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					Auckland District Health Board


               2008 Annual Report
CONTENTS                             Contents                                              Page

                                     Vision                                                4
                                     Directory                                             4
                                     Chairman’s Review                                     6
                                     Chief Executive’s Review                              8
                                     Key Facts and Figures                                 12
                                     Goal One: Lift the Health of the People of Auckland   20
                                     Goal Two: Lead Performance Improvement                28
                                     Goal Three: Live Within Our Means                     36
                                     Good Employer Obligations Report                      42
                                     Statement of Responsibility                           48
                                     Statutory Information                                 48
                                     Financial Statements
                                              Statement of Financial Performance           56
                                              Statement of Changes in Equity               57
                                              Statement of Financial Position              59
                                              Statement of Cash Flows                      60
                                              Notes to and Forming Part of the Financial
                                              Statements                                   62
                                     Appendix A – Statement of Service Performance         104
                                     Report of the Auditor-General                         125




2   Auckland District Health Board
The Board Members are pleased
to present the report of
Auckland District Health Board (“ADHB”)
and the Group comprising ADHB, its
subsidiary Charitable Trust and associates for
the year ended 30 June 2008.




 .
P N. Snedden         H. J. Burkhardt         29 October 2008
Chair                Chair Audit Committee




                                                               Annual Report 2008   3
    SECTION 1.
     Vision
     Hei Oranga Tika Mo Te Iti Me Te Rahi
     Healthy Communities, Quality Healthcare



     Directory
     Address for Service
     Auckland District Health Board
     First Floor Building 10
     Greenlane Clinical Centre
     Greenlane West
     Epsom
     Auckland

     Postal Address
     Private Bag 92024
     Auckland 1142
     Telephone: (09) 630 9817
     Facsimile: (09) 639 9816
     www.adhb.govt.nz


     Auditor
     Ernst & Young
     (on behalf of the Auditor-General)
     41 Shortland Street
     PO Box 2146
     Auckland 1140




4    Auckland District Health Board
                                       Goal

                                  Lift the health
                                   of people in
                                  Auckland city

                                    Our Vision
                              Healthy Communities,
                               Quality Healthcare
                   Goal                                   Goal
                                Hei Oranga Tika,
                                    mo te Iti
                    Lead
                performance
                                  me te Rahi           Live within
               improvement                             our means




Our Vision,                                         Our values
Goals and                                           are:
Values                                              Integrity
                                                    We are open, fair, honest and
Healthy Communities, Quality                        transparent in everything we do.
Healthcare - Hei Oranga Tika mo te
Iti Me te Rahi - is the vision for ADHB.
                                                    Respect
                                                    We care about and will be
We have three organisation-wide                     responsive to the needs of our
goals:                                              diverse people and communities.
•	Lift	the	Health	of	People	In	
  Auckland City.
                                                    Innovation
                                                    We will provide an environment
•	Lead	Performance	Improvement
                                                    where people can challenge current
•	Live	Within	Our	Means.	                           processes and generate new ways of
                                                    learning and working.
                                                    Effectiveness
                                                    We will apply our learning and
                                                    resources to achieve better
                                                    outcomes.




                                                                     Annual Report 2008   5
                                          Chair’s Review
                                          ADHB staff and leadership take a bow. You have delivered on a great
                                          achievement.

                                          If I sensed a central theme that goes through the performance of this last
                                          year, indeed the progress being made by this DHB in the last three years, it
                                          speaks of a determined focus. The financial result of a better than break even
                                          position for this last financial year is nothing short of a triumph. Not only did
                                          the money work but the service to Aucklanders and those using our facilities
                                          from elsewhere in New Zealand increased as well. This feat on the basis of the
                                          scale of the turnaround is unparalleled in my experience in the health sector,
                                          certainly in the last decade.

