Nelson Marlborough
Maori Health Action Plan 2013/14
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Table of Contents 1.
INTRODUCTION ................................................................................................................................................... 3
2.
NELSON MARLBOROUGH MAORI POPULATION .................................................................................................. 3 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10
POPULATION PROFILE................................................................................................................................................... 3 AGE GENDER.............................................................................................................................................................. 4 SOCIO ECONOMIC STATUS ............................................................................................................................................ 4 INCOME ..................................................................................................................................................................... 4 HOUSING ................................................................................................................................................................... 4 LIFE EXPECTANCY........................................................................................................................................................ 4 DEPRIVATION .............................................................................................................................................................. 4 LEADING CAUSES OF AVOIDABLE HOSPITALISATIONS ........................................................................................................... 4 LEADING CAUSES OF AVOIDABLE MORTALITY ..................................................................................................................... 4 HEALTH SERVICE UTILISATION ................................................................................................................................... 5
3.
DEDICATED MAORI HEALTH INVESTMENT ............................................................................................................ 5
4.
PRIORITISING MAORI HEALTH TARGETS FOR TE TAU IHU .................................................................................... 6
5.
NATIONAL MAORI HEALTH INDICATORS.............................................................................................................. 8 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8
DATA QUALITY ............................................................................................................................................................ 8 ACCESS TO CARE .......................................................................................................................................................... 9 MATERNAL AND CHILD HEALTH ..................................................................................................................................... 11 CARDIOVASCULAR DISEASE ......................................................................................................................................... 13 CANCER .................................................................................................................................................................. 15 SMOKING ................................................................................................................................................................. 17 IMMUNISATION .......................................................................................................................................................... 18 NELSON MARLBOROUGH DISTRICT MAORI HEALTH PRIORITIES (NOT ALREADY COVERED IN NATIONAL INDICATORS) ..................... 20
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1. INTRODUCTION Our 2013/14 Nelson Marlborough Maori Health Plan strengthens the alliance framework between Nelson Marlborough District Health Board (NMDHB), Nelson Bays Primary Health (NBPH) and Kimi Hauora Marlborough PHO (KHW MPHO), to achieve the vision of ‘Kia korowaitia aku mokopuna kite korowaitanga hauora’, ‘We want to wrap out future generations in a korowai of health and wellness’.1 By having greater ownership to Maori health and health inequalities, the responsibility will be shared by the alliance partners, across the continuum of care. There will be some major service transitional changes as the Maori health provider coalition work towards developing the structural and service changes needed to achieve national policy direction in terms of Whanau Ora. The overall aim for this development is to achieve Whanau Ora outcomes through working collaboratively. The achievements will be seen through implementation of Whanau Ora centered services that seek to improve access, ensure services are appropriate, good quality management systems and best practice is in place and the services respond to whanau and are culturally appropriate. To improve reaching equity of outcome for Maori, in 2013/2014 Nelson Marlborough will have a focussed effort on improving integration of services across the whole of system. This includes hospital services, general practice, Maori health providers and other community services. As part of the Maori Health coalition, clinical leadership will be developed that is a key enabler for integration to occur.
2. NELSON MARLBOROUGH MAORI POPULATION 2.1 Population Profile The Nelson Marlborough DHB service coverage area encompasses three Territorial Local Authorities, Tasman District Council, Nelson City Council, and Marlborough District Council. 8.9% of the Nelson Marlborough population are of Maori descent. Table 1 – Maori ethnic population medium projections by regional council area. (* 2006 baseline) 2
Territorial Local Authority Tasman District Nelson City Marlborough District Nelson Marlborough (Maori)
2006* 3300 (28%) 3900 (33%) 4600 (39%) 11,800
2011 3600 (27.5%) 4500 (34%) 5100 (38.5%) 13,200
2016 3800 (26.5%) 5000 (35%) 5500 (38.5%) 14,300
2021 4100 (26.5%) 5500 (35.5%) 5900 (38%) 15,500
Data from the Maori Health Profile 2007 and Statistics NZ identify that: There is an expected increase in the Maori population to 9.5% based on population projections. This still remains less than the national average of 15%. Maata Waka represents the largest portion of Maori living in Te Tau Ihu at about 92%. The highest average growth in the Maori population across the districts will be in Nelson at 2.2%, followed by Marlborough at 1.7%, and Tasman at 1.4%. Marlborough district has the highest proportion of Maori, followed by Nelson, then Tasman. The number of Maori enrolled within the PHO’s are as follows: 1. 2.
