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CE update News and views about our health from

OCTOBER 2019 Waikato DHB Chief Executive Dr Kevin Snee

This month we have seen the announcement of our new mental health facility which will be a significant investment in improving care for our patients. We also continue to work hard on delivering our budget and October sees another improvement in results for our finances. We are now only $500k behind plan. The two are linked because the availability of capital nationally is linked to improved financial performance within the sector and locally if our performance is worse than plan this could lead to a reduction in capital being made available; the capital investment is significant and has been set at $100 million. It was great to have the Prime Minister and Health Minister visit to tell us this news.

$100 million for new mental health facility Government recently approved funding for a new acute mental health facility for Waikato which will provide better care and support to people with mental health and addiction issues. Prime Minister Jacinda Ardern and Health Minister Dr David Clark announced the $100 million project to replace the aging Henry Rongomau Bennett Centre during a visit to Hamilton on 17 October. We are heartened by this announcement that will be a significant financial PĹ?whiri for Prime Minister Jacinda Ardern and Health Minister Dr David Clark investment for the new facility. The current Henry Rongomau Bennett Centre is no longer fit for purpose. It is outdated and does not provide the right environment to support a focus on recovery and mental wellbeing for patients, despite the hard work by dedicated staff. A number of independent inspections and reviews found the current facilities do not meet standards of privacy, security and safety. The reviews also highlighted the challenges for staff when providing care to service users who are acutely unwell. In addition, consideration is being given as part of a phase 2 development to extend the Midland Regional Puawai Henry Rongomau Bennett Centre inpatient facility to meet the New Zealand Corrections Increased Capacity Programme (including the Waikeria Prison 100 bed mental health hub 2022).

Healthy people. Excellent care

The number of beds required will be better defined once the Waikeria Model of Care work has been completed. Principles of co-design are integral to these developments. Input from service users, whÄ nau, MÄ ori, and staff so far have emphasised the need to ensure an environment and approach that is culturally based with a core focus on recovery and wellbeing. While we plan for the new facility, Henry Rongomau Bennett Centre has recently opened a new 7-bed rehabilitation and reintegration unit (Ward 41) that will support people who no longer need to be in an acute ward, but still are experiencing other barriers to safe discharge. They will stay in the ward to facilitate their reintegration into the community. This will help the service right now to better manage the high occupancy and demand of our acute inpatient services.

CE update

OCTOBER 2019

Update from the commissioners This month we started our Community and Public Health Advisory Committee (incorporating the Disability Support Advisory Committee) and the Hospital Advisory Committee meetings with our external appointees who bring a broad range of skills, experience and qualities. The roles of these committees are to consider and advise our DHB on health status, health priorities and the health needs of the Waikato people. The Hospital Advisory Committee advises on how our hospital services are performing for the community we serve. Both these meetings are held back to back as there is common membership across both committees which will now ensure coherence across the landscape of health. Both also reflect legislation with a priority on equity and improving Māori health and wellbeing outcomes. The DHB and commissioners are very grateful for the time and commitment of our external appointees as we can’t work effectively without the voices of those for whom we provide services. Our services need to focus on the needs of the individual and their whānau and how we facilitate their access. Seamless pathways of care are essential and we need to look outwards and then inwards in how we will do this. To do that we need the voice of the Waikato community. These committee meetings will be held every two months and are open to the public.

How we are shaping up

Waikato DHB now has a strong leadership team with Dr Snee having been in the role as CE for a few months, along with the commissioners who have been in place since May, and will remain until the next health board elections in 2022. We have framed up what is critically important to us: access in all ways to our services, patients feeling culturally safe, services that reflect our focus on the task to deliver on our Treaty obligations and equity of health outcomes. Quality of care continues to be a focus for us and the DHB has to live within the public dollars that are allocated to us.

Along with the savings plan there is a transformation programme of work underway to help us deliver quality sustainable services into the future. We want to work more closely and partner with other community health providers and whānau, so people can have care closer to their home where possible.

Annual Report

The Waikato DHB Annual Report for the financial year ending 30 June 2019 is now complete and was submitted to the Ministry on 31 October. We would like to thank all those who contributed and we appreciate the time and effort put into the report. Even more importantly, we appreciate the year’s work of service delivery. The report also draws a line under our deficit and reminds us of our service plans and budgets for the new financial year we are now well into.

