"Better, sooner and more convenient care from a unified and sustainable public health system."

• From the Chair
• From the Director's Desk
• 'Fantastic' health sector response to quake
• Success Story: ADHB supports Canterbury cases
• Disability Support Services helping the vulnerable
• Managing chaos: The CDHB communications perspective
• NHCC coordinates health sector response
• Health Workforce: Health workers making a difference
• IT Health Board: InterRAI assists transfers
• About this Newsletter

From the Chair

It is not surprising that this issue is so focussed on Christchurch. The earthquake has had a profound impact on our entire health and disability system, one that will last for some time.

The local and national response to this tragedy has been impressive. It reminds us just how critical a well functioning health and disability system is to our well-being; individually and collectively. It also demonstrates our ability to work effectively as a unified local and national health service in response to an emergency.

Maintaining this unity will be critical as we enter the rebuilding phase.

While Government has prioritised health and education, the earthquake has had a negative impact on the fiscal position. Rebuilding housing and health infrastructure in Christchurch will inevitably require some reprioritisation of health capital projects, in Canterbury and further afield. And the focus on improving value for money in health has just become even more important.

The earthquake has created new challenges that will require a reconsideration of how the sector works together to deliver health services.

It has underscored just how important an electronic health record is to be able to deliver well coordinated care, especially when large numbers of people are displaced. The National Health IT Board has identified how we might accelerate progress towards this goal.

The loss of existing facilities in Christchurch also creates the opportunity to rebuild facilities that are better suited to the post earthquake demographic and to patient-centric models of care that deliver better integrated care closer to home, with relatively less emphasis on hospital-based care. Canterbury DHB is continuing to engage clinicians in this process.

Over the next few months the National Health Board will work with the CDHB and the wider sector to make sure we maximise opportunities and minimise risks to the continued delivery of sustainable, quality, patient-centred health and disability services in Canterbury.

Dr Murray Horn
Chair

From the Director's Desk

There has been a tremendous response to the Canterbury Earthquake from the health and disability sector throughout New Zealand. 

During the past weeks Canterbury health and disability sector staff have shown true professionalism in the most trying circumstances.

The earthquake response saw the Canterbury District Health Board assisted by private hospitals, rest homes and disability services throughout the region.

Nationally, DHBs and disability services have worked on the transfer of patients and vulnerable people and DHBs have released staff to help out on the ground in Christchurch.

In Wellington we have operated the National Health Coordination Centre around the clock since the earthquake struck.

This newsletter highlights a sector wide response of which we can all be proud and showcases aspects of the work that is taking place.

The health and disability sector faces many challenges as a result of the Canterbury Earthquake and after watching the work and dedication shown by you all in the past fortnight I am certain that the sector is up to the task.

Chai Chuah, National Director 

'Fantastic' health sector response to quake

National Health Board member Mary Gordon says the health sector's response following the devastating Christchurch earthquake has reminded her how proud she is to be part of New Zealand's health system.

Mary is the Executive Director of Nursing at Canterbury District Health Board (DHB) and became Incident Controller for the DHB's Emergency Operations Centre (EOC) immediately after the quake. She has been sharing that round-the-clock role with the DHB's Chief Medical Officer and Chief Executive. Below are Mary's views as the incident controller.

"The medical and nursing staff went into action very quickly, the city rapidly became very congested and quite chaotic.

The Princess Margaret Hospital, as well as housing the DHB's corporate offices, provides older persons rehabilitation services and mental health services, and Burwood Hospital is an elective surgical hospital. But triage posts were established quickly at both hospitals. Injured people began arriving at them within minutes because they couldn't get to Christchurch Hospital. People were being rescued and transported on whatever was available.

Everyone has been working to ensure that health services keep operating as one system. It's a real testament to everyone involved. It's all about the patients and keeping health services going. Everyone has just mucked in.

There are people working in the EOC who don't normally work with each other, and many are doing roles that they never thought they'd be doing when they joined the DHB. Volunteers from other DHBs have been fantastic and just slotted in as part of our team and the attitude has been 'whatever it takes'.

