities 6 % DNA rate for outpatient appointments ‐ PR05
Maori 7 % DNA rate for outpatient appointments ‐ Pacific PR05
8 % Chemotherapy patients (Med Oncology and Haematology) attending FSA within 4 weeks of referral % Radiation oncology patients attending FSA within 4 weeks of referral PR05
9 PR06
4 36
Actual Target Prev. Period 55.6% >= 70% 57.3% 98.3 >= 99 130.73 9.7% <= 9% 8.9% 21.1% <= 9% 16.6% 19.2% <= 9% 17.6% 91.3% 100% 84.6% 96.4% 100% 99.6% Commentary proportional decrease relative to inpatients Day surgery cases stopped on Dec20th due to Xmas slowdown, accounting for proportional decrease relative to inpatients He Kamaka Waiora has been working with Cancer & Blood Services as well as NDSA Cancer Network, with a view to piloting “ring to negotiate Maori FSA’s”. The initiative went on hold due to a resignation, however the GM Cancer & Blood is keen to continue the work, and we are diaried to meet the 1st week of February2014. This rise was expected due to holiday break disruptions i.e., transport disruptions and/or change of location for patient. We expect a fall in this rate in the next month (a pattern observed for the last two years) This report is also capturing patients with non‐malignancies ‐ work is progressing to get this cohort of patients excluded from this report This report continues to capture patients with delay to treatment codes ‐ work continues to refine the report so this cohort Measure % Cancer patients receiving PR07
radiation/chemo therapy treatment within 4 0 weeks of DTT Average LOS for WIES funded discharges (days) PR07
4 PR07
8 Breastfeeding rate on discharge excluding NICU admissions * PR09
9 Mental Health ‐ 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera * Mental Health Average LOS (KPI Discharges) ‐ Te Whetu Tawera % Very good and excellent ratings for overall patient experience for inpatients (from physical health services, adult and paediatric) PR11
9 PR12
0 28 Day Readmission Rate ‐ Total * Number of CBU Outliers ‐ Adult PR15
4 PR17
3 37
Actual Target Prev. Period 100% 100% 100% 3.02 <= 3 2.8 8.9% <= 6% 10.1% 82.2% >= 80% 81.6% 4.1% <= 10% 10.7% 25.8 <= 21 35 87.6% >= 90% 81.9% 357 0 471 Commentary is not captured The service has been compliant with this target for the last 2 years. We continue to modify our processes to enable the current available resources to be able to meet the increasing demands. This is within common cause variation and does not represent a significant deviance from expected ALOS All rates are down this month, but this is probably seasonal fluctuations Breastfeeding rates are stable at >80% for past 3 months. All rates in the last 18 months have been above the Baby Friendly Hospital benchmark of 75% Meeting target Above target but continues to track slowly down month by month November results highest seen yet in this survey, though not yet at target. Work continues to reset hospital with results reflecting summer planning v high Measure Improved Health Status % Patients cared for in a mixed gender room at midday ‐ Adult Mental Health % long‐term clients with relapse prevention plans % Hospitalised smokers offered advice and support to quit PR17
5 PR12
5 PR12
9 Actual Target Prev. Period 15.2% 0% 18.1% >= 95% 95.8% 95.6% >= 95% 95.9% Note: * indicates that the actual value shown is for a prior period, due to no data available for December. Auckland District Health Board Meeting of the Board 19/02/14 38
number of General Medical patients above forecast Marked improvement. Continued daily focus at ward level 97.4% Commentary Meeting target We have exceeded meeting the target for this month and this quarter at 96%. 3. Performance of the Wider Health System (continued) Clinical Governance Commentary Surgical site checklist Surgical Safety Checklist Work on the use and documentation of the Surgical Safety Checklist continues and the result for this quarter (October – December) shows a non‐significant trend toward improved overall compliance (71% vs. 61%) compared with the previous quarter. A working group has been established to review the Surgical Safety Checklist process, culture and forms to identify further opportunities to improve on performance. Mastering adverse outcomes Good evidence supports the practice of early, honest and empathetic disclosure of adverse clinical outcome to patients and families and lowers the possibility of a complaint. These are difficult conversations and not all clinicians are comfortable in leading them. The Clinical Education and Training Unit (CETU), has with the support of the Medical Protection Society, provided 100 places on its highly regarded course on mastering adverse outcomes. The response from Senior Medical Officers has been high and CETU will seek to follow up with more training opportunities this year. The plan is to roll out similar training for staff working in related disciplines. Junior media workforce taskforce A taskforce has been formed to review opportunities for the junior medical workforce. The increasing output from domestic medical schools and diminishing international employment opportunities has led to higher competition for jobs in New Zealand DHBs. The taskforce comprises members from Health Workforce NZ, the Ministry of Health, DHBs, medical schools and the RDA. Taskforce members will meet with stakeholders in Auckland next month. We have representatives from the metro DHBs (CMOs, CEO, CETU, Intern supervisors) and the NRA which recruits, appoints and rosters on our behalf. A well trained, engaged and sustainable RMO workforce delivering the necessary medical specialists (including GPs) for New Zealand is the goal. 3.4 Māori Health Whanau Ora A Whanau Ora policy framework developed nationally and led by Waitemata DHB has been completed and is currently in the process of being endorsed through the national Maori Health forum Tumu Whakaraae. On completion of this process, it will then be shared with Waitemata and Auckland DHB services to confirm relevance at a local level and to determine the response required to implement. Whanau Ora centre developments are progressing well, with the business case for an Auckland DHB based centre nearing completion through the appropriate management and governance processes. Work has begun with Te Puna Hauora ki Raki Pae Whenua on the development of a centre in Northcote and health needs analysis and discussions with local iwi in the northwest of Auckland in the former Rodney district are under way through the locality work. 39
A draft integrated contract has now been completed for each provider and final discussions with the providers will be the focus of the next quarter, with a 1 July 2014 start date. It is expected that they will be a multi‐year contracts. The Maori Health Gain team are leading on behalf of Auckland and Waitemata DHB the Maternal and Child Nutrition and Activity project. While not under the Whānau Ora kaupapa, the development and delivery processes have certainly embraced the Whānau Ora principles. This is a Ministry of Health funded project and has a number of providers across the Maori, Pacific, Asian and South East Asian communities involved and also a number of specialist groups such as maternity services and primary care and NGOs such as Plunket etc. The programme was launched nationally last year by Minister Ryall and the point of difference for the project here in Auckland is the collective approach to this issue supported by an innovative text messaging tool. Maori Health Plan 2014/2015 Work is currently underway in the development of both the Maori Health Plan and the Annual Plans for both DHBs. A number of expectations have been identified and communicated with each of the portfolio and service teams and they include the need to ensure:  Real activity that can be measured against an outcome.  Identification of opportunities to support Whānau Ora Centre developments.  Engagement processes.  Focus on health gain. Primary Care A key component of the new PHO header agreement is the need to ensure that PHOs sign up to the Maori Health Plan. All PHOs are aware of this and the planning cycle will include robust engagement and agreement of strategies to be included in the Māori Health Plan with assigned PHO responsibility. The National Māori targets will be a key focus however there are also a number of local priorities that fall out of these targets and a number of strategies that are being developed i.e. Whanau Ora centres, locality development and self‐directed care activities that will require a collaborative approach to make a difference. The development of a diabetes management target is also underway and this work is being done in collaboration with ProCare who have a programme (including data collection) targeting this area underway. A full report with target recommendations will be presented at the April Manawa Ora meeting. 3.4 Pacific Health Auckland DHB ‐ Waitemata DHB and regional Pacific Health collaboration Provider Arm Service Development: 40