Response to Heather Simpson’s Health and Disability System Review – Interim Report Waikato DHB has responded to the Disability System Review – Interim Report.

There were no surprises and we thought it provided an insightful analysis of the health system issues and posed a series of pertinent questions. It rightly identifies the problems of complexity in terms of accountability, funding and organisation. We agree that the health system has failed to deliver on improving the health of Māori, addressing equity and Treaty of Waitangi obligations. We support a greater role for primary and community care and a stronger focus on prevention and promotion. We advised that emphasis should also be placed on addressing the needs of our rural and often deprived communities. We look forward with interest to the final report due with the Minister by the end of March 2020. Dr Karen Poutasi Waikato DHB Commissioner

OCTOBER 2019

CE update

Hui with Waikato Tainui

I recently attended a productive meeting with Donna Flavell, Waikato Tainui CE, and her team at iwi headquarters. I was impressed with their strategic vision and have suggested a number of ways that we could work together. We will be bringing together a subset of our management teams to work through current issues and opportunities to improve Māori health and outcomes and to build on the strengths in the Māori community.

Orientation has taken on a new life Te hono whakataki – our first meeting – is a new approach to what previously seemed like a long day for our new staff in the Bryant Education Centre listening to presentations about the different services.

Holidays Act Compliance

More than 100,000 health workers will have their holiday pay calculations reviewed going back to 2010 with an undertaking that any shortfall will be refunded. Investigations undertaken by the Labour Inspectorate of the Ministry of Business Innovation & Employment (MBIE) identified widespread issues for a number of employers that their payroll systems were not complying with the requirements of the Holidays Act. This meant that many employees were not receiving their correct leave entitlements. DHBs, the New Zealand Blood Service (NZBS), the New Zealand Council of Trade Unions (CTU), Health unions and the Labour Inspectorate have been working together to develop an agreed national audit process. The Holidays Act is complicated, outdated and has caused significant problems for employers and workers alike. For the workforce the Holidays Act presents complexities because of their wide ranging shift patterns and rosters covering a 24 hour a day, seven day week service. For the employers our payroll systems are also inadequate, and the result has been miscalculation of entitlements and noncompliance; this process is designed to address that. A joint approach to resolving this issue was agreed with MBIE’s Labour Inspectorate which includes: • An agreed baseline on how the Holidays Act applies to health sector employees; • A framework on how DHBs will assess and rectify non-compliance; and • A memorandum of understanding that details the agreement between the CTU, unions, DHBs and the Labour Inspectorate.

Te hono whakataki starts with a pōwhiri and even includes dance along the way. People who attended have said it is a ‘warm and inspiring’ welcome to the Waikato. There is also an expo where different services and some external companies have stands for staff to visit.

The 20 DHBs and the NZBS will be grouped into tranches for the review, beginning with the Auckland and Northland DHBs which are already underway. All reviews will be underway by April 2020 and it’s estimated that it will take between 12 and 18 months for each DHB to work through a process to review, rectify and remediate noncompliance issues.

This will evolve over time and the intention is to be increasingly focused on culture and values of the organisation. We hope to also move the event to a marae in the future.

DHBs and the Health unions will also be communicating with DHB employees as and when their reviews get underway, with details of how they can take part and be represented. Waikato DHB’s review is expected to get underway in November.

Industrial action

There continues to be a significant amount of bargaining activity amongst the allied health, scientific and technical workforces. The DHB is currently planning for further strike action from the medical imaging technologist, laboratory worker and psychologist workforces. It can be a challenging and difficult time during these strikes on both sides. I would encourage everyone to remember our values – Whakamana – Give and earn respect. While the DHB support staff members rights to participate in strike action, workers of the same discipline also have the right to work. This is a personal decision and needs to be respected, we all need to be kind and courteous with each

other. It is also important to remember that normal rules apply and staff are expected to continue to follow the DHB policies and procedures especially in relation to privacy and confidentiality. While the DHB has put in place contingency plans in an effort to minimise disruption to patients, prioritising emergency department and acute inpatients requiring diagnostics, this is now starting to have a significant impact on waiting times for outpatient clinics and elective surgery requiring imaging support and for patients requiring cardiac catheterisation. Thank you to everyone for working together during this time to keep our patients safe.

