10 December 2013 - Taranaki District Health Board

115 Pages·2013·2.93 MB·English

Distribution:
Committee Members:
F Gilkison, Acting Chair

A Ballantyne, Acting Deputy Chairman

K Eagles, R Handley,

T A Hohaia, P Leary

P Lockett, K Nielson,
AGENDA
A Rumball, A Tamati
Coopted member D Tamatea

COMMUNITY & PUBLIC
Management:
HEALTH ADVISORY
CEO
GM Planning, Funding & Population Health COMMITTEE/DISABILITY
GM Finance & Corporate Services
SUPPORT ADVISORY
Chief Advisor Maori Health
COMMITTEES
GM Hospital Services
Chief Medical Advisor
Quality Risk Manager

PA to Board
PA to GM, PF&PH

Advisors:

S Carrington, Media Advisor
P Franklin, Legal Advisor ORDINARY MEETING
File Copy

10 December 2013

Public: 12.30 pm
Midlands Health Network

Peter Jane, MoH

Te Whare Punanga Korero (7)
TH Gibson Corporate Meeting Room 1
Health Care NZ
Taranaki Base Hospital
Agnes Lehrke, Grey Power
Public Libraries – New Plymouth, Hawera, David Street
Stratford, Opunake, Patea, Manaia,
New Plymouth
Kaponga, Waverley, Oakura, Waitara, Bell

Block, Inglewood, Eltham
Media – Daily News, Newstalk ZB, Hawera
Star, Midweek, Opunake & Coastal News,

Stratford Press
Health Centres – Stratford, Patea,
Opunake, Mokau

Base Hospital Library
Hawera Hospital Library
Corporate Reception

1
COMMUNITY PUBLIC HEALTH ADVISORY
COMMITTEE and DISABILITY SUPPORT
ADVISORY COMMITTEE
MEETING AGENDA
Tuesday 10 December 2013
12.30pm
Corporate Meeting Room 1
Taranaki Base Hospital
David Street
New Plymouth
Pages Action
1 Apologies - Te Aroha Hohaia Resolution
2 Public Comment Verbal
3 Chairman’s Report Verbal
4 Attendance Schedule 4 Noting
5 Presentation NB: Part of
“Taranaki Rheumatic Fever Prevention Plan 35-50 resolution to
Dr Jonathan Jarman, Medical Officer of Health receive included
in GM P&F report
6 Minutes – CPHAC and DSAC meeting
6.1 Minutes of meeting held 29 October 2013 5-13 Resolution
6.2 Matters Arising
7 Management Reports
7.1 Chief Advisor Maori Health 15-22 Resolution
7.2 General Manager Planning, Funding & Population 23-34
Health
8 General Business Resolution
9 Date of Next Meeting Noting
Next meeting 25 February 2014.
December 2013- CPHAC DSAC Agenda
2
COMMUNITY PUBLIC HEALTH ADVISORY COMMITTEE
and
DISABILITY SUPPORT ADVISORY COMMITTEE
RESOLUTIONS
Agenda Resolution 
Item No
1 APOLOGIES
That the Community Public Health Advisory Committee and
Disability Support Advisory Committee receive and note the
apology from Te Aroha Hohaia.
6 Minutes – CPHAC DSAC meeting
 That the minutes of the Community Public Health
Advisory Committee and Disability Support Advisory
Committee meeting held 29 October 2013 be received
as a true and accurate record.
Management Reports
7.1  That the Community Public Health Advisory Committee
and Disability Support Advisory Committee receive and
note the Management Report from Chief Advisor Maori
Health
7.2  That the Community Public Health Advisory Committee
and Disability Support Advisory Committee receive and
note the Management Report from the General
Manager Planning, Funding and Population Health and
 Receive and recommend the "Rheumatic Fever
Prevention Plan October 2013 - June 2017" to
the Board.
 Receive and note "The Child & Youth Health
Compass"
3
Attendance Records 2013 - 2014
TDHB Community Public Health Advisory Committee Meetings
Date 27 Augus2t 9 20O1ct3ob1e0r 2D0ec1e3mb2e5 r F2e0b1r3uary2 92 0A1p4ril 22041 J4une 2014TOTAL
CPHAC
Pauline Lockett (cid:1)
A
(2010 and 2013)
Remaining position to be
NA
confirmed
Alex Ballantyne (cid:1) (cid:1)
(2010 (Deputy) and 2013)
Karen Eagles (cid:1)
A
(2010 and 2013)
Flora Gilkison (cid:1) (cid:1)
(2010 (Chair) and 2013)
Richard Handley
(2013)
Te Aroha Hohaia
A
(2013)
Pat Leary
(2013)
Kevin Nielsen
(2013)
Alison Rumball (cid:1)
A
(2010 and 2013)
Aroaro Tamati
(2013)
Co-Opted
(cid:1) (cid:1)
David Tamatea
Ella Borrows (cid:1) (cid:1)
(2010)
Mary Bourke (cid:1)
A
(2010)
Peter Catt (cid:1)
A
(2010)
Kura Denness
A **A
(2010)
Brian Jeffares
A A
(2010)
Colleen Tuuta (cid:1)
A
(2010)
KEY
(cid:1)
Attended
A Apology
LOA Leave of Absence
AB Absent
NA Not Applicable
**Kura Denness - attended Allied Laundry
4
COMMUNITY & PUBLIC HEALTH / DISABILITY SUPPORT ADVISORY
COMMITTEES

