-
‘Aakina to ora, hei oranga mauroa’ – Mahaki Albert, Tumu Tikanga
CM Health Look after yourself to preserve health and wellbeing
Counties Manukau District Health Board – Community & Public
Health Advisory Committee
COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC
HEALTH ADVISORY COMMITTEE (CPHAC)
Wednesday, 27 January 2021
Venue: Room 103, Ko Awatea, Middlemore Hospital; 100 Hospital
Road, Otahuhu; Auckland Time: 9.00am
Committee Members Colleen Brown – Committee Co-Chair Pierre Tohe
– Committee Co-Chair Barry Bublitz – Mana Whenua Dianne Glenn –
CMDHB Board Member Katrina Bungard – CMDHB Board Member Lana Perese
– CMDHB Board Member Paul Young – CMDHB Board Member Apulu Reece
Autagavaia – CMDHB Board Member Robert Clark – Mana Whenua Tipa
Mahuta – CMDHB Board Member
CMDHB Management Fepulea’i Margie Apa – Chief Executive Aroha
Haggie – Director, Funding & Health Equity Dr Gary Jackson –
Director, Population Health Dr Campbell Brebner – Chief Medical
Advisor, Primary & Integrated Care) Jessica Ibrahim –Executive
Advisor to the CE Vicky Tafau – Secretariat Board Observers
Brittany Stanley-Wishart Tori Ngataki
AGENDA: PART I – Items to be considered in this public
meeting
1. AGENDA ORDER AND TIMING Page No.
2. GOVERNANCE
9.00am
2.1 Apologies 2.2 Register of Interests
2.2.1 Does any member have an interest they have not previously
disclosed? 2.2.2 Does any member have an interest that may give
rise to a conflict of interest with
a matter on the agenda? 2.3 Confirmation of Public Minutes of
the Community & Public Health Advisory Committee
Meeting – 16 December 2020 2.4 Action Items Register 2.5 CPHAC
Draft Workplan 2021
002
003 005
006
016 018
3. UPDATES
9.30am 10.00am 10.30am
10.50am
11.05am
11.35am
3.1 Asian Health Status & Population Growth (Kitty Ko, Asian
Health Gain Advisor, Population Health)
3.2 Localities Update (Penny Magud, General Manager Locality
Services) 3.3 Faster Cancer Treatment Reporting Data (Aroha Haggie,
Director Funding & Health
Equity) Morning Tea 3.4 South Auckland Social Wellbeing Board;
5-Year Strategy (2020 – 2025) and 2-Year Action
Plan (Ann Wilkie, Programme Director) 3.5 Metrics that Matter; 6
Month Summary to December 2020 (Paul Hewitt, Senior Planning
Advisor; Zizi Jasim, Planning Advisor) – to be included
019
041 045
048
4. INFORMATION PAPER
4.1 Action Item from ARF: Implications of Covid-19 on Primary
Care 070
11.50am 5. RESOLUTION TO EXCLUDE THE PUBLIC 080
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
CPHAC BOARD MEMBER ATTENDANCE SCHEDULE 2021
Name 27 Jan Feb 10 Mar 21 April May 2 June 14 July 25 Aug Sept 6
Oct 17 Nov
Colleen Brown (Co-Chair)
No
Mee
tin
g
No
Mee
tin
g
No
Mee
tin
g
Pierre Tohe (Co-Chair)
Barry Bublitz
Dianne Glenn
Katrina Bungard
Lana Perese
Paul Young
Apulu Reece Autagavaia
Robert Clark
Tipa Mahuta
Brittany Stanley-Wishart
Tori Ngataki
002
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
CPHAC MEMBERS
DISCLOSURE OF INTERESTS
16 December 2020
Member Disclosure of Interest
Colleen Brown
(CPHAC Co-Chair)
Chair, Disability Connect (Auckland Metropolitan Area)
Member, Advisory Committee for Disability Programme Manukau
Institute of Technology
Member, NZ Down Syndrome Association
Husband, Determination Referee for Department of Building and
Housing
Chair, Rawiri Residents Association
Director and Shareholder, Travers Brown Trustee Limited
Board Member, NZ Neighbourhood Support
District Representative, Neighbourhood Support NZ Board
Pierre Tohe
(CPHAC Co-Chair)
Senior Executive, Tainui Group Holdings
Trustee, Taniwha Marae
Barry Bublitz Director, International Indigenous Council for
Healing Our Spirits Worldwide
Patron - Management Team, Te Mauri Pimatisiwin (A Journal of
Aboriginal and Indigenous Community Health)
Chair - Māori Research Review Committee
Chair, Wikitoria King Whānau Trust
Chair, Eva Newa Wallace Whānau Trust
Secretary, Mataitai Farm Trust
Turuki Health Care – Employee
Co – Chair Mana Whenua Kei Tamaki Makaurau Board
Co-Chair Kaitiaki Roopu: Whakangako te Mauri o te Tangata
Dianne Glenn Member, NZ Institute of Directors
Life Member, Business and Professional Women Franklin
Member, UN Women Aotearoa/NZ
Life Member, Friends of Auckland Botanic Gardens and Chair of
the Friends Trust
Life Member, Ambury Park Centre for Riding Therapy Inc.
Member, National Council of Women of New Zealand
Justice of the Peace
Member, Pacific Women’s Watch (NZ)
Member, Auckland Disabled Women’s Group
Life Member of Business and Professional Women NZ
Interviewer, The Donald Beasley Research Institute for the
monitoring of the United Nations Convention on the Rights of
Persons with Disabilities.
Member, Lottery Individuals with Disabilities Committee
Member, Expert Advisory Group to the Retirement Commissioner
working on retirement income
Katrina Bungard Deputy Chairperson MECOSS – Manukau East Council
of Social Services.
Elected Member, Howick Local Board
Deputy Chair, Amputee Society Auckland/Northland
003
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Member of Parafed Disability Sports
Member of NZ National Party
Lana Perese Director & Shareholder, Malatest International
& Consulting
Director, Emerge Aotearoa Limited Trust
Trustee, Emerge Aotearoa Housing Trust
Director, Vaka Tautua
Director, Malologa Trust
Director & Shareholder, Perese Wood Investments Limited
Paul Young Councillor, Auckland Council
Director, Paul Young International Ltd
Apulu Reece Autagavaia Member, Pacific Lawyers’ Association
Member, Labour Party
Trustee, Epiphany Pacific Trust
Trustee, The Good The Bad Trust
Member, Otara-Papatoetoe Local Board
Member, Pacific Advisory Group for Mapu Maia – Problem Gambling
Foundation
Board of Trustees Member, Holy Cross School
Member of the Cadastral Surveyors Board
Assessor of the Creative Communities Scheme South & East
Auckland
Robert Clark Chair Manawhenua I Tamaki Makaurau Health Board
Member of Te Whakakitenga (Waikato/Tainui Tribal Parliament)
Depty Chair Waikato Tainui Appointments Committee
Depty Chair Huakina Marae Forum
Ngati Tiipa Lands/ Te Kotahitanga Marae Trustee
Chair Counties Maori Rugby
Crown appointed Tangata Kaitiaki for Waikato Awa and West Coast
Harbours
Cultural Advisor for Counties Manukau Police
Deputy Chair of Te Hiku O te Ika
Tipa Mahuta Deputy Chair, Te Whakakitenga o Waikato
Councillor, Waikato Regional Council
Brittany Stanley-Wishart Deputy Chair, Pasifika Students in
Health in NZ (charity that receives funding from CM Health for its
biennial conference)
Tori Ngataki Board member, Ngāti Tamaoho Trust 2016 to 2020
(restanding) Board member, Second Natures Trust 2016 to 2021
Marae Rep, Te Whakakitenga o Waikato Inc 2017 to 2021
(restanding)
Director, Keep it Māori Ltd (social enterprise) 2019
004
-
Counties Manukau District Health Board –Community & Public
Health Advisory Committee 27 January 2021
COMMUNITY and PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS’ REGISTER
OF DISCLOSURE OF SPECIFIC INTERESTS
Specific disclosures (to be regarded as having a specific
interest in the following transactions) as at 16 November 2020
Director having interest Interest in Particulars of interest
Disclosure date Board Action Pierre Tohe Public Excluded Agenda of
8
April 2020 Mr Tohe does work for Waikato/Tainui.
8 April 2020 That PierreTohe’s specific interest is noted and
the Committee agreed that he may remain in the room and participate
in any deliberations of the Committee but is not permitted to
participate in any decision making, if applicable.
Lana Perese Integrated Primary Mental Health & Addiction
Services (IPMHAS)
Malatest International, the company Ms Perese is a Director and
Shareholder for, are evaluating IPMHAS. Also, Ms Perese is a Board
Director for Vaka Tautua which is one of the providers in the
Pacific Collaborative and potentially one of the Awhi Ora
providers
9 September 2020 That Lana Perese’s specific interest is noted
and the Committee agreed that she may remain in the room and
participate in any deliberations of the Committee but is not
permitted to participate in any decision making, if applicable.