CE update

OCTOBER 2019

Cyber security In August, DHBs were made aware of an unauthorised intrusion to the digital information systems of Tū Ora Compass Health PHO (Primary Health Organisation). A careful investigation has not yet been able to determine with any certainty whether the unauthorised access resulted in any information being taken. The security breaches affected up to one million Mid Central and Wellington patients primary care records.

Don’t get hooked Beware of phishing

Waikato DHB and PHOs in the Waikato district were not affected in this cyber incident, however it highlights the very real threat systems are under. The Ministry of Health has requested all DHBs and PHOs provide them with formal assurance that all solutions containing patient or staff data, accessible through the internet or via Connected Health, are secure and that the organisation has appropriate privacy and security controls in place. We are confident that we are taking reasonable and prudent steps, to ensure the protection of both patient and staff data and where risks are identified making informed decisions regarding the management of these. Waikato DHB continually review and strengthen the protocols and security measures to ensure systems and patient information are safe with a range of stringent measures, including external independent audit, overseen by a Privacy Officer and Information Security and Privacy Governance Group. It is our expectation that this security and privacy breach, on the back of other recent government sector breaches (Ministry of Culture and Heritage, NZTA, AirNZ, etc.), is likely to result in increased oversight and monitoring by the Ministry of Health and Department of Internal Affairs of our privacy and security controls and governance framework.

k Don’t be so quick to clic Think before sharing sensitive information s Store pins and password r pe pa in your head not on or in a book

• Don’t click on links in emails that ask for your personal information • Never open unexpected attachments • Delete suspicious messages, even if you know the source • Double check; is that plea for help from a colleague or a scammer?

Protect your information

Acknowledgement: Adapted from original resources developed by Taranaki DHB G3546HWF set of 5

Shrinking our environmental footprint Katie Hine is Waikato DHB’s newly appointed sustainability officer. She is a shared resource with the University of Waikato which appropriately makes the role more sustainable, and will spend two days a week (Tuesday and Friday) based at Waiora Waikato Hospital Campus. Katie has a strong background in sustainability, working as a waste minimisation officer at Waipa District Council while completing a postgraduate degree in environmental management. She took on the role of sustainability coordinator at the University of Waikato early this year and recently this extended to a shared role covering Waikato DHB as well. Katie acknowledges that some areas already have strong programmes in place – noting the work of engineer Stefan van Rooij and energy

management consultant Martin Lynch over several years to reduce energy consumption and demand. Her first action will be to benchmark where Waikato DHB is at now and what our carbon footprint is. Hopefully by the end of the year that will give us a picture of where most emissions are coming from, and once we know that we can identify opportunities and actions to take. Areas covered in the benchmarking will include • Energy use • Commuting • Gas use • Waste (and • Fuel use (fleet cars) recycling) • Air travel • Procurement So if you are keen to be involved, or if you / your area has a local initiative going you can share, let Katie know at: Katie.Hine@waikatodhb.health.nz Katie Hine

OCTOBER 2019

CE update

In the news for good reasons It’s great to see STUFF’s new series of articles ‘Hard Yakka’ which are delving into different areas, roles and people that don’t always make the media headlines. The stories will cover areas from public health nursing in the south, working at the front line from an ED receptionist to a trauma nurse and more besides. I hope you take the time to read and share these stories. Here’s a link to the Hard Yakka series: www.waikatodhb.health.nz/hardyakka

Moving to Waiora CBD (old Farmers building) The Waiora CBD building is on track and now being occupied on a phased basis, with project commissioning teams moving in during October and over 275 team members to move between 1 November and 2 December. The services moving in the November phase are Public Health, Strategy and Funding then START with Information Services in early December. They will occupy the first floor. Other services will move in the new year. Due to acceleration of the fit out program, we have been able to bring forward moves planned in 2020 by over a month. There will be between 500 and 600 staff moving to the Waiora CBD by the end of April.

Recruitment to vacancies and other executive team changes We have appointed Nick Wilson to be the director of communications. He comes to us with a good mix of skills having worked as a journalist before shifting to communications where he has worked across the public and private sectors. Nick currently leads the Communications team at Unitec and previously Nick Wilson was communications manager at Huawei.

