OTAGO DISTRICT HEALTH BOARD - Southern DHB · OTAGO DISTRICT HEALTH BOARD BOARD MEETING Thursday, 3...

OTAGO DISTRICT HEALTH BOARD

BOARD MEETING

Thursday, 3 May 2007 – 10.00 am

Board Room, First Floor, Dunedin Hospital

INDEX

Welcome Apologies

Interests Registers 1

Chairman’s Report

Minutes of Previous Meeting 2

Matters Arising CEO’s Report 3

Private Specialist Referred Laboratory Testing 4

Financial Report 5

Advisory Committee Minutes:

Community & Public Health and Disability Support

Advisory Committees

6

Hospital Advisory Committee 7

Elections 2007 – Order of Candidates’ Names on Voting

Documents

8

Information Item: Report from NZ Institute of Rural Health

9

Contracts Register 10

Review of Action Sheet 11

General Business

Next Meeting

Confidential Session:

RESOLUTION:

That the Board move into committee to consider the following agenda items:

Confidential Board Meeting Minutes 05.04.07

Confidential CEO Report

Draft 2007/08 District Annual Plan and Statement of Intent

Otago Community Oral Health Services

Confidential Community & Public Health and Disability Support Advisory Committees

Meeting 17.04.07

Confidential Finance, Audit & Risk Committee Meeting, 21.04.07

Confidential Hospital Advisory Committee Meeting 24.04.07

Risk Registers

Review of Action Sheet

The general subject of each matter to be considered while the public is excluded, the reason for

passing this resolution in relation to each matter, and the specific grounds under section 32,

Schedule 3 of the NZ Public Health and Disability Act 2000 for the passing of this resolution are

as follows:

General subject: Reasons for passing

this resolution:

Grounds for passing the resolution:

1. Confidential Board Meeting

Minutes 05.04.07

2. Confidential CEO Report

Sentinel Events

Reporting

CEO’s Financial Risk

Register

Suspected Fraud

Investigation

DAP & SOI 2007/08

Community

Pharmaceutical Budget

and Community

Pharmacy Services

Contract Proposal

3. Draft DAP & SOI

4. Otago Community Oral

Health Services

5. Confidential Community &

Public Health and Disability

Support Advisory

Committees Meeting

17.04.07

6. Confidential Finance, Audit

& Risk Committee Meeting,

21.04.07

7. Confidential Hospital

Advisory Committee

Meeting 24.04.07

8. Risk Registers

9. Review of Action Sheet

To allow

negotiations and

activities to be

carried on

without prejudice

or disadvantage.

S 32(a), Schedule 3, NZ Public Health

and Disability Act 2000 – that the

public conduct of this part of the

meeting would be likely to result in the

disclosure of information for which

good reason for withholding exists

under sections 9(2)(i), 9(2)(j) of the

Official Information Act 1982, that is

withholding the information is

necessary to enable a Minister of the

Crown or any Department or

organisation holding the information to

carry on, without prejudice or

disadvantage, commercial activities

and negotiations; and to protect

information where the making available

of the information would be likely

unreasonably to prejudice the

commercial position of the person who

supplied the information.


INTERESTS REGISTER

Board Member Date of Entry

Interest Disclosed Nature of Potential Interest with the Otago DHB

Richard John THOMSON (Chairman)

13.12.2001

23.09.03

1. Thomson & Cessford Ltd (Managing Director) 2. Susanna Shaya Imports Ltd (Directors)

3. Hawksbury Community Living Trust (Chairperson & Trustee)

4. HealthCare Otago Charitable Trust (Trustee) 5. General Medical Staff Fund (Trustee)

1. Thomson & Cessford Ltd is the Company name for the Acquisitions Retail Chain. ODHB

staff occasionally purchase goods for their departments from it.

2. Susanna Shaya Imports is a homeware importing Company. It has no dealings with

the ODHB. 3. Hawksbury Trust runs residential homes for

intellectually disabled adults in Otago and

Canterbury. It does not have contracts with the ODHB.

4. Health Care Otago Charitable Trust regularly

receives grant applications from staff and departments of the ODHB, as well as other community organisations.

5. The General Medical Staff Fund administers an

investment fund that makes grants to ODHB departments primarily for the advancement of teaching purposes.

Marie-Louise ROSSON (Deputy Chair)

23.11.2004

17.04.2007

1. Schizophrenia Fellowship Otago

2. Virgin Gold Ltd (Director)

Helen Marie ALGAR 16.12.2004

17.05.2005 06.04.2006

1. Waitaki District Health Services Forum (MDA Representative)

2. Royal New Zealand Plunket Society (Employee)

3. Waitaki Family Health Trust (Trustee) 4. Rural Women New Zealand (Associate Member) 5. Healthy Active Living Organisation (HALO) (Member)



Peter Alexander BARRON

03.03.2005 13.12.2001

05.09.2002

20.04.2004

17.08.2004

03.03.2005

19.07.2005 06.04.2006

1. Central Otago Pharmacy Ltd (Shareholder and Director) 2. The Otago Group Limited (Managing Director) 3. The Mackenzie Group Limited (Managing Director)

4. DIVO (Dunedin Intravenous Organisation) (Trustee) 5. Dunedin Pharmacy Limited (Consultant) 6. Aspiring Pharmacy Limited (Consultant)

7. Mackenzie Pharmacy (2001) Limited (Shareholder) 8. Aorangi Pharmacy Limited (Consultant) 9. Otago Pharmacy Limited (Consultant)

10. South Island Pharmacists Association (Executive and Member)

11. Pharmaceutical Management Joint Venture (Interim Board Member)

12. The Otago Campus Pharmacy Limited (Shareholder and Director)

13. Green Island Pharmacy Limited (Director)

14. Catlins Pharmacy Ltd (Shareholder and Director) 15. ACC Pharmacy Working Party (Member)

Mary GAMBLE 13.12.2001 10.01.2007 05.04.2007

1. University of Otago (Employee) 2. Hibernia Holdings Limited (Director) 3. Age Concern (Director)

1. Close association between Dunedin School of Medicine and ODHB.

2. Nil.

3. Age Concern holds some contracts with the ODHB. No personal income from Age Concern.

Susan JOHNSTONE 16.12.2004 1. Shand Thomson Ltd (Principal) 2. NZ Blood Service (Board Member)

3. Otago Polytechnic (Council Member) 4. Tourism New Zealand (Board Member) 5. Clutha Community Health Company Ltd (Accountant via

Shand Thomson; Fellow Principal, Shand Thomson, Brian

Dodds is Chairman) 6. Clutha Health Incorporated (Fellow Principal, Shand

Thomson, Brian Dodds is a Trustee; Accountant via Shand

Thomson) 7. University of Otago, School of Accounting (Advisory Board

Member)

8. Shand Thomson Nominees Ltd; Shand Thomson Nominees (2005) Ltd; Abacus (ST) Ltd; Abacus (ST) 02 Ltd

Spouse: 9. Otago Southern Region PHO (Board Member)

1. Only via CCHC viability 2. NZBS is a supplier to ODHB

3. OP places nursing trainees with ODHB 4. Nil 5. CCHC receives nearly all its funding from

ODHB

6. CHI is the sole shareholder of CCHC 7. Nil 8. Corporate Trustee Companies for Shand

Thomson that potentially may be co trustees in trusts that hold shares in client companies that have contracts with ODHB – eg client

pharmacy companies 9. PHO receives funding from ODHB 10-14. These entities all receive funding from ODHB



10. Tuapeka Community Health Co Ltd (Consultant/Accountant via Shand Thomson)

11. Tuapeka Health Incorporated (Consultant/Accountant via

Shand Thomson) 12. West Otago Health Ltd (Consultant/Accountant via Shand

Thomson)

13. Roxburgh & Districts Medical Services Trust Board (Consultant/Accountant via Shand Thomson)

14. Wyndham Rest Home Incorporated

(Consultant/Accountant via Shand Thomson)

James Malcolm MacPHERSON

23.11.2004

28.06.2005 06.10.2005 13.12.2001

22.04.2003

1. Mayor, Central Otago District

2. Otago Polytechnic (Co-opted Council Member) 3. Otago Forward (Member, Past Chairman) Spouse: 4. Central Otago Health Services Ltd (Registrar, Dunstan

Hospital) 5. Centennial Health, Alexandra (General Practitioner)

6. Branch Medical Officer, ACC

1. Advocate for district interests, occasionally

represent both consumers and suppliers of health services, explicitly link board membership with elected CODC position. No

personal interest. 2. OP has training interests in common with the

DHB, some potential for advocacy on behalf of

the polytechnic. No personal interest. 3. Theoretical influence at policy level. No

personal interest. 4. Spouse employed by DHB. Direct family

interest in DHB provision of OP services, especially diabetes-related, at Dunstan Hospital.

5. Any DHB decisions relating to or involving primary health providers, PHOs or primary referred services likely to have a direct

personal effect. Declare and withdraw as a matter of course.

6. ACC is a major customer of the DHB. Remote possibility of an influence, no personal

interest.

Judith MEDLICOTT 13.12.2001

23.11.2004

13.12.2001

23.11.2004

13.12.2001

1. Ashburn Hall Charitable Trust (Trustee)

2. Medlicotts, Barristers & Solicitors (Partner) Spouse: 3. General Practitioner

4. Mornington Primary Health Organisation (Trustee) Daughter: 5. Clinical Psychologist, Intellectual Disability Service, Otago

District Health Board



Branko SIJNJA

09.10.2004 1. Clutha Community Health Company Limited (Director) 2. Clutha Health Incorporated (Board Member) 3. Balclutha General Practitioners Limited

(Sharehodler/Director & General Practitioner) 4. New Zealand Medical Association (GP Council & Otago

Division Executive)

5. South Link Health (Member)

1. Operates publicly funded secondary health services under contract to ODHB

2. Owns for the Clutha community, the Health

facility in Balclutha from which GP services are provided.

3. Is a service company that employs the staff,

provides the equipment, disposables and administration to Dr Sijnja’s general practice

4. NZMA is the country’s largest pan-professional

medical organisation. It provides leadership of the medical profession, promotes professional unity, values and the health of New Zealanders.

5. An independent practitioner association which supports the business needs and advocacy of General Practices in most of the South Island.

Ralph David Huston STEWART

24.01.2002

03.02.2005 26.09.2006 30.01.2007

1. Part-time appointment as Specialist in Endocrinology, Provider, Otago DHB

2. Southland DHB Hospital Advisory Committee (Member) 3. Health Workforce Taskforce (Member) 4. SCL Otago Southland Ltd (Director)

Gail TIPA 27.01.2004 1. Manawhenua Health Working Group (Member)

2. Tipa and Associates (Director)

3. Te Runanga o Moeraki (Member)

4. Kai Tahu Ki Otago Charitable Trust (Trustee)

5. Timberlands West Coast

1. Manawhenua are consulted by the DHB. We have a long established health working group

to aid that consultation process. 2. Nil 3. Te Runanga o Moeraki is a named party to the

Kai Tahu Ki Otago – DHB MOU 4. Kai Tahu Ki Otago Ltd, part of the Kai Tahu Ki

Otago structure along with the Kai Tahu Ki Otago Charitable Trust, provides an umbrella

for Maori organisations who recently negotiated contracts with DHB

5. Nil

M:\Interests Register\Board\BoardInterestRegister-13DEC2001.doc


INTERESTS REGISTER FOR DHB EXECUTIVE GENERAL NOTICE OF INTEREST EMPLOYEE NAME

Date of Entry

Brian Rousseau 23.07.2004 09.03.2007

03.08.2006

Director of South Island Shared Services Limited New Zealand Institute of Rural Health (Trustee)

DHBNZ CEO Executive (South Island Representative)

Vivian Blake 23.07.2004 Lead Chief Operating Officer of the National DHB COO Group

Teresa Bradfield 16.03.2007 Bradfield partnership – equestrian centre Close association with Planning and Funding employee (husband)

Richard Bunton 17.03.2004 Managing Director of Rockburn Wines Ltd

Director of Mainland Cardiothoracic Associates Ltd Director of The Doctors Green Island Ltd

Director of the Southern Cardiothoracic Institute Ltd Director of Wholehearted Ltd

Peter Ellison 07.04.2006

08.03.2007

Registered Member – Kati Huirapa Runaka ki Puketeraki

Registered Member – Te Runanga o Otakou Macandrew Bay School Board of Trustees

Ngai Tahu Research Consultation Committee – Runaka Representative

Chris Fraser 09.10.2003

09.03.2007

Close association (sister) with the Director of Anglican Methodist Family Care Centre.

Officer of Southland District Health Board

Robert Mackway-Jones 25.03.2006 09.03.2007

Trustee, Family Start Support Services (Invercargill) Trust Officer of Southland District Health Board

Roy Morris 23.07.2004

19.10.2005

28.03.2006

22.08.2006

General Practitioner in private practice

Senior Clinical Lecturer Dunedin School of Medicine Member of South-Link IPA and UDAC

Otago/Southland Regional Director of ICTP RNZCGP Otago/Southland AVE facilitator RNZCGP.

Clinical Advisor to bpacNZ

Member of the Expert Advisory Group to the RNZCGP Member of the RNZCGP Pathways Working Group

Close association with the University of Otago Student Health Services (wife) Medical examiner to the Department of Social Development

Member of the CTA (Clinical Training Agency) Expert Advisory Group on General Practice

Karyn Penno 09.03.2007 Officer of Southland District Health Board

Minutes of the Otago District Health Board

Thursday, 5 April 2007, 10.00 am Boardroom, First Floor, Dunedin Hospital

Present: Mr R J Thomson Chairman Ms M L Rosson Deputy Chair

Mrs H M Algar Mrs M A Gamble

Mrs S J Johnstone Dr J M Macpherson

Dr J O Medlicott Dr B Sijnja

Prof R D H Stewart Dr G T Tipa

In Attendance: Mr B D Rousseau Chief Executive Officer Mrs V J Blake Chief Operating Officer Ms G Goodger Communications Officer Ms J Kloosterman Board Secretary Mr R Mackway-Jones Regional Chief Financial Officer

1.0 WELCOME

The Chairman welcomed everyone to the meeting.

2.0 APOLOGIES

Apologies were received from Mr P A Barron and Mr C Fraser, Regional General

Manager, Planning & Funding.

Moved Mr R J Thomson, seconded Ms M L Rosson, that the apologies be accepted.

Carried

3.0 MEMBERS’ DECLARATION OF INTEREST

The Chairman called for any adjustments or amendments to the Interests

Registers.

Action Point 257

Dr B Sijnja advised that he had resigned from the Otago Southern Region

Primary Health Organisation (PHO)

Mrs M A Gamble advised that she had agreed to be a member of the Executive

of Age Concern.

The Chairman asked if members were aware of any agenda items with which they

may have a potential conflict and reminded them of their responsibility to advise the meeting immediately should any potential conflict arise during discussions.

Minutes of Otago District Health Board, 5 April 2007 Page 1

Moved by Mr R J Thomson, seconded Mrs M A Gamble, that the Interests Registers be noted.

Carried 4.0 CONFIRMATION OF PREVIOUS MINUTES

Moved Mr R J Thomson, seconded Mrs H M Algar, that the minutes of the 8 March 2007 Board meeting be approved and adopted as a true and correct record.

Carried

5.0 MATTERS ARISING Elections 2007 – Order of Candidates on Voting Papers Ms M L Rosson notified the Board that, under Standing Order 2.19.1, she intended

to submit a notice of motion for consideration at the next meeting seeking revocation of the Board’s resolution to use the random system to determine the

order in which candidate names appear on voting documents.

6.0 CHIEF EXECUTIVE OFFICER’S REPORT

The Chief Executive Officer’s monthly report (tab 3) was taken as read and the following items discussed.

Southern Alliance Mr B D Rousseau, Chief Executive Officer, was pleased to announce that Mr Grant Taylor had been appointed to the new Regional Chief Information Officer role.

Mr Rousseau reported that the four regional groups would be going through a

change management process to ensure a more regional approach to the delivery of HR, Planning & Funding, Finance and IT support functions. During that

process, Mr Rousseau advised that there was likely to be a temporary reduction in the ability of these services to support the Board and its Advisory Committees,

and he asked for members’ patience during that time.

Members signalled that after a settling in period, they expected that things would

return to normal.

Primary Health Organisations (PHOs) Action Point 258 Mrs M A Gamble requested that reports to the Board on the progress of PHOs be

resumed.

Fund Raising for New Facilities and Equipment Mr Rousseau sought the Board’s endorsement for applications to the Healthcare Otago Charitable Trust to be prioritised and submitted by the DHB, rather than

individual services.

Dr G T Tipa requested that the proposed policy not be limited to the Healthcare

Otago Charitable Trust.


Recruitment and Selection Processes Mr Rousseau brought to members’ attention the report on the processes used to screen Otago DHB job applicants (Appendix 1).

Consultation and Conflict of Interest – Auckland DHBs’ Laboratory Judicial Review Members discussed the recent High Court decision on the Auckland Laboratory

Services contracting process and the implications that had for the DHB’s consultation process.

Action Point 259 Management were asked to give a presentation to the Board on the DHB’s consultation process, to allow members to review this and provide reassurance

that the DHB’s consultation strategy meets current expectations and that a

defined process is followed.

Mr B Rousseau, Chief Executive Officer, commented that the Otago DHB had been commended by the Ministry of Health on its consultation processes on a number

of occasions; however there were always opportunities to do things better.

Moved Dr G T Tipa, seconded Prof R D H Stewart, that the motion on fund raising be amended to include the Community Trust of Otago.

Carried

Moved Mr R J Thomson, seconded Prof R D H Stewart: 1. That the Chief Executive Officer’s Report be noted, and

2. That the Board approve the principle that applications to the

Healthcare Otago Charitable Trust and the Community Trust of Otago should be submitted by the DHB (as opposed to individual services) and that the priority should be for those services that have limited ability to raise funds publicly.

Carried

7.0 FINANCIAL REPORT

In speaking to the Financial Report (tab 4) Mr R Mackway-Jones, Regional Chief

Financial Officer, highlighted the following points.

The result for February was worse than budget but the result year to date was

still ahead of plan.

The end of year forecast had improved to $7 million, with almost $5 million of

this being mental health underspend.

If the distortions created by the mental health underspend and DSS wash-up

were removed from the Funds result, an operating deficit of about $900,000 would be left.

When PHO growth and additional funding was removed from pharmaceutical expenditure, there was a price growth of about $1.1 million, which largely

equated to the true Funds operating result.


Inter District Flow (IDF) data showed that Otago would have an unfavourable

notional wash-up of $296,000 for the first six months of the financial year.

The Provider financial summary, as submitted to the Hospital Advisory

Committee, showed a result that was slightly worse than budget for the month. The year to date issues in the Provider Arm had not changed.

The capital commitments forecast had improved from a $1 million cash overrun to a $300,000 overrun.

Following the presentation of his report, Mr Mackway-Jones answered members’ questions on the accounts.

Action Point 260 Management were asked to provide clarification on how additional DSS funding for

carer travel was being tagged for that purpose.

District Annual Plan Financials It was agreed that management would meet with Finance, Audit & Risk

Committee members after the meeting to schedule the next meeting of that

Committee.

Moved Mr R J Thomson, seconded Ms M L Rosson, that the Financial Report be noted.

Carried

8.0 COMMUNITY & PUBLIC HEALTH AND DISABILITY SUPPORT ADVISORY

COMMITTEES

In speaking to the unconfirmed minutes of the joint Community & Public Health

and Disability Support Advisory Committees meeting held on 20 March 2007, Ms M L Rosson, CPHAC & DSAC Chairperson, commented that there was a lot of

discussion with the Regional General Manager Planning & Funding on resource issues.

The Chairman asked members to be mindful of the need to prioritise what they ask staff to deliver on.

Moved Ms M L Rosson, seconded Mr R J Thomson, that the unconfirmed minutes of the joint Community & Public Health and Disability Support Advisory Committees meeting held on 20 March 2007 (tab 5) be noted.

Carried

9.0 HOSPITAL ADVISORY COMMITTEE

Moved Prof R D H Stewart, seconded Dr J O Medlicott, that the unconfirmed minutes of the Hospital Advisory Committee meeting held on 27 March 2007 (tab 6) be noted.

Carried


Matters Arising: Otago Polytechnic Nursing Student Placements It was noted that the Chief Nursing Officer had been asked to report back to the

Hospital Advisory Committee on the issue of the number of nursing student placements in the hospital.

10.0 CONTRACTS REGISTERS It was noted that the Document Register still needed to be updated with the

information requested by Board.

Moved Mr R J Thomson, seconded Dr B Sijnja, that the signing of the following documents be endorsed: Funding Administration St Clair Park Residential Centre Ltd – Variation to Agreement, Aged

Related Residential Care;

Dunedin PHO – Variation to Agreement, PHO V17.0;

St Clair Park Residential Centre Ltd – Variation to Agreement, Residential Long Term Care for up to Eight Mental Health Service Users at Any One Time;

Caring Communities Incorporated – Variation to Agreement, Family/Whanau Advocacy & Peer Support;

South Link Health Inc – Variation to Agreement, Acute Demand Project Pilot;

South Link Health Inc – Variation to Agreement, PCO Service Schedule – Otago;

Orthotics Otago Ltd – Variation to Agreement, Orthotic Services;

Elwyn Bates Group Ltd t/a Catlins Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services;

Elwyn Bates Group Ltd t/a Elwyn Bates Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services;

Albany Street Pharmacy Limited – Variation to Pharmacy Services Agreement for Extending Provision of Pharmacy Methadone Services for Opioid Dependence;

Otago Community Hospice Trust – Service Schedule, Personal Health Long Term Care;

Dunedin City Pharmacy Limited t/a Dunedin City Pharmacy, Pharmacy Services Agreement for the Provision of Pharmacy Services;

Dunedin City Pharmacy t/a Dunedin City Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services;

Dunedin City Pharmacy t/a Dunedin City Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Pharmacy Clozapine Services (Monitored Therapy Medicine Services);


Dunedin City Pharmacy t/a Dunedin City Pharmacy – Variation to Pharmacy Services Agreement for Extending Provision of Pharmacy Methadone Services for Opioid Dependence;

Albany Street Pharmacy Ltd – Pharmacy Services Agreement for the Provision of Pharmacy Services;

Albany Street Pharmacy Ltd – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services;

Albany Street Pharmacy Ltd – Variation to Pharmacy Services Agreement for the Provision of Pharmacy Clozapine Services (Monitored Therapy Medicine Services);

Dunedin Pharmacy Ltd t/a Bayview Pharmacy – Variation to Pharmacy Services Agreement for Extending Provision of Pharmacy Methadone Services for Opioid Dependence;

Dunedin Pharmacy Ltd t/a Bayview Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services;

Dunedin Pharmacy Ltd t/a Bayview Pharmacy – Pharmacy Services Agreement for the Provision of Pharmacy Services;

Aspiring Pharmacy Ltd t/a Aspiring Amcal Pharmacy – Pharmacy Services Agreement for the Provision of Pharmacy Services;

Aspiring Pharmacy Limited t/a Aspiring Amcal Pharmacy – Variation to Pharmacy Services Agreement for Extending Provision of Pharmacy Methadone Services for Opioid Dependence;

Aspiring Pharmacy Limited t/a Aspiring Amcal Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Pharmacy Clozapine Services (Monitored Therapy Medicine Services);

Aspiring Pharmacy Limited t/a Aspiring Amcal Pharmacy – Variation to Pharmacy Services Agreement for the Provision of Special Foods Services Infant Formulae;

Ari Te Uru Whare Hauora Ltd – Agreement, Tamariki Ora, Whanau Ora, DSM;

Presbyterian Support Otago Incorporated t/a Community First Pilot – Variation to Agreement;

Presbyterian Support Otago Incorporated t/a Ross Home & Hospital, Service Schedule;

Central Otago Pharmacy Limited t/a Alexandra Amcal Pharmacy – Pharmacy Services Agreement;

Presbyterian Support Otago Incorporated t/a Ross Home & Hospital – Service Schedule;

Larson’s Maniototo Pharmacy Limited t/a Larson’s Maniototo Pharmacy – Pharmacy Services Agreement;

St Clair Park Residential Centre Limited – Variation to Agreement, Residential Long Term Care for up to Eight Mental Health Service Users at a Time;

Otago Community Hospice Trust – Service Schedule, Palliative Care – Exceptional Circumstances Short Term Funding for Individual.

Total for the month: $3,783,253.19.


Provider:

IBM Global Financing – Leasing of Computer Equipment, $160,254;

Clinical Training Agency – Service Agreement, Postgraduate Nursing Training, $297,706;

Ministry of Health – Service Agreement, Fruit in Schools Co-ordination, Phase Three;

Ministry of Health – Variation, Southland Youth Suicide Prevention, $25,166;

Clinical Training Agency – Service Agreement, Nursing Entry to Practice, $157,450.

Carried

11.0 REVIEW OF ACTION SHEET Moved Mr R J Thomson, seconded Ms M L Rosson, that the action sheet (tab 8) be noted, with the amendment that the presentation on the Board’s consultation process is to be made to the Board rather than CPHAC.

Carried

CONFIDENTIAL SESSION The Chairman advised that the Chief Executive Officer had asked that item 5 be removed from his report, as he wished to further reflect on it.

Moved Mr R J Thomson, seconded Ms M L Rosson, that the public be excluded from the meeting to consider the following agenda items:

General subject: Reasons for passing this resolution:


1. Confidential Board Meeting Minutes 08.03.07

2. Confidential CEO Report Sentinel Events Reporting Financial Risk Register Suspected Fraud

Investigation Draft DAP 2007/08 Community

Pharmaceutical Budget and Community Pharmacy Services Contract Proposal

3. Confidential Community & Public Health and Disability Support Advisory Committees

Meeting 20.03.07 4. Confidential Hospital Advisory

Committee Meeting 27.03.07 5. Risk Registers 6. Review of Action Sheet

To allow

negotiations and activities to be carried on

without prejudice or disadvantage.

S 32(a), Schedule 3, NZ Public Health and Disability Act 2000 – that the

public conduct of this part of the meeting would be likely to result in the disclosure of information for which

good reason for withholding exists under sections 9(2)(i), 9(2)(j) of the Official Information Act 1982, that is withholding the information is

necessary to enable a Minister of the Crown or any Department or organisation holding the information to

carry on, without prejudice or disadvantage, commercial activities and negotiations; and to protect

information where the making available of the information would be likely unreasonably to prejudice the commercial position of the person who

supplied the information.

Carried


The meeting closed at 12.30 pm.

Confirmed as a true and correct record:

Chairman: _______________________________

Date: _____________________


CHIEF EXECUTIVE OFFICER’S REPORT

RECOMMENDATIONS: 1. The Board notes this report.

1 SOUTHERN ALLIANCE

The 3 regional managers have now either commenced consultation with their

respective staff defining departmental structures and roles best suited for delivery of the respective support services across both DHBs, or are in the final stages of

preparation for consultation. It is anticipated that a similar process will occur in IT once the new Regional CIO commences his employment on 07 May 2007.

2 FRAUD MINIMIZATION STRATEGIES The Finance, Audit and Risk Committee are currently in the process of developing a

Fraud Minimisation Strategy. It is envisaged that this strategy will be multi faceted

and have its genesis based on defining potential for risk in both the Provider Arm as well as the Funder of the DHB. It is planned to submit this strategy to the Board in

June 2007.

I have been in discussion with management from HealthPAC Audit and Compliance over the past few months regarding strategies to minimise potential for fraud.

HealthPAC Audit and Compliance are very keen to collaborate and assist in development of any Otago DHB fraud minimization strategies. One of the potential

strategies identified is implementation of a Fraud Hotline (see Appendix 1: Otago DHB

Fraud Hotline Proposal). A fraud hotline will be an important component of the DHB Fraud Minimisation Strategy. It is my intention to have this service commence as

soon as practically possible!

