Waikato DHB Maori Health Plan 2016-17

Waikato District Health Board MÄ ori Health Plan

Ki te Taumata o Pae Ora

2016-2017

Ki te Taumata o Pae Ora “Towards the summit or pinnacle of Pae Ora” 2

TABLE OF CONTENTS TABLE OF CONTENTS ................................................................................................................ 3 ACKNOWLEDGEMENTS ............................................................................................................ 4 FORWARD FROM ACTING EXECUTIVE DIRECTOR MĀORI HEALTH ........................................... 5 SUMMARY OF INDICATORS ...................................................................................................... 6 POPULATION PROFILE .............................................................................................................. 8 Our Population .................................................................................................................. 8 Health Profile .................................................................................................................... 9 MĀORI HEALTH PRIORITIES AND INDICATORS ....................................................................... 12 TE PUNA ORANGA HOLISTIC PROJECTS/PROGRAMMES TO ACHIEVE HEALTH TARGETS 13 NATIONAL PRIORITIES AND INDICATORS ............................................................................... 16 Data Quality .................................................................................................................... 16 Access to Care - PHO Enrolments .................................................................................... 17 Access to Care – Ambulatory Sensitive Hospitalisation (ASH) ........................................ 20 Child Health (Breastfeeding) ........................................................................................... 22 Cardiovascular Disease .................................................................................................... 25 Cancer Screening (Cervical) ............................................................................................. 26 Cancer Screening (Breast) ............................................................................................... 28 Smoking ........................................................................................................................... 30 Immunisation (1) ............................................................................................................. 32 Immunisation (2) ............................................................................................................. 34 Oral Health ...................................................................................................................... 37 Mental Health ................................................................................................................. 39 Rheumatic Fever .............................................................................................................. 41 Sudden Unexpected Death in Infancy (SUDI) ................................................................... 43 LOCAL PRIORITIES AND INDICATORS ...................................................................................... 47 1. Supporting Whānau Ora Provider Collectives and Whānau Ora Collective Plan ..... 47 2. Workforce ................................................................................................................ 54 3. Virtual Care .............................................................................................................. 54

ACKNOWLEDGEMENTS Ka hoki, anoo, ki te timatanga koorero e kiia ana, he honore, he korooria ki te Atua; kia tau, tonu, oona manaakitanga maha ki runga i a Kiingi Tuheitia me toona Whare Ariki, nui tonu. He maungarongo ki te whenua; he whakaaro pai ki ngaa taangata katoa! Ka whai iho nei he timatanga tuhononga o te mahere rautaki Māori o te Rohe Hauora o Waikato ki raro i te maru o ’Whānau Ora’; me te mihi ki ngaa manukura o teenaa iwi, o teenaa iwi me maataawaka o te rohe nei, kua whakaaengia, ka whakawhanakehia teenei tuhononga; hei tautokona te tirohanga whakamua, te anga whakamua o ’Whānau Ora’.Kia ara poutama, tonu, te kaupapa o ’Whānau Ora’, hei oranga ake mo te iwi nui tonu! Waikato District Health Board (DHB) wishes to thank and acknowledge the members of our Iwi Māori Council and Kaunihera Kaumātua, our Māori communities, and the Waikato DHB Board who participated in the development of Waikato DHB’s Māori Health Plan 2016-2017. In particular Waikato DHB wish to give special thanks to the people of Hauraki, Ngāti Maniapoto, Ngāti Raukawa, Waikato, Ngāti Tuwharetoa, Whanganui and all other iwi (Ngā Maata Waka) living within the Waikato DHB rohe.

FOREWORD FROM ACTING EXECUTIVE DIRECTOR MĀORI HEALTH Te Puna Oranga, the Māori Health Service, of the Waikato District Health Board, is going through a period of change. As part of that change, we are refreshing the way we plan to improve Māori health outcomes in the Waikato region. The new planning format will be predicated on a vision of “happy, healthy and wealthy Māori.” It will include a twenty year outlook statement based on where we expect Māori health to be in 2026 if we are to be intentional about achieving our vision. It will include a five year Māori Health Plan which will identify and articulate the key elements required to improve Māori health in this region. Finally, it will include a twelve month business plan that will identify where Te Puna Oranga will focus its resources as it transitions to the new planning regime. This will be a collaborative arrangement between Te Puna Oranga Māori Health Service and the Iwi Māori Council of the Waikato DHB. We expect to have the new planning format completed and forwarded to you by the end of August 2016. In the meantime, we submit this Māori Health Plan to satisfy the compliance requirements of the Ministry of Health. Millie Berryman Acting Executive Director Māori Health Te Puna Oranga Māori Health Service Waikato District Health Board

SUMMARY OF INDICATORS National

Baseline 2014/2015 unless otherwise stated

Indicators

Priorities

Māori

Primary Care Ethnicity Data Audit Toolkit Implemented

Data Quality

Ethnicity data accuracy

Access to care

Percentage of Māori enrolled in PHOs

91.95%

Ambulatory sensitive hospitalisation (ASH)

0-4 yrs 45-64 yrs

Access to care

Other

Target for Māori

95%

100%

9,088

7,956

7,936 or less

7,956

4,154

5,650 or less 2

Total:

Child health

Cardiovascular disease and diabetes

Cancer

Smoking

Exclusive or fully breastfed at LMC discharge

6 weeks

Exclusive or fully breastfed at 3 months

3 months

43%

54%

60%

Receiving breast milk at 6 months

6 months

50%

60%

65%

Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had a CVD risk recorded within the past five years

Breast screening rate

Cervical screening rate

10. Percentage of pregnant Māori women who are smoke free at two weeks postnatal

60%

66%

75%

84%

89.3%

11. Percentage of infants fully immunised by 8 months of age

90%

60.1%

68.1%

70%

60%

80%

60%

Total population WDHB-

82% Immunisation

88%

Total population WDHB-

91%

95%

Data retrieved from Trendly for period Q1 to Q4 2015

ASH data sourced from NSFL website for period 12 months to March 2016

Ministry of Health: 2016. Indicators for the Well Child Tamariki Ora Quality Improvement Framework: September 2015. Wellington: Ministry of Health 4

Data retrieved from Trendly for period Q1 to Q4 2015

Data sourced from Ministry of Health. 2015. Indicators for the Well Child/Tamariki Ora Quality Improvement Framework March 2015. Wellington: Ministry of Health. Time period: births between 1 January and 30 June 2014.

National

Indicators

Priorities

Baseline 2014/2015 unless otherwise stated

12. 75% of the eligible population (>65 years) are immunised against influenza annually

Māori

Other

55.25%

56%

75%

2013/2014:

Rate: 1.2 per 100,000

13. A two-thirds reduction from baseline in the number and rate of hospitalisations for acute rheumatic fever

4.8 per 100,000

Rheumatic Fever

2014/2015: 3.6 per 100, 000

Sudden Unexpected Death in Infancy

Mental Health

14. National SUDI target - 0.4 SUDI deaths per 1,000 live births

15. All caregivers of Māori infants are provided with SUDI prevention information at Well Child Tamariki Ora Core Contact 1

16. Mental Health Act: section 29 community treatment order comparing Māori rates with other (per 100,000)

2010-2014:

Oral Health

Please note this is a target for the total population 0.4 /1,000 live Māori births

1.48/1,000 live

.18/1,000 live

2014:

39.2% of Māori caregivers received SUDI info at Core Contact 1

59.9% of nonMāori caregivers received SUDI info at Core Contact 1

70% of caregivers of Māori infants are provided with SUDI prevention information at WCTO Core Contact 1

July 2012 to June 2013:

N/A

301

384 17. Percentage of Māori preschool tamariki are enrolled in the community oral health service

Target for Māori

Not able to be reported

95%

Local Priorities Supporting Whānau Ora Provider Collectives and Whānau Ora Collective Plan Workforce

18. Strengthen the relationship that the Waikato DHB has with its local Whānau Ora collective

19. A workforce that is reflective and responsive to the needs of Māori

Virtual Care

20. Increased delivery of health services to the large rural population closer to home.

POPULATION PROFILE Waikato DHB Population Waikato DHB serves a population of 400,820 and covers 21,220 square kilometres. It stretches from northern Coromandel to Mt Ruapehu in the south, Raglan on the west coast to Waihi on the east coast.

