The evolution of Whare Manaaki o te Tai Poutini

Eli-Ana Maiava

Eli-Ana Maiava created Whare Manaaki – a Kaupapa Māori community space for Mawhera (Greymouth) locals – knowing that a similar space was a valuable support system for her when she was a new mother. “My life was literally saved by a community space when I was living in the Hutt Valley,” she says.

“I had been experiencing some quite traumatic mental health issues and the scariest thing for me at the time was to be home alone with my baby. So, I could go there and be around other people, have a conversation and a cup of tea while someone held my baby.”

After moving to Mawhera from Wellington three years ago to connect with her iwi and Māori whakapapa, Eli’s aim was to work specifically for improving wellbeing of Māori on the West Coast, where her whānau are from. This led to a role in Community and Public Health (CPH) as Hauora Māori Health Promoter, when she noticed a gap in the community and decided to create Whare Manaaki.

What started out as a parenting programme, grew into a kaupapa Māori space for the entire community, offering a range of programmes to meet a variety of needs. Eli’s 20-year background of early childhood teaching, as well as mentoring, management, and a master’s degree in adult education was useful in creating and leading the programmes.

She also carried out research by interviewing 20 whānau on the West Coast about what their needs were and what barriers stood in the way of them being met. “How do we ensure our babies have good lives, with solid parenting? It’s about making sure that their whānau have their basic needs met so they have the capacity to then actively and intentionally think about the way they’re interacting and caring for their tamariki. That can be challenging when they’ve got a lot of stress hanging over their heads. We decided that a culturally safe, warm and inviting space where you can bring your family was the best way to support Māori parenting here on the Coast.”

“Māma or whānau can drop in for kai, community dinners or a cup of tea, and we’ve got plenty of resources for the tamariki to play with…”

The programmes range from gardening groups and breakfast clubs, to pepi and whānau coffee groups, and community Kapa Haka. “Māma or whānau can drop in for kai, community dinners or a cup of tea, and we’ve got plenty of resources for the tamariki to play with. We also do a Te Reo Māori playgroup where we do a bit of a song and a book reading session, to encourage use of Te Reo.”

An antenatal group is being developed and a Friday night rangatahi hangout programme has just started. Teenagers can come in off the street, have some kai, play some games and “just chill out together – there’s nowhere else for them to hang out on a Friday night.”

Community kai at Whare Manaaki

Staff at Whare Manaaki are currently working with other agencies to run a Safe Woman, Safe Family group, for women affected by violence in their lives, as victims or offenders. “We’ve also got a lunch programme where people can come and make kai and take it away for work or school, so that they’ve got full bellies. We offer everything with no judgement, we’ve got a pataka (pantry), vegetable garden and a freezer full of food to share with anyone. We’ve also got a community cupboard full of blankets and shoes and children’s clothes – people can help themselves.”

Eli, a mother of four tamariki aged 4 to 13 years, has resigned from her CPH role so she can dedicate more time to Whare Manaaki, which has grown exponentially. “There is just so much need, interest and support for it in the community. I’m not doing it alone, it’s part of a bigger collective and a community-led space and we all do our bit. It just took someone to take that first step and provide a space, and everyone else is filling it with all of these wonderful things.”

Eli is also a part of the South Island Alliance, Te Pā Harakeke/Nurturing Care in the First 1000 Days steering group, which is currently creating its framework principles for health services. “It goes back to well whānau and parents create well children, so looking a bit wider than just the children’s needs – what are the family’s needs in relation to doing well with that child?”

She says her ultimate goal in life is to raise wonderfully kind, confident and independent children. “And because I think collectively, like Māori tend to, I know that I can’t create those things for my children without them being surrounded by those things outside of our home as well. Ultimately, it’s about creating the environment I want my tamariki and other tamariki to grow up in, that’s going to instil a positive sense of identity and collective thinking around sharing of resources and wellbeing. That’s what I want in any project that I’m involved in, is to help create a better world for our tamariki.”


