Counties Manukau District Health Board Community & Public Health Advisory Committee Meeting Agenda Wednesday, 25 May 2016 at 1.30 – 4.30pm, Manukau Boardroom, CM Health Board Office, 19 Lambie Drive, Manukau Time Item 1.30pm 1. Welcome 1.30 – 1.45pm 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interest 2.3 Confirmation of Public Minutes (13 April 2016) 2.4 Action Items Register 3. Reports 1.45 – 2.00pm 3.1 TSI & CM Health Update 2.00 – 2.15pm 3.2 2nd Draft 2016-17 Asian Health Plan (Margie Apa) 2.15 – 2.30pm 3.3 2nd Draft 2016-17 Pacific Health Plan (Margie Apa) Afternoon Tea 2.45 – 3.45pm 4. Director of Primary Health & Community Services Report (Benedict Hefford) 4.1 Executive Summary/Responses to Action Items 4.2 National Health & IPIF Targets 4.3 Primary Health (3.00 – 3.10pm) 4.4 Systems Integration (Claire Naumann) 4.5 Locality Reports 4.6 Child Youth & Maternity 4.7 Mental Health & Addictions 4.8 Adult Rehabilitation & Health of Older People 4.9 Intersectoral Initiatives 4.10 Finance Report 3.45 – 3.50pm 5. Resolution to Exclude the Public 6. Confidential Items 3.50 – 4.00pm 6.1 After Hours Services – Verbal Update (Benedict Hefford) 4.00 – 4.05pm 6.2 Confirmation of Confidential Minutes (13 April 2016) 4.05 – 4.10pm 6.3 Action Items Register Confidential Next Meeting: Wednesday 6 July 2016 Manukau Boardroom, CM Health Board Office, 19 Lambie Drive, Manukau Counties Manukau District Health Board – Community & Public Health Advisory Committee Agenda BOARD MEMBER ATTENDANCE SCHEDULE 2016 – CPHAC Name 20 Jan Feb 2 Mar 13 Apr 25 May June 6 Jul 17 Aug 28 Sept Oct 9 Nov 21 Dec Lee Mathias (Board Chair)    Colleen Brown    Sandra Alofivae (CPHAC Chair)    David Collings    George Ngatai    g g g n n n Dianne Glenn  eti   eti eti e e e M M M Reece Autagavaia  o X  o o N N N Mr Sefita Hao’uli  X  Ms Wendy Bremner    Mr Ezekiel Robson    Mr John Wong    Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 COMMITTEE MEMBERS’ DISCLOSURE OF INTERESTS 25 May 2016 Member Disclosure of Interest Dr Lee Mathias, Chair • Chair Health Promotion Agency • Chairman, Unitec • Deputy Chair, Auckland District Health Board • Acting Chair, New Zealand Health Innovation Hub • Director, healthAlliance NZ Ltd • Director, New Zealand Health Partners Ltd • External Advisor, National Health Committee • Director, Pictor Limited • Director, John Seabrook Holdings Limited • MD, Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust • Colleen Brown • Chair, Disability Connect (Auckland Metropolitan Area) • Member of Advisory Committee for Disability Programme Manukau Institute of Technology • Member NZ Down Syndrome Association • Husband, Determination Referee for Department of Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel • Member, NZ Disability Strategy Reference Group Sandra Alofivae • Member, Fonua Ola Board • Board Member, Pasifika Futures • Director, Housing New Zealand • Member, Ministerial Advisory Council for Pacific Island Affairs David Collings • Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative George Ngatai • Chair Safer Aotearoa Family Violence Prevention Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae • Conservation Volunteers New Zealand Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board • Transitioning Out Aotearoa (provides services & back office support to Huakina Development Trust and provides GP services to their people). • Chair of Restorative Practices NZ. Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland Council • Life Member – Business and Professional Women Franklin • Member – UN Women Aotearoa/NZ • President – Friends of Auckland Botanic Gardens and Chair of the Friends Trust • Life Member – Ambury Park Centre for Riding Therapy Inc. • Vice President, National Council of Women of New Zealand • Member, Auckland Disabled Women’s Group • Member, Pacific Women’s Watch (NZ) • Justice of the Peace Reece Autagavaia • Member, Pacific Lawyers’ Association • Member, Labour Party • Member, Auckland Council Pacific People’s Advisory Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga Amata Preschool • Trustee, Epiphany Pacific Trust Sefita Hao’uli • Trustee Te Papapa Pre-school Trust Board • Member Tonga Business Association & Tonga Business Council • Member ASH Board • Board member, Pacific Education Centre Advisory roles: • Tongan Community Suicide Prevention Project (MoH) • Tala Pasifika (NZ Heart Foundation Pacific Tobacco Control) • Member Pacific People’s Advisory Panel, Auckland Council Consultant: • Government of Tonga: Manage RSE scheme in NZ • NZ Translation Centre: Translates government and health provider documents. • Promotus GSL on Rheumatic Fever campaign (HPA) • Taulanga U Society Rheumatic Fever Innovation project (MoH). • Member, Ministerial Advisory Council for Pacific Island Affairs. Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 Wendy Bremner • CEO Age Concern Counties Manukau Inc • Member of Health Promotion Advisory Group (7 Age Concerns funded by MOH) • Member Interagency Suicide Prevention Group Ezekiel Robson • Department of Internal Affairs Community Organisation Grants Scheme Papakura/Franklin Local Distribution Committee • Be.Institute/Be.Accessible ‘Be.Leadership 2011’ Alumni • Member, CM Health Patient & Whaanau Centred Care Consumer Council John Wong • Director, Asian Family Services at The Problem Gambling Foundation of New Zealand (PGF), also part of the PGF national management team • Member, National Minimising Gambling Harm Advisory Group • Chairman and Trustee, Chinese Positive Ageing Charitable • Chairman, Chinese Social Workers Interest Group of the Aotearoa New Zealand Association of Social Workers • Chairman, Eastern Locality Asian Health Group • Founding member and council member, Asian Network Incorporation (TANI) • Board member, Auckland District Police Asian Advisory Board • Member, Auckland and Waitemata DHBs Suicide Prevention Advisory Group • Board member, Manukau Institute of Technology (MIT) Chinese Community Advisory Group • Member, CADS Asian Counselling Service Reference Group • Member, Waitemata DHB Asian Mental Health & Addiction Governance Group • Member, Older People Advisory Group (ACC) • Member, University of Auckland Social Work Advisory Group • Member, Community Advisory Group of Health Care New Zealand • Member, Auckland Regional Public Health Service – Asian Public Health External Reference Group • Member of the Advisory Committee for the School of Social Sciences &Public Policy at AUT University Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 25 May2016 Director having interest Interest in Particulars of interest Disclosure date Board Action Mr George Ngatai CMH Quit Bus Mr Ngatai is a Director of 26 March 2014 That Mr Ngatai’s specific interest is noted Transitioning Out Aotearoa and the Committee agree that he may who is a partner provider along remain in the room and participate in any with CMDHB and Waitemata deliberations of the Committee but is not PHO in the Quit Bus. permitted to participate in any decision making. Ms Colleen Brown Emerge Aotearoa (formerly Ms Colleen Brown has been 22 October 2014 That Ms Brown’s specific interest is noted Richmond NZ Trust Ltd) involved with the family. and the Committee agree that she may remain in the room and participate in any deliberations of the Committee in relation to this matter because she is able to assist the Committee with relevant information, but is not permitted to participate in any decision making. Ms Dianne Glenn Liqour Licensing Ms Glenn is a member of the 15 April 2015 That Ms Glenn’s specific interest is noted District Licensing Committee 8 July 2015 and the Committee agree that she may of Auckland Council 2 March 2016 remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making. Ms Margie Apa Integrated Home & Ms Apa is Chair of the 8 July 2015 Ms Apa specific interest is noted and the Community Support Northern Presbyterian Support Committee agreed that she will excuse Services Redesign Services Network who are a herself from the room if and when any items current provider of home- in relation to this Conflict are discussed. based services. Mr Sefita Hao’uli Suicide Prevention Mr Hao’uli is a paid advisory 20 January 2016 That Mr Hao’uli’s specific interest is noted for the Toko Collaboration and the Committee agree that he may Project (suicide prevention for remain in the room and participate in any Tongan community) funded deliberations of the Committee but is not under MOH Innovation. permitted to participate in any decision making. Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 Minutes of Counties Manukau District Health Board Community & Public Health Advisory Committee Held on Wednesday, 13 April 2016 at 1.30 – 4.30pm, Manukau Boardroom, CM Health Board Office, 19 Lambie Drive, Manukau Present: Dr Lee Mathias (Board Chair), Ms Sandra Alofivae (Committee Chair), Ms Colleen Brown, Ms Dianne Glenn, Mr George Ngatai, Mr David Collings, Mr Ezekiel Robson, Ms Wendy Bremner, Mr John Wong, Mr Sefita Hao’uli and Apulu Reece Autagavaia . In attendance: Mr Benedict Hefford (Director, Primary Health & Community Services), Ms Karyn Sangster (Chief Nurse Advisor, Primary Care), Dr Campbell Brebner (Chief Medical Advisor, Primary Care) and Ms Dinah Nicholas (Minute Taker). Apologies: Mr Geraint Martin & Ms Margie Apa. 1. Welcome Ms Dianne Glenn opened the meeting with her reflections on a recent Asia/Pacific conference she attended, the theme of which was ‘Equity for Women’ and noted that as a district health board we should be aware of all aspects of diversity as we come to conclusions and strive for equitable outcomes for our community. 2. Governance 2.1 Attendance & Apologies Noted. 