Counties Manukau District Health Board Board Meeting Agenda

Counties Manukau District Health Board 

Board Meeting Agenda 

Wednesday, 30 November 2016 at 1.30 – 4.30pm, Room 107, Ko Awatea, Middlemore 

Hospital, Hospital Road, Otahuhu, Auckland 

Time 

Item 

1.00 – 1.30pm Board Only Session 

1.30 – 1.40pm 2. Governance 

1. Welcome (including incoming Board Members in attendance) 

1.40 – 1.50pm 

1.50 – 2.00pm 

2.00 – 2.10pm 

2.1. Attendance & Apologies – Wendy Lai, Reece Autagavaia 

2.2. Conflicts of Interest/Specific Interests 

2.3. Confirmation of Public Minutes – 19 October 2016 

2.4. Action Items Register 

3. Strategy 

3.1. Chair’s Report (Verbal Update) 

3.2. Chief Executive’s Report 

3.2.1. Occupational Health & Safety – Q1 Report (Bev Stone) 

4. General Business 

2.10 – 2.15pm 5. Resolution to Exclude the Public 

2.15 – 2.20pm 

2.20 – 2.25pm 

2.25 – 2.40pm 

2.40 – 2.50pm 

2.50 – 3.00pm 

3.00 – 3.10pm 

3.10 – 3.20pm 

3.20 – 3.30pm 

3.40 – 3.50pm 

3.50 – 4.00pm 

4.00 – 4.10pm 

4.10 – 4.20pm 

4.20 – 4.30pm 

4.30 – 4.40pm 

6. Confidential 

6.1. Confirmation of Confidential Minutes – 19 October 2016 

6.2. Action Items Register 

6.3. SMO Leave (Margaret White) 

6.4. National Oracle Solution (Margaret White) 

6.5. Manukau Land (Louise Zacest/John Hanson) 

6.6. Draft Fraud Monitoring & Management Policy (John Hanson) 

6.7. Scott Building Recladding (John Hanson) 

6.8. 70 Victoria Street, Pukekohe (John Hanson) 

Afternoon Tea Break 

6.9. Asset Disposal & Transfer (Margaret White) 

6.10. Bereavement Care Services Contract Award (Gloria Johnson/Ramari Matairangi) 

6.11. Draft Quality Accounts 2015/16 (Jo Rankine) 

6.12. Healthy Together 2020 - Technology Update (Sarah Thirlwall) 

6.13. Point of Care Devices (Sarah Thirlwall) 

6.14. IS Projects Update (Leanne Elder) 

Next Meeting: 15 February 2017 

Room 107, Ko Awatea, Middlemore Hospital, Otahuhu 

Counties Manukau District Health Board Agenda 

1

Board Member Attendance Schedule 2016 

Name Jan 10 Feb 23 Mar 4 May 15 June 27 July 7 Sept 19 Oct 30 Nov 

Lee Mathias (Chair) 

 

Wendy Lai (Deputy Chair) 

Arthur Anae - - - 

Colleen Brown 

Sandra Alofivae 

No Meeting 

Lyn Murphy 

David Collings * 

Kathy Maxwell 

George Ngatai 

Dianne Glenn 

Reece Autagavaia 

* Attended part meeting only 

Counties Manukau District Health Board Agenda 30 November 2016 

2

BOARD MEMBERS’ 

DISCLOSURE OF INTERESTS 

November 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 

Wendy Lai, Deputy Chair • Partner, Deloitte 

• Board Member Te Papa Tongarewa, the Museum of 

New Zealand 

• Chair, Ziera Shoes 

• Board Member, Avanti Finance 

Arthur Anae • Councillor, Auckland Council 

• Member, The John Walker ‘Find Your Field of 

Dreams’ 

Colleen Brown • Chair, Disability Connect (Auckland Metropolitan 

Area) 

• Member, 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 


3

Dr Lyn Murphy • Member, ACT NZ 

• Director, Bizness Synergy Training Ltd 

• Director, Synergex Holdings Ltd 

• Trustee, Synergex Trust 

• Member, International Society of 

Pharmacoeconomics and Outcome Research (ISPOR 

NZ) 

• Member, New Zealand Association of Clinical 

Research (NZACRes) 

• Member, Franklin Local Board 

• Senior Lecturer, AUT University School of Inter 

professional Health Studies 

• Member, Public Health Association of New Zealand 

Sandra Alofivae • Member, Fonua Ola Board 

• Director, Housing New Zealand 

• Member, Ministerial Advisory Council for Pacific 

Island Affairs 

• Member, Social Housing Reference Group 

• Chair, Social Investment Board 

David Collings • Chair, Howick Local Board of Auckland Council 

• Member, Auckland Council Southern Initiative 

Kathy Maxwell • Director, Kathy the Chemist Ltd 

• Regional Pharmacy Advisory Group, Propharma 

(Pharmacy Retailing (NZ) Ltd) 

• Editorial Advisory Board, New Zealand Formulary 

• Member, Pharmaceutical Society of NZ 

• Trustee, Maxwell Family Trust 

• Member, Manukau Locality Leadership Group, 

CMDHB 

• Board Member, Pharmacy Guild of New Zealand 

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 

• Justice of the Peace 

• Member, Pacific Women’s Watch (NZ) 

• Member, Auckland Disabled Women’s Group 


4

George Ngatai • Chair, Safer Aotearoa Family Violence Prevention 

Network 

• Director, Transitioning Out Aotearoa 

• Director, BDO Marketing 

• Board Member, Manurewa Marae 

• Conservation Volunteers New Zealand 

• Maori Gout Action Group 

• Nga Ngaru Rautahi o Aotearoa Board 

• Transitioning out Aotearoa provides services and 

back office support to Huakina Development Trust 

and also provide GP Services to their people 

• Chair, Restorative Practices NZ 

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 


5

BOARD MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS 

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at November 2016 

Director having interest Interest in Particulars of interest Disclosure date Board Action 

David Collings Innovation Hub Mr David Collings has a conflict 

of interest in regard to ATEED 

(being a member of the Local 

Community Board, which is 

part of the Auckland Council) 

and will be involved in the 

Innovation Hub. 

5 October 2011 The Board notes that Mr Collings has a 

conflict of interest in regard to the 

Innovation Hub. He may participate in the 

deliberations of the Board in relation to this 

matter because he is able to assist the Board 

with relevant information, but is not 

permitted to participate in decision making. 

David Collings 

Potential Botany Land 

Development 

Mr Collings declared a specific 

interest in relation to the 

Potential Botany Land 

Development, being a member 

of the Howick Local Board. 

4 September 2013 That Mr Collings’ specific interest be noted 

and that the Board agree that he may 

remain in the room and participate in any 

deliberations or decisions. 

Wendy Lai 

George Ngatai 

HBL – Food & Laundry & 

FPSC Programme 

Community Services 

Pharmacy Funding Policy 

Ms Lai declared a specific 

interest in regard to Deloitte 

providing support to HBL in the 

food and laundry and FPSC 

Programme. Deloitte has 

mainly been providing Oracle 

implementation resources to 

FPSC. Ms Lai is not directly 

involved with this work. 

Mr Ngatai declared a specific 

interest in terms of their GP 

Service being like to use a local 

Pharmacy. 

12 February 2014 That Ms Lai’s specific interest be noted and 

that the Board agree that she may remain in 

the room and participate in any 

deliberations, but be excluded from any 

voting. 

13 August 2014 That Mr Ngatai’s specific interest be noted 




voting. 


6

Wendy Lai HBL Business Cases Ms Lai declared a specific 

interest in regard to Deloitte’s 

involvement with HBL on this 

work. 

Wendy Lai 

Ko Awatea Panel Advisory 

Services 

Ms Lai advised that Deloitte 

have been shortlisted to 

provide Panel Advisory 

Services to Ko Awatea. This 

work does not have any 

involvement with the APAC 

Business Case 

Lee Mathias Otahuhu Boundary Change The Chair noted her Specific 

Conflict of Interest, being 

Deputy Chair at ADHB. 

Lee Mathias 

Northern Region Electronic 

Health Record (NEHR) 

Project & Regional 

Information Strategy (RIS 

10-20) Refresh 

The Chair declared her specific 

interest as a Director of 

HealthAlliance. 

Wendy Lai FPSC Ms Lai advised that Deloitte is 

involved with FPSC, but 

confirmed that she personally 

does not have any 

involvement. 

Wendy Lai EPIC Ms Lai noted that a Deloitte 

colleague worked with EPIC in 

the US. Mr Pearson and Mrs 

Zacest have met with him for 

his independent expertise on 

EPIC. 

13 August 2014 That Ms Lai’s specific interest be noted and 

that she may not participate in either the 

deliberations or determination of the Board 

in relation to this matter and is asked to 

leave the room. 

5 November 2014 Noted. Ms Lai advised on the 3 December 

2014 that Deloitte have now been selected 

to work with the Ko Awatea team to improve 

commercial awareness and increase income 

levels. 

25 March 2015 That Dr Mathias’ specific interest be noted 

and that the Board agree that she may 



voting. 

25 March 2015 That Dr Mathias’ specific interest be noted 




voting. 