1 2
Kimi Hauora Wairau Nelson Bays Primary Health (covering Nelson and Tasman) Total
Nelson Marlborough Maori Health and Wellness Strategy 2008 Statistics New Zealand
3
4,079 (Quarter 2) 7,413 (Quarter 2) 11,492
2.2 Age Gender The age structure for Te Tau Ihu Maori and the region’s total population differ significantly. Maori have a younger population than non-Maori. Maori living in the region have a younger age structure with 59% less than 29 years of age. The gender distribution for Nelson Marlborough Maori is split evenly (50%/50%).
2.3 Socio Economic Status Maori are disproportionately represented in the more deprived areas of New Zealand, including the Nelson Marlborough region. Maori households within Te Tau Ihu have less access to phones. A higher proportion of Maori in Te Tau Ihu have no qualifications than non-Maori in the area. Most adults are in work and have a good level of education.
2.4 Income Income has been claimed to be the most important modifiable determinant of health. Maori in Te Tau Ihu are less likely to earn over $10,000 per annum than non-Maori in the region. Maori in Te Tau Ihu are also unlikely to earn incomes in the highest categories. Maori households experience difficulties earning an income and most Maori individual workers are modest earners.
2.5 Housing Housing is a basic human need and has a large impact on people’s well-being and quality of life. Issues related to housing crisis, such as affordability problems, poor quality and household crowding, have many flow-on effects for people’s health, education, community participation, community cohesion and safety. Marlborough Maori are three times more likely to live in an overcrowded house than the overall Nelson Marlborough population.
2.6 Life expectancy The life expectancy of Nelson Marlborough Maori is 78.2 years for females and 73.5 years for males indicating Maori in the region live longer than the national average. However, Maori men and women in the region still die younger than their non-Maori/non-Pacific peers in Nelson Marlborough - 2.6 years younger for men and 3.1 years for women (Wellington School of Medicine, 2001). Life expectancy for Maori compares well to non-Maori.
2.7 Deprivation The 2006 deprivation profiles for Nelson Marlborough and its territorial authorities show: Maori are more heavily skewed towards the higher deprivation deciles than non-Maori for all three territorial authorities. This trend is most pronounced in the Nelson City region where 48% of Maori live in deciles 8, 9 and 10. However, the distribution of the local Maori population is less heavily skewed towards the higher deprivation deciles than in New Zealand as a whole (Wellington School of Medicine, 2001).
2.8 Leading causes of avoidable hospitalisations The six leading causes are (in order ranked highest to lowest) for Maori 0 to 74 years of age are, dental conditions; upper respiratory/ear nose and throat; angina and chest pain; asthma; pneumonia; and cellulitis.
2.9 Leading causes of avoidable mortality The four leading causes are (in order ranked highest to lowest), ischaemic heart disease; lung cancer; suicide and self inflicted harm; and COPD.