Staff Profile: Catherine Crichton

Quality Improvement Manager
Well Child Tamariki Ora Quality Improvement
Sudden Unexpected Death in Infancy

After nursing in mainly primary and community practice for 12 years, a change in direction and a passion for child health resulted in Catherine Crichton’s role with the South Island Alliance Programme Office (SIAPO).

From working in a neonatal unit, to a position at Starship Hospital, her nursing roles have been largely focused in the child health space. During Catherine’s most recent seven-year stint as a Public Health Nurse on the West Coast, she also worked as the B4 Schools Check coordinator, overhauling the process to be as streamlined, timely and cost-effective as possible. “It was exciting to be a part of change on a small scale, so that’s what attracted me to this position at SIAPO – I wanted to be a part of supporting change on a larger scale, across the Well Child spectrum.”

Lockdown was a catalyst for that change, and Catherine joined SIAPO in August 2020. “It’s been an interesting experience so far,” she says. “I’ve been able to network with a range of contacts much broader than what I could on the West Coast, where it’s so isolated that you make the most of who you meet, so I sort of carried that over into this role.”

Originally from Brazil, Catherine grew up in Wellington. From a young age, she had always enjoyed caring for others. “As a teenager, I helped look after special needs children, which gave me a lot of understanding about the difficulties that they and their parent’s go through. I also worked for IDEA Services, supporting children with intellectual disabilities, while I was training to become a nurse.”

Catherine is one of two Quality Improvement managers for Well Child Tamariki Ora (WCTO) Quality Improvement (QI) and Sudden Unexpected Death in Infancy (SUDI). The role is split to cover the South Island with her colleague Marijke Dryfhout, and they both facilitate the WCTO QI Steering Group.

Originally starting the role remotely, Catherine worked from her home in Westport while also keeping up clinical practice for a few months before moving to Christchurch. “Although it was hard leaving my close friends and support system in Westport, I love living in a city again and I’m really enjoying the SIAPO office environment.”

As part of the WCTO QI framework, she also facilitates the South Island Breastfeeding Working Group, supporting improved breastfeeding rates across the region. “It’s about looking at our data and assessing breastfeeding behaviour across the South Island, which has been a really interesting project to work on.”

Re-establishing the WCTO networking hui on the West Coast is another aim. “People have found it very beneficial and supportive to bring all the WCTO providers into one room and talk about what’s happening, so I want to help keep that momentum going to ensure everyone can keep doing the good work they’re doing.

“This way of working is completely new to me and I feel like I’m in a good place to branch out and see what else I can fit into this role.”


Mini-ACE for Cognitive Screening

The Mini-Addenbrooke’s Cognitive Examination (Mini-ACE) is the recommended cognitive impairment screening tool in New Zealand, to assist with dementia diagnosis.

The Mini-ACE replaced the Montreal Cognitive Assessment (MoCA©) test in September 2020, as New Zealand’s recommended cognitive screening test. Anyone who conducts cognitive impairment screening should be using the Mini-ACE test, unless they are willing to pay for individual training and certification through the MoCA Institute or they are using an alternate test for some reason.

Carole Kerr, dementia educator and registered nurse, says the initial changeover from 1 August last year went well. “Many practices have made the transition seamlessly and practice nurses are confident using Mini-ACE, after completing the one-hour training. The Mini-ACE is free, easy to use, takes around five minutes to complete, and online training is available on DHB and Ministry of Health learning platforms.”

The use of the Mini-ACE test is not prescriptive, but it is the recommended tool on NZ HealthPathways, for use by primary care and non-specialist dementia services. It evaluates four main cognitive areas – orientation, memory, language and visuospatial function.

Mini-ACE was identified as the most appropriate tool following a Cognitive Impairment Assessment Review last year, to find an alternative to the MoCA. The review was sponsored by the New Zealand Dementia Framework Collaborative and endorsed by the Ministry of Health and the National DHB Health of Older People Steering Group.

