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CE update News and views about our health from

NOVEMBER 2019 Waikato DHB Chief Executive Dr Kevin Snee

This month sees the October result of our finances showing that we have improved again but we are still not quite on plan. I will also discuss our approach to developing services in Tokoroa; why our involvement in Future Proof is so important; mental health services development; measles update; the opportunity to significantly increase the presence art in our hospital; the most recent impact of industrial action on our services and the impact it has had over the previous year; engagement with PHOs at a Midland Region level; the outcome of the restructure consultation and how we proceed from here.

Speaking Up for Safety

Discharge planning

Almost half our staff have done the Speaking Up for Safety one hour training session. While that sounds impressive, we still have over half that should be booking in now and attending. I want to make it clear that this is a very important programme and will only work well if the Speaking Up for Safety C.O.D.E. and process is understood by everyone.

A programme of work focusing on the ‘Last 1000 Days’ has been established to bring together a number of programmes aligned to good discharge planning. From December 2019 projects under the workstreams of pyjama paralysis, red days, green days and criteria-led discharge will be launched. I will provide a full report on the programme to our commissioners in January.

I received an email from one of our staff who is a volunteer Speaking Up for Safety trainer and she told me about a special session she had run for attendants. Many of whom struggled with speaking up as they were often treated by other staff (not all, but a majority) as, in their words, “the lowest of the low”. She said: “Their stories saddened me – when did we stop respecting people for being people no matter what role they had? The Speaking Up programme is also about culture change, making our DHB a place where our staff look forward to coming to work thereby ensuring our patients have the best care. This won’t happen unless we all respect each other – I think we speak the words but our actions say something completely different.” Thank you, for bringing this to my attention. I was also saddened by this as whatever people’s jobs are in this DHB they deserve to be treated with respect. Over the coming months I will be spending time in some services and also doing a shift with different staff groups. First off will be the attendants in December. I will use the opportunity to find out what they would like to see as a way of the DHB appreciating them and their work. There is a lot we do in terms of celebrating their successes, and I am told they are one of the most appreciated and popular groups when we share their stories on social media etc. However, for some reason, personal staff behaviour towards attendants (and potentially other support groups) does not always align with our values.

Healthy people. Excellent care

I would like to comment on an example of how our discharge processes are changing based on learning from some recent poorly managed discharges that I expressed concern over. A gentleman from a rural town was cleared for discharge on a Saturday morning. His wife did not drive, they could not afford to hire an ambulance and no shuttle was available. His family who lived a distance away were not able to collect him. He was safe for discharge and previously he may have been a candidate for the InterCity bus as a way of getting him home over a weekend. Learning from previous situations further discussion and options were explored. These included transport options such as Driving Miss Daisy, fleet car (driven by staff member) using backload option of ambulances from Tokoroa (where the ambulance was delivering a patient and returning back to base empty) or taxi hire. The patient did stay in hospital overnight in order to organise this because the ambulance backload option was available the following day. It is good to see staff are clearly reflecting on recent issues – we need to review whether other options could have been utilised to get the gentleman home safely the day he was fit for discharge.

CE update Tokoroa and South Waikato

I visited Tokoroa Hospital and attended South Waikato Community Forum, and I was impressed by the potential that was apparent. There appeared to be a well-resourced set of services and a substantial community facility which colocates two general practices, a community pharmacy, the community and hospital services and a number of private providers with around 6,500 outpatient visits from visiting specialists. However, it is not realising its potential for a number of reasons which include: • the development of services appear to be relatively unplanned and ad hoc – current out of hours arrangements are an example of this

• not enough time and effort has put in to making sure that services collaborate for the benefit of patients • lack of use of readily available technology to undertake virtual consultations by clinicians based in Hamilton • some retrenchment to Hamilton of SMOs in recent years which has seen a reduction in outpatients Tokoroa is a locality where we are determined to see early progress towards the development of locality based integrated services. This will require significant leadership and management input to work with the local community and local clinicians to ensure that initiatives the community have told us they wish to see are delivered. This includes being more responsive to the diversity of need in South Waikato, specifically with the mix of Pacifica, Māori and Pākehā populations. They want more local access, including to mental health crisis services. They have asked us to use the strong community networks that exist and work with them to address issues such as housing that impact significantly on health. In addition to making best use of resources we should move towards a virtual single organisation working as one rather than several colocated silos.