The Waikato DHB district takes in the city of Hamilton and towns such as Thames, Huntly, Cambridge, Te Awamutu, Matamata, Morrinsville, Ngaruawahia, Te Kuiti, Tokoroa and Taumarunui, covering six Iwi groups. Waikato DHB population breakdown is presented in the following table. Age Group 00 – 24 25 – 44 45 – 64 65 – 74 75+ Total

Ethnicity Māori 47,850 21,940 16,680 3,690 1,640 91,800

Pacific 5,700 3,200 2,120 500 280 11,800

Other 86,950 72,280 80,940 32,010 25,040 297,220

Total 140,500 97,420 99,740 36,200 26,960 400,820

The large rural population presents diverse challenges in service delivery and accessing health services. Significant points of interest include: • The population is expected to increase in Waikato but at a slower rate than the rest of New Zealand • We are more rural than New Zealand as a whole • We have a population that is getting proportionately older (the 65 plus age group is projected to increase by 52 per cent between 2011/12 and 2025/2026) • The population of children and young people is predicated to decline by 2026 • We have a Māori population which is growing at a slightly faster rate than other population groups and is estimated to be 23.3 per cent by 2026 8

• •

•

We have a population of Pacific people who make up an estimated 2.5 per cent of our population A higher percentage of people in our DHB live in areas of low socio-economic status compared to the New Zealand average (24.10 per cent live in areas classified as quintile five or most deprived, compared to a national average of 20 per cent) Ruapehu, Waitomo and South Waikato territorial local authorities have the highest proportion of people living in areas of low socio-economic status Inequalities in health tend to be highest for people living in areas identified as quintile four and five and these people are likely to experience lower life expectancy and higher rates of chronic conditions High numbers of the Māori population in our district live in areas identified as quintile four and five

Health Profile Understanding our health profile plays an important part in our planning and decision making processes. Key points of interest in terms of the health profile of the Waikato DHB population are8: • In 2012–2014, life expectancy at birth for Māori in the Waikato Region was 76.5 years for females (7.5 years lower than for non-Māori females) and 72.2 years for males (8.1 years lower than for non-Māori). • The all-cause mortality rate for Waikato Māori was twice as high as the non-Māori rate during 2008–2012. • Injury mortality was 85% higher for Māori than for non-Māori in Waikato. Males had higher rates of death from injury than females. • Potentially avoidable mortality and mortality amenable to health care were 2.6 times and 2.7 times as high for Māori as for non-Māori in Waikato during 2007–2011. • The all-cause rate of hospital admissions was 16 percent higher for Māori than for non-Māori during 2011–2013. • Almost 5,200 Māori hospital admissions per year were potentially avoidable, with the rate 38 percent higher for Māori than for non-Māori. The ambulatory sensitive hospitalisation rate was 75 percent higher. • The rate of hospitalisation due to injury was 19% higher for Māori than for nonMāori. Males had higher rates of admission than females. • The most common causes of injury resulting in hospitalisations among Māori were falls, exposure to mechanical forces, and complications of medical and surgical care, transport accidents, and assault. 8

Information in this section has been sourced from Robson B, Purdie G, Simmonds S, Waa A, Brownlee G, Rameka R. 2015. Waikato District Health Board Māori Health Profile 2015. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare

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• • • • • • • •

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Rates of hospital admission for injury caused by assault were over 5 times as high for Māori females as for non-Māori females and 2.4 times as high for Māori males as for non-Māori males. Males had higher rates than females. Compared to non-Māori, cancer incidence was almost 50% higher for Māori females while cancer mortality was close to twice as high. For Māori males, cancer incidence was similar to that of non-Māori, while cancer mortality was two-thirds higher. Breast screening coverage of Māori women aged 45–69 years was 55% compared to 68% of non-Māori women at the end of 2014 Cervical screening coverage of Māori women aged 25–69 years was 60% over 3 years and 75% over five years (compared to 78% and 91% of non-Māori respectively). Breast, lung, colorectal, uterine and cervical cancers were the most commonly registered among Waikato Māori women. The rate of lung cancer was 4 times the rate for non-Māori, as was the mortality rate. Breast cancer incidence and mortality rates were both two-thirds higher for Māori than for non-Māori. Colorectal registration and mortality rates were similar for Māori and non-Māori. Stomach cancer was the fourth leading cause of cancer death with 4 times the mortality rate of non-Māori. During 2011–2013 Māori with diabetes were nearly 4 times as likely as non-Māori to have a lower limb amputated. Māori adults aged 25 years were 82% more likely than non-Māori to be hospitalised for circulatory system diseases (including heart disease and stroke) in 2011–2013. Waikato Māori were 28% more likely than non-Māori to be admitted with acute coronary syndrome, 43% more likely to have angiography. Heart failure admission rates were 5 times as high for Māori as for non-Māori. Stroke admission rates were twice as high for Māori as for non-Māori, as were rates of admission for hypertensive disease. Chronic rheumatic heart disease admissions were almost 6 times as common for Māori as for non-Māori, while heart valve replacement rates were just over twice as high. By September 2014, 66% of Māori girls aged 17 years and 64% of those aged 14 years had completed all three doses of the human papilloma virus (HPV) immunisation. Coverage was higher for Māori than for non-Māori. Rates of hospitalisation for serious injury from self-harm were similar for Māori and non-Māori among those aged 15–24 years during 2011–2013 but over a third higher for Māori than for non-Māori at ages 25–44 years. Māori aged 45 years and over were 3.8 times as likely as non-Māori to be admitted to hospital for chronic obstructive pulmonary disease (COPD). Asthma hospitalisation rates were 2 to 3 times as high for Māori than for non-Māori in each age group.

On average, 2,180 Māori infants were born per year during 2009–2013, 40% of all live births in the DHB. Seven percent of Māori and 6% of non-Māori babies had low birth weight. • In 2013, two-thirds of Waikato Māori children aged 5 years and one-third of nonMāori children had caries. • At Year 8 of school, almost three in five Māori children and just over two in five nonMāori children had caries. • Māori children under 15 years were two-fifths more likely than non-Māori to be hospitalised for tooth and gum disease. • Māori were four-fifths more likely as non-Māori to be admitted to hospital for a mental disorder during 2011–2013. Schizophrenia type disorders were the most common disorders, followed by mood disorders. The Iwi groups within Waikato DHB district: •

The principal tribal Iwi groups that reside within the Waikato DHB district also affiliate to Tainui waka : • Hauraki • Ngāti Maniapoto • Ngāti Raukawa • Waikato Ngāti Tuwharetoa and Whanganui iwi groups also reside within Waikato DHB district. A significant proportion of Māori living within the Waikato DHB district affiliate to Iwi outside the district and collectively they are known as Maata Waka. Figure 2: Map of Te Rohe o Tainui

Mokau ki runga Tamaki ki raro Mangatoatoa ki waenganui Pare Hauraki Pare Waikato Te Kaokaoroa o Patetere Te hokinga mai ki te Nehenehenui

Mokau above Tamaki below Mangatoatoa in the middle The lands of Hauraki The lands of Waikato The lands Maniapoto and Raukawa

MĀORI HEALTH PRIORITIES AND INDICATORS The following sections of Ki te Taumata o Pae Ora 2016-2017 detail Māori health priorities and aligned indicators that have been selected at the national and local level. The first component focuses on Te Puna Oranga specific activities that align to more than one indicator; this is to avoid repeats throughout the document. The second component focuses on priorities and the aligned indicators summarised with the following headings:

• • • • •

Why is this a priority? Objective Actions to deliver improved performance Measure Reporting

Monitoring and Reporting The indicators and performance expectations identified in Ki te Taumata o Pae Ora 2016 - 2017 are monitored regularly. We provide a six monthly narrative report to the Senior Management and Board on our performance against all the indicators in this plan. Significant reports are provided and discussed in Board meetings and the reports are available to the public as part of the relevant Board agenda available on our website. The Iwi Māori Council and the Kaunihera Kaumātua receive the annual narrative reports with an additional annual Waikato DHB Māori Health Measures Omnibus. Our performance against the indicators in this plan is one of the tools used by the organisation (through the Iwi Māori Council, Kaunihera Kaumātua, the Board and Senior Management) to identify issues and inform decision-making to improve performance.

