2013/14 Annual review of the Waitemata District Health Board

Transcription

1 2013/14 Annual review of the Waitemata District Health Board Report of the Health Committee Contents Recommendation 2 Introduction 2 Improvements in service 2 Financial sustainability 2 Models of care 3 Life expectancy 3 Cardiac arrest services 3 Smoking 4 Mental health services 4 Staffing 4 Appendix 6

2 Waitemata District Health Board Recommendation The Health Committee has conducted the annual review of the 2013/14 performance and current operations of the Waitemata District Health Board, and recommends that the House take note of its report. Introduction The Waitemata District Health Board is the largest district health board (DHB) in New Zealand. It serves a diverse and rapidly growing population of more than 560,000 people and has a partnership with Te Runanga o Ngāti Whātua to address health inequities affecting Māori. The DHB is funded by the Ministry of Health to plan, purchase, and provide health services, including public hospitals and most public health services in its area. In 2013/14 the DHB s total revenue was $1, million, and its total expenditure was $1, million, resulting in a surplus of $3.534 million. 1 Improvements in service The performance of the Waitemata DHB has improved greatly in recent years. In response to problems raised in a previous Health and Disability Commissioner s report, the DHB developed a culture of putting patients first. 2 The DHB says it also listens to the concerns of clinicians and works with them to address issues to improve clinical services. It takes a holistic approach to hospital services, for example by improving the system of patient flow through all hospitals. This has helped patients to be seen more quickly in emergency departments. Elective surgery has also increased in Waitemata, and it is recording a high level of patient satisfaction. In 2013/14 the DHB achieved all of the national health targets set by the Minister of Health, regarding stays in emergency departments, access to elective surgery, waits for cancer treatment, immunisation, heart and diabetes checks, and help for smokers to quit. While it acknowledges it still has a lot of work to do, particularly regarding consistency of care, we congratulate the Waitemata DHB on the improvements that it has made, and on its performance in 2013/14. Financial sustainability The Waitemata DHB has stayed within its budget for the past five years. However it told us that it functions in a challenging economic environment of increasing demand as the area s population continues to grow rapidly and age. The organisation aims to remain financially sustainable and predicts a $1-million dollar surplus for 2014/15 and hopes to break even in 2015/16 and 2016/ Waitemata District Health Board annual report 2013/14, p Health and Disability Commissioner, North Shore Hospital: March to October 2007, published in Waitemata District Health Board annual report 2013/14, p

3 The DHB said that gains in healthcare outcomes and services are getting harder to make and maintain, but it does not think it will be necessary to reduce services in the short term. It is confident that maintaining a focus on quality and improvement will return positive results. In the past it has used comparisons with other DHBs as a benchmark for successful improvements; it now plans to compare its outcomes with Australian healthcare providers. Models of care The DHB adjusts its models of care to meet changing needs. For example, after it recognised that people in the Waitakere area faced access barriers it increased the opening hours of the local hospital s emergency department. We were interested to hear that the DHB also gives people access to specialist hospital staff through primary care providers like the New Lynn Integrated Family Health Centre. It also holds walk-in clinics for issues such as Māori diabetes. Palliative health care programmes in hospices and the community have also been improving. All hospices increased the number of inpatient beds and a single medical model of palliative care is being proposed for the whole DHB region. The DHB told us that it works to improve home-based support services. We heard that the standardised assessment tool interrai is useful, but time-consuming. The DHB has just invested over $1 million in the CARE pilot project in Rodney, which involves gerontology nurse practitioners assessing the needs of the elderly to improve their home-based care and decrease their need for hospitalisation. We will be interested to hear whether the pilot is successful, in which case it could be extended throughout the district. The DHB has a programme for increasing the number of patients screened for bowel cancer, and has been targeting its Māori and Pacific population. It told us that a surprisingly large number of polyps are being found during screening. As a preventative step the polyps are removed during the screening. Life expectancy We were particularly pleased to hear that the average life expectancy in Waitemata has increased and is the highest in New Zealand. The Waitemata average is 85.1 years, three years higher than the rest of the country. 4 Māori life expectancy in the area is 76 years which is also three years above the national average for Māori across New Zealand. 5 The DHB told us that the increase reflected a combination of factors including socioeconomic profiles, lower rates of smoking and obesity, rapid access to trauma services, use of statins, and better cancer treatment. It also explained that the large number of Asian migrants to the region, who have a very long life expectancy, boosts the average life expectancy in the Waitemata DHB catchment. Cardiac arrest services Treatment for cardiac arrests has improved in the Waitemata DHB in 2013/14 since a cardiology ward was opened at Waitakere in Patients need to access cardiac catheterisation laboratories as soon as possible after a heart attack. Before the new cardiology ward was opened, patients in Waitakere would have to wait up to five to six days 4 Waitemata District Health Board, responses to committee questions, p Waitemata District Health Board annual report 2013/14, p