3 NATIONAL PHARMACY CONTRACT

DHBs are continuing to negotiate at a national level with the Pharmacy sector in an endeavour to secure a contract after the current arrangements cease on 31 May 2007.

Whilst approximately 60% of pharmacies have signed up to the new national contract,

there remains significant dissatisfaction with the proposed contract and DHBs have recently received “Without Prejudice” notice from solicitors acting for a number of

pharmacies and the Pharmacy Guild of New Zealand of instructions to file proceedings in the High Court for process judicial review (see Appendix 2: Letter from Chen

Palmer).

Concurrent with these national negotiations, Otago DHB management are negotiating potential arrangements to supplement the national agreement with South Island

Pharmacy Association (SIPA) representatives to ensure that Otago DHB and Pharmacy

interests in Otago are met. Whilst the details of these negotiations are confidential (and included in the Closed Session agenda), I am confident that goodwill shown by

both parties will avert disruption of Community Pharmacy Services in Otago. Arrangements are currently being made to extend negotiations for a Community

Pharmaceutical Strategy agreement to include PHOs, as GPs are an essential component to any potential solution and agreement.

4 PHO UPDATE In response to a request at a previous Board meeting to include an update on Otago

PHOs activity/initiatives, Dr Roy Morris has provided the report at Appendix 3. As can be seen from the report, a number of PHOs are making steady progress on initiatives.

However, if PHOs are to meet the longer term objectives of the Primary Health Care Strategy, they will need to be in a position to employ more staff and contract with a

much broader scope of providers in their own right.

5 HEALTHY EATING, HEALTHY ACTION UPDATE The HEHA report from Melanie McKenzie, the Senior Regional HEHA Co-ordinator, is

attached at Appendix 4. With the appointment of Ruth Zeinert as the local HEHA Co-ordinator reporting to Melanie, I am confident that we will make rapid progress with

good collaboration between Otago DHB and Southland DHB on this major initiative for the DHB. Melanie will be requested to quarterly progress reports to the Board.

Brian Rousseau

CEO

26 April 2007

OTAGO PHOS UPDATE REPORT

All five Otago PHOs are interim funded

DUNEDIN PHO • Enrolled Population – 76,418

– Maori – 3,641 (4.8%)

– Pacific Island – 1,352 (1.8%) – NZ European – 56,125 (73.4%)

– Deprivation Quintile 5 – 10,032 (13.1%)

– High Needs Population – 13,846 (18.1%)

• 32 Practices

– 79 GPs – 42 Practice Nurses

Current Initiatives:

• Transport Assistance Scheme

• High Needs Health Check (1 July 2007) • Communication Strategy

• Language Line

• Emergency Prescription Service

• Under 25’s Sexual Health Consults

• Active Families • Health Promotion Scoping Exercise & Pilot Programmes

The Transport Assistance Scheme

Introduced after consultation with Maori and Pacific People’s groups in

Dunedin.

Transport difficulties emerged as one of the major barriers in accessing

primary health care services for their communities.

This scheme funds transport costs for patients who are unable to attend their general practice due to transport restrictions.

• To improve access to primary health care services, including

preventative services such as screening and well-health checks, for

high-needs patients. • To have more appointment times available in the general practice

environment as less home visits will be required. The PHO is aware

that many practices are frequently closing their general practices to

new patients.

• Increased uptake of programmes such as CarePlus and the Annual Subsidised Diabetic Review (ASDR), to result in better management

of chronic health conditions.

• To encourage those not accessing primary health care services to

enrol with a practice and receive benefits of ongoing care from one

provider.

• practices within the NZDep index 9-10 area are the highest users of the service;

• the scheme is being used for general health checks.

The promotion of this service will become more widespread in order to encourage uptake by the Maori and Pacific People’s population. Work has

already begun on this by meeting with Maori service providers, and

promotion at the Pacific People’s Expo.

Access - High needs health check (go-live planned for 1 July 2007)

This initiative is based on a similar programme run in 2004-2005 by Ngai

Tahu Development, where a letter was sent out to all members of Ngai

Tahu aged 55 years or over inviting them to present to general practice

for a free health check. The general practices were paid per health check

carried out. The scheme ran for one year with an uptake of just under 50% of those patients who had been sent a letter.

The Dunedin PHO has decided to implement a similar scheme for their

high-needs population; there is no age limit for this health check. The

programme will run for one year based on one free health check per person.

• To improve the health of the high needs population.

• To improve access to primary health care services.

• To detect chronic illnesses, particularly Diabetes and cardiovascular disease, at an earlier time in life in order to prevent further

complications.

• To increase awareness among those who do not visit their general

practice due to high costs of the reduced fees now available to most

age groups.

• To encourage PHO enrolment. • To meet CarePlus high-needs enrolment requirements.

• To increase the uptake of the Annual Subsidised Diabetes Review.

The identification of participants will take place outside of the general

practice environment for the following reasons:

• to capture those not accessing primary health care services, and

those not enrolled with a PHO, there is a need to look outside of the

primary health care setting;

• numerous programmes are already administered through general practice - potential risk in relying too heavily on general practices to

promote the programme; and

• other providers may be in a better position to identify the target

group for this programme.

The Dunedin PHO is collaborating with Maori providers, Pacific People’s

providers, and social service providers to promote this programme and to

identify participants amongst the people they support. Eligible patients

will be given a letter from their organisation/service provider inviting them

to visit their general practice for a free health check. The patient will take

the letter with them to the consultation. The clinical staff will be supplied with a health check form to guide them through all the areas to be

checked. This form will be sent to the Dunedin PHO and payment will be

made to the general practice.

The Dunedin PHO will be promoting two of its other Services to Improve

Access programmes in conjunction with this programme - Language Line

(interpretation service) and the Transport Assistance Scheme. Along with

cost, language and transport have been identified as major barriers for

high-needs groups when accessing primary health care. The Emergency Prescription programme will also be available for patients unable to afford

prescription charges arising from this health check.

It is hoped that these four programmes running together will provide an

effective outreach service.

Communication Strategy The Dunedin PHO felt that there was lack of awareness within the

community as to what a PHO is and how it could provide any benefits to

the health of the population. PHOs have also been seen as a threat to many Non-Governmental Organisations, who perceive the PHO as a

competitor for funds.

The Dunedin PHO decided to address these misconceptions and the

confusion surrounding the role of the Dunedin PHO by hiring a Media Services Consultant to raise the profile of the Dunedin PHO within the

community and amongst stakeholders.

The Dunedin PHO is re-launching its website, with new Dunedin PHO

branding in July 2007. Work is progressing on using the website as a link

for the community for all primary care services.

RURAL OTAGO PHO • Enrolled Population – 38,854

– Maori – 1,377 (3.5%) – Pacific Island – 219 (0.61%)

– NZ European – 22,016 (85.0%)

– Deprivation Quintile 5 – 1,414 (3.6%)


• Currently increasing by ± 100 per month • 13 Practices

– 37 GPs

– 46 PNs

Current Initiatives

• Diabetes Coordinator

• Amalgamation / Co-Location of Practices

• Relationship with Central Otago Health Services Ltd, Waitaki District

Health Services Ltd and Maniototo Health Services Ltd

Diabetes Coordinator The Rural Otago PHO has contracted Central Otago Health Services

Limited to provide the Diabetes Coordinator service. The Coordinator is

based at Dunstan Hospital but the role is mobile and works throughout the communities of Central Otago. They will assist people with diabetes in the

Central Otago area who are experiencing difficulties in getting to see

health professionals, mainly due to the travelling distances they face. The

Diabetes Coordinator service assists people with Diabetes in accessing the

health care they require to maintain good control of their diabetes by

providing support, education, nutrition advice, and health checks to people with Diabetes.

The Diabetes Coordinator ensures that people with Diabetes are aware of,

and assists with access to, essential services such as foot-care, retinal

screening, and nutrition advice. The Coordinator also works with General Practitioners (family doctors), hospital services, and other organisations to

enhance the programmes and services that already exist.

This service is a mobile service covering Cromwell, Wanaka, Clyde,

Alexandra, Ranfurly, and everywhere in between.

The Diabetes Coordinator receives referrals from General Practitioners,

Practice Nurses, Diabetes Otago, secondary services, and other

community services. The Coordinator can visit patients in their homes, at

their local general practice, or other centres in the community.

To date the coordinator has held a number of public meetings which have

been very successful. These meetings have included information for the

public on diabetes and where to get help. The coordinator is also working

with local providers to ensure that people are visiting for their annual

diabetes checks.

Amalgamation/Co-Location of Practices Practices in the Alexandra and Wanaka areas are looking at amalgamating

or co-locating to improve services to patients in the areas to provide a comprehensive healthcare service out of a single facility to improve access

to services to patients and to improve the recruitment and retention of

workers.

To date there has been an issue with the practices amalgamating as the Commerce Commission is not in favour of it, so the practices are

continuing to look at options for co-location.

Relationship with Central Otago Health Services Limited, Waitaki Hospital and Maniototo Hospital The Rural Otago PHO is working on developing relationships with the rural

hospitals in the PHO region to ensure that services are delivered to the

population in the best way and that duplication does not occur and to

work very closely with the rural hospitals to deliver care to the

community.

OTAGO SOUTHERN PHO • Enrolled Population – 15,269

– Maori – 1,149 (7.5%) – Pacific Island – 77 (0.5%)

– NZ European – 10,723 (70.2%)

– Deprivation Quintile 5 – 357 (2.3%)


• 10 Practices: – 10.6 FTE GPs

– 24 PNs

Current Initiatives

• After Hours Emergency Care • PHO Officer Role

• Consultation Reimbursement Scheme

After Hours Emergency Care Following the withdrawal of on call after hours support by several GPs in

the Balclutha and Owaka practice areas the board has had to implement a

plan to support the remaining GPs, and to provide an interim solution to

the immediate crisis while the board identifies and develops a longer term

more sustainable solution.

All calls received outside of routine clinic hours are diverted to a nurse led

triage service (HML Procare) to establish that the person does require an

urgent consultation before the on call GP is disturbed.

The process for after hours care is: • HML Procare will triage all after hours calls for patients of the

Owaka and Balclutha

• Patients needing to be seen by a doctor will be referred to the on

call GP

• Local GPs will be on call 24 hours Monday – Friday • Locum doctors will be recruited to provide on call support at

weekends (Saturday/Sunday)

• Local GPs are continuing to provide on call support while locum GPs

are recruited

This new system has been in place since 2 April 2007 and early indications

are that it appears to be working satisfactorily.

This plan is an interim one only, while the board looks at the long term

requirements for emergency care and identifies an alternative system that meets the community requirements for emergency care outside of routine

clinic times and is sustainable within the resources available. It is likely

this will involve utilisation of registered nurses with advanced training to

augment the GP roster.

PHO Officer Role In February 2006 the Otago Southern Region PHO board [OSRPHO]

commissioned Grafton Consulting Group to examine how the board should best structure itself for the future. A recommendation from this project

was that the board develop a role for a full time person to be employed

locally.

This recommendation was accepted and implemented by the board to see the PHO play an active part in shaping local services that will support the

vision and objectives of the Primary Health Care Strategy.

The PHO Officer role includes:

• Liaison with contracted providers

• Maori Health Plan development and implementation

• Service planning and development (Services to Improve Access, Health Promotion etc)

• Implementation of the Strategic and Annual plans

• Community liaison

• Supporting providers on specific issues (CarePlus and Quality

Improvement)

The PHO Officer represents the board within the community by

collaborating with providers and community groups while keeping the

board informed of the needs of the community that may impact on

primary health care. This also provides an opportunity to share ideas and resources to respond to those issues.

The appointment of a local PHO Officer occurred in October 2006 ensuring

the board can strongly participate in the delivery of the Primary Health

Care Strategy.

Services to Improve Access – Consultation Reimbursement Scheme The OSRPHO is developing a project to make available funding to assist

people unable to afford the cost of a GP consultation or subsequent prescription costs.

This pilot project is similar to one that operates in Southland where the

PHO has contracted with a community provider to develop strategies for

finding people with poor access to services and assisting them to access the appropriate services. The Southland programme does not include

prescription fees.

• To provide unrestricted access to primary health care services

• To remove cost as a barrier to people accessing primary health care • To encourage PHO enrolment by people not currently enrolled

• To improve the health of the population

This scheme will be available to people unable to afford the cost of

accessing primary healthcare.

The PHO will work with contracted providers, pharmacies, Maori providers,

education facilities and social service organisations to promote the

availability of the programme and ensure they know how to access the service when it is required.

Maori have identified GP consultation costs and prescription charges as a

barrier to accessing primary health care. A key to the success of this

programme will be to encourage uptake by the Maori population. This programme will commence within the next 2 months.

TAIERI AND STRATH–TAIERI PHO • Enrolled Population – 13,853

– Maori – 626 (4.5%) – Pacific Island – 95 (0.68%)

– NZ European – 10,903 (78.7%)

– Deprivation Quintile 5 – 907 (6.5%)


• 3 Practices – 13 GPs

– 16 PNs

Current Initiatives

• Chronic Health Management • Primary Mental Health

• Under 25’s Sexual Health Programme

• Transport Information & Coordination Service

• Taieri College Sexual Health Service

• Subsidised Podiatry Programme

Chronic Health Management The Taieri and Strath Taieri PHO identified through their strategic planning

process in 2005 a need to initiate a Chronic Health Management Programme with the aim of improving the health of patients with chronic

disease within the Taieri and Strath Taieri PHO.

Initially the programme has been based on developing software to ensure

that all providers in the PHO are collecting and storing data in the same

way. This allows for comparison data to be developed for the whole PHO. All practices in the PHO now have access to the software and are happy to

be using it.

The second phase of the programme is to develop specific patient

management information for the practices. This has started with all patients being contacted and brought in for a wellness check every three

years. The aim of this check is to carry out screening, discuss personal

health care with the patient and develop an accurate database of the

health of the Taieri and Strath Taieri population. This will assist the

programme to develop models of care for the appropriate conditions.

The model is designed to demonstrate how to:

1. Maximise the potential of Primary Care IT systems to monitor PHO

populations for precursor risk factors, at risk individuals and

asymptomatic individuals and ensuring individuals with chronic diseases are managed optimally.

2. Identify at risk individuals and implement interventions to reduce

progression down the life-course model of disease development.

3. Record health care data in an analysable, agreed and consistent

manner across the Care team and PHO.

4. Maintain chronic disease registers.

5. Implement nurse led clinics for well woman and well man

assessments. Establishing PHO wide population based information.

6. Reduce the risk factors for chronic disease by promoting healthy lifestyles.

7. Implement behaviour modification programmes utilising other

national and local programmes for at risk individuals.

8. Establish nurse led chronic disease clinics for Chronic Obstructive

Pulmonary Disorder, Ischaemic Heart Disease, Diabetes Mellitus and Hypertension.

9. Treat to target individuals with chronic diseases based on current

best practice guidelines.

10. Develop the role of the Advanced Primary Care Nurse to manage the

complex CarePlus patients and prevent unnecessary hospital

admissions and to flag failing patients early. 11. Establish a patient focus group to engage the local population with

the CHM agenda

12. Identify potential expert patients within the PHO community to

develop their role within the CHM programme.

Primary Mental Health – Mosgiel Family Health Counselling Centre Over the past three years the PHO has been working with the ODHB to

secure a contract for the delivery of a primary mental health service in the

region. This involved the transfer of the contract for the Mosgiel Family Health Counselling Centre to the PHO to provide clinical care for people

with moderate to severe mental illness through primary health care.

Primary mental health care will result in better care, people being

identified and referred earlier, and more comprehensive follow-up and

support.

Clinical Services will be provided for people who:

Have a moderate to serious mental illness and who are able to be

managed in a primary health setting with a shared care agreement

with secondary services where appropriate or necessary

Have a moderate to serious mental illness and who have been discharged from Secondary MH Services to be case managed by

their primary health care provider

Present with a moderate to serious mental illness and whose needs

are able to be meet in the primary health setting

Present to the PHO with mental illness and or addiction issues, that with a brief intervention can be prevented from escalating to the

level that secondary intervention is required

Seek information and advice about mental illness and how to

support a person with a mental illness eg Family/whänau/

significant other

75% of the clients will be adults, aged over 20 years and 25% of the

clients will be children and young people aged 0 – 19 years.

The service will provide ongoing clinical care after specialist services have

provided assessment and diagnosis, treatment plans are in place, support is available, and conditions are stabilised.

The service will provide:

Screening for mental health problems where appropriate Assessment of the mental health and addiction needs of people and

to meet these when they can best be met within primary health

care settings

Innovative initiatives based on evidence and best practice to

provide - Brief interventions of known efficacy

- Case management

Referral to secondary services where this is indicated

Follow-up for people who have ongoing yet stable mental health

conditions

Effective linkages with other mental health service providers, housing, employment, education and welfare services so that the

care of those with chronic and/or long term mental health problems

is effectively co-ordinated.

Information, advice, and support about how to protect and promote

individuals and families’ mental health Promotion of a better understanding of mental illnesses, both within

the services workforce and in the community

Promotion of mutual support and self-help initiatives for people

affected by mental illness

The PHO took over the service on 5th March 2007 and has appointed a

Project Manager to undertake the role of developing the service.

The PHO will develop the service further to meet the needs of the PHO

population. The service will address people’s needs holistically and

facilitate access to opportunities for people to manage their mental illness and ongoing mental health recovery through the creative use for personal,

social and cultural resources.

The anticipated outcomes for this service are:

A reduction in hospital admissions A reduction in the use of crisis services

An increase in consumer, family/whänau and staff satisfaction

MORNINGTON PRIMARY HEALTH ORGANISATION TRUST 15,300 patients registered

Uses a proactive team based approach, and developed areas of specialty within its medical and nursing teams

Has other on site service providers include a Dietician, Hearing Aid

Acoustician, Clinical Psychologist, Acupuncturist, Physiotherapists, and a

Pediatrician.

Abolition of patient co-payments for all registered patients under the age of 18.

Primary mental health service The service includes a specialist mental health nurse/nurse practitioner to

work alongside GPs, helping to coordinate appropriate services for clients/ people with minor mental illness and in some instances to joint share

cases.

Introduced to address the needs of the 17% of the total population that

have diagnosable mild to moderate mental health disorders that require intervention and treatment by using a case management and coordination

approach for the enrolled adult population of MPHO.

In collaboration with other Mental Health Services, MPHO provides access

to appropriate family therapy and counselling services and other treatment with a documented comprehensive clinical and cultural

management plan with identified and desired clinical and cultural

outcomes;

Based on evidence and best practice MPHO provides assessment, brief

interventions of known efficacy and case management services for adults with mild to moderate mental health problems.

In collaboration with Mental Health Services MPHO provides ongoing

monitoring of clinical and cultural problems/symptoms and regular review

of personal progress and treatment at specified intervals.

MPHO provides appropriate programmes designed to engage clients in

early intervention, maintenance of health, relapse prevention, problem

prevention and promotion of good mental health and mental health

education; This includes provision of consultation/liaison services and linkages with the Mental Health professional community and social

agencies as appropriate.

The North Community Mental Health Team triage nurse recently assessed

the number of referrals received from the Mornington Health Centre

2004 30

2005 32

2006 16

It would appear that this MPHO Mental Health Service has resulted in a significant decrease in referrals to secondary community referrals.

Mobile Maori/Pacific Island Health nurse Mornington PHO provides a mobile Maori/Pacific Island Health nurse and

community health service providing a range of general health education and promotion, advisory, liaison and co-ordination activities. A key

objective of the service is to ensure that the activities of the Mornington

PHO are co-ordinated and effectively targeted for Maori and Pacific

whanau, and that these whanau are assisted to better utilise those

services.

These services are delivered through:

• the development of a whanau health plan of specific conditions

and age groups, and the development of targets for

improvements in health status as agreed with each whanau

• face-to-face sessions with individuals to specifically discuss and

develop strategies to address their health needs

• face-to-face sessions with whanau to specifically discuss and

develop strategies to address their health needs

• hauora wananga – health education and information from a

Maori/Pacific perspective promoting an understanding of the Maori/Pacific view of health in terms of:

– – – –

taha tinana (physical wellbeing)

taha wairua (spiritual wellbeing)

taha hinengaro (mental wellbeing)

taha whanau (family wellbeing).

To provide Maori/ Pacific primary health care nursing services that focus

on health promotion, disease prevention and disease management across the lifespan in conjunction with the primary health care team. The

purpose of this role is to improve access to primary health care and

therefore improve health outcomes of Maori/ Pacific Island patients. The

Maori/ Pacific Health Nurse will provide leadership in the area of Maori/

Pacific Island health and contribute to the development of the primary health care team. The Maori/ Pacific Health Nurse will be instrumental in

the development and implementation of the Mornington Primary Health

Organisation Maori Health Plan.

Funding Mornington PHO funds this position from surplus Health Promotion and

Services to Improve Access Reserves.

Referrals are received from General Practitioners and Practice Nurses

within the MHC as well as local Maori Health Providers (Arai Te Uru Whare

Hauora and Te Roopu Tautaku), Otago Pacific Peoples Trust, Pacific

Resource Centre, Otago Youth Wellness Trust, Plunket, and many self referrals from family members.

Patient referrals are seen within 2 days from receipt of referral, this has

allowed for effective and coordinated health care for the patient and their

family due to the flexibility of the service (without time constraints)

providing positive health outcomes that meet the needs of the family.

The service has referred to local Maori and Pacific Health and Social

Providers, for services such as Tamariki Ora (Maori and Pacific) , Disease

State Management, Healthy Lifestyle, Smoking Cessation and Men’s

violence and wellbeing, this has provided the patients with a choice of service providers. Non government organizations (NGO) such as

Presbyterian Support Services for budget advice, Anglican Family Care for

food bank services, Housing New Zealand and Work and Income and

Plunket for wellchild services.

ODHB Primary Care Services The service works very closely with the ODHB - Outreach Immunisation

Service to provide positive vaccination outcomes in the community.

Families welcome the opportunity to vaccinate their children in an

environment that is safe and comfortable.

Secondary Care Services The service works closely with patients who are preparing for discharge

from hospital with involvement in hospital multidisciplinary meetings to ensure patients and their families understand what is happening on

discharge and what services will be put in place to assist with home

management. A key area that the Maori/Pacific island service is picking

up on is polypharmacy, patients are discharged from hospital on

medication but do not clearly understand that they need to stop taking medication prescribed by their General Practitioner. The service is able to

follow through with the discharge summary and ensure the General

Practitioner is updated on changes with health care.

Pharmacy The service works closely with local pharmacies; ensuring patients receive

medication that is manageable and affordable for them such as blister

packs and dispensing trays A large emphasis is on discussing medication

use with patients to ensure patients understand what medication are used

for and how often they should be taken.

Courtesy Coach Transportation

Patients of the Mornington Health Centre who are unable to make their

own way to the Health Centre either due to ill health, frailty, or financial disadvantage. This service is used by young families and elderly patients

as well as those with financial difficulties for whom alternative forms of

transport are cost prohibitive.

The Courtesy coach operates 5 days per week between 8.30 am and 5.30pm and is staffed by one permanent and two casual coach drivers.

All staff hold clean drivers licences and one is an ex policemen. It holds

up to 8 people and car seats are provided for young children. The Coach

will travel within a 5km radius of the Health Centre to collect and drop off

patients. The coach is well maintain and is regularly serviced and

appropriate insurances are held.

Patients can avail themselves of this service by asking for the coach to

collect them from their home when making an appointment to see either a

GP or Nurse. The Courtesy coach will also return them home following

their appointment.

Improving Access to Primary Health Care for Youth attending the Otago Youth Wellness Trust Young people aged between 11-18 years that attend the Otago Youth Wellness Trust (OYWT). The OYWT has identified several barriers that

prevent this group accessing primary health care services. Some of these

barriers include lack of money, anxiety, embarrassment related to seeing

the family general practitioner, transport and communication difficulties.

A significant proportion of these young people also do not have the social

or organisational skills to be able to access primary health care services.

Free primary health care services at Mornington Health Centre for young

people attending the OYWT that are referred by an OYWT social worker:

• MPHO would not claim the casual clawback from the enrolled

provider • Same day, time appropriate, General Practitioner or Practice

Nurse appointments will be available to youth attending the OYWT

• MPHO will work with the OYWT to identify other barriers to

access, solutions will be identified, and where possible

implemented • Courtesy coach will be available for doctor and nurse

appointments

Outreach Well Children and Immunisation Services Children under the age of 5 years that are enrolled at the Mornington

Health Centre who face barriers to immunisation and well child services.

Plunket staff will work with the MPHO to deliver well child and parent

support services to the clients of its General Practice providers with a

particular focus on high need priority populations. Plunket will work with

the Mornington Health Centre Team and other providers /services (such

as the Immunisation Co-ordinators) associated with those practices to

offer clients a co-ordinated service.

The working relationship between Mornington Health Centre (the only contracted provider to MPHO) and Plunket will involve:

• Both Plunket and Mornington Health Centre will have an identified

contact person to ensure easy flow of communications

• The Plunket Clinical Leader/ Operations Manager will meet with

the Nurse Development Manager/ Overdue Immunisation Outreach Nurse bimonthly to review overdue immunisation lists

and ensure children are linked up with a well child provider

• The Plunket Service accepts referrals from the Mornington Health

Centre Team to provide extra support to high needs families

• Mornington Health Centre team will develop systems to ensure all

children enrolled in MPHO are linked to a well child provider and this is documented

• Mornington Health Centre team accepts referrals from the Plunket

Nurse to ensure access to GP services

• The Plunket support team coordinator is the link person for

Mornington Health Centre team and other Plunket Nurses • Information will be shared about the full range of services each

party has and how it can be accessed.

Emergency Prescription Subsidy To provide an emergency backstop for patients who cannot afford to pick

up a prescription, but who will suffer consequences detrimental to their

health or the health of others by not picking up the medications.

• To reduce the incidence of patients defaulting on prescriptions

due to financial hardship. • To reduce further health costs and complications from illnesses

untreated due to financial difficulties.

• To recognise that a need exists that is not met by other health

and social services and to address that need.

Improving Access to Primary Health Care for Women that are overdue for Cervical Smears

Woman aged between 20-69 years that are eligible for a cervical smear

and are overdue. This service will target all overdue women but initially will have an emphasis on woman with an abnormal history.

A review of overdue deprivation status clearly identifies that those women

in deprivation 4/5 areas are not accessing Primary Health Care Services

for cervical screening despite having an abnormal history.

• All women that are overdue for their cervical smear will be offered

the opportunity to attend Mornington Health Centre for a free

cervical smear, by one of the Centre’s registered smear takers.

We will target seventy women a month starting with those women

that are overdue and have an abnormal history.

• Cervical screening clinics will be offered during the week, weekends and in the evenings.

• Special clinics will be run where there is a supervised play area

for children so that women that have difficulty with child care can

bring children with them.

• The courtesy coach will be available for appointments. • There will be a choice of cervical smear takers available.

• Will investigate the option of providing an add on service to

encourage women to attend.

Diabetes Prevention Programme

The diabetes prevention programme will address the population health objectives by adopting strategies that work towards improving and

maintaining the health of Mornington Primary Health Organisation (PHO)

patients. We will identify people and population groups within Mornington

PHO ‘at risk’ of developing type 2 diabetes and invite them to attend this

programme.

Patients enrolled in the Mornington Primary Health Organisation (PHO)

who fulfill predetermined risk factor criteria for firstly being ‘at risk’ of

developing type 2 diabetes, and secondly of developing the complications

of diabetes following diagnosis.

There will be an emphasis on identifying those people from Maori and

Pacific communities and those people adversely influenced by

socioeconomic factors as they are most at risk of developing type 2

diabetes (Ministry of Health, 2003). This will be done through our patient

management system.

