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Latest News & Events > What's Really Happening

Employment Court - Muldoon Case

Link to Media Releases

Background:

A claim was considered by the Employment Relations Authority in 2010 about Mr Muldoon’s casual – as and when required – employment, covering for an absent employee in 2008 and 2009. Mr Muldoon was not successful when the role was later advertised. The Employment Relations Authority decided the claim on the basis of the submissions made to it, and ruled in the DHB’s favour. That followed the advice the DHB had received.

Using his democratic right Mr Muldoon appealed. In the course of the appeal hearing, a quite different argument was presented, not by Mr Muldoon or his lawyer, but by the Judge. That was about fixed term contracts. On the basis of technical legal provisions applying to fixed term contracts, the Judge found against the DHB. That came as a surprise to the DHB and its advisors because it was not the basis of any claim previously raised with the DHB. The Court’s judgment has however now clarified how similar situations involving fixed term staff need to be treated by employers.

NMDHB Comments:

As the Employment Relations Authority originally found in favour of the DHB, when Mr Muldoon appealed the decision it was in the best interest of the DHB to defend the case.

Clarification of this aspect of employment law is an important one for the health sector as we rely on casual staff to fill rosters.

Court hearings are complex and often very expensive. The DHB relies on advice as to the risks it faces, however as already outlined, the decision was based on technical provisions which were not part of the original claim.

This decision also clarifies the law for a wide-range of organisations outside of health where rostering of casuals is common place.

Our learnings from this decision include the examination of how we use casual staff in long-term leave situations or to fill regular gaps in rosters and the documentation that reflects those arrangements.

All managers, not just in health, need to be aware that there is a point when the use of casual staff becomes more than casual and they need to immediately review the employment relationship.

Visit to the Health Select Committee (16th February 2011)

From the Board Chair - Jenny Black:

This morning in Wellington we made a presentation to the Health Select committee. It was very well received. The team supported questions from the floor and following the meeting we were advised by senior members of the Office of the Auditor General that they believed we went very well. They indicated that the Health Select Committee was suitably favourable to our overview.and are looking forward to hearing more about the outcome of our new approach for ELT in terms of meeting our objectives

Health Select Committee Presentation

Questions and Answers

Response to Ian Powell of the Association of Salaried Medical Specialists

RESPONSE TO IAN POWELL’S CIRCULAR OF 21^st DECEMBER 2010

Those of you who have seen Ian Powell’s two page missive on the Ophthalmology consultation will not be surprised that I feel compelled to respond.

When it became known there was a misunderstanding about the Rutherford consultation process by ASMS it was promptly and professionally handled by ASMS representatives and senior DHB staff. div>

It is most unfortunate that Mr Powell has chosen to vent his spleen on a topic which his staff had already appropriately dealt with.
That he chose to make personal and derogatory remarks about the CE of NMDHB was both very ill informed and inappropriate from a man who represents a very well respected group of clinical professionals.

In previous discussions at Joint Consultative Committees ASMS was kept advised of the process and we obviously each thought there was a clear and mutual understanding. When it was discovered that this was not, in fact, the case, there was mutual desire to quickly resolve this. This resulted in the meeting Ian refers to and I had thought the meeting was conducted in a professional and collaborative way, and lead to a clarification of the misunderstanding, and agreement on the way we would conduct future Rutherford consultations.

This seemed to me be an appropriate and professional handling of a situation in which misunderstandings can arise between parties from time to time, and the DHB and the ASMS representatives parted from that meeting on good terms.

Ian Powell’s subsequent response was therefore a considerable surprise to me, and strikes me as unfortunate that he has chosen to undermine the actions of his team by revisiting the process issues and reiterating his view of prior meetings and interpretations that were addressed at the meeting. It’s unfortunate too, that he has chosen to exclude some interesting information that was covered at the meeting, such as we only included the outsourcing option after discussion with our ophthalmologists and their view that it should be part of consultation.

Leaving the meeting aside, as I believe it was properly and adequately addressed by Ian’s team, it would seem the real issue behind Ian’s rhetoric is that of “privatisation”. It is clear that there is misunderstanding here too. Ian might see “outsourcing” as a euphemism for “privatisation, but there is a difference. Outsourcing has been a feature of the New Zealand health scene for many years. Outsourcing involves obtaining services, from an outside source, by whoever is responsible for making sure those services happen. Privatisation involves handing over the entire responsibility, an action that usually results in loss of control over the price, quality, volume etc by the previous organisation. I fully agree with Ian’s view regarding public health privatisation in the real context of the word.