6 May 2015 That Ms Lai’s specific interest be noted and 




voting. 

6 May 2015 That Ms Lai’s specific interest be noted and 




voting. 


7

Wendy Lai Botany Land Discussions Ms Lai advised that Deloitte 

has been appointed by the 

three parties involved in the 

Botany Land discussions 

(CMDHB, BUPA & East Health). 

She is not personally involved 

in this work. 

David Collings 

Lyn Murphy 

Lyn Murphy 

Kathy Maxwell 

Fencing of Swimming Pools 

Legislation 

Fencing of Swimming Pools 

Legislation 

MIT Nursing Programme 

Report 

Integrated Pharmacist 

Services 

Mr Collings advised that he is 

the Chair of the Howick Local 

Advisory Board Swimming Pool 

Fencing Exemption Committee. 

Mrs Murphy advised that she is 

the Deputy Chair of the 

Swimming Pool Fencing 

Exemption Committee for 

Franklin Local Board. 

Mrs Murphy is a Lecturer in 

the Faculty of Business & 

Information Technology at 

MIT. 

Mrs Maxwell is a Pharmacist/ 

Director of Kathy The Chemist 

Ltd. 

Sandra Alofivae Social Investment Board Mrs Alofivae has been 

appointed Chair of the Social 

Investment Board. 

17 June 2015 That Ms Lai’s specific interest be noted and 




voting. 

9 September 2015 That Mr Collings’ specific interest be noted 




voting. 

9 September 2015 That Mrs Murphy’s specific interest be noted 




voting. 

9 September 2015 That Mrs Murphy’s specific interest be noted 




voting. 

27 July 2016 That Mrs Maxwell’s specific interest be 

noted and that she may not participate in 

either the deliberations or determination of 

the Board in relation to this matter and is 

asked to leave the room. The Chair 

permitted Mrs Maxwell to read out a 

statement prior to her departure. 

27 July 2016 That Mrs Alofivae’s specific interest be noted 

and that she may not participate in either 

the deliberations or determination of the 

Board in relation to this matter, but may 

remain in the room. 


8

Minutes of Counties Manukau District Health Board 

Held on Wednesday, 19 October 2016 at 1.30 – 4.30pm Room 101, Ko Awatea, Middlemore Hospital, 

Hospital Road, Otahuhu, Auckland 

Present: 

In attendance: 

Apologies: 

Dr Lee Mathias (Chair), Mrs Dianne Glenn, Mrs Sandra Alofivae, Mrs Kathy 

Maxwell, Mr David Collings, Dr Lyn Murphy, Mrs Colleen Brown 

Mr Ron Pearson (Acting CEO), Mrs Lyn Butler (Board Secretary) 

Ms Wendy Lai, Mr George Ngatai, Apulu Reece Autagavaia, Mr Geraint Martin 

(Chief Executive) 

The Board met prior to the meeting to discuss the Board appraisal process which had recently been 

undertaken. 

1. Welcome 

The Chair welcomed everyone to the meeting, and congratulated the re-elected members to 

the Board, and extended commiserations to Mrs Kathy Maxwell and Mr David Collings. 

Dr Colin Thompson was in attendance. 

2. Governance 

2.1 Attendance & Apologies 

Noted. 

2.2 Conflicts of Interest/Specific Interests 

Noted. 

2.3 Confirmation of Public Minutes – 7 September 2016 

Resolution 

That the public Minutes of the Board Meeting held on Wednesday, 7 September 2016, 

were taken as read and confirmed as a true and correct record. 

Moved: Dianne Glenn Seconded: Lyn Murphy Carried: Unanimously 

2.4 Action Items Register 

Noted. 

3. Strategy 

3.1 Chair’s Report - verbal update (Lee Mathias) 

The Chair advised that she had completed the hA Occupational Health & Safety 

walkaround of the loading dock, stores and supply chain management, praising the 

Harley Gray Building which has all the right systems and processes in place. 


9

Mr Kevin Robinson has been tasked with a ‘deep dive’ review of the challenges in the 

area of infrastructure, and will focus on this for the next 12 months. Servers have been 

upgraded to get through to handover of the revamped NIP programme. One partner is 

not keen on focusing on ‘middleware’, which needs to be resolved before adding on. 

A reboot of the NIP programme is underway. The Northern Region is supportive of 

Phases 1-3, but Phase 4 requires more support. Mr Pearson advised that there would be 

termination costs of approximately $400,000, which is a frustrating outcome. The Chair 

advised that the contract from DIA was challenging, and all future Northern Region 

contracts must be legally reviewed prior to signing. 

Mr Pearson referred to the implications of rollout delay for NIP and NOS. The Chair said 

that there is a lack of storage space available in NZ. The Government has now advised 

that data can be stored in Australasia (Microsoft, Google, Cloud), which will provide a 

huge increase in storage available. 

3.2 Chief Executive’s Report 

The report was taken as read. 

Mr Pearson updated the Board on work around whole of system transformation. There 

is currently good core stability and discipline around systems, but this needs to be done 

on a wider basis. An update will be brought to the next Board Meeting. 

The Provider Arm is holding budget under pressure. Clinical Supplies are again over 

budget. There are concerns on quality and quantity of delivery of oral health by WDHB. 

APAC was extremely successful again this year. A detailed report will come to the 

November Board Meeting. 

Mrs Alofivae and Mrs Brown both referred to the ‘Talking Matters’ Contract in the Ko 

Awatea report, as they felt this was outside our core business. Mr Martin is to provide 

more detail on this, as it is more in the educational field. 

The Chair requested a Deep Dive on Clinical Supplies at the next HAC Meeting. 

Resolution 

That the Chief Executive’s Report be received. 

Moved: Lee Mathias Seconded: Kathy Maxwell Carried: Unanimously 

3.2.1 Health & Safety Update (Bev Stone) 

The report was taken as read. 

Mrs Stone advised that ‘Worker Participation’ is one of four changes under the 

new legislation, with the focus on hazard and risk processes. Worker Participation 

has been aligned with our risk framework. A H&S Community Health Worker is 

looking at the process from a clinical, operational and H&S perspective. 

H&S Committees currently function in siloes. There are 200 H&S reps at CMDHB, 

and drop In forums are held for staff. 

Mr Collings thanked Mrs Stone for her work during the joint H&S walkaround 

audits undertaken whilst he has been on the Board. 


10

4. General Business 

None. 

5. Resolution to Exclude the Public 

Resolution 

That the Board: 

Receive the Health & Safety Update. 

Moved: Dianne Glenn Seconded: Sandra Alofivae Carried: Unanimously 

Resolution 

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ 

Public Health & Disability Act 2000, that the public now be excluded from the meeting as detailed 

in the above paper. 

Moved: Lyn Murphy Seconded: Kathy Maxwell Carried: Unanimously 

The meeting closed at 3.55pm. The next meeting of the Board will be Wednesday, 30 November 

2016 at Ko Awatea, Middlemore Hospital. 

The Minutes of the meeting of the Counties Manukau District Health Board of 19 October 2016 are 

approved. 

Signed as a true and correct record on 30 November 2016. 

Chair 

………………………………………….. 

Dr Lee Mathias (Chair) 


11


Action Items Register (Public) 

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE 

 

19 October CE Report An update on the whole of system November Geraint Martin/ Included in November Meeting 

transformation will be brought to the next 

Board Meeting. 

David Lenihan papers. 

APAC was extremely successful again this year. 

A detailed report will come to the November 

Board Meeting. 

November 

Jonathon Gray 

This has been deferred to the 

February Board Meeting to allow 

the detailed financials to be 

completed. 

Mrs Alofivae and Mrs Brown both referred to 

the ‘Talking Matters’ Contract in the Ko Awatea 

report, as they felt this was outside our core 

business. Mr Martin is to provide more detail 

on this, as it is more in the educational field. 

November 

Geraint Martin 

Detailed information included in 

November CE Report. 

 

The Chair requested a Deep Dive on Clinical 

Supplies at the next HAC Meeting. 

November 

Phillip Balmer/ 

Margaret White 

On HAC Agenda for November. 

 


12

Recommendation 

It is recommended that the Board: 

Receive the Chief Executive’s Report. 


Chief Executive’s Report 

Prepared and submitted by: Geraint Martin, Chief Executive 

1.0 Introduction 

1.1 As routine, my report is set out in three sections: 

- Strategic – with a special focus on planning for 2016/17. 

- Operational – including the reports from the Director of Strategic Development, 

Director of Corporate & Business Services and Director of Ko Awatea. 

- Compliance – included is the report on Health & Safety. 

2.0 Strategic 

2.1 Building Momentum in Transformation 

This month, I want to brief the Board on progress in developing the Target Operating 

Model (TOM) for the delivery of Healthy Together 2020. 

David Lenihan joined my leadership team in July with responsibility for co-ordinating 

the delivery of our Healthy Together 2020 strategy. Since his arrival, David has 

invested significant effort in creating the ‘change frameworks’ that will enable us to 

be more focused, precise and systematised in our delivery. 