                                          Thanks are due to all of you who work here for your adoption of the mantra
                                          of Living Within Our Means. This achievement has come from clear focus on
                                          so much of the small incremental improvements that have made the use of the
                                          new facilities so effective. This determination to improve performance across
                                          the whole of the enterprise has seen stellar results. At Board level we recognise
                                          thanks are due to our predecessors for this result. Wayne Brown as chair for six
                                          years up until December 2007 and Harry Burkhart as Audit chair since 2004
    Pat Snedden                           have introduced strong governance discipline over the performance of the
    Chair                                 business.

                                          It was a smart decision to focus on three goals. Lift the Health of the People
                                          of Auckland, Lead Performance Improvement and Live Within Our Means
                                          were clear statements of intent and easy to grasp. As CEO Garry Smith has
                                          taken up the challenge to translate our three simple goals into action. This has
                                          galvanised the enterprise. Not surprisingly results have been impressive.

                                          So much of the health activity now in the DHB takes place outside of the
                                          hospitals with the primary care sector and with other agencies. The Health
                                          Housing Project with Housing NZ means families getting warmer and drier
                                          homes and more connection with the primary care providers. Health services
                                          are brought direct to the Pacific Island churches with the Healthy Village
                                          Action Zones and schools provide healthier food to schools with the Healthy
                                          Eating Healthy Action (HEHA) programmes. We have extensive diabetes care
                                          undertaken at primary care which is reaching large numbers of our community
                                          that haven’t been previously checked in a systematic way. Our innovative
                                          performance management programme with PHOs means we are getting more
                                          attention paid to the quality of care in the general practices in our area. All this
                                          is good news for the Aucklanders using the doctor and nurse services in the
                                          community.

                                          The performance improvement goal has seen a lift in numbers of people
                                          treated in our hospitals and a reduction in the cost of that treatment as the
                                          business has worked on extracting the best from the facilities. As more of
                                          the community want more certain access to elective surgery we have given
                                          it to them and we have managed this even as the year has seen significant
                                          disruption by strikes. This is a triumph of commitment and focus from our staff.

                                          ADHB people in every area of our activity, we salute you!




                                          Pat Snedden
                                          Chair

6        Auckland District Health Board
Board Members




   J. M. Agnew         S. M. Buckland          H. J. Burkhardt            R. J. Cooper         Dr. C. J. W. Chambers




  Dr. B. J. Fergus         Dr. I. K. Scott        Rt. Hon. R. J. Tizard    Seiuli Dr. J. M. Walker     I. R. Ward


   .
  P N. Snedden (Chair) - (facing page)




Chief Executive                                                   Clinical Board
G. Smith                                                          Dr. D. Sage (Chair)        Dr. J. Henley
                                                                  Dr. N. Argyle              Dr. B. Kent
                                                                  Dr. J. Bent                Dr. C. McArthur
Executive Management                                              T. Campbell                J. Mueller
G. Balla         (Director; Performance and Innovation)           Mr. I. Civil               Prof. S. Munn
N. Buchanan      (General Manager; Operations)                    Dr. D. Court               Dr. C. Palmer
T. Campbell      (Executive Director of Nursing)                  M. Dotchin                 B. Twomey
M. Dotchin       (General Manager; Clinical Services)             S. Fitt                    Dr. J. Van Schalkwyk
F. Dougan        (General Manager; Clinical Services)             Dr. R. Franklin            Dr. G. Williams
N. Glavish       (Chief Advisor Tikanga & General                 Dr. R. Frith               Dr. M. Wilsher
                  Manager; Maori Health)
K. Hyman         (General Manager; Clinical Services)
R. Jarrold       (Chief Financial Officer
                 - resigned 12 September 2008)
Dr. D. Jury      (Chief Planning and Funding Officer)
J. Mueller       (Director; Allied Health)
Dr. C. Palmer    (Clinical Leader; Planning and Funding)
V. Rawlings      (General Manager; Human Resources)
A. Redican       (General Manager; Pacific Health)
Dr. D. Sage      (Chief Medical Officer)
J. Vendrig       (Chief Information Officer)
Dr. M. Wilsher   (Deputy Chief Medical Officer)




                                                                                                     Annual Report 2008   7
                                          CEO’s Review
                                          What a year we have had!