I suspect the Minister knows the difference, as he has encouraged the use of all health facilities for the benefit of the provision of services to the New Zealand public, and I believe is fully accepting of the fact that the recent, superb growth in elective services would not have been achieved without the engagement, by DHBs, of private surgical capacity in an outsourcing agreement – in fact, “Better, Sooner, More Convenient”.

At t the risk of extending the document, I have added some references, which give me confidence that in this context I, at least, am fully up to play with the Government’s position and direction, and reinforces that I do not need to look guiltily at my team with an “own goal” on my conscience.

Another area for which I feel I need make no apology, despite Ian’s assertion, is in the area of his criticism of NMDHB and its leadership style with respect to clinical leadership and governance. I’m not sure how out of date Ian might be with regard to activities within DHBs, but I believe NMDHB’s new Executive Leadership Team, with eleven practising clinicians - five of whom are ASMS members - at the highest level of operational decision making and strategic advice, is something I believe is very much a part of a modern health system. Certainly it seems to be welcomed by clinicians.

With kind regards

John Peters

Chief Executive

References re Government Direction

….

A sustained increase in elective surgery cannot be achieved without using the resources and the capacity across the public and private components of our health system.
….
If the private sector had longer-term contracts with DHBs, it would be able to plan and so respond with better prices. They would supplement public hospital-provided electives, seeing more patients at less cost.
….
And in the future, doctors in training may get much needed experience across both public and private sectors.
….
In the future, the focus will be on getting patients seen, not where they are seen. The judicious use of public-private partnerships will increase the number of people getting access to vitally needed surgery, and reduce hospital waiting lists.

Tony Ryall - NZMA GPCME Conference in Rotorua - Smart Use of the Private Sector

Mr Ryall wants to see more flexible use of the private sector in health

Tony Ryall Recent NZ Doctor Article “In the Pink”

< The government wants the public sector to consider better ways of delivering its services. ... where services can clearly be provided better by the private sector it would be foolish not to have them do so.

Tony Ryall Speech to PSA Congress September 2010

The member is well aware that the Government believes that integrated family health centres will be developed by the private sector.

Tony Ryall - response to Parliamentary Question 22 April 2010

The government wants to increase the amount of surgery, the opportunities people have to be dealt with by doctors and nurses, and that's where our focus is going into. It's about the public hospitals organising themselves well, supplementing it with some private sector capacity if that's necessary

Tony Ryall - Interview with Mark Sainsbury 14 August 2009

Recruitment Expenses for Executive Leadership Team - November 2010

Media Release

15 November 2010

Recruitment Expenses for Executive Leadership Team

The Top of the South’s largest employer with 2179 employees and an annual revenue of $388 million makes no apologies for having a thorough process for recruiting executives to guide the organisation.

Recruitment for Nelson Marlborough District Health Board’s new Executive Leadership Team attracted 94 applications for the 18 positions advertised.

The DHB made major changes to its leadership structure to incorporate hospital-based specialists and community-based clinicians. This team is charged with managing the organisation and delivering on Board and Government health goals.

The DHB spent $139,000 on the recruitment process and included independent clinical input as well as flights and accommodation and independent assessments of candidates, selection for interview and in-depth assessment of short-listed applicants.

By managing the recruitment process internally the DHB saved 20% compared to the cost of outsourcing the process.

NMDHB Chief Executive John Peters said, “While we acknowledge that $139,000 is a large amount of money to spend at any time, this process had to follow best-practice recruitment methods.

“It pays to be thorough when recruiting at this level and with this level of responsibility.”

He said the process for employment of senior executives had to be rigorous and while in a lot of cases internal candidates were proven to be the best people for the positions there were numerous applicants for each position.

“The DHB did engage external experts to assist with the process of initial assessment of all candidates, selection for interview and in-depth assessment of short-listed applicants,” said Mr Peters.

He said the process followed generally accepted practices for the employment of executives with responsibilities of this nature and included reference and other background checks.

“Frontline staff will now have a greater say in how the DHB is run and the future of services, this follows the guidelines set down in the Government’s “In Good Hands” paper that recommended a greater role for clinical staff in executive level decision making.