‘Tautai Fakataha’ a Samoan Tongan term which relates to ‘navigate, guide, directing’ Pacific patients and families through the hospital system has been chosen as the name for Pacific support services at a team building exercise. These action words reflect the service provided. The focus of the navigation approach considers patients as active participants in their own care and empowered to improve engagement by addressing the patient’s specific barriers to care and access for the health care provided at Auckland and Waitemata DHBs. The service delivery model of care will be developed and presented to the equivalent team, who refer to themselves as Fanau ola workers in CMDHB in 14 February as part of the regional sharing of knowledge. This model of care will underpin the rationale of the Tautai Fakataha involvement in referral (triage), assessment, intervention (treatment), and outcome (handover/transfer/discharge) of the Pacific patient and family and we envisage better performance measures. It will also be articulated in the quality documentation for ease of transparency to the organisation. Pasifika Week March 3‐6th: A draft programme will be disseminated for this annual event driven by the Pacific steering committee and Pacific champions. The theme of this week is Pacific navigation with workshops and a focus on men’s health issues “Well Pacific blokes” and the re‐launch of the Pacific best Practice training (currently in hiatus). There will also be school performances, community displays and stalls. Pasifika well blokes: In conjunction with Pacific planning and funding team we are leading a project: Suicide Prevention within the Pasifika community with a focus on young Pacific young peoples in HVAZ community. We aim to engage with Ministry of Youth Development, Ministry of Social development services, Auckland council community development and WDHB Tupu services. The aims include upskilling of suicidology for young people at workshops, developing the leadership for suicide prevention amongst Pasifika young people and building upon existing youth leader resilience and leadership. We aim to see greater ability of our Pasifika young people in knowing how to respond safely if a suicide occurs. Pacific Action Plan – feedback: Consultation meetings over the Pacific Action plan with Pacific staff of ADHB and WDHB were held in December 2013. These valuable fono, enlisted Pacific staff to champion the Pacific objectives in their respective areas with representation coming from ARPHS, Lab plus, maternity, orthpaedics, surgical, mental health, and community health (child and womens, and sexual health). Business cases for Hospital Provider will be drafted up ready by March to come from the plan outlining what kind of resources are required to achieve the stated goals. These business cases will focus on: o Sustainability of organisational Pacific responsiveness through the Pacific Best Training practice, o Growing and nurturing Pacific health workforce from schools to job placements in health in ADHB/WDHB catchment area o Project management capacity to lead and develop health gain strategies in the hospitals such as reducing DNA and ASH rates, developing suitable model of care etc. The Pacific Best Practice training evaluation We have developed online survey questions with varying versions created according to each year, another for those who don’t receive a personal email and will respond via e‐nova communications and a version of survey created for attendees of a special 2013 Pacific workshop. The focus groups 41
interviews with Rehab plus and Maternity are underway. The next steps are the key stakeholder interviews which will elicit responses to their level of awareness of the Pacific Best Practice goals, the perceived success factors, suggestions for improvements, the challenges, and comments on future directions. Report due March 2014. Pacific Islands Health Science Academies In November 2013 our three DHBs (Human Resources and Pacific Health) submitted a tender to the Ministry of Health, Sector Capability and Implementation Directorate (SCI), Pacific Health Team. We responded jointly to a proposal to expand Health Science Academies and implement tertiary student mentoring for Pacific students. These initiatives aim to increase the supply of Pacific health workforce. Our joint bid won this competitive process and the outcome was formally notified on 13 January. We met with the Ministry of Health on the 29 January to confirm their expectations and implementation next steps. This is an exciting initiative to increase the supply of Pacific health workforce by joining up our pipeline – secondary Pacific school learners with strong foundations in science and technology subjects, successful retention and completion of tertiary qualifications and increased employment of Pacific people in the health sector. This is an important acknowledgement of the DHB’s leadership role in supporting Pacific health developments on a regional scale. The plan is to develop two to three new high school Health Science Academies for Pacific secondary students in the Auckland region. These are dedicated student cohorts within schools that focus on science, literacy and numeracy academics and exposure to health careers, professionals and environments. As Counties Manukau DHB already contracts two health science academies in South Auckland for Māori and Pacific students, it is anticipated that new academies will be in the West and Central Auckland areas if feasible. The contract also includes mentoring services for Pacific students in tertiary health study courses to increase engagement and success at this level and transition into health careers. A small regional governance group comprising Human Resource and Pacific health teams at each DHB will be established. For further detail about this work please contact Margie Apa, Director, Strategic Development and Executive Sponsor at Counties Manukau DHB (mb 021 727 354, DDI 09 262 9572). Planning & Funding Joint Auckland DHB – Waitemata DHB Pacific Health Action (draft plan) 2013‐2016 has been submitted to Funding Director as a CPHAC consultation paper in up and coming meeting. The Pacific health Gains manager will invite clinical director of Alliance Health Alan Moffitt and Rev Featunai to CPHAC who are currently members of the Pacific action plan working committee and speak for a specific response to the parking charges issue that was dominant in the consultation. Gwen Te Pania Palmer is now chairing CPHAC and is keen to have a Pacific representative on this. This will be represented by either Pacific Health Gains or General Manager. Auckland District Health Board Meeting of the Board 19/02/14 42
7.1 MoH Speech at the Association of Salaried Medical Specialists Annual Conference 43
45
46
47
48
49
50
51
52
8 PRESENTATION Stroke All Ages Progress Update February 2014 53
ADHB STROKE CARE
February 2014
55
1
Stroke Patient Flow – Current State
 Hyper‐acute stroke performs well (13% Thrombolysis vs. 6% target)
 All ages acute stroke unit (Ward 63)
– 79% acute stroke patients admitted to Ward 63 vs. national target of 80%
 Rehabilitation is not co‐located and is inequitable
Stroke Patient Flow
Home
Over 65
From Community
Acute
Level 2
OPH
(Rehab)
Ward 63 (Acute)
Under 65*
Home
Res Care
56
Rehab Plus
(Rehab)
* Occasionally patients over 65 years old are admitted to Rehab Plus (for example if the individual wishes to return to employment) Res Care
Home
Res Care
2
Stroke Patient Flow – Model Under Consideration
One Geographical Location
Level 2
Implement Helsinki principles
Rehab
Acute
Early Supported Discharge
Early Intense MDT
57
3
Acute Stroke Patients by Age on Ward 63
Age of Stroke Patients on Acute Stroke Ward 63
18 Months Data from 1/07/2012 to 31/12/2013 - (Primary Diagnosis I60. to I64.)
65
100
Patients
80
60
40
20
0
10
20
30
40
50
Age
58
60
70
80
90
100
4
Health Round Table Data – January to June 2013
Average Length of Stay by DHB
DHB
Acute
Rehab
Auckland
6.4 (n=330)
26.4 (n=74)
Canterbury
6.6 (n=425)
30.4 (n=94)
Waitemata (NSH)
6.9 (n=214)
24.1 (n=29)
Counties
6.6 (n=334)
26.4 (n=81)
Capital & Coast
5.2 (n=206)
29.7 (n=39)
Waikato
5.9 (n=245)
21.4 (n=63)
Source: Asklepios‐StrokeKPIs‐JanJun2013v1e‐HRT‐v1a (5).pdf
59
5
While this looks simple, there are several considerations
 Location of unit
 Rehab Plus viability without stroke patients
– Rehab Plus currently…
• Provides very high quality care
• Is profitable
– 33% of Rehab Plus patients are Stroke
– If becomes unviable, how do we maintain quality care for our remaining patients?