TE PUNA ORANGA HOLISTIC PROJECTS/PROGRAMMES TO ACHIEVE HEALTH TARGETS The following activities demonstrate a holistic approach to meeting the National Indicators. As they are referred to often throughout the Waikato DHB Māori Health Plan a summary of each project and which indicators they align to is provided below. More detail on how these activities will impact on achieving equity is detailed within the planning document.

1. 2. 3. 4.

What are we going to do? Attempt to contact caregivers of all pēpi, tamariki, and rangatahi admitted into Waikato hospital with rheumatic fever. Work with whānau to prevent readmission into hospital because of rheumatic fever Work with whānau to prevent other pēpi, tamariki and rangatahi from developing rheumatic fever Te Puna Oranga will provide the Ministry of Health with monthly reports on the progress of the implementation of Whare Ora

Measure Monthly reports

What are we going to do? Then Harti Hauora (HH) Tamariki Assessment tool referral pathway is evaluated reviewed and implemented in Waikato Hospital. Implementation of the Harti Hauora Tamariki Assessment tool in at least 3 other settings within Waikato and Midland region. Develop and implement 2x HH assessment tools targeting specific ages and gender

1. 2. 3.

Measure Report annually Report annually Development and implementation of 2x HH based assessment tools 14

What are we going to do? Measure Review and align Kaitiaki and Kaitakawaenga cultural Assessment tool realigned assessment tool to align with MÄ ori Health indicators.

NATIONAL PRIORITIES AND INDICATORS Data Quality Why is this a priority? Collecting accurate ethnicity data in accordance with the Ethnicity Data Collection Protocols will improve the quality of ethnicity health data. Target

Baseline Measure

Māori

Awaiting baseline data from June 2016 results of EDAT

Non-Māori

Awaiting baseline data from June 2016 results of EDAT

Awaiting baseline information before a target can be established

Objective

Actions to deliver improved performance

Measure

Reporting

Ethnicity Data Quality

Identify and create a set of KPI’s that will be used in different settings within the hospital to collect quality data ethnicity.

Create KPI’s that can be audited throughout the year to ensure quality data is captured

Annual reporting

Waikato DHB will continue to work with our local PHOs in order to improve and maintain the quality of ethnicity data submitted to national collections

Six monthly

The Midland Health Networks (MHN) will audit against its ethnicity data via its quality assurance programme. The MHN will provide information on the comparison between PHO enrolment and Census figures (refer to PHO enrolment section of this plan)

100% of Hauraki PHO’s practices within the Waikato DHB district will under-take the Ministry of Health’s Ethnicity Data Audit (by 30th of June 2017)

100% of National Hauora Coalition practices within the Waikato DHB district will undertake the Ministry of Health’s Ethnicity Data Audit (by 30th June 2017)

Access to Care - PHO Enrolments Why is this a priority? PHO enrolment is the first step in ensuring all population groups have equitable access to primary health care services and is therefore a critical enabler first point of contact health care. Differential access to and utilisation of healthcare services plays an important role in health inequities, and for this reason it is important to focus on enrolment rates for M훮ori.

Baseline Measure

M훮ori

91.95%

Non-M훮ori

95%

Target 100%

Objective

Actions to deliver improved performance

Measure

Reporting

Increase in the percentage of M훮ori enrolled in a PHO

Harti Hauora (HH) Tamariki Assessment tool referral pathway is evaluated reviewed and implemented in Waikato Hospital, with a specific access to care referral pathway.

HH Tamariki Assessment Tool is evaluated, reviewed and implemented by December 2016.

Publish evaluation findings in Academic Journal by December 2016.

6 monthly reporting

Implementation of the HH Tamariki Assessment tool with a specific access to care referral pathway in at least 3 other settings within Waikato and the wider Midland region, to increase whanau enrolment that may have been missed in other settings.

HH Tamariki Assessment Tool is piloted in at least 1 setting at the end of each of the following quarters-

Q3- Third setting

6 monthly reporting

Q1- First setting Q2- Second setting

Objective

Actions to deliver improved performance

Measure

Reporting

Design, develop and implement assessment tools based on the HH Tamariki Assessment Tool specifically targeting Kaumatua, Kuia, wāhine and tāne, with a specific access to care referral pathway.

Tool specifically developed to target Kaumatua, Kuia, wāhine and tāne by December 2016

6 monthly report

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific access to care referral pathway.

Cultural assessment reviewed and implemented by December 2016

6 monthly report

National Hauora Coalition will continue to support a range of Primary Health Organisation based initiatives to improve Māori engagement with primary care, including community events and the use of community workers and navigators to support Māori to connect with general practice

Waikato DHB will monitor PHO enrolments by providing a comparison of the enrolled population within our three local PHO’s relative to Census data that relates to the Waikato DHB district by the following dates-

Waikato DHB will monitor PHO enrolments by ethnicity on a quarterly basis.

First data set by June 2016 Second data set by December 2016 Third data set by June 2017 Midlands Health Network via its locality planning work is always actively comparing various views of the population to ensure that we are achieving the highest possible coverage as possible. In areas where it appears there are gaps then we will undertake local drives and always advise parents accessing care to enlist with a regular provider

Waikato DHB will monitor PHO enrolments by ethnicity on a quarterly basis.

First data set by June 2016

Objective

Actions to deliver improved performance

Measure

Reporting

Second data set by December 2016 Third data set by June 2017

Hauraki PHO will work to increase Māori enrolments in its PHO, via a media campaign and marketing, including promotion at community events, and through promoting enrolment in primary care through the Hauraki Whānau Ora Alliance, which connects to many whānau at a service provision level

Waikato DHB will monitor PHO enrolments by ethnicity on a quarterly basis.

First data set by June 2016 Second data set by December 2016 Third data set by June 2017

Access to Care â&#x20AC;&#x201C; Ambulatory Sensitive Hospitalisation (ASH) Why is this a priority? ASH is a proxy measure for avoidable hospitalisations, and unmet healthcare need in a community based setting. There are significant differences in ASH rates for different population groups and a key focus on activities to reduce ASH must address the current inequities. Target Total WDHB population

Baseline Measure

0-4 years

9088

45-64 years

7956

0-4 years-<7956 45-64 years <5836

Objective

Actions to deliver improved performance

Measure

Reporting

Fewer people are admitted to hospital for avoidable conditions

During 2016/17 Waikato DHB further develop and strengthen the workstream around improving ambulatory sensitive admissions rates. This will continue to be a joint primary and secondary care piece of work.

Ambulatory Sensitive Hospitalisations rates per 100,000 for the age groups 0-4 and 45-64 years are attained.

For both age groups 0-4 and 45-64 years:

Work with primary care alliance partners to reduce ambulatory sensitive admissions. Continue sharing ambulatory Data sharing process sensitive admission information with continues our primary care alliance partners (to aid decision-making from 1 July 2016 to 30 June 2017)

Narrative and quantitative report against all ASH initiatives by quarter 4 reporting period 2017.

Until that report is completed quarterly reports Top five ambulatory sensitive Areas for Waikato DHB will track each admission areas to be considered for district forwarded to map ASH initiative by prioritisation by map of medicine of medicine governance health priority governance group. An initiative via group for consideration and ethnic the MAP of Medicine will look to by quarter one comparison of improve referral pathways between utilisation of primary care and secondary care in services. regards to ASH health priority areas. (Completed June 2016)

Objective

Actions to deliver improved performance

Measure

Ensure that the MAP of Medicine has a strong equity focus integrated into its approach in order to support achieving health equity for Māori (July 2016). This will include the development of nodes within the MAP of Medicine that link health professionals to services that address determinants of Māori ASH rates such as income, housing, food security, social services and preventative health services.