005
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Minutes of Counties Manukau District Health Board Community and
Public Health Advisory Committee
Held on Wednesday, 4 November, 2020 at 9.00am – 11.30pm Room
101, Ko Awatea, 100 Hospital Road, Middlemore Hospital, Otahuhu,
Auckland
PART I – Items considered in Public Meeting
BOARD MEMBERS PRESENT
Colleen Brown (Co-Chair) Dianne Glenn Katrina Bungard Lana
Perese Paul Young Apulu Reece Autagavaia Robert Clark (Mana Whenua)
Brittany Stanley-Wishart (Board Observer)
ALSO PRESENT
Fepulea’i Margie Apa (CEO, CM Health) Dr Gary Jackson (Director,
Population Health) Aroha Haggie (Director, Funding & Health
Equity) Dr Christine McIntosh (acting Chief Medical Officer,
Primary & Integrated Care), standing in for the seconded Dr
Campbell Brebner) Jessica Ibrahim (Executive Advisor to the CE)
Vicky Tafau (Secretariat) (Staff members who attended for a
particular item are named at the start of the minute for that
item)
PUBLIC AND MEDIA REPRESENTATIVES PRESENT
No media representatives were in attendance.
WELCOME
The meeting commenced at 9.00am with a welcome from Colleen
Brown.
1. AGENDA ORDER AND TIMING
Items were taken as per the agenda.
006
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
2. GOVERNANCE
2.1 Apologies
Apologies were received from Pierre Tohe, Barry Bublitz and Tori
Ngataki and Robert Clark, Margie Apa and Aroha Haggie for
lateness.
2.2 Register of Interests
Disclosure of Interests – no amendments to note. Disclosure of
Specific Interests – no disclosures to note.
2.3 Confirmation of the Minutes of the joint Hospital Advisory
Committee/Community and Public Health Advisory Committee/Disability
Advisory Committee meeting held on 4 November 2020. Resolution
(Moved: Colleen Brown/Seconded: Dianne Glenn) That the minutes of
the Community and Public Health Advisory Committee meeting held on
4 November 2020 be approved. Carried
2.4 Action Items Register/Response to Action Items Ms Tafau to
put all provider presentations into the Resource Centre. CPHAC were
happy with Action Item progress. The Kootuitui response was
noted.
2.5 CPHAC Work Plan 2021 CPHAC asked for regular Oral Health
updates to be added to the work plan. Conversation ensued around
Oral Health service delivery in practices around Counties Manukau
and peoples’ negative experiences and how that might follow that
up. In terms of what is happening in the Prevention space, Dr
Jackson suggested asking ARDS and CADS to present to the committee
around explaining their customer feedback process. Auditing of
contracts to also be put on the work plan.
3. UPDATES 3.1 Mana Kidz Update to CPHAC (Phil Light, acting
General Manager-Integrated Child Youth; Dr Philippa
Anderson, Public Health Physician and Claudelle Pillay,
Immunisation Nurse Leader) Mana Kidz is a comprehensive school
based, nurse-led child health programme delivered in 88 schools
across the Counties Manukau region. There are approximately 34,000
tamariki consented onto the programme. 59 schools have a nurse and
whaanau support worker in school each day and 29 schools have a
nurse in school once a week. To supplement schools, Mana Kidz run
an 0800 line where schools and whaanau can ring if they have any
child health concerns, the aim of this line is to connect whaanau
with the appropriate team or service where applicable. The
comprehensive child health programme has three arms; rheumatic
fever prevention through sore throat management, skin infection
management and child health assessment and management. Dr Anderson
gave a broad overview of the information provided in the report and
note the following points:
007
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Mana Kidz has established more rigorous follow ups for
patients.
Nurse practitioners are working with the teams to assist in
increasing access for whaanau.
A lot of work has gone into providing training for nasal
pharyngeal swabbing.
Asked CPHAC to note the amount of research that is underway with
the programme. Looking at piloting COVID testing within schools,
potentially for the entire whaanau.
Mana Kidz is a valuable workforce in terms of past responses, eg
Measles in 2019, COVID in 2020.
RH Fever – in the May 2019 budget $12M was allocated for 4
years. The bulk of that funding was for a co-design piece. This has
now been contracted. ThinkPlace are partnering with local Maaori
& Pacific re innovative approaches to Rh Fever prevention and
treatment.
CPHAC advised that they would like to receive a copy of the
ThinkPlace report to the Ministry of Health. Dr Anderson told CPHAC
that the hope is that the information will flow both ways; CM
Health influencing ThinkPlace and ThinkPlace sharing data and
information with CM Health. The budget will also be divided between
the region to support programmes that are being implemented. Annie
Ualesi has been engaged by Think Place and a Maori contractor from
the Heart Foundation. Apulu Reece Autagavaia is hoping that the
funding will assist in resolving the racism issues that were raised
within the Rh Fever programmes dealing with whaanau. CPHAC was
advised that work is being done in KidzFirst around implicit racism
within the service. ThinkPlace have been clear that they wish to
work with CM Health. Action Invite MoH to provide their big picture
thinking around Rh Fever in Counties Manukau and regionally. CPHAC
would like Think Place to present around the ideas they have been
coming up with and how they’ll be implemented. June 2021. Colleen
is interested in how whaanau manage the purchasing of medication.
Dr Anderson advised that the medication is free. The premise of the
programme is that if we can deal with the Strep throats it will
prevent the Rh Fever. The focus of the programme is on the Group A
Strep Throats and Dr Anderson is pleased with the way this is
working. There is recognition that there is more work needed
locally in the health promotion space around Group A Strep Throat
and Rh Fever. Alliance Health+ has been funded to undertake this
work. In regard to the Impetigo Programme; if a child has impetigo
then comprehensive hygiene information is provided to the whaanau.
Clean, Cut, Cover is the information provided. Packs are given to
take home. Various programmes are working with whaanau to ensure
that homes either have washing machines or have access to washing
machines. Laundromat use is quite common for many homes. Ms Pillay
advised that there has been much improvement with impetigo over the
years and this has been corroborated by CM Health nursing staff. It
was reiterated to CPHAC that Ms Haggie will be bringing an
Immunisations Review to CPHAC in 2021.
008
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
3.2 Women’s Health in the Community Update (Dr Christine
McIntosh, acting Chief Medical Advisor, Primary & Integrated
Care) Dr McIntosh took CPHAC through the presentation, highlighting
the benefits of various forms of contraception. Hormonal
contraception has very low amounts of side-effects. It is essential
that providers in the community have the correct information to
provide to women in order for them to make fully informed decisions
around contraception. Contraception also assists women with
unplanned pregnancies; health issues, alcohol consumption, etc. A
planned pregnancy ensures that the woman can be in the best health
possible when planning to get pregnant. Through POAC women can be
referred to a practice that does provide contraception services. CM
Health offers free LARC free for women who are Maaori or Pacific,
quintile 5, CSC holders or are engaged in secondary mental health
services or CADS. Unintended birth is associated with poor health
and social outcomes for women. Reduced birth interval and >5
births carry increased risks for mama and pepe. 48.6% of post-natal
women reported having no antenatal discussion about contraception.
Removing financial barriers is key for women who are Maaori or
Pacific, Quintile 5, CSC holders or women involved with secondary
mental health services or CADS. Dr McIntosh noted that access to
the morning after pill has also improved. Primary Care and midwives
take responsibility for providing contraception information
antenataly so that women can be prepared. Best Start Pregnancy Tool
has the dissemination of this information built in. Birthing Hubs
will also be included in discussions around contraception
information dissemination. Apulu Reece Autagavaia noted that if all
women are well, all of the time, unintended pregnancies wouldn’t be
such an issue. Social and cultural norms associated with whaanau,
includes the value of whaanau. The tension about cultural norms and
well being can be difficult to navigate. Dr McIntosh advised CPHAC
that abnormal uterine bleeding is a prevalent problem in our
community (leads to anaemia) which can lead to uterine cancers.
This is compounded by obesity, so high rates for Pacific
particularly and also Maaori. GPs need to understand the issue, get
good background information and potentially take a biopsy.
Treatment offered is likely to be the mirena. This treatment
reduces periods almost totally, reduces anaemia and reduces the
risk of cells turning cancerous. So, communication/information is
crucial. Additional funding has been received to ensure more work
can be done in the community to assist women with Abnormal Uterine
Bleeding. The funding provided will go a long way to addressing the
equity gap. Action Dr McIntosh is to return to CPHAC in 2021 to
provide detailed information in regard to HPV in CM Health and a
presentation regarding the Best Start Pregnancy Tool.
5. RESOLUTION TO EXCLUDE THE PUBLIC
Resolution (Moved: Paul Young /Seconded: Robert Clark)
That in accordance with the provisions of Schedule 3, Clause 32
and Sections 6, 7 and 9 of the NZ Public Health and Disability Act
2000:
009
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
The public now be excluded from the meeting for consideration of
the following items, for the reasons and grounds set out below:
General Subject of items to be considered
Reason for passing this resolution in relation to each item
Ground(s) under Clause 32 for passing this resolution
2.1 Confirmation of Public Excluded Minutes 4 November 2020.
That the public conduct of the whole or the relevant part of the
proceedings of the meeting would be likely to result in the
disclosure of information for which good reason for withholding
would exist, under section 6, 7 or 9 (except section 9(3)(g)(i)) of
the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3,
S32(a)]
Confirmation of Minutes As per the resolution from the public
section of the minutes, as per the NZPH&D Act.