MINUTES – PUBLIC (Unconfirmed)

Tuesday 29 October 2013
12.30pm
Stratford District Council Chambers
61-63 Miranda Street
STRATFORD

Present
Flora Gilkison (Chairperson), Peter Catt, Alex Ballantyne, Ella Borrows, Alison
Rumball, Colleen Tuuta, David Tamatea

In Attendance
Sandra Boardman (General Manager, Planning Funding & Population Health), Dr
Greg Simmons (Chief Medical Advisor), Ngawai Henare (Chief Advisor Maori
Health), Matua Ramon Tito (Kaumatua), Sue Carrington (Communications
Advisor), Vicki Kershaw Portfolio Manager Primary Health Care & Pharmacy),
Gillian Campbell (Clinical Services Manager), Tammy Taylor (Minute Taker),
Veronique Bauristhene (Corporate Administration).

755.0 Apologies
Resolution
That the apologies from Mary Bourke, Kura Denness, Brian Jeffares, Karen
Eagles, Pauline Lockett (Board Members) and Tony Foulkes (Chief Executive) be
received and noted.
Catt/Borrows
Carried

756.0 Welcome
Dr Gilkison called upon Matua Ramon Tito to open the meeting. Dr Gilkison
welcomed those present.

Dr Gilkison took the opportunity, as the new Board will be in place in December,
to thank Dr Catt for his work as Chair and Deputy Chair of both CPHAC and
DSAC. Dr Catt has been of huge support and has contributed invaluable clinical
information to both Committees over the last 12 years.

Special thanks were also paid to Mrs Borrows for her three years on the
Committee. Mrs Borrows has brought a wealth of community knowledge,
particularly to the CPHAC meetings.
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757.0 Public Comment
Mrs Nager requested time for public comment and as part of this thanked the
retiring Board Members for their work, and to those Board Members returning, she
expressed her congratulations.

On Page 16 of Mrs Boardman’s report, is reference to Primary Mental Health
Initiative Vouchers. Mrs Nager hopes that this matter can be clarified in terms of
those people eligible for the vouchers and how they can be obtained.

Mrs Nager would like it noted, in light of the presentation on the Agenda (“I’m Not
Well, Where Should I go?”) that after hours appointments in South Taranaki are
very scarce.

758.0 Chairperson’s Report
Dr Gilkison took the opportunity to acknowledge a recent report from the Ministry
of Health entitled Health Loss in New Zealand: A Report from the New Zealand
Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. Dr Gilkison
summarised the key strategic causes of illness and felt that this was very useful
for providing a framework when looking at key drivers for future work.

759.0 Attendance Schedule
The Attendance Schedule will be included in all Board Papers from this point on
and simply requires noting by Board Members. The Attendance Schedule for
today’s meeting was noted.