People who work in health have the ability to adapt quickly and problem solve in innovative ways. We've had to make some quick decisions, such as evacuating a large number of aged care patients. The National Health Coordination Centre has been very supportive of us and in helping with the logistics.

Our primary care sector has been amazing – general practice working with district nurses and community pharmacists to make sure that they're up and running. We've got all but four GP practices open and all but six community pharmacies. But they're not back to normal. They may have power, but they haven't all got water and most of them haven't got sewerage, so it's still a fragile situation.

We're accepting a different level of service. Two weeks ago a GP practice that had no water or toilet facilities and fluctuating power would have been unacceptable. Now that's regarded as operational.

Our infrastructure and utilities are still very vulnerable. We're not doing any major surgery – only simple elective surgery – because of power fluctuations and sewerage leaks. Fifty percent of the city still has no sewerage and there's concern about the sewerage infrastructure.

I would say the coming months are going to be difficult for health sector workers. People working in health are no different from the general Christchurch population. We've got people like me who have minor damage to their homes and others whose houses will probably be demolished and they're not able to live in them at the moment.

We all know people in the health sector who have died and are missing and many have also lost family and friends, so there are a lot of things that health workers are going to have to face in the future, and we will need to support them.

We've had such positive feedback from the Ministry of Health, National Health Board and other DHBs throughout New Zealand. It makes the staff feel that the rest of the country's with them."

Success story: ADHB supports Canterbury cases

By Justin Rawiri Auckland District Health Board Incident Controller

They say a crisis brings out the best in people – and that has certainly been the case in the way Auckland's health sector has responded to the Christchurch earthquake.

Auckland District Health Board (ADHB) has been proud to play its part in the national response to provide support for the people of Canterbury during their time of need.

We have worked alongside our Northern Region colleagues to coordinate and allocate our available resources in the most effective, efficient way possible.

The good relationships we have with Waitemata, Counties Manukau and Northland DHBs, together with Auckland Regional Public Health Service (ARPHS), have been critical and we are very grateful for their ongoing cooperation and goodwill.

Of course, our ability to assist would be limited without the willingness of our staff to contribute.

Our Incident Management Team has been overwhelmed by the eagerness of ADHB employees from all walks of life to pitch-in and volunteer their services.

The compassion for their fellow New Zealanders shown by staff has been inspirational - and it serves as a reminder of the very strong commitment we share.

To date, 35 ADHB staff have worked on the ground in Christchurch – from services including the Department of Critical Care Medicine, Orthopaedic, Cardiology, Children's Emergency Department, Neonatal Intensive Care Unit, Resource Team, Admission and Planning Unit, Forensic Pathology, Quality and ARPHS.

Retrieval teams from the Paediatric Intensive Care Unit and the Adult Emergency Department have also made flying visits to Christchurch.

Back in Auckland, many staff have been willing to alter their usual shift patterns and be part of 'work-around' strategies to help cater for staff absences.

Auckland City Hospital has so far treated six adult patients transferred from Christchurch Hospital.

Starship Hospital has provided care for a further five child patients.

In addition, we have had at least 24 Christchurch people presenting at our emergency departments and three of these have been admitted for treatment.

We have also played a role in the Auckland region's assistance for home dialysis patients, with 11 people treated at Greenlane Clinical Centre.

Four aged residential care patients were treated at Auckland City Hospital, again as part of a coordinated regional strategy.

Staff have also been digging deep to provide financial assistance to Cantabrians through a range of donation options.

Cash and non-perishable food donations have been collected at our main reception desks and a Red and Black Mufti Day on March 4 – where staff were encouraged to wear the Canterbury colours and make a donation – was particularly successful.

This event included draping a large red and black flag over Auckland City Hospital – a rare sight indeed in this part of the country!

The way ADHB staff embraced the occasion was further proof that we are all New Zealanders and when times are tough, we stick together. 

Disability Support Services helping the vulnerable

Disability Support Services (DSS) has been working with providers to ensure disabled people are being supported in Christchurch.