Mental Health update

The Mental Health Acute Service Acute Sustainability Response Plan contains six specific areas of focus: • Establish a 10 bed community based acute alternative • Housing wrap around supports • High needs packages of care • Increased funding to the provider arm to cover the immediate additional staffing costs whilst community based interventions are implemented (additional seven inpatient beds in the acute inpatient facility) • Expand the Crisis and Home Based Treatment Teams • Review and Care Planning for inpatient cohort for discharge This plan started in July 2019. Numbers of admissions and current occupancy of the inpatient unit have not yet decreased or seen any significant changes to date. This is due to the ongoing demand for acute hospital admissions. The additional seven Rapid Reintegration and Rehabilitation inpatient beds opened on 29 October 2019, with full occupancy. This will see some reductions in pressures on staff and other service users in the existing inpatient wards. While there have been significant gains since implementation, the major impacts of the plan will not be fully realised until all the elements of the plan are completed and fully implemented. Specifically: • The implementation of the Acute Alternative to Admission facility

• Suitable and sustainable placement options for all the inpatients identified with multiple and complex needs – these service users are likely to have long periods of inpatient stay, or frequent admissions, and require high levels of resource and support on the ward Te Ahwi Whānau has been appointed as the preferred provider for the Acute Alternative to Admission facility. The provider is confident that seven beds will be open in December, increasing to 10 beds in March 2020. Utilisation of dedicated packages of care for multiple and complex needs clients have seen a number of successful discharges, however, successfully discharging clients of this type is a slow process and the lack of provider resources to support people in this group presents challenges and risks. Strategy and Funding are working closely with the provider to ensure continued progress in this area.

Industrial action

The DHBs have received strike notices for a total of 227 days, the majority of have been from APEX or the NZRDA. The DHB recognises the rights of union members to take strike action in support of their pay claim, but this has had a significant impact on the delivery of services to patients and staff. The DHB is grateful to all of our staff who have assisted in maintaining life and limb-preserving services during the strike action. The DHBs have made offers that are aligned to those accepted by the majority of our clinical staff and we do not think striking workforces should expect to get more than groups who take a more constructive approach to bargaining with the DHBs.


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Leadership restructure

We have now confirmed changes to our Executive Leadership Team which group similar functions more closely to improve our alignment, coordination, allocation of resources, and strategic decision-making.

A proposal was shared with staff last month and we received a lot of great feedback which has helped to shape the new structure. A second proposal for change has also been created as a result of this feedback, focused on strengthening leadership in Māori health, Pacific health, and population health. This process is ongoing at this time.

Future Proof

I have attended two meetings relating to Future Proof / Te Tau Tiitoki. This is a joint project set up to consider the important issues that affect our sub-region now and over the next 30 years as outlined in the “Future Proof Strategy 2017”. The Future Proof sub-region partners are the territorial authorities of Hamilton City Council, Waipa District Council and Waikato District Council, Waikato DHB, Waikato Regional Council, NZ Transport Agency, and Waikato iwi. As the region’s largest employer and agency with a Waikato regional geographic reach, it is incumbent on the DHB to demonstrate civic leadership, and to look at how it can support collaborative work that benefits the health of the wider community. Our sub-region is an area of rapid population growth and development. The population of the sub-region is projected to increase by around 30 percent over the next 30 years. The high growth rates have placed considerable pressure on all three territorial areas and associated service providers. Dealing with the impacts of growth is a major challenge facing this sub-regional community. Future Proof has historically had a focus on core infrastructure provision (three waters and transport) but this focus is changing in recognition of the need to focus growth planning on supporting achievement of broader community wellbeing outcomes.


