1. Wairarapa DHB Issues and Gap Analysis and opportunities Fred Wheeler CNM – Community Janice Byford Jones - ADON Wednesday, 29 June 20161

2. Introduction & background Demographics: – Population 40,000 Large rural area approximately – 6,000 km ² Wednesday, 29 June 20162

3. Continued…… Wednesday, 29 June 20163 AreaSquare KmsPopulation (1000s) Masterton & North Wairarapa 240023 South Wairarapa Carterton Featherston Martinborough Greytown 3600 8989

4. Wednesday, 29 June 20164 Our place

5. AGENumber % of population National average Projection 2026 4511000288.3% higher Reduced to 25% of population 65650016.5%4.0% higherIncreased to 30% of population Wednesday, 29 June 20165 The last health needs analysis showed that 28% of deaths were from cancer due to the aging population this figure will inevitably rise Continued……

6. GAP current nursing resource for workload. Current FTE to provide all patient services including ward in reach, staffing of out patient clinics 5 each month and home visits is 2.4FTE 0.4FTE is for leave cover 0.6FTE Based in South Wairarapa and 1.4 based in Masterton. These are graded as cancer resource nurses The number of patients currently managed by the oncology team is 116. Wednesday, 29 June 20166

7. Context for Wairarapa We want to be able to meet the needs of Wairarapa population Also want to work regionally so there are no barriers and resources are utilised in a safe and smart way How we function is different to main centres Mainly because our service is part of a bigger service and works within that bigger service. We work in support of 2 cancer centers CCDHB and MCDHB. Benefit of Cancer Nurse Coordinator (CNC) role – we believe this should be at CNS level to ensure not only coordination of care, patient advocacy and expert care but also as a change agent where necessary to create new paths or processes, to break/erase barriers to quality patient care. Wednesday, 29 June 20167

8. Current communication and pathway Wednesday, 29 June 20168 Patient seen by GP GP refers to Consultant Physician or Surgeon WDHB GP may refer to Surgeon/Physician at Hutt as a result of integrated working/3DHB collaboration GP may refer directly to Oncologist at CCDHB/MCDHB Cancer society may get self referral from patient not yet referred to oncology nurses. Oncologist sees patient at WDHB Clinic /or at CCDHB/MCDHB Oncologist at centre may refer on to other centre for patient convenience/preference.

9. Issues and opportunities Oncology nursing team may have no awareness of referral or any appointments made by the cancer center. Information and legibility of the referrals or requests for information or follow up may be poor. Benefit of Cancer Nurse Coordinator (CNC) role: – Establish Single point of entry system so all Oncology referrals are sent to Oncology team CNC. – Patients can then be triaged according to their need. Oncology team/CNC navigates patient through the system. The CNC role will also facilitate either developing or strengthening patient pathways and processes from the point of referral onwards Wednesday, 29 June 20169

10. Cancer Target monitoring This role would also then ensure that the patient pathway is tracked and where it appears that delay in achieving the faster cancer indicators will occur that prompt intervention takes place to get them back on track. This would be enabled by the single point of entry approach. Wednesday, 29 June 201610

11. Generic model Medical/Surgical rather than Tumor streams. We are a small DHB with a single 38 bedded medical/surgical ward we have to manage patients generically. We work to the protocols of 2 different cancer centers; it would be impractical for us to work under a tumor stream model. Wednesday, 29 June 201611

12. GAPS Lack of common protocols/guidelines – The 2 cancer centres work to different protocols it would be beneficial if common protocols were developed across all cancer centres. Complete regional collaboration – Whilst good relationships exist between WDHB with CCDHB & MCDHB, currently the same linkages do not exist with HVHDHB. (no contact with TDHB or WhDHB) – Regional training and ongoing support for these roles is vital to their success. Wednesday, 29 June 201612

13. Conclusion/Thoughts Whilst common frameworks and agreed principles are essential we are concerned about how one consistent model can be applied to all DHB’s it needs to be tailored to meet the different gaps that services have in coordination of care. Based on information available we believe that this role should sit within the oncology service to compliment our current model of care which is based around effective care coordination although no definitive decision has been made on that. The new role should address identified gaps as described above in the context of each DHB’s current operating environment. Wednesday, 29 June 201613