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2.10
Health service utilisation Primary care Maori 2.29
Average number of GP visits per patient, per annum. (NBPH) Number of outpatient attendances 11/12 (including IDF) Total outpatient attendances by health speciality (over 8% Maori attendances)
Paediatric inpatient discharges (includes IDFs) Tertiary cardiac inpatient discharges for NMDHB patients treated elsewhere 11/12
Secondary care Maori 9350 (6.25% of all admissions) Paediatric Medical [560] - 14% Substance Abuse [160] - 12% detox (social) Audiology [321] - 11% Dental [131] - 11% Maternity Services [158] - 10% to Mother (no community LMC) Ear Nose and [319] - 9% Throat 15.73%
Non Maori 2.74 Non Maori 149976 (93.75% of all admissions) Paediatric Medical [ 3,450] - 86% Substance Abuse [1,228] - 88% detox (social) Audiology [2,566] - 89% Dental [ 1,083] - 89% Maternity Services [1,370] - 90% to Mother (no community LMC) Ear Nose and [3,286] - 91% Throat 84.26%
Cardiology
[9] – 5.7%
Cardiology
[150] – 94.3%
Cardiothoracic surgery
[7] - 5%
Cardiothoracic surgery
[135] - 94.69%
While there are disparities between Maori and non-Maori in terms of health status and the social determinants of health, Nelson Marlborough chooses to operate from a wellness model as opposed to an illness model. Equity is intrinsic to quality improvement. If Maori in Te Tau Ihu had equity of access, this does not necessarily result in equity of health outcome3. Nelson Marlborough services must recognise and understand why there are disparities, and set forward a programme to reduce these as part of their overall quality improvement processes.
3. Dedicated Maori Health Investment A recent stocktake of Maori health spend within Nelson Marlborough DHB has identified that $5.8 million is budgeted on Maori health. There are however a number of Maori staff or programmes that support both primary and secondary care services/programmes to assist them reach or improve their service delivery to Maori. This will include activities such as cultural training, ethnicity data collection, or service planning. For the purpose of this exercise, these activities are not counted in the stocktake.
Dedicated Maori Health Service Budgets Maori Personal Health Maori Mental Health and Addictions Maori Health of Older People Maori Disability Services Maori Primary Health Organisations ($85,000 KHW and $ Nelson Bays which includes programme resourcing and associated Maori staffing costs) Maori Hospital and Specialist Mental Health Services 3
Roadmap to Reducing Disparities
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Value $1,896,728 $1,626,358 $ 73,173 $ 386,432 To be confirmed $ 603,171
Maori Public Health Maori Ministry of Health National Contracts Other
$ 386,079 $ 177,295 $ 400,845
Please note that in support of achievement against PHO Performance Programme indicators, an alignment of PHO resources are used to support the delivery of these goals.
4. PRIORITISING MAORI HEALTH TARGETS FOR TE TAU IHU The development of Maori health plans and the establishment of national Maori health targets means that District Health Boards will be closely monitored on their ability to reduce health disparities in the foreseeable future. In 2011 NMDHB started a project to develop a long-term Maori Health Outcomes Framework for Nelson Marlborough. The decision for doing this was to establish what information was needed, recommend a list of population indicators, and the method by which the DHB would capture and report information to the local community, NMDHB Board and the Iwi Health Board covering the life of the 30-year Maori health vision. In 2012/13, NMDHB signed off on the framework and started the process of implementation. The environment is ripe to create the positive change across the sector. Strengthened working relationships, agreed partnerships or alliances and collaborative action to whanau will over time bring results that the community can take ownership of. NMDHB 2012/2013 indicators were used as part of the local balance score card for Maori health. Reports were prepared for the Nelson Marlborough Health Alliance, PHO Boards, NMDHB Board and Iwi Health Board noting progress against these indicators. The Iwi Health Board has made it clear that for 2013/14 its focus will be towards strengthening the measurement of Maori health gain and creating strategic opportunities around accountabilities and ownership of results. The majority of indicators developed are also covered within the National Indicators. Additional indicators at a local level are Maori Health Coalition integration, Programmes of Care, and Oral Health. The Alliance will meet quarterly to review progress against this plan. NMDHB Maori Health Outcomes Framework is as follows:
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5. National Maori Health Indicators 5.1 Data Quality We will undertake these initiatives/ activities and actions a.
b.
c.
d.
e.
Continue to review and compare PHO ethnicity data on a quarterly basis for accuracy. Continue to review and compare Hospital Ethnicity data on a quarterly basis. Continue to provide training to frontline general practice administrators to improve data capture, and ensure good data collection processes in line with the Cornerstone Accreditation standard. Continue to deliver ethnicity training to all new hospital administration staff. Delivery of refresher ethnicity training to existing hospital staff. Implement the Primary Care Ethnicity Data Audit Toolkit in NBPH and KHW PHOs when this becomes available.
