CE update News and views about our health from
SEPTEMBER 2019 Waikato DHB Chief Executive Dr Kevin Snee
I am in my second month in the organisation at the time of writing and I came to some conclusions last month about what the problems are that we have to deal with. I continue to be impressed by the quality of a great many of our staff and clearly there are real strengths to build upon, but I continue to be very concerned about many of our systems and processes and I see evidence of significant cultural problems. This month I have spent a lot of time sitting down with managers working through their budgets and reinforcing the importance of financial prudence and accountability. We have to ensure financial control in order to deliver the best value for the investment that is made. There are some very early signs that we may be starting to see greater control, but it is too early to say for sure. I recently announced that Leena Singh has been appointed as chief operating officer and this has been widely welcomed.
She has an excellent reputation, a good understanding of the issues in Waikato DHB and comes originally from Hamilton. She will commence work in early January. I’d like to apologise to the rural localities for not getting out to visit you yet. I can assure you that you will not be forgotten and that a key part of our strategy is how we improve our services in your area. I am arranging for a series of visits so I can have a good understanding your issues and I can support you to resolve them.
Embracing Māori culture
Te Wiki o te Reo Māori / Māori language week heralded a month of activity in the organisation. Staff are being encouraged to engage with te reo Māori and recognise the importance of understanding Māori culture as a means of not only enriching their lives but being able to provide a better service for their patients. Te Puna Oranga have a range of activities to take part in over the next month. Go to the te reo Māori intranet page in the ‘Staff community’ section on the intranet to see what is on and also have a look at some of the videos of staff saying their pepeha. Have a go at writing your own pepeha. One of my objectives is to make the speaking of te reo Māori more available in this organisation. I have a target to get at least 500 people enrolled in learning te reo Māori. I had the privilege of attending the annual Koroneihana at Tūrangawaewae Marae, and then subsequently meeting Kiingi Tūheitia. He is clearly keen to explore opportunities working with the DHB to improve the health of local Māori – there may be opportunities also to raise the profile of Māori culture in the organisation working with him. I attended the local staff orientation process which will change from October. I am keen to see this process develop and improve, with more of a focus on culture and values to inspire new starters rather than on information giving. I have asked that we use powhiri and whakawhanaungatanga as a key element within this process. It would be ideal if we could use a local marae to conduct the orientation.
Healthy people. Excellent care
Staff practising waiata and writing their pepeha
CE update
SEPTEMBER 2019
University of Waikato and Waikato DHB develop nursing degree We have joined forces with the University of Waikato to develop a Bachelor of Nursing programme. I met recently with the University of Waikato vice-chancellor Professor Neil Quigley to discuss this new venture that has been in the planning for a while now. This is an exciting development for the University of Waikato and Waikato DHB. It is essential that we grow our healthcare workforce and having a nursing programme within University of Waikato sits well for us and the university is well-placed to offer a degree that will develop nursing graduates with the right mix of skills to meet the demands peculiar to the Waikato. Waikato DHB’s chief nursing and midwifery officer Sue Hayward has been involved since the early stages and for her this is a legacy for Waikato DHB to work in partnership with the university to create another nursing succession plan that will ensure we have a future nursing workforce that is going to be as nimble as we need it to be to adapt to our increasing rural focus and the need to support Māori in achieving health gains. This particular programme, once we have the curriculum developed, will have differences one being the weaving of psychological health alongside physical health throughout the duration and another being the way we as a DHB will offer clinical experience during the student years. This university degree will give potential applicants a choice where to study, as for some individuals university appeals better than a polytechnic and of course vice versa. Having more than one school of nursing offering differences within programmes and exists within the bigger regions, so this places Waikato DHB at this level. Nursing will sit as one of three programme streams in the University of Waikato’s School of Health.
L-R Waikato DHB chief nursing and midwifery officer Sue Hayward and chief executive Dr Kevin Snee with University of Waikato pro vice-chancellor for the Faculty of Arts and Social Sciences Professor Allison Kirkman and vice-chancellor Professor Neil Quigley To support the development of its Bachelor of Nursing programme, the University of Waikato has appointed Professor Matthew Parsons as professor of gerontology. Professor Parsons has resigned from his position with University of Auckland Faculty of Medical and Health Sciences, where he holds the position of professor in gerontology across Waikato DHB and the University of Auckland. He starts his position at University of Waikato on 8 October. Once the University of Waikato and Waikato DHB complete the development of the new nursing programme, it will be submitted it to the Nursing Council of New Zealand and the Committee on University Academic Programmes (CUAP) for approvals. If approved, enrolments will open for the first semester of 2021.