2.2 Disclosure of Interest/Specific Interests The Disclosures of Interest were noted with no amendments. 2.3 Confirmation of Public Minutes (2 March 2016) Resolution That the Public Minutes of the Counties Manukau District Health Board Community & Public Health Advisory Committee meeting held on Wednesday 2 March 2016 were taken as read and confirmed as a true and accurate record. Moved: Mr George Ngatai Seconded: Ms Colleen Brown Carried: Unanimously Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 2.4 Action Item Register Public Noted. Community CPHAC meeting 28 September – Mr Hefford to look into whether it can be held at the Star Centre at the Total Healthcare Clinical Hub and advertise the meeting in some local community papers. 3. Presentation 3.1 Rapid Response – Franklin Locality Ms Helen Lees and Ms Karen Ballard from the Franklin Rapid Response Team took the Committee through their presentation highlighting the following: • The aim of the unit was to develop a coordinated network that links primary and secondary services within the Franklin locality in a timely manner to reduce avoidable hospital admissions and grew initially out of the 20,000 Bed Days programme. • When first set up it was difficult to sell the concept as it was only a pilot but has now become permanently funded through CM Health with 1.5FTE. • Response times to 1st contact are usually within the 0-1hour timeframe where a full nursing assessment is undertaken. • Patients only remain active with the Team for that particular contact and are always handed back to the GP so they are aware of what supports they have put in place. • Areas for improvement – being able to administer IV antibiotics and take bloods. The Chair thanked the presenters for their presentation. 3.2 Mental Health Deep Dive Ms Tess Ahern, GM Mental Health, Mr Pete Watson, Clinical Director and Ms Wendy Brown, Service Development Manager took the Committee through their presentation highlighting the following: Transformation - we want people in our communities with mental health and addictions to live longer, healthier lives and we believe that by working together we can improve access to a range of services and supports, be better able to care for people when they are unwell and help them maintain their wellbeing when they are well. There will be a ‘shift to the left’ away from a Mental Health & Addiction centric service delivery model to a community located person & whaanau centric model. Model of Care Reviews & Development - next steps will include ongoing service development through whole of system projects and model of care reviews with detailed business cases and implementation plans for transformation covering sector reconfiguration, workforce development, system infrastructure and community development. The Chair thanked the presenters for their informative deep dive into our Mental Health service. 3.3 Northern Region Clinical Pathways in Primary Care Dr Campbell Brebner, Ms Kathryn de Luc, GM Franklin Locality and Dr Charlotte Harris, Clinical Lead took the Committee through their presentation highlighting the following: • The Auckland Regional Health Pathways is a repository of information. • The Static website (a pathway represented in a fixed format such as an algorithm on paper or in non-interactive form on a computer) went live on 24 August 2015 and is funded 50/50 by the 3 Auckland metro DHBs and 7 PHOs. All GPs can access and utilise Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 the website, with some 300+ practices currently doing that. The site has 560+ clinical pages; 95+ being localised for the CM Health community. • The Dynamic platform (a pathway represented in an interactive form on a computer and changes in response to data entered) is integrated with practice management systems (PMS) although is not integrated with Concerto e-referrals yet. This platform is funded by the 4 Northern region DHBs only. It has only rolled out to 92 practices to date and has 10 pathways currently available. • The objective of the pathways is to standardise primary care management of common conditions and enable primary care to work at the top of its scope, reduce variation of care and inequities in outcome. • Clinical pathways need to be seen in the context of the wide integration strategy being pursued by the DHBs. The pathways can only realise their potential benefit if they become an integral component of other system-wide programmes of work, especially those seeking to establish more integrated and collaborate models of care. • The benefits are many: From a patient perspective – they receive consistent care and increased o engagement with decision-making From a provider perspective – easy access agreed standards of care, efficient o referral process, a culture change From a system perspective – more care right place, right time, working at top of o scope Future costs avoided with breakeven by FY2020/21. o The Chair thanked the presenters noting that this is certainly the way forward, focussing on quality and providing our community with something that has the ability to impact meaningfully on their lives. 