We expect these actions will support improved performance in the following ways Accurate capture and reporting of PHO/hospital data.
To deliver the Health Target for 2013/14
Measured by
In support of system outcomes
Accuracy of ethnicity reporting in PHO registers .
Maori living longer, healthier and more independent lives.
Baseline 98.69% 97.62%
Good health and independence are protected and promoted.
95% of patients enrolled on a PHO register have ethnicity recorded. 95% data accuracy for ethnicity data collected in the hospital.
100% of new hospital frontline admin staff receive training on ethnicity data capture.
100% practices receive training on ethnicity recording within the current Cornerstone Accreditation cycle.
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NBPH KHW PHO Total
97.5%
13/14 100% 100% 100%
Access for Maori to primary care: number of Maori enrolled in PHOs (as reported by PHOs) divided by number of total Maori in NMDHB service area (as defined by Census Stats NZ 2013 figures)
Maori receive better disability services.
health
and
5.2 Access to care We will undertake these initiatives/ activities and actions a)
Continue to monitor ASH. b) Implement the oral health actions (see section 5.8) to address ASH admissions for children 0-4 years c) Work across the whole of system on how services can enhance working with Maori, including the Whanau Ora tool and He Taura Tieke.
We expect these actions will support improved performance in the following ways Patients are cared for through a comprehensive local provider network. Populations with high health need who have socioeconomic disadvantage are prioritized Identify areas of focus for service improvement to Maori. Support Maori patients access primary health care services Maori receive services that meet their needs Services are provided in a timely manner Reduction in acute hospital demand
To deliver the Health Target for 2013/14
Measured by
In support of system outcomes
8% of both PHO’s enrolments are Maori.
Quarterly review Enrols Baseline NBPH 7,413 (7.8%) KHW 4,079 PHO (9.6%) Total 11,492
Maori living longer, healthier and more independent lives.
ASH rates per 100,000 national 12/13 targets: Maori and < 95% non-Maori 0 to 74 years Maori and < 95% non-Maori 0 – 4 years Maori and < 95% non-Maori 45 to 64 years Conditions that drive the ASH rates for Maori are as follows: 0 – 4 years Dental, Upper Respiratory and ENT, Asthma,
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ASH
Maori 0 – 4 years Maori 45 to 64 years Maori 0 to 74 years Total Population - 0 – 4 years Total Population - 45 to 64 years Total Population - 0 to 74
13/14 7,561 4,160 11,721
Base (MoH May13) 177%
13/14
≤151%
140%
≤119%
160%
≤136%
112%
≤105%
52%
≤ 52%
76%^
≤ 76%
Good health and independence are protected and promoted. Maori receive better health and disability services.
Gastroenteritis/Dehydration, Dermatitis and Eczema. 45 â&#x20AC;&#x201C; 64 years; Angina and Chest Pain, Cellulitis, Congestive Heart Failure , Myocardial infarction, Pneumona and Epilepsy. 0 to 74 years; Dental, Upper Respiratory and ENT, Asthma; Gastroenteritis/ Dehydration, Pneumonia.
10
years
5.3 Maternal and Child health We will undertake these initiatives/activities and actions Breastfeeding a. Continue to support and encourage Maori mothers to provide breast milk as the sole or primary source of nutrition for their babies b. Encourage and support local providers to promote breastfeeding to Maori mothers. c. Maintain Baby Friendly Hospital Initiative status. d. Ongoing training and support of volunteers to support mothers who are experiencing difficulties with breastfeeding. E.g. Mum4Mum programme e. Continue to support Maori health care providers with advice and guidance from primary care Lactation Consultant
We expect these actions will support improved performance in the following ways Breastfeeding Improved community awareness about lactation support and antenatal education.
To deliver the Health Target for 2013/14
Measured by
In support of system outcomes
Breastfeeding Exclusive and full breastfeeding at 6 weeks (75%), 3 months (62%) and six months (29%).