There are still health professionals who have not realised about the change from MoCA to Mini-ACE who need to be encouraged to use the new tool, says Carole. “We have to ensure continuity by completing the training and supporting practice nurses with Mini-ACE. It’s a very effective tool to help support a timely diagnosis and it is important that we use the same tool as much as possible.”

More information


Spait Chair Carol Atmore Steps Down

News
28 Jul 2020

Dr Carol Atmore

Dr Carol Atmore has resigned as chair of SPaIT, after five years in the role. She has been a member of SPaIT since 2012 and has made an enormous contribution to the Alliance, bringing a strong primary care focus to our regional focus.

Carol, a practising GP, has recently taken up a role as Head of Department, in the Department of General Practice and Rural Health within Otago Medical School at the University of Otago in Dunedin. She has a doctorate in rural health and was also chair of Alliance South (Southern DHB’s local alliance) up until late last year.

“I have really enjoyed the opportunity to be involved with the work of the South Island Alliance. I have had the pleasure to work with many fantastic people throughout the South Island in this role.” Carol says. “I strongly believe in the kaupapa of a single South Island health system and hope to support this work as the opportunity arises from within my other roles.”

South Island Alliance chair Jenny Black says Carol’s extensive knowledge of the South Island, due to her time in the different DHBs, made her contribution invaluable. “She understood rural and remote South Island as well as urban, she had a great balance of primary vs secondary clinical issues and she knew the importance of strategic thinking and planning ahead. We’ll miss her enormous contribution and thank her sincerely for it – and we wish her well for her next challenge.”

Anna Wheeler, Associate Director Nursing and Midwifery, South Canterbury DHB, has replaced Carol as the new chair of SPaIT.


Regional Outcomes And Equity Report 201819

 

News
27 May 2020

The Regional Outcomes and Equity Report 2018/19 is now available. It brings together a range of data from various sources to measure performance against our South Island Alliance Outcomes Framework and priority focus areas (2018–21).

The intention of the report is to establish a baseline dataset for regular reporting and update at regional level across a wide range of health specialties. It is also intended to assist with defining strategies and activities to address future activity and challenges, particularly in achieving equity.

Data highlights that progress is being made in many areas. However, there is much more we could do, particularly to address inequity for Māori across the South Island.

We trust this report will initiate the generation of new ideas, innovation and problem-solving as together we seek to address challenges, with a strong focus on improving equity for Māori.

This report brings together a range of data from various sources to measure performance against our South Island Alliance Outcomes Framework and priority focus areas (2018–21).

The intention of the report is to establish a baseline dataset for regular reporting and update at regional level across a wide range of health specialties. It is also intended to assist with defining strategies and activities to address future activity and challenges, particularly in achieving equity.

Data highlights that progress is being made in many areas. However, there is much more we could do, particularly to address inequity for Māori across the South Island.

We trust this report will initiate the generation of new ideas, innovation and problem-solving as together we seek to address challenges, with a strong focus on improving equity for Māori.

Click here to access the report.


Microsoft Teams The New Solution For Alliance Meetings

 

News
25 May 2020

Organising meetings for more than 80 Alliance work groups across the South Island is no small feat. Over the course of a year, that’s hundreds of meetings for over 1000 people – consumers, clinicians, health professionals and leaders across the South Island health and social system.

Alliance meetings are held virtually and face-to face, using a variety of digital solutions to accommodate our broad and widespread membership. During the Covid-19 response, as the SIAPO team switched to working from home, we also needed to switch to a single virtual meeting solution – to avoid confusion, provide better support and enable better online collaboration.

As part of the regional roll out of Office 365, Microsoft Teams became available for us all to use and has since been adopted as the single  solution for all our Alliance meetings.