Three core elements underpin this reinvigorated approach to delivering HT2020: 

1. Making change clear: Creating a clear view of ‘what HT2020 change means’ and 

the impact the strategy will have on our services, staff and communities. 

2. Making change affordable: Managing change within the wider context of our 

financial situation and operational pressures. 

3. Making change engaging: Engaging clinicians in the leadership of change. Valuing 

their knowledge and their time. 

1. Making change clear: What will the health system look like after we have 

delivered HT2020? What will be different and what does success look like? 

Work is progressing to answer these questions in detail using a tool called a 

‘Target Operating Model (TOM)’. An operating model is simply a way of 

describing “how we do what we do’. The HT2020 TOM describes what the 

future operations of Counties Manukau Health will need look like to deliver 

Heathy Together. Building on all the work undertaken to date, the HT2020 

TOM will describe the processes, IT systems, contracts, facilities and people 

skills needed to run the health system in 2020. 


13

The TOM will also help us model scenarios and services to determine the best 

operating state. It will help us create a clear operational view of our vision. It 

will enable us to navigate the change journey effectively, prioritising where we 

focus our efforts. 

2. Making change affordable: We cannot deliver change at any cost. We must 

deliver change while balancing our budget. We must also deliver change while 

continuing to provide high-quality services today. 

Work is underway to develop an affordable roadmap for change. This work will 

use the TOM, and our population health data, to approach change from two 

perspectives: 

i. Delivering change initiatives that produce benefits in the short term. These 

benefits will focus on transforming services to increase the capacity of the 

health system to deal with rising ‘in-year’ demand. 

ii. Delivering change initiatives that provide benefits in the medium to long 

term. These benefits will impact the nature of service demand (e.g. Social 

Investment Board). 

The TOM, and its roadmap, are being used to bolster our approach to 

preparing our budgets for 2017/18. It will ensure that our change 

investments are precise and that they deliver value we can measure. 

3. Making change engaging: The TOM will provide a blueprint for the choices we 

need to make and how we prioritise our change efforts. It will also facilitate a 

much more consistent and meaningful way of engaging our clinicians in the 

design of safe ‘whole of system’ health services. 

Supported by senior clinicians, a network-based engagement model is being 

developed that will involve clinicians from across the whole system. These 

‘whole system networks’ will put clinicians at the heart of leading the design of 

Healthy Together services. 

David will be presenting in more detail at the Board Meeting. 

2.2 Appointment of Director of Patient Care/Chief Nurse & Allied Health Officer 

I am delighted to announce that Jenny Parr has been appointed to this crucial 

strategic role. Jenny is currently leading on the Patient Experience at Waitemata 

DHB, and before that has extensive Director of Nursing experience in London. 

It is a homecoming for Jenny, who was brought up in Papatoetoe and trained at 

Middlemore. She will join us in mid-January 2017. 


14

3.0 Operational 

3.1 Primary, Community & Integrated Care 

The health target results for quarter one show immunisation rates at 94% and Better 

Help for Smokers to Quit at 89%, meaning both are one percentage point away from 

achievement of the annual target. We expect to reach these targets in Quarter Two. 

Performance against the new ‘Raising Healthy Kids’ target is low at 29%. 

Performance for this target in Q1 is calculated on six months rolling data of obese 

children identified, referred, and referral acknowledged between 1 March 2016 to 31 

August 2016. As our numbers of children in this category are very high, it is not 

possible to systematically collect this information manually. An automated system 

has now been introduced to record this data, which will result in a jump in 

achievement at the end of Quarter Two and it will give a true reflection of our target 

performance in subsequent quarters. Care pathways, a Ko Awatea led campaign, and 

new nutrition and physical activity services are all being established to try and turn 

the tide on rising child obesity in South Auckland. 

Indicators in most other areas of child health, including SUDI, acute rheumatic fever 

rates, and Before School Checks are ahead of target and showing improvement, 

however, we are continuing to work with the Auckland Regional Dental Service on a 

plan to clear the backlog of unseen children. 23,060 patients with long term 

conditions are benefiting from proactive care co-ordination and goal-based care 

plans, and 400 are benefiting from Reablement. The positive trend in terms of 

declining rates of acute hospitalisations, ED attendance and re-admission continued 

during Q1. 

3.2 Hospital Services 

Hospital Services remains responsible for the delivery of three national health 

targets; Shorter Stays in Emergency Departments, Improved Access to Elective 

Surgery, and Faster Cancer Treatment (FCT). In October, both the Emergency 

Department and Elective Surgery targets were achieved, and good progress was 

made towards delivery of the FCT target (a result of 84%) excluding patient choice is 

88. We have been preparing for a combined workshop on the 7 th of November at 

which we can share learnings and identify improvement opportunities from each of 

the working groups. We continue to meet our diagnostic targets in cardiology, 

colonoscopy, CT and MRI. 

We have been working with community and primary care to improve our System 

Level Measures. The locality GMs and community teams have joined the fortnightly 

MMCSG meeting to progress key initiatives in this area. We have made good 

progress in our SLMs with no growth in discharges, a reduced LOS and 2,221 less 

overnight beds occupied as a result. 

We are making good progress with our theatre improvement project although the 

RMO strike on 18 and 19 October 2016 has had a detrimental effect on our 

improvement work. There were 93 elective cases postponed which also impacted on 

our production plan. Any further strikes will exacerbate this further. 


15

We have reviewed all follow up growth alongside our FSA waiting times to ensure we 

are proactive in addressing pressure areas and responding to growth pressures with 

a range of options including sending back to primary care, virtual clinics, and GP 

advice hotlines. The new ophthalmology expansion site has been approved and work 

has begun to design and fit out new clinics on Level 3 Galbraith. Equipment ordering 

is underway and we are planning on commissioning in December. 

Health Target Summary – 2016/17 

Target Current Results Status 

by 30 

June 

2017 

Emergency 

Departments 

95% of patients will be admitted, discharged, or transferred from an 

Emergency Department (ED) within six hours 

September result: 96% 

ACHIEVE 

Elective Surgery* 

Elective surgery will increase by an average of 4,000 discharges per 

year 

Faster 

Treatment 

Cancer 

September result: 110.1% 

WEIS: 100% (YTD 22,877 actual against 22,939 planned) 

ESPI2: 0.1% 11 FSA breaches in September (target of 0) 

ESPI5: 0.4% 13 FSA breaches for treatment for Q1 (target of 0) 

85% of patients receive their first cancer treatment (or other 

management) within 62 days of being referred with a high suspicion 

of cancer and a need to be seen within two weeks. 

ACHIEVE 

October result (preliminary result only): 84% 

88% performance excluding patient choice related reasons for 

October. 

ON 

COURSE 

Immunisation 

Note: Indicative results for October suggest CM Health is within 1% 

of the target of 85% for the first time, reflecting the dedicated 

efforts of the team and wider system. 

95% of eight month olds will have had their primary course of 

immunisation on time (and significant progress has been made 

towards the target for the Maaori and Pacific population groups). 

September result: 94% for total population 

• Maaori coverage: 86% 

• Pacific coverage: 96% 

ON 

COURSE 

Raising 

Kids** 

Healthy 

ACTION: An Immunisation Taskforce was established in October 

2016. An analysis of the reasons behind the late immunisation of 

Maaori babies has been performed in order to eliminate equity gaps 

and better understand how CM Health can assist Maaori whaanau 

with the immunisation decision and accessing services. 

95% of obese children identified in the Before School Check (B4SC) 

programme will be offered a referral to a health professional for 

clinical assessment and family based nutrition, activity and lifestyle 

interventions (by December 2017) 

Result (for 6 months to the end of August 2016): 29% 

NEW 

TARGET 

Note: An electronic referral process from B4SC to primary care 


16

has been set up and operational since 30 September 2016. We are 

confident that all referrals from 30 September will be acknowledged 

and therefore we are on track to achieve the health target (100% 

acknowledgement should be reflected in reporting from Q4 

2016/17 due to delay in reporting). 

Tobacco 

Primary 

90% of PHO enrolled patients who smoke have been offered help to 

quit smoking by a health care practitioner in the last 15 months 

October result: 83% 

Note: A dip in performance in the first month of each quarter is 

expected due to changing PHO enrolment patterns (baselines). 

Maternity 90% of pregnant women who identify as smokers upon registration 

with a DHB-employed midwife or Lead Maternity Carer are offered 

brief advice and support to quit smoking 

September result: 86% 

Note: Recent DHB category changes within the Maternity Clinical 

Information System (MCIS) system have distorted this result. 

Investigation is in progress. 

ON 

COURSE 

ON 

COURSE 

ACHIEVED: Already meeting target/will meet target by 30 June 2017. 

ON COURSE: Includes actions to meet target; expected to meet target by 30 June 2017. 

* Performance against the Elective Surgery target is reported one month in arrears. 

** New health target for 2016/17 with data provided from the MOH quarterly (for previous 6 

months) 


17

4.0 Strategic Development 

Deep Dive – Social Investment Board Update 

The SIB met for the first time on the 23 rd September. This report offers a summary of the 

SIB’s work to date and insights on the implications for health. To recap, the SIB’s first cohort 

‘off the rank’ in the 16/17 year is Mangere, 0-5yr olds with the focus on the three priority 

outcomes: 

• reducing the number of children experiencing substantiated physical abuse 

• increasing the number of children participating in ECE before they start school 

• reducing the number of preventable child hospitalisations for illnesses. 