The diabetes prevention programme combines individual and group sessions.

The group programme is provided by a range of health professionals

included a practice nurse, dietician and exercise consultant. There are

eight sessions focused on the patients recognising their individual risk of developing type two diabetes and how this can be managed through:

• Increasing physical activity

• Dietary modification

• Behaviour/ Lifestyle change

• Goal setting

The practice nurse manages individual appointments for initial

assessment, ongoing monitoring and patient support. Patients will be

followed up at 3 monthly interval up to one year and then a practice

decision will be made regarding ongoing follow up.

Individual appointments can also be arranged with the dietician and

exercise consultant where one on one sessions maybe beneficial.

Improving Access to Smoking Cessation Counselling For those patients who wish to quit smoking.

Focus on Maori & Pacific Island and those from lower socioeconomic

groups. The Nurses Clinic runs a smoking cessation programme. The aim

of this activity is to identify smokers within the practice and to support patients who want to quit smoking as identified as a population health

objective in the NZ Health Care Strategy. Referrals will be received from

the GPs, community, and public health nurses. We will accept referrals

for casual patients. We can offer both group and individual smoking

cessation sessions. The cessation programme is based on the Guidelines

for Smoking Cessation (National Health Committee, 2002). The nurses running the programme are registered through the quit line to provide

subsidised nicotine patch and gum exchange cards. There is strong

supporting evidence for individual and group sessions along with the use

of NRT (Clearing the Smoke, 2004).

Health Promotion MPHO is part of a committee comprising representatives of Mornington,

Dunedin and Taieri and Strath Taieri PHO’s. This committee has been

involved in two joint health promotion proposals to date. The first is the “Active Families” programme, which is a joint initiative between the three

PHO’s listed above, SPARC New Zealand, Sport Otago and the Dunedin

City Council. The program is specifically aimed at raising the levels of

activity amongst primary and intermediate school children and their

families. The programme commenced 1 January 2006 and will run for a

period of two years. To date the programme has been involved in a community wide media campaign, resource development and distribution,

a community-based health education component and roll out of

programmes to children referred into the programme.

The second initiative is the joint appointment of two Health Promotion Project Officers to work under the supervision of Public Health South to

firstly research the area of Health promotion requirements of the enrolled

populations and secondly to run pilot programmes based on their findings.

This second initiative commenced in July 2006 and to date these project

officers are researching and making recommendations to the Committee regarding appropriate programmes to be rolled out in Otago.

MPHO has meet all of its Performance Management targets for the six

months ended 31st December 2006 and almost all for the period ended

30th June 2006.

One of the main focuses of the Quality Improvement Committee has been

the development of the Cardiovascular Risk Assessment and Management

Programme which MHC intends to roll out from 1 June 2007. This

programme will screen approximately 800 patients annual and it is

estimated that 16% of patients will have a cardiovascular risk greater

than 15% and require intensive intervention from general practitioners,

practice nurses, dieticians and exercise consultants. MPHO has been

working closely with MSD and they are providing the software to support the practice with the implementation of the programme.

Dr Roy Morris Primary Care Advisor 26 April 2007

HealthHealth Payments, Agreements & C

PACompliance

HealthPAC Audit & Compliance

Otago DHB Fraud Hotline Proposal

April 2007

_________________________________________________________________________________ Prepared by Kristin Sutherland Page 1 of 6

Otago DHB Fraud Hotline Proposal – April 2007

HealthHealth Payments, Agreements & C

PACompliance

Brian Rousseau CEO Otago DHB Private Bag 1921 DUNEDIN 26 April 2007 Dear Brian We are pleased to submit our preliminary proposal as discussed with you, to provide a fraud hotline to Otago DHB. We submit this preliminary proposal for discussion. As set out in the attached preliminary proposal, and we hope you have experienced, HealthPAC Audit & Compliance has an excellent record in the delivery of counter fraud and risk management activities in the health sector. We trust that you will find our submission of interest and relevant to you. We look forward to progressing it with you. Yours Sincerely Paul Johnstone Risk Assessment and Intelligence Manager, HealthPAC Audit and Compliance

Prepared by Kristin Sutherland Page 2 of 6


Table of Contents

1. Introduction 4

2. Risk 4

3. Objective 4

4. Proposal for Fraud Hotline 4

5. Enhanced Fraud Hotline Details 5

6. Cost 5

7. Competencies 6



1. Introduction HealthPAC Audit & Compliance (A&C) would like to work hand in hand with Otago DHB to establish a counter fraud culture where fraud is not tolerated, and people feel able and empowered to voice their concerns. HealthPAC Audit & Compliance has put together proposal for the provision for a fraud hotline. 2. Risk Further to our discussion and comparison with overseas agencies we agree that numerous fraud risks exist within the DHB itself and in the provider arm of the DHB. Some of these risks include:

• Payroll Fraud • Contract management fraud • Employee fraud • Incorrect expenses claims

We believe, as you do, that a fraud hotline would provide an avenue for employees and the public to report any concerns they may have. 3. Objective The fraud hotline is being set up by Otago DHB in response to the risk of fraud within the DHB itself and the provider arm of the DHB. The objective of the fraud hotline is to collate, assess and investigate information provided. 4. Proposal for Fraud Hotline HealthPAC Audit & Compliance propose to provide Otago DHB with a fraud hotline service utilising the current national fraud hotline number. The advantages of this are the minimal cost to set up such a service and the tapping into existing knowledge and systems. Fraud Hotline Currently HealthPAC Audit & Compliance currently provide a national fraud hotline number that is utilised mainly by internal HealthPAC staff and DHB staff. The fraud hotline has not been promoted to a large extent to the health sector as a whole, as current resources are limited. Proposed Enhanced Fraud Hotline HealthPAC A&C would help Otago DHB promote the fraud hotline number to DHB and provider arm staff at Otago DHB. HealthPAC A&C would receive calls and then evaluate and advise on the information provided to them to the Otago DHB. Effectively HealthPAC A&C would act as an information collation and assessment centre and then provide an advisory and management role on counter fraud issues to Otago DHB.



5. Enhanced Fraud Hotline Details Fraud Awareness Campaign The success of a fraud hotline is intrinsically related to the success of the fraud awareness campaign that promotes it and supports it. HealthPAC A&C believe that a fraud awareness campaign should include:

• Support from the highest levels within the DHB – namely the CEO and the board

• Presentations to staff discussing fraud and what it might be and look like • Posters promoting the fraud hotline and examples of fraud • Pens provided to staff to constantly remind them about fraud and the hotline • Post it pads promoting the fraud hotline • Fraud awareness days in the hospital and the DHB promoting the hotline and

the reason for it, and giving the line a ‘face” The hotline The phone line itself would be coordinated and manned by a member of the HealthPAC A&C team who was formerly a CIB police officer and is trained in the collection and collation of sensitive and confidential information. The hotline would be manned during normal business hours (8:30am-4pm), with a message service operating outside these hours. An email service would run in conjunction with the hotline, which would provide another avenue for people to supply information. The information The information collected would be recorded and stored securely to meet all legal requirements. Reporting the information All calls received in relation to Otago DHB would be reported to the DHB at board level. It is suggested that HealthPAC A&C would provide a report to the board monthly on information received by the fraud hotline. Along with the collated information HealthPAC A&C would provide the board appropriate evaluation and advice on how to proceed with any issues that may arise. Any information requiring urgent action will be reported to the chairman of the board as soon as possible. 6. Cost

The cost of the hotline would include a nominal cost for providing the line and manning the line. The fraud awareness programme would incur costs for materials and some HealthPAC A&C staff time, along with time of Otago DHB staff. We would utilise some of our legal advisers (solicitor and barrister) time and advice.



Although this difficult to cost at this stage as we do not know what the work load will be we would estimate a nominal sum of $10,000 per annum ( excl. GST) we be adequate initially. This initial cost includes:

• Equipment required for fraud hotline operation • Staff time to man and assess information • Reporting to the board monthly • Assistance with the fraud awareness programme.

Note that the cost of materials for the fraud awareness programme would be met by Otago DHB. Funding would need to be flexible as demand will only be assessed after the hotline is in operation for a few months. HealthPAC A&C, in conjunction with Otago DHB, would like to perform a review of the service after six months of operation. Counter fraud investigations arising out of information provided on the hotline would be priced on a case by case basis. 7. Competencies HealthPAC’s Audit & Compliance team has an extensive depth of knowledge and experience in risk assessment and analysis, audit, fraud investigation and litigation of health sector claims & funding and financial auditing. Our past experience means that we are aware of the risks and intricacies relating to the NZ health sector, so we know where to focus our counter fraud programmes. In our team we have several ex-police and detectives who specialise in health sector counter fraud investigations and risk management.


HEHA Implementation Plan Report Board Meeting Date: 3 May 2007 Report Prepared by: Melanie McKenzie, Senior Regional HEHA

Coordinator, Regional Planning and Funding Team

Date Report Prepared: 24 April 2007 Recommendation That the Board notes the content of this report.

1. Introduction Healthy Eating, Healthy Action ~ Oranga Kai, Oranga Pumau (HEHA) is the Ministry of Health’s strategy to improve nutrition, increase levels of physical activity and reduce obesity. The Otago DHB is required to develop a HEHA Implementation Plan (a ‘Ministry Approved Plan’) for the Otago district. This is intended to be a living process, the first iteration of which will outline the process by which the Plan will be developed over the coming year. The content of the first Plan will include: • A snapshot of all current activity in our district to implement the HEHA Strategy, the

health need and any implicated gaps in programme delivery • Activity prioritising breastfeeding, activities in schools and early childhood settings,

workforce capacity and capability, primary and secondary care and children, young people and families

• A plan for action, communication and ongoing MAP development 2. Progress to Date The Otago District Health Board has appointed Ruth Zeinert as the Regional HEHA Coordinator based with the Regional Planning and Funding team. The Otago HEHA Coordinator reports to Southland’s Senior Regional HEHA Coordinator, Melanie McKenzie. A Draft HEHA Implementation Plan was submitted for feedback to the Ministry of Health on 30 April 2007. Stakeholders to support this Plan have been identified, including PHOs, Maori providers, education, regional sports trusts, local government and communities, and progress is being made to systematically engage with them. A regional HEHA education sub-group has been assembled to coordinate implementation of the Nutrition Fund, with representation from public health, NGO, schools representative, early childhood education representative, and the DHB HEHA Coordinator.

3. Development of the Final Document The final Plan requires sign off by:

• The DHB’s CEO, • Board Chair or representative, • Mahi Hauora, • Project Sponsor, • General Manager Maori Health • Project Coordinator and • The HEHA Steering Group

Significant work lies ahead in order to complete the Plan within the specified timeframes (see below).

April 2007 May 2007 June 2007

30th: Draft MAP due with Ministry of Health

21st: Mahi Hauora meeting – draft Plan presented

22nd: CPHAC meeting – draft Plan presented

7th: Board meeting – Final Plan approved

15th: Final Plan due with Ministry of Health

PRIVATE SPECIALIST REFERRED LABORATORY TESTING

RECOMMENDATIONS: 1. The Board notes this report. 2. The Board approves proceeding to consultation with stakeholders (based

on the appended consultation paper) on whether private specialist referred laboratory testing should continue to be funded by DHBs.

1. BACKGROUND

Historically, DHBs have paid for private specialist referred laboratory testing from public funding. DHB CEOs have now questioned whether this should continue, and late

last year the Wellington region DHBs took a decision to cease funding private specialist referred laboratory testing from public funding effective 01 November 2006. Whilst

variable, dependant on private specialist access in different DHB regions, we have estimated that up to 5% of the cost of community referred laboratory testing is from

referrals from private specialists.

2. PROPOSED CONSULTATION

South Island DHB CEOs have agreed that stakeholders need to be consulted and their

feedback considered in deciding whether to recommend to their respective Boards

whether DHBs should continue to fund private specialist referred laboratory testing. CEOs also agreed that there was benefit in South Island DHB collaboration on this

initiative. Accordingly, SISSAL was requested to develop a project plan and the required consultation documentation for consideration by Boards. This project plan

and a draft consultation document are appended to this paper.

3. PROPOSED NEXT STEPS

In order for this initiative to proceed collaboratively across the South Island, DHB

CEOs have agreed to seek approval from their Boards to proceed to consult with stakeholders on whether private specialist referred laboratory testing should continue

to be funded by DHBs. Accordingly, I seek the Otago DHB Board’s approval to

proceed to consultation based on the appended SISSAL draft consultation document.

Brian Rousseau CEO

25 April 2007

Project Plan

Supporting the South Island District Health Boards

South Island Shared Service Agency Limited

Project Title: Discontinuing Access to Publicly Funded Private Specialist Referred Laboratory

Tests

Client: South Island District Health Boards

Sponsor: Craig Climo, Chief Executive Officer, South Canterbury DHB

Project Manager: Nicola Trolove, SISSAL

Start Date: 1 February 2007 Expected completion date: 31 January 2008

Project plan Approved Declined

Name: Nicola Trolove Designation: Service Manager, Personal Health

Date: 20 March 2007 Attachments: None

Background

In February 2006, the Minister of Health agreed in principle to District Health Boards (DHBs) discontinuing payment for laboratory tests referred by private specialists. The Minister gave permission to Hutt Valley (HV) and Capital and Coast (CC) DHBs to include this as an aspect of their laboratory service tender and asked for a report back on how the operational issues would be addressed. The Minister acknowledged that the policy change was significant and that there should be national consistency regarding this issue.

In October 2006 the South Island Chief Executive Officers (CEOs) requested that SISSAL prepare a briefing paper describing the approach taken by Hutt Valley and Capital and Coast DHBs to implement this change and outlining options for the South Island. The paper incorporated feedback from the South Island General Managers Network (SIRGMN).

In December 2006, the South Island CEOs agreed to a regional approach with planning to commence in February 2007. Craig Climo (South Canterbury DHB) was identified as the Lead CEO. A regional working party was to be established with project management support provided by SISSAL.

In February 2007, further clarification was sought from the Minister on the requirement to consult and legal advice was received from Greg Brogden, Corporate Solicitor, Canterbury DHB regarding provisions in existing laboratory agreements to initiate this change.

In March 2007, the CEOs agreed that a generic consultation process be developed for use by individual DHBs with the consultation question being;

“Whether the DHB should introduce and implement the change”. They also noted that:

a. consultation would involve a broad range of stakeholders, (including public notification) with a specified timeframe for feedback and objections to be lodged.

Ref: PHR14 Created on: 20/03.07 Version:1 Review date:

File path:M:\BOARD\Agendas 2007\May\Project Plan from Template docwith changes2.doc

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b. the consultation process would be robust, so as to reduce the risk of challenge.

c. the Ministers approval for DHBs to implement this policy change would be noted.

d. the consultation documents would indicate that the change has been implemented in the Wellington region.

e. that some DHBs were still to agree on entering into the consultation process (approvals would be sought from individual Boards once the generic consultation documents have been agreed by the CEOs).

f. following consultation, DHBs would make independent decisions on whether or not to proceed and the timing of this.

In March 2007, the regional working party was convened and the Ministry of Health requested an update on the progress with this initiative in the South Island.

Current Laboratory Services Contract Considerations All existing agreements include payment for private specialist referred laboratory tests and the majority are in the first year of their term. Agreements vary in duration from one to eight years. The status of existing agreements has been summarised below.

DHB Laboratory Provider

Term Nature Service Type

Nelson Marlborough

Private 5 year (expires Nov 2011) (With right of renewal for 5 years subject to satisfactory performance)

Bulk funded Schedule and Non Schedule Community and Hospital tests

Private 1 year (expires Sept 2007)

Fee for service Schedule and Non Schedule tests

West Coast

Provider Arm In service agreement Schedule and Non Schedule tests

Private 5 year (expires Oct 2011)

Fee for service (with risk share)

Schedule tests only

Private 5 year (expires Oct 2011)

Fee for service (with risk share)

Schedule tests only

Canterbury

Provider Arm In service and service level agreements Schedule and Non Schedule Community and Hospital tests

South Canterbury

Private 5 year (expires Mar 2009) (With right of renewal for 5 years subject to satisfactory performance)


Otago and Southland

Private 8 years (expires Aug 2014) plus 2 years




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Project Objective and Approach

The objective of this project is to support a regional approach to this proposed policy change.

SISSAL will achieve this by:

• Coordinating the activities of the regional working party.

• Coordinating the development of consultation resources based on the Wellington examples. • Supporting DHBs to undertake local consultation as required. • Assisting DHBs to analyse consultation findings as required. • Supporting DHB implementation planning, where a decision is made to implement the

proposed change, and as required.

Regional Working Party

The Regional Working Party comprises the following representatives:

Nelson Marlborough DHB Jim Hurring Portfolio Manager, Personal Health West Coast DHB Peter McIntosh Senior Planning and Funding Analyst Canterbury DHB Bridget Lester Portfolio Manager, Primary Care South Canterbury DHB Nathan Taylor Administration/Risk Manager Otago DHB Peter Hay Portfolio Manager Southland DHB Rachna Luthra Policy Analyst

Other resources: South Canterbury DHB Craig Climo Lead CEO

SISSAL Nicola Trolove Project Manager

Canterbury DHB Greg Brogden Legal Advice

The role of the regional working party will be:

• to act as district contacts for the project manager.

• to have input into project planning and implementation.

• to agree the proposed generic consultation process.

• to agree the content of generic consultation documents for use by South Island DHBs.

• to provide updates on progress with DHB consultations.

• to identify the outcomes of consultation.

• to inform of any DHB decisions regarding whether or not to proceed with implementation of the proposed change.

• to provide updates on provider relations and progress with contract negotiation/amendment,



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where required by DHBs.

• to provide updates on implementation planning, where applicable.

The Regional Working Party will meet as required (with email correspondence between times) and participate in the project to its completion date - 31 January 2008.

The project manager will provide monthly updates to the Regional General Managers (Planning and Funding) Network (SIRGMN) and South Island CEOs Forum.

Project Deliverables

Listed below is a summary of the project deliverables. A comprehensive work breakdown structure is outlined later in this project plan.

• Agreed generic consultation process and documents developed.

• Consultation undertaken and analysed where appropriate (DHBs and SISSAL).

• Implementation planning supported where applicable (DHBs and SISSAL).

• Progress tracked and feedback provided to project team, SIRGMN and SI CEOs.

Project Milestones

February 2007 Commence project planning. Confirm Minister’s imperative regarding this change. Receive legal advice. Confirm consultation question. March 2007 Convene regional working party and develop generic consultation documents. April 2007 CEOs approve generic consultation process and documents (for use by individual South Island DHBs). May 2007 DHB(s) approval / other decision to proceed with public consultation on this policy change. DHB(s) establish ongoing dialogue with laboratory providers. June 2007 DHB(s) commence public consultation, where applicable.



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August 2007 DHB(s) present consultation findings where applicable. DHB(s) provide approval / other decision to proceed with implementation of the policy change. September 2007 DHBs undertake implementation planning, where appropriate, involving contract negotiation, variation to the agreement, development of information resources regarding the change (public and providers), and development of evaluation framework. SISSAL to provide support/assistance. October 2007 Distribute public and provider information and notification of change, where applicable. November 2007 Implement change where applicable May 2008 Undertake evaluation (six month post implementation review) where applicable

DHB Specific Priorities and Constraints Related to this Project

• Timing will vary for individual DHBs. • Implementation and / or consultation in one DHB will have an impact on other DHBs (ie where

patient care crosses DHB boundaries). • Otago and Southland CEOs propose to undertake a joint process of consultation and

planning (due to their shared laboratory agreement). • With the exception of Otago/Southland, existing laboratory agreements afford limited

opportunity to initiate this change, requiring that a contract variation is agreed by both parties. • Effective and ongoing communication with local laboratory providers will be essential to this

process.

Assumptions

• All relevant background information will be available to the project manager and Lead CEO as requested and in a timely manner.

• Stakeholders will be available for key discussions.

• All project participants support a regional process.



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Resource Implications and Constraints

• Nil operational budget.

• DHBs will meet the resource requirements of their project representatives.

• Maternity leave requirements for project manager.

Current resource allocation: SISSAL resources available to the project include:

• Project Management (0.4FTE) • Analyst Support (FTE to be confirmed)

Additional resources available to the project include:

• Legal Support (as required from Canterbury DHB) • Communications support (individual DHBs to provide)

Key Stakeholders

Laboratory Providers

South Island District Health Boards

Private Specialists

Private Patients

General Public

Non-government Organisations

Health Insurance Companies

Ministry of Health and Business Units (HealthPAC etc)

Unions

General Practitioners (GPs)

Primary Health Organisations (PHOs)

Other DHBs



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Project risks and strategies to mitigate

The following risks have been identified:

Identified Risk Mitigation Strategy

Challenges to the consultation process Ensure robust process undertaken consistently across the region

The role and influence of media and special interest groups

Consult with all special interest groups and ensure clear messages are available to the media

Poor relationship management with laboratory providers

DHBs initiate discussions early on and maintain effective communication throughout

Work Breakdown Structure (to be further developed)

Task By whom By when Status

Project Planning (Feb – Mar 2007)

Confirm consultation question SI CEOs 01/03/07 Complete

Confirm regional working party SIRGMN 01/03/07 Complete

Draft project plan Project Mgr 20/03/07 Complete

Consultation Planning (Mar – April 2007)

Draft generic consultation process and documentation

Project Mgr 20/03/07 Complete

Draft generic consultation process and documentation agreed by project group

Working Party

26/03/07 Complete

Draft documents above submitted to SIRGMN for feedback

Project Mgr 27/03/07 Complete

SIRGMN feedback received and incorporated SIRGMN 04/04/07 Complete

Draft documents submitted to CEOs Project Mgr 11/04/07 Complete



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CEOs approval received CEOs 16/04/07 Complete

DHB approval(s) to consult/ other decision obtained CEOs May Board meetings

Project Reporting and Communication (Feb 2007 – Jan 2008)

Progress Report to SIRGMN Project Mgr 26/04/07 Complete

Progress Report to CEOs Forum Project Mgr 09/05/07 Complete

Progress Report to SIRGMN Project Mgr 25/05/07

Progress Report to CEOs Forum Project Mgr 13/06/07












Beyond this - meeting dates to be confirmed Project Mgr

Consultation Implementation (May – July 2007)

Stakeholders identified DHBs Tbc

Laboratories approached regarding upcoming consultation

DHBs Asap

Consultation documents tailored to individual DHB requirements

DHBs Tbc

Timeframe and deadline for consultation established DHBs Tbc

Public notice and consultation letters distributed to stakeholders

DHBs Tbc



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Feedback received DHBs Tbc

Independent analysis of consultation findings Tbc Tbc

Consultation summary compiled and made available to interested parties

DHBs Tbc

Consultation results assessed by DHBs DHBs Tbc

Decision made regarding whether or not to implement the change

DHBs Tbc

Stakeholders informed of DHB decision DHBs Tbc

DHB Decision regarding whether or not to implement the change (Aug 2007)

Implementation Planning, where appropriate (Sep – Nov 2007)

Implementation Planning DHBs Tbc

Contract Negotiation / Variation DHBs Tbc

Development of information resources regarding the change

DHBs Tbc

Public and Provider notification of the change DHBs Tbc

Development of evaluation framework DHBs Tbc

Implementation (Nov 2007 - )

Evaluation (May 2008 – six month review post implementation)

Dear Sir/Madam

Payment for Laboratory Tests for Private Patients

in the districts covered by South Island DHBs

Over recent months we (the South Island DHBs) have been reviewing our contracts for laboratory tests. Along with the specifications of these contracts, we have also been discussing who should pay for laboratory tests when patients are treated by private specialists, private hospitals and private clinics. We know that other parties are also interested in this issue. Each DHB will be asking the opinion of community groups and individuals within a timeframe that conforms to the DHBs processes. The South Island DHBs are asking your opinion on the issue. To assist we have prepared some background information in this letter, together with the Questions and Answers attached. These documents, and other more detailed material about the laboratory contracts, can also be downloaded from www.X. (under ‘Latest News’) We would appreciate your feedback on this issue. Please send us your response before 5pm Day/Month/Year. 1 The problem When people in our district see their family doctor (or GP) with a problem that needs higher levels of care or treatment, they can be referred to a medical specialist or clinic at one of the public hospitals e.g. X Hospital, X Hospital. Treatment people are given in a public hospital is generally free, anywhere in New Zealand. People can also decide NOT to use the public health system and see a private medical specialist, a private hospital or private clinic for treatment instead. This is treatment you have to pay for and many people have health insurance to pay for this. The problem is that at present, public health money is paying for all laboratory tests, whether people are being treated privately or by the public health system. So even if you have surgery in a private hospital and the cost is being paid by your health insurance, public health money is paying for your private specialist referred laboratory tests. When public health money is used to pay for private specialist referred laboratory tests, this means that public services are affected as a result i.e. if we are using public money to subsidise the private system then this money can’t be used for health services within the public health service. This equates to $X million a year across the region 2 The consultation questions Unless there are good reasons not to do so, we (the South Island DHBs) intend to cease subsidising the private health sector by paying for private specialist referred laboratory tests. We need to know if you think that:

i. Public health money should continue to pay for all laboratory tests, even when you are treated by private medical specialists, private clinics or private hospitals;

ii. Public Health money should continue to pay in some situations, for some patients or some laboratory tests referred by private specialists; iii. Public health money should not be used to pay for laboratory tests when you are

treated by private medical specialists, private clinics or private hospitals.

3 Decisions that have already been made and are NOT part of this consultation It is important to note that we have already decided PUBLIC HEALTH MONEY WILL CONTINUE TO PAY for laboratory tests that are needed when you are treated by your family doctor (GP), a midwife, a dentist, hospital staff or other parts of the public health system e.g. family planning services. 4 The cost of laboratory tests We know that the average cost of a laboratory test for private patients is about $10.00, but some tests cost more. The costs range from simple tests at less than $10, to more complex tests for rare conditions that can cost up to $200 and more. It is estimated that the South Island DHBs are paying about $X million per year in laboratory tests for patients who are treated by private medical specialists, private clinics or private hospitals. 5 Paying for these tests in future It is proposed that DHBs will not be funding the cost of private specialist referred laboratory tests. This may mean that you might be asked to cover this cost by your private specialist, private clinic or private hospital. We would like to know your views on the issue outlined in this letter and the Questions and Answers. You can let us know what you think by:

filling in the form that is part of this letter; OR writing your own response to the issue;

Send the form or your response to X at either of the following addresses - Post at: X Email at: X The closing date for consultation is X. If you have already commented on this issue, your comments will be considered. Yours sincerely X X

Paying for Laboratory Tests for Private Patients Consultation Questionnaire from the South Island DHBs.

We need to know if you think that: 1 Public health money should continue to pay for all laboratory tests, even when you are treated by private medical specialists, private clinics or hospitals; YES ڤ NO ڤ Any comments? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2 Public health money should continue to pay in some situations, for some patients or some tests referred by private specialists YES ڤ NO ڤ If you answered YES, please tell us which patients or which tests should still be paid for with public health money? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 3 Public health money should not be used to pay for laboratory tests when people are treated by private medical specialist, private clinics or private hospitals. YES ڤ NO ڤ 4 Any other thoughts or comments? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ When complete, please send this to X by Post at: Email at: X Fax at:X X

Remember, we need your response by 5pm, X.

FINANCIAL REPORT

Board Meeting Date: 3 May 2007 Financial Report as at: 31 March 2007 Report Prepared by: Robert Mackway-Jones, Regional CFO Date: 23 April 2007

Recommendation: That the Board note the financial report.