 Capacity of community based services required for early supported discharge  Clinical leadership in Older Peoples Health
60
6
High Level Plan
 Aug 2013: Stroke review report circulated  Oct 2013: Implication assessment of recommendations completed
 Nov 2013: Key stakeholders identified
 Dec 2013: Multidisciplinary leadership governance team formed across all services providing acute stroke and rehabilitation (led by Barry Snow) – future state proposed
 Feb/Mar 2013: Key Stakeholders 1:1s with Barry Snow and Sue Waters  Apr 2013: Go‐see Waikato stroke unit
 May 2013: Evaluate site options at ADHB
61
7
APPENDIX
62
8
ADHB Data for Primary Diagnosis I60.. To I64..
Rehab Location
NULL – No Inpatient Rehab
Number of Patients
Acute ALOS
Rehab ALOS
673
5.01
A Plus Links
171
8.27
27.04
Rehab Plus
55
10.95
32.04
899
6.00
27.90
Grand Average
18 Months of Data from 1/7/2012 to 31/12/2013
63
N/A
9
Rehab Length of Stay by Service
Lenght of Stay of Stroke Rehab by Service
Length of Stay of Stroke Rehab by Service
18 M onths Data from 1/07/2012 to 31/12/2013
A P lus Links
30
100
20
80
60
0
Rehab P lus
30
Days
Fr equency
10
40
32.0364
20
27.0409
20
10
0
0
0
15
30
45
60
Days
75
90
A P lus Links
Rehab P lus
Str oke Rehab Ser vice
64
10
Health Round Table ALOS Acute Care
65
11
Health Round Table ALOS Rehabilitation
66
12
Stroke Patients (excludes community rehab)
Source: 7422 ‐ Stroke Patient Bed Utilisation Data.xlsx 67
13
Stroke Patients (excludes community rehab)
Source: 7422 ‐ Stroke Patient Bed Utilisation Data.xlsx 68
14
Rehab Plus Discharges by Primary Diagnosis
 312 discharges in 2012/13
– 103 of 312 (33%) had stroke as a primary diagnosis
– 58 of the 103 stroke patients were from Waitemata
2012/13 Rehab Plus Discharges by Diagnosis Category
Diag2Group
Total Patients ALOS
# of Stroke Pts ALOS
Diseases of the circulatory system
122
27.8
103
28.7
Injury, poisoning and certain other consequences of external causes
73
23.9
Diseases of the nervous system
39
23.5
Diseases of the musculoskeletal system & connective tissue
17
24.4
Endocrine, nutritional and metabolic diseases
15
27.9
Neoplasms
12
16.2
Diseases of the digestive system
10
26.0
Symptoms, signs and abnormal clinical and laboratory findings, NEC
7
28.1
Certain infectious and parasitic diseases
4
20.3
Factors influencing health status and contact with health services
4
9.9
Diseases of the respiratory system
3
19.6
Diseases of the genitourinary system
2
22.7
Diseases of the skin and subcutaneous tissue
2
4.1
Diseases of the blood and blood‐forming organs and certain disorders involving the immune mechanism
1
57.6
Mental and behavioural disorders
1
18.0
Total
312
25.2
697862.4 total bed days
2956.1 stroke bed days
23 beds @ 100%
8.5 beds @ 100%
15
Rehab Plus LOS & Discharges (All Patients incl Non‐Stroke)
70
16
9 LIFT THE HEALTH OF PEOPLE IN AUCKLAND CITY 9.1 CPHAC Committee Recommendations ‐ Nil 9.2 Maori Health Gain Advisory Committee Recommendations
71
9.1 CPHAC Recommendations ‐ Nil 73
9.2 Maori Health Gain Advisory Committee ZĞĐŽŵŵĞŶĚĂƚŝŽŶƐ 75
Maori Health Plan 2014/2015 Recommendation That the Board: 1. Note the planning approach outlined in the Maori Health Plan 2014/2015 2. Note the recommendation as endorsed by the Maori Health Gain Advisory Committee; That the delegation for sign off on draft and final draft Maori Health Plan 2014/2015 be given to Chief Executive Officer – Lead Maori, Dr Dale Bramley, with copies to be distributed to Manawa Ora and Boards for their information. Prepared by: Marlene Skelton (Corporate Business Manager) 1. Background The attached report was considered by the Maori Health Gain advisory Committee at its meeting held on 29 January 2014. This report is submitted for the information of Board Members. 77
Māori Health Plan 2014/15 Recommendations That the Board Approve: 1.
2.
the planning approach outlined below for the Māori Health Plan 2014/15 the delegation for sign off on draft and final draft Māori Health Plan 2014/15 to Chief Executive Officer ‐ Lead Maori, Dr Dale Bramley for approval, with copies distributed to Manawa ora and Boards for information to follow. Prepared by: Marty Rogers (Māori Health Gain Manager, Māori Health Gain Team, Planning and Funding, ADHB/WDHB) Endorsed by: Simon Bowen (Director Health Outcomes) and Debbie Holdsworth (Director Funding) Glossary ADHB ANZACS QI CVD DHB Kia Ora Hauora Manawa Ora MoU PHO Te Tiriti o Waitangi TPK WDHB 1.
Auckland District Health Board All New Zealand Acute Coronary Syndrome Quality Improvement Cardiovascular Disease District Health Board Māori health workforce development programme Māori Health Gain Advisory Committee Memorandum of Understanding Primary Healthcare Organisation The Treaty of Waitangi Te Puni Kōkiri (Ministry of Māori Development) Waitemata District Health Board Executive Summary The Māori Health Gain Team will facilitate the development of the Māori Health Plan 2014/15 for both Auckland and Waitemata DHBs. Please note that for the purpose of this paper we refer to a single Māori health plan for 2014/15. Legislative and policy stipulations require two separate plans for each respective DHB to be submitted. While there will be two separate plans to accompany the respective DHB Annual Plans, the Māori Health Gain Team will endeavour to ensure the layout and the content is the same. Effectively we will be writing a single plan, with local variances noted where appropriate. The purpose of this paper is twofold, firstly to seek endorsement of the proposed approach to developing the Māori health plan and to advise the Board of significant changes to the requirements of the Māori health plan in 2014/15 and secondly approval for delegated sign off of the plans to Lead CEO Māori, Dr Dale Bramley. 79
2.