In addition, the SIB was asked by Cabinet to: 

• build an analytical base for the SIB’s work 

• develop information sharing arrangements 

• ensure alignment with the Children’s Team and the new children’s entity and 

• deliver and assess interventions. 

We are building the plane while flying… 

Ideally, the implementation of a social investment approach for South Auckland would see us 

achieving the following from a whole of social sector perspective: 

• firstly establishing the analytical capability that would enable a systematic analysis of 

the coverage and insights on the reach, impact and effectiveness of current 

investments; 

• identify more readily at risk groups ‘in real time’ meaning we can shift resources to 

reach and intervene early and opportunistically for those groups; 

• measure the effectiveness of services so that we know what works well and what 

doesn’t; 

• adapt the way we purchase, commission/contract or deliver so that we are more 

relevant and responsive to needs as they emerge. 

In reality, we are developing our collective capacity to achieve these objectives at the same 

time as preparing to implement improvements. 

Building local analytical capability will take some time…. 

Analytics has been defined as the ‘scientific process of transforming data into insight for 

making better decisions’ 1 . Data includes both quantitative and qualitative information. 

Building analytical capability will take time. We are in early design phase and heavily reliant 

on national developments and are working to ensure we are aligned. Below is a picture of 

the components of the analytical ‘system’ in simple form. Its components comprise (in very 

crude terms!): 

• defined data extracts from national systems and local information 

• ‘pipes’ to enable safe, secure data transfer between agencies and organisations 

providing services 

• a ‘tank’ to store data in a form that enables joining up data at an individual level where 

that is available and appropriate for use 

• intelligence to mine and analyse and make meaning of what we see 

• formulation of advice on trends and observations of what’s happening (e.g. what is 

working? What is not?) 

1 https://www.informs.org/About-INFORMS/What-is-Analytics 


18

This advice can then inform changes to what we do by making investment decisions that aim 

to improve. 

Now that we have clarified where the local analytical capability for social investment may sit 

alongside national, we will now progress to more detailed design and build. This will require 

additional investment and take more time. To this point the collective work of the ‘analytics 

work stream’ has focused on sourcing data across agencies to inform early SIB decision making. 

Investigation of analytical platform issues has been undertaken by a subset of the working 

group. 

Next steps will require work on both of those fronts and it is timely for agencies to revisit 

whether the right people to inform that next stage are in the workstream. 

We have gathered enough information to see opportunities to improve the experiences of 

Māngere at risk 0-5yr olds and their families… 

We do not need to wait for full analytical capability to be built before acting. Sources of advice 

include reflecting on best practice and seeking Māngere community insights on what is effective 

and supported. Along with analysis of available data provided to us from agencies on universal 

and targeted services delivered in Māngere, we can draw some early observations. 

• Analysis of PHO enrolment data (consistent with wider census analyses) highlights the 

dynamic nature of the Māngere population – 12.5% of children aged 0-5 years had shifted 

out of the SIB area in one year period (this figure rises to 16% if children who become 

unenrolled in a year are also taken into account), a further 13% had changed address within 

the SIB area and a smaller number had shifted into the SIB area. This has significant 

implications for analytical work (including choice of denominator), intervention design and 

implementation, continuity of follow-up, and evaluation. 

• Statistics New Zealand estimated population for the Māngere SIB area is consistently lower 

than actual number of unique people who had interactions with publicly funded services in 

the corresponding time period, such as the actual count of individuals from the IDI or the 

Health Tracker constructed population. In line with the principle agreed at the first SIB 

meeting, that we will work in such a way that we make/keep people in need visible, we 

provisionally recommended the use of the Health Tracker constructed population (subject 

to further inputs from other sector analysts) as the population denominator. The choice of 

health tracker population denominator is expected to provide more realistic but lower 

calculated coverage level of services overall. 


19

• The advantage of using the Health tracker is that Primary Health Organisation enrolment is 

high and contact details are potentially available from previous health service utilisations to 

support better identification and recall of people who could benefit from a range of 

universal and targeted services. 

• Initial analyses suggest there are substantial opportunities to improve the reach and 

coverage of universal services (ECE, Well Child, Oral health, Maternity, Primary Care) for 

children aged 0-5 years in Māngere. 

• Gaps in information exist, including around reach, coverage and impact of current services 

and describing the person-journey through various existing services (including referral 

pathways, service configuration, nature and thresholds for intervention, volumes, and 

outcomes). This is particularly the case for targeted services. 

• There are areas where additional process mapping would be particularly valuable to 

understand the reach of current services, identify unmet need and inform interventions 

thinking, for example, understanding the impact of drug and alcohol addiction and gaps in 

addressing this need. This process mapping could also be able to identify particular 

information gaps that need to be addressed to facilitate analytics, monitoring and 

evaluation going forward. 

When compared against internationally recognised best practice there are opportunities for 

improvement in our current offerings 

To determine the range of opportunities for investment, the Social Investment Board (SIB) 

applied an intervention logic adapted from the US Centre for Disease Control and Prevention 

Technical Package reviewing policy, norms and programmatic activities that are likely to reduce 

child abuse. Professionals confirm that these same interventions are likely to improve ECE 

participation and potentially reduce hospitalisations. 


20

Mangere community views are we should ‘get on with it’ and engage them in detailed 

conversation and co-design on the critical themes 

At the first meeting of Mangere community leaders that included 27 community NGOs and 

providers, the key themes offered up about the social investment approach were: 

• many observations were shared on how rules can be flexed and agencies could use their 

discretion to better use current resources to support vulnerable families- one example 

shared was of a solo mum who had never missed her rent payment, had a child in ECE and 

had a job in the neighbourhood etc. Her mum passed away which caused emotional stress 

and she took in her mum’s dog (which she had an emotional connection too). Housing NZ 

issued an eviction notice on the basis that the dog was not permitted on the premises…. It 

took 8 weeks of meetings for that NGO and eventually a phone call to Minister Bennett to 

get them to reconsider their decision and not issue an eviction notice. Yet the ability to be 

compassionate and flexible is within agency’s discretion; 

• get the basics right to improve ECE participation and engagement. There are logistical 

barriers for families in the area (e.g. transport) that need to be considered in planning the 

location and support of ECEs; 

• agreement that quality of ECE needs a closer look, including the format of ECE teaching so it’s 

more culturally relevant. There is a strong network of ECEs in some areas (e.g. Pasifika, 

community based NGOs) that a collective approach can be built on but this needs time (i.e. a 

day or two for deep dive into issues not a few hours); 

• There was also talk about transparency around contract funding, and some providers have 

had their contracts ended and money reallocated elsewhere without understanding why – 

this is despite evidence, in their view, that services on the ground are working. The 

destabilising effect this has on local workforces and services was undervalued and not 

recognised by agencies; 

• Community asked about other agencies not on the SIB – Auckland Council, Immigration. 

These agencies have significant impact on local issues. Jobs are critical – people essentially 

need jobs and employment but face barriers to being in employment. 

There was an overwhelming concern about the institutional racism their clients face from 

some frontline workforces and lack of compassion for a diverse community with many 

English second language speakers. 

Investment Opportunities 

Community have spurred us to get on with it. Triangulating evidence, available information and 

advice so far from Mangere communities the following investment opportunities are grouped into 

three. These groupings shape recommendations to the SIB. Investment does not just mean new 

financial resource. It may also mean redeployment or focus of existing resources. It includes 

time and workforce commitment to optimising the use of current offerings. 

1.1 Invest in improving reach and coverage of universal services and this will increase access to 

targeted services also 

Universal services are an important entry pathway to targeted services e.g. B4School check 

referral to Special Education Services; Well Child or Primary Care referral to parenting 

support and/or mental health and addictions services. Review of current universal service 

offerings in the Mangere area and working with the community to make them more relevant 

and accessible is an important form of investment for the SIB. 


21

1.2 Improve and better coordinate / integrate ‘Business as Usual’ functions 

Many agencies identified opportunities to improve what is currently offered to Mangere 

populations. Some may see this as doing ‘business as usual better’ and can encompass many 

improvement opportunities – reducing the wait time between referrals, simplifying or 

streamlining referrals between agencies to reduce risk of children falling through the crack, 

making it easier for English second language families to access help. There are BAU 

opportunities within agencies that impact on others (e.g. access to Benefits and entitlements, 

stronger linkages between oral health services and ECE settings). 

There are also common themes emerging from community and agency feedback about the 

inconsistencies and mixed level of knowledge among front line workers who work with 

children and their families. The Vulnerable Children’s entity has a workforce development 

capacity and capability work programme to strengthen the front line skills of all those 

working with children. The SIB Office invited the Children’s Team to consider piloting a ‘place 

based approach’ that may involve providing all front line workers in Mangere who work with 

vulnerable children consistent professional development and timely access to evidence 

based advice on practice. These opportunities can apply to all front line workforces that 

interact daily with at risk children and their families in Mangere e.g. police, tenancy 

managers, ECE workers, NGO providers, MSD workforce, healthcare and social sector agency 

workforces. 