Reporting

Asthma

Continue implementing Whare Ora (WO) a healthy homes initiatives which seek to make homes warmer drier and healthier and safer by installing a range of products ( floor and ceiling insulation, thermal curtains, heating devices, dehumidifies, mould kits, fire alarms and draft stoppers) and refer onto social support services/ Whānau Ora if required.

Complete 400 Healthy Monthly Home Assessments in the reporting Waikato district (By June 2017)

Respiratory infections - pneumonia Continue implementing Whare Ora (WO) Rheumatic Fever/Heart Disease Implementation of actions identified in the Waikato DHB’s Rheumatic Fever Prevention Plan 2015-2016 (refer to Rheumatic Fever section of this plan) (quarterly reports to the Ministry of Health on progress against actions and targets detailed in the plan and a reduction in the incidence of Rheumatic fever rates is evidenced.

Continue successful cross sector approach with stakeholders in Whare Ora programme (ongoing). Ensure whānau are receiving intervention assistance from Whare Ora programme within 7 weeks of being referred. (ongoing)

Child Health (Breastfeeding) Why is this a priority? Breastfeeding provides infants with nutritional needs and builds immunity for the first six months of life, to provide protection against a range of conditions. Breastfeeding also provides benefits in terms of bonding between mama and pēpi and can support better health outcomes. Research shows that children who are exclusively breastfed for around 6 months are less likely to suffer from childhood illnesses such as respiratory tract infections, gastroenteritis and otitis media. Breastfeeding benefits the health of mama and pēpi, as well as reducing the risk of SUDI, asthma and childhood obesity. Nationally, breastfeeding rates for Māori infants start at a slightly lower rate as the total population, and drop off more quickly than the total population at the 3 and 6 month time points. Breastfeeding is an important area of focus because there is significant room for improvement, and breastfeeding has wide-reaching benefits and potentially results in reduced cost for families.

Māori

Exclusive or fully breastfed at LMC discharge (4-6 weeks)

66%

Exclusive or fully breastfed at 3 months

43%

Receiving breastmilk at 6 months

50%

Non-Māori Exclusive or fully breastfed at LMC discharge (4-6 weeks)

Baseline Measure

Target

73%

Exclusive or fully breastfed at 3 months

60%

Receiving breastmilk at 6 months

64%

6 weeks- 75% 3 months- 60% 6 months- 65%

Objective

Actions to deliver improved performance

Measure

Reporting

Increase the proportion of Māori infants that are breastfed (fully and exclusively at 6 weeks, and 3 months)

Promote and train kaimahi that work with, or intend to work with hapῡ Māori, on how to use the newly developed Hapū Wananga Curriculum (Kaupapa Māori Pregnancy and Parenting curriculum) for the Midland region that promotes, empowers and encourages breastfeeding.

2x training sessions throughout Midland region by June 2017

6 monthly report

(exclusively, fully and partially breastfed at 6 months)

Promote breastfeeding to Māori whānau/communities by holding Latch On and World Breastfeeding week activities, raising awareness of the importance of breastfeeding and to assist with Māori uptake. Waikato DHB will encourage Māori wāhine to participate in media and other events held by Māori providers and PHO’s.

Participation in Latch On and World Breastfeeding Events during August 2016

Annual report

Waikato DHB will promote the use of the Midland breastfeeding app.

Ongoing

6 monthly report

Waikato DHB Breastfeeding Champion will continue to provide workshop/s on the importance of promoting breastfeeding to PHO staff within the Waikato DHB district

1 workshop by December 2016

Annual report t

Waikato DHB and/or Te Puna Oranga, active involvement in the Breastfeeding Action Coalition Kirikiriroa (B.A.C.K.) roopu to discuss activities that will increase the number of Māori breastfeeding, supported the

Attendance 80% of scheduled meetings between June 2016- July 2017

6 monthly report

A key objective of all promotion activities will be to highlight the importance of breastfeeding in building immunity against a range of infectious diseases and combating childhood obesity and diabetes

Objective

Actions to deliver improved performance

Measure

Reporting

development of the content of the app. The app will be promoted via primary care, health promotion and through our Hapῡ Wananga classes and Hapῡ Wananga postnatal classes. Midland Maternity Action Group is committed to increasing breastfeeding rates in the Midland DHB’s.

Develop a Midland Breastfeeding Framework to inform and prioritise breastfeeding initiatives in the Midland region.

Q1-Q4 2016/17

Midland Breastfeeding App – BreastFedNZ

12 month mark: September 2016

Midland breastfeeding friendly accredited spaces added WCTO and pregnancy and parenting service providers added Issues and barriers to breastfeeding identified in focus groups of Midland breastfeeding framework are addressed, where applicable

Evaluation of effectiveness and uptake. Content is reviewed against topics of smoke free pregnancies, safe sleeping, mental health messages, alcohol and drugs, maternal nutrition, immunisation, etc.

Increased visibility of Māori breastfeeding women, partner and whānau support in app, website, and resources

Implement the ‘Midland Use of Donor Breastmilk Protocol’

Q2 2016/17

Cardiovascular Disease Why is this a priority? The burden of cardiovascular disease (heart and stroke) is greatest among the Māori population, and mortality is more than twice as high compared to non-Māori. CVD risk assessments are an important tool to enable early identification and management of people at risk of heart disease and diabetes. Fast access to treatment for heart related attacks is essential to achieve health equity and improve health outcomes for Māori.

Baseline Measure

Māori

84%

Non-Māori

89.3%

Target 90%

Objective

Actions to deliver improved performance

Measure

Reporting

Increase the percentage of the eligible Māori population who have had their CVD risk assessed within the past 5 years and decrease the number of tertiary cardiac interventions performed

Design, develop and implement assessment tools based on the HH Tamariki Assessment Tool specifically targeting Kaumatua to include a specific CVD risk assessment referral pathway.

Tool specifically developed for 6 monthly Kaumatua and Kuia by report December 2016

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific CVD risk assessment referral pathway.

Cultural assessment reviewed and implemented by December 2016

6 monthly report

Cancer Screening (Cervical) Why is this a priority? In 2012, Māori women were twice as likely as non-Māori to develop cervical cancer, and 2.3 more likely to die from it. Regular cervical screening detects early cell changes that would, over time, lead to cancer if not treated. Nationally, cervical screening coverage for Māori is 62.2%, compared to coverage in European/Other populations with coverage at 82.2%. Improving screening coverage and monitoring of the timeliness and experience of colposcopy for Māori women is therefore an important activity.

Baseline Measure

Māori

60%

Non-Māori

80%

Target 80%

Objective

Actions to deliver improved performance

Measure

Reporting

Raise our Māori cervical screening rates to match or better national target requirements

With the establishment of the Project Board, communication between the DHB and the three PHOs to determine how best limited funding can support Māori (and Pacific Island) women to participate in cervical screening through implementing projects will continue.

Hold monthly regional cervical screening collaboration meetings and annual smear taker update focused on improving quality and increasing coverage.

Monthly meetings and annual smear taker update occur

Continue to provide cervical smears at no cost to all eligible Māori women living in Waikato DHB. Offer PHOs additional funding for out of hours smear taking on a fee for service basis.

Increase in cervical screening rates by PHO

Quarterly report

Undertake a pilot project (between June 2016 to December 2016) to identify and offer cervical smear tests to inpatients and outpatients within WDHB

Key measurements:

Report at conclusion of pilot programme

-Number of women overdue for screen -The number of women offered cervical screen -The number of women screened

Waikato DHB will work with the Key activities with measurable Annual report new support to screening services outputs provider to create an action plan that will focus on increasing the

Objective

Actions to deliver improved performance

Measure

Reporting

number of eligible Māori wāhine who have had a cervical screening event in the past 36 months and to ensure that Māori women are supported to attend colposcopy appointments.