ENDS

Questions and Answers

Recruitment Expenses for Executive Leadership Team

Why did the DHB restructure the senior leadership of the organisation?

NMDHB has embarked on a major change to its leadership structure to incorporate significant numbers of clinicians (both hospital based specialists and community based experts) into the team that is charged with managing the organisation and delivering on the Board’s and Government’s health goals.

When did the new Executive Leadership Team (ELT) commence?

On 1 November most ELT members were in place, the only position to be readvertised is the Chief Medical Officer (CMO) where an acting CMO is in place until an appointment is made.

Did some people apply for more than one position?

There were 68 people with 94 applications across the 18 positions.

Who managed the recruitment process?

NMDHB managed the recruitment of the new ELT internally. We advertised and recruited for eighteen positions. Had we outsourced the management of the recruitment process this would have added an additional 20% to expenses.

The organisation did engage external experts to assist with the process of initial assessment of all candidates, selection for interview and in-depth assessment of short-listed applicants. In the interest of impartiality we engaged an external clinician to be part of the candidate interview process and engaged specialist administrative support for the period.

What specific items were included in the recruitment expenses?

Total costs of the Executive Leadership Team recruitment and appointment process are broken down as follows:

Travel costs related to candidate interviews/assessment centres = $4420.00
External assessment support and associated travel and accommodation costs including assessment of electronic questionnaires for 37 candidates selected for interview, consultants attending 16 assessment interviews and conducting 10 assessment centres, provision of feedback to all candidates = $111,423.00
External clinician travel and accommodation costs, preparation and participation in 37 interviews = $10,427.00
External administration assistance for the recruitment period including travel costs $13,371.00

NMDHB Announces New Leadership Structure - October 2010

Nelson Marlborough District Health Board's new health management line-up was revealed today (04/10).

Click here for Profiles of the new ELT team
The new Executive Leadership Team includes a mix of clinicians from hospital and community practice, and managers some of who are new to the DHB and some who are in the current Strategic Leadership Team (SLT) or District Managers team.

The restructure, announced in June, will come into operation on November 1, 2010.
Chief Executive John Peters said, "The team now embraces broad clinical experience and coverage, which we have not had working at this level of DHB leadership in the past.

"It is combined with some new management leadership and vital continuity offered by existing DHB leaders. I am particularly pleased that it has also offered the opportunity for several existing people to further develop their careers within the organisation."

The ELT has two distinct functions; Service Delivery and Support. In Service Delivery there are a number of directorates that have a service director working in conjunction with executive clinical directors; one from hospitals and one from the community. There is also a director of Allied Health and a new presence for Marlborough at the top table?.

Mr Peters said this configuration have greater collaboration between primary and secondary health services which will focus on improving care for patients.

The support area includes strategy and planning, and corporate services.

He acknowledged the work of the members of the current SLT and District Managers whose positions had been affected and the commitment and patience shown by people as the new team was formed.

The position of Chief Medical Advisor formerly held by Dr Andre Nel has been re advertised and the acting CMA Heather McPherson will continue in the role until a suitable applicant had been selected.
ENDS

SERVICE DELIVERY
Medical Surgical Services Directorate    Executive Clinical Director Specialist          Dr Bruce King    Executive Clinical Director Community       Dr Elizabeth Wood    Service Director                                       Dr Peter Bramley (PhD Medicine)
Mental Health Services Directorate    Executive Clinical Director Specialist          Dr Heather McPherson    Executive Clinical Director Community       Dr Jocy Wood    Service Director                                       Robyn Byers Community Based Services Directorate    Executive Clinical Director Specialist          Dr Nick Baker    Executive Clinical Director Community       Dr Bev Nicolls    Service Director                                       Peter Burton
Clinical Services Support Directorate    Executive Clinical Director Specialist          Dr Stephen Busby    Executive Clinical Director Community       Dr Neil Whittaker    Director Allied Health                                Hilary Exton    Service Director                                       James Bowyer
Marlborough Services Directorate Executive Clinical Director Specialist             Dr Jeremy Stevens Executive Clinical Director Community          Dr Ros Gellatly * Service Director                                          Carey Virtue Director of Nursing and Midwifery                 Robyn Henderson
Director of Maori Health and Whanau Ora      Harold Wereta
Chief Medical Officer                                    TBA **
CORPORATE SUPPORT General Manager Corporate Services               Nick Lanigan General Manager Organisational Development  Denise Hutchins
General Manager Strategy and Planning           Dr Sharon Kletchko
CE’s Office Board Secretary                                             Mike Cummins
Business Development Manager                       Keith Rusholme
Chief Executive                                               John Peters