Breastfeeding Quarterly reviews.
Maori living longer, healthier and more independent lives.
Establish baseline and monitor rates of breastfeeding on discharge from hospital for Maori.
Good health and independence are protected and promoted.
Increased number of Maori mothers exclusively or fully breastfeeding.
Establish baseline and monitor access to the Lactation consultancy service for Maori women.
Exclusive and Full at Feb 2012 Maori 6 weeks Maori 3 months Maori 6 months NonMaori 6 weeks Non Maori 3 months Non Maori 6 months
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Base
13/14
60%
75%
54%
62%
15%
29%
72%
75%
60%
62%
22%
29%
Maori receive better health and disability services.
Antenatal Care (a) Work with the sector to ensure that every Maori pregnant woman is registered with an LMC. (b) Work with LMCs and within maternity services to enable clinicians to support pregnant women who smoke to quit. (c) Work with Maori providers to support their continued access to culturally responsive antenatal education services.
Antenatal Care Increased number of Maori women who register with LMC by week 12.
Child Health a) Improve and support quality improvement of B4 School programme including high quality data reporting and collection. b) Work with Maori Health Providers to promote B4 School Checks. c) B4 school coverage maintained through joint work with primary care, education services and NMDHB. d) Continue to ensure Maori children under the age of six years have access to free after hours primary care.
Child Health Continue support for Maori children to receive a B4 School Check.
Increased number of Maori mothers attending antenatal education programmes. Reduced waiting times to access primary and specialist care services.
Decreased Ambulatory Sensitive Hospitalizations rates for 0-4 year olds.
Antenatal Care (a) Number Maori whanau who attend antenatal classes . (b) Measure the percentage of Maori women accessing DHB funded parenting and pregnancy education. (c) 90% of Maori pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with an LMC are offered advice and support to quit.
Antenatal Care Antenatal class attendances Maori
Child Health (a) At least 80% of Maori children receive a B4 School Check before their th 5 birthday (b) A decrease in ASH rates for 0-4 year olds. (identified in Section 5.2)
Coverage of the eligible population:
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Non-Maori
Smoking Pregnant Women Maori NonMaori
B4 School Checks Maori NonMaori
Develop baseline for 13/14 Collect baseline data Collect baseline data
Develop baseline for 13/14 Collect data Collect data
Base (6mths to Dec2012) 70.5% 91%
baseline baseline
13/14
80% 80%
5.4 Cardiovascular disease We will undertake these initiatives/activities and actions a.
b.
c.
d. e.
Continue to collect the number of Maori in the cohort (identified in the 2009 NZ CVD guidelines) who have had a CVD risk recorded in the past 5 years and compare this rate to that of the nonMaori cohort. Continue the Maori GRx service who work with Maori whanau referred to the service to reduce their CVD risk through increasing their physical activity Review existing processes to invite/recall Maori for CVD risk assessment. Identify systemic changes required and implement accordingly. Facilitate Maori to access CVD risk assessments. Ensure Maori providers are aware of cardiac pathways.
We expect these actions will support improved performance in the following ways To better understand if cardiovascular services are reaching Maori whanau.
To deliver the Health Target for 2013/14
Measured by
In support of system outcomes
90% of the eligible Maori population have had their CVD risk assessed within the past five years
Reviewed quarterly.
Maori living longer, healthier and more independent lives
Maori Nelson Wairau NonMaori Nelson Wairau
Improved care co-ordination across a range of settings. Improved access to primary care. Improved connectivity across the whole of system.
CVD
Base Q2 59% 38.18%
30.35%
13/14
61% 40%
32%
Number of tertiary cardiac interventions: 70% of Maori high risk ACS patients accepted for coronary angiography will receive an angiogram within 3 days of admission. 95% of Maori patients presenting with Acute Coronary Syndrome who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within one
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Base angiogram Maori Non-Maori
11/12
13/14
85.7% 88.5%
70% 70%
Good health and independence are protected and promoted. A more unified and improved health and disability system. Maori receive better disability services.
health
and
f.