Background and Changes for 2014/15 Māori health plans for 2014/15 are due to the National Health Board on the 14th of March (1st draft) and final draft on the 26th of May 2014. The Māori Health Plan is a document by which the DHBs’ commitment to achieving Māori health gains and reducing health inequalities can be assessed, measured and monitored by governance committees, the public and providers alike. District Health Boards have been required to submit annual standalone Māori health plans to the Ministry of Health in conjunction with the annual planning processes, for the last five years. The Māori health plan requirements are set out in the Operational Policy Framework with an accompanying template (appendix one). The Māori Health Plan is required to include the following three components: a health status section, a section on national (mandatory) priorities and a section on local priorities, in which up to three priorities can be included. Features of the national indicators required for plans include the following: ‐
the most recent baseline performance result for the indicator (by ethnicity) ‐
a target that will be achieved within the twelve‐month term of the plan clearly stated activities by the DHBs and PHOs which are specific, time‐bound, and evidence‐
‐
based and are therefore most likely to increase the baseline rate towards the target ‐
explicit statements about monitoring processes which will be undertaken throughout the year such as quarterly review of performance data. The major change to be introduced to the plan requirements for 2014/15 is that PHOs are now required to contribute and outline activity and monitoring mechanisms to help achieve associated targets. Minor changes to the Māori health plan template for 2014/15 include the introduction of two new priority areas and associated indicators, preschool enrolment in oral health services and a rate reduction in the Mental Health Act: section 29 community treatment order indefinites comparing Māori rates with other. 3.
Approach The Treaty approach outlined will be utilised within the plan as in previous years. 3.1 Framework The proposed framework features four domains aligned to the articles of Te Tiriti o Waitangi, each of which are important for achieving the overall goal of Māori health gain and eliminating disparity between Māori and non‐Māori. Article 1 – Kawanatanga (governance) is equated to health systems performance. That is, measures that provide some gauge of the DHBs’ provision of structures and systems that are necessary to facilitate Māori health gain and reduce inequities. It provides for active partnerships with iwi at a governance and operational level. Article 2 – Tino Rangatiratanga (self‐determination) is in this context concerned with opportunities for Māori leadership, engagement, and participation in relation to DHB activities. 80
Article 3 – Oritetanga (equity) is concerned with achieving health equity, and therefore with priorities that can be directly linked to reducing systematic inequities in determinants of health, health outcomes and health service utilisation. Article 4 – Te Ritenga (right to beliefs and values) guarantees Māori the right to practice their own spiritual beliefs, rites and tikanga in any context they wish to do so. Therefore, the DHBs have a Tiriti obligation to honour the beliefs, values and aspirations of Māori patients, staff and communities across all activities. 3.2 Engagement Engagement with both internal and external stakeholders, throughout the development of the Māori Health Plan 2014/15 is crucial. Our approach will be to engage openly with our MoU partners, Māori health providers and Māori across the two districts. A workshop in January will be the first of two for providers to meet with the Māori Health Gain Team and to review work undertaken by the DHBs in past plans, and provide input into future activity. A further workshop and subsequent review points has been included in the process timeline (Appendix Two). Internal engagement will occur with planning and funding portfolio managers (e.g. primary care, long term conditions and mental health) and clinical leaders. Engagement with these internal stakeholders will occur in tandem with annual planning activity where Māori Health Gain Team members will be providing advice on priorities in that plan. Appendix One gives an example of the range of government priorities for both the annual plans and the Māori Health Plan. Similar to previous years, the DHBs will ensure that all activity that is presented in the Māori Health Plan 2014/15 is congruent with the annual plans. Primary care are recognised as having a key role in delivery of the plan and being a significant contributor to improved health outcomes for Māori. Thus, we will be closely working with PHOs on both the content of the plan and the contribution primary care will make in achieving the outcomes. Given the new requirements for PHOs, additional fora with PHO leaders and stakeholders will be convened to develop and agree on associated activity and monitoring arrangements. 3.3 Setting objectives and measures A number of priorities are prescribed by the Ministry of Health (Appendix One). DHBs however are given an opportunity to develop local priorities for their own communities and providers. Engagement with the range of stakeholders mentioned in the previous section and a review of health data will provide a list of priorities that can be assessed against the following criteria: ‐
Consistency with Auckland and Waitemata DHB strategic priorities (including national priorities) ‐
Consistency with local Māori health aspirations ‐
Alignment with national and regional indicators ‐
Extent of ethnic inequality ‐
Disease burden ‐
Extent to which health issue is responsive to feasible intervention by the DHB ‐
Data quality ‐
Allocative efficiency and value for money. 81
Once priorities have been ranked and scored, proposed activity will be developed in close consultation with the relevant portfolio managers, clinical leaders and providers. This exercise will determine the list of actions and measures to achieve the local target/priority in twelve months. 4.
Authorities/Sign‐offs The plan will receive sign off from MoU partners, PHOs and Dr Debbie Holdsworth, Director of Funding and Simon Bowen Director of Outcomes. It is requested that final approval for the Māori Health Plans be delegated to the Chief Executive Officer ‐ Lead Māori, as the timelines for feedback and submission to the National Health Board are not well aligned with the Manawa Ora meeting schedule (NHB feedback due to DHBs on the 28th April, with final due 26th May). As feedback will be received on the 28th of April, this allows only three days to agree on amendments with key contributors and stakeholders prior to the deadline for submission of May Board papers (longer may be required to work with PHOs and other stakeholders). An update will be provided to the April Manawa Ora meeting and final plans distributed to Manawa Ora committee members for information in the July Māori Board papers. Please see additional sign off points in Appendix Two. 5.
