CAPITAL AND COAST DHB HOSPITAL ADVISORY COMMITTEE MEETING HELD IN THE BOARD ROOM, LEVEL 1, 54 CAMBRIDGE TERRACE ON FRIDAY 7 JULY 2006 PUBLIC SECTION

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1 CAPITAL AND COAST DHB HOSPITAL ADVISORY COMMITTEE MEETING HELD IN THE BOARD ROOM, LEVEL 1, 54 CAMBRIDGE TERRACE ON FRIDAY 7 JULY 2006 PUBLIC SECTION PRESENT: Ken Douglas (Chair) Hilda Broadhurst Marion Bruce Lani Wills John Cook Ruth Gotlieb Lynn McBain Peter Dady Rose McEldowney Bob Henare (ex officio) IN ATTENDANCE: Meng Cheong (Chief Operating Officer) Peter Satterthwaite (Business Manager, Corporate Support) Cheyne Chalmers (Director of Nursing & Midwifery) Calum Laurie (Acting CEO, Director of Finance) Chris Lowry (Business Manager, Medical/Surgical Services) Sandy Dean (Executive Coordinator, Governance) APOLOGIES: Margot Mains, Geoff Robinson, Judith Aitken (ex officio) NON COMMITTEE MEMBERS PRESENT: Margaret Faulkner PUBLIC PARTICIPATION The Committee noted that there were no members of the public present. CONFIRMATION OF MINUTES The minutes of the meeting held on 8 June 2006 were confirmed as a true and correct record of proceedings. MINUTES OF PREVIOUS BOARD MEETING The Committee noted that the Board had agreed that at each HAC meeting the minutes of the Public Section of the previous Board meeting would be circulated for information. The minutes of the Board meeting held on 7 June 2006 was tabled. The Chair provided a brief summary of the Board meeting held on 5 July The Committee: 1. Noted that once the District Annual Plan is finalized, a copy would be circulated to committee members, as well as a copy of the District Strategic Plan and Statement of Intent. These papers will be reflected in future meetings. 2. Noted that the Oral Health Strategy had been agreed by the Board and the next report would come through HAC. ACTION POINT SCHEDULE The Committee noted the status of the Action Points schedule.

2 HOSPITAL & HEALTH SERVICE REPORT FOR THE MONTH OF MAY 2006 PART 1 The Committee noted the content of this report and approved the Executive Summary to go to the Board. Balanced Scorecard The Committee noted the balanced scorecard trends. Financial Performance The Committee noted the financial position YTD is a $13.3m operating deficit against a targeted surplus of $2.2m giving an overall YTD financial position of $15.5 unfavourable against budget. As forecasted, the Year End position is likely to be a breakeven position with the additional adverse costs to the provider being offset by surplus funds with the funder. The underlying deficit position is of concern to the Board and sits largely with the H&HS provider. The major part of this cost is personnel. The DHB continues to benchmark and control activity to make sure all services have suitable funding lines. Large increases are due to the nursing MECA and PSA settlement. These are being funded separately from the forecast. The budget for this year anticipated some savings in personnel that have not been achieved. The budget for next year also recognizes a large additional cost for the provider and additional funds have been budgeted to cover this. The Chief Operating Officer (COO) will report regularly on initiatives that have been put in place to the cover costs of services going forward. The Committee raised the question of services that should be provided in the community that are currently being provided in the H&HS, such as Maternity Services and the A&M. There is a separate funding stream to cover services such as these. The key is to ensure that the provision of the service and the respective funding is provided simultaneously. The Committee recommended the Board note that all the following issues are being progressed vigorously: 1. Currently there is no payment for over delivery of non case weight IDFs. This is under negotiation and is expected to be addressed in 07/08 year. 2. Work with other DHBs continues to ensure that C&C DHB is paid for cancer, renal and cardiology services. C&C DHB has been actively working on the risks it has being a regional provider. Air Ambulance The Committee noted that the referring DHB pays for air ambulance flights for patients. Life Flight Trust is a fully dedicated life flight service and they have seen a 30% reduction in their usage as local carriers are being used that may be cheaper but not necessarily as well resourced for transporting people requiring medical support. A group is to look at the effects of the change in policy. Ground up Budgets The Committee noted that ground up budgets have been established, including revenue strengthening strategies plus efficiency gains in areas where improvements are needed.