* Ros will share the role and be supported by Dr Grant Johnson and Dr Rod Bird
** This position will be re-advertised

Media Release - 4 October 2010

Executive Leadership Team - Organisation Perspective - 16 June 2010 NMDHB is responsible for the effective delivery of health services to the people of Nelson, Tasman and Marlborough. This includes hospital based services, community based services and referrals to appropriate tertiary centres.

The DHB is facing a number of challenges, including ageing population and financial pressures with service demands and costs outstripping traditional service capacity and the need to regain financial sustainability following a period of annual deficits. In addition, sustaining base hospitals in each of Blenheim and Nelson offers both challenge and opportunity. The need for a whole of systems approach for services in the district is overwhelming, and reflects a significant change in our approach.

This combination offers exciting new opportunities for the district, and the DHB Executive Leadership Team has been structured to respond by:
-focusing services on the patient/client, with service providers working together across the care continuum
-engaging clinical leadership from both hospital and community based services at the highest level of decision making for both strategic direction and operations
-centring service delivery at the executive level of the organisation through service directorates responsible for services across the district
-providing support for the three service directorates through the common Clinical Support Services Directorate, the Director of Nursing and Midwifery, the Chief Medical Officer and the Director of Maori Health and Whanau Ora
-Marlborough services, while delivered by the other service directorates, having its own directorate at the ELT table to inform and facilitate effective services across both base hospitals and communities
-supporting service delivery as a whole by a corporate support structure of General Manager Strategy and Planning, General Manager Corporate Services, General Manager Workforce and Organisation Development and a Chief Executive’s Office.

Each of the Service Directorates is led by a coalition of a full time Service Director and part time Clinical Directors (ELT) from hospital based and community based services. The ELT Clinical Directors will have differing FTE contribution, depending on the needs and decisions of respective Directorates.

The ELT Clinical Directors are those that represent the overall clinical perspective of the directorate at the ELT table. They are not expected to be the clinical directors for all specialties or programmes covered by the directorate, and it is anticipated that each directorate will establish suitable clinical leaders/directors relating to specific specialties and programmes as required. These specialty clinical directors will attend and represent the specialty or programme as required.

The organisation is keen to move away from an environment that was characterised by inconsistent systems and processes which led to an inability to gather good information correlating activity against financial performance. We also seek to address an historical lack of rigour in managing accountabilities, to improve our capacity to plan and to correct a trend of people working at a level below their role.

The Rutherford Initiative is an organisation-wide programme to ensure value for money through a systematic approach to ensure we are spending each dollar to achieve the best possible result. The Executive Leadership Team is individually and collectively responsible for implementing the accepted recommendations of the Rutherford Initiatives.

Correction to Article on Senior Leadership Team - 10 June 2010
There are currently 11 SLT members six of whom retain their current positions. The articles "Managers face axe in health shakeup" Nelson Mail, 4/6/10 and in "Key jobs on line as health budget tightens" Marlborough Express 7/6/10 incorrectly stated that the Chief Executive was the only person to retain his position.

This change in structure brings clinical directors into the leadership team which is part of the move toward the changes signalled through the "in Good Hands" paper. These leadership initiatives also align the Executive Leadership Team more closely with primary health clinicians to ensure the Government's targets of "Quicker, sooner, more convenient healthcare" is achievable in the district.

In Good Hands' provided guidance to DHBs on how they could foster effective clinical leadership and institute a more participatory approach for their doctors, nurses and other health staff. See our media release and the ELT Structure below... ELT Structure

Media Release - 3 June 2010 NMDHB Announces New Leadership Structure
Nelson Marlborough District Health Board has announced the restructure of its senior leadership team.
The new structure brings those people concerned with district-wide delivery of services into the senior team and increases the input of clinicians. It is also intended to achieve greater clarity and accountability across both operational and support functions.