While we still accommodate other technologies where required, Teams is our preferred option. It has simplified our job of hosting meetings immensely and enhanced the way we work together across the South Island health system. We would like to thank all our colleagues who joined us in this transition.

During the pandemic response period, within Canterbury DHB:

Here are some of the benefits our team has found:

When we’re back in the office, we’re also expecting Teams to spell the end of manoeuvring bulky video conferencing equipment between rooms and floors of our building, hunting for missing cables and controls, and begging for tech support.

  • Alliance group members experiencing issues with Teams or wanting more information should contact the relevant group facilitator.

New Look South Island Alliance Board Appointed

News
23 May 2020

The South Island Alliance hosted the South Island Board induction day in Christchurch, on 13 March. Hon Dr David Clark, Minister of Health, Dr Ashley Bloomfield, Director-General of Health, and John Whaanga, Deputy Director-General Māori Health, met with new and existing South Island DHB members.

Following district health board (DHB) elections last year, the new-look South Island Alliance Board welcomes three new members. The Board is made up of the five South Island DHB Chairs; Jenny Black (Chair) of Nelson Marlborough DHB, Ron Luxton of South Canterbury DHB, and new members – Sir John Hansen of Canterbury DHB, David Cull of Southern DHB, and Hon Rick Baker of West Coast DHB.

Jenny Black says she has seen a lot of progress during her time chairing the Board over the past seven years. “While we have a long way to go yet, there have been many achievements to celebrate along the way. The five DHBs are now much more connected, as we continue to collaborate and ensure the delivery of a more sustainable and equitable service for all South Islanders – regardless of rurality, age or culture.”

In terms of regional planning, she says it’s essential that the whole South Island health system is connected – especially important in the new post-COVID-19 health environment. “It must work for everyone. And with three new faces on the Board for 2020, I look forward to working with them, to see how much harder and faster we can go.”Ron Luxton, who has been a member of the South Island Alliance Board since 2016, says that their vision is for a strong public health system for all South Islanders.

“We are constantly working towards a strong patient-centred public health system, where regional services are provided with adequate workforce and care as close to home as possible. This is an excellent opportunity to focus on integration of South Island IT services and providing a truly regional perspective on our future health learning.”

The South Island Alliance hosted the South Island Board induction day in Christchurch, on 13 March. Hon Dr David Clark, Minister of Health, Dr Ashley Bloomfield, Director-General of Health, and John Whaanga, Deputy Director-General Māori Health, met with new and existing South Island DHB members, as they listened and learned about Ministry of Health expectations and our region’s alliancing approach.Jenny would like to acknowledge the invaluable contributions from outgoing board members, Dr John Wood, Canterbury DHB, and Kathy Grant, Southern DHB.

South Island Alliance Board

Jenny Black (Chair), Nelson Marlborough DHB


Jenny started her career as a dietitian in 1982 and gained her understanding of the ‘healthy to illness’ health care spectrum during her professional practice. Jenny believes in keeping people well and providing care as close to home as possible. She has been Chair of Nelson Marlborough DHB since 2011.


Ron Luxton, South Canterbury DHB


Ron is a retired pharmacist, who owned and operated a community pharmacy in Temuka for 34 years. He is a member of many boards and committees, including chair of the Aoraki MRI Charitable Trust and director of the South Canterbury Eye Clinic. Ron has been part of South Canterbury DHB Board for the past 19 years, including 12 years as Vice Chair and three years as Chair.


Sir John Hansen, Canterbury DHB


Sir John is a retired judge of the High Court of New Zealand and a member of the Courts of Appeal in Vanuatu and Solomon Islands. Formerly a member of the Hong Kong Judiciary; Board of New Zealand Cricket; Chair of Forsyth Barr Stadium, Sir John also held a number of post-earthquake roles in Christchurch.


Dave Cull, Southern DHB


Dave became the 57th Mayor of Dunedin in October 2010 and was re-elected in both the 2013 and 2016 mayoral elections. Before politics, he was a presenter for Television New Zealand and an author. David was appointed chair of Southern DHB in 2019.