Appendices Appendix One Targets Below is a list of priority areas that will need to be mapped against the framework. Offered below are compulsory priority areas required in the Māori health plans. National Māori health priority areas (compulsory for the Māori health plan) Health Issue Indicator(s)Target Data Quality Accuracy of ethnicity reporting in PHO registers as measured by Primary Care Ethnicity Data Audit Toolkit DHBs who are implementing the Primary Care Ethnicity Data Audit Toolkit can submit their data form this initiative otherwise DHBs can use the Percentage of Māori enrolled in PHOs which acts as a proxy for reporting on the Ethnicity Data Audit Toolkit. DHBs should also comment on how they are improving the quality of their ethnicity data. (by ethnicity) Access to care 1. Percentage of Māori enrolled in PHOs 2. Ambulatory Sensitive Hospitalisations rates per 100,000 for the 0‐74, 0‐4, and 45‐64 age groups The target setting process is listed with DHB Planning Package information. 82
Health Issue Indicator(s)Target (by ethnicity) Child health Exclusive breastfeeding at 6 weeks, 3 months, and 6 months (by ethnicity) Cardiovascular disease 1. Percentage of the eligible population who have had their CVD risk assessed within the past five years (ht) 2. 70 percent of high‐risk patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’) 3. 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 Cancer Smoking Immunisation Rheumatic Fever 1. Breast Screening 70% of eligible women will have a BSA mammogram every two years. 2. 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) 1. Hospitalised smokers provided with advice and help to quit (ht) 2. Current smokers enrolled in a PHO and provided with advice and help to quit (ht) (by ethnicity) 1. Percentage of infants fully immunised by eight months of age (ht) 2. Seasonal influenza immunisation rates in the eligible population (65 years and over) (by ethnicity) 2013/2014 rheumatic fever target ‐ number and rate reductions, 10% below 3‐year average (by ethnicity) Oral Health Preschool Enrolments (by ethnicity) Mental Health 1
1. Mental Health Act: section 29 community treatment order indefinites comparing Māori rates with other. 1 reporting to the Office of the Directors of Mental Health 83
Appendix Two Major Milestones Dates Māori provider briefing 14 November Confirmation of requirements/questions He Kete Hauora 20 December Waitemata Annual Plan Meeting 16 January Auckland Annual Plan Meeting 21 January Māori Provider Meeting 23 January Māori Health Plan approach to Manawa Ora 29 January PHO Fora (10‐14) Feb TBC Draft content due 21 February Draft to SMT (D/L 01 March) 6 March MoU Comment/input (D/L for comment 01 March) 6 March MHP Draft to National Health Board 14 March MHP to Manawa Ora 23 April MHP Feedback to DHBs 28 April PHO Fora 01 May (TBC) MoU Liaison 01 May (TBC) MHP To Auckland DHB Board (D/L 01/05) 14 May MHP To Waitemata DHB Board (D/L 09/05) 21/05 FINAL MHP DUE TO NHB 26 May 84
Appendix Three Proposed Selection Criteria for Local Māori Health Priorities Appendix A This appendix outlines the proposed process to set the local indicator set. The process draws on the Waitemata DHB Ethnic Inequality Framework (Hosking 2009), work of the Bay of Plenty District Health Board 2011 (Bay of Plenty DHB) which has been a pilot site for Māori Health Plan development, and the methodology used by the Taranaki District Health Board 2011 (Taranaki DHB). Conceptual framework A conceptual framework that is specifically concerned with ethnic inequalities in health and is of high relevance to Māori within the Waitemata DHB region was identified that would make explicit the logic for indicator selection and/or actions relevant to selected indicators. That ‘Pathways to Inequalities’ framework (Reid and Robson 2007, based on Jones 2001) identifies three main pathways that contribute to ethnic inequalities in health. Those pathways are: ‐
differential access to the determinants of health or exposures leading to differences in disease incidence ‐
differential in access to health care; and ‐
differences in the quality of care received. The simplified diagram below, adapted from the Waitemata DHB CVD Framework, shows the relationship between causal pathways for illness and health services. Source: Hosking 2009. Search strategy for identifying potential indicators The main strategies for identifying potential indicators were: ‐
to review Māori community priorities identified through formal consultation over the last few years (including engagement with Treaty partners Tihi Ora MaPO and MoU partner Te Whānau o Waipareira Trust) ‐
to investigate the relevance of Ministry identified potential local priority areas ‐
appraisal process for potential indicators ‐
the appraisal process gave consideration to the following seven factors in setting local indicators for the MHP. 85
1. Consistency with Waitemata DHB strategic priorities 2. Consistency with local Māori health aspirations 3. Complementary to national and regional indicators 4. Extent of ethnic inequality 5. Disease burden 6. Extent to which health issue is responsive to feasible intervention by the DHB 7. Data quality. Each of these factors is briefly elaborated below. 1. Consistency with Auckland and Waitemata DHB strategic priorities Auckland and Waitemata DHB priority areas have been identified through a four phase process that drew on the DHB Māori Health Needs Assessment (the HNA is informed by district population characteristics including demography, socio‐economic determinants, health status and demand for health services), and involved analysis by an internal DHB group, alignment with key policies and plans, and engagement with Treaty Partners. The following list of priorities was identified; cancer, respiratory conditions, diabetes, CVD, access, mental health, oral health, inter and/or intra sectoral collaboration, quality, Healthy Eating Health Action, disability, youth, child, whānau ora, and, workforce development. 2. Consistency with local Māori health aspirations Selected indicators should be consistent with the preferences of local Māori as identified by consultation carried out by the Auckland and Waitemata DHB in the last few years. The three priority areas identified through local Māori community consultation, as identified in Appendix B of Te Tirohanga are – access to services, health promotion to facilitate healthy lifestyles, and chronic disease management. 3. Complements national and regional indicators The local indicators should be complementary to the national and regional indicators identified in the Plan. For example, ‘Exclusive breastfeeding at 6 months’ is identified as a national level indicator of maternal health. Consistency with these criteria would therefore exclude other breastfeeding rate indicators as potential local level Māori health indicators. 4. Extent of ethnic inequality Rate ratios are used to provide evidence that an ethnic inequality exists and to gauge the extent of ethnic inequality between Māori and non‐Māori. 5. Disease burden Rate ratios in isolation do not give a reliable indication of the extent of the problem. For example, there may be wide ethnic inequalities with regard to a given health issue but the crude numbers may be small and the severity low (e.g. low fatality). Therefore, disease burden (Māori morbidity and/or mortality) should also be considered. 6. Extent to which health issue is responsive to feasible intervention by the DHB Indicators should be developed in areas where health issues are responsive to intervention by the DHB, that is, where local health sector provider activities are able to make a measurable difference 86