3.4 Diabetes Care Improvement Package (DCIP) Changes Update Dr Campbell Brebner took the Committee through his presentation highlighting the following: DCIP is a package worth around $1.2m (50/50 MoH/DHB). In 2012 the pre-existing programme (DCS) changed from an annual check to start incentivising practices for improved HBa1c and provided some allied health resource for the practices. We have started to see slow improvement in control but not at a rate that we would like to see and we are also unfortunately seeing an increase in the number of poorly controlled diabetics. We have currently 33,000+ enrolled diabetic patients – 25% with HBa1c greater than 75 with 66% being Maaori/Pacific. We have therefore had to look to remodel the package to focus on patients with poorly controlled diabetes to optimise their clinical management. The approach being used is an ARI-type approach, developing MDT case reviews, using a collaborative improvement methodology, care planning and interventions. The aim is to recruit up to 20 practices who have around 5100 of the poorly controlled diabetics out of a total of 8300. The prior funding to the practices will be reshaped - they will no longer get the incentivisation payment but they will be paid to participate in the collaborative and the MDT care planning activity. Progress to date – 12 practices recruited with 2500 poorly controlled diabetics. An inaugural learning session is planned for May which will include practices, the diabetes services, allied health providers and PHO improvement facilitators. Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016 In response to a question whether the incentivisation payment could change so it didn’t go to the practice but went to the patient, Dr Brebner advised that that is not what is being factored in at this point but it could possibly be looked at. Initial data from patients that have been through ARI, including diabetic patients, shows on just about every score in terms of how much confidence and understanding patients have about their condition and how to manage that, after 12 months that has gone up. Procare have also undertaken some analysis that shows that patients in ARI at CM Health are doing better in terms of their glucose control after 12 months. As long as this is patient-centred and based around patient goals it should give us a crack at shifting the curve in this area. 4. Director of Primary Health & Community Services Report Mr Hefford took the Committee through some highlights of the Report. 4.1 Executive Summary The Children’s Team launched 22 March but has challenges. As background, in CM Health we have approximately 600-700 children at any one time who are under formal CYF care and intervention. We also have 3,500 children just below that level who are at risk of being seriously abused and neglected and it will be these children that are targeted by the Children’s Team. They will need to be referred into the service. The team is a virtual team joining up access to social services to better proactively support these children. Each family will have a Lead Professional appointed to them however, the family does not have to accept the services offered, it is voluntary unlike a CYFs intervention. There are concerns if the referrals don’t come in or the family don’t accept the services offered. There are also concerns whether the Team would turn down a referral if it came from outside the Manurewa/Clendon/Papakura area. It is early days and there is a genuine interest and energy to make this work. Further updates will be provided to the Committee in the coming months. Winter Planning – this was reviewed last year in light of the Franklin locality’s stand out performance in terms of success (ie) ED attendances, flu vaccinations. One of the key learning’s was to communicate a very simple message to contact your family doctor first and we will be pushing this concept this winter and will also be looking to roll out Rapid Response to the other localities. Some communications will be going out in two weeks including the back of buses, Google search pop-ups (ie) if someone Google’s ‘flu’ a pop-up from CM Health will say to contact your family doctor first. Falls – we have received some money from ACC for Falls prevention. Further information on this will be included in the next Director’s Report. 4.2 National Health & IPIF Targets The report was taken as read. 4.3 Primary Health The report was taken as read. 4.4 Systems Integration The report was taken as read. 4.5 Locality Reports The report was taken as read. Counties Manukau District Health Board – Community & Public Health Advisory Committee 25 May 2016