                                          It is with great pleasure I can tell you that the ADHB has completed the
                                          year ahead of budget financially, while producing more health outputs than
                                          contracted and more than the year before. We have experienced an increase
                                          in productivity, improvements in efficiency and better management of our
                                          waiting lists.

                                          The results in health terms show significant improvements across many
                                          services, with noteworthy improvements being a 10 % increase in cardiac
                                          surgery performed and a 6.4 % increase in the amount of elective surgery
                                          completed for the ADHB population.

                                          This is a historic year for us. For the first time in eight years, the ADHB has
                                          “Lived Within Our Means” in reporting better than a breakeven result.

                                          The ADHB has continued to focus on a whole system approach, implementing
                                          many community initiatives and gaining ground in the fields of Maori and
                                          Pacific health as well as within older people’s and child health services in the
                                          community.
    Garry Smith
    Chief Executive                       At ADHB, we seek to continually remember that a District Health Board
                                          is much more than a hospital. We are responsible for the ‘whole of the
                                          system’ – prevention to keep our population well and for those needing care,
                                          ensuring access to the most appropriate clinical services. Put simply, our goal
                                          is to create a healthier Auckland. Increasingly this has meant that focus has
                                          broadened from the treatment and care of disease in hospitals, to providing
                                          the community with the education, resources and skills to help them live
                                          healthier lifestyles.

                                          For the first time in the history of ADHB, a Primary Health Care Plan plotting
                                          a course for primary care development across the district is being drawn up.
                                          This plan will focus on keeping people well - a stance consistent with the DHB
                                          imperative to ‘Lift the Health of People in Auckland City’. Working with primary
                                          care in collaboration with our PHOs is vital to improve the health of our
                                          population.

                                          In brief, we:
                                          •	Had	approximately	2 million patient contacts this year;
                                          •	Treated	69,300 people who stayed in hospital more than one night (3.2%
                                            more than the previous year);
                                          •	Treated	approximately	49,900 people who stayed in the hospital for less
                                            than a full day (2.3% more than the previous year);
                                          •	Spent	$70m on drugs for patients in hospital and a further $94m on drugs
                                            for patients in the community;
                                          •	Looked	after	44,425 people with outpatient appointments for ophthalmology
                                            (eyes) – up 4% on the previous year;
                                          •	Had	7,785 babies born (up 5.5% on the previous year);




8        Auckland District Health Board
•	Cared	for	over	2,885 people on in-centre haemodialysis (up 24% on the previous
  year);
                                                                                        Fast facts
                                                                                        What is the Nutrition
•	Saw	53,500 people visited adult ED (up 1.8% on the previous year);                    Fund?
•	Saw	29,400 children visited Starship ED (up 1.3% on the previous year);               The Nutrition Fund is aimed
•	Reduced	our	cost	per	operating	room	minute	–	12% less than 06/07;                     at helping schools and early
                                                                                        childhood services to improve
•	Awarded	$350,955 from the Nutrition Fund last year to 72 Auckland schools and         their food environment so
  early childhood centres;                                                              that only healthy, nutritious
•	863	people	registered	and	participated	in	the	Green Prescription Community            foods are sold and promoted,
  Programme delivered by Sport Auckland and funded by the ADHB;                         and children are equipped
                                                                                        with the skills and knowledge
•	Launched	the	Healthy Village Action Zone (HVAZ) which is a church based
                                                                                        they need to make healthy
  community programme targeted at Pacific Communities. 30 Auckland churches
                                                                                        food choices inside and
  are onboard currently. HVAZ is a finalist in the Health Innovation Awards;
                                                                                        outside school, and hopefully
•	Are	currently	developing	a	draft	Primary Health Care Plan in partnership with         throughout their lives.
  ADHB PHOs.