to the health of Māori. Consideration was also given to feasibility of intervention within the 12 month period. 7. Data quality Quality data are suitable and sufficient for the purpose for which they are collected. High quality data needs to possess a number of scientific, statistical and methodological attributes. SMART criteria may be applied. The SMART acronym refers to the following mix of criteria – specific (measurement appropriately captures the level of detail required), measurable (measurement process is possible within available resources), accurate (indicator correctly measures the phenomenon it purports to measure), reliable (replicable measurements) and timely (data are up‐to‐
date). 87
10 LIVE WITHIN OUR MEANS 10.1 Finance Report 10.2 Authorised Banking Signatories 89
10.1 Finance Report 91
Financial performance Report Recommendation That the Board receive this Financial Report for December 2013 Prepared by: Rosalie Percival, Chief Financial Office 1. Executive Summary The planned 2013/14 financial result for Auckland DHB is a surplus of $100k to be generated by a small deficit in the Provider arm and breakeven results in Funder and Governance arms. Revenue is budgeted as it is received, this is largely equal payments of one twelfth of the full year funding while expenditure varies depending on seasonality, days in the month, public holidays and annual leave. For the month of December, the DHB consolidated result was similar to budget, with a surplus of $1.5m achieved against a budgeted surplus of $1.5m. For the year to date (YTD), the consolidated DHB result is $398k favourable to budget, with the Governance and Funder arms generating a $0.6m surplus ($7.4m better than budget) and the provider arm generating a $1.1m deficit ($7.0m worse than budget). The previously reported 2012/13 year end result has not changed from a surplus of $154k and at this point in time there are no known changes that would result in this needing to be amended. Auckland District Health Board Summary Results Month of December 2013 $000s
Actual
Income
MOH & IDF Sourced - Base
MoH Sourced (Other Contracts - Incl CTA)
Other Income
Trust & Donation Income
Financial Income
Month
Budget
Variance
Actual
YTD
Budget
Variance
145,309
10,170
10,965
5
610
167,058
144,682
11,037
9,498
95
667
165,979
627 F
867 U
1,467 F
90 U
57 U
1,079 F
871,452
67,103
62,225
319
5,773
1,006,873
868,093
66,868
56,728
613
4,003
996,305
3,359 F
235 F
5,498 F
293 U
1,770 F
10,568 F
66,841
1,588
1,841
3,080
19,115
56,980
11,631
1,395
3,103
165,573
65,593
1,626
1,978
2,860
17,727
59,123
11,123
1,380
3,099
164,508
1,248 U
37 F
138 F
219 U
1,388 U
2,142 F
508 U
15 U
4U
1,065 U
398,107
11,050
12,661
18,342
118,706
351,775
69,859
8,299
18,617
1,007,416
391,935
9,689
12,079
17,161
115,323
357,115
67,073
8, 280
18, 591
997,247
6,171 U
1,361 U
582 U
1,181 U
3,383 U
5,340 F
2,785 U
20 U
26 U
10,170 U
1,485
1,471
15 F
(543)
(942)
Expenditure
Personnel
Outsourced Personnel
Outsourced Clinical Services
Health Alliance
Clinical Supplies
Funder Payments - NGOs & IDF Outflow s
Infrastructure & Non-Clinical Supplies
Finance Costs
Capital Charge
Total Operating Expenditure
Net Surplus / (Deficit)
93
398 F 2. Result by Arm Results by Division
Funder
Provider
Governance
Net Surplus / (Deficit)
8,076
(6,544)
(47)
1,485
5,789
(4,310)
(8)
1,472
2,287 F
2,234 U
39 U
15 F
1,078
(1,111)
(510)
(543)
(6,859)
5,910
7
(942)
7,937 F
7,021 U
517 U
398 F The provider arm had a deficit for the month of $(6.5)m offset by Funder and governance arm deficits totalling $8.0m. There has been considerable focus on the provider arm to recover the negative performance to budget for the half of the year and this will continue. Work is also underway to prepare for the 2014/15 budget round and further savings and efficiencies are expected to be required in 2014/15. 3. Financial Commentary for December 2013 Financial Performance
Month
The result for the month is driven by higher revenue and higher operational costs. The month’s revenue was higher than the budget by $1.1m. This was the result of a)
Favourable Base & IDF revenue $0.6m mainly for Mental Health b)
Lower than expected MOH Sourced Side Contracts $(0.8)m for training and other contracts c)
Higher Other Revenue $1.5m following higher Non‐residents and cost recoveries from other DHB’s The month’s expenditure was higher than the budget by $(1.1)m. This was the result of: a)
Unfavourable variance in Personnel Costs of $(1.2)m due to higher Medical Costs $(1.0)m driven by RMO over appointments and savings assumptions not being met; higher Nursing Costs $(0.4)m due to average cost per FTE assumptions not being met. b)
Unfavourable variance in Outsourced Costs $(0.04)m are driven by higher Health Alliance outsourcing costs $(0.2)m. c)
Unfavourable Clinical Supply costs $(1.4)m. The overspend in clinical supplies this month was in a number of categories, most notably Pharmaceuticals $(0.8)m for PCT costs and savings not achieved, but also Treatment Disposables $(0.3)m and Diagnostic Supplies $(0.3)m. d)
Unfavourable variance in Infrastructure Costs $(0.5)m driven consulting fees for strategic improvement projects $(0.1)m, the Process Improvement Team $(0.1)m and NRA Project costs $(0.2)m. e)
Favourable Funder Payments $2.1m driven by delays in commencement of Strategic Programmes and a lower need for a Funder risk pool. 94
Year to date
The year to date revenue was higher than the budget by $10.6m. This was the result of a)
Favourable Base & IDF Revenue $3.3m due to devolvement of Primary Mental Health; Aged Nursing Care & Dementia Care, Late Effect Treatment, and Eating Disorders b)
Favourable MoH Other Contracts $0.2m driven by Clinical Training Contracts. c)
Higher Research Grants $2.5m. Note that costs of this research are spread throughout the overspend categories year to date in the provider arm. d)
Non‐resident revenue $0.7m e)
Gains on derivative financial investment $1.8m The year to date expenditure was higher than the budget by $(10.2)m. This was the result of: a)
b)
Unfavourable variance in Personnel Costs of $(6.2)m due to higher Medical Costs $(3.8)m driven by RMO over appointments and savings assumptions not being met and higher Nursing Costs $(2.8)m due to average cost per FTE assumptions not being met. Outsourced Services overall $(3.1)m unfavourable – LabPlus delay in planned repatriation of send away tests $(0.6)m (workout programme now underway), Radiology CT/MRI $(0.4)m (timing ‐ expected to meet budget for the year), hA IT costs $(1.2)m savings target not achieved, Outsourced Medical Personnel costs $(1.0)m – for costs of locums and cover. c)
Clinical Supplies costs $(3.3)m unfavourable – driven largely by higher than planned usage of Pharmaceuticals $(2.4)m particularly cancer drugs $(0.8)m with the balance being Savings not achieved. f)
Favourable variance in Funder payments $5.3m driven by lower payments for PHO’s $1.8m and Disability Support Contracts $0.8m driven by delayed payments due to renegotiation of the contract and delays in commencement of Strategic Programmes and a lower need for a Funder risk pool. d)
Unfavourable variance in Infrastructure Costs $(2.8)m driven consulting fees for strategic improvement projects $(0.8)m and the Process Improvement Team $(0.7)m as well as Cost of sales for additional Retail Revenue $(0.7)m. 95
4. Performance Graphs by Month & YTD Net Results 8
6
$ Millions
4
2
0