The new Executive Leadership Team (ELT) will come into operation on 1 September, 2010.
Chief Executive (CE) John Peters said, “The previous structure served the organisation well for the past four years, with surpluses and new initiatives in a number of recent years.
“However with changing pressures and priorities the Leadership Team needed to work towards long term clinical and financial viability of the DHB while including greater clinical involvement.”
Some of the pressures and priorities included moving into deficit from a period of sustained surpluses, changed long term outlook, and changed political priorities.
Mr Peters said the new structure goes well beyond the functions that traditionally reported to the Chief Executive, offering an exciting leadership opportunity to take the DHB into a challenging future.

The ELT will have two distinct functions; Service Delivery and Support.
Service Delivery includes: Director of Nursing and Midwifery, Director of Maori Health and Whanau Ora, Chief Medical Officer as well as Primary and Secondary Clinical and Service Directors in; Medical/Surgical, Primary (including Oral Health and Public Health), Mental Health, Clinical Support, and Wairau Services.
Support functions include General Manager (GM) Strategy and Planning, GM Corporate Services, GM Workforce and Organisational Development, and CE Office Support . ENDS

DHB Coffers Shipshape - for now - October 2010

We were disappointed in the Nelson Mail article from 1 October, 2010 "DHB Coffers Shipshape" that says:
"The cost-cutting plans for psychogeriatric services, ophthalmology and patient travel are under way" which suggests that the Rutherford Initiative is cost-cutting in these areas – whereas these services are currently being looked at by Rutherford but it is primarily to review and determine whether the DHB can work in a different way to deliver the same services.

For example the preferred model that is currently under consultation for Psychogeriatric Services may increase the spend but better outcomes for patients and the modern delivery of services is the goal.

The DHB has always been clear that Rutherford is looking at ways of working smarter and making the necessary changes to deliver the same services in the best way and in some cases that will mean savings but its prime objective is not cost cutting.

Golden Bay - Joan Whiting Rest Home - September 2010

23 September 2010

Media Statement

Nelson Marlborough District Health Board, Chief Executive, John Peters:

We are delighted that the Joan Whiting Rest Home will continue to provide rest home care in Golden Bay, both in its present setting and then in the new Integrated Family Health Centre (IFHC). We are especially pleased that the people currently in the resthome get to stay on. This also means that people can now admit their loved ones to Joan Whiting with confidence that there will be a continuity of service through to the new facility being opened.

Recent meetings with the Ministry of Health have resulted in a timeframe for completion of the IFHC and this has meant that the Ministry and the DHB are able to ensure the funding so that the current residents of Joan Whiting can remain in the Bay, while the new facility is built.

This is not only a significant step forward for the IFHC in Golden Bay, but has also allowed resolution to the difficult issues surrounding the Joan Whiting Rest Home. We have confidence in the process we are following for health care services in Golden Bay, and once the IFHC is completed in 18 months time there will be increased assurance of long-term sustainable healthcare in the Bay.

ENDS

16 September 2010

The DHB has worked on several proposals that have been forwarded to the Minister’s office for consideration. We are supportive of Aged Care in Golden Bay however we are also duty bound to be fiscally responsible and work within the District Annual Plan that has been signed off by the Minister.
In the past we have supported the Joan Whiting Trust on top of the standard resthome subsidy while the trust was deliberating on whether to join the Integrated Health Care Centre that was being planned. Our records show this support as:

$155,000 from October 2008 to December 2009

$130,000 loan from Nelson Marlborough Hospitals’Trust

The country is currently in a particularly tight fiscal environment and the plans that the DHB have made to break-even in 2012 are dependent on the DHB making some hard decisions to benefit all in the long term.

The $24m that we have received from the Government in the last two years does not cover the increase in expenses for the same period and we have had to make changes to the way some services have been delivered through our Rutherford Initiative project. And while we must make decisions about where the health dollar is spent we believe that support for Golden Bay through this DHB has been considerable.

Murchison Hospital and Health Centre - 17 August 2010

Murchison Hospital and Health Centre will remain open however residents will have to pay for GP visits.

This comes after a half a century of being a “special area” where GP visits were provided free-of-charge to residents. This designation was removed in 1993 when the Government revoked all “special area” status.

Information released at a public meeting last night (16/08) showed that while there may still be a deficit for the facility built in 2007, Nelson Marlborough District Health Board would continue to support the community of Murchison through meeting the shortfall.