760.0 Presentation – “I’m Not Well, Where Should I Go?”
This presentation was delivered by Mrs Kershaw (Portfolio Manager, Primary
Health Care & Pharmacy) and Mrs Campbell (Clinical Services Manager).
Midlands Health Network also had some input into this. A copy of the
presentation text is included below:

SLIDE 1

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SLIDE 2
What’s the Problem?
 A significant number of people in Taranaki advise they are unable to get an
acute appointment with their GP Practice on the day they telephone
 People choosing to go to hospital emergency departments for treatment of
minor ailments when primary health care should be their medical ’home’
 Hospital care should be for emergencies and acute care and is generally
episodic but is currently being overloaded with patients of lower acuity who
could be managed in Primary Care

SLIDE 3
What Are We Doing About It?
 Taranaki DHB facilitated a ‘think tank’ on 13 August to identify the issues
and solutions with the aim of better meeting the acute demand of the
Taranaki population.

 Any solutions would need to meet the Government’s priorities of services
for patients to be provided ‘closer to home’ and ‘better, sooner more
convenient’.

SLIDE 4
Taranaki DHB Primary Health Acute Demand ‘Think Tank’ – 13 August 2013
Attendees
 St John Health Services
o Regional and Local Management
 Midlands Health Network
o Senior Clinicians and Management
o General Practitioners
 Taranaki DHB Hospital Services, Planning & Funding and Information
Technology Management Services
o Senior clinicians and management
 Medibank Health Solutions-Healthline
o Management
 Medicross Accident and Medical Clinic
o General Practitioner

SLIDE 5
What Did the ‘Think Tank’ Identify?
 GP’s and Accident and Medical Clinics advised that GP Practices in
Taranaki are mostly working at full capacity
 25,000 non-urgent patients presenting annually to Emergency Departments
with minor ailments

SLIDE 6
What’s the Current Situation?
 1:1750 patients per GP in Taranaki
 Midlands Health Network consider 1:1500 patients per GP is optimum but a
GP with an experienced team of nurses can provide care for 2000 -3000

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SLIDE 7
Where To From Here?
 Midlands Health Network are working with General Practice teams to
identify potential service delivery models that may increase capacity in
General Practices
 Identifying how Taranaki DHB can better inform the population on the
advantages of using Healthline as a first point of call for minor ailments
 The potential for St John Ambulance to transport patients to the right
service to provide services that meet the patient’s level of acuity

Discussion
The committee through the Chair thanked the presenters and the general
agreement was that this was a very worthwhile and informative presentation.
The committee wanted to ensure the issues were effectively communicated to the
public as a clear and concise message. The committee were also interested in
capacity generally available in the community including A and M clinics.
 It was advised by Mrs Campbell that during the ‘Think Tank’ it became clear
that GPs and A&M Clinics had no extra capacity. The demand for health
services for non-urgent patients is great. If the Emergency Department has
25000 presentations (approx. 70 per day) and primary care is at capacity –
where can the patients go?
The committee inquired about the level of input into the Think Tank from a
variety of different community groups, notably South Taranaki Community
Forum and Maori Providers.
 Management responded that this was North Taranaki only due to the growth
experienced at the Emergency Department and a lot of historical work has
already been done for South Taranaki – whereas this was the first exercise for
North Taranaki.
 Re Maori provider input the response was that the exercise was to enable the
primary GPs, Accident & Medical and Hospital Services to get together to
share information and look at issues. i.e. the exercise was mainly for Providers
who deliver acute services. The Providers invited were ones who all saw acute
demand patients and this enabled every Provider to see a clear picture across
the sector of how other Providers were affected by acute demand.
The committee inquired whether there would be another forum for consumers and
management responded that at some point, through the strategic work being
undertaken by the DHB, community and consumer forums would be established
to look at a raft of issues.
It was noted by the Chair that perhaps the terminology was confusing and that it
should be referred to as a ‘Provider Think Tank’.
The committee asked to be reminded of the ratio of GPs to population as well as
the visit ratio for the Midland area. Taranaki visit ratio is higher than the Midland
overall ratio and there was some discussion about the rationale for visits and what
the reason may have been for Taranaki to be higher than the overall Midland
region. The question was asked are Taranaki people going to the doctor too often
and what other services may be able to be used to provide quality health care but
not necessitate a doctor visit. The Committee further noted that if this information
was put to the media it may be a useful way to educate the public and to ensure
that services can be more effectively used to ensure Better Sooner More
Convenient but not necessarily have to have a face to face visit with a doctor.
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 Management responded that while there are 72 GPs who work in Taranaki,
not all full-time. The latest population statistics show Taranaki has a
population of 109,000.
.
Dr Catt gave a very good explanation about the change to GP practice; he
explained that most of the patients seen at his practice are for there for chronic
care conditions and not acute care. Chronic care conditions include
cardiovascular disease, diabetes, cancer follow-ups etc. Acute care such as a
sprain or broken bone is not as frequent. Chronic care patients take longer to see
in a consultation process with consultations taking 15 minutes when they used to
be given 10 minutes.
The payment system confines the level of change said Dr Catt. Payment is still
based on fee for service - which is Doctor driven.
He noted that there could be improved capacity of the GP/practice by doing
email/virtual consultations, such as those being undertaken by the Midland Health
Network. The payment method around this is very difficult, and patients are not
used to paying for email consultations.