4 in the Waitakere coronary care unit for access to the North Shore labs, whereas patients on the North Shore would be examined within one or two days. The benchmark standard for the country is three days. Since the Waitakere cardiology ward was opened, waiting times have dropped for Waitakere patients to two to three days. Smoking The prevalence of smoking in the Waitemata DHB dropped from 17 percent in the 2006 census to 12 percent in the 2013 census. 6 There was also a decline in smoking of more than 10 percent for Māori in the area to 27 percent between the two censuses. 7 The organisation was the highest-rated DHB for performance against the national health target of better help for smokers to quit, with 97 percent of hospitalised smokers receiving advice on quitting smoking in quarter four of 2013/14. 8 The Ministry of Health s target is 95 percent. The DHB said, however, that the probability of smokers quitting after initial advice is very slim, and there is a need to take multiple approaches simultaneously. It also said there remained a need to strengthen legislation against smoking, which is still one of the leading causes of death in New Zealand. We asked whether the DHB had a view on e-cigarettes and whether they could be used as therapy for quitting. The DHB said that it gives traditional nicotine replacement therapy to patients in the form of nicotine patches or gum. It does not have an official policy on e- cigarettes, and would need to see research evidence before giving an opinion on their potential for quit programmes. Mental health services Waitemata DHB has the largest mental health service in New Zealand. It told us that the burden of mental ill health is much larger than people commonly understand. Suicide rates among young people are a concern for the DHB, despite its having the third-lowest suicide rate in the country. It said that alcohol and drugs have a significant adverse effect on mental health. The DHB said that mental health is one of its priority areas and it is addressing the issue in hospitals, primary care, and the community. There has also been a large increase in the number of prisoners in the area and the DHB s forensic services want to work with prisons to provide services. We asked whether people have been more willing to come forward with mental health issues as a result of improvements in mental health services. The DHB said that the stigma around mental health issues has declined and that public awareness campaigns have made it easier for people to seek help, but the effective provision of services needs a lot of ongoing attention. Staffing We noted that the DHB has no female employees receiving a salary of more than $440,000, while it has 11 male staff being paid more than this. 9 The DHB said it does not have a specific policy of encouraging women into senior positions, but that all applications for positions are assessed equally. The DHB also said that the medical profession is changing, 6 Waitemata District Health Board annual report 2013/14, p Ibid, p Ibid, p Waitemata District Health Board, responses to committee questions, p

5 and that more women than men are emerging from medical schools. This is reflected in the increasing number of women becoming specialists and taking senior roles. 5

6 Appendix Committee procedure We met on 11 February and 1 April 2015 to consider the annual review of the Waitemata District Health Board. We heard evidence from the Waitemata District Health Board and received advice from the Office of the Auditor-General. Committee members Simon O Connor (Chairperson) Jacqui Dean Kevin Hague Hon Annette King Barbara Kuriger Dr Shane Reti Carmel Sepuloni Scott Simpson Barbara Stewart Evidence and advice received Waitemata District Health Board, Responses to written questions, received 9 February and 16 March Office of the Auditor-General, Briefing on the Waitemata District Health Board, dated 11 February Organisation briefing paper, prepared by committee staff, dated 9 February