Ensure accurate collection of Maori ACS information by working with the Central Region and the MoH in the implementation and rollout of ANZAC QI and the national cardiac surgery register
month
14
5.5 Cancer We will undertake these initiatives/activities and actions
a.
b.
4
Work with Breastscreen South, Primary Care and Maori Health providers to continue the provision of appropriate population Breast screening services and maintain high coverage for Maori women. Work with all stakeholders, particularly the Maori Health providers providing Cervical Screening Invitation and Recall 4 services to improve cervical screening coverage for Maori women through: a. Using the register to support invitation and recall b. Meeting twice yearly to share, plan and improve I&R strategies c. Ensuring good access to services for rural women d. Monitoring and feedback quarterly on progress and achievement.
We expect these actions will support improved performance in the following ways Lower cervical cancer mortality rates for Maori women.
To deliver the Health Targets for 2013/14
Measured by
In support of system outcomes
No of eligible Maori women who have had a cervical screen in the last three years.
Reviewed quarterly. Cervical Sept Screening 12 NCSP Maori 62.1% Other 82.6%
Improved access and earlier intervention to timely treatment.
Lower breast cancer mortality rates for Maori women. Establish a baseline for Maori bowel and prostate cancer rates.
No of eligible Maori women who have had their mammogram within the last two years
Improved access to cancer clinical/ support services for Maori.
Breast Screening
80% NA
As at Nov 12
13/14
83.1% 73.6 % 85.3%
84% 74%
Maori Pacific Other
Proportion of Maori patients referred urgently with a high suspicion of cancer who receives their first cancer treatment
13/14
86%
Improved connectivity across the whole of system. Maori living longer, healthier and more independent lives Good health and independence are protected and promoted. A more unified and improved health and disability system. Maori receive better health and disability services.
Bowel and prostate review and client pathway reviewed th by 30 June 2014. Base Maori > 62 days
13/14 Collect baseline data
Currently I&R contracts are with: Te Korowai Trust, Te Hauora o Ngati Rarua, Victory Community Health and Kimi Hauora Wairau (Pacific focus)
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within 62 days. c.
d.
Review bowel and prostate cancer rates for Maori within Te Tau Ihu, including the pathway to care. Identify areas across the whole of system where the cancer treatment pathway can be improved for Maori health patient, which will link into the Cancer Care Coordination role.
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Proportion of Maori patients referred urgently with a high suspicion of cancer who have their first specialist assessment within 14 days. Proportion of Maori patients referred urgently with a confirmed diagnosis of cancer who receives their first cancer treatment (or other management) within 31 days of decision to treat.
5
tx NonMaori 62 days tx
Collect baseline data
Base Maori > 14 days tx NonMaori > 14 days tx
13/14 Collect baseline data
Base Maori > 31 days tx NonMaori > 31 days tx
13/14 Collect baseline data
Collect baseline data
Collect baseline data
In 2013/14 Baseline data is being collected for the three new Cancer treatment indicators. NMDHB is implementing the information systems to report against these measures. Further information on cancer treatment timeframes will be included in the 2014/15 Maori Health Plan.
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5.6 Smoking We will undertake these initiatives/activities and actions
a.
b.
c.
d.
e.
Work with Maori communities and settings to promote and facilitate Smokefree environments and lifestyles. Work with LMCs and within maternity services to enable clinicians to support pregnant women who smoke to quit. The Cessation Support Directory will be reviewed annually by 31 March each year and be available to LMCs so they can refer to appropriate services. Continue to deliver ABC training across the whole of system, primary, community and secondary care. Monitor ABC coverage quarterly, across primary and secondary care (by ethnicity) and work more closely with areas where coverage is not reaching targets Identify whether smoking data on number of Maori under 25â&#x20AC;&#x2122;s can be collected, in order to implement a suitable
We expect these actions will support improved performance in the following ways Improved data collection to inform local planning. Earlier intervention to support Maori pregnant mothers to cease smoking. Increase the chance of smokers making a quit attempt without or with the support of nicotine replacement therapy. Increase in successful quit attempts, leading to a reduction in smoking rates and a reduction in the risk of the individuals contracting smoking related diseases.