NMDHB Chief Executive, John Peters said, “Murchison Hospital and Health Centre will probably never be economically viable as the income generated from six continuing care beds does not support standard staffing ratios 24 hours per day 7 days per week.

“However the DHB will continue to support the facility as it serves a dual purpose of providing continuing care beds for elderly people of Murchison and it is the first response for road accidents on the busy stretch of State Highway 6 that carries a large amount of tourist traffic.”

“The payment for GP visits will contribute an additional $60,000 per year and go some way towards addressing the deficit incurred in providing the Murchison Hospital and Health Care facility,” said Mr Peters.

The charges have been estimated based on the amounts being paid in other GP practices throughout the District which depending on a patient’s age and whether they have a Community Services Card range from $25-$45, with children under six years of age free.

The information came from the DHB’s Rutherford Initiative that takes its name from the famous Lord Rutherford quote, “we haven’t the money so now we have to think.” Every service within the DHB will be reviewed under the Rutherford Initiative both hospitals and community providers.

The DHB also recommended that a Nurse Practitioner be appointed to provide additional Primary Care cover for the community. This position will be developed to work in conjunction with GP services of the area.

Mr Peters said the average deficit for the Murchison Hospital and Health Care Centre between 2006 and 2009 was in excess of $100,000 per year.

ENDS

Questions and Answers

What services does Murchison Hospital and Health Care Centre Provide?

MHHC provides Primary and Aged Care services to a catchment area from the Murchison Township extending from Boundary Road in the South to St Arnaud in the north. These services include:

Six Aged Care beds, palliative, respite and Needs Assessment and Coordination services;
Three day GP support;
24/7 access to Prime-trained nursing services for emergency and acute care;
Various registered-nurse Community Services; and
Other services provided by Health Care professionals.

What is a “special area” and why haven’t Murchison residents paid for their GP services?

Murchison was designated as a “special area” by the Government in the early 20th century to ensure miners living in the area had ready access to health services. As a result the community currently does not make contributions/co-payments towards primary care services as do other residents of Nelson Marlborough and indeed New Zealand. Murchison to all intents and purposes stopped being a special area in 1993 when the Government revoked all “special area” status.

How much of the shortfall will these charges cover?

Murchison Hospital and Health Centre will probably never be economically viable –the accounting data shows that the income does not meet the overheads. A large part of this shortfall comes from maintaining standard staffing ratios 24 hours per day 7 days per week.

However the DHB will continue to support the facility as Murchison Hospital and Health Centre serves a dual purpose of providing continuing care beds for elderly people of Murchison and as the first response for road accidents on the busy stretch of State Highway 6 that carries a large amount of tourist traffic.

Between 2006 and 2009 the average shortfall was in excess of $100k.

What will the GP charges be based on?

The co-payment amount has been estimated based on the amounts being paid in other GP practices throughout the District. It should also be noted that the total estimated consultations per annum is less than the 2008/2009 actual consults for Murchison.

The benefits of GP charges were determined by applying the Nelson region average consults per annum by age group (supplied by Nelson Bays PHO) to Murchison’s patients by age group as at January 2010 and applying a Co-Payment amount. The current level of patients (1075) is higher than the 976 total used in making this estimate.

What is a Nurse Practitioner? (From Nursing Council NZ)

Nurse Practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills. They practice both independently and in collaboration with other health care professionals to promote health, prevent disease and to diagnose, assess and manage people’s health needs.

They provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests, and administering therapies for the management of potential or actual health needs.

They work in partnership with individuals, families, whanau and communities across a range of settings. Nurse Practitioners may choose to prescribe medicines within their specific area of practice.

Murchison currently has a senior nurse who is close to completing her Nurse Practitioner qualifications

To view a copy of the Murchison Hospital Staff - Rutherford Report Summary click here

Katherine Rock

Communications Advisor

Nelson Marlborough District Health Board

Ph 03 546 1824 or 0274466799

Private Bag 18

Nelson

email katherine.rock@nmdhb.govt.nz

www.nmdhb.govt.nz

Appropriate Spending on CE Credit Card - August 2010

5 August 2010

Media Release

Appropriate Spending on CE Credit Card

The release of credit card expenditure details for Nelson Marlborough District Health Board’s (NMDHB) Chief Executive (CE) has shown that all transactions were appropriate.

The analysis of credit card expenditure was part of information gathered for a recent Official Information Act request to all DHB CEOs.