SIB will be asked to consider what role it wants to play in making these opportunities visible. 

1.3 Further investment in intervention settings 

The Intervention Logic offered a lens to identify potential areas that would benefit from 

further investment. The following five settings are proposed as priority areas for further 

implementation detailed planning and resources to be applied to support the next stages of 

development. The SIB Working Group is invited to consider these investment opportunities 

for endorsement. 

• Expanded family violence 

• Vulnerable tenancies 

• Intensive family home visiting 

• Alcohol and drug addiction 

• Engagement in quality early childhood education 

Evaluation and Outcomes 

An Evaluation Plan and draft Outcomes Framework is proposed to be submitted to Minister 

of State Services for endorsement. The Evaluation Plan focuses the scope of evaluation on 

the actions of the SIB and its contribution to improving outcomes in Mangere. This is to be 

distinguished from an evaluation on whether the SIB is effective as a PBI approach. This will 

be evaluated by the National Support Office for PBIs. 

In addition, the Outcomes Framework aims to marry indicators that are aligned with the 0- 

5yr framework endorsed by Ministers AND local data that is collected by agencies from front 

line. It provides a starting point for wider agency and community engagement during 

engagement for evaluation planning. 

On endorsement the SIB will run a tender process to conduct the evaluation and aim to have 

engagement early 2017. 


22

Conclusion 

Hence we offer up a menu of actions to help us achieve our objectives alongside accelerating 

community engagement. The medium run game is building our collective capability to systematically 

identify opportunities to improve outcomes for our target population, and evaluate more rapidly to 

underpin a social investment operating model. 

We will get resistance, the closer we get to requiring commitment from parties the more challenge 

we will get. Let’s be specific about where those challenges are likely to come from and what specific 

advice/direction we want to give to push through – these are the decision rights that Ministers are 

seeking advice on. 

Our goal for 22 November SIB meeting is to agree that the actions, evaluation and draft outcomes 

framework to proceed to committing resources to build capability and its componentry while kicking 

off some actions that can be rapidly tried and tested to make a difference. 

Directorate Highlights 

There are 4 teams that provide “corporate services” and 2 direct patient support services (Maaori and 

Pacific cultural support) in the Strategic Development Directorate. The table below summarises 

Directorate highlights and risks as at end September. 

Highlights 

Strategic Planning 

• 15/16 Annual Report first draft completed. 15/16 planning cycle review in progress. 16/17 Annual 

Plan Q1 report in progress. Maaori, Pacific and Asian health plans have been released and are 

publicly available. 

• Work in progress to align regional ICR process implications including translation into 2016/17 

prioritisation. 

• Cross population plan reporting improvement process underway. 2017/18 planning cycle 

organisation in progress in consultation with key stakeholders. 

• Asian Health Gain recruitment in progress with interviews planning for 26-27 October. 

Communications Channels 

• New structural arrangements are in place and currently recruiting for the three resulting vacancies. 

New appointments are expected by early December. The team are now operating to a central 

calendar of events and activities across the organisation which should result in an improvement of 

proactive support. 

• Significant effort has gone in to supporting contingency planning for the NZRDA strike including 

coordination at a national and regional level. Outside of that, national media interest in mental 

health issues are so far focussed at Waitemata and Waikato DHBs. The team are also supporting the 

Social Investment Board communications needs which have increased following the Minister of State 

Services recent public announcement of the Board’s activities. 

• The intranet redevelopment is well advanced and a small oversight process will be stood up shortly 

and communication across the organisation will begin in the next month. healthAlliance have 

confirmed a Microsoft Sharepoint platform is available which is a well-established and proven 

intranet platform used by large organisations. Early user engagement has been helpful in a 

preliminary assessment of business need. It has identified many users associate Southnet with other 

related system problems including Objective functionality. This has been identified as a project and 

communication risk. 

Risk & Privacy 

Risk 

• Progressing with the Hospital Key Risk Register. 


23

• Risk integration with Capital prioritisation programme. 

• Continuing with ELT Risk discussions and integration with other operational risk teams. 

• Daptiv risk reporting design and configuration in progress. 

• Engaged and Effective Workforce in-depth review submitted to Audit, Risk and Finance Committee. 

• Quality of Care in-depth review being compiled for submission to the relevant committees in 

November 2016. 

Privacy 

• Privacy Policy compiled and ready for Clinical Governance Group approval in November 2016. 

• A number of procedure guidelines in progress. 

• Communication Strategy compiled, approved by the Privacy Committee, planning for deployment. 

• Information Strategy in progress with Corporate Records team. 

• All 6 streams of the privacy programme of work progressing. 

• A number of Privacy Impact Assessment’s reviews in progress. 

• 8 privacy breaches for the period, with additional one relating to regional DHBs. 

• Investigation process for CM Health (Quality Assurance/ Legal/ HR/ Consumer Council 

representative) discussed with gaps identified and recommendations for improvement to be 

defined. 

Maaori Health Development 

• Implementation of Manawhenua i Taamaki Makaurau Hauora Plan ongoing. 

• Integrated Service Agreement outcome contracts implemented. 

• Successful Indigenous Health Conference held 12-14 October Honolulu. 

• Implementating new Letter of Agreement with Manawhenua I Taamaki Makaurau. 

Pacific Health Development 

• Pacific Health Plan published and reporting against this plan has commenced. 

• 10 Week Train the Trainer program with Temple Ministries has been implemented. Nine community 

groups plus CM Health staff attended the information night. Five community groups attended the 

first train the trainer session on the 27 th September 

• Pacific workforce -relationships continue to be built with main tertiary providers to enable a more 

collaborated approach to engaging and enabling students throughout their study and into the 

health workforce. Events have been held in conjunction with tertiary providers of where students 

and their mentors linked up and were provided a Leadership New Zealand Professional mentoring 

session. 

• Samoa contract has been extended for another six month for the ILP 

• Telehealth – more cases are sent for review to the telehealth team at CM Health. 


24

5.0 Finance 

Key Highlights/Issues (September 2016): 

1. While the monthly result posted a slightly positive variance, our operating performance remains 

very tight, as anticipated in the setting of the Annual Plan. 

Month 

YTD 

Net Result 

September 2016 

September 2016 

Full year 

Act Bud Var. $000 Act Bud Var. Last year Bud Forecast 

3,369 3,361 8 Hospital Provider 11,176 11,154 22 9,927 41,138 41,138 

(3,630) (3,629) (1) Integrated Care (10,851) (10,903) 52 (6,272) (43,592) (43,592) 

(1,462) (1,466) 4 Ko Awatea (4,378) (4,384) 6 (3,525) (17,451) (17,451) 

(1,723) (1,734) 11 Provider (4,053) (4,133) 80 130 (19,905) (19,905) 

2,139 2,242 (103) Funder 6,677 6,725 (48) 3,383 26,900 26,900 

(53) (208) 155 Governance (532) (624) 92 (225) (2,495) (2,495) 

363 300 63 Surplus (deficit) 2,092 1,968 124 3,288 4,500 4,500 

5000 

4000 

3000 

Surplus 

2000 

1000 

0 

-1 000 

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 

-2 000 

-3 000 

Actual 

Budget 

2. Provider arm volumes (case weights) are on contract YTD. ED presentations for September are 

1% below the same period last year, reflecting the benefits of a milder winter. Many services 

continue to operate with a level of net vacancies (partly covered by locums, bureau, overtime, 

and casual staff). We continue to prioritise strategies to keep our bed occupancy lower, and 

redeploy nursing staff to ensure we manage care safely with lower FTE than budgeted. The 

September intake of Nursing New Entry to Practice (NETP) and New Entrant to Specialist 

Practice (NESP) has increased staff numbers available in several areas. Outsourcing has been 

required to meet contracted elective surgical volumes primarily due to a shortage in Anaesthetic 

Technicians. 

3. Unfavourable provider arm timing differences (revenue and expenditure) reflect delays for a 

number of key initiatives, namely: Opening of the Retail Pharmacy, Procurement, Inventory and 

projects to reduce clinical costs associated with Diagnostic and Pharmacy user groups. YTD 

these delays have been offset by additional ACC revenue accruing from the ACC Arrears 

initiative, supplemented by the favourable effect of net vacancies. Actions are underway to 

ensure that key initiatives fully deliver as planned over the balance of the year. 

4. The junior doctors (RDA) industrial action was extremely well handled by the organisation with 

no major issues occurring although negatively impacting on elective waiting lists. 


25

5. Primary, Community and Healthy Together initiatives as a whole are on budget YTD, largely due 

to minor one off favourable variances offsetting an unfavourable trend in the Funder’s major 

savings programme. Demand driven costs such as Aged Residential Care continue to reflect 

strong growth. Looking forward, the budgeted savings outlook is very challenging and will 

necessitate alternative options in meeting the year-end target position. 

6. We are presently completing the first formal forecast update based on the YTD September 

result. This is proving challenging as expected. The forecast position is additionally challenged 

by the lack of anticipated benefits/savings from NOS, NIP, FPSC procurement and Food as well 

as industrial action, delayed realisation of budgeted initiatives and on-going IDF flow challenges. 