To deliver the Health Target for 2013/14
Measured by
95% of Maori hospitalised smokers will be provided with brief advice and support to quit by July 2014 â&#x20AC;&#x201C; reported quarterly.
Hospitalised smokers Maori Non-Maori
Q2 2012 96.62% 95.98%
13/14
GP KHWPHO Maori KHWPHO Non-Maori NBPH Maroi
12/13 24.29%
13/14 90%
19.48%
90%
50.75%
90%
90% of enrolled Maori patients who smoke and are seen in General Practice are offered brief advice and support to quit smoking â&#x20AC;&#x201C; reported quarterly.
Progress towards 90% of pregnant Maori women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit.
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Pregnant Maori women Maori NonMaori
In support of system outcomes
NA NA
13/14
Collect data Collect data
Reviewed quarterly
baseline baseline
Maori living longer, healthier and more independent lives Good health and independence are protected and promoted. A more unified and improved health and disability system. Maori receive better health and disability services. Increase the chance of smokers making a quit attempt without or with the support of nicotine replacement therapy. Increase in successful quit attempts, leading to a reduction in smoking rates and a reduction in the risk of the individuals contracting smoking related diseases.
programme for 2014/2015. f.
Work collaboratively across the sector, through a Nelson Marlborough Health Alliance workstream, to identify and implement key actions towards the broader goal of Smokefree Aotearoa by 2025
5.7 Immunisation We will undertake these initiatives/ activities and actions
We expect these actions will support improved performance in the following ways
To deliver the Health Target for 2013/14
a.
Early enrolment of newborn babies with general practice to facilitate timely immunization.
95% Maori newborns enrolled in the NIR at birth. (measure NIR)
b.
c.
Collaborate with PHOs and other key stakeholders to determine and implement the best configuration of, and working relationship between immunisation services that will support improved performance in immunisation coverage. Review and compare the provision of the national flu vaccine to older and eligible population groups in each PHO.
Continue Maori participation on the redeveloped
Collaboration with health and community services to improve rates of immunisation for Maori. Maintain high rates of immunisation for eight month old babies. Immunisation services are delivered through general
100% of Maori newborns are enrolled with general practice (measured at 6 weeks)
85% of Maori eight months old will have their primary course of
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Measured by
In support of system outcomes
NIR Maori NZE Pacific Asian Other
Base 13/14 Collect baseline data Collect baseline data Collect baseline data Collect baseline data Collect baseline data
Maori living longer, healthier and more independent lives
GP Maori Pacific Other
Base 13/14 Collect baseline data Collect baseline data Collect baseline data
Maori receive better health and disability services.
Immunisation Coverage at 8 months old 8 mth Base 12 13/14 olds months
Good health and independence are protected and promoted. A more unified and improved health and disability system.
Improved immunisation coverage leads directly to reduced rates of vaccine preventable disease, and consequently better health and independence for children. This equates to longer and healthier
Immunisation Governance Group that leads improved service and performance improvement. (through this group a workplan based on key themes of: Collaborative Leadership; Health Professional Engagement; Community Engagement; Access and Equity; Systems and Processes. d.
e.
f.
Continue to monitor and evaluate immunisation coverage. Develop systems by 30 June 2014, to identify immunisation status of children presenting at hospital and for immunisation if not up to date (e.g. opportunistic vaccination, referral to GP or OIS)
practice, outreach services, school and other community settings. Having a more cohesive whole of system approach to achieving immunisation targets.
immunisation (six weeks, three months and five month events) on time by July 2013, and 90% by July 2014
85% of 6 week immunisations for Maori are completed (measured through the completed events report at 8 weeks).
Seasonal influenza immunisation rates in the eligible population (65 years and over)
Monitor newborn enrolment processes and develop systems (e.g. review transfer of clinical information at birth) for seamless handover of mother and child as they move from maternity care services to general practice and WCTO services.