Harti Hauora Tamariki tool making a real difference I met recently with Dr Nina Scott – she talked to me about Harti Hauora Tamariki programme which is really impressive. Harti Hauora Tamariki, is a Waikato-based comprehensive, equityfocused child health programme that offers screening, interventions and follow-up packages to children in hospital and their whānau. It is all about improving access to health and social services for tamariki and their whānau. Many of the kids aged 0-4 years who are hospitalised with diseases of poverty are being re-admitted within six months. We’re not fixing the root cause of the disease, which is poverty. But there are quite a lot of things we can do to help that, like making sure they have a warm, insulated house, making sure they are enrolled with a GP, making sure they’re up to date with immunisation, and the parents get some good smoking cessation support, all of these things and much more. The Harti screening tool and follow up protocols make it really easy for hospital staff to complete with whānau. Dr Nina Scott
Earlier this year, Harti Hauora won an award for being an Outstanding Innovation at the Health Roundtable in Melbourne.
SEPTEMBER 2019
CE update
Quality of care
The Kudos Awards
At a recent meeting of the Consumer Council the commissioners and I heard a distressing story about how our discharge planning had failed a patient. On further investigation I have heard about other patients where discharge has been very poorly managed. I have asked for this to be addressed as a matter of urgency. I am grateful to the Consumer Council for alerting me to this problem.
I recently attended the Kudos Science Excellence Awards where I was privileged to present the award for medical science to Grant Christey, representing the Midland Trauma Research team, with Douglas White, rheumatologist of the DHB also a finalist.
A little more about our Consumer Council
Our DHB is fortunate to have a strong and capable Consumer Council made up of 12 members who bring a range of skills and lived experiences. This group have a great passion for ensuring we engage with consumers effectively and keep them at the forefront of what we do. Consumer councils are important in today’s world of health, as they can help health services change fundamentally by providing a consumer perspective, coming up with new ideas, and working in partnership with the DHB. I would encourage you to think about how you could use consumers more in the development of your service. Take a look at the range of experience we have within our Consumer Council here: www.waikatodhb.health.nz/about-us/ consumer-council/members
Amanda Oakley received an award for her lifetime of internationally recognised work in dermatology. Midland Trauma Research Centre was the winner of the Waikato DHB Medical Science Award. Midland Trauma Research Centre is the premier trauma research group in the country, led by Waikato trauma specialist Grant Christey. Its work includes clinical research, quality improvement initiatives, and research aimed at raising awareness and ultimately trauma prevention. Watch their Kudos videos: • Midland Trauma Research Centre www.waikatodhb.health.nz/kudosMTRC • Amanda Oakley www.waikatodhb.health.nz/kudosOakley • Douglas White www.waikatodhb.health.nz/kudosWhite
Supreme award winner – Adjunct Associate Professor Amanda Oakley awarded The University of Waikato Lifetime Achievement Award
Consumer Council co-chair Gerri Pomeroy (right) promoting the Disability Responsiveness Plan hui while Kimai Ross (left) translates for an online video The recent video promotion is an example of how our Consumer Council members can help support what we do: www.waikatodhb.health.nz/about-us/get-involved/publicconsultations/draft-waikato-dhb-disability-responsiveness-plan To engage with the Consumer Council, you can contact them through the Quality and Patient Safety team by emailing consumercouncil@waikatodhb.health.nz. This is monitored by the Consumer Engagement team, and does not go directly to Consumer Council members.
Waikato DHB Medical Science Award winners and finalists. L-R Dr Douglas White, Dr Grant Christey (Midland Trauma Research Centre – winner), Dr Kevin Snee, and Dr Ruth Martis, from Wintec
CE update
SEPTEMBER 2019
Measles update It is very sad in a developed country that we are seeing the re-emergence of a disease that should have been long forgotten. I remember vividly contracting measles as a young person and I remember being very ill. In my time as a clinician I have seen a child become profoundly disabled following measles encephalopathy. There is a lot of misinformation out there that people have been taken in by and so are not immunising their children and I suspect they have forgotten how bad measles can be.
Cancer care at Waikato DHB You may have heard in the media about the Government’s intention to form a National Cancer Agency to support the work of DHBs in managing our cancer burden, with one stated aim being to reduce disparity in access to treatment between different regions throughout the country. Clinicians involved in cancer care in this hospital and community are supportive of any measure that improves timely cancer care for all. Some of the political discussion around this announcement included the stated wish to set up key performance indicators (KPIs) for DHBs in the management of cancer, by which the performance of DHBs can be measured. This may have left you with the impression that we don’t already have KPIs that we work to, and may have given some in the community the impression that cancer care is random and disorganised. I would like to reassure all our staff and the community that this is far from the case. Under guidance of the Midland Cancer Network we have robust standard treatment guidelines for all main tumour types, a comprehensive network of clinical cancer nurses that aid individual patient journeys and a region wide system of multidisciplinary meetings that not only help look after Waikato patients but facilitate care to cancer patients from one Midland coast to the other. We monitor and report on many KPIs already, including 31 day and 62 day faster cancer treatment targets. Most importantly we have a bunch of dedicated people that are doing their best every day to help people, in often trying circumstances. There won’t be a DHB in the country that doesn’t have room for improvement, including us. We are hopeful that the National Cancer Agency can help focus cancer care in this country and we look forward to working with them.