3.1 Strategic Discussion That the public conduct of the whole or
the relevant part of the proceedings of the meeting would be likely
to result in the disclosure of information for which good reason
for withholding would exist, under section 6, 7 or 9 (except
section 9(3)(g)(i)) of the Official Information Act 1982.
[NZPH&D Act 2000 Schedule 3, S32(a)]
Commercial Activities The disclosure of information would not be
in the public interest because of the greater need to enable the
Board to carry out, without prejudice or disadvantage, commercial
activities. [Official Information Act 1982 S9(2)(i)]
Carried This first part of the meeting concluded at 10.30am.
SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT
HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING
OF 16 DECEMBER 2020.
__________________________________ Colleen Brown Committee
Co-Chair
010
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Minutes of Counties Manukau District Health Board Community and
Public Health Advisory Committee
Held on Wednesday, 4 November, 2020 at 9.00am – 11.30pm Room
101, Ko Awatea, 100 Hospital Road, Middlemore Hospital, Otahuhu,
Auckland
PART I – Items considered in Public Meeting
BOARD MEMBERS PRESENT
Colleen Brown (Co-Chair) Dianne Glenn Katrina Bungard Lana
Perese Paul Young Apulu Reece Autagavaia Robert Clark (Mana Whenua)
Brittany Stanley-Wishart (Board Observer)
ALSO PRESENT
Fepulea’i Margie Apa (CEO, CM Health) Dr Gary Jackson (Director,
Population Health) Aroha Haggie (Director, Funding & Health
Equity) Dr Christine McIntosh (acting Chief Medical Officer,
Primary & Integrated Care), standing in for the seconded Dr
Campbell Brebner) Jessica Ibrahim (Executive Advisor to the CE)
Vicky Tafau (Secretariat) (Staff members who attended for a
particular item are named at the start of the minute for that
item)
PUBLIC AND MEDIA REPRESENTATIVES PRESENT
No media representatives were in attendance.
WELCOME
The meeting commenced at 9.00am with a welcome from Colleen
Brown.
1. AGENDA ORDER AND TIMING
Items were taken as per the agenda.
011
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
2. GOVERNANCE
2.1 Apologies
Apologies were received from Pierre Tohe, Barry Bublitz and Tori
Ngataki and Robert Clark, Margie Apa and Aroha Haggie for
lateness.
2.2 Register of Interests
Disclosure of Interests – no amendments to note. Disclosure of
Specific Interests – no disclosures to note.
2.3 Confirmation of the Minutes of the joint Hospital Advisory
Committee/Community and Public Health Advisory Committee/Disability
Advisory Committee meeting held on 4 November 2020. Resolution
(Moved: Colleen Brown/Seconded: Dianne Glenn) That the minutes of
the Community and Public Health Advisory Committee meeting held on
4 November 2020 be approved. Carried
2.4 Action Items Register/Response to Action Items Ms Tafau to
put all provider presentations into the Resource Centre. CPHAC were
happy with Action Item progress. The Kootuitui response was
noted.
2.5 CPHAC Work Plan 2021 CPHAC asked for regular Oral Health
updates to be added to the work plan. Conversation ensued around
Oral Health service delivery in practices around Counties Manukau
and peoples’ negative experiences and how that might follow that
up. In terms of what is happening in the Prevention space, Dr
Jackson suggested asking ARDS and CADS to present to the committee
around explaining their customer feedback process. Auditing of
contracts to also be put on the work plan.
3. UPDATES 3.1 Mana Kidz Update to CPHAC (Phil Light, acting
General Manager-Integrated Child Youth; Dr Philippa
Anderson, Public Health Physician and Claudelle Pillay,
Immunisation Nurse Leader) Mana Kidz is a comprehensive school
based, nurse-led child health programme delivered in 88 schools
across the Counties Manukau region. There are approximately 34,000
tamariki consented onto the programme. 59 schools have a nurse and
whaanau support worker in school each day and 29 schools have a
nurse in school once a week. To supplement schools, Mana Kidz run
an 0800 line where schools and whaanau can ring if they have any
child health concerns, the aim of this line is to connect whaanau
with the appropriate team or service where applicable. The
comprehensive child health programme has three arms; rheumatic
fever prevention through sore throat management, skin infection
management and child health assessment and management. Dr Anderson
gave a broad overview of the information provided in the report and
note the following points:
012
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Mana Kidz has established more rigorous follow ups for
patients.
Nurse practitioners are working with the teams to assist in
increasing access for whaanau.
A lot of work has gone into providing training for nasal
pharyngeal swabbing.
Asked CPHAC to note the amount of research that is underway with
the programme. Looking at piloting COVID testing within schools,
potentially for the entire whaanau.
Mana Kidz is a valuable workforce in terms of past responses, eg
Measles in 2019, COVID in 2020.
RH Fever – in the May 2019 budget $12M was allocated for 4
years. The bulk of that funding was for a co-design piece. This has
now been contracted. ThinkPlace are partnering with local Maaori
& Pacific re innovative approaches to Rh Fever prevention and
treatment.
CPHAC advised that they would like to receive a copy of the
ThinkPlace report to the Ministry of Health. Dr Anderson told CPHAC
that the hope is that the information will flow both ways; CM
Health influencing ThinkPlace and ThinkPlace sharing data and
information with CM Health. The budget will also be divided between
the region to support programmes that are being implemented. Annie
Ualesi has been engaged by Think Place and a Maori contractor from
the Heart Foundation. Apulu Reece Autagavaia is hoping that the
funding will assist in resolving the racism issues that were raised
within the Rh Fever programmes dealing with whaanau. CPHAC was
advised that work is being done in KidzFirst around implicit racism
within the service. ThinkPlace have been clear that they wish to
work with CM Health. Action Invite MoH to provide their big picture
thinking around Rh Fever in Counties Manukau and regionally. CPHAC
would like Think Place to present around the ideas they have been
coming up with and how they’ll be implemented. June 2021. Colleen
is interested in how whaanau manage the purchasing of medication.
Dr Anderson advised that the medication is free. The premise of the
programme is that if we can deal with the Strep throats it will
prevent the Rh Fever. The focus of the programme is on the Group A
Strep Throats and Dr Anderson is pleased with the way this is
working. There is recognition that there is more work needed
locally in the health promotion space around Group A Strep Throat
and Rh Fever. Alliance Health+ has been funded to undertake this
work. In regard to the Impetigo Programme; if a child has impetigo
then comprehensive hygiene information is provided to the whaanau.
Clean, Cut, Cover is the information provided. Packs are given to
take home. Various programmes are working with whaanau to ensure
that homes either have washing machines or have access to washing
machines. Laundromat use is quite common for many homes. Ms Pillay
advised that there has been much improvement with impetigo over the
years and this has been corroborated by CM Health nursing staff. It
was reiterated to CPHAC that Ms Haggie will be bringing an
Immunisations Review to CPHAC in 2021.
013
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
3.2 Women’s Health in the Community Update (Dr Christine
McIntosh, acting Chief Medical Advisor, Primary & Integrated
Care) Dr McIntosh took CPHAC through the presentation, highlighting
the benefits of various forms of contraception. Hormonal
contraception has very low amounts of side-effects. It is essential
that providers in the community have the correct information to
provide to women in order for them to make fully informed decisions
around contraception. Contraception also assists women with
unplanned pregnancies; health issues, alcohol consumption, etc. A
planned pregnancy ensures that the woman can be in the best health
possible when planning to get pregnant. Through POAC women can be
referred to a practice that does provide contraception services. CM
Health offers free LARC free for women who are Maaori or Pacific,
quintile 5, CSC holders or are engaged in secondary mental health
services or CADS. Unintended birth is associated with poor health
and social outcomes for women. Reduced birth interval and >5
births carry increased risks for mama and pepe. 48.6% of post-natal
women reported having no antenatal discussion about contraception.
Removing financial barriers is key for women who are Maaori or
Pacific, Quintile 5, CSC holders or women involved with secondary
mental health services or CADS. Dr McIntosh noted that access to
the morning after pill has also improved. Primary Care and midwives
take responsibility for providing contraception information
antenataly so that women can be prepared. Best Start Pregnancy Tool
has the dissemination of this information built in. Birthing Hubs
will also be included in discussions around contraception
information dissemination. Apulu Reece Autagavaia noted that if all
women are well, all of the time, unintended pregnancies wouldn’t be
such an issue. Social and cultural norms associated with whaanau,
includes the value of whaanau. The tension about cultural norms and
well being can be difficult to navigate. Dr McIntosh advised CPHAC
that abnormal uterine bleeding is a prevalent problem in our
community (leads to anaemia) which can lead to uterine cancers.
This is compounded by obesity, so high rates for Pacific
particularly and also Maaori. GPs need to understand the issue, get
good background information and potentially take a biopsy.