Other highlights include:                                                               What is Green
                                                                                        Prescription?
•	We	opened	a	new	Interventional	Vascular	Theatre.	It’s	the	first	of	its	kind	in	New	
  Zealand and probably a first within Australasia;                                      A Green Prescription is a
                                                                                        health professional’s written
•	We	performed	100 paediatric spinal procedures. This exceeded the target agreed
                                                                                        advice to a patient to be
  with Ministry of Health and New Zealand Orthopaedic Association;
                                                                                        physically active, as part of the
•	Buchanan	Rehabilitation	Centre	became	smokefree	on	31	May	2008;                       patient’s health management.
                                                                                        Green Prescriptions are
•	We	celebrated	100 years of delivering world class Oral Health Services to the
                                                                                        available nationwide. The
  population of Auckland;
                                                                                        programme is administered by
•	National	Women’s	Health	gained	baby	friendly	accreditation	from	the	World	            SPARC.
  Health Organisation;
•	Auckland	City	Hospital	(ACH)	was	selected	as	one	of	eight	hospitals	in	the	world	
  for a pilot study on Safe Surgery Saves Lives;
                                                                                        What is Healthpoint?
                                                                                        Healthpoint is a tool that
•	ACH	became	the	first	NZ	hospital	to	join	the	AVERT	trial	(a	very	early	stroke		
                                                                                        allows doctors, patients and
  rehabilitation trial);
                                                                                        caregivers to access local
•	We	were	the	first	NZ	Hospital	to	introduce	the i-bleep system as part of the After    information about what
  Hours model of care;                                                                  to expect prior to, during
                                                                                        and following a referral to
•	We	now	have	74 sites live in the Healthpoint website.
                                                                                        secondary/tertiary medical
Delve through the pages of this annual report and read more about the activities        healthcare services.
we’ve undertaken to fulfil our three goals: Lift the Health of the People of Auckland
                                                                                        The information is approved,
City, Lead Performance Improvement and Live Within Our Means.
                                                                                        regularly reviewed and
                                                                                        updated by clinicians.
I head an organisation that is made up of over 9000 staff. I attribute our success to
each and every one of them – this past year has been full of significant milestones
for the ADHB, and we couldn’t have done it without our staff and our partners in the
community.




Garry Smith


                                                                                                Annual Report 2008          9
     Who We Are?

                     Western bays                    Eastern bays

                                        Hobson
                         Eden-Albert



                     Avondale-Roskill
                                        Tamaki-Maungakiekie




     The changing face of Auckland.
     The Auckland District Health Board (ADHB) covers the same population of people
     as the Auckland City Council.

     Our population is increasing every year.


     Who we are – our demographic data
     •	ADHB	is	the	fourth	largest	DHB	in	the	country	by	population	but	we	double	our	
       size because of the work we do for the other DHBs – which makes us the largest
       overall;
     •	We	had	428,310 people in the 2006 census, approximately 10% of the total
       population of New Zealand, and 39,550 more people since the 2001 census;
     •	The	population	is	projected	to	grow	(medium	projection)	to	567,844 people by
       2026, a 32.6% increase from 2006;
     •	In	2006,	the	largest	ethnic	group	was	European/Other	group	with	58% of the
       total population, followed by Asian at 22.7%, Pacific at 11.2% and Maori at
       8.2%;
     •	In	2006,	there	were	27,709 children aged 0–4 years (6.5% of the ADHB
       population) and 51,249 (12% of the population) aged 5–14 years, a total of
       18.5% of the total population. 40,432 (9.4% of the population) were people
       aged 65+;
     •	Overall	life	expectancy	at	birth	is 77.9 years for males and 81.9 years for
       females;
     •	3.8% of people in ADHB were unemployed in 2007 but this is expected to
       increase to 4.6% by 2009;
     • 25.7% of our children aged under 5, and 30.1% of children and young people
       aged 5–24 years live in the most deprived areas.
     •	By	2026	it	is	projected	that	the	proportion	of	the	population	aged	0–14	years	
       will have declined to 16.1%, while those aged 65+ will have increased to
       13.5% of the total population;
     •	Maori	and	Pacific	people	are	a	very	young	population	with	about	50% of the
       people aged less than 25 years old.




