Regional Services Programme benefitting patients and communities

It has been a significant year for the regional health programmes TAS has helped lead.

 
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As part of the Regional Services Plan, we’ve built strong and collaborative relationships with programme partners across diverse areas like cardiac care, sudden unexplained death in infants (SUDI), and stroke intervention.

We’re also proud to have worked alongside the Central Region Service Planning Forum (CRSPF) on an Equity Framework, designed to achieve health equity for all New Zealanders.

“The Central DHBs’ regional programmes reach all pockets of our communities, from caregivers and babies through to those needing lifesaving therapy,” said Tricia Sloan, General Manager, TAS Services Group.

“By taking a whole of system approach to eliminating inequities and improving quality, safety and experience of care across the region, the benefits are far-reaching.”

SUDI PREVENTION - MAKING SUDDEN UNEXPECTED DEATH IN INFANTS HISTORY

Preventing SUDI through safe sleeping practices and smokefree whānau is a key regional priority and one close to people’s hearts.

TAS Child Wellness, Planning and Improvement Managers Jessica Sandbrook and Katie Kennedy have been leading collaboration with the Central Region DHBs on developing and implementing local SUDI prevention plans that empower whānau to protect their pepi from SUDI, and meet Ministry of Health requirements.

This' year’s achievements have included support for DHB portfolio managers and local safe sleep coordinators on programme initiation and development. Regional connections have been strengthened through monthly online hui for DHB safe sleep coordinators. Katie and Jessica have collaborated with Hapai te Hauora on National Safe Sleep guidelines and SUDI prevention needs assessments.


“The two key modifiable risk factors that impact on SUDI are smoking during pregnancy and bedsharing”

Jessica Sandbrook, TAS Child Wellness, Planning and Improvement Manager


TAS has supported DHBs who have existing SUDI prevention programmes, and also worked alongside Hutt Valley DHB to set up and outwork their new safe sleep device service, Moe Ora. This service is directly connected to the hapu mama stop smoking service - a clever approach to support whānau to protect pepi from SUDI.

A highlight for TAS was the regional SUDI prevention wānanga hosted at Napier’s Pukemokimoki Marae to support workforce development for kaimahi.

“The two key modifiable risk factors that impact on SUDI are smoking during pregnancy and bedsharing,” says Jessica Sandbrook.

“The goal of the SUDI prevention programme is to address these factors in a mana enhancing way, utilising a safe sleep solution designed by Māori for Māori. The respect and value given to a wahakura woven from harakeke is valuable for the pepi that will sleep safely in one tonight, and for their wider whānau to see the DHB’s value and investment in a kaupapa Māori solution.”

 
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“The hui was designed to support collaboration with health workers across the region and identify ways to support whānau to act on the knowledge that separate sleep surfaces are safest for baby and ‘smoke-free’ is best for pregnant women, babies and whānau.”

The hui was grounded in a Māori worldview, provided as a wānanga, and held on Pukemokimoki Marae. Participants learned about the history of wahakura - New Zealand’s first indigenous response to reduce the inequity of SUDI for Māori whānau - from its creator Dr David Tipene-Leach.

“The National SUDI Prevention Coordination Service (NSPCS) were pleased to attend this well organised and facilitated hui. It offered the team an opportunity to meet face to face with and hear directly from those at the coal-face and to answer their conerns and queries directly,” said Fay Selby Law, National SUDI Prevention Programme General Manager.


“Those in attendance were personnel from a wide range of health and community organisations within the Central Region, who each have a stake in providing SUDI prevention messaging through their specific work programme. There were opportunities to hear from well-known SUDI prevention advocates and workshops to discuss and learn from one another.”

Fay Selby Law, National SUDI Prevention Programme General Manager


STEMI - NEW INITIATIVE ENABLING QUICKER ACCESS TO LIFE SAVING TREATMENT

Every day in New Zealand, five people will suffer the most life-threatening form of heart attack (myocaridal infarction), and approximately 20% will die.

To minimise these statistics, TAS was proud to facilitate conversations between clinical leads on introducing a new out-of-hospital treatment pathway for cardiac patients in the Central Region.

Known as STEMI (ST elevation myocardial infarction), this new pathway enables paramedics to give a clot busting drug to patients in the community and then transport those patients directly to the most appropriate hospital.

The pathway was launched initially by DHBs in the Central Region and is a collaborative treatment method developed by St John, the Ministry of Health and the Cardiac Network. TAS managed the complexities of in-depth discussions between partners, enabling the pathway to move forward.