Treatment offered is likely to be the mirena. This treatment
reduces periods almost totally, reduces anaemia and reduces the
risk of cells turning cancerous. So, communication/information is
crucial. Additional funding has been received to ensure more work
can be done in the community to assist women with Abnormal Uterine
Bleeding. The funding provided will go a long way to addressing the
equity gap. Action Dr McIntosh is to return to CPHAC in 2021 to
provide detailed information in regard to HPV in CM Health and a
presentation regarding the Best Start Pregnancy Tool.
5. RESOLUTION TO EXCLUDE THE PUBLIC
Resolution (Moved: Paul Young /Seconded: Robert Clark)
That in accordance with the provisions of Schedule 3, Clause 32
and Sections 6, 7 and 9 of the NZ Public Health and Disability Act
2000:
014
-
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
The public now be excluded from the meeting for consideration of
the following items, for the reasons and grounds set out below:
General Subject of items to be considered
Reason for passing this resolution in relation to each item
Ground(s) under Clause 32 for passing this resolution
2.1 Confirmation of Public Excluded Minutes 4 November 2020.
That the public conduct of the whole or the relevant part of the
proceedings of the meeting would be likely to result in the
disclosure of information for which good reason for withholding
would exist, under section 6, 7 or 9 (except section 9(3)(g)(i)) of
the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3,
S32(a)]
Confirmation of Minutes As per the resolution from the public
section of the minutes, as per the NZPH&D Act.
3.1 Strategic Discussion That the public conduct of the whole or
the relevant part of the proceedings of the meeting would be likely
to result in the disclosure of information for which good reason
for withholding would exist, under section 6, 7 or 9 (except
section 9(3)(g)(i)) of the Official Information Act 1982.
[NZPH&D Act 2000 Schedule 3, S32(a)]
Commercial Activities The disclosure of information would not be
in the public interest because of the greater need to enable the
Board to carry out, without prejudice or disadvantage, commercial
activities. [Official Information Act 1982 S9(2)(i)]
Carried This first part of the meeting concluded at 10.30am.
SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT
HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE MEETING
OF 16 DECEMBER 2020.
__________________________________ Colleen Brown Committee
Co-Chair
015
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Items once ticked complete and included on the Register for the
next meeting, can then be removed the following month.
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Community & Public Health Advisory Committee Meeting –
Action Items/Resolution Register – 16 December 2020
DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES
COMPLETE
Standing Items
Locality Updates: Provide updates for Locality Hubs in general
until established enough to provide individual deep dives.
27 January 2021
Penny Magud
ARPHS – six-monthly update. 2 June and
17 November 2021
Doone Winnard
Quarterly Non-Financial Summary: Quarterly report. 27 January
2021
Paul Hewitt Agenda Item 3.5 Metrics that Matter
20/21 Metro Auckland SLM Improvement Plan – quarterly
report.
10 March 2021 Robin van Ausdall
26.9.2018 3.1 4.3 Healthy Families New Zealand: Update to CPHAC
in 6 months’ time. HFNZ have issued an invitation to host CPHAC at
Amersham Way, Manukau.
TBC Phil Light Have not been able to confirm for December. Will
try for early 2021.
1.7.2020 4.1 Utilisation of Auckland Regional HealthPathways:
CPHAC asked Auckland Regional HealthPathways to return in a years’
time. CPHAC would like to be updated on how well has equity been
‘baked in’ and include progress on links to Disability.
2 June 2021 Catherine Turner
9.9.2020 4.1 Mental Health: The team were asked to report back
to CPHAC in three months’ time providing strategic analysis on how
the work we do works in with the rest of the country. Include
information around future demand.
10 March Charles Tutagalevao, Ian Soosay, Pam Hewlett
4.11.2020 3.1 Covid Testing Strategy: CM Health Board wish to be
kept up to date with where this strategy is at, due to workforce at
places like hotels and Americold type workplaces, are likely to be
South Auckland residents.
TBC TBC
4.11.2020 3.2 Faster Cancer Treatment: reporting data to be
provided to CPHAC.
27 January Aroha Haggie
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Items once ticked complete and included on the Register for the
next meeting, can then be removed the following month.
Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES
COMPLETE
4.11.2020 3.2 Immunisation Rates Early 2021 Aroha Haggie ELT’s
work programme has a deep dive on Immunisations to pick apart what
is happening there. Ms Haggie will come back to the committee as
soon as they can with the plan of where they need to focus
16.12.2020 3.1 Rheumatic Fever Funding: Invite MoH to provide
their big picture thinking around Rh Fever in Counties Manukau and
regionally. CPHAC would like Think Place to present around the
ideas they have been coming up with and how they’ll be implemented.
June 2021.
2 June
16.12.2020 3.2 Women’s Health in the Community: Dr McIntosh is
to return to CPHAC in 2021 to provide detailed information in
regard to HPV in CM Health and a presentation regarding the Best
Start Pregnancy Tool.
017
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Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
DRAFT CPHAC Committee Work Plan 2021
Meeting Date Strategic Deep Dive Operational Deep Dive Standing
Items External / Regional Presentations Public Excluded
27 January Intesectoral Collaboration
SWB – 5 Yr Strategy & 2 Yr Action Plan (Ann Wilkie)
Asian Health: Health Status & Population Growth (Kitty
Ko)
Localities Update (Penny Magud)
Metrics that Matter
(Paul Hewitt & Zizi Jasim)
10 March
Primary & Integrated Care Community Workforce &
Capacity
(Matt Hannant & Campbell Brebner)
Te Ranga Ora Update (Matt Hannant)
Mental Health - Provide analysis on how the work we do works in
with the rest of the
country. Include information around future demand.
(Charles Tutagalevao, Ian Soosay, Pam Hewlett)
SLM Improvement Plan Quarterly Report (Kate Dowson
National Hauora Coalition – Current State & Future
Planning
(Dr Rawiri Jansen, Simon Royal)
Funder Report/Dashboard (Timing TBC) (Fran Voykovich)
21 April Treaty of Waitangi Audit Results (TBC)
(Sharon McCook)
Pacific Health – Fanau Ola Update incl Nurses presenting Patient
Stories
(Doana Fatuleai)
Winter Plan – Focus on Vaccinations (Fran Voykovich)
Q3 Non-Financial Summary Report TBC
(Paul Hewitt & Zizi Jasim)
Mental Health & Addiction: Suicide
Prevention/Postvention
progress report
2 June Provider Development
(Aroha Haggie/Funder GMs)
Health Pathways – Innovations & Learnings from 2020 and how
well has equity been ‘baked in’. Include progress on links to
Disability. (Campbell Brebner, Catherine Turner)
ARPHS 6-Monthly Update to CPHAC
Jane McEntee
Funder Report/Dashboard (Timing TBC) (Fran Voykovich)
Budget 21/22 Funder Discussion
(Aroha Haggie, Steve Murray)
14 July
What is happening in the Prevention space? ARDS & CADS re
their customer feedback
process. (Gary Jackson)
Consumer Council re Engagement in the Community
Renee Greaves
Te Ranga Ora Progress Update (Earnest Pidakala, Matt
Hannant)
Localities Update (Penny Magud)
SLM Improvement Plan Quarterly Report
(Kate Dowson)
Contract Auditing
(?)
25 August Weight Reduction Service
(Gary Jackson)
Alcohol Harm Minimisation – Strategy Refresh (Gary Jackson)
Women’s Health: Best Start Pregnancy Tool
(Dr McIntosh)
Annual Report (Paul Hewitt & Zizi Jasim)
Q4 Non-Financial Summary Report
TBC (Paul Hewitt & Zizi Jasim)
Funder Report/Dashboard (Timing TBC)
(Fran Voykovich)
6 October Update on Women’s Health
Primary Birthing Units (Mary Burr/Sarah Tout)
Southern Corridor Progress (Alan Greenslade)
Startwell Nurses – How has 2021 been for
vulnerable mothers/whaanau?
Funding Arrangements to ensure Improved Health Outcomes for
Vulnerable Whaanau
(Aroha Haggie)
17 November Smokefree 2021/Vaping Area Update
(Basil Fernandes)
SLM Improvement Plan Quarterly Report (Kate Dowson
Q1 Non-Financial Summary Report
TBC (Paul Hewitt & Zizi Jasim)
ARPHS 6-Monthly Update to CPHAC Jane McEntee
Funder Report/Dashboard (Timing TBC) (Fran Voykovich)
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Date:
Asian Health Asian Health Status & Population Growth
January 2021
Kitty KoAsian Health Gain Advisor
Directorate of Population Health
Hello, Kia Ora, Talofa Lava, Namaste, Nǐ hǎo, Pagbati,
An-young-ha-se-yo, Jom reab suar, Xin Chao
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Asian population in Counties Manukau & Who are Asian
people?
The New Zealand health and disability sectorclassifies ethnicity
data according to theMinistry of Health protocols. The term
‘Asian’used in the New Zealand Census and relateddata sets, refers
to people with origins in theAsian continent, from China in the
north toIndonesia in the south and from Afghanistanin the West to
Japan in the East. This differsfrom the definition used in other
countriessuch as the United Kingdom or the USA.
