BOP DHB responds to health target data

Today the Minister of Health released the fourth quarter results of the health targets introduced as a way of improving the performance of health services. The targets provide the health sector, both secondary and primary, with a clear focus for action.

We have improved our performance in each of the six health targets, although this is not necessarily reflected in our relative national rankings.

The Ministry targets are split into two key areas,
1. Hospital performance which focuses on improved access to elective surgery, shorter visits to the Emergency Department, and reduced waiting times for cancer treatment radiotherapy, and
2. Preventative measures, with key indicators being increased immunisation, better help for smokers to quit and better diabetes and cardiovascular management.

Improved access to Elective Surgery

2009/10 has been a particularly successful year for Tauranga and Whakatane Hospitals including achieving 100 percent compliance with our elective surgery discharges target.

We also provided 300 more elective operations and 1300 more acute patient discharges than the previous year.

In addition to our health target responsibilities we:
• Completed 100 complex cardiology procedures such as pacemaker insertions.
• Performed 255 extra procedures in our Outpatients Department, with significant increases in ENT minor operations, sleep apnoea assessments and urology cystoscopies.
• Improved patient access to specialist assessments in outpatients with 2,941 more first and 2,329 follow-up visits provided when compared with the previous year, and including significant increases in cardiology, oncology, gynaecology, and orthopaedics procedures.

We have continued to meet the requirements for elective waiting times targets and have achieved a decrease in the waiting times for patients in a number of areas.

Many procedures that used to require general anaesthetic and a trip to theatre are now completed as day surgery. This contributed to the increased numbers of day surgery procedures which are not included in the health target reporting.

Shorter stays in emergency departments

This health target requires 95% of patients to be admitted, discharged, or transferred from an Emergency Department (ED) within six hours.

Our quarter four combined Tauranga and Whakatane result was 84% giving us a ranking of 15.

During this fourth quarter our Emergency Departments have had to respond to unprecedented numbers of people who were generally unwell including suffering from seasonal influenza who whilst in need of health care services, were not in need of emergency or specialist care.

In one recent 24-hour period there was an increase of 58 percent (daily average 115 to 182) in the number of people presenting at Tauranga’s ED, and in Whakatane an increase of 36 percent from a daily average of 56 to 76 people.

In total 62,961 people presented at our Emergency Departments an increase of 8% on the previous year.

We have plans in place to achieve our target by June 2011. Actions being implemented include using active communications to encourage a change of mindset for patients who use ED as their primary care provider, implementing fast-tracking into and through ED for patients who have been referred by their GP, and focussing on giving faster access to ward beds to speed the movement of patients from the Emergency Department into wards.

Shorter waits for cancer treatment

This health target requires that everyone needing radiation treatment will have this within six weeks by the end of July 2010 and within four weeks by December 2010.

Our results against this target have been consistently strong throughout the year and target was achieved at quarter four.

This result is continuing good news for the people in the Bay of Plenty.

Increased immunisation

This health target requires 85% of two year olds to be fully immunised by July 2010; 90% by July 2011 and 95% by July 2012.

Our immunisation rates are still falling short of the 85% target and this is disappointing but we have recognised that we need to do something radical to change this poor performance. As a result we have completely changed our approach to the service delivery model used by the primary health sector to deliver this service.

However, there were some pleasing results. Our rates for Māori two-year olds increased from 68% to 73% and in Te Kaha, the DHB employed GP Dr. Rachael Thomson immunised 92% of the local three month old children.

In the Bay of Plenty we do have a number of parents and caregivers who are anti-immunisation. Working with the Bay Of Plenty Immunisation Advisory Group we have identified the need to provide better and more timely information to parents and caregivers to enable them to make an informed decision on immunisation. This action should assist in the achievement of this target.

In addition our Planning and Funding team has led a process to redesign Outreach Immunisation Services (OIS), involving Primary Health Organisations (PHOs), Toi Te Ora - Public Health Service, the Immunisation Advisory Centre (IMAC), and Community Child and Youth Health Services (CCYHS).

We are confident these plans will increase protection for children in the Bay of Plenty and we will continue working closely with PHOs, primary health and GPs to lift performance in this area.

Better help for smokers to quit

This health target required 80% of hospitalised smokers to be provided with advice and help to quit by July 2010; 90% by July 2011; and 95% by July 2012.

This health target has proven most challenging with 22% of our population identified as smokers.

Persistence has paid off and we have more than doubled the number of patients provided with advice and help to quit smoking. Our staff have worked exceptionally hard to achieve this improvement. Of particular note are the results achieved by Opotiki Health Centre, which achieved a 100% rate of intervention and quit smoking advice to Māori and 83% overall.

Although short of target, this result places us amongst the better performers nationally.

Better diabetes and cardiovascular services

This health target is made up of three distinct components; diabetes detection and follow-up, diabetes management and CardioVascularDisease (CVD) risk assessment. The target table does not discriminate between the results for each measure it is solely an average of the three measures.

The primary sector’s performance against the CVD risk assessment of the health target has been solid through the four quarters, with quarter four results confirming that the target for both the total population and Māori has been achieved.

However, the targets set for the detection and follow-up of diabetes and the diabetes management indicator were met.

Work is underway with the primary sector to increase the skill base particularly for healthcare assistants, look at how the primary and secondary clinicians can better align their testing and screening work and to complete a diabetes diagnostic data audit.

In addition a GP practice-by-practice survey to identify the issues which are hindering their ability to deliver on the target is underway.

We will also continue working with the primary sector to lift performance in this target.

I am pleased with the hospital performance results and will continue encouraging my staff to improve the patient journey and service levels. We enjoy providing a high level of care and service to our community.

I am also looking to our primary health providers in the area of preventative services – immunisation, and diabetes and cardiovascular disease to show an increased focus on the targets and improved performance in 2010/11.

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