Cancer Screening (Breast) Why is this a priority? Historically, Māori women have significantly higher incidence and mortality from breast cancer compared to non-Māori. Inequities in access to screening services need to be addressed to ensure Māori women experience the benefits of early detection of breast cancer.

Baseline Measure

Māori

60.1%

Non-Māori

68.1%

Target 70%

Objective

Actions to deliver improved performance

Measure

Reporting

Raise our Māori breast screening rates to match or better national target requirements

With the establishment of the Project Board, communication between the DHB and the three PHOs to determine how best limited funding can support Māori (and Pacific Island) women to participate in breast screening through implementing projects will continue.

Hold monthly regional breast screening collaboration meetings and annual breast screening update focused on improving quality and increasing coverage.

Quarterly report

WDHB will continue to contact women who have not been screened or are under screened identified by Breast Screen Midland (BSM) via data matching or as non-responders.

Maintain an up to date database of women who have not been screened or under screened

Monthly report to BSM

Promote breast screening to Māori women in Hamilton in particular, i.e. MAMAgram month of May.

MAMAgram event May 2017

Quarterly report

BSM will lead, implement and evaluate the activities outlined in the Breast Screen Midlands (BSM) regional plan.

Implementation and evaluation of activities outlined in the BSM regional plan follow the timelines provided

Quarterly report

Undertake a pilot project (between June 2016 to December 2016) to identify and offer mammogram to eligible inpatients and outpatients within WDHB

Key measurements:

Report at conclusion of pilot programme

-Number of women overdue for screen -The number of women offered mammogram -The number of women screened

Objective

Actions to deliver improved performance

Measure

Reporting

Support collaborative working relationships between providers across the breast screening pathway via the regional breast screening hui held twice a year and the BSM coordinator who meets with key stakeholders on a more regular basis.

Attend 2x hui a year

6 monthly report

Waikato DHB will continue to work with the University of Auckland to explore reasons for lower survival for Māori women with breast cancer and to develop and intervention to support Māori women with breast cancer to have longer survival.

An academic publication

6 monthly progress report

Implement other initiatives as agreed Measures will be determined between Te Puna Oranga and BSM as per each initiative managers that will enhance the implemented. participation of Māori wāhine in BSM – The improvement in Māori BSM coverage as outlined in the BSM plan and/or the Waikato DHB Māori Health plan, with specific reference to increasing coverage in Hamilton, Tokoroa, Morrinsville and Kihikihi/Te Awamutu (towns where there is a significant volume of Māori wāhine and the BSM mobile is visiting in this period). There is currently a Service Level Agreement being drafted between BSM and Te Puna Oranga which will include activities.

Quarterly reports

Smoking Why is this a priority? Hapu Māori wahine have very high smoking prevalence (three times higher than the national prevalence). Smoking during pregnancy increases the risk for pregnancy complications and tobacco smoke harms babies before and after they are born.

Baseline Measure

Māori

60%

Target

Total WDHB population

82%

95%

Objective

Actions to deliver improved performance

Measure

Reporting

Smoking cessation: Percentage of pregnant Māori women who are smoke free at two weeks postnatal

Promote and train kaimahi that work with, or intend to work with hapῡ Māori, on how to use the newly developed Hapῡ Wananga Curriculum (Kaupapa Māori Pregnancy and Parenting curriculum) for the Midland region that promotes, empowers and encourages mama to be smoke free.

2x training sessions within Midland region by June 2017

6 monthly report

Continue to deliver Hapῡ Wananga 12 classes by June 2017 classes targeting young Māori mama, with a specific focus on being smoke free. Provide a referral pathway for mama and whānau to be smoke free.

6 monthly report

Hapῡ Wananga Post-natal classes will measure the previous and current smoking status and provide a referral pathway if needed.

6 monthly report

2x classes by June 2017

Objective

Actions to deliver improved performance

Measure

Reporting

Design, develop and implement assessment tools based on the HH Tamariki Assessment Tool specifically targeting wÄ hine to include a specific smoke free referral pathway.

Tool specifically developed for wÄ hine by December 2016

6 monthly report

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific smoke free referral pathway for hapáżĄ mama.

Cultural assessment 6 monthly reviewed and implemented report by December 2016

Immunisation (1) Why is this a priority?

“Immunisation is the most effective way to actively protect your child from preventable diseases, ranging from whooping cough to meningitis and measles” (Immunisation Advisory Centre, 2013). Although immunisation rates are high there is still a large health equity gap between Māori and non-Māori. Initiatives need to target Māori pēpi in order to achieve health equity.

Baseline Measure

Māori

88%

Total WDHB population

91%

Target 95%

Objective

Actions to deliver improved performance

Measure

Reporting

Raise the percentage of our pēpi fully immunised by 8 months of age

Implementation of the HH Tamariki Assessment tool with a specific immunisation for pēpi referral pathway in at least 3 other settings within Waikato and the wider Midland region, to increase whanau enrolment that may have been missed in other settings.

HH Tamariki Assessment Tool is piloted in at least 1 setting at the end of each of the following quarters-

6 monthly report on HH

Q1- First setting Q2- Second setting Q3- Third setting

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific immunisation for pēpi referral pathway.

Cultural assessment reviewed and implemented by December 2016

6 monthly report

Hapῡ Wananga classes will continue to review feedback from participants to promote discussion on immunisation for pēpi.

Ongoing in future classes

6 monthly report

Hapῡ Wananga Post-natal classes will measure the number of eligible pēpi and whether they have been fully immunised. A referral pathway will be offered to whānau.

First class completed by December 2016

6 monthly report

Second class completed by June 2017

Objective

Actions to deliver improved performance

Measure

Reporting

Maintain our Under Fives Immunisation Steering Group Actions to support increasing children's immunisation rates (for two years and five years) to 95 percent:

Quarterly

Include, monitor and increase the four-yearold milestone as part of the immunisation alliance steering group outputs.

Immunisation (2) Why is this a priority? In 2014 Māori had the second highest rate of influenza confirmed hospitalisation, 49.2 per 100,000. The 65 years and over age group also have the highest rates of influenza admissions to ICU. A 75 percent influenza vaccination rate is required to provide the best protection for this age group and in particular for Māori. If we are able to increase immunisation rates for Māori we will see a significant reduction in overall influenza cases

Baseline Measure

Māori

55.25%

Non-Māori

56%

Target 75%

Objective

Actions to deliver improved performance

Measure

Reporting

Increase the percentage of Kaumātua and Kuia (65 years and over) seasonal influenza immunisation

Continue to work with local Māori provider on Kaumātua programmes to promote and provide access to out-reach flu vaccination services to Māori within the Waikato DHB district. Implementation of project in March 2016 to coincide with the beginning of the 2016 flu immunisation season (Mauri ora ki ngā Kaumātua) and will continue through to September 2016.

Te Puna Oranga will report on the number Kaumatua and Kuia immunised at a programme or event Te Puna Oranga was a partner at.

Quarterly report.

Working with Māori providers will ensure that immunisation is championed on a wide front rather than just through GP services or more mainstream services. Continue to spread the health marketing campaign that promotes the benefits of immunisation and identifies where Kaumātua 65yrs+ can get free immunisation (campaign implemented in March 2016 led by Te Tumuaki Anaru Thompson and his wife).

Number of events and/or displays the marketing campaign took place.

Provide a list of participating pharmacies and other services that have free influenza immunisation for 65years and over.

Ensure that Kaumātua 65yrs+ can access free influenza immunisation from not only GP’s but also Pharmacies to ensure a wider range of services can provide immunisation

Objective

Actions to deliver improved performance

Measure

Reporting

Design, develop and implement an assessment tool based on the HH Tamariki Assessment Tool specifically targeting Kaumatua and Kuia with a specific seasonal influenza referral pathway for the 2017 influenza season.

Tool specifically developed for Kaumatua and Kuia by December 2016

6 monthly report

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific seasonal influenza referral pathway.