Reference: Counties Manukau Health (2020). Annual Plan 2020/21.
Auckland. Counties Manukau Health. Retrieved from
https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2020-21-CM-Health-Annual-Plan-incorporating-2020-21-Statement-of-Perform....pdf
020
https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2020-21-CM-Health-Annual-Plan-incorporating-2020-21-Statement-of-Perform....pdf
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Asian populations in Counties Manukau
The largest Asian sub-groups in Counties Manukau in 2018 were
Indian (~half) and Chinese (~a third). The highest numbers resided
in Eastern locality (Howick, Pakuranga) and Manukau locality
(Papatoetoe, Manurewa, Papakura)
Reference: Lees J., Lee M. & Winnard D .(2021) Demographic
Profile: 2018 Census, Population of Counties Manukau. Auckland:
Counties Manukau Health. In publication.
CM Health localities by prioritised ethnic groups, ER population
2018
Maaori Pacific AsianNZ Euro/
OtherTotal
Eastern 9,300 6,700 68,200 71,200 155,700
Franklin 14,600 3,400 6,800 55,900 82,500
Manukau 48,400 50,000 63,300 49,600 210,300
Maangere/Ootara 19,600 65,200 18,600 10,000 112,300
Total 92,360 125,440 158,040 191,170 567,010
Maaori Pacific AsianNZ Euro/
OtherTotal
Eastern 6% 4% 44% 46% 100%
Franklin 18% 4% 8% 68% 100%
Manukau 23% 24% 30% 24% 100%
M/O 17% 58% 17% 9% 100%
Total 16% 22% 28% 34% 100%
Chinese Filipino Indian Korean Other Asian
TotalAsian
% of CM HealthAsian pop
32% 6% 48% 3% 11% 100%
% of CM population
9% 2% 13% 1% 3% 28%
Estimated ER count
51,030 11,340 73,710 5,670 17,010 158,040
CM Health Asian subgroups, 2018
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Life expectancy
• Life expectancy of Asian people is consistently greater than
both the overall life expectancy and the average life expectancy of
NZ European/Other ethnic groups.
• When we look deeper into the drivers of life expectancy, we
see diversity of health status within the many Asian ethnicity
subgroups.
• As the ‘healthy migrant effect’ typically reduces over 5-7
years of New Zealand residency, to sustain this relatively high
life expectancy, we are focused on early ill-health prevention and
effective management of long term conditions in our Indian and
Chinese communities.
Reference: Counties Manukau Health (2020). Annual Report 2019.
Auckland. Counties Manukau Health. Retrieved from
https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2019_CM_Health_Annual_Report.pdf
022
https://www.countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Annual-reports-and-plans/2019_CM_Health_Annual_Report.pdf
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Diabetes prevalence by ethnicity in Auckland metro in 2018
• Pacific, Indian and Māori populations have the highest
diabetes prevalence in the Auckland metro region. Based on
longitudinal laboratory results, the crude diabetes prevalences for
people aged 15 and over were 15.1%, 12.0% and 8.6% for Pacific,
Indian and Māori populations in metro Auckland in 2018.
• By age 70, 19% of the adult population of metro Auckland in
2018 had developed laboratory-confirmed diabetes. This varied
significantly by ethnicity, with European/Other at 12% compared
with Indian at 44% and Pacific at 50%. Reference:
Chan, W. C., Lee, M. (AW) & Papaconstantinou, D. (2020).
Understanding the heterogeneity of the diabetes population in Metro
Auckland in 2018. Auckland: Counties Manukau Health. Retrieved from
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf
023
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf
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Diabetes prevalence by ethnicity and NZDep2013 quintile in metro
Auckland in 2018
• Pacific people living in the most socioeconomic deprived areas
have the highest diabetes prevalence.
• Pacific and Indian people living in the least socioeconomic
deprived areas in Auckland metro still have almost twice the age
standardised diabetes prevalence than the New Zealand European and
Other group living in the most socioeconomic deprived areas.
Reference: Chan, W. C., Lee, M. (AW) & Papaconstantinou, D.
(2020). Understanding the heterogeneity of the diabetes population
in Metro Auckland in 2018. Auckland: Counties Manukau Health.
Retrieved from
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf
024
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Understanding_the_Heterogeneity_of_the_diabetes_pop.pdf
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Number of poorly controlled diabetes by ethnicity and by DHB in
2019
Reference: Chan, W. C. & Lee, M. (AW) (2020). Update on
Diabetes prevalence in 2019 based on laboratory results in the
Auckland Metropolitan Region (from TestSafe). Auckland: Counties
Manukau Health. Retrieved from
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020-09-Updates_on_diabetes_prevalence_in_2019.pdf
There are over 6,000 Indian people with diabetes living in CM
Health. While more likely to have controlled diabetes than Maaori
and Pacific people with diabetes there are still ~16% with very
poorly controlled diabetes
025
https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020-09-Updates_on_diabetes_prevalence_in_2019.pdf
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Access to prevention services by ethnicity
Reference: Draft Counties Manukau Health Annual Report 2020.
026
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Access to prevention services by ethnicity
Reference: Draft Counties Manukau Health Annual Report 2020.
Asian data is not reported here?
027
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Access to early detection and management services by
ethnicity
Reference: Draft Counties Manukau Health Annual Report 2020.
Asian data is not reported here?
028
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Barriers to access services
Practical barriers
Lack of English languageproficiency
Inadequate knowledge andawareness of existinghealth services
Cultural barriers
Intense stigmatisation aroundmental illness that exists
amongmany Asian cultures
Religious beliefs, and culturaldifferences in the presentationas
well as treatment of mentalillness
Systemic barriers
Lack of interpreter services orculturally / linguistically
appropriatehealth information
Lack of bilingual health professionals,incompatible Western
healthtreatment models
Lack of cultural competence in healthcare
Reference: Ko, S. W. K. (2013). A Review of Asian Mental Health
Service Development in Auckland, New Zealand (Unpublished master’s
dissertation). University of Auckland, Auckland, New Zealand.
029
-
Barriers to access services
Reference: Cen, D. (2017). Project report for preventing
barriers to Immunisation for Asian population in the Counties
Manukau region. Auckland: Counties Manukau Health.
030
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Making health decisions by ethnicity and age group
Reference: Azhaara, A. (2017). POPULATION HEALTH 302
ORGANISATION PROJECT REPORT - Oral Health in Young People.
Auckland: Counties Manukau Health.
Half of the young participants stated their parents made health
decisions for them instead of them making own health decisions even
these young people were already in their early 20s.
A Chinese elderly also said family member made health decisions
for him/her; again this is very common among Asian cultures for
adult children make decision for their elderly parents.
The above show the cultural differences when accessing,
approaching and utilising health services; thus, a specific
approach to engage with Asian communities is needed in health
promotion and delivering health services.
031
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Factors affecting health decisions by ethnicity and age
group
Reference: Azhaara, A. (2017). POPULATION HEALTH 302
ORGANISATION PROJECT REPORT - Oral Health in Young People.
Auckland: Counties Manukau Health.
Cost was a major factor affecting health decisions for young
participants; while language and transport were barriers for
elderly Chinese.
For adults who were parents, time, priority and cost were the
factors affecting health decisions as they needed to work and look
after their families; they often put their own health to the last
on their priority list.
The above shows different age groups within Asian communities
need different approaches when accessing, approaching and utilising
health services.
032
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Asian Health Gain Advisor role
Build RelationshipsTo establish & grow collaborative and
positive relationships
LeadershipProvide advice, promote and facilitate Asian health
gain by influencing local
ownership and commitment to integrated & collaborative
approaches
Local Strategic & Annual Planning
Provide advice, encouragement & support to Locality
Leadership Groups in development of Asian health gain
activities
Evaluation, Reporting & Communication
Support the Planning Team in building planning & performance
reporting in a
manner that enhances visibility at executive & service
delivery levels
across the district
Regional Planning Liaison & Networking
Be a visible advocate for the health & wellbeing of the
diverse Asian communities living in Counties
Manukau
Service Development Advice & Support
Work closely with subject matter experts to build their
understanding of Asian health needs and challenge CM
Health’s performance and opportunities to improve
Asian Health Gain Advisor
033
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Asian Health Gain Advisor role
CM Health Asian Health & Wellbeing Community Network
currently has over 230 members; across DHBs, PHOs, NGOs and
community organisations including students and individuals who are
interested in Asian Health.
Members include Chinese, Indian, Filipino, Korean, Vietnamese,
Cambodian, Japanese, South Asian, and others, etc.
034
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Asian Health Gain Advisor role
Asian cultural celebrations
& Asian Health
Action Roadmap
035
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Asian Health Gain Advisor role
Cultural advice needed
Asian speaking support
Asian speaking
therapists
Asian info and resources for cancer patients and families
Chinese and Vietnamese
lawyers
Cultural input for diagnosing and
developing treatment plan for Asian mental health service
users
Cultural input into updating CM
Health’s policies & procedures
Queries for accessing services
in CM Health
Share learning and influencing&
Requests from frontline clinicians
036
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Communities in Action (Community Flu Fighters Programme in Asian
communities)
Korean Positive Ageing Charitable Trust Takanini School Road
Gurdwara Sri Kalgidhar Sahib Temple
Wat Khemaraphirataram Cambodian TempleBotany and Flat Bush
Ethnic Association
• A total of 945 individuals received the vaccines in 2020.