Hon Rick Barker, West Coast DHB


Rick was raised on the West Coast and was an MP for 18 years and a Cabinet Minister for six. He was elected to the regional council in 2013, representing the Hastings constituency, and was appointed Deputy Chair three years later. Rick was appointed chair of West Coast DHB in 2019.


GP Uptake In E-ordering A Positive Outcome From Lockdown

 

News
19 May 2020

Laura Anderson, Medical Laboratory Technician at MedLab South, Nelson.

Electronic ordering of lab tests has been available around the country for some time now, but the uptake from GPs has been relatively low in some regions.

With COVID-19 forcing the country into lockdown, and for many GPs – taking them online, e-ordering lab tests to support virtual consults saw significant uptake in the Nelson Marlborough district.

MedLab South Lab Manager Rebecca Brosnan says to have more GPs move to e-ordering and be able to continue providing their consults, albeit virtually, is one of the silver linings from the level 4 lockdown. “It’s good for GPs and a real win for us at MedLab South where we’ve seen great gains in efficiencies and in accuracy of data as a result of the increase in e-ordering,” says Rebecca.

Rebecca has been working closely with Clinical Information Systems Director Dr Bev Nicolls at Nelson Marlborough Health since April 2019 to get GPs and clinicians in the region to order their tests electronically through the e-ordering platform.

Rebecca says many were geared up to use e-ordering well before lockdown and initial uptake last year was encouraging, but only about 25% were actively using it in place of the traditional order form method. The traditional method of ordering tests requires a lot of manual data entry for lab staff, and in some cases with bulk test orders from clinicians, it presented a real challenge when the patient presented for their test.

GP and Clinical IS Director Dr Bev Nicolls says not only is the new e-ordering process saving significant time for the lab team, it is giving GPs much needed information and control.“When you’re handing a patient their lab test order details on paper, once they leave the room there’s no way to know if they’ve had the test, you can’t easily change the test order, nor can you see where the testing process is at. If they are using e-ordering, then they’ll have that information and that control,” says Dr Nicolls.

Like other e-referral systems, lab e-ordering is interfaced into a variety of practice management systems allowing GPs to request a test easily with relevant information available, get patient test results sooner, improve the patient experience at the testing centre, removal of double handling of information, improved accuracy, and freeing up resources in the lab.

Following level 4 lockdown restrictions, the lab saw an immediate jump to around 50% of the region’s GPs using e-ordering for lab tests, with many more who knew about it now requesting to access the platform soon after. With the support of MedLab South, GPs were provided with remote installs of the platform and online video training to learn how to use e-ordering. This brought the use of e-ordering from 25% to well over 80% in a matter of weeks. MedLab South are now rapidly trying to get all GPs and hospital clinicians to be using e-ordering to further build on the gains seen during the COVID-19 level 4 lockdown period.

Southern Community Lab Group CEO, Dr Peter Gootjes says much of the success of e-orders in the region can be attributed to the leadership of the clinical teams and lab staff. “The clinical leads have been highly engaged with the lab which allows us to continue innovating in the way we work together and the way we deliver services. That’s vital when we face a health crisis like COVID-19,” says Dr Gootjes.

MedLab South hopes to see e-ordering continue to have high-levels of use when GPs return to more in-person consults, as well as continue to see further uptake across general practice and hospital outpatients and the hospitals overall.


Collaborative Response Enables Urgent Dental Care

 

News
28 Apr 2020

Dr Lester Settle, chair of the South Island Alliance’s Hospital Oral Health Workstream.

Measures taken to prevent the spread of Covid-19 have dramatically changed how emergency dental care is being delivered across the South Island, with dentists and DHBs working collaboratively to provide the essential service.