At the completion of discussions during the presentation itself (as per above), The
Chair asked for brief comment or any questions from Board Members. These
were received as follows:

 Mrs Borrows commented that it would be good to change to Nurse
Practitioners or provide nurse-led clinics, but there is still resistance from some
Doctors to let this happen. There is the need to break down the silos. How
does capitation work for nurse-led clinics?
 Dr Catt agreed that many Doctors are resistant to Nurse Practitioners and the
change, but they may have to in light of the way performance monitoring is
heading for GPs.
 Mr Ballantyne noted that people seem to be attending far too much and yet
there is a large segment not going at all. Important to try and rationalise the
service.
 Ms Tuuta expressed a strong reservation around increasing capacity of
General Practices unless there is a major shift in the current model of care.
She would like to know the numbers of part-time versus full-time GPs in
Taranaki. Does the DHB know the numbers of people accessing the Healthline
service and what percentage is being directed to ED?
 Mrs Campbell responded that she did not have figures to hand for Healthline,
but was very surprised to see not only how high the number was, but the
relatively low number that are then referred to ED.
 Ms Tuuta noted the need for a Communications Plan to get the message out
to the general public around Healthline and the service it offers as well as
Healthline Vs ED.
 Mrs Rumball commented that she would like to see an education campaign to
change the mind-set and increase community knowledge around Healthline;
suggesting that Community Forums could also be used to spread this
particular message.
 Mr Tamatea advised that he had been given different numbers by the
Midlands Health Network in terms of rural GPs and practice numbers. He
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asked what would happen to elderly people who cannot speak for themselves,
if they need to contact Healthline. There needs to be a face-to-face option.

Dr Gilkison wrapped this part of the Agenda up by agreeing that the workshop
was part of a growing problem and steps are being taken to try and address the
problem. In addition, the DHB must not lose sight of the larger picture of what a
health family is – including housing, education, spirituality, nutrition, exercise etc –
a holistic approach.

761.0 Minutes – Previous CPHAC / DSAC Meeting
Resolution
That the Community and Public Health Advisory Committee and the Disability
Support Advisory Committee resolve to accept the Minutes of the meeting held on
27 August 2013 as a true and accurate record.
Tamatea/Ballantyne
Carried

761.1 Matters Arising from Previous Minutes

761.2 Mr Ballantyne asked for clarification around the Ethnicity Data Toolkit and
whether this is being used or not.

Discussion
 Mrs Henare explained that the Ministry of Health sponsored the development
of an Ethnicity Data Toolkit because of the importance of accurate ethnicity
data in the DHB and Primary Health Organisations. The Taranaki Alliance
Leadership Team met recently to discuss ethnicity data and Mrs Boardman
was present at that meeting. Mrs Boardman advised that overall the Midlands
Health Network achieves a high level of compliance with collecting ethnicity
data. However, there are two practices that have recently joined the Midlands
Health Network in Taranaki and these have reduced the level of compliance
locally. The Alliance Leadership Team (ALT) recognises that the induction
process for new practices should resolve this issue. The DHB agreed to give
MHN 12 months to gain full compliance with ethnicity data collection and if this
does not happen, the Ethnicity Data Toolkit will be reconsidered by ALT.
 Mrs Henare felt that it was depended on what the PHO was using to determine
the accuracy of the ethnicity data. The conversations are around the actual
accuracy of the data collected, not whether data is being collected.
 Mrs Boardman relayed to the Board that there is a protocol from the Ministry of
Health that outlines what is expected of DHBs for ethnicity data collection.
 In addition to the protocol, Dr Catt advised that data collection is part of a
general audit of GP practices. Ethnicity data also accounts for
payment/funding of General Practices.

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