‐2
‐4
‐6
Jul
Aug
Sep
Net Results for 11/12 Act
Oct
Nov
Dec
Net Results for 12/13 Act
Jan
Feb
Mar
Apr
Net Results for 13/14 Bud
May
Jun
Net Results for 13/14 Act
Cumulative Net Results
4
2
$ Millions
0
‐2
‐4
‐6
‐8
‐10
Jul
Aug
Sep
Oct
Nov
Dec
Cumulative Net Results for 11/12 Act
Cumulative Net Results for 11/12 Act
Jan
Feb
Mar
Apr
May
Jun
Cumulative Net Results for 13/14 Bud
Cumulative Net Results for 12/13 Act
96
5. Efficiencies, process improvements and changes in service delivery models The budget includes a total of $74.4m of initiatives of this type. Year to date overall the DHB is close to the planned year to date budget for these items which is $31.4m for the half year. Further detail regarding forecasts and mitigations is provided in the HAC reporting. 6. Financial Position Statement of Financial Position
as at 31 December 2013
$'000
Public Equity
Reserves
Revaluation Reserve
Accumulated Deficit from Prior Year's
Current Year's Surplus/(Deficit)
Total Equity
Actual
Budget
Variance
Actual
Var from
Actual
Dec-13
Dec-13
from Bud
Nov-13
Prev Mth
Jun-13
576,798
576,248
368,020
370,584
(464,666) (464,520)
(542)
(942)
(97,188)
(94,878)
479,610
481,370
550F
576,798
2,564U 368,020
146U (464,666)
400F
(2,028)
2,310U
(98,674)
1,760U 478,124
0F
576,798
0F 369,430
0F (464,821)
1,486F
154
1,486F
(95,236)
1,486F 481,562
Non Current Assets
Fixed Assets
Derivative Financial Instruments
Investments
- Health Alliance
- HBL
- Other Investments
- Trust Funds
Total Non Current Assets
867,733
2,909
885,633
-
17,900U
2,909F
869,377
2,909
1,644U
0F
873,698
1,759
24,769
9,959
247
8,288
913,905
35,841
9,483
245
4,855
936,057
11,072U
476F
2F
3,433F
22,152U
24,769
9,959
247
8,274
915,534
0F
0F
0F
14F
1,630U
24,769
8,297
247
6,686
915,457
Current Assets
Cash & Short Term Deposits
Trust Deposits
Trade & Other Receivables
Inventory
Total Current Assets
81,285
18,955
54,106
13,211
167,558
49,816
21,910
65,073
13,865
150,664
31,469F
2,955U
10,967U
654U
16,894F
96,028
18,300
48,548
13,041
175,916
14,744U
656F
5,558F
171F
8,359U
81,619
20,499
55,533
12,884
170,535
Current Liabilities
Interest Bearing Loans & Borrowings
Trade & Other Payables
Employee Benefits
Funds Held in Trust
Total Current Liabilities
(62,774)
(61,345)
(130,319) (131,907)
(139,705) (144,807)
(1,157)
(1,130)
(333,954) (339,189)
Working Capital
(166,396)
Non Current Liabilities
Interest Bearing Loans & Borrowings
Employee Benefits
Total Non Current Liabilities
Net Assets
1,429U
(63,689)
1,588F (127,546)
5,102F (153,073)
27U
(1,154)
5,235F (345,462)
915F
(1,069)
2,773U (134,619)
13,368F (149,213)
2U
(1,146)
11,508F (286,047)
(188,525)
22,129F (169,546)
3,149F (115,512)
(244,413) (244,225)
(23,486)
(21,937)
(267,898) (266,162)
188U (244,398)
1,549U
(23,466)
1,736U (267,864)
15U (294,325)
19U
(23,369)
34U (317,694)
479,610
481,370
Statement of Cashflows 97
1,760U
478,124
1,486F
482,250
Month and Year to Date 31 December 2013
Actual
Operations
Cash Received
Payments
Personnel
Suppliers
Interest paid
Capital Charge
Funder payments
GST
Net Operating Cashflows
Year to
Date
Budget
Month
$000's
Budget
Variance
Actual
Variance
166,117
2,104U
1,005,331
996,332
8,999F
(74,364) (66,096)
(25,048) (31,483)
(2,281)
(1,362)
(18,617) (18,714)
(56,980) (59,927)
824
0
(176,466) (177,582)
8,268U
6,435F
919U
97F
2,947F
824F
1,116F
(407,123)
(205,255)
(8,118)
(18,617)
(351,775)
(287)
(991,175)
(394,903)
(197,807)
(8,172)
(18,589)
(361,942)
0
(981,413)
12,220U
7,448U
54F
28U
10,167F
287U
9,762U
164,013
(12,453)
(11,465)
988U
14,156
14,919
763U
582
667
85U
3,440
4,002
562U
Capital
Sale of Assets
Purchase Fixed Assets
Investment in HA & HBL
0
(1,732)
(475)
0
(4,610)
(1,924)
0F
2,878F
1, 449F
0
(15,726)
(2,137)
0
(27,660)
(10,829)
0F
11,934F
8,692F
Net Investing Cashflows
(1,625)
(5,867)
4,242F
(14,423)
(34,487)
20,064F
Financing
Equity Injections
New Loans
Loans Repaid
Equity Repayment
Loans Repaid
0
0
0
0
0
(0)
(9)
0
0
0
0F
9F
0F
0F
0F
0
(9)
0
0
0
(1)
(58)
0
0
0
1F
49F
0F
0F
0F
Net Financing Cashflows
0
(9)
9F
(9)
(59)
50F
Total Net Cashflows
(14,078)
(17,341)
3,263F
(276)
(19,627)
19,351F
Opening Cash
Total Net Cashflows
Closing Cash
122,606
(14,078)
108,528
93,923
(17,341)
76,582
28,683F
3,263F
31,946F
108,804
(276)
108,528
96,209
(19,627)
76,582
12,595F
19,351F
31,946F
964
80, 320
81,284
27,243
108,527
41
49,756
49,797
26,785
76,582
Investing
Income
Cash & Short Term Deposits
HBL Sweep Deposit
ADHB Cash
A+ Trust Deposits - Short & Long Term
Total Cash & Deposits
Commentary on Financial Position 98
923F
30,564F
31,487F
458F
31,945F 




Lower Fixed Assets are driven by a slower than anticipated Capital expenditure programme $20.0m Lower Debtors due to timing differences in Debtors and Accrued Receipts Lower Trade & Other Payables driven by the timing of creditor payments. Lower Employee Benefits are driven by the timing of salary payments and higher levels of annual leave accrued. The facilities with Ministry of Health (MoH), formally with the Crown Health Financing Agency, are fully drawn. The weighted average on MoH borrowing is 5.3%. Auckland District Health Board Board Meeting – 19 February 2014 99
10.2 Authorised Banking Signatories 101
Auckland District Health Board Authorised Banking Signatories Recommendation: That the Board: a) Approves staff positions and Board Member positions included in Schedules 1, 2 and 3 as Auckland DHB Authorised Signatories for banking arrangements in place for the DHB; b) Note that this approval means that any new staff employed at ADHB or healthAlliance to these positions (following any staff changes) or new Board members appointed to these positions, automatically have Auckland DHB Board authority to act as Auckland DHB Authorised Banking Signatories as provided in Schedules 1, 2 and 3; and c) Approve that the Board Chair and Chair of the Audit and Finance Committee sign the attached Schedules 1, 2 and 3 on behalf of the Board and that they be delegated authority to approve any amendments to these Authorised Signatories’ Schedules in future. Reporting on any such future approvals will be provided to the Board via the Audit and Finance Committee. Prepared by Endorsed by Date : Auxilia Nyangoni, Deputy Chief Financial Officer : Rosalie Percival, Chief Financial Officer : 10 February 2014 1. Purpose This paper seeks Board approval for updated authorised signatories for Auckland DHB (ADHB) banking arrangements currently in place with the following:  National Health Board (NHB) (i.e. ex‐Crown Health Financing Agency). ADHB has a loan portfolio of $254.5M with the NHB made up of various loan facilities maturing over a period of up to ten years;  Shared Commercial Banking Arrangements for DHBs with Health Benefits Limited (HBL) and Westpac. ADHB is party to the DHB sector shared commercial banking arrangements now in place. Westpac provides transactional banking and HBL provides treasury services for the DHB cash sweep arrangements including cash investments; and  Private Sector Banking arrangements. ADHB private sector banking arrangements in place include transactional banking with Westpac (per shared commercial banking arrangements noted above), $50M private sector bonds maturing in September 2015 and interest rate hedging arrangements in the form of Bond Forward Rate Agreements with Westpac. ADHB’s charitable trust (A+ Trust) also has banking arrangements with Westpac and ASB and authorised signatories for these were last updated and approved by the Trust Board in November 2013. These are not included in this request. Authorised signatories for ADHB need to be updated to reflect staff