1. Consolidated Results Summary

DHB Consolidated Financial Performance March 2007

Month Year to Date AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

36,300 38,149 (1,849) Revenue 345,179 342,167 3,012 458,084

(13,815) (13,499) (316) Less Personnel Costs (120,789) (119,685) (1,104) (159,800)(22,587) (25,434) 2,847 Less Other Costs (216,577) (222,128) 5,551 (300,546)

(102) (784) 682 Net Surplus / (Deficit) 7,813 354 7,459 (2,262) Summary of Results March 2007


(52) 5 (57) Governance (404) (52) (352) 0(76) (460) 384 Funds 1,733 (66) 1,799 (2,204)

26 (329) 355 Provider 6,484 472 6,012 (58)(102) (784) 682 Net Surplus / (Deficit) 7,813 354 7,459 (2,262)

Summary Comment

• The result for March was ahead of budget, although a deficit of $102k was recorded • YTD the result is still significantly favourable with a surplus of $7.8m compared

against a budgeted surplus of $0.4m • The year end forecast has not been updated for this report given the monthly result

was largely in line with prior forecasts, it still projects a surplus of $7m (with $5m relating to mental health underspend). However part of the ongoing review and preparation of the final District Annual Planning submission will be incorporating an update to this. By necessity, this will be completed after completion of this report.

ODHB Board Meeting Financial Report

1

2. DHB Funds Results

Month Year to Date Annual

Actual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

32,330 34,711 (2,381) Revenue 313,272 312,395 877 418,126

0 0 0 Less Personnel Costs 0 0 0 0(32,406) (35,171) 2,765 Less Other Costs (311,539) (312,461) 922 (420,330)

(76) (460) 384 Net Surplus / (Deficit) 1,733 (66) 1,799 (2,204) Expenses (24,999) (24,447) (552) Personal Health (223,604) (220,021) (3,583) (293,748)

(4,065) (4,508) 443 Mental Health (35,941) (37,569) 1,628 (53,346)(3,102) (5,976) 2,874 Disability Support (49,889) (52,708) 2,819 (70,353)

(1) 0 (1) Public Health (22) 0 (22) 0(79) (80) 1 Maori Health (641) (721) 80 (961)

(160) (160) 0 Other (1,442) (1,442) 0 (1,922)(32,406) (35,171) 2,765 Expenses (311,539) (312,461) 922 (420,330)

Summary Comment

• The Income & Asset Testing (DSS) washup was paid in cash this month, hence the large negative revenue adjustment is offset by cost reductions

• The final Aged Residential Care price increase funding was paid, costs for this have already been paid to providers

Personal Health • Three main variances in month:

o an IDF provision was taken based on data for the 1st six months, this was $296k unfavourable

o Pharmaceutical expenditure was $112k unfavourable o the travel and accommodation account contained an adjustment for incorrect

coding of payments which meant it shows an unfavourable variance of $120k, however the offset for this is contained in the DSS home support budget

• Key unfavourable expense variances YTD are Pharmaceuticals ($3.6m), PHO payments ($247k), rural support ($340k)

• Additional funding has been received for PHO's and primary referred component of Pharmaceuticals, covering bulk of variances

Mental Health

• Community residential beds are under budget by $559k for month, YTD this is now over $2m under budget

• The Year end projection for mental health underspend remains around $5m DSS Residential Care

• Home support had a coding correction where travel & accommodation has been charged to, with this fix the YTD variance is only $19k

• Carer support is continuing its trend of over expending, YTD variance unfavourable by $555k

• The view of the DSS residential budget is complex as described below with three items impacting the view, these are the Income & Asset Testing (IAT) changes, price increases not budgeted where additional funding and costs have been incurred and the quantum of financial savings factored in the budget.

The final IAT washup adjusted revenue down by $1.54m per annum. The budget had assumed that the DHB would pay back costs rather than have its revenue reduced. The


2

impact is the same, but causes distortion in the view of funding and cost for this service between the actuals and budgets. The cost variance in the residential care lines is now favourable by $2.58m; with the distortion of $1.54m removed, the budget is favourable by $1.04m. Funding for price increases has been received of $653k with increases already awarded to providers earlier, assuming the two equal and given both the funding and cost were not budgeted, the budget is favourable by $1.65m. Of this, the one off gain between the accruals for the washup made last financial year and the final agreement amounted to $1.3m. This means that the level of savings assumed and modelled into the budget are being met.

3. DHB Governance Results

Month Year to Date Annual

Actual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

257 229 28 Revenue 2,245 2,060 185 2,747

(184) (140) (44) Less Personnel Costs (1,265) (1,254) (11) (1,670)(173) (132) (41) Less Other Costs (1,815) (1,289) (526) (1,652)

48 48 0 Plus Allocation 431 431 0 575(52) 5 (57) Net Surplus / (Deficit) (404) (52) (352) 0

Summary Comment

• The YTD variance is driven by Legal / Prof fees which are $330k unfavourable • Capital charges on the funder result are also higher than budgeted due to the

improved funder result v budget, the impact is $210k unfavourable • These variances has been partially offset YTD by higher interest earnings • The unfavourable variation in the month is as a result of recharging two months worth

of regional costs between Otago & Southland

4. DHB Provider Summary Results

This section of the report was provided to the Hospital Advisory Committee at its meeting on 24 April 2007.


21,702 21,106 596 Revenue

192,026

188,738 3,289 251,909 (13,631)

(13,358) (272) Less Personnel Costs

(119,524)

(118,435) (1,089) (158,130)

(516) (391) (125) Less Outsourced Cost (3,838) (3,433) (405) (4,589) (4,076) (4,159) 82 Less Clinical Supplies (33,435) (34,955) 1,520 (47,274)(3,453) (3,527) 74 Less Non Clinical (28,746) (31,443) 2,697 (41,973)

26 (330) 355 Net Surplus / (Deficit) 6,485 479 6,012 (57)


3

Summary Comment:

• March’s result is a surplus of $26k compared to a budgeted deficit of $330k, favourable to budget by $355k

• The major impacts for the month were;

- Joint Orthopaedic Initiative volumes double monthly budget. - Medical costs over budget following YTD trend - Nursing costs over budget due to increase in annual leave entitlements. - High outsourced costs due to outsourcing of Ophthalmology clinics and

settlement of old invoices to Southland DHB for Radiology services (MRI / CT scans).

- Treatment Disposables over budget reflected in high Blood and Catheter costs.

- Continued IS savings through transaction avoidance.

• YTD the overall result is still significantly favourable with a surplus of $6.5m compared to a budgeted surplus of $0.5m.

• Mental Health within the overall result has a $409k surplus against a budgeted deficit

of $750k. The “result” after removing the mental health component would be a surplus of $6.076m against a budgeted surplus of $1.229m.

Key YTD Issues Some of the key issues for the current year include items shown in the following table. These are discussed in the body of the report. Item $’000 Medical Salaries (2,534) Nursing overtime/penal payments (685) Legal Fees (majority re IS investigation) (582) Orthopaedic initiative volumes behind (approx net impact) (479) IT maintenance support 1,954 Clinical equipment leasing & support costs 1,446 Allied Health FTE under budget 1,040 Capital Charge wash-up recalculation 678 Management / Admin FTE under budget 802 Nursing FTE’s under budget 662 IT equipment leasing 571


4

Revenue

Area $'000Month

VarianceYTD

Variance Comment YTDCTA Revenues 9 151Training Fees and Subsidies (2) (12)ACC Revenues (52) (183)Patient / Consumer sourced 102 493 Additional non resident income.Public Health 30 554 Primarily Maori Health Development. Prior year amtDSS (33) (309)

Other DHBs 2 39Low Pharmaceutical sales to Southland DHB offset by Cardiac Surgery being invoiced to Capital and Coast

Other Government 14 38470 1,117

OtherInterest earnings (12) (225)Supplier Rebates 9 91 Growth & Delivery rebatesResearch Funds 0 72 Offset for Nursing / Consumable costsTrust Donation 4 78SCL recharges 99 731 Post August 2006Miscellaneous 45 503

145 1,250

Personal HealthMammography 7 62 Volumes > budgeted ytd Orthopaedics 253 (736) Joint Orthopaedic Initiative volumes < budgetedTeam Based Midwives 13 37Miscellaneous 3 (38)

276 (675)

Mental HealthNew Contracts 14 256 Primhed plus Community Alcohol & Drug Service

14 256

Internal Revenue TransfersLaboratory adjustment 0 928 Delays to regional service offsetting costsNeeds Assessment Unit 37 166Misc 54 247

91 1,341

Total Revenue 596 3,289

• Approx. 50% of the favourable YTD revenue variance is attributable to the adjustment of laboratory funding (covering costs incurred) up to Aug06 as well as the cost recovery of RMO salaries / rents and utilities from SCLOS post Aug06.

• The Orthopaedic Initiative revenue shows a favourable variance for the month,

reflecting 37 joints completed in March against a budgeted 19. YTD 62 joints have been completed against a budget of 117. The plan is still to complete all JOI volumes by year end by scheduling additional theatre time including Saturday if necessary. Associated revenue and costs have been included in the February forecast.

• Other areas where revenue is significantly ahead of budget include

- additional Mental Health & Public Health contracts and - non-resident charging. (difficult to budget accurately as variable from year to

year) Salaries Monthly Salary Total Costs The following table summarises the overall salary position.


5

Area $'000

MonthFTE

Actual

MonthFTE

Budget

Month FTE

Variance

YTD Actual $'000

YTD Budget $'000

YTD Variance

$'000

YTDFTE

Actual

YTDFTE

Budget

YTDFTE

VarianceMedical 288.50 287.60 (0.90) (35,869) (33,334) (2,534) (2.95)

(17.78) (45,738) (45,454) (285)(1.35) (18,652) (19,481)

(3,830) (4,071)(15,435) (16,089)

(0.97) (119,524) (118,428) (1,096)

295.65 292.69Nursing 988.94 971.16 980.93 988.22 7.29Allied Health 468.45 467.10 829 464.01 474.35 10.33Support 131.44 137.15 5.71 241 134.61 140.68 6.07Management / Admin 407.09 420.44 13.35 654 416.60 429.16 12.56Total Salaries 2,284.42 2,283.45 2,291.81 2,325.10 33.29 YTD costs are $1.1m over budget. FTE’s are well under budget with the budget including a rolling vacancy factor of 40 FTE. Hence the real vacancy factor compared to approved staffing complements is around 82 FTE as shown below; FTE Analysis - Vacancies

Mar-07 Mar YTD Forecast YEVariance from budget (0.97) 33.29 24.73

add backVacancies budgeted 40.00 40.00 40.00Restructure savings not achieved 35.00 11.67 17.50

Real Vacancy FTE 74.03 84.96 82.23 The above FTE forecast reflects an assumption that actual FTE savings are around 25 compared to the 60 FTE budgeted from January to June. The graph bellows shows the FTE change during the year highlighting the Lab outsourcing (Jul-Aug06), the vacancy level from Sept06 to Dec06 prior to the budgeted restructure, then the affect of the restructure (both actual and budgeted) hitting January07.

Provider Actual versus Budgeted FTE

2,200

2,220

2,240

2,260

2,280

2,300

2,320

2,340

2,360

2,380

Jul-0

6

Aug-0

6

Sep-0

6Oct-

06

Nov-06

Dec-0

6

Jan-0

7

Feb-07

Mar-07

Apr-07

May-07

Jun-0

7

FTE

Actual FTE

Budget FTE

Medical Salaries Medical salaries have an unfavourable variance of $152k for the month and $2.5m YTD, as shown below:


6

Area $'000

Month Actual $'000

Month Budget $'000

Month Variance

$'000

MonthFTE

Actual

MonthFTE

BudgetYTD Actual

$'000

YTD Budget $'000

YTD Variance

$'000

YTDFTE

Actual

YTDFTE

Budget

YTDFTE

VarianceOrdinary (2,365) (2,229) (136) 245.83 232.35 (19,767) (19,909) 142 237.67 236.62 (1.05)Back-pays 114 0 114 (1,170) 0 (1,170)Accident Leave 0 0 0 (1) 0 (1) 0.01 (0.01)Annual Leave Accrued (357) (322) (36) 21.95 32.96 (3,032) (3,206) 173 30.03 36.19 6.16Annual Leave Taken 0 0 0 (12) 0 (12)Long Service Leave 0 0 0 (15) 0 (15) 0.03 (0.03)Other Leave (9) 0 (9) 0.60 (65) 0 (65) 0.69 (0.69)Statutory (incl Time in Lieu) 23 (105) 128 11.07 (722) (735) 13 7.79 8.80 1.01Sick Leave (43) (57) 15 4.41 6.04 (342) (496) 154 4.46 5.97 1.52Training (incl CME)/ Study Lv (59) (50) (9) 6.93 5.18 (522) (429) (93) 6.37 5.10 (1.26)Sub Total (2,696) (2,763) 67 279.72 287.60 (25,648) (24,774) (873) 287.05 292.69 5.65

Allowances (667) (565) (102) (5,485) (4,971) (514)Overtime (97) 0 (97) 8.78 (891) 0 (891) 8.54 (8.54)Penal (0) (30) 30 (72) (261) 189ACC Levy (15) (15) (0) (137) (130) (7) 0.06 (0.06)Continuing Med Education (58) (86) 28 (623) (758) 135Gratuities 0 0 0 (91) 0 (91)Superannuation (138) (130) (8) (1,146) (1,141) (5)Other benefits / costs (215) (145) (70) (1,776) (1,299) (476)Total Medical Salaries (3,886) (3,734) (152) 288.50 287.60 (35,869) (33,334) (2,534) 295.65 292.69 (2.95) Provisioning has now been taken for the unsettled ASMS (senior doctors collective); an amount of $533k YTD has been provided. The YTD result also includes provisions of around $850k for job sizing that is yet to be finalised. The table above is sub totalled showing the various components that need to be viewed together for analysis purposes. The job size impact however could be removed as it is not related to the daily management of time from the current budgets perspective. With this removed, the YTD variance becomes unfavourable by $23k which does not correlate with the FTE being under budget by 5.65. Generally, higher than planned salary rates will cause this variation. The annual leave accruals also does not equate to the FTE under budget, if wage rates have increased, there is a flow on impact against outstanding leave, the budget attempts to calculate this impact. The budgetary phasing of annual leave can be problematic, assumptions are made with respect to the amount of leave taken at given periods, and often this will vary from that actually taken. Other significant unfavourable variance is occurring with allowance and overtime/penalty type payments. As previously reported, the overtime includes penal payments and allowances paid in the RMO area where breaches are made in terms of the run category hours or where cross cover type payments are made to fill gaps in the rosters. Variances occur as budgets set on an expectation of a compliant roster. Some additional allowances being paid to SMO’s were in fact missed from the budgeting process, these payments include allowances for Orthopaedic ACC work / Radiology screen reads that are now around $140k over budget. Professional membership costs (shown in other benefits) are another cost considerably over budget. ($276k YTD) The table below breaks the variance into categories.

Area $'000

Month Actual $'000

Month Budget $'000

Month Variance

$'000

MonthFTE

Actual

MonthFTE

BudgetYTD Actual

$'000

YTD Budget $'000

YTD Variance

$'000

YTDFTE

Actual

YTDFTE

Budget

YTDFTE

VarianceSpecialist Medical Officer (2,121) (1,863) (258) 110.28 108.93 (18,347) (17,013) (1,334) 112.52 114.16 1.64Joint Clinical Medical (239) (251) 11 11.40 10.80 (2,379) (2,223) (155) 11.12 10.67 (0.46)Registrars (967) (1,039) 72 119.66 115.81 (9,595) (9,001) (594) 120.24 115.81 (4.43)House Officers (285) (349) 64 47.16 52.06 (3,149) (3,040) (109) 51.77 52.06 0.29Other benefits / costs (273) (232) (42) (2,399) (2,057) (342)Total Medical Salaries (3,886) (3,734) (152) 288.50 287.60 (35,869) (33,334) (2,534) 295.65 292.69 (2.95) The above FTE and $’s include non budgeted Lab staff costs which are cost neutral due to funding from CTA, the balance recovered from SCLOS. Currently this includes $257k YTD for the 4 RMO’s and $309k YTD for 0.5FTE Joint Clinical and 0.7FTE SMO’s.


7

Nursing Salaries Nursing salaries has an unfavourable variance of $400k for the month. The following table provides the breakdown of the variance by area: Area $'000 Month

Actual $'000

Month Budget $'000

Month Variance

$'000

MonthFTE

Actual

MonthFTE

Budget

YTD Actual $'000

YTD Budget $'000

YTD Variance

$'000

YTDFTE

Actual

YTDFTE

Budget

YTDFTE

VarianceOrdinary (3,557) (3,588) 31 815.24 802.46 (30,756) (31,358) 602 796.47 809.15 12.68Back-pays 209 0 209 (130) 0 (130)Accident Leave (13) 0 (13) 3.37 (117) 0 (117) 3.16 (3.16)Annual Leave Accrued (579) (441) (139) 64.41 78.78 (3,966) (4,579) 613 84.13 98.74 14.61Long Service Leave (4) 0 (4) 0.60 (53) 0 (53) 0.75 (0.75)Other Leave (20) 0 (20) 3.92 (106) 0 (106) 2.59 (2.59)Sick Leave (161) (162) 1 33.72 36.02 (1,246) (1,362) 115 32.37 35.03 2.66Statutory (incl Time in Lieu) (177) (155) (22) 31.32 34.48 (1,402) (1,035) (367) 34.57 26.31 (8.26)Training (incl CME)/ Study Lve (81) (77) (4) 18.28 16.50 (540) (645) 105 13.47 16.07 2.60Sub Total (4,384) (4,422) 38 970.86 968.24 (38,317) (38,979) 662 967.51 985.30 17.79

Allowances (672) (576) (96) (4,759) (4,904) 145 0.01 (0.01)Overtime (147) (13) (135) 18.08 2.92 (917) (111) (805) 13.41 2.92 (10.49)Penal (19) (93) 74 (511) (631) 120ACC Levy (33) (36) 3 (292) (311) 19Gratuities (17) 0 (17) (228) 0 (228)Superannuation (21) (19) (2) (198) (168) (30) 0.01 (0.01)Other Benefits / Costs (85) (39) (45) (515) (349) (167)Total Nursing Salaries (5,378) (5,198) (180) 988.94 971.16 (45,738) (45,454) (285) 980.93 988.22 7.29 The favourable monthly variance of $38k is a close correlation to the FTE variance; however there are some large variances within this due to the following;

• Reversal of the PTR back-pay accrual offset partially by the accrual for the NMW (Nursing Midwife) collective that expired 31 December 2006 (accrued at 2.1%)

• Increase in annual leave entitlement for staff on 3 weeks annual leave. • Favourable variance in rates due to fluctuations in unpaid day’s accrual. As per last

months report this is a timing difference, in this case negating the prior month’s unfavourable variance caused by this.

YTD the overall nursing variance is unfavourable to budget by $285k. Within this, the sub category of ordinary hours and leave has a favourable variance of $662k that is a reasonable correlation with the under budget FTE of 17.79. Offsetting this is higher than planned overtime. However as previously reported the budgetary provision between overtime and penal payments is a little light. Within the overall nursing result, health care assistants continue to be 13 FTE and $428k over budget. Lab nursing staff employed until 7 August distorts the result by around $148k compared to the budget in this area. Allied Health FTE were under budget for the month by 1.3 FTE. The favourable variance in costs of $19k is due mainly to;

• Reversal of PTR back-pay accrual offset by • Increase in annual leave entitlement for staff on 3 weeks annual leave, • Overtime over budget continuing ytd trend and • Professional fees over budget (ytd under budget however)

YTD, salary costs are $829k and 10 FTE under budget. On a YTD basis, the Allied category includes additional laboratory staff costs of $226 (12 FTE from July to 7 August) for which no budget existed. Other distortions include the impact of the MRT strike which resulted in less salary cost & FTE.


8

Sick leave, overtime and allowances are unfavourable by $318k YTD. The overtime impact of $178k continues to reflect the level of vacancies. Support Salaries FTE for this group of staff remains under budget both monthly and YTD by approx 6FTE, resulting in favourable cost variances to budget. Management Administration On a YTD basis both FTE and costs are under budget driven by the restructuring of the executive staff and vacancies in admin staff across a number of areas. As a large % of these staff are in the top pay bracket, the variance both monthly and YTD is driven by rate differentials to budget as well as the FTE variance.

Area $'000

Month Actual $'000

Month Budget $'000

Month Variance

$'000

MonthFTE

Actual

MonthFTE

BudgetYTD Actual

$'000YTD Budget

$'000

YTD Variance

$'000

YTDFTE

Actual

YTDFTE

Budget

YTDFTE

VarianceOrdinary (1,436) (1,463) 26 369.40 361.76 (12,232) (13,065) 833 357.23 367.41 10.18Back-pays (7) (7) (235) (235)Annual Leave Accrued (191) (120) (71) 21.62 28.19 (1,294) (1,371) 77 33.12 35.43 2.32Long Service Leave (3) (3) 0.79 (18) (18) 0.23 (0.23)Other Leave (3) (3) 1.05 (35) (35) 1.05 (1.05)Sick Leave (34) (41) 7 10.24 10.04 (309) (353) 45 10.09 9.90 (0.19)Statutory (incl Time in Lieu) 5 (71) 77 0.46 17.65 (429) (484) 55 12.15 13.66 1.51Training (incl CME)/ Study Lve (9) (15) 6 1.70 2.37 (55) (134) 79 1.33 2.34 1.01Sub Total (1,678) (1,710) 32 405.26 420.01 (14,605) (15,407) 802 415.20 428.74 13.54

Allowances (33) (26) (7) (327) (226) (101)Overtime (9) (2) (7) 1.83 0.43 (53) (18) (35) 1.41 0.42 (0.98)Penal 1 (3) 4 (13) (31) 18ACC Levy (11) (12) 1 (97) (106) 9Gratuities (33) (33)Superannuation (9) (9) 0 (77) (79) 2Other Benefits / Costs (32) (25) (7) (230) (221) (9)Total Management / Admin Salaries (1,770) (1,787) 17 407.09 420.44 (15,435) (16,089) 654 416.60 429.16 12.56


9

Expenditure Outsourced Outsourced costs are $405 over budget YTD. Costs (variance to budget) associated with the Laboratory until 6 August in this categories amounted to $192k unfavourable, so when removed for analysis purposes the true operating variance is $213k or 6.2% unfavourable compared against the YTD budget. The large monthly variance of $124k is due to Ophthalmology clinic invoicing (clinics previously performed by staff member so partial offset against salary) and old invoices paid to SDHB for Radiology services. The YTD overspend is driven by additional radiology services (MRT strike), outsourced maintenance staff (offsetting reduced FTE costs) and lithotripsy costs. There is a partial offset against savings from the IT Helpdesk which has now been brought in-house. Clinical Supplies In total this budget is under spent by $1,520k with a $82k favourable variance occurring in March. The YTD result includes $263k of lab costs incurred to 6 August, so again the true operating costs could be viewed as being $1,783k or 5.1% favourable to the YTD budget. The most significant YTD non-lab costs are:

• Blood products costs, $466k unfavourable • Catheters, $139k unfavourable • Equipment depreciation, $102k unfavourable • Equipment lease costs, $658k favourable • Service contracts, $788k favourable • Prothesis costs (mainly OI related & Pacemakers), $556k favourable • Pharmaceutical costs, $586k favourable • Shunts & Stents, $171k unfavourable

The high Blood product costs relate to a particular patient event, over $300k of cost was incurred in October with funding reimbursement received from the national haemophilia pool; this is shown in the Other Government category and was received in November. Catheters have become a major ytd variance this month due to a large monthly unfavourable variance. The number of stents (costs in Catheter code) inserted in March was 96 against a YTD average of 72. Number of stents inserted per patient in March was 1.95 against a YTD average of 1.8 The variations between equipment depreciation and lease costs are related. Items that should be classified as finance leases are now treated as such on a monthly basis rather than being adjusted at year end. The budget however was set showing the costs as an operating lease. Between the two categories the total is underspent and this is partly attributable to medical imaging equipment. Related to this are the service contract costs; these contribute favourably another $788k to the total variance. The majority of this resulted from the renegotiated contract with Phillips for the majority of Radiology Equipment. The favourable prothesis cost variance is around $522k of which $373k relates to Hips and Knees Prosthesis being under budget due primarily to the under delivery of the Joint Orthopaedic Initiative (JOI). This is offset by reduced revenue however both are expected to increase to budget by year end as additional lists have been planned both on Saturdays and during the week.


10

Shunts and stents also have an unfavourable variance of $183k. This overrun is in 2 areas mainly;

• Cardiology - more stents are deployed per patient due to an increase in drug eluting stents.

• General Surgery – due to an increase in the number of endoluminal stents over budget.

Pharmaceuticals are favourable by $521k. This is continued to be driven by the Pharmacy Production Unit ($394k) which is approximately offsetting the reduced revenue of $374k (Southland District Health Board $500k). Other areas also have considerable cost variations, unfavourable is Oncology & Haematology Services ($143k), while some favourable variances include Main Operating Theatre $41k and ICU $76k. Additionally, in November a rebate was received for the community hospital dispensed drugs, this amounted to $208k. Infrastructure & Non Clinical Supplies The total variance is favourable to budget by $2.7m. There is only a minor lab cost distortion of $60k within this total. The favourable cost variance is driven by information systems cost reductions, a favourable capital charge recalculation and partially offset by high legal fees. Hotel service costs are $365k favourable to budget for the year with $139k relating to patient meal costs, $103k relating to cleaning and $128k lower laundry costs. Facilities costs are $196k under budget for the year. Building insurance costs are considerably lower than planned at $133k with savings being achieved by the national placement. Electricity costs are $142k under budget and maintenance costs are $189k over budget YTD driven by a monthly unfavourable variance in outsourced maintenance of $326k. (due to an accrual of $400k made in March for a number of deferred maintenance projects including kitchen floor, hot water pipes and concrete spalling). Gas costs are $106k unfavourable (partially offset by delivery rebate in revenue) and steam costs are $62k favourable. IT systems and Telecommunication costs are $2.6m below budget. Within this, IS equipment costs are below budget by $563k. Leased equipment is now treated on a monthly basis as finance leases and assets are capitalised with the equivalent lease costs charged as depreciation. Improved processes have been put in place with respect to leasing schedules. IT/IS maintenance fees are below budget by $1.95m. Previously paid contract expenses are no longer incurred and cost savings of around $250k per month are being captured via this category. Other telecommunication costs (data, line rental, calls) are a close alignment to budget being underspent by $1k YTD. Interest and Financing costs are under budget by $694k YTD. In November a sizeable credit was received on capital charges as a wash-up was completed on the opening 2005/06 and closing equity position for the prior financial year. Currently professional fees & expenses are $669k over budget. High legal fees are being incurred as part of the IS transaction investigation. No potential cost recovery has been factored to the accounts.


11

Mental Health Component The mental health ringfence component is calculated from net surplus or deficit “underspend” within the funder-arm results. From a provider aspect, the mental health result is expected to break-even over time. However variations of funded FTE compared to actual numbers employed, if significantly different can lead to potential funding “washup” between the mental health funder and provider. If positions are unfilled but funded it could reasonably be expected that a “surplus” will result that should be clawed back and go into the calculation of underspend to carry into the next financial year. On the other hand if the mental health provider is showing a budgeted deficit, then the expectation is that the provider and funder will agree how to manage the shortfall. The table below shows a summary of the mental health result YTD and the appendices include the detailed financial performance statement for mental health. Mental Health (budget as per DAP)

AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

2,855 3,158 (303) Revenue 26,042 28,424 (2,382) 37,899(1,852) (2,345) 493 Less Personnel Costs (18,029) (21,101) 3,072 (28,135)

(332) (335) 3 Less Other Costs (2,682) (3,015) 333 (4,020)671 478 193 Contribution Margin 5,331 4,308 1,023 5,744

(540) (555) 15 Overhead Allocation (4,922) (4,996) 74 (6,661)131 (77) 208 Net Surplus / (Deficit) 409 (688) 1,097 (917)

Month Year to Date

The differences between the salaries and revenue when comparing to the actuals and the way the annual budget was set involve subsequent clarification over services that often are blurred between DSS and Mental Health. This confusion created an annual budget view of a projected deficit that will not materialise from a mental health aspect. A restatement of the budget removing DSS items shows the following result; Mental Health (budget excl DSS)

AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

2,855 2,886 (31) Revenue 26,042 25,905 137 34,563(1,852) (2,171) 319 Less Personnel Costs (18,029) (18,952) 923 (25,385)

(332) (317) (15) Less Other Costs (2,682) (2,807) 125 (3,749)671 398 273 Contribution Margin 5,331 4,146 1,185 5,429

(540) (545) 5 Overhead Allocation (4,922) (4,896) (26) (6,532)131 (147) 278 Net Surplus / (Deficit) 409 (750) 1,159 (1,103)

Month Year to Date

This highlights the favourable Mental Health personnel costs driven by vacancies.