Cultural assessment reviewed and implemented by December 2016

6 monthly report

The Midland Health Network (MHN), National Hauora Coalition (NHC) and the Hauraki PHO will provide information and vaccinate Kaumātua 65yrs + across the Waikato DHB district

Success will be monitored through the completion of tasks within specified timeframes and evidence of an improving trend and/or attainment of the seasonal influenza immunisation target.

in a more timely and efficient manner.

Waikato DHB and Te Puna Oranga will develop a business case for an on-site Harti Hauora Hub which will conduct health promotion and opportunistic screening and immunisation of Māori. One of the services provided will include opportunistic immunisation against influenza. The business case will be developed by 1st July 2015

The Midland Health Network, Hauraki PHO and the National Hauora Coalition PHO will all collaborate in development of annual PHO/ DHB Influenza strategy (completed by 30th June 2016) Waikato DHB will collect and monitor the health sectors performance for Māori/ high need 65yrs+ on a monthly basis from GP’s Pharmacists and primary care as a

Objective

Actions to deliver improved performance

Measure

Reporting

whole (from 1st July 2015 to 30th June 2016

Oral Health Why is this a priority? Nationally as at December 2014, 76% of all pre-schoolers and 64% of Māori pre-schoolers were enrolled in the Community Oral Health Services (COHS). The inequity between Māori and non-Māori enrolments is significant therefore the need for more Māori targeted initiatives and programmes is crucial.

Target 95%

Objective

Actions to deliver improved performance

Measure

Reporting

Increase the number of Māori pre-school children enrolled in the Community Oral Health Service

Dental Conditions

Quarterly

Waikato DHB will work to promote early enrolment in Child Oral Health Services and work to promote Oral Health with whānau.

Oral Health Information will

With the implementation of the National Child Health Information platform (NCHIP) into community oral health services enrolment from birth will be used for enrolment for Community Oral Health and logging of oral health milestones in addition to data matching

NCHIP will be used to record enrolment

Oral Health Co-ordination and Health Promotion Community Oral Health will promote oral health for preschoolers with a particular focus on Māori Whānau.

Harti Hauora (HH) Tamariki Assessment tool referral pathway is evaluated reviewed and implemented in Waikato Hospital, with a specific COHS referral

HH Tamariki Assessment Tool is evaluated, reviewed and implemented by December 2016.

Publish evaluation findings in Academic Journal by

Objective

Actions to deliver improved performance

Measure

Reporting

pathway.

December 2016.

6 monthly reporting on HH

Implementation of the HH Tamariki Assessment tool with a specific COHS referral pathway in at least 3 other settings within Waikato and the wider Midland region, to increase whÄ nau enrolment that may have been missed in other settings.

HH Tamariki Assessment Tool is piloted in at least 1 setting at the end of each of the following quarters-

6 monthly report on HH

Q1- First setting Q2- Second setting Q3- Third setting

Mental Health Why is this a priority? New Zealand has very high rates of compulsion of patients under the Mental Health Act, compared with similar jurisdictions. Māori are nearly three times as likely as non-Māori to be treated under a community treatment order which represents a significant disparity.

Baseline Measure

Māori

384

Non-Māori

301

Target N/A

Objective

Actions to deliver improved performance

Measure

Reporting

Improve mental health and addiction outcomes for Māori within Health Waikato services

The establishment of the working group to improve Mental Health and Addiction outcomes for Māori within Health Waikato services will continue to meet and plan activities that will impact positively on reducing section 29 rates for Māori.

Improving trend in the reduction of section 29 Community Treatment orders evidenced.

Quarterly reporting

Objective

Actions to deliver improved performance

Measure

Reporting

The working group has developed a set of indicators to monitor performance of Health Waikato services for Māori patients.

Monitor the percentage of Māori who have an acute admission within 28 days for discharge from the inpatient unit as compare with other ethnicities

A specific methodology has been chosen to provide analysis of and monitor performance against indicators. Provide monthly reports of results.

Percentage of Māori in adult inpatient beds placed in seclusion and the number of hours Māori are in seclusion as compared to other ethnicities Percentage of Māori who are followed up by Community Mental Health Team within 7 days of discharge from inpatient unit. Measure if the contact has been telephone or face to face.

Percentage of Māori with current treatment/recovery plans in place as compared with other population groups.

Whilst there are significant concerns about the use and sense of this KPI, the Director of Clinical Services for Health Waikato will: •actively encourage judicious uses of the MHA, as clinical needs dictate. •encourage all Responsible Clinicians to review their use of Indefinite CT orders

Progress reported quarterly in PP26 -– Mental Health and Addictions Service Development Plan

Rheumatic Fever Why is this a priority? Rheumatic fever is a serious but preventable illness that mainly affects Māori and Pacific children and young people aged 4 to 19 years. Reducing rheumatic fever will contribute to achieving equity of health for Māori.

Total WDHB population

Baseline Measure

2013/2014

4.8 per 100, 000

2014/2015

3.6 per 100, 000

Target 1.2 per 100, 000

Objective

Actions to deliver improved performance

Measure

Reduction in the number and rate of hospitalisations for acute rheumatic fever

Implementation of actions identified in the Rheumatic Fever 2015 refreshed prevention plan.

Actions will be measured Quarterly specific to the actions noted in the Waikato DHB’s Rheumatic Fever Prevention Plan

Whare Ora healthy homes initiative will be promoted and implemented throughout the Waikato region for eligible whanau.

400 healthy homes assessments completed from June 2016-2017

Ensure that all cases of acute and recurrent acute rheumatic fever are notified with complete case information to the Medical Officer of Health within seven days of hospital admission. Ensure patients with a history of rheumatic fever receive monthly antibiotics not more than 5 days after their due date.

Reporting

Monthly reporting

Annual

Undertake an annual audit of rheumatic fever secondary prophylaxis coverage for children aged 0-15 years, youth aged 15-24 years, and adults aged 25+ years.

Identify and follow-up known risk factors and system failure points in cases of recurrent rheumatic fever.

Follow-up on any issues identified by the 2015/16 audit of recurrent hospitalisations of acute rheumatic fever and unexpected rheumatic heart disease.

Objective

Actions to deliver improved performance

Measure

Confirmation and exception report against the actions to deliver improved performance

Reporting

Please also see the Waikato DHBâ&#x20AC;&#x2122;s Refreshed Rheumatic fever prevention plan-

http://www.waikatodhb.health.nz/asse ts/public-health-advice/public-healthtopics/rheumatic-fever/The-WaikatoDHB-refreshed-2015-Rheumatic-Feverprevention-plan.pdf

The-Waikato-DHB-re freshed-2015-Rheumatic-Fever-prevention-plan.pdf

Sudden Unexpected Death in Infancy (SUDI) Why is this a priority? The target for SUDI will be lowered from 0.5 to 0.4 SUDI per 1,000 live births. The target has been lowered to match the reduced rate of SUDI among non-Māori infants (0.38 SUDI per 1,000 live births during 2010-2014). Yet there is still a significant difference in SUDI rates between Māori and non-Māori families living in Waikato DHB. The target for ‘Caregivers provided with SUDI information at Well Child Tamariki Ora Core Contact 1’ is lowered from all caregivers to 70% of caregivers. The target has been changed from a final target to an interim target. The interim target is slightly higher than levels of current service provision to non-Māori (62.6%) due to the higher SUDI rates of Māori.