and Board member changes that have occurred, as well as to align ADHB with arrangements adopted by other regional DHBs that allow hA to undertake some activities on behalf of DHBs in relation to HBL shared banking arrangements. Ministerial approval granted to this effect is attached to this report. Once all specimen signatures are obtained, these will be forwarded to the relevant institutions to replace all previously authorised personnel. Board approval is required for any changes in banking signatories. To facilitate timely updates of authorised signatories following any staff/Board member changes, we recommend that the Board approve nominated staff positions and Board member positions as authorised signatories as opposed to staff names only. In the event of any position being disestablished in a restructure, we recommend that the nearest applicable role be nominated. We also recommend that the Board delegate authority to the Board Chair and Chair of the Audit & Finance Committee to approve any future amendments to the Schedules to update for staff or Board member changes or replacement of restructured positions with applicable new roles. Any such changes in authorised signatories will be reported to the Board via the Audit & Finance Committee in retrospect or in advance depending on the timing of these changes. 103
Schedule 1 Auckland DHB (ADHB) Authorised Signatories for Private Sector Banking Arrangements including Bonds The ADHB Board approves the following staff positions as authorised banking signatories effective immediately. This list replaces any previously advised signatories. Signing Rules: Transactional Banking (including payroll payments) and Any two signatories acting together. Money Market Dealing Authorities Derivatives Dealing Authorities Chief Financial Officer and any other authorised signatory acting together. Private Bonds Chief Financial Officer and any other authorised signatory acting together. Position Name Specimen Signature Signatories for all private sector banking arrangements including payroll Chief Executive Officer (ADHB) Ailsa Clare Chief Financial Officer (ADHB) Rosalie Percival Deputy Chief Financial Officer (ADHB) Auxilia Nyangoni Group Manager Corporate Finance & Planning Grant Barnett (ADHB) General Counsel (ADHB) Bruce Northey Finance Manager (ADHB) Rosser Thornley General Manager Finance & Strategy (hA) Ross Chirnside Manager Financial Control (hA) Gordon Herdman Financial Accountant (hA) Jenny Tiong Signatories for Payroll Payment s only. HR Information & Systems Improvement Patricia Helen Manager (ADHB) Butcher Payroll Systems Accountant (ADHB) Gary Grant Alpaugh
Team Leader (ADHB) Tania Parsons Payroll Subject Matter Expert (ADHB) Mike Grattan Reports Administrator (ADHB) Reginald Francis Booth Signed on behalf of the Board by: Dr Lester Levy Ian Ward Board Chair Chair, Audit & Finance Committee Dated this day of 2014 104
Schedule 2 Auckland DHB Authorised Signatories for Loan Facilities with the National Health Board The Auckland DHB (ADHB) Board approves the following as the names, offices and specimen signatures of persons who have been duly authorised to give any notices and other communications, to agree to extend the expiry dates of Facility Schedules and, to take any other action required, under or in connection with the ADHB loans with the National Health Board. This list is effective immediately and replaces any previously advised signatories. Signing Rule: Two signatories acting together, including at least one from Group 1. Signatory Position Name Specimen Signature Group 1 Board Chair (ADHB) Lester Levy 1 Chair, Audit & Finance Committee Ian Ward (ADHB) 1 Chief Executive Officer (ADHB) Ailsa Clare 1 Chief Financial Officer (ADHB) Rosalie Percival 2 Deputy Chief Financial Officer Auxilia Nyangoni (ADHB) 2 Group Manager Corporate Grant Barnett Finance & Planning (ADHB) 2 General Manager Finance & Ross Chirnside Strategy (hA) 2 Manager Financial Control (hA) Gordon Herdman 2 Financial Accountant (hA) Jenny Tiong Signed on behalf of the Board by: Dr Lester Levy Ian Ward Board Chair Chair, Audit & Finance Committee Dated this day of 2014 105
Schedule 3 Auckland DHB Authorised Signatories for Shared Commercial Banking arrangements with Health Benefits Limited (HBL) and Westpac New Zealand Limited The following are the positions, names and true signatures of persons who have been authorised by the Acceding Party to give any notices and other communications under, or in connection with, the Master Agreement on behalf of the Acceding Party. Signing Rule: Any two signatories acting together. Position Name Specimen Signature Board Chair (ADHB) Chair, Audit & Finance Committee (ADHB) Lester Levy Ian Ward Chief Executive Officer (ADHB) Ailsa Clare Chief Financial Officer (ADHB) Rosalie Percival Deputy Chief Financial Officer (ADHB) Auxilia Nyangoni Group Manager Corporate Finance & Planning (ADHB) Grant Barnett Signed on behalf of the Board by: Dr Lester Levy Board Chair Dated this day of Ian Ward Chair, Audit & Finance Committee 2014 106
107
11 GENERAL BUSINESS 109
12 PUBLIC EXCLUSION 111
Resolution to exclude the public from a meeting Recommendation: That in accordance with the provisions of Clauses 32 and 33, Schedule 3, of the New Zealand Public Health and Disability Act 2000 (“Act”): The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of each item to be considered: Reasons for passing this resolution in relation to each item: Ground(s) under Clause 32 for the passing of this resolution 12.1 Confirmation of the Public Excluded Minutes of the Auckland District Health Board Committee Meeting 11 December 2014 Confirmation of Minutes As per resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act 2000. That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.02 2013 Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] Action Points 11 December [Official Information Act 1982 S.9 (2) (i)] 12.03 Anatomical Pathology Capacity Business Case Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.04 Seed Funding Proposal for Auckland City Hospital Level 5 Front Door Project Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.05 Biological Treatment of Infertility Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] Auckland District Health Board Meeting of the Board 19 February 2014 That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.06 Human Resources Report Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] 12.07 Community Laboratories Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 S.9 (2) (j)] Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] [Official Information Act 1982 S.9 (2) (i)] 12.08 Starship Children’s Health Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.09 Review of 2014/15 Annual Plan and Statement of Intent for Auckland DHB Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.10 Management of Patients with Acute Spinal Cord Impairment Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.11 New Zealand Health Innovation Hub Stakeholders Quarterly Report Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] Auckland District Health Board Meeting of the Board 19 February 2014 That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 12.12 Health Innovational Hub – Operational Agreement Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] 12.13 Children’s Services Auckland District Health Board Meeting of the Board 19 February 2014 Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 S.9 (2) (i)] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000]