12

Capital Commitments

Capital Budget as at 31 March 2007 2006/07 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12$000's $000's $000's $000's $000's $000's $000's

Budgeted Capital Spend 2006/07 10,812 10,812

less Capitalised / WIP (Includes capitalised leased assets 975K) 6,129 less Committed YTD 12,533

Total Committed + Spent + Capitalised 18,662 18,662less gross value of leased capital (9,469)plus lease payment 482 1,927 1,927 1,927 1,927 1,445plus computer lease payments 237 345 317 138Capital Available (7,850) 900 (2,272) (2,244) (2,065) (1,927) (1,445)

Major Committed / Purchased Items

To be Leased : CapitalVarian Linac iX (incl building upgrade) 4,227 250 1,000 1,000 1,000 1,000 750Digital mammography equipment 2,619 131 524 524 524 524 393Siemens 64 Slice CTScanner 1,648 101 403 403 403 403 302

8,494 482 1,927 1,927 1,927 1,927 1,445To be Purchased :Relocation Breast Care Serv-Blng Fitout Portion 367Lab Redevelopment - Fitout portion 529Philips EasyRIS(software & implementation) 442Oncology Grnd Floor Building Fitout 374Digital mammography equipment 188Mobile Breastscreening Trailer Unit 109Radiology CT Scanner-Blng Fitout 149CSB Fire Alarm Upgrade 126Sleep Diagnostic Equipment 76Kodak Miniloader Developer 59Radiology Conference room - Fitout 228Holter Monitoring System 67Siemens Antares Ultrasound Machines (2) 419

3,133

Cash Timing

Finance Lease Payments

The above table shows two aspects, one the gross capital commitments and expenditure and the other view is the actual cash timing of the capital based on a finance leasing strategy for key items. Cash timing When the timing of lease payments is considered, the current year’s capital budget has a residual balance available of $900k. The Y.E forecast indicates a further $1.5m of expenditure in the last 3 months resulting in a overspend of $600k. The impact and commitment of leasing is shown in the out-years and this will be incorporated into planning for the 2007/08 District Annual Plan (DAP). Capital affordability continues to be a significant issue and is one of a number of key issues forming part of the 2007/08 DAP planning. Minor Capital Purchases The RCFO has reviewed the capex policy and has raised the Otago DHB limit at which a purchase is classified as a capital from $200 to $500. This recognises;

• the inefficiencies of having the limit set at $200 given the high approval / processing cost of each capital item.

• the alignment of Otago DHB policy with Southland DHB under the Southern Alliance. We have reviewed the 07/08 budget, including additional operational cost for these minor purchases, decreasing the capital budget accordingly. There will be no restatement of items currently on the asset register.


13

Provider Forecast The forecast has not been restated this month; however the table below has been updated for March07 year to date actuals and budget.

Year-to-Date Annual Annual Forecast Last 3 MthsActual Budget Variance Budget Forecast variance Forecast Budget Variance

$'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000 $'000REVENUE

MoH - Personal Health 3,277 3,952 (675) (0)

(309) (413) (105)

(17)

(12) (2)(183) (217) (34)

(22)(165)

5,492 5,492 2,214 1,540 674 MoH - Mental Health 256 0 256 0 298 298 42 0 42 MoH - Public Health 4,717 4,163 554 5,549 6,214 665 1,497 1,386 112 MoH - Disability Support Services 4,542 4,851 6,468 6,055 1,513 1,617 MoH - Maori Health 0 0 0 0 0 0 0 0 0 Clinical Training Agency 3,275 3,124 151 4,173 4,307 134 1,032 1,049 Inter District Flows 0 0 0 0 0 0 0 0 0 Training Fees and Subsidies 77 89 111 109 31 22 10 Accident Insurance 4,602 4,785 6,388 6,171 1,570 1,603 Other Government 3,186 2,801 384 3,739 4,101 362 916 938 Patient/Consumer Sourced 1,320 827 493 1,108 1,436 328 116 281 Other Income 4,503 3,253 1,250 4,361 5,707 1,346 1,204 1,108 97 InterProvider Revenue (Other DHB's) 1,347 1,308 39 1,744 1,858 114 510 436 74 Internal Revenue (DHB Fund to DHB Pr 160,923 159,584 1,339 212,776 214,178 1,402 53,255 53,192 63Total Revenue 192,026 188,738 3,289 251,909 255,927 4,018 63,900 63,171 729

EXPENDITURE

Personnel Expenses Medical Personnel Nursing Personnel 141 426 Allied Health Personnel 829 1,208 379 Support Services Personnel 248 354 106 Management / Administration Personn

(35,869) (33,334) (2,534) (44,454) (48,181) (3,727) (12,313) (11,120) (1,193)(45,738) (45,454) (285) (60,866) (60,724) (14,986) (15,412)(18,652) (19,481) (25,986) (24,778) (6,126) (6,505)(3,830) (4,077) (5,418) (5,064) (1,234) (1,340)

e (15,435) (16,089) (21,398) (20,361) (4,926) (5,309)(119,524) (118,435) (1,089) (158,121) (159,109) (988) (39,585) (39,686)

(810) (781) (29) (1,055) (994) (184) (274)(19) (9) (10) (12) (25) (13) (6) (3) (3)(75) (74) (2) (98) (97) (22) (25)(87) (5) (82) (7) (109) (102) (21) (2) (19)

654 1,036 383Total Personnel Costs 101

Outsourced Expenses Outsourced Medical 61 91 Outsourced Nursing Outsourced Allied Health 1 2 Outsourced Support Services Outsourced Management/Administratio (218) (339) (452) (248) (30) (113)

(2,071) (1,651) (420) (2,199) (2,597) (398) (526) (548)121 204 83

Outsourced Clinical Services 22 Outsourced Corporate / Governance Se (557) (574) (765) (743) (186) (191)

(3,838) (3,433) (405) (4,588) (4,813) (225) (975) (1,155)

(12,348) (11,812) (536) (16,067) (16,348) (281) (3,999) (4,255)

17 22 5 Outsourced Funder Services 0 0 0 0 0 0 0 0 0Total Outsourced Services 180

Clinical Supplies Treatment Disposables 256 Diagnostic Supplies & Other Clinical Su (1,241) (1,163) (78) (1,582) (1,664) (82) (423) (419) (4)

(5,885) (7,257) (9,676) (8,466) (2,582) (2,419) (162)(1,106) (939) (167) (1,277) (1,442) (165) (336) (338)(3,769) (4,155) (5,593) (5,793) (200) (2,024) (1,438) (585)(8,316) (8,902) (12,109) (11,397) (3,081) (3,207)

(771) (728) (43) (971) (1,079) (108) (308) (243) (65)(33,435) (34,955) (47,275) (46,188) (12,752) (12,320) (432)

(5,594) (5,960) (7,942) (7,449) (1,855) (1,982)(8,072) (8,268) (11,021) (10,921) (2,849) (2,753) (96)(1,605) (1,539) (67) (2,050) (2,127) (77) (522) (511) (11)(4,708) (7,300) (9,728) (6,386) (1,677) (2,428)(5,044) (5,739) (7,703) (6,891) (1,846) (1,964)(1,307) (638) (669) (850) (1,915) (1,065) (608) (212) (396)(1,983) (1,944) (39) (2,590) (2,751) (161) (767) (646) (121)

(375) (486) (111)

Instruments & Equipment 1,372 1,210 Patient Appliances 2 Implants & Prosthesis 386 Pharmaceuticals 586 712 126 Other Clinical SuppliesTotal Clinical Supplies 1,520 1,087

Infrastructure & Non Clinical Expenses Hotel Services, Laundry & Cleaning 365 493 127 Facilities 196 100 Transport IT Systems & Telecommunications 2,591 3,342 751 Interest & Financing Charges 694 812 118 Professional Fees & Expenses Other Operating Expenses Democracy 0 375 486 0 0 111 Subsidiaries & Joint Ventures 0 0 0 0 0 0 0 0 0Total Infrastructure & Non-Clinical Supp (28,314) (31,012) (41,398) (38,439) (10,125) (10,386)

(431) (431) (575) (575) (144) (144)

(185,542) (188,265) (251,957) (249,124) (63,581) (63,691)

(48) (520)

2,697 2,959 261

Internal Allocations 0 0 0

Total Expenses 2,723 2,833 110

Net Surplus / (Deficit) 6,484 472 6,011 6,803 6,851 319 839


14

Key assumptions include:

• No further FTE savings from restructuring • Reversal of unutilised restructuring provision of $870k • Reversal of PSA settlement costs accrued, benefit of over $600k, future cost impact

still being assessed • Staff vacancies continue at same levels. • IS transactions avoided resulting in savings of over $3m • Legal costs factored at nearly $1m with no cost recovery factored • Volume targets met, OI volumes to be met by year end. • Favourable capital charge wash-up of $600k factored • Capital purchasing leasing over budget by $1.3m, cost impact $482k of leasing • No major impact of year end employee entitlement assessments

5. Financial Statements

The financial statements follow.


15

Otago District Health BoardAnnual

Part 1: DHB Consolidated Actual Budget Variance Variance Actual Budget Variance Varaince Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 1.1: Statement of Financial Performance

REVENUEGovernment and Crown Agency sourcedMoH

MoH - Vote Health - - (0) U 0% - - (0) U 0% - Vote Health MoH Mental Health 3,922 3,902 20 F 1% 35,331 35,121 210 F 1% 46,828 Vote health MoH non Mental Health 25,180 27,578 (2,398) U (9%) 248,152 248,200 (48) U (0%) 332,533 PBF Adjustments - - (0) U 0% - - (0) U 0% - MoH Funding Subcontracts - - (0) U 0% - - (0) U 0% - MoH - Personal Health 812 536 276 F 51% 3,907 3,952 (45) U (1%) 5,491 MoH - Mental Health 14 - 14 F 0% 406 - 406 F 0% - MoH - Public Health 493 463 30 F 6% 4,682 4,163 518 F 12% 5,549 MoH - Disability Support Services 506 539 (33) U (6%) 4,542 4,851 (309) U (6%) 6,468 Clinical Training Agency 358 350 9 F 2% 3,275 3,124 151 F 5% 4,173

MoH Total 31,284 33,368 (2,084) U (6%) 300,295 299,410 885 F 0% 401,042

Other Government IDF's - Mental Health Services 349 349 (0) U 0% 3,142 3,142 (0) U 0% 4,190 IDF's - All others (non Mental health) 2,878 2,881 (3) U (0%) 25,903 25,931 (28) U (0%) 34,575 Other DHB's 147 145 2 F 1% 1,347 1,308 39 F 3% 1,744 Training Fees and Subsidies 5 7 (2) U (32%) 77 89 (12) U (14%) 111 Accident Insurance 487 539 (52) U (10%) 4,602 4,785 (183) U (4%) 6,388 Other Government 337 323 14 F 4% 3,186 2,801 384 F 14% 3,739

Government and Crown Agency sourced Total 4,204 4,245 (41) U (1%) 38,258 38,057 200 F 1% 50,748

Other RevenuePatient / Consumer sourced 200 98 102 F 104% 1,320 827 493 F 60% 1,108 Other Income 611 438 173 F 40% 5,306 3,872 1,434 F 37% 5,186

Other Revenue Total 811 536 276 F 51% 6,627 4,699 1,927 F 41% 6,294

REVENUE TOTAL 36,300 38,149 (1,849) U (5%) 345,179 342,167 3,012 F 1% 458,084

EXPENSESPersonnel costs

Medical Personnel (3,881) (3,739) (142) U (4%) (35,903) (33,386) (2,517) U (8%) (44,522) Nursing Personnel (5,381) (5,198) (183) U (4%) (45,760) (45,454) (307) U (1%) (60,866) Allied Health Personnel (2,165) (2,184) 19 F 1% (18,652) (19,481) 829 F 4% (25,986) Support Personnel (433) (455) 23 F 5% (3,830) (4,073) 244 F 6% (5,427) Management/Administration Personnel (1,955) (1,922) (33) U (2%) (16,644) (17,292) 648 F 4% (23,000)

Personnel costs Total (13,815) (13,499) (316) U (2%) (120,789) (119,685) (1,104) U (1%) (159,800)

Outsourced ServicesMedical Personnel (159) (92) (67) U (73%) (810) (784) (26) U (3%) (1,059) Nursing Personnel (2) (1) (1) U (131%) (19) (9) (10) U (108%) (12) Allied Health Personnel (10) (8) (2) U (25%) (75) (74) (2) U (3%) (98) Management/Administration Personnel (15) (1) (14) U (2,493%) (87) (5) (82) U (1,643%) (7) Outsourced Clinical Services (34) (40) 6 F 15% (232) (357) 124 F 35% (475) Outsourced Corporate/Governance Services (233) (186) (47) U (25%) (2,071) (1,651) (420) U (25%) (2,199) Outsourced Funder Services (62) (65) 3 F 5% (557) (574) 17 F 3% (765) DHB Governance & Admin (s/b zero) (30) (29) (1) U (3%) (285) (253) (32) U (13%) (337)

Outsourced Services Total (545) (422) (123) U (29%) (4,137) (3,706) (431) U (12%) (4,953)

Clinical SuppliesTreatment Disposables (1,625) (1,427) (198) U (14%) (12,348) (11,812) (536) U (5%) (16,067) Diagnostic Supplies & Other Clinical Supplies (97) (140) 44 F 31% (1,241) (1,163) (78) U (7%) (1,582) Instruments & Equipment (670) (806) 137 F 17% (5,885) (7,257) 1,372 F 19% (9,676) Patient Appliances (112) (113) 1 F 1% (1,106) (939) (167) U (18%) (1,277) Implants and Prostheses (469) (515) 46 F 9% (3,769) (4,155) 386 F 9% (5,593) Pharmaceuticals (1,010) (1,075) 66 F 6% (8,316) (8,902) 586 F 7% (12,109) Other Clinical & Client Costs (94) (81) (13) U (17%) (771) (728) (43) U (6%) (971)

Clinical Supplies Total (4,076) (4,159) 82 F 2% (33,435) (34,955) 1,520 F 4% (47,274)

Infrastructure & Non-Clinical SuppliesHotel Services, Laundry & Cleaning (648) (671) 23 F 3% (5,603) (5,968) 366 F 6% (7,953) Facilities (1,173) (911) (262) U (29%) (8,072) (8,268) 196 F 2% (11,021) Transport (203) (185) (19) U (10%) (1,722) (1,643) (79) U (5%) (2,189) IT Systems & Telecommunications (490) (823) 333 F 40% (4,751) (7,337) 2,586 F 35% (9,778) Interest & Financing Charges (707) (671) (36) U (5%) (5,491) (5,976) 485 F 8% (7,953) Professional Fees & Expenses (80) (91) 11 F 12% (1,811) (812) (999) U (123%) (1,081) Other Operating Expenses (216) (236) 20 F 8% (2,098) (2,098) (0) U (0%) (2,795) Democracy (32) 8 (40) U (501%) (285) 74 (359) U (486%) 85 Subsidiaries, Joint Ventures & Minority Interests - - 0 F (0%) - - 0 F (0%) -

Infrastructure & Non-Clinical Supplies Total (3,549) (3,579) 30 F 1% (29,833) (32,028) 2,195 F 7% (42,687)

Payments to ProvidersChild and Youth (32) (26) (6) U (23%) (226) (239) 12 F 5% (318) Laboratory (1,659) (1,559) (99) U (6%) (13,866) (14,334) 468 F 3% (19,012) Maternity (208) (112) (96) U (86%) (1,223) (1,004) (219) U (22%) (1,339) Maternity (Tertiary & Secondary) - (0) 0 F 100% (6) (1) (5) U (1,069%) (1) Pregnancy and Parenting Education (2) (5) 3 F 59% (32) (41) 9 F 23% (54) Neo Natal - - 0 F (0%) - - 0 F (0%) - Sexual Health - (15) 15 F 100% - (132) 132 F 100% (176) Adolescent Dental Benefit (110) (103) (7) U (7%) (914) (930) 16 F 2% (1,240) Other Dental Services (23) - (23) U (0%) (201) - (201) U (0%) -

March 2007

Current Month Year to Date

Page 1



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Dental - Low Income Adult (201) (213) 12 F 6% (1,580) (1,917) 337 F 18% (2,556) Child (School) Dental Services - - 0 F (0%) - - 0 F (0%) - Pharmaceuticals (3,394) (3,347) (48) U (1%) (34,432) (30,861) (3,571) U (12%) (40,971) Management Referred Services - (2) 2 F 100% - (14) 14 F 100% (19) Population Based Services - - 0 F (0%) (37) - (37) U (0%) - General Medical Subsidy (93) (133) 39 F 30% (952) (1,274) 322 F 25% (1,609) Primary Practice Services - Capitated (1,687) (1,641) (46) U (3%) (15,350) (14,769) (581) U (4%) (19,692) Practice Nurse Subsidy (13) (54) 41 F 76% (153) (487) 334 F 69% (649) Rural Support for Primary Health Pro (289) (258) (32) U (12%) (2,658) (2,318) (340) U (15%) (3,090) Immunisation (124) (131) 7 F 5% (177) (276) 99 F 36% (617) Radiology (89) (113) 24 F 21% (822) (835) 14 F 2% (1,122) Other Community Based Services - - 0 F (0%) 15 - 15 F (0%) - Palliative Care (89) (133) 45 F 33% (1,060) (1,201) 142 F 12% (1,602) Meals on Wheels (14) (16) 1 F 9% (180) (143) (37) U (26%) (190) Domicilary & District Nursing (262) (325) 63 F 19% (2,527) (2,923) 396 F 14% (3,897) Community based Allied Health (18) - (18) U (0%) (162) - (162) U (0%) - Chronic Disease Management and Educa (648) (646) (2) U (0%) (5,830) (5,812) (18) U (0%) (7,749) Medical Inpatients (92) (135) 43 F 32% (829) (1,218) 388 F 32% (1,624) Medical Outpatients - 0 (0) U 100% - (0) 0 F 100% 0 Surgical Inpatients (56) (66) 10 F 16% (502) (596) 94 F 16% (794) Surgical Outpatients - - 0 F (0%) (37) - (37) U (0%) - Paediatric Inpatients (63) (98) 34 F 35% (580) (881) 301 F 34% (1,174) Paediatric Outpatients (69) (78) 9 F 12% (479) (699) 220 F 31% (932) Pacific Peoples' Health (89) (54) (35) U (64%) (748) (489) (259) U (53%) (653) Emergency Services (216) (96) (120) U (126%) (861) (860) (1) U (0%) (1,147) Minor Personal Health Expenditure (1,387) (1,113) (274) U (25%) (10,112) (10,015) (96) U (1%) (13,854)

Personal TOTAL (10,928) (10,469) (458) U (4%) (96,521) (94,268) (2,252) U (2%) (126,081)

Mental HealthMental Health to allocate - - 0 F (0%) - - 0 F (0%) (2,254) Acute Mental Health Inpatients - - 0 F (0%) - - 0 F (0%) - Sub-Acute & Long Term Mental Health - - 0 F (0%) - - 0 F (0%) - Crisis Respite (12) (18) 6 F 34% (133) (159) 25 F 16% (212) Alcohol & Other Drugs - General (107) (58) (50) U (86%) (559) (519) (40) U (8%) (691) Alcohol & Other Drugs - Child & Yout (59) (57) (2) U (3%) (501) (511) 9 F 2% (681) Methadone - - 0 F (0%) - - 0 F (0%) - Child & Youth Mental Health Services (57) (60) 3 F 6% (541) (543) 3 F 0% (725) Forensic Services - (2) 2 F 100% - (16) 16 F 100% (22) Kaupapa Maori Mental Health Services - - 0 F (0%) - - 0 F (0%) - Kaupapa Maori Mental Health - Inpati - - 0 F (0%) - - 0 F (0%) - Mental Health Community Services (73) (34) (40) U (117%) (494) (305) (190) U (62%) (406) Prison/Court Liaison - - 0 F (0%) - - 0 F (0%) - Mental Health Workforce Development (13) (3) (11) U (412%) (39) (24) (15) U (66%) (31) Day Activity & Work Rehabilitation S (65) (70) 6 F 8% (656) (632) (23) U (4%) (843) Advocacy / Peer Support - Consumer (76) (35) (41) U (119%) (536) (313) (223) U (71%) (418) Other Home Based Residential Support (2) (1) (1) U (77%) (7) (10) 2 F 23% (13) Advocacy / Peer Support - Families a (0) (0) (0) U (2%) (4) (4) (0) U (1%) (5) Community Residential Beds & Service (434) (993) 559 F 56% (3,932) (5,938) 2,006 F 34% (8,917) Minor Mental Health Expenditure (0) (11) 11 F 98% (42) (100) 58 F 58% (132) Inter District Flow Mental Health - (375) (375) 0 F (0%) (3,374) (3,374) 0 F (0%) (4,499)

Mental Health Total (1,274) (1,716) 443 F 26% (10,819) (12,448) 1,629 F 13% (19,849)

Public HealthCommunicable Diseases (1) - (1) U (0%) (20) - (20) U (0%) - Physical Environment - - 0 F (0%) (2) - (2) U (0%) - Meningococcal - - 0 F (0%) - - 0 F (0%) -

Public Health Total (1) - (1) U (0%) (22) - (22) U (0%) -

Disability Support ServicesAT & R (Assessment, Treatment and Re (183) (203) 20 F 10% (1,651) (1,831) 180 F 10% (2,441) Information and Advisory (3) (2) (1) U (76%) (4) (16) 12 F 74% (21) Needs Assessment (18) (19) 0 F 2% (163) (167) 4 F 2% (223) Home Support (454) (721) 267 F 37% (6,319) (6,299) (19) U (0%) (8,487) Carer Support (262) (162) (100) U (61%) (2,176) (1,620) (555) U (34%) (2,134) Residential Care: Rest Homes (583) (1,773) 1,190 F 67% (15,354) (15,501) 147 F 1% (20,513) Residential Care: Loans Adjustment 10 - 10 F (0%) 130 - 130 F (0%) - Residential Care: Hospitals (153) (1,730) 1,577 F 91% (12,112) (14,973) 2,861 F 19% (20,133) Ageing in Place (105) (100) (5) U (5%) (801) (901) 99 F 11% (1,201) Environmental Support Services (69) (40) (29) U (73%) (499) (359) (140) U (39%) (479) Day Programmes (12) (22) 10 F 44% (138) (198) 60 F 30% (264) Respite Care (80) (54) (26) U (49%) (427) (482) 56 F 12% (643) Community Health Services & Support (7) (4) (3) U (75%) (19) (38) 19 F 51% (50) Inter District Flow Disability Suppo (174) (174) 0 F (0%) (1,562) (1,562) 0 F (0%) (2,082) Day Programmes 7 - 7 F (0%) (1) - (1) U (0%) - Disability Support Other (53) (13) (41) U (327%) (145) (113) (33) U (29%) (150)

Disability Support Services Total (2,141) (5,015) 2,874 F 57% (41,241) (44,060) 2,819 F 6% (58,823)

Page 2



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Maori HealthMaori Service Development (12) (5) (7) U (136%) (117) (45) (72) U (162%) (59) Maori Provider Assistance Infrastruc - - 0 F (0%) - - 0 F (0%) - Minor Maori Health Expenditure (6) (68) 63 F 91% (40) (614) 574 F 93% (821) Whanau Ora Services (55) - (55) U (0%) (413) - (413) U (0%) -

Maori Health Total (72) (73) 1 F 2% (570) (659) 89 F 14% (880)

Internal Allocation (should be zero) - - 0 F (0%) - - 0 F (0%) -

EXPENSES TOTAL (36,401) (38,933) 2,532 F 7% (337,366) (341,809) 4,442 F 1% (460,346)

NET RESULTS (102) (784) 683 F 87% 7,813 354 7,459 F 2,107% (2,262)

Part 1.1A: Supplemental Information to Statement of Financial PerformanceDepreciation (998) (901) (97) (11%) (5,818) (8,112) 2,295 28% (10,816) Interest costs (245) (223) (22) (10%) (2,014) - (2,014) (0%) - Financing component of Operating Leases (14) - (14) (0%) (135) - (135) (0%) - Capital Charge (466) (421) (45) (0%) (3,319) (3,768) 449 (0%) (5,012) Gain/(Loss) on Disposal of Assets - - - (0%) 82 1 81 (9,541%) - Donations 4 0 4 (0%) 78 1 77 7,300% 1

Page 3



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Part 1.2: Statement of Financial Position

Current Actual $(000)

Previous Month Feb

07Monthly Movemt.

Current Budget $(000)

Annual Budget $(000)

Current AssetsPetty Cash 10 10 - 10 10 Bank Account (1,904) (1,906) 2 4,219 37 Short Term Investments 28,800 28,250 550 - - Short Term Investments - Trusts - - - - - Prepayments 821 972 (151) 3,618 3,618 Accounts Receivable – Control Account 10,488 10,753 (265) 13,379 13,307 Provision for Doubtful Debts (57) (57) - (57) (57) Accrued Debtors 6,892 8,662 (1,770) 17,821 17,821 Inventory / Stock 2,996 2,921 75 3,129 3,129 Provision for Obsolete Stock - - - - Assets Held for Resale 235 235 - -

Current Assets Total 48,281 49,840 (1,559) 42,119 37,865

Non Current AssetsLand, Buildings & Plant 121,659 121,637 22 124,122 125,097 Clinical Equipment 60,901 60,853 48 62,082 63,432 Other Equipment ( incl Finance Leases ) 8,545 8,523 22 15,726 15,876 Information Technology 13,516 13,808 (292) 9,494 9,719 Motor Vehicles 201 201 - 168 168 Trust Properties - - - - - Provision Depreciation – Buildings & Plant (2,985) (2,652) (333) (3,114) (4,152) Provision Depreciation – Clinical Equipment (50,416) (50,021) (395) (53,139) (54,378) Provision Depreciation – Other Equipment (6,892) (6,828) (64) (7,039) (7,220) Provision Depreciation – Information Technology (9,971) (10,114) 143 (8,645) (8,891) Provision Depreciation – Motor Vehicles (164) (163) (1) (159) (160) Provision Depreciation – Trust Properties - - - - - WIP 3,025 2,626 399 1,075 1,075 Investment in Subsidiaries 31 31 - - - Investment in Associates - - - - - Long Term Investments - - - - - Long Term Investments – Trusts - - - - -

Non Current Assets Total 137,450 137,901 (451) 140,571 140,566


Previous Month Feb

07Monthly Movemt.