Māori

Non-Māori

Baseline Measure

SUDI rate per 100,000 live births between 2010- 2014

1.48 per 100,000 live births

% of caregivers provided with SUDI prevention information at Well Child Tamariki Ora Core Contact 1

39.2%

SUDI rate per 100,000 live births

.18 per 100,000 live births

% of caregivers provided with SUDI prevention information at Well Child Tamariki Ora Core Contact 1

59.9%

Target 0.4 SUDI deaths per 1000 Māori live births Increase enrolment and consequent access to Well Child Tamariki Ora Core Contact 1 of 70% caregivers of Māori infants to enable timely provision of SUDI prevention information

Objective

Actions to deliver improved performance

Measure

Reduction in Māori rates for sudden unexpected death in Infancy (SUDI)

Partnership with Whakawhetu National SUDI Prevention for Māori to provide workforce development plan for prevention training to health workers and other kaimahi

Create plan by end of Q2 in Annual report collaboration with ‘call to action discussion document’ (action point below)

Waikato DHB will:

Promote the services of Well Child Tamariki Ora providers and timely enrolment (4-6 weeks) during pregnancy and post-natal period

Annual report

Work with LMC’s, Maternity facilities, NCHIP and the Child Health Coordination Service to ensure that there is timely enrolment into WCTO services

Ensure that WCTO providers build good relationships with LMC’s and maternity facilities to ensure referrals to WCTO are done in a timely manner.

Increase in the number of core 1 checks by 31 Dec 2016

6 monthly report

Work with key maternity people and Well Child Tamariki Ora providers with WCTO Quality Manager to develop a continuity of Care pathway

Completed by Quarter 1 2016/2017

Reporting

Q1 report 16/17

Work with WCTO providers to ensure SUDI information is included in their core 1 check

As a result of the Tamaiti Hui May 2016 a Call to Action discussion document specific for Waikato region addressing antenatal education and care, and postnatal care will be produced to address SUDI risk factors. Input from Whakawhetu, Te Puna Oranga, WDHB, Waikato CYMRC, maternity stakeholders, WCTO governance group, and PHO will be included.

Document will have a number of actions-

Annual report

1. Collaborative approach to SUDI prevention 2. Specific activities, initiatives, projects to assist common vision 3. Support for health services to implement SUDI prevention factors, i.e. safe sleep policies 4. Improve communication between providers and health and social services

Objective

Actions to deliver improved performance

Measure

Reporting

5. Improved access for whanau, hapῡ mama, and community to health resources/ health care Business case for sustainable funding Review and amend if necessary ‘Safe Infant Sleeping – Birth to 1 Year’ policy used within Waikato hospital

Renewal of policy by end of Annual report Q3

Te Puna Oranga membership on the Waikato Child and Youth Mortality Review Committee to provide recommendations to National CYMRC who can influence policy at a National level.

Attendance at minimum of 90% of meetings throughout the year

Waikato DHB will invest in pēpi-pods, mini- Purchase a minimum of pod, wahakura and cots for at risk whānau. 400 safe sleep devices.

Safe Sleep messages and practices are distributed with pēpi pods and wahakura to high needs whānau residing within the Waikato DHB region

6 monthly reporting

Minimum of 400 pēpi-pods Quarterly and wahakura distributed report from June 2016 to June 2017. Change for our Children The number of pēpi -pods and wahakura distributed to whānau data, loaded onto Change for our Children database

Waikato DHB will promote Safe Sleep Participation in at least 1 Annual report messages and the Waikato pēpi -pods and event during safe sleep day wahakura programme at community events with specific emphasis on safe sleep day. Promote and train kaimahi that work with, or intend to work with hapū Māori, on how to use the newly developed Hapū Wananga Curriculum (Kaupapa Māori Pregnancy and Parenting curriculum) for the Midland region that promotes SUDI prevention messages and solutions for whānau.

2x training sessions 6 monthly throughout Midland region report by June 2017

Objective

Actions to deliver improved performance

Measure

Reporting

Harti Hauora (HH) Tamariki Assessment tool referral pathway is evaluated reviewed and implemented in Waikato Hospital, with a specific SUDI prevention referral pathway. The pathway may require access to a safe sleep device or referral to services that support SUDI prevention, i.e. Well Child Tamariki Ora enrolment, immunisation for pēpi, smoke free pathway or breastfeeding support.

HH Tamariki Assessment Tool is evaluated, reviewed and implemented by December 2016.

Publish evaluation findings in Academic Journal by December 2016.

6 monthly reporting on HH

HH Tamariki Assessment Tool is piloted in at least 1 setting at the end of each of the following quarters-

6 monthly report on HH

Implementation of the HH Tamariki Assessment tool with a specific SUDI prevention referral pathway in at least 3 other settings within Waikato and the wider Midland region, to increase whanau enrolment that may have been missed in other settings. The pathway may require access to a safe sleep device or referral to services that support SUDI prevention, i.e. Well Child Tamariki Ora enrolment, immunisation for pēpi, smoke free pathway or breastfeeding support.

Q1- First setting Q2- Second setting Q3- Third setting

Review and implement Kaitiaki and Cultural assessment 6 monthly Kaitakawaenga cultural assessment to reviewed and implemented report include a specific SUDI prevention referral by December 2016 pathway. The pathway may require access to a safe sleep device or referral to services that support SUDI prevention, i.e. Well Child Tamariki Ora enrolment, immunisation for pēpi, smoke free pathway or breastfeeding support.

Whare Ora assessment tool will be reviewed to include a specific referral pathway for SUDI prevention to ensure a safe sleep device for pēpi is available, such as a pēpi-pod or wahakura.

Whare Ora assessment tool Monthly is reviewed to include a reporting. specific safe sleep device referral pathway by December 2016.

LOCAL PRIORITIES AND INDICATORS 1. Supporting Whānau Ora Provider Collectives and Whānau Ora Collective Plan With the disestablishment of the Waikato Regional Leadership Group for Whānau Ora and the move towards the Commissioning Agency Te Pou Matakana the shape of Whānau Ora on our local landscape has shifted significantly. Currently the Waikato DHB district has only one Whānau Ora collective within its district which is funded by Te Pou Matakana the Whanau Ora Commissioning agency for the North Island and that is Te Ngira. Te Ngira comprises of membership from Wāhi Whanui, Raukura Hauora, Nga Miro and Te Kohao Health. Formerly these providers had aligned themselves to Te Koiora our Northern Collective and to the National Urban Maori Authority (NUMA). As a way forward the Waikato DHB has committed to developing “Te Poutama o Whanau Ora” an action plan with Te Ngira to strengthen the implementation of Whanau Ora within the Waikato DHB district. “Te Poutama o Whanau Ora Action Plan 2016” will define joint work and support from Waikato DHB towards Te Ngira and Whanau Ora as a formal programme within the Waikato DHB district. Key areas of focus will focus on three key areas: 1. Mahi tahi - to work as one in collaboration 2. Kaitiakitanga - Iwi guardianship in relation to Whanau Ora 3. Puawai – to support Whanau Ora capacity development

Actions against the above three strategic directions are detailed in the following action tables.

Working with the Whānau Ora Partnership group is crucial to improving the health of Māori in Waikato. The activity in the following action plan cannot be achieved without collaboration between Whānau Ora providers, Te Puna Oranga (Māori Health Service) and Waikato DHB. In November 2015, the Whānau Ora Partnership Group agreed to a set of indicators to support Whānau Ora, including five key areas for the health sector that contribute to Whānau Ora to achieve accelerated progress towards health equity for Māori and Pacific, and Whānau Ora in the next four years. The indicators are: • • • •

Mental health (reduced rate of Māori committed to compulsory treatment relative to non-Māori); Tobacco (95 percent of all pregnant Māori women smoke free at two weeks post-natal); Asthma (reduced asthma and wheeze admission rates for Māori children (ambulatory sensitive hospitalisations 0-4 years)); Oral health (increase in the number of children who are caries free at age 5); 47

•

Obesity (by December 2017, 95 percent of obese Māori children identified in B4 School Check programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions).

Objective

Actions to deliver improved performance

To support the capability and capacity of Whānau Ora within the Waikato DHB district

The Waikato DHB has committed to developing “Te Poutama o Whānau Ora” an action plan with Te Ngira throughout the 2016-2017 period to strengthen the implementation of Whānau Ora within the Waikato DHB district.

