National Nati news / Politics
Written by: Teepa Wawatai (NPH Chairman) & Rose Kahaki ( NPH CEO)
17 Nov 2016

Our vision, “Kia tu pakari kei tua o kapenga” (Stand strong and strive for excellence) coupled with our mission “each generation living longer than the last”, is the culmination of a proud history of Ngati Porou-led services, a forward focus on improved health outcomes through better lifestyles and choices, and to not only stand strong in the current fiscally depressed health environment but to identify opportunities that validate that which is uniquely Ngati Porou.

Another year has passed by and we continue to work at a fast and furious pace, however the question remains: how has this translated into making a difference locally? We have put ourselves at the forefront of new initiatives, worked collectively with TRONPnui, Hauora Tairawhiti and other social and health services, focussed in on improving quality in our health services and systems, and gained nationally recognised accreditation for the hospital, maternity services and Home Based Support Services. Our Primary Care manager/teams and the Quality Coordinator have worked tirelessly toward achieving Cornerstone Accreditation in all seven Community Health Centres and we are awaiting confirmation and certification.

FINANCE

Our financial result for the 2015 year shows a loss of $721,000. We set a financial goal of a $722,000 deficit and we delivered on that goal. Next year we will set another milestone for ourselves and continue to work towards our ultimate goal of reaching a break even position. This year has been challenging and we thank our staff for working to reduce our operating deficit while continuing to provide a quality health service to our people.

NPH continues to post a deficit and the way forward rests on changing the way we do things. However, delivering services to small rural and isolated communities with a population that is static or decreasing, challenges our Board, management and staff to think outside the square. One way forward is for the Crown to invest in Ngati Porou via the Accord which was part of the Ngati Porou Treaty Settlement Agreement.

EAST COAST REVIEW

The East Coast review was initiated in 2013/14 to look at sustainable health services for the Coast. Hauora Tairawhiti, TRONPnui and NPH are still considering the best options for the future. Decisions around which services should be retained and which should go (i.e. potentially the hospital, maternity, Pakeke/Elderly care and X-Ray), or whether there should be more investment in the Coast, continue to be discussed. We are planning further consultation with communities before any final decisions are made.

BERL REPORT

As part of developing a case to validate the importance of NPH services to the district BERL (Business Economic Research Ltd) was engaged, using grants from Te Puni Kokiri and JR McKenzie Trust, to undertake an economic impact assessment for the provision of our services. Their report was launched at Te Tini o Porou in November 2015 by the Chair of TRONPnui Selwyn Parata, the Chair of NPH Mr Teepa Wawatai, Te Puni Kokiri CE Mere Pohatu and Dr. Ganesh Nana (Chief Economist for BERL). The report determined that NPH injects an additional $5.5 million of GDP (2014) to the local economy. It also reported that NPH has a direct economic impact on local whanau and communities through the employment of 150 people (105 full time equivalents).

THE ACCORD 

Te Runanganui o Ngati Porou will lead a discussion with Crown Ministers in regard to addressing the deficits in health outcome/services for Ngati Porou whanau. The objective of the “Health Accord” would be to seek a Crown commitment to invest in an innovative model of care and supporting infrastructure, that will increase the life expectancy and health status of the resident population on the East Coast to the same as, or comparable to, that experienced by the wider population of NZ. A business case is in development to support these discussions.

PHO PERFORMANCE

Over the last 18 months Ngati Porou Hauora’s quarterly performance results have ranked in the top 5 PHOs more often than any other PHO in the country, particularly for the Minister’s health targets for Better Help for Smokers to Quit and More Hearts and Diabetes Checks. From 1 July 2016, the Ministry of Health will change the way it measures PHO performance and new measurements will be implemented.

NPH participates at the local Tairawhiti Integrated Forum table with Hauora Tairawhiti, Midland PHO and National Health Coalition. The priorities for the year focussed on children getting the best start in life, Health of Older People, Acute Demand and Long Term Conditions. A move to a broader Midland United Regional Integration Alliance Leadership group is in process for next year to agree joint DHB/PHO initiatives and advance health outcomes regionally.

HEALTH DASHBOARD

We often ask ourselves what difference does NPH have on the health outcome of whanau? This information is difficult to get as population health data is collected at a whole region level. Through Ministry of Health funding we developed, for the first time, a report of health data (Health Dashboard) for the population enrolled with the Hauora. This information provides a view of the impact of services and initiatives on communities and evidence of health outcomes for whanau over time. It also provides data for us to feedback to communities, funders and the Crown.

RESEARCH

We have worked with several researchers, Otago University and other health organisations to ensure NPH is supporting and contributing to relevant health research locally and nationally. NPH has supported Prof. Tony Merriman and Dr. Lisa Te Morenga’s work on the project ‘Living well, living longer: New knowledge about what genes and kai have to do with the gout, diabetes and heart disease’, and to discuss their findings with communities on the East Coast. Further research opportunities are being developed for next year.

COMMUNITY CLINICS (PRIMARY CARE)

There has been a steady growth to 9185 in our client base throughout the year, attributed mainly to the Gisborne Service Puhi Kaiti. Our focus on diabetes has seen significant shifts in reducing Hb1ac for many of our whanau: 59% have achieved an Hba1c less than or equal to 64mmol/ mol.

The Huringa Pai initiative, additional diabetes clinics, Dietetic interventions with whanau and the outreach work of our Diabetes Nurses have made a huge impact.

Our Mamas and Pepi service has expanded to cover the coast and we were successful in picking up a small contract to focus in on Rheumatic Fever prevention. Although NPH was a top performer in the provision of Aukati Kai Paipa (advice to stop smoking) service, we were unsuccessful in regaining this contract.