Extensive reviews currently underway, to confirm mitigation/steps deliver to year end agreed 

budget. 

7. Annual audit is now effectively complete. No material issues or concerns have arisen. The 

formal representation letter is expected from Audit New Zealand by mid-December. 

8. The October monthly result is on budget. A full report will be presented to the December Audit 

Risk and Finance meeting. 


26

6.0 Ko Awatea 

Ko Awatea Extension 

The project to extend the KA facility has progressed well to the extent Leighs Construction has 

been engaged as the contractor, alongside Jasmax and the other consultants, to deliver the 

final design and a Guaranteed Maximum Price; which is currently being worked through. 

Engagement with key stakeholders including co-design of spaces with staff, patient and 

whanau has also progressed well. With resource consent being secured, early site works to 

commence in December 2016 and full construction due to start in February 2017, the 

communications with both internal and external parties has ramped up. In conjunction with 

the facility extension, the design of the new carpark is finalised and resource consent will allow 

construction to kick-off with the removal of some trees and clearing of the site. 

Patient Experience/Co-Design 

• Activity update 

Tier 1 (CMH) Tier 2 (National) Tier 3 (International) 

Living Well: Co-designing 

Specialised Rehabilitation 

and Community 

Wellbeing Services. 

Co-designing the 

development of Oncology 

Cancer Pathway for 

people to access care in 

CMH. 

Continued support for 

the Consumer Council 

and development of an 

Evaluation framework. 

Supporting development 

of an engagement / codesign 

plan for the 

HT2020 

teams. 

technology 

KA has been awarded a contract to 

deliver an eight month co-design 

programme with a focus on Surgical Site 

Infection commissioned by the HQSC. 

Includes teams from eight DHBs. [CMH 

has one team in the programme, 

sponsored by Jacqui Wynn Jones and 

their focus is on Surgical Care in 

Orthopaedics.] 

KA has been awarded a contract to 

deliver an eight month co-design 

programme supporting Taranaki and Hutt 

Valley DHBs who between them have 10 

project teams focused on a range of 

projects including improving the 

experience of discharge medications in 

mental health, bloodletting for children 

and information provided for bowel 

screening. 

Continuing commissioned 

co-design programmes for: 

the Agency for Clinical 

Innovation – Sydney who 

have five teams co-designing 

services including those for 

childhood incontinence and 

access to mental health 

services, and; Western 

Health Services Melbourne 

who have six teams codesigning 

services including 

the opportunity of peer 

support for consumers and 

families post intensive care, 

noise within the hospital and 

reducing ‘did not attends’ 

within specialist adult clinics. 

Supporting Improvement and Transformational Change 

• Handle the Jandal – Community organising Polynesian youth 

With a current focus on transforming the education system to enable Polynesian student 

success, Handle the Jandal’s aim is to deploy the collective voice and actions of 

Polynesian youth throughout the network - to transform inequities experienced by 

Polynesian students in the education system. The campaign youth leadership team of 

10 members have: 

- Recruited and launched four student leadership teams with 15 students in Otahuhu, 

Mangere, Otara and Manurewa on 27 October 2016. 

• Theatre utilisation 

The goal is to improve current elective operating theatre sessions utilization from 85% to 

90% on a weekly basis within 12 months of project commencement. The project is at the 


27

stage of solution implementation / trial discussion and gaining a consensus on the 

measurement system and the utilisation operational definition. Currently, the project 

team is engaging Heads of Departments (clinical heads) with regards to the next phase, 

measurement system and potential solutions. 

Knowledge Access Supporting Evidence-Based Practice 

• Childhood Obesity clearinghouse 

Supporting CMH work on childhood obesity (Health Equity strategy) the CMH Library has 

created a clearinghouse site for quick access to resources and documents. It will help our 

staff, partners and the wider community understand how childhood obesity relates to 

health equity, what is being done about it in New Zealand and overseas, how effective 

these approaches have been, and the challenges for health professionals and communities 

wanting to create healthier lives for children. It is updated weekly and is complemented by 

the CMH Library’s clearinghouse on Health Equity. Both clearinghouses are freely available 

to the wider New Zealand community via the HealthPoint website. 

To promote access to the resource, the Counties Manukau Health Library has assigned a 

dedicated Information Specialist to provide programmatic support for all childhood obesity 

initiatives at CMH. The library also regularly shares links to the latest updates to the 

clearinghouse via social media using the #obesity hashtag on Twitter. 

Building Capability 

• Core Organisational capabilities 

As part of the People Strategy work plan the Organisational Development team have 

been working on the development of Core Organisational Capabilities, the work began in 

late 2015 and has progressed to the point of implementation. The work identifies 

foundational capabilities required by our workforce to deliver our Healthy Together 

2020 Strategy, and align with our values. Why we need capabilities: 

- We need to grow organisational capability in specific areas to transform the 

health system and better respond to our communities’ changing health needs. 

- Core capabilities are used to ensure the organisation as a whole works towards 

and embodies the same strengths. 

- Core capabilities identify those foundational capabilities required by our 

workforce to deliver our strategy. 

- Defining our most strategically important capabilities helps ensure that 

employees skills and efforts are directed toward achieving our goals. 

- They provide an effective tool that can shape the development/re-design of our 

people processes. 

• Cluster framework for capabilities 

Strategic cluster – Setting Direction: relates to strategic capabilities 

(big picture & future focused) 

People cluster – Engaging People: relates to interpersonal capabilities 

(relationship focused) 

Performance cluster – Delivering Results: relates to delivery-related 

capabilities (results focused) 

Research & Development 

• Development of The College of Leadership Innovation Management & Beliefs 

World Health CLIMB – College of Leadership, Innovation, Management and Beliefs (‘CLIMB’) 

– was launched by Peter Hillary and Jonathon Gray at APAC 2016. World Health CLIMB is an 


28

innovative approach to leadership development that will allow systems around the world to 

address global health and care ‘mountains’, with the key aim to provide Great Care 

Everywhere. CLIMB aims to increase access to leadership training for people working in 

health on a global scale. CLIMB will position KA and CMH as world leaders in healthcare 

system transformation. It will achieve this by delivering world-class education over five 

platforms of learning: 

OUTFITTERS: Online training providing the base information and skills managers 

need. Content is donated from health systems around the world for online 

distribution. 

BASE CAMP: Online multilevel coursework, combined with real world interaction, 

focused on advanced leadership capabilities and mindsets. Participants earn 

certification ‘badges’ that can be shared and accessed online. 

MOBILISING: Local leadership development and culture-building programmes at 

specific organisation sites. Leadership teams work with World Health CLIMB 

consultants to substantially transform their local systems. 

ASCENT: Global Leadership Cohorts assemble in person for a series of leadership 

intensives designed to prepare participants to be the architects and thought 

leaders of the future. Intensive content focused on strengthening leadership 

courage and character. 

SUMMIT: Annual conclave of recognised experts and senior leaders from health 

and other sectors assembled to share new ideas, perspectives and insights of 

leadership that will be used to keep all other levels of World Health CLIMB 

curriculum, current and relevant. 

• Highlights 

APAC 2016: 

• WH CLIMB launched to global 

audience. 

• First ‘Summit Leaders’ meeting 

held. 

• 72 delegates registered interest. 

KA Activity: 

• Mike Wagner KA Senior Fellow, led 

three-day workshop in September and 

again in December 2016. 

• Steering Group established; Outfitters 

and Ascent planned to go-live on 1 July 

2017. 

Strengthening Cross-System Collaboration 

• Talking Matters collaborative contract (further information as requested by the Board) 

Reported in October, Ko Awatea has been awarded the ‘Talking Matters’ collaborative contract 

by COMET Auckland. 

This work is closely aligned to the vision and goals of the South Auckland Social Investment 

Board. This work builds on the success of the earlier collaboration between Ministry of 

Education and Ko Awatea working with local early childhood centres improving enrolments 

and participation in early childhood education, and the ‘Look Who’s Talking!’ project looking to 

strengthen children’s early language development using a social interaction approach to oral 

language development, working with speech language therapists. A key component of the 


29

project is how we use improvement methodology to raise community involvement in quality 

education. 

Background: Talking Matters is a ‘whole of community’ initiative aiming to transform the 

potential of our children by growing confident young listeners and speakers who are 

enthusiastic about learning and ready for reading at age five years. 

About one third of Auckland’s annual 21,000 new school entrants do not have the oral 

language and early literacy needed to learn to read easily. Research clearly points towards 

differences in language use between families who struggle economically and socially, and 

those with greater economic and social advantages. Children from low socio-economic (SES) 

backgrounds are starting school with a 3,000 word vocabulary compared with the 6,000 used 

by children from higher SES backgrounds (van Hees, 2011). Talking Matters aims to build on 

the strengths of families, family-facing services, educators and communities so that our 

children build their listening and speaking skills and get the best chance for their future. 

Talking Matters is focusing on family and community action related to families with babies and 

small children (aged 0-3 years). 