DSS activated an emergency operations centre, including an 0800 number when the quake hit and has been working with providers, disability organisations and the local Needs Assessment Service in Christchurch.

All providers were contacted within 24 hours and almost 200 disabled people were evacuated within the first couple of days. Two hundred and sixty people have now been relocated including some non-Ministry clients.

"Our priority was to get all the disabled people who had to be evacuated into a safe environment as soon as possible", says Anne O'Connell, Group Manager DSS.

"Our providers from around the country have pulled together to accommodate those who had to be moved and it has been an incredible effort by everyone to get as many people relocated as we did and in a such a short time."

CBM (NZ), a volunteer agency that helps disabled people in emergencies, worked with the Needs Assessment Service to locate disabled people in welfare/evacuation centres. DSS also worked with Deaf Aotearoa and the Foundation for the Blind to address the needs of those with visual or hearing impairments.

DSS' equipment providers got emergency repair and replacement services up and running within the first two days to help those whose equipment such as wheelchairs was damaged.

"As we now start moving into the recovery phase, our attention is turning to the residential services who did not need to be evacuated immediately but who still have no water or sewerage," says Anne O'Connell.

"We also have a lot of disabled people who live in their home who have limited facilities and may be having difficulty getting support workers."

It will take time to get everything back up and running but DSS is looking at how to support those providers who have taken on extra clients, providers that have to look at the future of their services and those disabled people who have been relocated.

Managing chaos: The CDHB communications perspective

Steve Addison NHB Principal Advisor (Sector Relationships and Engagement) writes about the CDHB communications team's efforts to manage media calls under great pressure following the Canterbury Earthquake.

Immediately following the Canterbury earthquake more than 1,000 local and international media descended on Christchurch.

There was intense media focus on the way in which the entire health and disability sector in Canterbury had responded to the earthquake and the CDHB communications team quickly geared up to manage constant incoming calls.

The media wanted stories and interviews about the way in which the Emergency Department at Christchurch Hospital had coped with the 365 patients who had arrived in the hours following the earthquake.

By the next morning the communications team had begun setting up opportunities with key clinical and management staff including one on one interviews, media conferences and hospital visits.

The first press conference saw Christchurch Hospital Emergency Department physician Prof Mike Ardagh talk about the ED being like a war zone with the injured arriving on the back of utes, in ambulances, on boards on top of police cars and later by helicopters, which landed in the street outside. He described it as controlled chaos and was very proud of the way staff had worked without knowing the fate of their loved ones or homes.

The media also wanted stories on the improvised triage centres set up at Latimer Square, an inner city park and at other CDHB and private hospitals around the city. CDHB CMO Dr Nigel Millar was interviewed about the efforts of staff at the non acute The Princess Margaret Hospital who set up a makeshift triage centre as the injured turned up at the hospital's front door.

Later media attention turned to requests for interviews with victims and by now many media kept a vigil outside the hospital's doors. Most behaved well and accepted that hospitals were out of bounds but several had to be escorted by security from Christchurch Hospital.

Patient interviews were a contentious topic and were only allowed where clinically appropriate, under very tight controls and with patients and families who had agreed to speak to media.

Staff throughout the hospital co-operated in trying circumstances and were understanding and accommodating of media needs.

Other communications commitments included CDHB CEO David Meates' daily media conference at Civil Defence Headquarters followed by one on one interviews with key reporters.

The traffic with the media was not all one way and CDHB communications staff worked on press releases to promote public health messages. Media opportunities were also arranged with Medial Officers of Health Dr Alistair Humphrey and Dr Ramon Pink who spent many hours in interviews and talking live on TV and radio.

A key message from Dr Humphrey was that people should support one another to ensure that everyone got through the tragedy as a community.

A week after the quake, as international media interest wanes, local media are now following stories of the heroic actions of many health staff who went above and beyond the call of duty to continue to provide care to Christchurch people.