There has been some uncertainty around dental care as it was initially not considered an essential service, says Dr Lester Settle, chair of the South Island Alliance’s Hospital Oral Health Workstream. “Dentistry is particularly difficult as it often sits outside of mainstream health, yet unresolved dental infection can still be life threatening, so it’s really important to seek help if you have any dental concerns.”

To ensure safety for both the patient and dentist, procedures have been put in place, so dental care is available for those who need it. Dentistry is one of the highest risk professions for transmitting viruses such as COVID-19, due to its close range and most dental procedures generating aerosols – tiny droplets that stay suspended in the air for up to an hour, harbouring the virus. For this reason, options for safe dentistry are limited to urgent care. “Toothache, for example, doesn’t necessarily meet guidelines for acute/urgent care, as it is not considered life threatening. But it’s incredibly hard to control with just pain relief at home, so we would encourage people with toothache – or any other dental issues – to contact us.”

The New Zealand Dental Council (NZDC) set regulatory standards for dentists to comply with during level 4, and level 3, including a higher level of personal protective equipment (PPE). However, PPE proved difficult to source by general dentists working in the community.To deal with the challenges of providing a safe service, DHBs worked together to find local solutions.

In Canterbury, the local New Zealand Dental Association (NZDA) branch, Community Dental Service (CDS) and Hospital Dental Service (HDS), joined forces to set up a coordinated call centre response for patients with acute dental needs.After basic data is collected, this is then directed to CDS or a general dentist for a free telehealth consultation. If the problem is not deferable, then the patient is directed to a community-based dental practice or the DHB, says Dr Settle. “DHBs have been able to provide emergency practices with small amounts of vital PPE to enable care for those patients presenting through the DHB pathways.”

To enable wider access, Canterbury DHB also redirected funding to increase its subsidy to Community Services Card holders. The call centre currently receives about 80 calls a day during the week, with approximately 160 calls on the first day of the week. Dr Settle says the level of co-ordination and speed to enable the service was unprecedented. “The coordinated response between what are traditionally disparate groups has been inspiring.”


Planning For Our Shared Digital Future

 

News
27 Feb 2020

The Alliance Training and South Island Data and Digital Health Strategy Workshop was held on 14 February.

As healthcare and information technology constantly evolves, reviewing new ways of working is an integral part of collaborating as an alliance.

The Alliance Training and South Island Data and Digital Health Strategy Workshop was held on 14 February in Christchurch, to refresh and upskill, reflect on the past and talk about how to face the challenges of our shared digital future.Attendees included Information Services Service Level Alliance (IS SLA) members, South Island CIOs, Clinical Informatics Leader, South Island Information Services Programme Leads, as well as South Island health professionals who are involved in regional Information Services alliance activity.

The morning session covered the history and principles of alliancing, how to participate in an alliance model, how to measure regional alliancing framework for large system transformation, as well as identifying ‘wicked’ problems faced regionally in an alliance framework. In the afternoon session, the South Island Data and Digital Health Strategy was discussed, with attendees working in groups to talk about ways to operationalise the strategic programmes, of innovation and transformation, empowering the healthcare workforce, data and insights, patient participation, and future of work.

Karl Rivett, Change Delivery Manager for IT at Southern DHB, says the workshop was a good opportunity to understand the purpose of the Alliance and to discuss implementation of the strategy. “Looking at the different compositions of resource (clinical, corporate, IT, public representation), what they need to consider and how they work going forward, is of great interest to me and the role that I have. It’s clear the world of healthcare is never standing still, so whether you experience it as a patient, clinician or supporting staff, we need to constantly consider how we best leverage new ways of working, solutions and processes – and that’s what working in an alliance can do for us.”

Dr Peter Gent, a GP in Dunedin, has been a member of the IS SLA for the past five years. He says the workshop was a useful opportunity to refresh knowledge of the Alliance structure. “One of the main benefits of the workshop was to talk about alliancing as a collaborative working method. It was also great to discuss the Information Services strategic plan with the wider members of the Alliance, not just the SLA.”