Current LiabilitiesAccounts Payable Control Account (19,179) (21,994) 2,815 (25,908) (25,945) Accrued Creditors (3,645) (3,693) 48 30 30 Income Received in Advance (113) (113) - (113) (113) Capital Charge Payable (2,232) (1,998) (234) (401) (392) GST & Tax Provisions (account codes: 9530-9550; 962 (1,589) (2,086) 497 (1,995) (1,477) Unclaimed Creditors Monies - - - - - Term Loans – Finance Leases (current portion) (1,618) (1,742) 124 (1,133) (893) Term Loans – Private (current portion) - - - - - Term Loans – Crown (current portion) (102) (102) - (102) (102) Payroll Accrual & Clearing Accounts (excl tax - account (9,626) (8,957) (669) (13,386) (12,515) Employee Entitlement Provisions (16,831) (16,180) (651) (17,355) (17,355)

Current Liabilities Total (54,935) (56,865) 1,930 (60,363) (58,762)

WORKING CAPITAL (6,654) (7,025) 371 (18,244) (20,897)

NET FUNDS EMPLOYED 130,796 130,876 (80) 122,327 119,670

Non-Current LiabilitiesLong Service Leave – Non-current portion (1,252) (1,252) - (1,250) (1,250) Retirement Gratuities – Non-current portion (6,167) (6,167) - (6,068) (6,068) Employee-Entitlement Provisions (705) (705) - - - Term Loans – Finance Leases (non-current portion) (1,644) (1,682) 38 (1,997) (1,997) Term Loans – Private (non-current portion) - - - - - Term Loans – Crown (non-current portion) (49,949) (49,949) - (50,330) (49,644) Custodial Funds (2,199) (2,139) (60) (1,953) (1,953)

Non-Current Liabilities Total (61,916) (61,894) (22) (61,598) (60,912)

Crown EquityCrown Equity (53,244) (53,244) - (53,244) (53,244) Trust and Special Funds (no restricted use) - - - - - Revaluation Reserve (49,593) (49,593) - (49,593) (49,593) Revaluation Reserve – Trust Assets - - - - - Other Reserves (290) (290) - - - Retained Earnings - DHB Governance & Funding Admin 1,428 1,376 52 1,094 1,058 Retained Earnings - DHB Provider 41,095 41,121 (26) 42,896 43,018 Retained Earnings - DHB Funds (8,276) (8,352) 77 (1,882) 4

Crown Equity Total (68,880) (68,982) 102 (60,729) (58,758)

NET FUNDS EMPLOYED (130,796) (130,876) 80 (122,327) (119,670)

Page 4



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Part 1.3: Statement of Movement in EquityCurrent Actual $(000)

Previous Month Feb

07Monthly Movemt.



Total equity at beginning of the period (68,982) (67,666) (1,316) (61,649) (64,766) Net Results for the period 102 (1,316) 1,419 920 6,008 Revaluation of Fixed Assets - - - - - Equity Injections - - - - - Other - - - - - Movement in Trust and Special Funds - - - - - Total Equity at end of the period (68,880) (68,982) 102 (60,729) (58,758)

Part 1.4: Statement of Cashflows

Operating ActivitiesGovernment and Crown Agency Revenue 37,579 37,961 (382) 333,861 322,844 11,018 419,654 Other Revenue Received 811 536 275 6,626 4,700 1,926 15,676

Total Receipts 38,390 38,497 (107) 340,487 327,543 12,944 435,330

Payments for Personnel (12,495) (12,217) (278) (120,854) (115,581) (5,273) (157,179) Payments for Supplies (6,779) (6,016) (763) (55,581) (56,045) 464 (75,639) Interest Paid (317) (204) (113) (2,256) (2,051) (205) (2,900) Capital Charge Paid (232) (409) 177 (1,351) (3,624) 2,273 (4,638) GST (Net) & Tax (495) (240) (255) (556) (423) (133) (826) Payment to own DHB Provider (Eliminated) - - - - - - - Payment to own DHB Governance & Funding Admin - - - - - - - Payments to other DHB’s (1,936) (1,660) (276) (15,053) (14,951) (102) (19,935) Payments to Providers (14,811) (14,567) (244) (134,735) (123,019) (11,716) (186,555)

Total Payments (37,065) (35,313) (1,752) (330,386) (315,694) (14,692) (447,671) -

Net Cashflow from Operating 1,325 3,184 (1,859) 10,101 11,849 (1,748) (12,341)

Investing ActivitiesSale of Fixed Assets - - - - - - - Decrease in Investments and Restricted &Trust Funds A - - - - - - -

Capital ExpenditureLand, Buildings & Plant (545) (325) (220) (2,950) (2,600) (350) (3,575) Clinical Equipment (51) (450) 399 (1,880) (3,600) 1,720 (4,950) Other Equipment (22) (50) 28 (824) (400) (424) (550) Information Technology (53) (75) 22 (717) (600) (117) (825) Motor Vehicles 0 - 0 (34) - (34) -

Total Capital Expenditure (671) (900) 229 (6,405) (7,200) 795 (9,900)

Increase in Investments and Restricted & Trust Funds A 60 - 60 246 - 246 -

Net Cashflow from Investing (611) (900) 289 (6,160) (7,200) 1,040 (9,900)

Financing ActivitiesEquity Injections - - - - - - - New DebtPrivate Sector - - - 65 - 65 - RHMU - - - - - - (86)

Repaid DebtPrivate Sector (162) (80) (82) (653) (720) 68 (960) RHMU - - - (381) - (381) (600)

Other Non-Current Liability Movement - (2) 2 - (1) 1 - Other Equity Movement - - - - - - -

Net Cashflow from Financing (162) (82) (80) (969) (721) (248) (1,646)

Net Cashflow 552 2,202 (1,650) 2,972 3,928 (955) (23,887) Plus: Cash (Opening) 26,355 25,660 695 23,934 23,934 - 23,934 Cash (Closing) 26,907 27,862 (955) 26,906 27,862 (955) 47

Carry forward checkClosing Cash made up of:Balance Sheet Cash 26,907 27,862 (955) 26,907 27,862 (955) 47 Total Cashflow Cash (Closing) 26,907 27,862 (955) 26,907 27,862 (955) 47

-

Page 6


Part 2: DHB Governance & Funding Actual Budget Variance Variance Actual Budget Variance Variance Budget

Administration $(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Statement of Financial Performance

REVENUEGovernment and Crown Agency sourced

e LoanInternal revenue (DHB Fund to DHB Governance) 160 160 (0) U (0%) 1,442 1,442 0 F 0% 1,922 Other Government - - (0) U (0%) - - (0) U (0%) - Other DHBs - - (0) U (0%) - - (0) U (0%) -

Government and Crown Agency sourced Total 160 160 (0) U (0%) 1,442 1,442 0 F 0% 1,922

Other Income 97 69 28 F 41% 803 619 184 F 30% 825

REVENUE TOTAL 257 229 28 F 12% 2,245 2,060 184 F 9% 2,747

EXPENSESPersonnel costs

Medical Personnel 4 (6) 10 F 175% (34) (51) 17 F 33% (68) Nursing Personnel (3) - (3) U (0%) (22) - (22) U (0%) - Allied Health Personnel - - 0 F (0%) - - 0 F (0%) - Support Personnel - - 0 F (0%) - - 0 F (0%) - Management/Administration Personnel (186) (135) (51) U (38%) (1,209) (1,203) (6) U (0%) (1,602)

Personnel costs Total (184) (140) (44) U (31%) (1,265) (1,254) (11) U (1%) (1,670)

Outsourced ServicesMedical Personnel - - 0 F (0%) - (3) 3 F 100% (4) Allied Health Personnel - - 0 F (0%) - - 0 F (0%) - Support Personnel - - 0 F (0%) - - 0 F (0%) - Management/Administration Personnel - (2) 2 F 100% (14) (17) 3 F 18% (23) Outsourced Corporate/Governance Services - - 0 F (0%) (1) - (1) U (0%) - Outsourced Funder Services (30) (29) (1) U (3%) (284) (253) (31) U (12%) (337)

Outsourced Services Total (30) (31) 1 F 3% (299) (273) (26) U (9%) (364)

Clinical SuppliesInstruments & Equipment - - 0 F 0% - - 0 F 0% - Other Clinical & Client Costs - - 0 F 0% - - 0 F 0% -

Clinical Supplies Total - - 0 F 0% - - 0 F 0% -

Infrastructure & Non-Clinical SuppliesHotel Services, Laundry & Cleaning (1) (1) 0 F 4% (8) (9) 0 F 4% (12) Facilities - - 0 F (0%) (0) - (0) U (0%) - Transport (19) (12) (7) U (63%) (115) (104) (11) U (10%) (139) IT Systems & Telecommunications (5) (4) (1) U (16%) (43) (38) (5) U (14%) (50) Interest & Financing Charges (56) (13) (43) U (328%) (447) (237) (210) U (89%) (250) Professional Fees & Expenses (23) (20) (3) U (16%) (504) (174) (330) U (190%) (232) Other Operating Expenses (8) (17) 10 F 56% (115) (154) 39 F 25% (205) Democracy (32) (34) 2 F 4% (285) (301) 16 F 5% (402) Subsidiaries, Joint Ventures & Minority Interests - - 0 F (0%) - - 0 F (0%) -

Infrastructure & Non-Clinical Supplies Total (143) (101) (43) U (42%) (1,517) (1,016) (500) U (49%) (1,288)

Internal AllocationsInternal Allocation from/to DHB Provider 48 48 0 F 0% 431 431 0 F 0% 575

Internal Allocations Total 48 48 0 F 0% 431 431 0 F 0% 575

EXPENSES TOTAL (309) (224) (86) U (38%) (2,649) (2,113) (537) U (25%) (2,747)

NET RESULTS (52) 5 (57) U (1,094%) (405) (52) (352) U (673%) (0)

Part 2: Full Time Equivalent Numbers Annual Actual Budget Actual Budget Budget

Medical Personnel 0.30 0.30 0.30 0.30 0.30 Nursing Personnel 0.60 - 0.78 - - Allied Health Personnel - - - - - Management/Administration Personnel 17.03 18.04 17.31 18.04 18.04

Total Full Time Equivalents (FTE's) 17.93 18.34 18.39 18.34 18.34

Year to DateCurrent Month

March 2007


Page 7


Part 3: DHB Provider Actual Budget Variance Variance Actual Budget Variance Variance Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 3.1: Statement of Financial Performance

REVENUEGovernment and Crown Agency sourcedMoH - Vote Health - - (0) U 0% - - (0) U 0% - MoH - Personal Health 812 536 276 F 51% 3,277 3,952 (675) U (17%) 5,492 MoH - Mental Health 14 - 14 F 0% 256 - 256 F 0% - MoH - Public Health 493 463 30 F 6% 4,717 4,163 554 F 13% 5,549 MoH - Disability Support Services 506 539 (33) U (6%) 4,542 4,851 (309) U (6%) 6,468 Clinical Training Agency 358 350 9 F 2% 3,275 3,124 151 F 5% 4,173 Internal revenue (DHB Fund to DHB Provider) 17,829 17,736 92 F 1% 160,923 159,584 1,339 F 1% 212,776 Ministry of Health Revenue 20,011 19,624 387 F 2% 176,991 175,674 1,317 F 1% 234,457

Other GovernmentOther DHBs 147 145 2 F 1% 1,347 1,308 39 F 3% 1,744 Training Fees and Subsidies 5 7 (2) U (32%) 77 89 (12) U (14%) 111 Accident Insurance 487 539 (52) U (10%) 4,602 4,785 (183) U (4%) 6,388 Other Government 337 323 14 F 4% 3,186 2,801 384 F 14% 3,739 Government and Crown Agency sourced Total 20,988 20,639 349 F 2% 186,203 184,657 1,546 F 1% 246,439

Other RevenuePatient / Consumer sourced 200 98 102 F 104% 1,320 827 493 F 60% 1,108 Other Income 514 369 145 F 39% 4,503 3,253 1,250 F 38% 4,361

Other Revenue Total 714 467 247 F 53% 5,823 4,080 1,743 F 43% 5,469

REVENUE TOTAL 21,702 21,106 596 F 3% 192,026 188,738 3,289 F 2% 251,909

EXPENSESPersonnel costsMedical Personnel (3,886) (3,734) (152) U (4%) (35,869) (33,334) (2,534) U (8%) (44,454) Nursing Personnel (5,378) (5,198) (180) U (3%) (45,738) (45,454) (285) U (1%) (60,866) Allied Health Personnel (2,165) (2,184) 19 F 1% (18,652) (19,481) 829 F 4% (25,986) Support Personnel (433) (455) 23 F 5% (3,830) (4,077) 248 F 6% (5,427) Management/Administration Personnel (1,770) (1,787) 17 F 1% (15,435) (16,089) 654 F 4% (21,398) Personnel costs Total (13,631) (13,359) (272) U (2%) (119,524) (118,435) (1,089) U (1%) (158,130)

Outsourced ServicesMedical Personnel (159) (92) (67) U (73%) (810) (781) (29) U (4%) (1,055) Nursing Personnel (2) (1) (1) U (131%) (19) (9) (10) U (108%) (12) Allied Health Personnel (10) (8) (2) U (25%) (75) (74) (2) U (3%) (98) Support Personnel (15) (1) (14) U (2,493%) (87) (5) (82) U (1,643%) (7) Management/Administration Personnel (34) (38) 4 F 10% (218) (339) 121 F 36% (452) Outsourced Clinical Services (233) (186) (47) U (25%) (2,071) (1,651) (420) U (25%) (2,199) Outsourced Corporate / Governance Services (62) (65) 3 F 5% (557) (574) 17 F 3% (765) Outsourced Services Total (516) (391) (124) U (32%) (3,838) (3,433) (405) U (12%) (4,589)

Clinical SuppliesTreatment Disposables (1,625) (1,427) (198) U (14%) (12,348) (11,812) (536) U (5%) (16,067) Diagnostic Supplies & Other Clinical Supplies (97) (140) 44 F 31% (1,241) (1,163) (78) U (7%) (1,582) Instruments & Equipment (670) (806) 137 F 17% (5,885) (7,257) 1,372 F 19% (9,676) Patient Appliances (112) (113) 1 F 1% (1,106) (939) (167) U (18%) (1,277) Implants and Prostheses (469) (515) 46 F 9% (3,769) (4,155) 386 F 9% (5,593) Pharmaceuticals (1,010) (1,075) 66 F 6% (8,316) (8,902) 586 F 7% (12,109) Other Clinical & Client Costs (94) (81) (13) U (17%) (771) (728) (43) U (6%) (971) Clinical Supplies Total (4,076) (4,159) 82 F 2% (33,435) (34,955) 1,520 F 4% (47,274)

Infrastructure & Non-Clinical SuppliesHotel Services, Laundry & Cleaning (647) (670) 23 F 3% (5,594) (5,960) 365 F 6% (7,942) Facilities (1,173) (911) (262) U (29%) (8,072) (8,268) 196 F 2% (11,021) Transport (184) (173) (11) U (6%) (1,605) (1,539) (67) U (4%) (2,050) IT Systems & Telecommunications (485) (819) 334 F 41% (4,708) (7,300) 2,591 F 35% (9,728) Interest & Financing Charges (651) (658) 7 F 1% (5,044) (5,739) 694 F 12% (7,703) Professional Fees & Expenses (57) (72) 15 F 20% (1,307) (638) (669) U (105%) (850) Other Operating Expenses (209) (219) 10 F 5% (1,983) (1,944) (39) U (2%) (2,590) Democracy - 42 (42) U (100%) - 375 (375) U (100%) 486 Infrastructure & Non-Clinical Supplies Total (3,405) (3,479) 74 F 2% (28,314) (31,012) 2,697 F 9% (41,398)

Internal AllocationsInternal Allocation from/to DHB Governance & Admin (48) (48) 0 F (0%) (431) (431) 0 F (0%) (575) Internal Allocations Total (48) (48) 0 F (0%) (431) (431) 0 F (0%) (575)

EXPENSES TOTAL (21,676) (21,435) (241) U (1%) (185,542) (188,265) 2,723 F 1% (251,966)

NET RESULTS 26 (329) 356 F 108% 6,484 472 6,011 F 1,273% (57)

March 2007


Page 8



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Part 3.1A: Supplemental Information to Statement of Financial PerformanceDepreciation (998) (901) (246) (27%) (9,166) (8,112) 1,053 (27%) (10,816) Interest cost (225) - (225) (0%) (1,689) - (2,014) (0%) - Interest cost Private (2) - (2) (0%) (21) - (21) (0%) - Interest cost from CHFA (222) - (222) (0%) (1,994) - (1,994) (0%) - Financing component of Operating Leases (14) - (14) (0%) (135) - (135) (0%) - Capital Charge (410) (408) (2) (1%) (2,872) (3,531) 659 (1%) (4,762) Gain/(Loss) on Disposal of Assets (5) - (5) (0%) (5) - 0 (0%) - Donations 4 - 4 (0%) 82 1 81 (1,700%) 1



Previous Month Feb

07Monthly Movemt.



Current AssetsPetty Cash 10 10 - 10 10 Bank Account (22,763) (23,515) 752 6,082 3,825 Short Term Investments 28,800 28,250 550 - - Short Term Investments - Trusts - - - - - Prepayments 660 755 (95) 3,618 3,618 Accounts Receivable – Control Account 10,488 10,753 (265) 8,205 8,132 Provision for Doubtful Debts (57) (57) - (57) (57) Accrued Debtors - - - - - Inventory / Stock 2,996 2,921 75 3,129 3,129 Assets Held for Resale 235 235 - - -

Current Assets Total 20,369 19,352 1,017 20,987 18,657

Non Current AssetsLand, Buildings & Plant 121,659 121,637 22 124,122 125,097 Clinical Equipment 60,901 60,853 48 62,082 63,432 Other Equipment ( incl Finance Leases ) 8,545 8,523 22 15,726 15,876 Information Technology 13,516 13,808 (292) 9,494 9,719 Motor Vehicles 201 201 - 168 168 Trust Properties - - - Provision Depreciation – Buildings & Plant (2,985) (2,652) (333) (3,114) (4,152) Provision Depreciation – Clinical Equipment (50,416) (50,021) (395) (53,139) (54,378) Provision Depreciation – Other Equipment (6,892) (6,828) (64) (7,039) (7,220) Provision Depreciation – Information Technology (9,971) (10,114) 143 (8,645) (8,891) Provision Depreciation – Motor Vehicles (164) (163) (1) (159) (160) Provision Depreciation – Trust Properties - - - WIP 3,025 2,626 399 1,075 1,075 Investment in Subsidiaries 31 31 - - - Investment in Associates - - - Long Term Investments - - - Long Term Investments – Trusts - - -

Non Current Assets Total 137,450 137,901 (451) 140,571 140,566


Previous Month Feb

07Monthly Movemt.



Current LiabilitiesAccounts Payable Control Account (1,905) (2,391) 486 (10,219) (10,518) Accrued Creditors (3,645) (3,693) 48 - - Income Received in Advance (113) (113) - (113) (113) Capital Charge Payable (2,232) (1,998) (234) (408) (410) GST & Tax Provisions 773 447 326 512 955 Unclaimed Creditors Monies - - - - - Term Loans – Finance Leases (current portion) (1,618) (1,742) 124 (1,133) (893) Term Loans – Private (current portion) - - - - - Term Loans – Crown (current portion) (102) (102) - (102) (102) Payroll Accrual & Clearing Accounts (9,626) (8,957) (669) (13,385) (12,509) Employee Entitlement Provisions (16,831) (16,180) (651) (17,355) (17,355)

Current Liabilities Total (35,299) (34,729) (570) (42,203) (40,945)

WORKING CAPITAL (14,930) (15,377) 447 (21,216) (22,288)


Page 9



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Non-Current LiabilitiesLong Service Leave – Non-current portion (1,252) (1,252) - (1,250) (1,250) Retirement Gratuities – Non-current portion (6,167) (6,167) - (6,068) (6,068) Employee - Other Entitlements – Non-current portion (705) (705) - - - Term Loans – Finance Leases (non-current portion) (1,644) (1,682) 38 (1,997) (1,997) Term Loans – Private (non-current portion) - - - - - Term Loans – Crown (non-current portion) (49,949) (49,949) - (50,330) (49,644) Trust and Special Funds – restricted use (2,199) (2,139) (60) (1,953) (1,953)

Non-Current Liabilities Total (61,916) (61,894) (22) (61,598) (60,912)

Crown EquityCrown Equity (53,244) (53,244) - (53,244) (53,244) Trust and Special Funds (no restricted use) - - - Revaluation Reserve (49,593) (49,593) - (49,593) (49,593) Revaluation Reserve – Trust Assets - - - - - Other Reserves (290) (290) - - - Retained Earnings - DHB Provider 41,095 41,121 (26) 43,979 44,413 Retained Earnings - DHB Governance & Funding Admin 1,429 1,376 52 1,101 1,058

Crown Equity Total (60,604) (60,630) 26 (57,757) (57,366)

NET FUNDS EMPLOYED (122,520) (122,524) 4 (119,355) (118,278)

Part 3.3: Statement of Movement in Equity


Previous Month Feb

07Monthly Movemt.



Total equity at beginning of the period (60,630) (59,616) (1,014) (58,076) (57,414) Net Results for the period 26 (1,014) 1,040 319 48 Equity Injections - - - - - Other - - - Total Equity at end of the period (60,604) (60,630) 26 (57,757) (57,366)

Page 10



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

March 2007


Part 3.4: Statement of CashflowsOperating ActivitiesGovernment and Crown Agency Revenue Received

Government & Crown Agency Sourced 2,448 2,085 363 14,343 17,966 (3,623) 24,487 Internal Receipts for DHB Provider 17,829 17,476 353 160,921 157,281 3,640 209,708 Internal Receipts for DHB Governance & Funding Admi 160 160 0 1,440 1,442 (1) 1,922 Receipts from Other DHBs 147 146 1 1,348 1,309 39 1,746 Receipts from Other Government Sources 830 869 (40) 7,866 7,676 190 10,237

Government and Crown Agency sourced Total 21,413 20,736 677 185,918 185,673 245 248,100

Other Revenue Received 811 536 275 6,626 4,700 1,926 6,293

Total Receipts 22,224 21,272 952 192,544 190,373 2,171 254,393

Payments for Personnel (12,495) (12,217) (278) (120,854) (115,581) (5,273) (156,574) Payments for Supplies (6,779) (6,016) (763) (55,581) (56,045) 464 (75,169) Interest Paid (317) (204) (113) (2,256) (2,051) (205) (2,900) Capital Charge Paid (232) (409) 177 (1,351) (3,624) 2,273 (4,867) GST (Net) & Tax (326) (152) (174) (761) (494) (267) (937)

Total Payments (20,149) (18,997) (1,152) (180,803) (177,795) (3,008) (240,447)

Net Cashflow from Operating 2,075 2,275 (200) 11,741 12,578 (837) 13,946

Investing ActivitiesSale of Fixed Assets - - - - - - - Decrease in Investments and Restricted &Trust Funds - - - - - -

Capital ExpenditureLand, Buildings & Plant (545) (325) (220) (2,950) (2,600) (350) (3,575) Clinical Equipment (51) (450) 399 (1,880) (3,600) 1,720 (4,950) Other Equipment (22) (50) 28 (824) (400) (424) (550) Information Technology (53) (75) 22 (717) (600) (117) (825) Motor Vehicles 0 - 0 (34) - (34) -

Total Capital Expenditure (671) (900) 229 (6,405) (7,200) 795 (9,900)

Increase in Investments and Restricted & Trust Funds 60 - 60 246 - 246 -

Net Cashflow from Investing (611) (900) 289 (6,160) (7,200) 1,040 (9,900)

Financing ActivitiesEquity Injections - - - - - - - New Debt - - Private Sector - - - 65 - 65 - CHFA - - - - - - (86)

Repaid Debt - - Private Sector (162) (80) (82) (653) (720) 68 (960) CHFA - - (381) - (381) (600) Other Non-Current Liability Movement - (2) 2 - (1) 1 - Other Equity Movement - - - - - - -

Net Cashflow from Financing (162) (82) (80) (969) (721) (248) (1,646)

Net Cashflow 1,302 1,293 9 4,612 4,657 (45) 2,400 Plus: Cash (Opening) 4,745 4,799 (54) 1,435 1,435 - 1,435 Cash (Closing) 6,047 6,092 (45) 6,047 6,092 (45) 3,835

Carry forward checkClosing Cash made up of:Balance Sheet Cash 6,047 6,092 (45) 6,047 6,092 (45) 3,835 Total Cashflow Cash (Closing) 6,047 6,092 (45) 6,047 6,092 (45) 3,835

Part 3.5: Full Time Equivalent Numbers Annual Actual Budget Actual Budget Budget

Medical Personnel 288.50 287.60 295.64 292.69 291.42

Nursing Personnel 988.94 971.16 980.93 988.22 983.96

Allied Health Personnel 468.45 467.10 464.01 474.35 472.54 Support Personnel 131.44 137.15 134.61 140.66 139.80 Management/Administration Personnel 407.09 420.44 416.60 429.16 426.99

Total Full Time Equivalents (FTE's) 2,284.42 2,283.45 2,291.79 2,325.08 2,314.70


Page 11


Part 4: DHB Funds Actual Budget Variance Variance Actual Budget Variance Variance Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 4.1A: Personal Health - Statement of Financial Performance

REVENUEVote health MoH - Mental Health 3,923 3,902 21 F 1% 35,331 35,121 210 F 1% 46,828 Vote health MoH - Non Mental Health 25,180 27,578 (2,398) U (9%) 248,152 248,200 (48) U 0% 332,533 PBF Adjustments - - (0) U 0% 629 - 629 F 0% - MoH - Funding Subcontracts - - (0) U 0% 115 - 115 F 0% - MoH – IDF Revenue (Mental Health Services) 349 349 (0) U 0% 3,142 3,142 (0) U 0% 4,190 MoH – IDF Revenue (Other Services) 2,878 2,881 (3) U 0% 25,903 25,931 (28) U 0% 34,575 Other Income - - (0) U 0% - - (0) U 0% -

REVENUE TOTAL 32,330 34,711 (2,381) U (7%) 313,272 312,395 878 F 0% 418,126

EXPENSESPayments to Providers

Child and Youth (174) (168) (6) U (3%) (1,505) (1,515) 10 F 1% (2,020) Laboratory (1,706) (1,606) (99) U (6%) (14,290) (14,758) 468 F 3% (19,577) Maternity (208) (112) (96) U (86%) (1,268) (1,004) (264) U (26%) (1,339) Maternity (Tertiary & Secondary) (457) (457) 0 F (0%) (4,120) (4,115) (6) U (0%) (5,486) Pregnancy and Parenting Education (4) (7) 3 F 41% (50) (59) 9 F 16% (78) Neo Natal (286) (286) 0 F (0%) (2,570) (2,570) 0 F (0%) (3,427) Sexual Health (54) (68) 15 F 21% (484) (616) 132 F 21% (822) Adolescent Dental Benefit (110) (103) (7) U (7%) (914) (930) 16 F 2% (1,240) Other Dental Services (23) - (23) U (0%) (211) - (211) U (0%) - Dental - Low Income Adult (201) (213) 12 F 6% (1,580) (1,917) 337 F 18% (2,556) Child (School) Dental Services (180) (180) 0 F (0%) (1,620) (1,620) 0 F (0%) (2,160) Pharmaceuticals (3,738) (3,626) (112) U (3%) (36,950) (33,337) (3,613) U (11%) (44,269) Management Referred Services - (2) 2 F 100% - (14) 14 F 100% (19) Population Based Services - - 0 F (0%) (37) - (37) U (0%) - General Medical Subsidy (93) (133) 39 F 30% (952) (1,274) 322 F 25% (1,609) Primary Practice Services - Capitated (1,687) (1,641) (46) U (3%) (15,350) (14,769) (581) U (4%) (19,692) Practice Nurse Subsidy (13) (54) 41 F 76% (153) (487) 334 F 69% (649) Rural Support for Primary Health Pro (289) (258) (32) U (12%) (2,658) (2,318) (340) U (15%) (3,090) Immunisation (124) (131) 7 F 5% (177) (276) 99 F 36% (617) Radiology (325) (349) 24 F 7% (2,948) (2,962) 14 F 0% (3,957) Other Community Based Services - - 0 F (0%) 15 - 15 F (0%) - Palliative Care (89) (133) 45 F 33% (1,060) (1,201) 142 F 12% (1,602) Meals on Wheels (56) (58) 1 F 3% (558) (521) (37) U (7%) (694) Domicilary & District Nursing (582) (582) 0 F (0%) (5,238) (5,238) 0 F (0%) (6,983) Community based Allied Health (486) (531) 44 F 8% (4,490) (4,775) 285 F 6% (6,366) Chronic Disease Management and Education (81) (63) (18) U (28%) (732) (570) (162) U (28%) (760) Medical Inpatients (3,310) (3,308) (2) U (0%) (29,787) (29,769) (18) U (0%) (39,692) Medical Outpatients (2,096) (2,140) 43 F 2% (18,898) (19,256) 359 F 2% (25,675) Surgical Inpatients (4,193) (4,193) 0 F (0%) (37,737) (37,737) 0 F (0%) (50,316) Surgical Outpatients (879) (890) 10 F 1% (7,914) (8,007) 94 F 1% (10,677) Paediatric Inpatients (238) (238) 0 F (0%) (2,138) (2,138) 0 F (0%) (2,851) Paediatric Outpatients (154) (154) 0 F (0%) (1,386) (1,386) 0 F (0%) (1,848) Pacific Peoples' Health - - 0 F (0%) (37) - (37) U (0%) - Emergency Services (672) (706) 34 F 5% (6,063) (6,358) 294 F 5% (8,477) Minor Personal Health Expenditure (118) (115) (3) U (3%) (924) (1,032) 109 F 11% (1,377) Price adjusters and Premium (715) (680) (35) U (5%) (7,354) (6,121) (1,232) U (20%) (8,162) Travel & Accomodation (271) (151) (120) U (80%) (1,355) (1,355) (1) U (0%) (1,806) Inter District Flow Personal Health (1,387) (1,113) (274) U (25%) (10,112) (10,015) (96) U (1%) (13,854)