We have been responding to a measles outbreak which initially centred in the Auckland region. To date (24 September) Waikato has 19 confirmed cases. To ensure a coordinated response a Coordinated Incident Management System (CIMS) structure has been put in place. More vaccines have been secured for New Zealand but, while we wait for it to arrive here, the national priority is ensuring all children receive their vaccines on time at 15 months (12 months in Auckland) and 4 years to maintain the national childhood immunisation schedule. This page on our website www.waikatodhb.health.nz/ measles is updated frequently with confirmed measles cases, advice, resources and information about vaccine supply.
Waikato DHB have been:
• coordinating stock levels and supply of vaccine to ensure continuity of the childhood MMR vaccination programme • trialling pop up clinics with iwi and Pacific providers
• supporting track and trace with the Public Health unit
Green light for another cath lab and upgrade to interventional radiology suites We have agreed to fund the fourth cardiac catheterisation laboratory (cath lab). The intention is for it to open in February 2020, that it will enhance our capacity to serve both the local patients who need urgent treatment usually following a heart attack or heart conditions and it will also enable us to deal with the number of patients who are coming from the regions. The additional capacity, at a cost of approximately $1.4m, is being created on level 3 of Meade Clinical Centre in space designated for future expansion of interventional radiology and cath labs and currently used for storage. Also approved is $2.7m to be spent on replacing and upgrading two existing interventional radiology suites in Meade Clinical Centre.
SEPTEMBER 2019
CE update
Out and about in Waikato Hospital I am getting to know the Waikato Hospital and it is clear that while there are some excellent facilities in the hospital there are some problems with infrastructure that need to be addressed. This is of concern as some areas have deteriorated beyond the point where minor maintenance intervention will suffice and a full refit is required. I see that there are problems with a number of wards with space constraints in the Elizabeth Rothwell Building. The postnatal ward is not fit for purpose; for example, you may have four mothers and their babies trying to bond and get some rest post-partum within a small room with little privacy. Even the Waikids wards that have been redesigned more recently are not necessarily serving us well and staff struggle to work within a footprint where the space constraints can make it difficult to manage patients acutely and accommodate family members. To enable solutions to these areas, a business case for development of vacant space at level 3 in Elizabeth Rothwell Building is being worked on by the Women’s Health service, which will alleviate space pressures and improve patient and visitor amenity. We are not going to be able to fix things overnight and our ability to do so is impacted by our financial situation, but we still need to keep those areas in mind for upgrades as resources allow. However, we need to get back into a better financial balance so we can actually generate some investment to sort out some of these long standing problems.
Industrial action There continues to be a significant amount of bargaining activity amongst the Allied Health, Scientific and Technical workforces. The DHB is currently planning for further strike action from both the Medical Imaging Technologist and Psychologist workforces.
Medical Imaging Technologist workforce
Whilst APEX Medical Imaging Technologists called off their planned strike on 26 August they have issued further strike notices to all DHBs (with the exception of Whanganui) for a full withdrawal of labour from 0700 Monday 30 September to 0700 Tuesday 1 October 2019 and from 0700 Wednesday 2 October to 0700 Thursday 3 October. We have also been informed that there is a strong possibility the union may ballot for further 24 hour withdrawals of labour over the next month. The potential strike action will have a significant impact on services throughout the DHB impacting on general X-ray and CT services to ED, inpatients, outpatients and theatres both onsite at Waikato Waiora site and the rural hospitals. The cardiac catheterisation lab and interventional radiology will also be significantly impacted. The DHB has been progressing well with contingency planning in efforts to minimise disruption to patients, but will needed to cancel and reschedule outpatient and elective work that is reliant on imaging support during this time. Further mediation is planned with the union on 23 September.
Psychologist workforce
APEX Psychologists have issued a third partial strike notice to DHBs nationally to take effect from 0800 on Tuesday 1 October to 0800 Friday 1 November. During the period of strike action psychologists will only provide a maximum of two hours face to face care to patients and their families a day. Contingency planning is underway to minimise disruption to patients.
CE update
SEPTEMBER 2019
Mental health and addictions I also visited the Henry Rongomau Bennett Centre and it is clear that it is not an ideal therapeutic environment for people suffering with serious mental health problems and can also see that it must be a challenge for staff to work in, especially when the facility is full. I know that staff are doing their best in this not so good situation. Work is progressing in this area to create greater community capacity for people suffering with mental health challenges and additional beds are being commissioned within the existing facility which will help to improve conditions in the short term. There is also a comprehensive business case proposal that is with the government and seeks funding to: • build a new fit-for-purpose acute and sub-specialty facility located at Waiora Waikato Hospital campus.