We said farewell and thank you to Georgina Paerata who led the Primary Health Services on the Coast for the past 3 years. Her leadership supported our turnaround in performance and was central to increasing clinical training opportunities for staff. We welcomed Dr Margaret Charles from Dunedin to the NPH whanau and fare-welled Dr Rob Wilks, Dr Sally Murdoch and Dr Debra Bromiley. Thank you Rob, Sally and Debra for your contribution and services to NPH.

Recruiting skilled health staff continues to challenge us as it does in other rural health centres. We are thankful to the committed locum/ resident doctors and nurses who continue to support NPH service during the difficult times when locums are unavailable to cover leave. Dr Akindele Ojo enjoyed 2 months sabbatical in rural NZ and a month in his homeland Canada, where he reconnected with his whanau. However sadly for NPH and the communities, Dr Ojo has returned to Canada to live and work.

WHANAU ORA (NATI AND HEALTHY)

As signalled in our strategic plan, NPH is not just about health services. It is very much about whanau and communities, addressing the factors that impact on health and working together to make positive moves toward better, healthier lives. Although there’s very little funding support, NPH has taken the opportunity of some small relevant contracts to liven up this area of our mahi.

We have worked towards partnership with whanau, looking at longer term aspirations and broader aspects of health and wellbeing, as well as assisting them to meet immediate issues affecting their health.

This year, the new Whanau Ora team has worked with 65 families and over the next year NPH will strengthen this partnership approach across all services, and with TRONPnui Social Services, Te Pou Matakana, Hauora Tairawhiti, Hauiti Hauora and wider community groups. As part of the Healthy Families East Cape (HFEC) Collective (NPH, Hauiti Hauora, Whanau a Apanui, Ngai Tai, Whakatohea, Midland DHB and Turanga Health) we are implementing a systems approach to prevention, focussing on interventions in schools, workplaces and communities, using Maori frameworks specific to the different regions. We have resurrected to some degree the “Nati and Healthy” brand and way of working within our current funding levels and looking for more funding in the 2016/17 year will be a major objective.

HURINGA PAI

The Huringa Pai programme was initially led by Dr Willem Jordaan and the Puhi Kaiti Team of NPH, starting in February 2016. Staff and whanau enrolled at Puhi Kaiti Clinic were invited to walk with Dr Jordaan during his lunch break, and over time numbers and interest has grown. The programme focuses on whanau who are pre-diabetic to stop the progression toward full blown diabetes. Huringa Pai encourages us to move, get more active with and for our whanau, and focus on better eating. It is a movement that can change hearts and minds to crave a better lifestyle. The Huringa Pai programme has been inspirational, motivational and has gained wider whanau, community and cross sector support. The “#964MoveWhanauHeart framework” is a call for action led and owned by individuals and whanau. We are pleased to be working alongside whanau/community leaders and mentors, Sport Gisborne, Kaiti Schools, Super Grans, Tau Awhi, Ka Pai Kaiti, Ministry of Health and the Heart Foundation.

TE PUIA HOSPITAL

The hospital services include Medical and Nursing services, Acute Medical, Maternity inpatients, Community Midwifery, Long Stay Elderly Care, 24 hour Accident & Emergency, Specialist Outpatient Clinics, X-ray, Physiotherapy, Medical Records, Kitchen and Cleaning services and Property Maintenance. We have maintained our Pakeke/Elderly service with an occupancy rate greater than 50% and Respite Care bed days have increased by 80%. We continue to encourage whanau to utilise our long term care at Te Puia.

We provided clinical experience for student and trainee intern doctors from Christchurch, Wellington and Brisbane, and supported our Registered Nurses to work in Hauora Tairawhiti Emergency Department and attend PRIME training. We reviewed a number of services throughout the year, looking specifically at maintaining service to whanau at the best possible price. We combined the Quality Coordination and Education Coordinator functions and are in discussions with Hauora Tairawhiti to deliver Physio and Occupational Health services. A review of the kitchen / food services resulted in disestablishing our casual pool of workers and rearranging duties with existing staff. Property and Maintenance was reviewed and an asset management plan was developed to manage workload.

Maternity Services are supported by our resident midwife and a local independent midwife. We had 49 births in the year ending 30 June 2016, a slight increase from the previous year. Specialist Clinics continue at Te Puia and are held on a four to six weekly basis by visiting consultants from Hauora Tairawhiti. These include Ear Nose & Throat, Gynaecology, Medical, Surgical, Obstetrics and Podiatry. We are especially grateful to the specialists who work with us in this way to improve access for whanau.

CHALLENGES AHEAD

Challenges ahead for NPH continue to be reducing our deficit, retaining needed services on the Coast, recruitment and retention of skilled staff, innovative and cost effective service delivery/changes and finding better ways of working together through alliances and influence.

Furthermore, improved health outcomes for whanau and a reduction in premature death remains our ultimate goal.

Nga mihi,

Teepa Wawatai
Chairperson, Ngati Porou Hauora

Rose Kahaki
Chief Executive Officer, Ngati Porou Hauora

To read the other reports from TRONPnui's 2016 Annual Report, as well as other supporting AGM material. Please click here.

Listen to Radio Ngati Porou's Hui A Tau interviews with TRONPnui representatives

TRONPnui representatives have been interviewed on RNP's Nga Take o te Wa current affairs show, in the lead up to the Hui a Tau. Radio Ngati Porou have made the interviews available on their SoundCloud account for those who were unable to listen to the live interviews.

Teepa Wawatai (Ngati Porou Hauora Chair) 
https://soundcloud.com/radiongatiporou/interview-teepa-wawatai-nph-chair