3 $19m worth of initiatives have been identified and will be reported to HAC on a quarterly basis. Consultation fees The Committee requested a breakdown of the major areas of consulting fees and noted the policy that any fees for the NRH will be taken out of the DHB accounts. RMO Industrial Action The Committee noted that many additional hours of work were required by staff before, during and after the RMO industrial action to ensure contingencies were in place and managed well for patient safety. Management appreciated the support of the Board over this time. The hospital responded well to the challenge. As a result of the experience gained over this time, work is being done to analyse different models of working that could be sustainable in the future. Chris Lowry, Business Manager and Tim Maling, Clinical Director, Medical/Surgical Services were thanked for their work over the RMO industrial action. Mental Health Services The Committee noted the difficulties in recruiting registered staff and experienced mental health support workers and hence the opening of the second cottage had been delayed to ensure that there is no risk to the quality of care. Clinical Support Services The Committee congratulated staff for the saving of $ k from a reduction in wastage of oncology drugs. Nurse led clinics The Committee noted the table quantifying the number of patients seen by nurses in nurse led clinics this year and the total of 7713 people who previously would have had to wait for a doctor. This is in addition to other clinics that are staffed by nurse specialists. The role of nurse specialists in the NRH is being addressed. Cancer Control The Committee discussed the cost of early intervention vs. the cost of complications if the disease is not detected early. There was discussion on the likely trends in future cancer care. The MoH is trying to estimate the cost of cancer control across the country so that funding can be allocated to meet demands. Smoke-free hospital The Committee noted that the smell of smoke at main entrances to the hospital was not good. This is hard to control, but there will be an increase in security patrols in those areas. Progress with the District Annual Plan The Committee noted the update with respect to the DAP and that C&C DHB is doing reasonably well.

4 Productivity Report The Committee noted that there was a reduction in the hospital s productivity over the third quarter and will also be over the fourth quarter. The main reason has been a shortage of anaesthetists and anaesthetic technicians and this is being addressed. Patient Postponement The Committee requested that the list of reasons for postponement be reconfigured into categories that C&C DHB can influence and those it cannot influence. It would also be useful to have the list divided into groups to show Maori and Pacific postponements. Theatre turnaround times Valuing the theatre minute is a measure of focus for improving theatre turnaround times. Glossary The Committee noted that the glossary required further updating. HAC Self Review Questionnaire HAC members were asked to provide to Sandy any rewording of the HAC self review questionnaire. Sandy will circulate the amended questionnaire including a time by which the response should be returned. Sandy will then aggregate the responses for the Committee to discuss at the next meeting. The results should then be submitted to the Board for their advice as part of the HAC report. Ruth Gotlieb left the meeting at 2.45pm. RESOLUTION TO EXCLUDE THE PUBLIC The Committee resolved that the public be excluded from the following parts of the proceedings of this meeting, namely: for the Agenda items and general subject matter to be discussed as set out in the first column in the table below, on the grounds under clause 34 of Schedule 3 to the New Zealand Public Health and Disability Act 2000 as set out in the second column in the table below and for the reasons set out in the third column of the table below (including reference to the particular interests protected by the Official Information Act, where applicable) TABLE The following Agenda items are recommended for consideration in public exclusion section under clause 34 of the Health and Disability Services Act: paragraph (a) i.e. the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i)) of the Official Information Act Agenda item and general subject of matter to be discussed Minutes of meeting held 8 June 2006 Public excluded section Grounds under clause 34 on which the resolution is based paragraph (a) i.e. the public conduct of the whole or the relevant part of the meeting would be likely to result in the Reason for passing the resolution in relation to each matter, including reference to OIA where applicable OIA, section 9(2)(a) to protect the privacy of natural persons OIA, section 9(2)(ba) to protect information which is subject to an obligation of confidence

5 Hospital and Health Service Report Part II disclosure of information for which good reason for withholding would exist under any of sections 6, 7 or 9 (except section 9(2)(g)(i) of the Official Information Act 1982 same as above where the making available of that information would be likely to prejudice the supply of information from the same source, and it is in the public interest that such information should continue to be supplied. OIA, section 9(2)(j) to enable this organisation to carry on, without prejudice or disadvantage, commercial and industrial negotiations. same as above CONFIRMED that these minutes constitute a true and correct record of the proceedings of the meeting. DATED this day of 2006 Ken Douglas Chair