• 568 from Chinese organisations, 85 from Indian, 148 from
Korean, 9 from Cambodian, and 135 from ethnically diverse
organisations.
Transport, language, time, priorities, mistrust, and lack of
support are barriers to the elderly Asian population accessing
influenza vaccinations via the traditional access points of G.P
practices or community pharmacies.
Influenza immunisation rates can be improved by offering
vaccinations where elderly Asian people socialise as social
connectedness is fundamental to Asian culture and
“community is where the heart is”. 037
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Communities in Action (Community Flu Fighters Programme in Asian
communities)
038
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Well-done Asian Communities!
039
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Questions & Answers
Source:
https://elearning.tki.org.nz/Media/Images/Equity-vs-equality
040
https://elearning.tki.org.nz/Media/Images/Equity-vs-equality
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Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Counties Manukau District Health Board Community & Public
Health Advisory Committee
Locality Community Health Services - Community Hubs Update
Recommendation It is recommended that the Community & Public
Health Advisory Committee: Receive the update on the Locality
Community Health Service Community Hubs. Note this report is being
simultaneously submitted to the 267 January Executive Leadership
Team meeting.
Prepared and submitted by: Penelope Magud General Manager
Locality Services on behalf of Margie Apa, CEO, Counties Manukau
Health. Executive Summary This paper details the developments that
have occurred to date in regards to the utilization of the 4
Community Hubs and details the developments approved to be
implemented over the next 6 months. Background Counties Manukau
Health (CM Health) has for several years been progressing a
programme of work which is progressively integrating and extending
the role of Primary Care and Community Health Services within the
District’s health and social care system. Grow Community Hubs is a
key investment strategy for CM Health, with the intention to
deliver more outpatient/ambulatory services closer to patients’
homes in Primary Care and locality based Community Hubs. This is
part of a broader health service delivery network connecting
general practice, community care, specialist services, Middlemore
Hospital and Manukau Health Park. The plan is for Community Hubs to
offer a core suite of services, beyond the scope of general
practice, as well as specific services appropriate to the needs of
the locality population. The hubs will provide the necessary
community infrastructure to enable provision of extended services
in the locality community areas and enable an expanded range of
services to be delivered in the community from a ‘neutral space’
where a range of professionals can work from, and patients can be
referred to, in a model that complements established GP-patient
relationships and enhances CM Health provision of more accessible
ambulatory care. Locality Community Health Service manages 4
Community Hubs in Mangere, Otara, Botany and Pukekohe as well as
the integrated Mental Health and Community Health facility at
Awhinatia in Takinini. The service is still currently delivering
District Nursing Services from Building 38 Western Campus,
Middlemore, however plans are being developed to ensure that these
clinics transfer to the hubs at Mangere and Otara. Services can be
and are delivered directly or coordinated virtually from these 5
community sites. As Community Hubs are primarily about services,
rather than facilities, they are located and organised differently
in each locality taking into account pre-existing local services,
service mobility needs, operating models and optimal service
location.
041
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Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
As Community Hubs are further developed they will be an integral
part of an integrated continuum connecting health and social
services across home, community, NGOs, general practice and
hospital settings. They will be supported by an effective
information and communication system. Community Hub Developments to
date: Mangere Hub Mangere Hub is in Waddon Place; it currently has
7 clinic rooms which over quarter 1 & 2 of the 20/21 financial
year has had in excess of 4,500 clinic attendances at the following
clinics:
Acute Allied Health Clinics
Cardiology
Child Development
Contraception clinic
Diabetes
Endocrinology
Gastroenterology
General Medicine
Neurology
Ophthalmology Diabetes
Pediatric Medicine
Podiatry
Psychological Medicine
Renal Medicine
Respiratory Medicine
Rheumatology
Stroke Otara Hub Otara Hub is located at 112 Braids Road, Otara.
This is a property which is owned by Ngati Tamahoo and until
November 2020 CM Health held a license to occupy 6 clinic rooms.
The hub currently operates out of 6 Clinic rooms which over quarter
1 & 2 if the 20/21 financial year has provided 1301 allied
health or nurse led clinics for Otara domiciled patients in the
following clinical areas:
Cardiology
District Nursing clinics (DN clinic volumes are not included in
the figure above)
Diabetes
Allied Health clinics
Maternity
Child development
Retinal Screening
Outreach Cervical Screening Ngati Tamaoho own the building and
CM Health has recently negotiated a 5-year lease of the whole
property. This will enable CM Health to expand clinic space from 6
to 11 clinics, as well as create a staffing hub for community
health staff & space to provide virtual telehealth. Eastern Hub
(Botany Superclinic) 14 clinic rooms providing in excess of 13,000
clinic attendances. Currently functioning at 94% utilization Monday
to Friday 8.30 – 4.30, this is an increase from 23% in February
2017 22% of all patients attending clinics in the Eastern Hub are
not Eastern Locality domiciled. District Nursing clinics 7 days per
week Retinal Screening Clinics 6 days per week Primary Care provide
evening cervical screening clinics Integrated care model being
developed,
042
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Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
The locality Community Health, Mental Health and Primary Health
staff are aware of the range of clinics that are run from the hub
and identify the opportunity for consultation or joint visits for
their patients.
The Nurse Clinic Coordinator has aligned clinics for patients to
reduce the need for patients to come to the hub multiple times in a
week.
Clinic Coordinator and Hub Nurses have spent time with
clinicians providing education on how the hub staff can support the
clinics in the provision of patient education and health care. This
has led to clinicians involving the hub nurse’s consultations to
enable patients’ needs to be better supported within the community
system e.g. referral to complex care, DN referral or additional
health education.
The hub has introduced a more comprehensive review of those
patients who DNA to help identify barriers to attendance rather
than just focusing on the process.
CM Health own the Unit Title for Unit A, with Care Group
(Formerly East Care owning the unit titles for B & C), Care
group have submitted a formal letter of interest to the Board to
purchase Unit A Pukekohe Hospital – Outpatients
Infusion clinic provided in partnership with Medicine has
commenced 1 day per week, providing blood transfusion and venous
sections to 4 local patients that would normally be admitted to
Middlemore Medical Assessment Unit weekly
Clinic Coordinator Registered Nurse has been recruited to, to
oversee the coordination of the clinics, ensure clinicians are
appropriately supported in line with the other hubs & Manukau
Health Park Modules
Locality Leadership Group submitted a report to Board Chair
& CEO in regards to local needs & short, medium & long
term recommendations of what needs to be delivered & developed
locally
Pukekohe Hospital Outpatients has the capacity to provide 6000
outpatient clinics per annum Monday to Friday. The current
facilities are 99% utilized providing 5,986 outpatient clinic
appointments per annum. This includes private Local Midwife
Clinics, as well as regional services such as Wheelchair Services,
Starship Diabetes services, CADS services
5% of patients attending clinics at Pukekohe Hospital are not
domiciled in the Franklin Locality. These patients are domiciled in
Manukau locality, typically in the Karaka, Drury region.
Approved Developments to occur in the next 6 months Locality
Community Health Services are working with all divisions to confirm
the clinics that should be delivered within each of the hubs as
well as the staffing level, competency and equipment that is
required to support new locality based community hub
services/clinics. Mangere
10 additional clinic rooms – 100 additional clinics per week
Monday to Friday with the opportunity to look at providing further
evening and weekend clinics, particularly with District Nursing
clinics relocating to Mangere hub and being required to operate 7
days per week with some evening clinics too.
District Nursing clinics to move from Building 38 to Mangere
Hub
Establishment of a community base for staff – Including
Community Health multidisciplinary nursing & allied health
teams as well as children’s services
Otara
5 additional clinic rooms; group therapy area – 60 additional
clinics or group sessions per week Monday to Friday. Like Mangere
there is the opportunity to look at providing further evening &
weekend clinics, particularly as all District Nursing clinics will
be provided in the hubs and away from western Campus. These clinics
will be operational 7 days per week with some evening clinics
too.
Re-establish District Nursing clinics across the week and extend
to cover evenings & weekends
Establishment of a community base for staff – including
Community Health multidisciplinary nursing & allied health
teams and Public Health Nursing
043
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Counties Manukau District Health Board – Community & Public
Health Advisory Committee 27 January 2021
Franklin
12 additional clinic and procedure rooms (e.g. physician and
nurse provider outpatient clinics; patient tele-health rooms;
infusions & minor surgical procedure rooms; nurse
support/preparation area; patient toileting facilities).
Ongoing development of the Community Ward to provide a medical
pathway to support admission avoidance & earlier transitions of
care from Middlemore Hospital
Awhinatia (Manukau)
As a CM Health community based multi service site the plan is to
ensure retinal screening has the ability to provide clinics from
this site. The service is currently working through contractual
issues with the clinic where screening is currently provided
from.
Opportunity to review what clinics could also be provided from
the Awhinatia site as part of an integrated model of care with
Mental Health and Locality Community Health Services.