• refurbish the existing Henry Rongomau Bennett Centre to extend our Puawai services once the new building is complete. The business case has a defined vision through extensive feedback with the help of the Waikato community, health professionals, and those with lived experience. There is also a significant development on the horizon with 100 mental health beds to be commissioned at Waikeria Prison. Last week I met with executive director Mental Health and Addictions service Vicki Aitken and Department of Corrections MHS Programme director Jill Lane about the new facilities being built there. This development is the first of its kind in NZ and signals a real change in culture and approach within the Department of Corrections. The design, delivery and governance will be a partnership between Corrections, Waikato DHB and mana whenua. We will provide the clinical health staff who will be supported by cultural and custodial staff. This will be a regional facility and the development offers a real opportunity to ensure better flow from our forensic beds. Conversations are also occurring about how we might cooperate to grow the workforce and share training and development. At a time when we are also developing our own new model of care, there is an exciting opportunity to ensure we learn from one another and maximise how we utilise our shared resources.
Last month we sadly lost one of our mental health patients to suspected suicide. I was interviewed along with leaders from mental health and addictions services Vicki Aitken and Dr Rees Tapsell by reporter Libby Wilson from the Waikato Times. The write-up in the Waikato Times was a balanced article and handled the whole issue very sensitively as well as giving an insight to challenges and care we provide to our mental health and addictions patients – the issue of suicide is always difficult especially in relation to mental health patients. Read the article here: www.stuff.co.nz/national/health/115324573/key-differences-betweenwaikato-dhb-mental-health-patient-deaths-psychiatrist-says
Mental Health Awareness Week 23-29 September We have just had Mental Health Awareness week and I hope everyone has had a chance to spend some time thinking about your own wellbeing and discover the things that make you feel good and do more of them. Explore your way to wellbeing – Whāia te ara hauora, Whitiora. That’s the theme set from the Mental Health Foundation. “When you uplift your personal wellbeing, you uplift the wellbeing of your whānau, communities and Aotearoa as a whole.”
Mental health and addictions staff getting involved with various awareness and wellbeing activities during Mental Health Awareness Week
SEPTEMBER 2019
CE update Waikato Health System Plan, Te Korowai Waiora
New Zealand Health and Disability System Review The interim report of the New Zealand Health and Disability System Review chaired by Ms Heather Simpson has been published and is out for discussion. There are no surprises, it provides in a good analysis of what the health system issues are and poses a series of questions. It rightly identifies the problems of complexity in terms of accountability, funding and organisation. This is not primarily an issue of there being “too many DHBs” as it has been portrayed by certain individuals but if anything the complexity relates to other aspects of the system. The report also highlights the need to address culture and leadership as a priority. It recognises that the health system has failed to deliver on improving the health of Māori and in achieving the progress anticipated in the primary care strategy developed nearly 20 years ago – but reinforces its relevance. The final report with recommendations will be published in March 2020 – systemreview.health.govt.nz
A reminder that you can also find out more about our Waikato Health System Plan, Te Korowai Waiora, released last month. Click here to view the plan or visit www.waikatodhb.health.nz/hsp The 10-year plan that sets out a pathway to meet the challenges of the future and to have a Waikato health system that works for our communities. Vision for good health and wellbeing in the Waika to North Waikato
Waitomo - Otorohanga
North Ruapehu
Thames - Coromandel
- Hauraki
Greater Hamilton
Matamata - Piako
South Waikato
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HOSPITAL
IWI N GAKAUNUI COMMUNITY HEALTH SERVICES
Enhance wellbeing
HEALTH SERVICE S
and prevention
Improve access and choice close to where people live
Support whānau as active participants in their health
SOCIAL SERVICE S Whānau centred – listen to the voice and experience of whānau
SCHOOL LIBRARY
COMMU NITY SERVICE S
WAIKATO
Address determina
nts of health
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A plan to improve the health and wellbeing of people of the Waikato
Parking It is clear that there is a major problem with our ability to accommodate staff and patients to park their cars. This can cause particular distress for patients who may not be able to attend clinic appointments and then appear as a ‘Did Not Attend’, which would more correctly be described as a ‘Could Not Park’. I have asked for work to be done to describe a comprehensive travel plan to look at how we reduce the number of cars coming to the Waikato site through:
• encouraging alternative modes of transportation e.g. cycling, walking, subsidised bus transport • pricing
• policing of car parking to ensure that staff do not park in areas designed for patients
• enabling more services to be provided in the localities either through relocation or by through the use of technology. There are good examples in other parts of the country where this approach has been successful. The local plan is being worked on together with key internal and external stakeholders.
This update will be published monthly, if you have anything happening in your area and think I should know about it please email news@waikatodhb.health.nz