The focus for the communications team is also shifting with more emphasis on internal communications as the fallout from the quake has affected all staff in different ways.  It will be some time yet before 'business as usual' resumes for many working in the Canterbury Health System.

NHCC coordinates health sector response

More than 180 health sector staff from around the country have so far gone to Christchurch to help, following last month's earthquake.

Their movement was just one of the tasks overseen and coordinated by the National Health Coordination Centre (NHCC) in Wellington. The Centre had 24-hour cover for the first week and is now operating from 7am to 7pm.

The Ministry of Health's Director of Emergency Management, Charles Blanch, says there have been requests for staff across the health sector – 'everything from clinical and nursing staff to steam and maintenance engineers'.

He says the Centre made extensive use of transport and accommodation provided by Defence Force New Zealand for staff sent to Christchurch, including initially housing a number of them at the tent city established at Burnham military camp.

The NHCC has also supported the evacuation of 368 aged care residents from damaged and unusable facilities – identifying capacity and matching residents to receiving DHBs – and working with Defence and St John Ambulance to arrange their transport.

The NHCC is now working on supporting Canterbury DHB with short, medium and long-term planning.

He says the Centre is also working with the Ministry of Social Development to develop the psycho-social recovery framework, which ranges from basic counselling support for those affected by the quake, to referrals and provision of mental health support services.

"We're also in discussions with the Department of Prime Minister and Cabinet on the recovery framework and how that's managed in the future, including looking at how we transition the ongoing recovery into existing units and teams within the Ministry of Health."

Health Workforce: Health workers making a difference

Most people who choose to work in health do so because they want to make a difference to people. Never has this been more evident than in the past couple of weeks following the Christchurch earthquake.

The co-ordinated approach of hospitals and health workers throughout the whole of New Zealand to support Christchurch and its residents has been remarkable and the dedication of all individuals involved in the response has been outstanding. They have demonstrated immeasurable commitment, adaptability and resilience over these past couple of weeks, as well as an amazing team approach and selfless effort to care for others.

Recovery will be a focus for the sector for some time to come and events such as this serve as a reminder of the importance of supporting our staff, maintaining their resilience and protecting their wellbeing, as well as ensuring we have the workforce we need to respond to all situations.

Health Workforce New Zealand will hold a stakeholder meeting to take place in the second half of the year that will focus on supporting providers to plan for the health workforce they need now and into the future. This will include the wellbeing of the health workforce and the elements that contribute to it.

Brenda Wraight, Director, Health Workforce New Zealand

IT Health Board: InterRAI assists transfers

The National Health IT Board played a small part in the Canterbury Earthquake, through InterRAI – a tool that assesses at risk elderly people.

Getting help to vulnerable people in the community who need it most after the recent earthquake in Christchurch was made easier because of a relatively new computerised aged care assessment programme called InterRAI – an evidence based clinical assessment and planning tool developed in collaboration with researchers from over 30 countries.

Dr Nigel Millar, Canterbury DHB Chief Medical Officer said, "The InterRAI programme was an enormously valuable resource in helping find the people who were at greatest risk and supported the transfer of over 300 elderly people to locations throughout New Zealand. This proceeded independently without distracting the emergency team."

Incident Controller for Vulnerable People, Stella Ward said, "After the earthquake the North Island team were able to work with international support to review the system and provide a summary for the emergency response team in Christchurch."

The National Health IT Board has driven a national approach to InteRAi implementation with systems running continuously in Canterbury and Taranaki. This approach meant the system was not interrupted by the earthquake.

Dr Millar went on to say, "We received stunning support from receiving DHBs and expert logistical help from the military to move these treasured people. The recent decision to roll out the InterRAI to rest home residents will add to our capacity to respond to emergencies in the future and to protect the well-being of vulnerable people in care.

"InteRAI is being implemented at every District Health Board as part of a 3-4 year national project and The National Health IT Board has been driving the rollout out of InterRAI to over 700 aged care facilities across the country."

About this Newsletter

This newsletter is published by the National Health Board. To join or unsubscribe from the mailing list please email enquiries@nationalhealthboard.govt.nz

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