044
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Counties Manukau District Health Board- Community & Public
Health Advisory Committee 27 January 2021
Counties Manukau District Health Board Community and Public
Health Advisory Committee
Faster Cancer Treatment Reporting Data
Recommendation It is recommended that the Community and Public
Health Advisory Committee: Receive the Faster Cancer Treatment
Reporting Data paper. Note this paper was endorsed by the Executive
Leadership Team on 15 December to go forward to the Community &
Public Health Advisory Committee for their information. Note that
the information provides an update of FCT performance and related
activity noting that the focus of FCT is predominantly at the
hospital for diagnosis and treatment. Note that FCT performance for
October 2020 is 88% in terms of the hospital based specialist
treatment being delivered within 62 days. Note that since May 2020,
the monthly performance remains at or above 85%. Covid19
contingency plans are in place to maintain cancer services across
various levels of alert status. Note that there is potential
benefit from further work to address joint Primary Care and
Hospital actions to ensure that Equity considerations are
adequately incorporated, and FCT can sustainably meet the target of
90%. Note the actions identified in the paper in relation to
continued development of FCT performance.
Prepared and submitted by: Aroha Haggie Director Funding &
Health Equity Glossary ADHB Auckland District Health Board CNC
Cancer Nurse Coordinator CTT Cancer Tracking Team DNA Did Not
Attend ED Emergency Department FCT Faster Cancer Treatment FSA
First Specialist Assessment GP General Practitioner MOH Ministry of
Health NCN Northern Cancer Network Purpose
The purpose of this paper is to provide an update on Faster
Cancer Treatment (FCT) reporting data in line with action 3.2 from
the 4 November 2020 Meeting of the Community and Public Health
Advisory Committee. Background FCT has a current target of 90% of
patients to receive their first cancer treatment (or other
management) within 62 days of being referred with a high suspicion
of cancer and a need to be seen within two weeks.
045
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Counties Manukau District Health Board- Community & Public
Health Advisory Committee 27 January 2021
The current reporting of FCT data is mandated by MOH for 13
tumour streams and the focus is on hospital patient flow
performance. Not all cancer care is included in the FCT reporting.
Rather FCT reporting is restricted to measuring the timing of care
where clear pathways are in place – 62-day pathways. Hospital based
cancer treatment The FCT target and current reporting is focused on
hospital based cancer patient flows, with performance recorded
against all tumour streams. Actual volume of treatment numbers are
not reported as part of FCT. One of the key challenges across all
the tumour streams is to ensure that FCT is a core priority of all
clinical teams and support staff involved in the patient pathway.
In the past 12 months services have refocused on the need to meet
the FCT target and are ensuring patients are continuously
facilitated, predominantly by the CNC and CTT. For the month of
October the achieved level of FCT was 88%. In terms of patient
numbers this means that 30 of 34 eligible patients were treated
within 62 days. If 1 additional patient had passed this would have
achieved the 90% target. Of the four patients who breached: two
patients were delayed in medical oncology at ADHB and two other
patients faced delays due to in-house capacity constraint.
A key component of all FCT activity is developing collegial
relationships across all services and also externally with regional
NCN colleagues and specifically with ADHB as the tertiary provider
of treatment. This includes engagement with regional meetings and
data evaluation to establish consistency in application of the
business rules to standardise the comparison of performance against
the target and monitor the various cancer pathways. Recently senior
managers and clinicians from the organisation’s cancer service
participated in a regional review of the gynaecological endometrial
cancer pathway to improve FCT performance. The cancer service
intends to progressively engage in similar regional reviews for
other tumour streams. Community/Primary Care Currently, the FCT
reporting data excludes any primary care related information.
However there are steps being taken to capture information that
will allow better monitoring of how patients are being detected and
progressed through the system of care. Cancer screening data, such
as for Breast and Bowel cancers are also reported separately and do
not form part of FCT reporting. From a population health
perspective,
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Counties Manukau District Health Board- Community & Public
Health Advisory Committee 27 January 2021
the Cancer Steering Group does ‘deep dives’ into specific tumour
streams (2-3 times a year). This provides an in-depth analysis of
cancer registrations, treatments, and mortality for that tumour
stream, as well as ethnicity-based volumes so that a reasonable
view of equity and outcome for each deep dive can be developed. FCT
is largely predicated on the specific grading of each patient by
hospital specialists for an FSA appointment. The hospital based
grading of patients for FSA is however dependent on the supplied
information from the GP. Equity Equity considerations are an
important part of the funding of services. Utilisation by ethnicity
indicates that in particular tumour streams, there is lower
achievement of FCT performance for Maori and Pacific patients. This
is difficult to measure on a month by month basis as the volumes in
each group are small. In the 12 month period Nov 2019 – Oct 2020
FCT performance has been 85% for both Maori and 85% Pacific
patients.
Discussion In the Counties Manukau district, there is a growing
and aging population, with an expected increase in incidence for
all cancer types. Volumes requiring specialised treatments such as
chemotherapy and radiotherapy are also projected to increase. There
will be increased capacity constraint, particularly in Breast,
Gynaecology and Head & Neck tumour streams. Patients require
upfront outpatient and diagnostic services to reach a diagnosis or
be excluded from the FCT pathway. This creates the need for
additional outpatients, radiological and biopsy procedures. The
decline in FCT performance against the target for Maori and Pacific
patients is particularly worrying. Delays to treatment impose ill
health onto the community and a poorer outcome for individual
patients. Reportedly, Maori and Pacific patients have trouble
engaging with services, demonstrate significantly higher outpatient
DNA rates in existing models of care and frequently have comorbid
conditions affecting management. This is not always evident as
patients that delay due to comorbidity or patient choice are
excluded from the FCT target. In the case of delays caused by
patient choice it is important to understand the barriers that
prevent individuals from engaging in timely access to services.
Hence, while the FCT target focus is predominantly at the hospital
for diagnosis and treatment, there are areas that would potentially
benefit from further collegial work with Primary Care. A community
focus can be taken to assist hospital FCT performance, as
follows:
Deeper review of the barriers for patients presenting to GP -
current data suggests that a significant number of patients (mainly
Maaori & Pacific) present to ED with subsequent diagnosis of
late stage cancer. It would be worth exploring what the gaps are,
and how these result in patients not being referred earlier or
obtaining an earlier diagnosis.
Potential of developing Marae based services and
like-opportunities that may improve the experience of Maaori
patients with a suspicion / diagnosis of cancer.
89.2% 94.7% 5.5%88.8% 100.0% 88.2% -11.8%376 334Total
84.6% 94.4% 9.8%85.3% 100.0% 83.3% -16.7%68 58Pacif ic
Islander
100.0% 100.0% 0.0%100.0% 0.0% 100.0% #DIV/0!6 6Other
81.3% 100.0% 18.8%84.6% 100.0% 100.0% 0.0%65 55Maori
100.0% 100.0% 0.0%100.0% 100.0% 100.0% 0.0%18 18Indian
90.2% 92.1% 1.9%European 186 170 91.4% 100.0% 81.8% -18.2%
-14.3% 100.0% 90.9% -9.1%
Variance
Asian 33 27 81.8% 100.0% 85.7%
Oct 2020 Variance May 2020 - Jul
2020
Aug 2020-Oct
2020
Period 01 Nov 2019 To 31 Oct
2020
Performance Trends last 6 months
62-day target: passes and
capacity breaches
Ethnicity
Patients Passed
62 Days
62 day
compliance
%
62 day
compliance
Trend
Sep 2020
FCT HeatMap Report Includes patients with first treatment period
01 Nov 2019 To 31 Oct 2020
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Counties Manukau District Health Board- Community & Public
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Developing information sets for primary care referrals so that
the decision making around cancer suspicion could be better
prioritised
Exploring the use of basic diagnostic tests in primary care to
support referrals (e.g. pipelle procedures undertaken in primary
care; to decongest the volume of patients on a suspicion of cancer
pathway as patients with a negative pipelle are more likely to not
have a cancer).