The Auckland Talking Matters collaborative will be run at a localised Auckland level, initially 

within Mangere-Otahuhu and one other community yet to be identified. Under this 

Agreement, Ko Awatea have external funding from the NEXT Foundation to provide 

improvement methodology support to work alongside the COMET Talking Matters project 

team to deliver improvement expertise coaching and support at an individual organisational 

level as well as with the collaborative Talking Matters groups. 


30

7.0 Compliance 

7.1 There are no major compliance issues to report. The Health & Safety report is 

included below. 

Activities for the month are up-to-date as outlined in the Health and Safety plan. 

The ACC Partnership Programme Renewal Audit was undertaken in October by an 

external auditor. 

The Audit findings confirmed that CM Health continues to meet tertiary level 

requirements. These findings were supported by site visits to Decontamination 

Sterilisations and Cleaning Services and Community District and Allied Health Nursing 

(Orakau Road). 

The following strengths and achievements were noted: 

• Increased Health and Safety due diligence is in place with evidence of 

performance reports and six-weekly deep dive risk reviews to the Board and 

Executive Leadership Team 

• A robust Health and Safety Management Framework is in place 

• The Community Health Worker risk review being undertaken with consideration 

of a comprehensive range of tools that also aligns with clinical pathways and 

service delivery 

• The transition from Hazard to Risk Management and the development of process 

that aligns to the corporate methodology of risk management 

• Injury Management is positively influencing rehabilitation outcomes 

The recommendations for improvement included: 

• Health and Safety Key Performance Indicators should be included in the 

performance development review framework for managers at all levels 

• The process for corrective activities for incidents should be strengthened 

• The Contractor Management system and processes are to be strengthened 

There were no notifiable events to WorkSafe in October 2016. One event has been 

notified to Worksafe in November, which I will brief the Board on. 

As this is my last report to this particular Board, and I know that the Board membership will be 

changing as a result, I would just like to offer my personal thanks to the leadership that Lee Mathias 

and the Board have given the DHB over the last three years. It has been a privilege to have worked 

with you. I look forward to working with current Board Members that are remaining and also look 

forward to welcoming Dr Lester Levy as the new Chair. For those leaving, can I wish you well and 

please stay in contact. 


31


Occupational Health and Safety – Q1 Report 

Recommendation 

It is recommended that the Board: 

Receive the Health and Safety quarterly report for the period ending 30 September 2016. 

Prepared and submitted by: Bev Stone, Manager Occupational Health & Safety Service 

Executive Summary 

This paper reports on quarterly health and safety activity for the period ending 30 September 2016. 

Quarterly Report Highlights 

Health and Safety Performance Overview 

LAG INDICATORS 

LEAD INDICATORS 

Lost Time Injuries: 

Audits: 

Lost Time Injury Frequency Rate 5.00 Percentage Completed (Average) 77% 

Lost Time Injury Severity Rate 189.92 Number of Hazards Identified 1 

Lost Time Incidents 13 Training: 

Number of Injury Claims 79 Number of H&S Reps Trained* 9 

Cost of Injury Claims $19 822 Number of Managers Trained* 0 

Incidents: Welcome Day Attendees 209 

Total Number of Incidents 278 Health Monitoring: 

Number of Notifiable Injuries 0 Pre-Employment Health Screening 362 

The above table provides a high level overview of Counties Manukau Health (CM Health) Health and 

Safety performance for this quarterly reporting period. Commentary is included in further detail in this 

report. 

*Please refer to the Training section further in this report for full details on the H&S training for the quarter 

Counties Manukau District Health Board 30 November 2016 

32

Quarterly Performance 

Notifiable Event Notifications 

During this quarter, there were no incidents which required external notification to WorkSafe NZ: 

Work Place Inspections (As per the 2015/2016 Health and Safety Action Plan) 

• One cycle of work place inspections was completed in Aug 2016 with a 77% return rate which is 

consistent with the previous cycle in June. 

• The completion outcomes are driven by other conflicting work priorities at the time of inspection. 

• The inspection tool is being reviewed for easy reporting and cross referencing with the risk registers. 

• The next inspection cycle will be undertaken in Oct 2016. 

External Workplace Audits 

• The external ACC Partnership Programme Workplace Safety Management Practices Audit is 

scheduled for October 2016. The aim is to maintain Tertiary status. 

Injuries and Impact 

Incident Notifications 

• There was a 19% decrease in the total number of incidences recorded for this period from 344 for 

the last quarter to 278 for this quarter 

• BBFE incidences have increased with 25% from 54 incidences in the previous quarter to 67 in the 

current quarter. This could be attributed to the increase in awareness messages throughout the 

organisation resulting in improved notifications. 

• Manual / Patient handling was the main cause of incidents across MACS in this period, but overall 

notification shows a decrease of 11% from 76 incidences recorded for the last quarter to 67 

incidences this quarter 

• Manual / Patient handling and Slip/trip/fall were the main cause of incidents across SACS in this 

period with an overall decrease of 19.5% with 72 incidences for the last period to 58 incidences for 

this period 

• The number of incidences in Mental Health decreased with 29% from 55 incidences for the previous 

period to 39 incidences for this period. 

The primary causation of incidents was attributed to Assaults / Behavioural injury types. 


33

Incident Notifications - count of incidents with incident date occurring July - September 2016. 

Lost Time Injuries (LTI’s) - count of workplace injuries with injury date occurring July – September 16. 

* Not all Divisions are shown here only those who reported incidents and LTI’s for this quarter. 

Data is accurate as at time of reporting and may change month on month for some measures. 

CM Health Lost Time Injury Frequency Rate (LTIFR) and Lost Time Injury Severity Rate (LTISR) 

Frequency and Severity Rates for the quarter has decreased slightly, indicating that the number of injuries 

were less than the previous quarter, and required less time off from work for injury impact. 

LTIFR 

LTISR 

July – September 2016 5 189.92 

April – June 16 20.63 953.83 

LTIFR (Lost Time Injury Frequency Rate) = (# of Lost Time Injuries / Hours Worked) x 1,000,000. 

LTISR (Lost Time Injury Severity Rate) = (# of Lost Hours / Hours Worked) x 1,000,000. 

Note: 

• The increased frequency rate in Pacific Health was due to a sharp object incident causing an open 

wound injury and resulted in time off work. 


34

Lost Time Injury Rate – DHB Benchmarking 

Benchmarking data relates to large, medium and small DHBs with information provided and used in the 

Human Resources Quarterly Report. The CM Health OHS Service does not have oversight into the context 

of the data provided by other DHB’s, however based on the data provided, CM Health is performing well 

overall in relation to the other large DHBs. 

Sep-16 Sep-15 

All DHBs 10.1 9.7 

DHB Sep-16 Sep-15 

Size 

Large 11.4 9.8 

Medium 8.5 9.2 

Small 5.2 10.0 

Outliers Sep-16 Sep-15 

Highest 21.9 18.7 

Lowest 0.0 0.0 

Region Sep-16 Sep-15 

Northern 7.6 9.3 

Midlands 5.1 6.8 

Central 10.1 8.8 

Southern 17.9 13.0 

All workplace injuries or illnesses that result in lost work time divided by worked hours (in millions). 

Notes – As KPI data is reasonably low a DHB Total graph only is provided. 

Number of Lost Time Injuries per Division 

There was a 60% decrease in lost time injuries, with 13 people requiring post injury care compared to 33 for the 

last reporting period 


35

Injury Impact – Claims Overview 

• A total of 79 ACC claims were received for the period, which was less than the 100 received for the 

previous quarter. 13 Claims were declined following investigation ensuring CM Health did not incur 

unnecessary claims costs 

• Trends continue to indicate effective injury management of claims lodged vs. claims accepted 

• Injuries resulting in ACC Claims continue to be predominantly caused by musculoskeletal injuries 

* This includes Medical and Social Compensation costs and Weekly Compensation cost estimates for days lost which are based on average salaries 

across divisions, as provided by Well NZ (Third Party Administrator). 

• The total claims cost for the period is $19 822 compared to $49 882 for the previous period 

indicating a 60% decrease. 

• The total weekly compensation cost for the period is $2 666 compared to $15 384 for the previous 

period indicating an 82% decrease in weekly compensation cost. 


36

• This indicates a 65% decrease in the overall costs compared to the previous quarter. This highlites 

improved case management under the new agreement with Well NZ and CM Health case 

coordinator. Additionally there was an overall decrease in the number of lost time injuries resulting 

in lower weekly compensation costs. 

Injury Trends 

• When considering the OHS critical risk profile, there was no notable change in the number of 

incidents resulting in injuries from 212 the last quarter to 210 this quarter. 

• All incidents have been investigated and managed as appropriate. 

Health and Safety Management Framework Improvement 

The Health and Safety Management Framework is underpinned by the Health and Safety Action Plan 

2015/2016. The Framework and Action Plan is currently being reviewed and updated. 

The Health and Safety Action Plan 2015/2016 is currently being finalised and is attached in Appendix A. It 

continues to have an ongoing focus on the following priority areas: 

Hazard and Risk Management 

• As per new the WorkSafe Guidelines, the OHSS work plan will be redesigned to include H&S, 

Occupational Health and Wellness components with an increased focus on risk. 