This month sees the October result of our finances showing that we have improved again but we are still not quite on plan. The September result was an $8.9m deficit against a $9.2m budgeted deficit (a $0.3m favourable variance) resulting in a year-to-date result for the quarter of a $27.0 deficit against a $26.9m budgeted deficit (a $0.1m unfavourable variance). So we are almost back on plan.

Regional governance update We reported last month on changes to regional governance arrangements bringing together DHB chairs and MIRB chairs strengthening the relationship between local Crown entities and local Iwi. Since then we have agreed to name this governance group Te Manawa Taki – The Pulsating Heart. This symbolises that the leadership is: • always ready to go

• the health hub of Te Ika a Maui

• the strong heartbeat of the fish without which it cannot swim • leading for others to follow

Measles update Waikato DHB has moved from emergency planning to recovery phase; including management of vaccine, catch up immunisation for priority groups and information for the community and health professionals. There will be a programme for addressing the long-standing immunity gap when sufficient vaccine is available. There have been 35 confirmed cases of measles in Waikato DHB since 1 August (51 since 1 January 2019). It was great to see the collaborative efforts of those who worked on the ground from Te Puna Oranga, Hauraki PHO and Te Kōhao Health to promote youth wellbeing and MMR immunisation at Te Mana Kuratahi (National Primary Schools Haka Competition) event.

Te Mana Kuratahi

The Measles Activation site provided a perfect opportunity for the team to connect and korero with over 200 children about measles, immunisation and general health with three people vaccinated and 18 getting help to enrol with a GP.

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Clinical education awards The DHB’s ability to recruit excellent staff and deliver excellent care greatly depends on being a centre of excellence in learning, training, research and innovation. Clinical educators are a key to achieving this and growing the next generation of committed and talented doctors. Congratulations to all who received awards: Dr Ryan Paul was awarded the 2019 New Zealand Clinical Educator of the Year by the Medical Council. Dr Paul is a consultant endocrinologist who has worked as a prevocational educational supervisor at the Waikato DHB from 2015 to 2018, and since then has continued as a regular teacher in the PGY1 and PGY2 formal education programmes, is also involved in diabetes education of registrars, primary care and nurses, and students at the University of Waikato. He is a keen researcher who regularly assists PGY1 and PGY2 doctors in audits. Dr Paul has also been heavily involved in the support of junior doctors who come to practice in New Zealand from the UK and Ireland.

Dr Ryan Paul

He remains involved in the DHB’s orientation programme for new doctors of all levels. Full story available at or click here. Waikato DHB also held its own clinical education awards. Now in its fifth year, the Clyde Wade Award recognises the excellence of Waikato DHB’s clinical teaching. This year’s award went to a neurology specialist based at Waikato Hospital, Dr Matthew Phillips. Dr Phillips stood out amongst 30 other strong nominees who were voted in by registered medical officers (RMOs). The Waikato Excellence in Surgical Education Awards went to senior registrar in Plastics Dr Eric Tan. The Medical Registrar Award was also given jointly to Dr Parvinder Heran and Dr Ayan Sabih.

Dr Eric Tan and Dr Matthew Phillips

2020 Year of the Nurse and Midwife This is the first time World Health Organisation (WHO) has moved away from a disease or issue focus for the year. It honours the 200th birth anniversary of Florence Nightingale, and includes the “Nightingale Challenge” that asks every health employer around the world to provide leadership and development training for a group of young nurses and midwives during 2020. Waikato DHB is one of the first in New Zealand to register for the challenge, as it aligns so well with the relaunch of the Pebbles programme offered by our Professional Development Unit. Nurses and midwives are at the heart of our patient care, and we will regularly showcase their work and report on the Nightingale Challenge, Pebbles programme and other initiatives through the 2020 year.