PAYMENTS TO PROVIDERS TOTAL (24,999) (24,446) (553) U (2%) (223,605) (220,021) (3,585) U (2%) (293,748)

Mental HealthPayments to Providers

Mental Health to allocate (189) (189) 0 F (0%) (1,701) (1,701) 0 F (0%) (4,522) Acute Mental Health Inpatients (501) (501) 0 F (0%) (4,506) (4,506) 0 F (0%) (6,008) Sub-Acute & Long Term Mental Health (235) (235) 0 F (0%) (2,119) (2,119) 0 F (0%) (2,825) Crisis Respite (20) (25) 6 F 23% (204) (229) 25 F 11% (306) Alcohol & Other Drugs - General (215) (165) (50) U (30%) (1,526) (1,486) (40) U (3%) (1,982) Alcohol & Other Drugs - Child & Yout (66) (65) (2) U (3%) (571) (581) 9 F 2% (774) Methadone (62) (62) 0 F (0%) (558) (558) 0 F (0%) (744) Child & Youth Mental Health Services (311) (314) 3 F 1% (2,822) (2,825) 3 F 0% (3,767) Forensic Services (318) (320) 2 F 1% (2,865) (2,881) 16 F 1% (3,841) Kaupapa Maori Mental Health Services (100) (100) 0 F (0%) (900) (900) 0 F (0%) (1,200) Kaupapa Maori Mental Health - Inpati (38) (38) 0 F (0%) (343) (343) 0 F (0%) (457) Mental Health Community Services (915) (876) (40) U (5%) (8,070) (7,880) (190) U (2%) (10,506) Prison/Court Liaison (17) (17) 0 F (0%) (151) (151) 0 F (0%) (201) Mental Health Workforce Development (13) (3) (11) U (412%) (39) (24) (15) U (66%) (31) Day Activity & Work Rehabilitation S (65) (70) 6 F 8% (656) (632) (23) U (4%) (843) Advocacy / Peer Support - Consumer (79) (38) (41) U (109%) (564) (341) (223) U (65%) (455) Other Home Based Residential Support (22) (21) (1) U (4%) (185) (188) 2 F 1% (250) Advocacy / Peer Support - Families a (0) (0) (0) U (2%) (4) (4) (0) U (1%) (5) Community Residential Beds & Service (496) (1,056) 559 F 53% (4,495) (6,501) 2,006 F 31% (9,668) Minor Mental Health Expenditure (27) (38) 11 F 29% (288) (346) 58 F 17% (462) Inter District Flow Mental Health - (375) (375) 0 F (0%) (3,374) (3,374) 0 F (0%) (4,499)

PAYMENTS TO OTHER PROVIDERS TOTAL (4,065) (4,508) 443 F 10% (35,941) (37,569) 1,629 F 4% (53,346)

Public HealthPayments to Providers

Communicable Diseases (1) - (1) U (0%) (20) - (20) U (0%) - Meningococcal - - 0 F (0%) (2) - (2) U (0%) -

PAYMENTS TO OTHER PROVIDERS TOTAL (1) - (1) U (0%) (22) - (22) U (0%) -

Disability SupportPayments to Providers

AT & R (Assessment, Treatment and Re (1,038) (1,058) 20 F 2% (9,346) (9,525) 180 F 2% (12,701) Information and Advisory (3) (2) (1) U (76%) (4) (16) 12 F 74% (21) Needs Assessment (47) (48) 0 F 1% (427) (431) 4 F 1% (575) Service Co-ordination (57) (57) 0 F (0%) (511) (511) 0 F (0%) (681) Home Support (454) (721) 267 F 37% (6,319) (6,299) (19) U (0%) (8,487) Carer Support (262) (162) (100) U (61%) (2,176) (1,620) (555) U (34%) (2,134)


March 2007

Page 12



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)


March 2007

Residential Care: Rest Homes (583) (1,773) 1,190 F 67% (15,354) (15,501) 147 F 1% (20,513) Residential Care: Loans Adjustment 10 - 10 F (0%) 130 - 130 F (0%) - Residential Care: Hospitals (153) (1,730) 1,577 F 91% (12,112) (14,973) 2,861 F 19% (20,133) Ageing in Place (105) (100) (5) U (5%) (801) (901) 99 F 11% (1,201) Environmental Support Services (69) (40) (29) U (73%) (499) (359) (140) U (39%) (479) Day Programmes (12) (22) 10 F 44% (138) (198) 60 F 30% (264) Respite Care (80) (54) (26) U (49%) (427) (482) 56 F 12% (643) Community Health Services & Support (27) (24) (3) U (13%) (197) (216) 19 F 9% (288) Inter District Flow Disability Suppo (174) (174) 0 F (0%) (1,562) (1,562) 0 F (0%) (2,082) Day Programmes 7 - 7 F (0%) (1) - (1) U (0%) - Disability Support Other (53) (13) (41) U (327%) (145) (113) (33) U (29%) (150)

PAYMENTS TO OTHER PROVIDERS TOTAL (3,102) (5,976) 2,874 F 48% (49,889) (52,708) 2,820 F 5% (70,353)

Maori HealthPayments to Providers

Maori Service Development (12) (5) (7) U (136%) (117) (45) (72) U (162%) (59) Maori Provider Assistance Infrastruc - - 0 F (0%) (10) - (10) U (0%) - Minor Maori Health Expenditure (13) (75) 63 F 83% (101) (676) 575 F 85% (902) Whanau Ora Services (55) - (55) U (0%) (413) - (413) U (0%) -

PAYMENTS TO OTHER PROVIDERS TOTAL (79) (80) 1 F 2% (641) (721) 80 F 11% (961)

Governance and AdministrationOutsourced Services

Outsourced Funder Services (160) (160) (0) U (0%) (1,442) (1,442) 0 F (0%) (1,922)

EXPENSES TOTAL (32,406) (35,171) 2,764 F 8% (311,539) (312,461) 922 F 0% (420,331)

Summary of resultsSubtotal IDF Revenue 3,227 3,230 (3) U (0%) 29,046 29,074 (28) U (0%) 38,765 Subtotal all other Revenue 29,103 31,480 (2,377) U (8%) 284,227 283,321 906 F 0% 379,361

REVENUE TOTAL 32,330 34,711 (2,381) U (7%) 313,272 312,395 878 F 0% 418,126

Subtotal IDF Expenditure (1,935) (1,661) (274) U (16%) (15,047) (14,951) (96) U (1%) (20,435) Subtotal all other Expenditure (30,471) (33,509) 3,038 F 9% (296,491) (297,509) 1,018 F 0% (399,896)

EXPENSES TOTAL (32,406) (35,171) 2,764 F 8% (311,539) (312,461) 922 F 0% (420,331)

TOTAL FUNDS NET RESULT (76) (460) 384 F 83% 1,733 (66) 1,799 F 2,728% (2,204)

Page 13



$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)


March 2007



Previous Month Feb 07

Monthly Movemt.



Current AssetsBank Account 20,860 21,610 (750) 21,770 23,408 Short term investments - - - - - Prepayments 161 215 (54) - - Accounts Receivable – Control Account - - - 4,021 5,371 Accrued Debtors 6,892 8,662 (1,770) 17,851 18,160

Current Assets Total 27,913 30,487 (2,574) 43,642 46,939

Current LiabilitiesAccounts Payable Control Account (17,274) (19,603) 2,329 (16,114) (16,069) Accrued Creditors - - - (17,851) (18,160) Income Received in Advance - - - - - Capital Charge Payable - - - - GST & Tax Provisions (2,363) (2,532) 169 (2,391) (2,531)

Current Liabilities Total (19,637) (22,135) 2,498 (36,356) (36,760)

WORKING CAPITAL 8,276 8,352 (76) 7,286 10,179


Crown EquityRetained Earnings - DHB Funds 8,276 8,352 (76) 4,280 (9,998) Retained Earnings - Mental Health ringfence - 3,005 (181)

Crown Equity Total 8,276 8,352 (76) 7,286 (10,179)

NET FUNDS EMPLOYED 8,276 8,352 (76) 7,286 (10,179)

Part 4.3: Statement of Movement in EquityCurrent Actual $(000)

Previous Month Feb 07

Monthly Movemt.



Total equity at beginning of the period 8,352 8,050 302 7,745 (5,146) Net Results for the period (76) 302 (378) (460) (5,033) Equity Injections - - - - - Other - - - - - Total Equity at end of the period 8,276 8,352 (76) 7,286 (10,179)

Part 4.4: Statement of Cashflows

Operating ActivitiesGovernment and Crown Agency sourced 34,155 34,860 (706) 310,305 295,893 14,412 400,274 Other Revenue - - Total Receipts 34,155 34,860 (706) 310,305 295,893 14,412 400,274

Payment to own DHB Provider (17,829) (17,476) (353) (160,921) (157,281) (3,640) (212,776) Payment to own DHB Governance & Funding Adm (160) (160) (0) (1,440) (1,442) 1 (1,922) Payments to other DHB’s (1,936) (1,660) (276) (15,053) (14,951) (102) (20,435) Payments to Providers (14,811) (14,567) (244) (134,735) (123,019) (11,716) (166,572) Interest Paid - - Capital Charge Paid - - GST (net) & Tax (169) (89) (80) 206 71 135 (244) Total Payments (34,905) (33,952) (952) (311,944) (296,622) (15,322) (401,949)

Net Cashflow from Operating (750) 908 (1,658) (1,639) (729) (910) (1,675)

Investing ActivitiesIncrease in Investments and Restricted & Trust Funds - -

Financing ActivitiesEquity Injections - - - New DebtPrivate Sector - - - CHFA - - - Repaid DebtPrivate Sector - - - CHFA - - - Other non-current liability movement - - - - - Other equity movement - - -

Net cashflow from Financing - - - - - - -

Net Cashflow (750) 908 (1,658) (1,639) (729) (910) (1,675) Plus: Cash (Opening) 21,610 20,862 748 22,499 22,499 - 22,499 Cash (Closing) 20,860 21,770 (910) 20,860 21,770 (910) 20,824

Carry forward checkClosing Cash made up of:Balance Sheet Cash 20,860 21,770 (910) 20,860 21,770 (910) 20,824 Total Cashflow Cash (Closing) 20,860 21,770 (910) 20,860 21,770 (910) 20,824

Page 14

Part 7: Treasury Report

Part 7.1: Debt as at month end

Amount ($000) Due Base Rate Margin Total Rate

CHFA Fixed Rate Loan 1,250 28/09/2007 6.160% 6.16%CHFA Fixed Rate Loan 20,000 30/09/2010 6.040% 6.04%CHFA Fixed Rate Loan 21,250 28/11/2007 6.500% 6.50%CHFA Dunstan Loan 7,296 0.000% 0.00%EECA Loan 255 Qrtly Instalment 0.000% 0.00%Finance Leases 3,437 Mthly Instalment 5.000% 5.00%BNZ Working Capital ($18 Million) 1,906 7.770% 0.15% 7.92%

Total Debt & Overdraft 55,394 Average Cost of Debt 5.40%

Part 7.2: Key Performance Indicators

Part 7.2A: CHFA Debt Financial CovenantsActual

28/02/07Actual

31/01/07 BudgetInterest Cover is not less than 2.5 times 9.41 5.50 5.33Total Debt divided by (Debt plus Equity) not to exceed 65% 44.52% 45.60% 46.53%Secured Liabilities not more than 5% of Assets 1.81% 2.09% 1.78%Guaranteeing Assets more than 95% of Group Assets 100.00% 100.00% 100.00%

Part 7.2B: Cash ManagementActual

28/02/07Actual

31/01/07 TargetBank Account:Cheque A/c High ($000) $1,107 $603 <= $1,000Cheque A/c Average ($000) $214 $118 <= $ 500Days in Overdraft 3 5 0 Overdraft High ($000) $(52) $(2,180) $0

Funds Invested ($million days) 1,264.0 1,164.5 >= 800Funds Drawn ($million days) 1,497.5 1,674.0 <= 2000Peak Term Funding : Available Credit Limits 74.9% 75.0% <= 95%

Part 7.3: Cash Balances as at Month End ($000)

O D H B Consolidated

Short Term Deposits:Bank of New Zealand 13,250 ANZ BankASB Bank 15,000Westpac

Other:Cash at Bank (1,906)Petty Cash 10

Total Cash Balances (O/D) 26,354

Page 15

Minutes of the Joint Meeting of the Community & Public Health and Disability Support Advisory Committees held on Tuesday, 17 April 2007, commencing at 10.00 am, in the Board Room, First Floor, Dunedin Hospital Present: Ms M L Rosson Chairperson

Mrs H M Algar

Mr P A Barron

Prof S M Dovey Dr M D H Holdaway

Mrs D R McKay Dr B Sijnja

Dr G T Tipa Ms P J Wakefield

In Attendance: Mr C Fraser Regional General Manager,

Planning & Funding

Mr B D Rousseau Chief Executive Officer Ms G Goodger Communications Officer

Ms J Kloosterman Board Secretary Dr R Morris Primary Care Advisor

1.0 WELCOME

The Chairperson welcomed everyone to the meeting.

2.0 APOLOGIES

Apologies were received from Mrs K N Bowen and Ms B A Long. An apology for lateness was received from Mrs D R McKay.

3.0 MEMBERS’ DECLARATION OF INTEREST

The Chairperson called for any adjustments or amendments to the Interests

Registers.

Action Point 91 Ms M L Rosson requested that Virgin Gold Ltd (Director) be added to her entry.

The Chairperson asked if Committee members were aware of any agenda items

with which they may have a potential conflict and reminded them of their

responsibility to advise the meeting immediately should any potential conflict, actual or perceived, arise during discussions.

Minutes of the CPHAC & DSAC, 17 April 2007 Page 1

4.0 PREVIOUS MINUTES Moved Dr M D H Holdaway, seconded Mr P A Barron, that the minutes of the 20 March 2007 joint meeting of the Community & Public Health and Disability Support Advisory Committees be approved and adopted as a true and correct record.

Carried

5.0 MATTERS ARISING

Agenda and Reports – Resourcing of the Committees Members raised issues in relation to the resourcing and role of the Community & Public Health and Disability Support Advisory Committees, and their relationship

with the community and PHOs (Public Health Organisations).

Mrs D R McKay joined the meeting at 10.05 am.

Mr B D Rousseau, Chief Executive Officer, advised that the Southern Alliance

Regional Managers were stretched at the moment and asked for members’ patience while the regional support structure was being established. He

anticipated that this would take 3-6 months. Mr C Fraser, Regional General Manager, Planning & Funding, concurred with members that resources had to meet their expectations. He emphasised,

however, that he was not aware of any part of the planning and funding programme being deferred or slowed down. The most significant impact of

regional restructuring was a reduction in resources to write reports, as a lot of the

work he had previously undertaken had had to be delegated to the next tier of staff. Under the new structure report writing would become the responsibility of

managers reporting to the Regional General Manager. Until these appointments were made, it would be difficult to respond to the Committees’ expectations on

report content.

Primary Referred Pharmaceutical Services It was noted that Action Point 84 would be responded to next month.

6.0 PRESENTATION – PRIMARY CARE

Dr Roy Morris, Primary Care Advisor, gave a presentation to the Committees on Primary Care in the Otago DHB area.

Dr Morris commented that primary care was a major part of health provision and

to do justice to it in half an hour was impossible. His presentation therefore

focussed on General Practice and Dr Morris offered to give presentations at a later date on other aspects of primary care if the Committees so wished.

Dr Morris’ presentation included an overview of:

The New Zealand picture (including life expectancy, avoidable mortality, cost

effectiveness, access, quality improvement, and health target areas); Otago’s population and health profile;

National goals for primary health care;

Primary Health Organisations (PHOs), including local performance, initiatives and issues.


Following his presentation, Dr Morris answered members’ questions on PHOs.

Action Point 92 Dr Morris was thanked for his presentation and was asked to provide an update in

three months’ time.

Dr R Morris, Primary Care Advisor, left the meeting at 11.20 am.

7.0 HEALTHY EATING, HEALTHY ACTION (HEHA)

Melanie McKenzie, Regional HEHA Project Manager, and Ruth Zeinert, HEHA

Regional Co-ordinator, joined the meeting to introduce themselves to members, explain their roles and provide an overview of HEHA activity.

Mrs McKenzie advised that their current focus was to develop a HEHA Plan, the

first draft of which had to be submitted to the Ministry of Health by 30 April and

the final plan by 15 June. This involved a lot of engagement with key stakeholders, agencies and groups who would be implementing the plan, many of

whom were outside the health sector. The first steps were to identify the needs of the Otago population, undertake a stocktake and then identify any gaps that

exist.

Mrs McKenzie also advised that part of their role was to implement the Nutrition Fund, which was designed to support positive nutrition environments in schools.

In response to questions about outcome indicators, Mrs McKenzie advised that the New Zealand Health Survey was capturing information such as BMI (Body Mass

Index), fruit and vegetable intake, etc. It was noted that a lot of information was also held by primary care providers.

A general discussion was held on strategies and initiatives to change behaviours

to bring about improvements in health.

The Chairperson thanked Mrs McKenzie and Ms Zeinert for their briefing and

extended the Committees best wishes for the work they were undertaking.

Action Point 93 It was agreed that the draft HEHA Plan would be submitted to the May meeting of

the Committees.

Ms P J Wakefield left the meeting at 11.50 am.

8.0 PROVIDER ARM CONTRACT PERFORMANCE – OUTPATIENTS (Action Points 85, 61 & 65)

Dr Colleen Coop, Group Manager, Emergency, Medicine and Surgery, joined the meeting and gave members an update on the Provider Arm’s plans for outpatients

and discussed members’ concerns about outpatient services.

Dr Coop undertook to relay members’ feedback and suggestions to the managers who would be involved in the Outpatients Review project.

The Chairperson thanked Dr Coop for her attendance.


9.0 STRATEGIC PRIORITIES

The strategic priorities reports (tabs 3-6) were taken as read. The following items

were highlighted during discussion.

1. Reduce Inequalities in Health (tab 3)

Māori Provider Development

Members noted that the official opening (Whakawatea) for Uruuruwhenua

at Dunstan had gone extremely well.

Action Point 94 Dr G T Tipa requested that proposals for Whanau Ora services include proof of need, to ensure services are delivered to areas of high need,

rather than to areas where providers wanted to deliver them.

Moved Mrs H M Algar, seconded Dr B Sijnja, that the progress report on the strategic priorities to reduce inequalities in health be noted.

Carried

2. Promote and Enhance Independence (tab 4) Mental Health

Mental Health Rural – Central Otago

Members noted and discussed the report outlining the process used to scope mental health needs in Central Otago. Mr C Fraser, Regional

General Manager, Planning & Funding, advised that a specialist had been

engaged to undertake this work and he was happy to place reliance on his advice.

Mental Health (Provider Arm) Under-spend

Mr Fraser explained the historical under-spend in mental health, the ring-fencing of mental health funding, and the realignment of services to the

Mental Health Blueprint. He identified that the main constraints in developing services were a limited Mental Health workforce and that the

accumulated unspent funds could only be applied to one-off projects.

Mrs D R McKay left the meeting at 12.30 pm.

During discussion, it was noted that the quantum of under-expenditure

was about 1% of total Mental Health funding and a large part of this resulted from being unable to fill staff vacancies.

Mr B D Rousseau, Chief Executive Officer, advised that Mental Health

expenditure issues would be addressed with the Ministry of Health before

the next District Annual Plan (DAP) was finalised.

Moved Prof S M Dovey, seconded Dr M D H Holdaway, that the progress report on the strategic priorities to promote and enhance independence be noted.

Carried


3. Reduce the Incidence and Impacts of Chronic Disease and Cancer (tab 5)

Moved Ms M L Rosson, seconded Dr G T Tipa, that the progress

reports on the strategic priorities to reduce the incidence and impact of chronic disease and cancer be noted.

Carried

4. Maintain and Enhance our Capability to Deliver Quality Health Services (tab 6)

Primary Care Development Collaboration with Southland

Mr C Fraser, Regional General Manager, Planning & Funding, reported that

all four regional executive managers had now been appointed and Southland and Otago Planning & Funding staff met together for the first

time on 1 February. A proposal for a regional Planning & Funding team structure would be submitted to the Regional Executive Management Team

in May and, if approved, would be consulted on with staff.

Dr B Sijnja declared a conflict as a rural provider and asked how shared services would affect the alignment of rural hospitals. Mr Fraser advised that there was a potential opportunity to look at all hospital services from a regional perspective.

Immunisation

Action Point 95 Members requested further information on the immunisation rate at

15 months to assist with interpretation of the reported data.

Moved Dr B Sijnja, seconded Prof S M Dovey, that the progress report on the strategic priorities for maintaining and enhancing the DHB’s capability to deliver quality health services be noted.

Carried

10.0 FINANCIAL REPORT The Funds financial report as at 28 February 2007 (tab 7) was taken as read. It

was noted that this had been considered by Board at its last meeting.

Moved Ms M L Rosson, seconded Mr P A Barron, that the Financial Report be noted.

Carried

11.0 CONTRACT PERFORMANCE Provider Arm Moved Ms M L Rosson, seconded Dr G T Tipa, that the key performance indicators for the Provider Arm as at February 2007 (tab 8) be noted.

Carried


Action Point 96 An explanation was requested for the high number of Paediatric bed days for

patients with lengths of stay greater than 30 days.

12.0 OTHER ITEMS

Public Health South Reports

The Public Health South report for March 2007 and a report on the impact of air pollution on health in Otago (tab 9) were taken as read.

Members commented that the report on air quality was very interesting.

Action Point 97 Members noted that Public Health South had offered to assist the Otago Regional Council to improve air quality in Otago and requested that an update be provided

on assistance provided.

13.0 INFORMATION ITEMS

Ministry of Health Publications The list of Ministry of Health publications was noted.

Towards a New Zealand Medicines Strategy Members discussed the proposed New Zealand Medicines Strategy and thanked

Dr David Holdaway for submitting a personal submission on this.

14.0 OVERVIEW OF STRATEGIC FRAMEWORK/STRATEGIC OPPORTUNITIES

Moved Ms M L Rosson, seconded Mr P A Barron, that the strategic framework summary be noted.

Carried

15.0 GENERAL BUSINESS

Waitaki Maternity Services Mrs H M Algar advised that she had been approached by parents in the Waitaki

region to alert her to a Ministry of Health specification on a 12 hour postnatal

turnaround, which effectively meant that if a woman in a rural area delivered in Dunedin Public Hospital then she had to return to her hospital of origin within 12

hours for that hospital to receive funding. Mrs Algar expressed her concern about the effect of this policy on child and maternal health, particularly in relation to

attachment, breast feeding, support, maternal mental health and the child’s future health.

Mr B D Rousseau, Chief Executive Officer, stressed that women were not

arbitrarily discharged from Dunedin Hospital 12 hours after giving birth.


Mr C Fraser, Regional General Manager, Planning & Funding, informed members

that the issue raised was part of current contract negotiations. He advised that the policy had been in place for years but it had been found that a lot of claims

had been paid to rural health providers outside the policy and these had been stopped. Rural providers were being encouraged to discuss splitting the fee

associated with post 12 hour care with Queen Mary, so that the decision around transfer can be made around what is most appropriate for the mother and child,

as opposed to the funding model.

Mr Fraser expressed his annoyance that information had been publicly disclosed

midway through contract negotiations.

Moved Ms M L Rosson, seconded Dr M D H Holdaway, that the public be excluded from the meeting to consider the following agenda items: General subject: Reason for

passing this resolution:


1. Confidential Minutes 2. Otago Community

Oral Health Services 3. Management of

Demand Driven

Services – ED, Urgent Primary Care and After Hours

Primary Care Services in Dunedin

4. Risk Register 5. Action Sheet

To allow negotiations

and activities to be carried on without

prejudice or disadvantage

S 34(a), Schedule 4, NZ Public Health and Disability Act 2000 – that the public conduct of

this part of the meeting would be likely to result in the disclosure of information for which good reason for withholding exists under sections

9(2)(i) and 9(2)(j) of the Official Information Act 1982, that is, the withholding of the information is necessary to enable a Minister of the Crown or any

Department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities and negotiations.

Carried

The meeting adjourned at 1.05 pm for lunch and resumed at 1.35 pm.


Confirmed as a correct record:

Chairperson …………………………………………………….

Date …………………………………………………….


Minutes of the Hospital Advisory Committee Meeting Held on Tuesday, 24 April 2007, commencing at 10.00 am, in the Board Room, First Floor, Dunedin Hospital

Present: Prof R D H Stewart Chairman Dr J B Adams Mrs M A Gamble

Mrs S J Johnstone Dr J M Macpherson

Dr J O Medlicott Mr P E Menzies Mr R J Thomson

In Attendance: Dr C Coop Acting Chief Operating Officer

Mrs V J Blake Chief Operating Officer Ms T Bradfield Chief Nursing Officer

Mr R W Bunton Chief Medical Officer Ms G Goodger Communications Officer

Ms J Kloosterman Board Secretary

Mr G Paris Business Analyst

1.0 WELCOME

The Chairman welcomed everyone to the meeting. A special welcome was

extended to Dr Colleen Coop who had been Acting Chief Operating Officer during Mrs Vivian Blake’s absence on leave.

2.0 APOLOGIES

An apology was received from Mr B D Rousseau, Chief Executive Officer.

Moved Prof R D H Stewart, seconded Mrs S J Johnstone, that the apology be accepted.

Carried

3.0 DECLARATION OF INTERESTS

The Chairman called for any adjustments or amendments to the Interest

Registers. None were advised.

The Chairman asked if Committee members were aware of any agenda items with which they may have a potential conflict and reminded them of their responsibility

to advise the meeting immediately should any potential conflict arise during

discussions.

Moved Prof R D H Stewart, seconded Dr J M Macpherson, that the Hospital Advisory Committee and Executive Interest Registers be noted.