Measure

Quarterly report completed detailing progress against initiatives and activities in “Te Poutama o Whanau Ora Action Plan” 2016-2017, 90% “Te Poutama o Whānau Ora Action Plan 2016” of actions and will define joint wok and support from outcomes detailed in Waikato DHB towards Te Ngira and Whānau plan attained. Ora as a formal programme within the Waikato DHB district. Key areas of focus will focus on three key strategic directions: (1) Mahi tahi - to work as one in the spirit of co-operation. Key areas of focus include: -progressing integrated contracts

-identify how Waikato DHB can give support to Te Ngira collective impact project

-sharing of information and expertise to support Whānau Ora programme within the Waikato district -secondments to support Whānau Ora, -media and communications plan to promote

Whānau Ora developments and successes in the Waikato district, -promotion as appropriate to whanau on how to access whānau direct funding/ support,

-formalisation of processes to ensure that the

Whānau Ora collectives can participate in

Waikato DHB Annual Planning and Māori Health Plan development,

-completion of a stocktake of how other sectors are progressing Whānau Ora with a view to identify opportunities to collaborate.

Reporting Quarterly reporting

(2) Kaitiakitanga - Iwi guardianship, Key areas of focus include:

Quarterly reporting

- establishment of processes that support’ our Iwi Quarterly report completed detailed Relationship Board Iwi Maori Council to progress against effectively monitor and evaluate Whānau Ora initiatives and activities in ”Te Poutama o within the Waikato DHB district Whānau Ora Action - ensure that success stories, key trends and the Plan” 2016-2017, 90 % of actions and performance of Whānau Ora implementation in - outcomes are attained. the Waikato DHB district is presented 2 x per year by Te Pou Matakana to Iwi Maori Council. (3) Puawai – to support Whānau Ora capacity development, key areas of focus include: -progressing integrated contracts, -identification of funding shortfalls that impede Whānau Ora rollout in the Waikato inclusive of service provision gaps in Hauraki, Raukawa and Maniapoto. -workforce development/ training for Whānau Ora kaimahi, exploration of the feasibility of how research can demonstrate the value added by Whanau Ora. Strengthen the relationship that the Waikato DHB has with its local Whānau Ora collective

Waikato DHB will actively promote Whānau Ora collectives programmes, initiatives, projects that improve the health of Māori in the Waikato region.

Quarterly reporting

Waikato DHB will collaborate with Whānau Active collaboration and Quarterly Ora collectives to meet the national indicators engagement in at least reporting within the Māori Health Plan. 3 projects throughout the Waikato region with Whānau Ora Collectives between June 2016- June 2017 Te Puna Oranga will actively connect whānau and communities with Whānau Ora Collectives services. E.g. One of the referral pathways used in Hapῡ Wananga classes in Hamilton for Community Oral Health Services include Raukura Hauora O Tainui.

Annual report (quarter 4) on activity undertaken to progress the Whānau Ora approach

Referral pathways for assessment tools (HH, Kaitiaki and Kaitakawaenga), and programmes such as Hapῡ Wananga will be reviewed and

Quarterly reporting

monitored 6 monthly

Mental health and Addictions

Working group to improve Mental Health and Addiction outcomes for Māori within Health Waikato services established and indicators identified.

Improving trend in the reduction of section 29 Community Treatment orders evidenced.

Quarterly

Monitor the percentage of Māori who have an acute admission within 28 days for discharge from the inpatient unit as compare with other ethnicities. Percentage of Māori in adult inpatient beds placed in seclusion and the number of hours Māori are in seclusion as compared to other ethnicities Percentage of Māori who are followed up by Community Mental Health Team within seven days of discharge from inpatient unit. Measure if the contact has been telephone or face to face. Percentage of Māori with current treatment/recovery plans in place as compared with other population groups. Tobacco control

Train kaimahi that work with, or intend to work with hapū Māori, on how to use the newly developed Hapū Wananga Curriculum (Kaupapa Māori Pregnancy and Parenting curriculum) for the Midland region that promotes, empowers and encourages mama.

2x training sessions throughout Midland region

Quarter 4

Design, develop and implement assessment tools based on the HH Tamariki Assessment Tool specifically targeting wāhine to include a smoke free referral pathway.

Tool specifically developed for wāhine

Quarter 2

Review and implement Kaitiaki and Kaitakawaenga cultural assessment to include a specific smoke free referral pathway for hapῡ mama.

Cultural assessment reviewed and implemented

Quarter 2

Asthma

Continue implementing Whare Ora healthy homes initiative seeking to make homes warmer, drier, healthier safer and refer onto social support services / Whānau Ora if required.

Complete 400 Healthy Home Assessments in the Waikato DHB district

Quarter 4

Oral health

Harti Hauora Tamariki Assessment tool will include an oral health enrolment assessment and referral pathway of all children admitted and screened using the Harti Hauora tool.

Increased enrolment of Māori tamariki and Pacific children with Community Oral Health Service

Quarter 3

Harti Hauora Tamariki Assessment tool referral pathway is evaluated reviewed and implemented in Waikato Hospital, with a specific Community Oral Health Service referral pathway. Implementation of the Harti Hauora Tamariki Assessment tool with a specific Community Oral Health Service referral pathway in at least three other settings within Waikato and the wider Midland region, to increase whānau enrolment that may have been missed in other settings.

Harti Hauora Tamariki Assessment Tool is evaluated, reviewed and implemented

Quarter 2

Quarters 1,2,3

Assessment Tool is piloted in at least 1 setting per quarter

Obesity

Harti Hauora Tamariki Assessment tool will include a body mass index assessment and referral pathway

Tool includes a body mass index assessment and referral pathway of all children admitted and screened

Quarter 4

Partnership

Waikato DHB actively engage and collaborate with the Whānau Ora Commissioning Agencies in its priority programme planning initiatives

Annual report on activity undertaken to progress the Whānau Ora approach.

Quarter 4

Waikato DHB is committed to a heightened focus in this area to achieve accelerated progress towards Whānau Ora and health equity. Through Te Puna Oranga (Māori Health

Service) we are running a number of holistic projects / programmes to achieve targeted improvements. These projects / programmes will impact on a number of different health indicators. The following table provides a summary of these holistic projects / programmes.

2. Workforce Objective

Actions to deliver improved performance

Measure

Reporting

A workforce that is reflective and responsive to the needs of Māori

Bicultural education for Waikato DHB staff to build cultural competency

Annual report (quarter 4) on proportion of staff in selected categories in Midland DHB’s who are Māori with significant trends identified

Quarterly

E-learning Bicultural Education Training and Ethnicity Data Collection training developed and implemented by Waikato DHB All new and existing staff who have not completed Treaty of Waitangi training are enrolled on to the online Treaty of Waitangi and healthcare e-course

All staff working directly with Māori patients, whānau and/or community are supported to attend Te Ara Totika (TOW workshop) Continue to promote Hauora Māori Training Fund to kaimahi working in the unregulated health and disability sector within the Waikato region. Gateway - exposure of Māori students to health (year 12 / 13) (April 2017) Continue to work with Human Resources to support gateway placements at Waikato hospital for Māori students interested in a health career

3. Virtual Care Objective

Actions to deliver improved performance

Measure

Reporting

System Integration

Update report identifying progress made during the quarter against the actions to deliver improved performance. The report will include:

Quarterly

Health needs assessment tools used in the areas of child health and mental health and addictions.

Objective

Actions to deliver improved performance

Measure

Reporting

timeframes for delivery Where quantitative measures are reported â&#x20AC;&#x201C; Reports must include baseline, target and quarterly performance progress Pharmacy Action Plan

Develop and implement medicines adherence and optimisation services of high quality (the Pharmacy Council of New Zealandâ&#x20AC;&#x2122;s Medicines Management Competence Framework and the National Pharmacist Services Framework are good references in developing these services) that must include targeted volumes for each service by year end Develop and implement an efficient medicines supply chain Commission services to best meet the identified demand.

Update report identifying progress made during the quarter against the actions to deliver improved performance. The report will include:

Quarterly

Whether the DHB is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered in the quarter Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery Where quantitative measures are reported â&#x20AC;&#x201C; Reports must include baseline, target and quarterly performance progress