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Round the Bridges

First of all, a big thank you to the 370 staff who registered for the Round the Bridges event this Sunday under the Waikato DHB banner. You successfully achieved our goal of winning the 12km Corporate Challenge Trophy. The fastest four team members’ finish times are combined and measured against every other business team. Our four fastest runners were Scott Robinson, Eve Pullar, David Sears and Logan Robinson. Working in healthcare is often intense and sometimes stressful, and so I encourage everyone to take up opportunities to have breaks, get some fresh air, keep up a level of physical exercise that is appropriate for you and enjoy it. Events like Round the Bridges are as much about team building and having fun as they are about fitness.

Art in the hospital

How our hospital looks is important to visitors, staff and patients and there is evidence that art can contribute to healing. So it is good that contemporary New Zealand art continues to be added to the Hospital collection by the Waikato Hospital Art Committee. The Waikato Hospital Art Trust is very active and has recently received generous donations from the Waikato Health Trust, the Donny Trust, the Cardiology, Ophthalmology, Anaesthesia and Radiology Trusts. Donations have also been received from a urologist and from Bridgewater Day Surgery. These funds are for the Waikato Hospital Art Committee’s major activities e.g. purchasing new works and displaying selected works on loan from the James Wallace Arts Trust Collection. The James Wallace Arts Trust curator is currently working with our ex officio art committee member and art curator, Ms Kate Darrow, to select works that are suitable to adorn the walls of the Meade Clinical Centre. These works aim to reflect the Waikato region’s physical and cultural landscape. I have underlined the importance of the artworks displayed reflecting the Māori cultural heritage. In addition, the Waikato Hospital Art Committee has recently purchased what I am told is a stunning new artwork by the Niuean/New Zealand artist John Pule.

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Release of draft report – Independent investigation into conduct of Dr Nigel Murray Following settlement of legal proceedings, Waikato DHB is now able to release more information from the draft report ‘Independent Investigation into the Conduct of Dr Nigel Murray’, including content that was previously redacted. The draft report was commissioned by the DHB in 2017. It remained in draft form as Dr Murray’s resignation as chief executive of the DHB was accepted by the former Board, which brought an end to this investigation process. Media requested the draft report and the DHB shared the view that it was in the public interest to make information available. However, Dr Murray brought legal proceedings against Waikato DHB in the Employment Relations Authority. As a result of these initial proceedings, the DHB was permitted to release the draft report with redactions in January 2019. The Serious Fraud Office in July this year announced its decision not to prosecute Dr Murray, prompting a new request from the NZ Herald for the redactions to be removed from the draft report. Dr Murray then brought further proceedings against Waikato DHB in both the Employment Relations

Authority and the High Court to prevent further information being released from the draft report. A settlement has now been reached in the High Court proceedings which permits the DHB to release more information with the removal of many redactions, over and above the version of the draft report we released in January 2019. Dr Murray has also agreed to withdraw the proceedings in the Employment Relations Authority. The DHB had no desire to be drawn into these processes which have not been straightforward. There was added complexity due to the report remaining in draft form because of the agreement reached with the previous Board. We have incurred significant external legal costs in relation to recent proceedings and issues concerning Dr Murray, in addition to the use of significant internal resources and staff time. These costs would have been considerably higher if the case went to hearing. We would much rather our focus and public funds are committed to the delivery of quality healthcare in our community and it is our intention that the matter is now at an end. The draft report is available here.

Part of the community I conclude this update with two examples of getting out into our communities, and bringing our communities into our hospitals.

Honey Hireme the Kiwi Ferns league captain and team mate Kanyon Paul visited Waikato Hospital with the world cup they recently won at the League Nine’s tournament in Australia. #LocalLegends

Great collaborative efforts from Te Puna Oranga, Hauraki PHO and Te Kōhao Health to promote youth wellbeing and MMR immunisation at the Te Mana Kuratahi (National Primary Schools Haka Competition) recently in Hamilton.

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

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CE update - November 2019