John Peters has been CE of NMDHB for five years, and has responsibility to the public and the board for delivering health services to the value of $380m per year to the population of Nelson Marlborough district.

The analysis of DHB CEOs’ use of credit cards showed that there were different processes in each individual DHB for card use. In NMDHB the card is for CE work-related expenses including taxis and meals, professional development, conferences and accommodation where charge-back is unavailable.

While CE John Peters’ use of the credit card was high in comparison to some other CEs, NMDHB encouraged credit card use as a transparent and efficient means of recording expenses for accounting purposes.

Total expenditure on the card for $2008/09 was $21,300 and $10,400 for 2009/10 which covered 368 transactions, of which 249 were for taxis and 41 were for parking charges.

Almost one third of the total card expenditure for this two year period was for other staff members. This included conferences for staff members charged to the CE’s credit card, for convenience purposes, all of which was

appropriate DHB spending.

The majority of transactions were associated with the demands of Mr Peters’ role as a senior health executive on national and regional health committees (see attached list). These meetings and committees plan and coordinate regional and national health services. The majority of transactions on the NMDHB CE’s credit card were for taxis used while attending these meetings.

Mr Peter said, “You will note that since the National Health Board has taken on responsibility for areas that CEs previously worked on there has been a decrease in travel and meetings that I need to attend. I anticipate that these will continue to decline.”

The CE acts within his delegated financial authorisation where credit card expenses were concerned and Suzanne Win, Board Chair subsequently views and signs off expenditure.

Suzanne Win said she was comfortable with the analysis of the spending and the authorisation process for credit card expenditure.

“There is a policy for credit card use that Mr Peters adheres to and this process meets the approval of Audit New Zealand,” she said.

Mr Peters said, “There have been occasions where it was appropriate for me to charge meals to the card, for example in recognition of a Strategic Leadership Team member being farewelled or where it was appropriate to share a meal with strategic partners like the Primary Health Organisations.

“I am always mindful of the financial circumstances and have kept expenses to a minimum. However I do need to engage with others in local, regional and national planning and provision of health services.

“The expenses are all scrutinised by the annual audit process and no issues have been raised.”

The CE’s credit card is a Westpac Business Credit Card that is paid monthly with no interest charged.

ENDS

Credit Card Usage 2008/09 and 2009/10

Taxis	249
Parking	41
Other	71
*Purchase on behalf of others	7
	368

*Purchase on behalf of other staff members 2008/09 and 2009/10 $9200.96

Health committees and meetings attended during the 2008/09 year and 2009/10 year

2008/09

Value for Money, Wellington (monthly although many were teleconferences)

SI (South Island) CEOs, Christchurch bi monthly

CEO Executive, Wellington bi monthly

National CEOs, Wellington monthly

NQIP (National Quality Improvement Programme), Wellington periodically

PFG, (Performance Framework Group) Wellington monthly

Health Management System Collaborative, Wellington starting off in September 08 and progressing through to end 2009

Strategic Leadership Team (SLT) Advance – July 08

Australasian Health Leaders Conference – August 08

Learning Set, Queensland – August 08

SLT Advance – October 08

International Health Leaders Conference – October 08

Innov’8 Conference, Wellington October 08

Learning Set, Tauranga – December 08

SLT Advance – March 09

HSRA Learning Lab, Wellington – March 09

Healthlink Conference, Wellington – April 09

SLT Advance – May 09

2009/10

Performance Framework Group – no longer attending

Health Management System Collaborative – no longer attending

CEO Exec

SI CEOs

National Quality Improvement Programme – no longer attending

National Institute of Health Innovation

National CEOs

Trip to UK (paid for by Ministry of Health) – September 09

Learning Set, Melbourne – October 09

SLT Advance – November 09

SLT Advance – March 10

Questions and Answers

Why is the CE’s card used for other staff?

Sometimes it is convenient that conference bookings or other purchases are made by credit card on line to receive early registration discounts. These items amount to nearly one third of the value charged to the CE’s card in the last two years.

Who audits the CE’s expenses?