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to Dec2012 83% 89% 81% 92% 81%
Maori NZE Pacific Asian Other
6 week imms Maori Other
90% 90% 90% NA 90%
Base 13/14 Collect data Collect data
Influenza coverage for 65+ years KHWPHO NBPH total enrolment High need KHWPHO NBPH Maori
Base 12
baseline baseline
Dec
Target Dec 13
58.99% 67.16%
60.50% 68.69%
52.02% 68.65% To be established
58.50% 69.65% 65%
lives. The changes required to reach the target immunisation coverage levels will lead to better health services for children, because more children will be enrolled with and visiting their primary care provider on a regular basis.
5.8 Nelson Marlborough District Maori Health Priorities (not already covered in National indicators) We will undertake these initiatives/ activities and actions
We expect these actions will support improved performance in the following ways
To deliver the Health Target for 2012/13
Measured by
In support of system outcomes
Support the embedding of the Maori Health Coalition integration by transitioning Maori health providers into a new entity structure, as well as transitioning prioritised health services aligned to current Maori health need.
Improved access for Maori to primary health services.
a.
Maori health coalition st established by 31 January 2014.
Increased productivity and better use of financial resources.
Work with two Programmes of Care (Cancer and Cardiovascular Disease) to assess whether the pathways designed are appropriate for Maori. .
Better value for money, by sharing resources across the system. Stronger clinical oversight of Maori health services. Improve responsiveness to Maori. Earlier diagnostics and earlier access to treatment. Improved services.
Improve oral health outcomes for Maori by: Community Oral Health Service (COHS) model of care identifies high risk children. COHS will undertake a six month trial of providing
Maori Health Coalition model agreed by November 2013.
utilization
of
Appropriate pathways that support Maori. To improve quality of service provision, that will reduce the 30% difference between Maori and non-Maori oral health hospitalizations.
Maori living longer, healthier and more independent lives Good health and independence are protected and promoted.
a)
Demonstrated Maori input into programmes of care development. b) Integration of Maori pathways into the NM alliance pathways programme.
Maori representation st confirmed by 31 July 2013.
a.
a.
b.
c.
Number of children under five enrolled in DHB funded dental services - 5,750 Decayed, Missing, Filled Teeth (DMFT) at year 8 – Maori 1.38 Proportion of children
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At least two pathways reviewed and adapted to meet Maori health need by th 30 June 2014.
b.
c.
Increase adolescent enrolment rates. Increased number of preschool enrolment rates. Decayed and missing filled teeth for Year 8 children and proportion
A more unified and improved health and disability system. Maori receive better disability services
health
and
oral health kits to high risk families attending the service and monitor and report any oral health improvement. (Noting that Well Child/Tamariki Ora providers also distribute oral health kits to families) Work collaboratively with Maori Well Child/Tamariki Ora providers and others (e.g. early childhood education settings) to develop strategies to improve oral health in Maori children. Focus Oral Health Week (September) to include high risk families and Maori. Work with the Mental Health Service Directorate and district PHOs to establish improved Kaupapa Maori services, including strengthening Primary Mental Health Stepped care for Maori.
NMDHB will work with the South Island Health Alliance and develop and implement a Rheumatic Fever Prevention
caries free at 5 years of age – Maori 70% Utilisation of adolescent oral health services – 85%
of caries free at 5 years of age.
8% of patients supported through Primary Mental Health Initiatives (BIC, SMART, Extended GP Consults and Packages of Care) are Maori. Baseline demographic data is collected on youth presentations to PMH.
Percentage increase in Maori youth accessing primary mental health services.
st
Agreed Rheumatic Fever Prevention Plan approved st by 31 October 2013.
d.
Improve Maori.
responsiveness
to
Earlier access to treatment. Improved services.
utilization
of
Appropriate pathways that support Maori. Improved preventative measures for Maori as a key risk population are developed, which reduces the burden of
Plan delivered October 2013.
21
by
31
Plan.
rheumatic fever (and its consequences) in the South Island.
22