“The result is a crucial reduction in the time it takes to receive lifesaving treatment. A quicker journey to hospital means the loss of heart muscle is minimised, enabling patients to potentially go back to work two weeks later, rather than months after their heart attack,” says Jeanine Corke, TAS Planning and Improvement Manager.

Craig Johnston said the ability to have STEMI patients assessed in the community by St John paramedics will “decrease transfer waiting times to Wellington Hospital, preserve cardiac function and improve outcomes for patients across the region”.

Any initiative involving emergency healthcare relies on the expertise, composure and care of the paramedics, nurses and doctors delivering this lifesaving treatment around the clock. The impact on clinical teams is significant and Capital Coast DHB and St John’s role in providing this 24/7 service has been fundamental to its success.

Around 350 patients each year could benefit from the pathway, resulting in improved long term survival and the delivery of equitable healthcare to all New Zealanders, particularly those living in rural and remote areas.

“This is a crucial step in achieving regional equity which is one of the fundamental goals of the Cardiac Network and represents a lot of hard work from all involved. We still have more work to do. The current pathway only benefits those patients who call 111 and we will be looking to extend the pathway for those patients who attend emergency departments of non-PCI capable hospitals this year,” said Nick Fisher, Clinical Lead Central Cardiac Network and Head of Department Cardiology, Nelson Marlborough DHB.


“TAS has organised the work programme and managed most of the project streams within the work programme.”

Craig Johnston, Midcentral DHB General Manager Strategy, Planning and Performance


CENTRAL REGION EQUITY FRAMEWORK - ESTABLISHING EQUITY FOR ALL

Over the past year, TAS has supported Central Region DHBs to strengthen the equity focus in the Regional Services Plan. A major piece of that work has been the development of a Central Region Equity Framework. The Framework, informed by the Ministry of Health’s ‘Equity of Health Care for Māori’ has been designed to provide guidance to the Central Region Service Planning Forum on strengthening their commissioning role to achieve equity.

Central Region DHB Chief Executives have agreed that the implementation approach for the Framework includes regional activity focused on strengthening equity in the Regional Services Plan, local activity building the capacity and capability of staff in each DHB, as well as local activities that would be captured in the DHBs’ Annual Plans.

People who are poor, have chronic conditions/disease, live with disabilities, live rurally and are of different ethnicities will have poorer health, greater exposure to health risks and poorer access to health services. In New Zealand, the differences between Māori and non-Māori are the most persistent and compelling equity issues in health. Achieving equity for Māori is a priority, as health gaps across the life-course is significant for Māori.

While the Equity Framework takes a very broad approach, the companion Treaty of Waitangi DHB obligations document under development will provide guidance to the Central Region DHBs on what they need to do meet their Treaty of Waitangi obligations, as well as achieve equity for Māori.

 
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STROKE CLOT RETRIEVAL SERVICE - REDUCING THE LONG-TERM IMPACT OF STROKE ON PATIENTS

Stroke is the second most common cause of death and adult disability in New Zealand and worldwide. Nationally, around 8,500 people had a stroke in 2015/16 and about 50,000 lived with the consequences of stroke.

Launched in the Central Region in April 2019, the Regional Stroke Clot Retrieval Service is a highly specialised treatment, involving removal of a blood clot in the brain when ‘clot-busting’ drugs cannot dissolve the clot.

“It has a high success rate, significantly improving the likelihood of a patient walking out of hospital the next day versus a long process of rehabilitation and recovery or potential permanent disability,” said Stephanie Calder, TAS Director, Regional Services Programme.

To get the Regional Stroke Clot Retrieval Service over the line, TAS helped support the introduction of the Service within the six Central Region DHBs, along with bordering DHBs in Nelson-Marlborough and Taranaki.

Early intervention with endovascular clot retrieval (ECR) is the most effective treatment available to reduce the debilitating impact of strokes, and improve survival rates.

“The implementation of a regional ECR service will help to reduce current inequities in achieving best patient outcomes, reducing overall post-stroke disability.”

The service applies to patients presenting to one of the participating emergency departments (Hastings, Hutt, Masterton, Nelson, Taranaki Base, Wairau, Wellington, or Whanganui hospitals). There is strong evidence that clot retrieval, as a procedure, directly prevents avoidable costs in acute medical care, neurosurgical procedures, rehabilitation for stroke patients, as well as aged residential care.


“The implementation of a regional ECR service will help to reduce current inequities in achieving best patient outcomes, reducing overall post-stroke disability.”

Stephanie Calder, TAS Director, Regional Services Programme