These expenses are audited each year, as part of the focus on Sensitive Expenditure. No issues have been reported by Audit NZ with regard to the use of the CE's credit card. This is audited against the credit card policy as outlined below:

Sensitive Expenditure Policy Letter to CE and SLT

Credit Card

You have been issued with an NMDHB credit card. You may use the card for the purchase of:

food and alcohol for a business meeting as *above
petrol for a DHB vehicle when the preferred supplier is not available
flowers on the bereavement of a senior staff member, Board or committee member or a member of their immediate family
minor consumables for the DHB Office
urgent changes to air travel that cannot be made through Orbit.

The card may be used for the following business expenses:

professional work related subscriptions
approved courses and conferences
taxis and other transport when travelling on DHB business
purchase of gifts on retirement.

You may not use the credit card for a cash advance unless exceptional circumstances arise, eg when travelling and your personal belongings are lost or stolen.

* Alcohol

You may pay for alcohol for a business related meeting with a supplier, contractor, other business partner and occasional appropriate staff functions. The amount is not to exceed $10 per person.

Why is NMDHB CE credit card usage higher than some other DHB CEs?

The use of a credit card for all possible transactions reduces the transaction cost of using alternatives such as taxi chits, and charge backs. It is also a very transparent means of reporting expenses.

As Nelson is not a major centre most meetings of a national or regional nature are held in Wellington and Christchurch with associated taxi charges to-and-from airports.

NMDHB’s CE participated in a higher than average number of national and regional activities over the two year period.

What is a Learning Set?

A Learning Set brings together people of similar roles to share experience and knowledge. This is appropriate professional development for the CE of a $380m health care service.

What is an Advance?

This is a two-day planning workshop for SLT.

Why did the Marriot Vancouver refund $2144.19 in 28 October 2008?

This amount was refunded after the CE discovered the hotel had charged the full room rate instead of the conference room rate.

Click this link for further information.

Katherine Rock

Communications Advisor

Nelson Marlborough District Health Board

Ph 03 546 1824 or 0274466799

Private Bag 18

Nelson

email katherine.rock@nmdhb.govt.nz

www.nmdhb.govt.nz

DHB Finds no Basis for Davis/Fargo Complaint - June 2010

After a thorough investigation into the complaint from Victoria Davis no evidence has been found to substantiate her claims that she was told to hire a private nurse to care for her mother in Nelson Hospital.

See our media release below...

Media Release - 2 June 2010

DHB Finds No Basis for Fargo Complaint

After a thorough investigation into the complaint from Victoria Davis no evidence has been found to substantiate her claims that she was told to hire a private nurse as ward nurses were too busy to care for her mother.

The Nelson Marlborough District Health Board has complete confidence in the nursing care provided in Nelson Hospital Medical Unit.

Chief Executive John Peters said, "There is no evidence to verify the allegation that Ms Davis was told to employ her own nurse. And under no circumstances would we condone public hospital nursing care being supplemented with private nurses paid for by families.

"I would like to assure the community and patients that it is not, and has never been, the policy of the DHB to require families or patients to provide their own nurse.

"The Medical Unit provides a very high standard of care and from this investigation we can categorically say that from the evidence produced by our staff and the lack of cooperation on the part of Victoria Davis that at no stage was it suggested to Ms Davis that private nursing was required."

Ms Davis may have confused a nurse's comment about prioritising her mother's needs as not meeting her wishes because when asked if her mother would get a shower at a specific time the nurse indicated that there were other clinical priorities for her mother's care at that time.

Staff were interviewed and the Director of Nursing and Midwifery Robyn Henderson, reviewed the patient's clinical file and advised that there was clear evidence that NMDHB nurses not only planned the patient's care but delivered this consistently throughout the patient's hospital stay. Clear documentation, including a comprehensive nursing care plan is evidenced in this file.

"In these notes there is mention of a family friend who was at the patient's bedside and did what we would expect any friend to contribute to care. However we were unaware that this was a paid carer and the complainant has refused to give any information around the name, agency, or qualifications of the carer who described herself as a "former carer but was now a family friend"," said Ms Henderson.

She said the nurses caring for the patient delegated only things that would normally be delegated to any family member or friend of family. There was never any expectation on the part of staff, that this friend would 'nurse' the patient.

"If anyone has issues with care in any facility we would expect them to speak with the Charge Nurse Manager," said Mrs Henderson.

If this patient had been assessed as needing a higher level of clinical care she would have been admitted to ICU.

"Nursing staff encourages the contact a patient has with friends and relatives as sometimes having familiar people involved in basic cares has a reassuring effect on elderly patients," she said.

ENDS