Carried

Minutes of the Hospital Advisory Committee, 24 April 2007 Page 1

4.0 MINUTES OF THE PREVIOUS MEETING

Moved Mr R J Thomson, seconded Mrs M A Gamble, that the minutes of the 27 March 2007 meeting of the Hospital Advisory Committee be approved and adopted as a true and correct record.

Carried

5.0 MATTERS ARISING

There were no matters arising from the previous minutes that were not covered by the agenda.

6.0 EXECUTIVE REPORTS

The Executive Reports for March 2007 (tabs 3-5) were taken as read. Chief Operating Officer’s Report (tab 3) In presenting her report, Dr C Coop, Acting Chief Operating Officer, brought the

following items to the Committee’s attention. Contract Performance: Total activity for March (including Inter-District Flows and adjustment for

uncoded cases) was 3% above plan; elective activity (including IDFs) was 6%

ahead of plan and acute activity (including IDFs) was 7% behind plan. Year to

date total activity was on plan, with electives 2% ahead of plan and acute activity 1% behind plan.

Financial Performance: The Provider Arm produced a positive variance against budget of $355k for

March and was positive year to date by $6,012k.

In March revenue was positive against budget by $596k and expenses were

negative against budget by $241k. For the year to date revenue was positive

against budget by $3,289k and expenses were positive against budget by $2,723k.

A major contributor to the March financial result was the number of additional

joints completed for the Orthopaedic Initiative contract.

Operational Performance: Full-time equivalent (FTE) staff vacancies had reduced slightly to 111 FTEs.

Medical outliers for March were 114, compared to 125 for the previous year.

A solution to reduce the number of medical outliers had been developed but had not been implemented due to staff vacancies.

Elective theatre utilisation at 85% was on target.

Resourced occupancy at 89% during March was indicative of the high level of

activity in the hospital.


Joints (Orthopaedic) Initiative Dr Coop reported that a greater number of joints had been completed during

March. However, there was still concern that there would be a shortfall of 10 joints against target and this could be adversely affected by ongoing industrial

action.

Ophthalmology Services Dr Coop was pleased to report that the cataract initiative had been completed for

the 2006/07 year. There were, however, issues in the Ophthalmology Service arising from current Senior Medical Officer (SMO) vacancies, which were affecting

the number of First Specialist Assessments (FSAs) and treatments that could be provided.

To address staff shortages, a locum had been employed and negotiations were

under way for a locum working for the University to undertake additional sessions. In addition, nurse-led services for follow-up appointments were being increased

and weekend clinics were being considered.

Dr Coop gave an assurance that all urgent and semi-urgent patients were being

seen and no glaucoma patients were being turned away.

Accreditation and Certification Survey Dr Coop reported that the surveyors’ verbal comments following the survey and audit of the hospital were very pleasing for all services and there was a lot to be

proud of. Some facilities issues were raised, which had been included in master

site planning.

Following the presentation of her report, Dr Coop answered members’ questions.

The following points were highlighted during discussion.

Contract Performance Management and staff were congratulated on the way they had maintained

contract performance during industrial action.

It was noted that Ministry of Health data showing that the Otago DHB was 7% behind its targeted contract volumes was out of date. Contract volumes were in

fact slightly ahead of plan.

Influenza Campaign

Members expressed their disappointment with the low uptake of influenza

vaccination by staff.

Staff Shortages The Chairman noted that the shortage of Ophthalmologists and other senior medical specialists was a national issue. He commented that professional groups

had an obligation to ensure that training programmes provided enough persons to meet service provision needs.

Members discussed succession planning strategies, including the possibility of targeting Otago Medical School alumni in recruitment efforts.


Action Point 260 The Chief Operating Officer undertook to work with the Chief Medical Officer to

develop a recruitment and retention strategy for medical staff that incorporated

succession planning.

Chief Medical Officer’s Report (tab 4)

Staff Credentialling Mr R W Bunton, Chief Medical Officer, reported that the Clinical Board

recommended a compulsory pre-employment credentialling assessment.

Chief Nursing Officer’s Report (tab 5)

Ms T Bradfield, Chief Nursing Officer, reported that Exercise Cruickshank, a major

national multi-sector influenza pandemic planning exercise, would be held over

four days in May.

Health and Disability Commissioner’s Report Ms Bradfield informed the Committee that the organisation was being assessed against the Health and Disability Commissioner’s report on an incident at Capital

and Coast DHB. From a nursing perspective, Ms Bradfield said she was comfortable with the systems in place but checks were being made to ensure they

were being utilised appropriately.

Mr R W Bunton, Chief Medical Officer, advised that the Health and Disability

Commissioner’s report had engendered a lot of discussion and Chief Medical Officers were meeting in Wellington to determine if there should be a unified

response. Mr Bunton said that an assurance could be given that the Otago DHB had systems in place that were as good as they were anywhere else but he was

not sure that a total assurance could be given that such an incident would not happen, as personal relationships and judgement calls could not be prescribed.

Members discussed the Capital and Coast incident and debated the importance of contributing systems factors and personal responsibility.

Midwifery Ms Bradfield was pleased to report that Jenny Woodley had commenced as

Midwifery Director.

Nursing Student Placements Ms Bradfield advised that she had not yet met with the Otago Polytechnic to

further discuss student placements in the hospital but she had noted the Committee’s comments on this issue. She advised that placements had not been

able to be given to five students out of 120 and other opportunities for clinical exposure for these students were being explored.

During discussion, members emphasised the importance of staff training by all

health providers.


7.0 PERFORMANCE REPORTS

Key Performance Indicators (tab 6) The Committee reviewed the performance reports for March 2007 and noted the

following points.

Percentage of Emergency Department Patients Seen within Specified Times (KPI#2)

Dr C Coop, Acting Chief Operating Officer, advised that triage 3 and 4 targets were not being met, with the main contributing factors being the number of

attendances, staff vacancies and sick leave.

Overtime Dr Coop advised that the main contributing factor to the increase in overtime was vacancies in Mental Health. High occupancy in the Neonatal Intensive Care Unit

(NICU) and extra joints completed at the weekends were subsidiary contributing

factors.

Total Admissions versus Number Added Above the Threshold Dr Coop advised that there was an issue with the Orthopaedics data, relating to the impact of joint initiative cases, which was being investigated. It was noted

that there may also be a possible issue with cataract reporting.

Did Not Attend (DNA) Rates Whilst Otago’s DNA rates were about the second lowest in the country, it was

agreed that the level of DNAs was still undesirable and efforts had to be made to reduce this waste of resources.

In response to members’ questions, Dr Coop advised that the Provider Arm had

33-35 different departments dealing with outpatients and their appointment practices all differed. This would be addressed when the Outpatients Project

commenced mid-year.

Activity Inpatient IDF Outflows

Members noted that reported inpatient IDF outflows for the six months to the end

of December 2006 were less than budget but they were advised that this could have been affected by delays in reporting.

Outpatients It was noted that the reported outpatient activity did not include nurse led clinics.

Financial Report (tab 7)

In speaking to the Financial Report as at 31 March 2007, Mr G Paris, Business

Analyst, highlighted the following points.


The March Provider result was favourable to budget, giving a year to date

surplus of $6.5 million.

The main driver of the favourable revenue variance was a catch-up on the joint (orthopaedic) initiative, with 37 joints completed in March against a

budget of 14.

The favourable revenue variance was offset by unfavourable expenses and staff costs.

Following the presentation of his report, Mr Paris answered members’ questions.

Action Point 261 Management were advised that any change in policy regarding the minor capital

threshold should be submitted to Board for approval.

Strategic Initiative Report (tab 8)

In speaking to the Strategic Initiative Report, Dr C Coop, Acting Chief Operating Officer, highlighted the changes that had occurred over the month and answered

members’ questions on these.

Clinical Group Reports (tab 9)

The Committee reviewed the Clinical Group reports for March 2007.

Diagnostic & Support Services Group Dr C Coop, Acting Chief Operating Officer, highlighted the following events:

The opening of the new breast screening facility on 18 April by the Minister of Health;

The installation of the Radiology Information System (RIS) and Computed Tomography (CT) Scanner;

Implementation of the new waste initiative.

Emergency Medicine & Surgery Services Group Visiting Hours

Members debated the proposal to more actively enforce hospital visiting hours to allow staff to carry out clinical duties and patients to rest versus keeping public

access as open as possible.

Volunteers

The assistance provided by volunteers in the Emergency Department was

gratefully acknowledged. Mrs V J Blake, Chief Operating officer, indicted that she would like to roll this model out to other services but attracting enough volunteers

was a problem.

Dr J O Medlicott left the meeting at 11.45 am.


Mental Health and Clinical Services Dr Coop reported that the main issue affecting Mental Health Services during

March had been staff vacancies. She commented that detailed planning could not occur until the outcome of the new Mental Health services proposal was

known.

Report Format Action Point 262 It was suggested that it would be useful for the report summaries to be divided

into groups.

Human Resources (tab 10)

The Human Resources report was taken as read. Dr C Coop, Acting Chief Operating Officer, brought the following items to the Committee’s attention.

The statutory minimum four weeks annual leave was introduced on 1 April 2007;

HR staff had been focussed on putting the Southern Alliance joint venture into

operation and ensuring that the two HR teams started working together as one;

A number of industrial negotiations were under way and several of these had

proceeded to industrial action.

Capital Expenditure (tab 11)

It was noted that the CT Scanner Room upgrade and the Breast Screening relocation had been completed within budget.

Quality Improvement and Risk Management (tab 12)

Accreditation and Certification The summary of the verbal feedback from surveyors on the survey and audit

completed during the week of 19 March 2007 was noted.

Complaints Members supported the proposal to make the process for complaints more

accessible and personalised, possibly with verbal contact. It was noted that there was evidence that a prompt and meaningful response on behalf of the

organisation, ie a clear indication that the complaint had been taken on board and would be looked into, had a great deal of value in mitigating litigation.

Moved Prof R D H Stewart, seconded Mrs M A Gamble, that the Executive and Operational Reports be noted.

Carried


8.0 ACTION SHEET Moved Prof R D H Stewart, seconded Mr R J Thomson, that the action sheet (tab 13) be noted.

Carried

9.0 NEXT MEETING

29 May 2007.

CONFIDENTIAL SESSION Moved by Prof R D H Stewart, seconded Mr P E Menzies, that the public be excluded from the meeting to consider the following agenda items:

General subject: Reason for passing this resolution:


1. Previous Confidential

Meeting Minutes 2. Confidential HR

Report

3. Confidential CMO Report

4. Risk Register 5. Confidential Meeting

Action Sheet

To allow

activities to be carried on without

prejudice or disadvantage

S 34(a), Schedule 4, NZ Public Health and

Disability Act 2000 – that the public conduct of this part of the meeting would be likely to result in the disclosure of information for

which good reason for withholding exists under sections 9(2)(i) & (j) of the Official Information Act 1982, that is, the withholding of the information is necessary to enable a Minister

of the Crown or any Department or organisation holding the information to carry out, without prejudice or disadvantage,

commercial activities and negotiations.

Carried

Mrs M A Gamble left the meeting at 12.05 pm.


Certified as a true and correct record:

Chairman: ____________________________

Date: ____________________________


ELECTIONS 2007 – ORDER OF CANDIDATES ON VOTING PAPER As per Standing Order 2.19.1, the Chief Executive Officer gives notice that he has

received a written request from Ms Louise Rosson that the Board re-debate the following resolution passed by Board on 8 March 2007:

That the random system be used to determine the order in which candidate names appear on voting documents.

This request has been signed by not less than one-third of Board members.

***************************** The following is the relevant section of the report on the 2007 Elections considered by Board at its 8 March 2007 meeting. 3. ORDER OF CANDIDATES ON VOTING PAPER

The Local Electoral Regulations 2001 gives local authorities (including DHBs) the

option to choose the order of candidates on the voting document. The options are:

(a) Alphabetical by surname

(b) Pseudo-random order – where names are ‘drawn out of a hat’ and that order appears on every document

(c) Random order – where every voting document effectively has a different order on it, ie the order of candidates is randomly generated for every elector.

Pros and Cons:

Alphabetical order has the advantage that voters can find candidates easily on the

voting form. Candidate profile statements will be published in alphabetical order.

A fully random option is given to avoid the possibility of unfair advantage if

electors choose to vote or rank candidates in descending order from the top of

the list. The main disadvantages are that candidate profiles will not be in the same order as the names on the voting papers and it will increase administrative

complexity.

The pseudo-random (‘names out of a hat’) option also has the disadvantage that

candidates’ names on the voting papers will not be in the same order as the candidate profiles.

The Board has until 29 June 2007 to decide on the order of candidates’ names. If a resolution is not passed by then, the default arrangement is alphabetical by

surname.

Jeanette Kloosterman

Board Secretary

30 April 2007

2007 Elections 30/04/2007 1

ALPHABETICAL BALLOT SHEETS: WHY I’D RATHER BE ATHOLL THE ARDVARK THAN ROCKY THE RACOON A request has been made to review the decision taken to run a random order ballot paper in the DHB elections this year. I believe that the information contained in this paper is relevant to any consideration of a change to the Boards policy. It discusses the impact of the “donkey vote” on voting outcomes and presents data that demonstrates that this was a very significant factor in determining who was elected to DHB’s in 2004. It contrasts the outcomes in DHB’s that used an alphabetical ballot paper versus those (like Otago) that used a randomised ballot paper. That analysis supports strongly the case for randomisation. The term “donkey vote” is one that is frequently used in Australian elections. Australia uses preferential voting (like STV as used in DHB elections). In Australia voting is compulsory. This has lead to some voters (either through lack of information or as a protest) simply ranking some or all candidates in the order that they occur on the ballot paper. Generally this occurs from the top down but it may also be from the bottom up. A range of academic papers estimate that the impact of this on the outcome is between 1.5% and 4% of the vote. It is estimated that this accounts for the outcome of approximately 10% of federal seats. EG King & Leigh in their paper “ballot order effects under compulsory voting” (2006) states: “ It has long been suspected that the order in which candidates’ names are placed on a ballot somehow influences the decision-making process of voters. Theories of ballot position have suggested, variously, that candidates benefit from being placed first on the ballot, due to a ‘primacy effect’, or last on the ballot, due to a ‘recency effect’ (Jacob, Kalmus and Luttmer 2004; Koppell and Steen 2004). These theories are based on the notion that voters are less likely to make rational decisions when presented with a choice of candidates about whom they have little information. When voters are ignorant about a series of candidates they seek other cues, such as name familiarity or a candidate’s political party, to assist the decision-making process (Miller and Krosnick 1998). In the absence of any such cues, or where voters are ignorant about or ambivalent towards the candidates presented, it has been shown that the ordering of candidates on the ballot influences a voter’s decision (Upton and Brook 1975; Bakker and Lijphart 1980; Darcy and McAllister 1990; Brockington 2003; Koppell and Steen 2004; Alvarez, Sinclair and Hasen 2006). These studies have not uniformly agreed on the size of the ballot order effect, nor on whether the benefit accrues only to those at the top of the ballot. The type of election may also matter. Ho and Imai (2004) suggest that if a ballot order effect does exist, it tends to affect only local, relatively unpublicised elections or those elections where the candidates are non-partisan or are largely unknown to the voting public.

In the majority of studies however, the ‘primacy effect’ of first place on the ballot has been shown to deliver the greatest benefit to candidates. Analysing Ohio state elections, Miller and Krosnick (1998) suggest that first place increases a candidate’s percentage of votes earned by 2.3 percentage points compared with last place on the ballot. Ho and Imai (2004) alternatively show that candidates in non-partisan elections increase their vote share by 3.3 percentage points when listed first on the ballot, while candidates in Democratic or Republic primary races boost their vote by between 2 and 4 percentage points when listed first” I believe that there is a strong argument that can be made that DHB elections strongly fit the categorisation of non-partisan, local, and in which the candidates are largely not well known to the voting public. It is also likely to be the case that some names will be well known and a large number not. In such a situation in a ranking system election you could hypothesise that voters are likely to rank those names known to them first. They will then do one of three things to the balance:

• Carefully consider whatever information has been provided with the ballot papers and continue ranking.

• Decide to rank only those names that they feel some confidence in and not rank

at all those candidates that they do not feel a confidence in or do not feel they know enough about to rank.

• Rank those they know or value as above and then complete ranking the others

regardless. It is in this kind of situation that there is an increased likelihood that remaining candidates will be ranked in the order that they appear on the ballot paper.

If one feels that this is important and distorts election outcomes in a non sensible manner then you will find the randomisation option a sensible precaution that removes this impact Whilst there is overseas evidence that this occurs one might decide that the impact is sufficiently small or unproven and ignore it. A justification for this might be that alphabetical listing is the simplest to find candidates names on and is what people are used to seeing, so there would have to be a strong reason for doing it differently. In my view the answer to that question is best provided by analysis of what happened in New Zealand in 2004. The answer to that question is startling in my view. EMPIRICAL ANALYSIS OF 2004 RESULTS In 2004 five Boards (including Otago) used a randomised ballot paper. Sixteen Boards used an alphabetical listing. The difference between outcomes in those two groupings is large and shows, both within and across samples, that the choice of option significantly

affects who gets elected. Some examples just to illustrate: (To assist with interpretation you should know that in alphabetical listing Boards 29% of candidates were successful and in random list Boards 27% were successful. This is because the relative number of positions available versus candidates standing was slightly different in each case)

• In those DHB’s where names were listed alphabetically, 53% (8 out of 15) of candidates whose name started with “A” were elected (versus the average of 29%). In those who used randomisation 30% (3 out of 10) were elected (versus the average of 27%. But that is a small sample size you might say.

• OK. Lets look at those candidates whose names were from A to D.

Alphabetically listed elections returned 49% (49 out of 99) of those as successful candidates, compared with the average across all names of 29%. This is almost 70% more than you would expect. In randomised ballot papers 24% (9 out of 38) of candidates were successful versus the 27% average.

• If your name was Atholl the aardvark you had more than twice as much chance of

being elected in an alphabetical listing Board than poor old rocky the Racoon. His group (names from Q to T) only got 21% (14 out of 68) of their members elected. If Rocky had been sensible and stood in a random listing Board he would have increased his chances to pretty much bang on the national average for randomised Boards (29%, 8 out of 28, versus the average of 27%).

I could go on, but perhaps the best way to see how alphabetic listing has distorted the outcomes is to look at the following two graphs. The first graph shows the impact of alphabetic position on the overall results. I hypothesised that if there was an impact due to order it would be strongest in names at the beginning of the alphabet and would progressively diminish as names started with later numerals. One test of this is to add each letter of the alphabet progressively to the mix. First look at A’s only, then look at A’s + B’s, then A’s to C’s etc. (it would obviously also be good to look at each letter alone but this results in too small a sample size to give a reliable result for most letters). As can be seen from the graph below the effect of position is very powerful in Boards that use alphabetical listing. However, there is no effect in Boards that use a random list.

IMPACT OF ALPHABETIC V'S RANDOM ORDER ON VOTING OUTCOMES IN 2004 DHB ELECTIONS

0%10%20%30%40%50%60%

A - A A - C A - E A - G A - IA - K A - M A - O A - Q A - S A - U

A - W A - Y

ALPHABETIC CATEGORY

% O

F C

ATE

GO

RY

ELEC

TED

Alphabetic Random

The second graph shows the impact of position in the alphabet on likelihood of being elected by breaking the alphabet down into four letter groups (6 for the last group – but there aren’t any x’s or z’s so it is effectively 4) and comparing each groups success rate in the two systems.

IMPACT OF ORDER BY CONSOLIDATED LETTER GROUPINGS

0%

10%

20%

30%

40%

50%

60%

A - D E - H I - L M - P Q - T U - Z

ALPHABETIC GROUPINGS

% O

F C

ATE

GO

RY

ELEC

TED

Alphabetic Random

Both graphs show an extremely strong impact, due to position on the ballot paper, on likelihood of election. Those candidates that are listed high on the paper have up to twice as much chance of being elected than those placed further down the ballot paper. This effect is removed when names are randomised. CONCLUSIONS There is no logical reason that I can think off why Atholl the Aardvark is a better candidate than Rocky the Racoon simply because of their name. Yet Atholl is twice as likely to be elected as Rocky purely because of their name. If that is how democracy should be determined then the world is an even sillier place than I have credited it to be. There may be some logical reason why Aadvarks make better Board members than Racoons. There may be even a reason why Racoons are better governors than Aadvarks. People should be able to make their own decision and vote accordingly. They ought to be able to do so knowing that their considered opinion will not be upset by donkey voting distorting the outcome. In 2004 Rocky would have needed to get almost twice a many deliberate, considered, votes than Atholl in order to get elected simply because Atholl got considered votes and the donkey vote. The figures clearly demonstrate that. It is not a small impact. It is a large impact. In DHB elections that used random ballot papers these effects did not occur. Rocky or Atholl got elected because people wanted them to be and voted for them deliberately. That seems like a pretty sound system to me and a close approximation to what is supposed to happen in a democratic election. Instead of considering changing back to a flawed system we should probably be asking for an investigation into how deeply flawed the 2004 elections were in 16 other DHB’s Richard Thomson

FUNDING ADMINISTRATIONCONTRACTS REGISTER (EXPENSES) - APRIL 2007

CONTRACT/VARIATIONPROVIDER NAME DESCRIPTION OF SERVICES SIGNED BY END DATE

Orthotics Otago LimitedOrthotics Services are an integrated component of support services for people who have disabilities and for whom some form of ortisosis has been assessed as being required.

Richard Thomson 30.06.09Agreement

Budge's Central Pharmacy and Book Shop LimitedPharmacy Services Base Agreement and Special Foods Infant Formulae. New nationally negotiated agreement.

Judy Walker 28.02.10Pharmacy Services Agreement

Oamaru Pharmacy Limited Pharmacy Services Base Agreement including Methadone Services and Special Foods Infant Formulae. New nationally negotiated agreement.


V R Witt t/a Tapanui Pharmacy Pharmacy Services Base Agreement including Methadone Services and Special Foods Infant Formulae. New nationally negotiated agreement.


The Salvation Army New Zealand TrustThis contract funds an alcohol and other drug intensive community based brief intervention programme of 80 hours for targeted groups with similar needs. The focus in Dunedin city is programmes for women. Programmes in Oamaru and Central Otago focus on s

Chris Fraser 31.03.08Variation to Agreement

Te Roopu Tautoko Ki Te Tonga Inc This service provides a range of general health education and promotion, advisory, liaison and co-ordination activities specifically targeted at Rangatahi


Elsdon Enterprises Limited t/a Thornbury House Rest Home Thornbury facility in process of being assigned at the time the national variation to increase prices was actioned. New provider did not get increased rate on assigned contract.

Michael Bradfield EvergreenVariation to Agreement

West Otago Health Limited Community Health Services - To promote and maintain independence of people having difficulty in caring for themselves. To provide district nursing, physiotherapy, O/T and speech therapy. Meals on wheels.


Radius Residential Care Limited t/a Fulton HomeRadius Residential Care, trading as Radius Fulton Home is a rest home. They are able to provide appropriate care for mental health consumers with high and complex needs who are not assessed a 'like in age and interest' to people over 65 years. This cont


Excel - Funding Administration - Contracts Register - April 2007

FUNDING ADMINISTRATIONCONTRACTS REGISTER (EXPENSES) - APRIL 2007

Mornington Primary Health Organisation

PHO Agreement - Add service specification for Maori & Pacific Island Health Nurse utilising services to improve access and health promotion funding. Pilot for two years. Objective to ensure activities of PHO are coordinated and effectively targeted for


Alzheimer's Disease & Related Disorders Society Otago t/aDementia carer support - to assist carers of sufferers from dementia, to cope with the role of caring for the person with dementia.

Chris Fraser 28.02.09Alzheimers Society Otago

Presbyterian Support - Otago Incorporated t/a Ross Home & Exceptional Circumstances palliative care for named individual Judy Walker 15.04.07HospitalService Schedule

Lucey Holdings Limited t/a North Otago DispensaryPharmacy Services, including Special Foods Services Infant Formulae Judy Walker Evergreen

Pharmacy Service Agreement

TOTAL AMOUNT FOR THE MONTH: $1,632,992.65

Excel - Funding Administration - Contracts Register - April 2007


DOCUMENT REGISTER – APRIL 2007

Description Signed By

Document Otago District Health Board / …

Type

Brief Explanation

Value

1

2

Solicitor Review

Contingent

Liability

Anniversary

Date

Ministry of Health Service Agreement (Revenue)

Provision of Intellectual Disability Services

$1,744,496 Richard Thomson

- - - 30 June 2007

3 May 2007

BOARD ACTION SHEET As at April 2007

Action Point No.

SUBJECT ACTION REQUIRED BY STATUS EXPECTED COMPLETION

DATE 143-10/05

&

259-04/07

Community Consultation Process (Minute item 6.0)

Presentation to be made to Board on the DHB’s consultation process, to allow

members to review this and provide reassurance that the DHB’s consultation strategy meets current expectations and that a defined process is followed.

RGMP&F Planned for June 2007 Board meeting. June 2007

195-04/06 Te Waka Hauora (Minute item 2.0)

A group to be convened to explore the issues and find a resolution in the context

of overall prioritisation of services. Key objectives to be considered before the process. Also to be considered in the

context of PHOs and Māori health providers.

KHM Ensuring effective primary care services for Maori has been added as an initiative to

the 2007/08 DAP. A working party will be convened to assist the Otago DHB in developing strategies to ensure whanau

who aren’t accessing primary care are engaged with primary providers and PHOs.

PHOs are also in the process of rolling out their Maori Health Plans.

December 2007

247-02/07 Master Site Planning (Minute item 7.0)

The establishment of a capital reserve to be referred to FAR Committee.

RCFO Work in progress.

250-03/07 Oncology Growth (Minute item 6.0)

1. The Clinical Director, Emergency & Medicine to be invited to give a

presentation to the Board. 2. Clarification to be provided on:

How the introduction of more

efficient radiation machines and new treatment protocols equated to reduced capacity;

Whether machine QA (quality

assurance) processes could be completed out of hours;

How the cost of running existing

facilities for longer hours compared to the cost of additional capital investment;

Whether it would be feasible to site the proposed third Linac in Southland and what Southland’s role in this would be.

COO Will be actioned upon Clinical Director’s return from sabbatical leave.

May 2007

Action Point No.

SUBJECT ACTION REQUIRED BY STATUS EXPECTED COMPLETION

DATE 252-03/07 Access to Primary,

Secondary and Tertiary Health Care for People with Intellectual Disabilities in Otago (Minute item 9.0)

Key points raised by Board members to be

conveyed to the Working Party.

RGMP&F Work in progress.

253-03/07 Contracts/Documents Registers (Minute item 11.0)

Documents Register to be reformatted to

distinguish between contracts where funds are paid to the DHB and those where the DHB pays contractors.

RCFO Work in progress.

257-04/07 Interests Register (Minute item 3.0)

Dr Sijnja and Mrs Gamble’s entries to be updated.

BS Completed. n/a

258-04/07 PHOs (Minute item 6.0)

Reports to the Board on the progress of PHOs to be resumed.

CEO RGMP&F

Noted. Will be reported in the May 2007 CPHAC/DSAC.

May 2007

260-04/07 DSS Funding (Minute item 7.0)

Clarification to be provided on how additional DSS funding for carer travel is being tagged for that purpose.

RGMP&F 10% increase to Home Support rates includes a 2.4% FFT increase.

OTAGO DISTRICT HEALTH BOARD - Southern DHB · OTAGO DISTRICT HEALTH BOARD BOARD MEETING Thursday, 3...

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Transcript of OTAGO DISTRICT HEALTH BOARD - Southern DHB · OTAGO DISTRICT HEALTH BOARD BOARD MEETING Thursday, 3...