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South Auckland Social Wellbeing Board 5-Year Strategy (2020 –
2025) and 2-Year Action Plan
S
Appendix 1. 5-year strategy & 2-year work plan
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Contents
The South Auckland Social Wellbeing Board 3
Purpose of this document 4
Introduction – the next 5 years 5
What we know 6-8
Our Strategic Aspirations and Success Factors 9
Prevention, crisis and resilience building in an end-to-end
system 10
The 5 Year Strategy 11
Why are we doing this 12-13
Executing the Strategy - the 2 Year Action Plan 14
Accountabilities 15
2020/2021 Work Programme 16
Our commitment to innovate and disrupt 17
Infrastructure 18
Appendices – descriptions of new initiatives 19-21
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Independent Chair Sandra Alofivae
Advisor to the Chair Lewis Holden (State Services
Commission)
Accident Compensation Corporation: Neil Phillips
Council: Gael Surgenor
Ministry of Pacific Peoples Sina Aiolupotea- aiono
Ministry of Social
Mark Goldsmith
NZ Police John Tims
Oranga Tamariki Glynis Sandland
Te Puni Kokiri Martin Mariassouce
The South Auckland Social Wellbeing Board (as at June 2020)
Department of Corrections Alistair Riach
Kainga Ora Karen Hitchcock
Ministry of Education Isabel Evans
Ministry of Health Clare Perry
Ministry of Justice Julia Lynch
Counties Manukau DHB Margie Apa
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Our community is diverse and vibrant with
strong cultural values. We need to leverage the strengths and
work better together at all levels to achieve sustainable future
change
Engage Others in the diversity, equity challenge and
opportunties in our community
We need agency mandate at all levels to
enable our local leaders to do what it takes to make a
difference for our communities
Achieve Mandate to do what it takes to make a difference
for our children & whānau
As a Board we are committed to breaking down the barriers and
disrupting the
parts of the system that aren‘t working optimally for our
community
Ensure Commitment to break down the barriers & disrupt
the system where required
Purpose of this document
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Introduction The next 5 years – building on the work to date The
development of this 5 year strategy and 2 year action plan is
intended to create a shared medium term
vision, and to identify the actions required to achieve the 5
year goals. There is a deliberate shift to a “next
phase” view for the SASWB, building on the cross-cutting themes
from learnings to date. The 2 year action
plan is aligned to the confirmed 2 year funding path, including
the Joint Venture for Family Violence and Sexual
Violence (JV) funding for early years family violence
initiatives.
Factors impacting our community in the next 5 years
The Board has identified a number of factors that will impact
our local environment, and therefore the role
and function of the SASWB over the short-medium term,
including:
• An increased agency focus on relationships with Iwi and NGOs,
and enabling communities to take active
roles
• A strong focus on partnerships, prevention and participation,
however, at the same time,
acknowledgement of an increase in intensive support models that
are currently operating within single
agency silos
• Agencies’ operating models are evolving, building on learnings
from the COVID response, and include
a general shift by the majority of agencies from central to
local / regional decision making
• The COVID recovery response. There will be a significant
impact in South Auckland, particularly on
unemployment, housing, financial security and the resulting
psychological distress and trauma. There is
an exacerbation of existing stressors for already at risk
families, but also a population cohort who have
never required support before now accessing support. The Board
considers it has a role to play in
supporting South Auckland’s COVID recovery phase
• The social housing building programme (volume and density)
will have an impact on the ability of existing
infrastructure and supporting services including schools to meet
the needs of a growing and potentially
vulnerable population.
There is a consensus that the impact of these factors in the
medium term will benefit from enhanced
collaboration, a specific focus on communities of greatest need,
and a wellbeing strength based approach.
Our journey to date and the shift to the next phase
Since its inception in 2016, the SASWB has applied a
whānau-centred early support and prevention approach
to improving long term outcomes for children. The original ‘5
intervention settings’ have evolved over time,
to testing initiatives across the spectrum of prevention, crisis
and building whānau resilience. We recognise
the unique features of our community, the local nuances and the
need to understand the complexities and
growing inequity for our Māori and Pasifika populations. The
ongoing refinement of the PBI infrastructure,
governance and management arrangements, and the backbone
function over time, has enabled the SASWB
to test and learn rapidly, and therefore respond in a timely
way, to community needs as a collective, when
required.
Building resilient communities through greater collective
impact
The SASWB’s member agencies have collectively been on a journey
of mindset change, contributing to the
design of different ways of working that use evidence and
insights to achieve greater collective impact.
There is still more work to do to integrate the culture change
throughout the member organisations, and
this will be a key piece of work in the 2 year action plan.
Agencies have achieved a significant shift on the spectrum from
networking / co-ordination as a group,
where information was exchanged for mutual benefit, to an
advanced level of co-operation and
collaboration where there is now some common planning, formal
communication flows and some
resource sharing and concessions. The SASWB is on the cusp of
being able to achieve greater collective
impact and an end to end system; a system that will support and
enable communities to build social
capital, whānau resilience and long term intergenerational
change. The key elements required to achieve
this are highlighted in Figure 1, and work on these elements
form the foundation of the Board’s 5 year
strategy.
Figure 1: Key elements to
achieve greater collective
Impact and an end-to-end
system
There is more work to be done to make a long-term difference
through evidence-based disruption
Long term sustainability continues to be a key driver of the
SASWB’s strategy.
Embedding the collaborative way of working into core business,
and formalising iwi and community
partnerships will enhance our ability to respond to the
consistent theme across all SASWB prototypes; that
there is a high complexity of underlying stressors for a large
proportion of South Auckland families, and
systems are currently disproportionately accessible to those
that do not require them the most.
The strategy and action plan will reinforce the test and learn
approach but will also incorporate an intent
to act on its mandate to disrupt where necessary to achieve
outcomes for whānau. There will be support
for agencies to identify and implement core business
improvements that are gained from improved
collaboration; inform system level change; and to break down
organisational barriers and silos.
We will continue to support and work in partnership with other
PBIs and across Tāmaki Makaurau to
create an environment that supports and enables protective
factors in communities; share learnings; and present national
themes for system level change.
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What we know: There are many opportunities to make a real
difference for children and whānau
• Agency commitment, passion and investment in South
Auckland
• Effective collaborative / local infrastructure established
through building of
trusted relationships and mindset evolution over time – and a
recognition
that this takes time
• Deep understanding of South Auckland community, the
complexities of its
unique population groups & challenges
• A willingness to challenge the status quo and tackle what is
often considered
as “too hard”
• An Independent Board Chairperson
• Ability to incorporate strategic and operational insights
• Relationships functioning well with proven deliverables
• Diversity across agencies
• An agile backbone function / Implementation Office
• Focus on achieving a whānau-centred approach
• A common purpose driven by shared culture and vision &
ability to
influence and challenge each other
• A testing / learning framework underpinning design and
delivery
• Funding uncertainty – resulting in lack of staff security /
consistency
• Decision making at local level being impacted by centre
• Different governance arrangements across agencies, and a lack
of
regional autonomy for some who then cannot fully participate in
SASWB
activity and/or local decision making
• National barriers – national policy influencing local ability
to exercise
discretion and therefore a tendency to err on the side of
caution locally
• Ability to navigate complexity of Manawhenua and Matawaka in
South
Auckland
• Ability to respond to the complexity within the Pasifika
community
• Currently a government agency focus only with no Iwi / Māori
/
community input at governance level
• Shift to a focus on wellbeing rather than deficits
• Embed learnings and performanceimprovement
opportunities into agencies / system
• Systematise established trusted relationships across
agencies
• Iwi / community voice at the table
• Build community relationships and partnerships that ‘live’
the Treaty partnership approach
• Better define whānau
• Springboard off COVID-19 operating model enhancements
• Align with other Auckland regional initiatives for impact
(APO,
ASSLG, Regional Public Sector Lead)
• Connect and share learnings with other PBIs and NGOs
• Resource investment in Auckland region
• Increase visibility of learnings in Wellington
• Mandate for disruption
• Risk aversion & organisational inertia
• Scale and complexity of South Auckland – risk of being put
in
the “too hard” basket
• Reprioritisation of collaborative resources back into
agencies
at discretion of individual agencies
• The need to continue to prove ‘legitimacy’ to ensure
longevity
• Pace of change limiting communication / real engagement
with communities
• Limitations on local mandate and flexibility from centre
Our 5 year strategy
builds on our strengths,
and the opportunities
we have identified, that
will continue to
strengthen the
effectiveness of the
SASWB’s collaborative
way of working to
achieve improved
outcomes for children
and whānau.
The 2 year Action Plan
specifically incorporates
mitigation strategies to
address known
weaknesses and threats
that limit our ability to
achieve our goals.
Wea
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s St
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s
Thre
ats
O
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ort
un
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s
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Strong cultural values and unique needs Access to support is
impacted by size and inequity
It is complex, but we need to do better…
1 in 10* adults receive care for a diagnosed
mental health condition
On average, we receive more than 60 Police 111 calls every day
relating to family harm
A further 18,500 people receive other income support
Almost 20,000 people in South Auckland receive Job Seeker Income
Support (43% of the
total for Auckland)
Almost 70,000 people live with one or more
long term health conditions
1,086 school age children are not attending school
We have the highest number of child protection referrals
nationally with over 1,000 per year
What we know: We need to work differently to be able to respond
to the diverse and complex needs of our community
* This rate is potentially impacted by lower than expected
access rates for some populations
40% of total CM population is born overseas
16% Māori
21% Pasifika
27% Asian
1 in 2 children live in the most socially deprived areas
Māori (36%) and Pacific (32%) populations aged
-
147
different ethnicities
Nearly two-thirds of people in Māngere-Ōtāhuhu identify as
Pacific (61%), alongside almost half of the people in
Ōtara-Papatoetoe (46%) and one-third of the people in Manurewa
(33%)
18% of those who had been born overseas had been living in New
Zealand
-
Our strategic aspirations and success factors
In 5 years time, we will be able to say....
We will know we’ve succeeded when....
1 Children and whānau are leading the development of their own
“one plan” and they trust us to support them
2
We are working in partnership with Iwi
3
Collaboration across government and non-government organisations
is the way of working