CE update Tokoroa and South Waikato
I visited Tokoroa Hospital and attended South Waikato Community Forum, and I was impressed by the potential that was apparent. There appeared to be a well-resourced set of services and a substantial community facility which colocates two general practices, a community pharmacy, the community and hospital services and a number of private providers with around 6,500 outpatient visits from visiting specialists. However, it is not realising its potential for a number of reasons which include: • the development of services appear to be relatively unplanned and ad hoc – current out of hours arrangements are an example of this
• not enough time and effort has put in to making sure that services collaborate for the benefit of patients • lack of use of readily available technology to undertake virtual consultations by clinicians based in Hamilton • some retrenchment to Hamilton of SMOs in recent years which has seen a reduction in outpatients Tokoroa is a locality where we are determined to see early progress towards the development of locality based integrated services. This will require significant leadership and management input to work with the local community and local clinicians to ensure that initiatives the community have told us they wish to see are delivered. This includes being more responsive to the diversity of need in South Waikato, specifically with the mix of Pacifica, Māori and Pākehā populations. They want more local access, including to mental health crisis services. They have asked us to use the strong community networks that exist and work with them to address issues such as housing that impact significantly on health. In addition to making best use of resources we should move towards a virtual single organisation working as one rather than several colocated silos.
NOVEMBER 2019
Mental Health update
The Mental Health Acute Service Acute Sustainability Response Plan contains six specific areas of focus: • Establish a 10 bed community based acute alternative • Housing wrap around supports • High needs packages of care • Increased funding to the provider arm to cover the immediate additional staffing costs whilst community based interventions are implemented (additional seven inpatient beds in the acute inpatient facility) • Expand the Crisis and Home Based Treatment Teams • Review and Care Planning for inpatient cohort for discharge This plan started in July 2019. Numbers of admissions and current occupancy of the inpatient unit have not yet decreased or seen any significant changes to date. This is due to the ongoing demand for acute hospital admissions. The additional seven Rapid Reintegration and Rehabilitation inpatient beds opened on 29 October 2019, with full occupancy. This will see some reductions in pressures on staff and other service users in the existing inpatient wards. While there have been significant gains since implementation, the major impacts of the plan will not be fully realised until all the elements of the plan are completed and fully implemented. Specifically: • The implementation of the Acute Alternative to Admission facility
• Suitable and sustainable placement options for all the inpatients identified with multiple and complex needs – these service users are likely to have long periods of inpatient stay, or frequent admissions, and require high levels of resource and support on the ward Te Ahwi Whānau has been appointed as the preferred provider for the Acute Alternative to Admission facility. The provider is confident that seven beds will be open in December, increasing to 10 beds in March 2020. Utilisation of dedicated packages of care for multiple and complex needs clients have seen a number of successful discharges, however, successfully discharging clients of this type is a slow process and the lack of provider resources to support people in this group presents challenges and risks. Strategy and Funding are working closely with the provider to ensure continued progress in this area.
Industrial action
The DHBs have received strike notices for a total of 227 days, the majority of have been from APEX or the NZRDA. The DHB recognises the rights of union members to take strike action in support of their pay claim, but this has had a significant impact on the delivery of services to patients and staff. The DHB is grateful to all of our staff who have assisted in maintaining life and limb-preserving services during the strike action. The DHBs have made offers that are aligned to those accepted by the majority of our clinical staff and we do not think striking workforces should expect to get more than groups who take a more constructive approach to bargaining with the DHBs.