• Development of specific risk plans for identified high risk issues continued with specific relevance to 

Community Health Work and Moving and Handling 

Incident Management and Injury Prevention 

• Staff shortages and workload notifications appear to have increased in the incident reporting system 

• The H&S Advisory team continue to investigate all incidents notified 

• Incident data analysis and findings are being assimilated into the risk management framework 


37

Contractor Management 

• Contractor Management remains a an uncoordinated organisational compliance risk with a gap analysis 

planned with an external H&S Risk Consultant to support the design of a credible and practical framework 

that will comply with the new legislative requirements 

• Investigation of the dimensions of external partnerships has been initiated 

Training 

• Review and update of the organisational Health and Safety Induction booklet has commenced 

• Impact of the legislative changes for training, specific to H&S Representatives, will be presented to the 

Workforce Education Committee and ELT. These changes have prompted an overall review of the H&S 

Training Framework. The aim is to have a robust, cost effective framework in place early 2017. 

• The training provided to H&S Representatives during this quarter was a refresher only. There was no 

Manager training sessions scheduled during the quarter. 

Employee (Worker) Participation 

• New legal compliance regulations for Worker Participation to be reviewed, with the aim of confirming 

changes and impact on current processes 

• H&S Recognition Programme planning has commenced with the Awards to be announced in Q2 

• Regional Worker Participation Agreement progressed and is pending finalisation 

External, Legislative and Industry Updates 

• WorkSafe has released guidance i.e. “The Approved Code of Practice for the Management and Removal of 

Asbestos” which aims supports WorkSafe’s target of a 50% reduction in asbestos-related disease by 2040. 

Asbestos is the single biggest cause of deaths from work-related disease. On average about 170 people die 

every year from asbestos-related diseases. 

CM Health has a number of build projects and this guidance is of relevance to those projects with specific 

focus on our workers and the contractors who undertake work on our behalf. 

Next Steps 

• The next Board paper will provide an in-depth review on the Health and Safety Training Framework based on 

compliance requirements but with a CM Health operational focus 


38

Appendix A: Health and Safety Action Plan 2015/2016 

Health and Safety Action Plan 2015/2016 

H&S System 

Leadership and Practice 

Responsibility, 

Commitment & 

Legal Obligations 

H&S Information, 

Document 

Management & 

Communications 

Prevention as a Culture 

Hazard/Risk 

Management 

Emergency 

Preparedness & 

Response 

Contractor H&S 

Management 

2015 2016 

Q3 Q4 Q1 Q2 Q3 Q4 

Develop annual (15/16) Health 

and Safety Plan in alignment 

with priority health and safety 

core objectives 

Implementation of online Preemployment 

Health Screening 

Develop Health and Safety 

Recognition Programme 

collateral and communicate 

accordingly 

Progress formalised hazard 

risk assessment system: 2nd 

pilot trial of Hazard Risk 

Register tool/template 

Consult stakeholders on 

comprehensive emergency 

drills 

Investigate current state of 

health and safety as part of 

the contractor management 

process 

Guideline development for 

health and safety leadership, 

planning and due diligence 

Development of a Health and 

Safety Communications 

Strategy 

Amalgamate pilot feedback 

into the tool/template and 

develop Hazard Risk Register 

guidelines 

Check ER plans/schemes for 

currency Objective review 

dates 

Commence ACC-based selfassessment 

to identify gaps in 

the health and safety 

contractor management area 

Annual review of Health & 

Safety Policy (update and issue 

accordingly) 

Assist in embedding of 

organisational H&S objectives 

Communicate legislative 

changes to organisation as 

appropriate 

Review and update HSMS 

manual 

Hazard Risk Register training 

Engage with Emergency 

Response (ER) stakeholders to 

obtain ER information for 

incorporation into the HSMS 

manual 

Gather health and safety 

contractor management 

support documentation 

Develop annual (16/17) Health 

and Safety Plan in alignment 

with priority health and safety 

core objectives 

Establish H&S leadership and 

performance measurement 

targets 

Review and update OHS 

intranet pages 

Support workplace area 

Hazard Risk Registers 

development (ongoing 

process) 

Incorporate ER detail into the 

HSMS manual 

Develop health and safety 


support documentation in 

consultation with stakeholders 

Engage with stakeholders on 

inclusion of H&S in 

recruitment processes. 

Prepare communications and 

information for bi-annual ACC 

Partnership Programme Audit 

2016 

Support workplace area 

Hazard Risk Registers 

development (ongoing 

process) 

Review of orgnasitonal health 

and safety critical risk profile 

Pre-ACC Partnership 

Programme audit checks of 

organisational ER 

Embed health and safety 


support documentation into 

consultation with stakeholders 

Bi-annual review & update of 

EPG 

Prepare and disseminate 

communications and 

information for National 

Safety Week 

Engage with HR regarding 

workplace Bullying & 

harassment 

Investigate fatigue as an 

organisational risk 

Engage with organisational ER 

stakeholders for participation 

in the 2016 ACC Partnership 

Programme audit 

Commence review of clinical 

access agreements for tertiary 

providers 

Finalise input of H&S as part of 

clinical access agreements for 

tertiary providers 


39

Prevention as a Culture (Continued) 

Safe Design, 

Procurement & 

Disposal of Assets 

Review health and safety as 

part of the procurement 

process 

Investigate opportunity to 

embed health and safety into 

procurement processes and 

consult with stakeholders 

Work with stakeholders to 

ensure health and safety is 

embedded into procurement 

processes 

Hazardous 

Substances, Waste 

Management, 

Minimisation & 

Sustainability 

Organisational HSNO 

certification due 

Approved Handler certification 

due 

Organisational HSNO 

certification due 

Wellbeing and 

Medical 

Management 

Currently being scoped and 

developed 

Initiate Flu Programme Plan 

Flu Programme 

H&S Training & 

Competency 

Progression of organisational 

Manual Handling project 

Investigate feasibility of a 

National DHB HS Symposium 

Finalisation of eLearning 

general health and safety 

orientation course 

(implementation TBC in 

alignment with organisational 

requirements) 

Manual Handling Project 

(ongoing) 


capability building (training) 

material 

Review & update HS Rep 

training 



material (ongoing) 

Facilitate health and safety 

capability building training 

Identify preferred training 

provider network 



material (ongoing) 

Facilitate health and safety 

capability building training 

Investigate development of Job 

Task Cards in collaboration 

with Recruitment 

Consult with the Building 

Capability team on Skills and 

training matrices 

Review health and safety 

training programme and update 

for 2017 

Incident 

Management 

Health and safety system and 

structure development 

Commence development of 

incident investigation 

guideline 

Identify key CMH documents 

to embed health and safety 

data 



(ongoing) 

Development of incident 

investigation guideline 

Embed health and safety data 

into identified key CMH 

documents 



(ongoing) 

Conduct half yearly incident 

data analysis 



(ongoing) 

Build capability in Incident 

Management 

Investigate status of linkages 

between incident investigation 

findings and hazard & risk 

management 

Conduct half yearly incident 

data analysis and update 

organisational risk register and 

generic hazard/risk register if 

required 

Check that improvement 

opportunities are assimilated 

into the hazard & risk 

management system 


40

Counties Manukau Health Board Meeting 

Resolution to Exclude the Public 

Resolution: 

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health 

and Disability Act 2000: 

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 items to be Reason for passing this resolution in 

considered 

relation to each item 

1. Minutes of 19 October 2016 That the public conduct of the whole or 

the relevant part of the proceedings of 

the meeting would be likely to result in 

the disclosure of information for which 

good reason for withholding would exist, 

under section 6, 7 or 9 (except section 

9(3)(g)(i))of the Official Information Act 

1982. 

[NZPH&D Act 2000 Schedule 3, S32(a)] 

2. Action Items That the public conduct of the whole or 







1982. 


3. SMO Leave That the public conduct of the whole or 







1982. 


4. National Oracle Solution That the public conduct of the whole or 







1982. 

Ground(s) under Clause 32 for passing 

this resolution 

Confirmation of Minutes 

For reasons given in the previous 

meeting. 

For reasons given in the previous 

meeting. 

Commercial Activities 

The disclosure of information would not 

be in the public interest because of the 

greater need to enable the Board to 

carry out, without prejudice or 

disadvantage, commercial activities. 

[Official Information Act 1982 S9(2)(i)] 









5. Manukau Land That the public conduct of the whole or 











41

6. Fraud Monitoring & 

Management Policy 



1982. 


That the public conduct of the whole or 







1982. 











7. Scott Building Recladding That the public conduct of the whole or 







1982. 








8. 70 Victoria Street, 

Pukekohe 









1982. 









9. Asset Disposal & Transfer That the public conduct of the whole or 







1982. 








10. Bereavement Care Services 

Contract Award 

11. Draft Quality Accounts 

2015/16 









1982. 
















42

12. Healthy Together 2020 – 

Technology Update 





1982. 









1982. 













13. Point of Care Devices That the public conduct of the whole or 







1982. 


14. IS Project Update That the public conduct of the whole or 







1982. 

















43

Counties Manukau District Health Board Board Meeting Agenda

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?