Restructure of tier 3 management

The restructure document for tier 3 will be published very shortly and then after a two week consultation it will be implemented. As CE I am responsible for the smooth running of Waikato DHB and ultimately responsible for any failings. Any executive team is a key organisational design choice, including the size of that executive team and the delineation of functions. The intention of the executive restructure is to focus on organisational wide and strategic level decisions and applying this framework in an intentional way. There are many good people in and around the executive leadership team who are accountable directly to me but there are simply too many for me to provide oversight on and the executive leadership team is too large to provide for effective decision-making. I believe it is important that at the executive level there is a clear focus on the clinical perspective and clinical quality. Waikato DHB is a complex health system that provides tertiary services for the Midland Region of over 900,000 people.

Interim chief operating officer appointed for Waikato DHB as Ron Dunham leaves

Interim chief operating officer Ron Dunham is leaving Waikato DHB on Friday 1 November. Director of Ambulatory, Cancer and Regional services Alex Gordon will take the role of acting chief operating officer when he returns from annual leave on Tuesday 5 November, replacing Ron who has been interim chief operating officer since January 2019. I would like to take this opportunity to thank Ron for stepping into this challenging role and staying with us for much longer than he intended. Your support has been much appreciated. Alex will be in the role until Leena Singh joins us in January 2020 as permanent executive director of Hospital and Community services.

CE update

OCTOBER 2019

Measles update As at 8am 30 October 2019, there have been 34 confirmed cases of measles in Waikato DHB since 1 August (50 since 1 January 2019). Most are related to the Auckland outbreaks. The Ministry of Health have confirmed supply of the vaccines through until the end of year. This will enable the continued delivery of the national childhood immunisation schedule as well as extending the priority groups as follows: • Vaccination of all 1 to 4 year olds whose vaccinations are overdue – including active recall of children aged under 5 years who need catch-up vaccination. • Vaccination of all unimmunised children aged 5 to 14 years of age (one catch-up dose of MMR for those aged 5 to 14 years who do not have one documented MMR vaccination) A Measles Action Plan and group formed from the Coordinated Incident Management System (CIMS) team, and endorsed by the Ministry of Health, will oversee the measles response and ensure that a strong equity focus is maintained. Out of all cases over 80 percent have been Māori and Pacific ethnicity with 19 percent non-Māori and Pacific. This page on our website www.waikatodhb.health.nz/measles is updated frequently with confirmed measles cases, advice, resources and information about vaccine supply.

My Kai

Congratulations to the Nutrition and Food team for their successful implementation of the new electronic platform My Kai that provides personalised nutrition care and improved patient safety. I hear it went seamlessly live on 22 October with all patients receiving their meals on time. My Kai automatically picks up the diet requirements entered into the Patient Flow Management system (PFM), so a patient’s menu choices, meals and beverages are customised to their individual dietary needs and clinical care while they are in hospital. In the past patients selected meal items not knowing whether they were suitable for them or not.

DID YOU KNOW? Over 2400 patient meals are prepared each day at Waikato Hospital

We have an excellent Nutrition and Food service and they have invested a substantial amount of work into My Kai over the last year to replace and streamline a number of outdated systems. I couldn’t agree more with the My Kai tagline, ‘food is medicine’, as it does play a part in each patients care plan.

What’s new with My Kai:

• Patients can trust that menu choices offered for them are already suitable for the diet code(s) that clinical staff enter for them into PFM

• In some wards, Nutrition and Food staff are taking the patients meal selection at the bedside directly onto an electronic device without the need for paper menus • Ability to automatically calculate nutrients based on meal selection

• Nutrition information and diet codes stay with the patient wherever they are within the hospital. Clinical staff can enter and make changes to a diet code directly into PFM without needing to make a phone call • No more faxing of menu

• Ability to capture and trend information needed for menu planning, ordering and production that will help reduce things like food waste and better plan nutritional needs My Kai will also enable more patient centred care in the future such as options for patients to order their meals online themselves.

This update will be published monthly, if you have anything happening in your area and think I should know about it please email news@waikatodhb.health.nz