10   Auckland District Health Board
Annual Report 2008   11
                                      Key Facts and figures
                                      Our population
                                      Auckland city population, census 2006 and projection

                                      Year                       Population     Population increase       Growth from 2006
                                      2006                        428,310
                                      2011                        464,296                    35,986                      8.4%
                                      2016                        499,121                    34,825                     16.5%
                                      2021                        533,850                    34,729                     24.6%
                                      2026                        567,844                    33,994                     32.6%
                                                                              Source: Source: ADHB Statement of Intent 2008 -11


                                      Primary Health Organisations
                                      PHOs                                      Enrolled Population         Full Time Doctors
                                      Auckland PHO Ltd                                     43,172                         41
                                      AuckPAC Health Trust Board                           37,173                         20
                                      ProCare Network Auckland Limited                    302,735                        272
                                      Tongan Health Society Incorporated                    4,955                          5
                                      Tamaki Healthcare Charitable Trust                   43,580                         55
                                                                                          431,615                        393

                                      Work in the community
                                      The type of provider              Number of providers     Number of beds (if applicable)
                                      Community laboratory              1
                                      Dentists                          65
                                      Health of older persons           110                     4,225 contracted beds
                                      services (residential care)
                                      Health of older persons           10
                                      services (non residential care)
                                      Carer support                     100 (as at 31 Dec 2007)
                                      Home-based support                12
                                      Maori health services             2
                                      Mental health services            20                      212 contracted beds (among
                                                                                                other services purchased)
                                      Mental health services (alcohol 6                         180 contracted beds (among
                                      and other drug services)                                  other services purchased)
                                      Pacific health services           3
                                      Personal health services          5
                                      Chemists                          110
                                      Pharmacy (wholesalers)            5
                                      PHOs                              6
                                      Women’s and children’s            19
                                      health services
                                                                                          Total beds in the community 4,617
                                                                                     Source: ADHB Statement of Intent 2008 -11




12   Auckland District Health Board
Our staff and contractors
                                                      2006/07      2007/08
How many?                                            as at June   as at June
Total FTE ( full time equivalent)                        7,392        7,540
Total staff members ( part & full time)                  8,583        9,286

Professions
Medical                                                 1,031        1,080
Nursing                                                 2,986        3,128
Technical & Allied                                      1,627        1,697
Other ( funding/ governance/ support services etc)      1,748        1,635
                                                        7,392        7,540




                                                                               Annual Report 2008   13
                                      Public Health
                                      The Auckland Regional Public Health Service for the Auckland Regional Area
                                      Period: July 2007 – June 2008

                                      1 046 918    Health information resources distributed
                                          5 496    Visitors to the resource centres
                                          4 362    Notifications of gastrointestinal infections investigated
                                            586    Food complaints investigated
                                             85    Food programmes assessed
                                            118    Food premises licenses processed
                                            741    Refugees screened
                                            835    Refugee vaccinations and tests
                                            981    TB contacts investigated
                                            213    Staff trained for the pandemic response workforce
                                             59    Businesses, organisations, and agencies participating in work place
                                                   health programmes
                                           2 000   People (250 teams) participated in Featbeat - a workplaces
                                                   programme promoting physical activity
                                              61   Tobacco control purchase operations - to support Keeping Kids
                                                   Smokefree
                                              84   Control purchase operations to ensure compliance with the Smoke-free
                                                   Environments Act
                                             191   Premises visited to monitor and prevent alcohol sales to minors
                                             648   Premises visited for sale of alcohol compliance with good host
                                                   responsibility
                                             413   Healthy housing interventions (397 insulation and ventilation)
                                             201 Joint healthy housing assessments with Housing NZ resulting in 198
                                                 health and social referrals within the Healthy Housing Programme
                                                 (ADHB area). From these 413 housing interventions (including 397 for
                                                 insulation and ventilation)
                                              33 Public health submissions were made on significant public health issues
                                              65 Early Childhood Education Centres were assessed for public health
                                                 and safety compliance
                                             284 Early Childhood Education Centres participated in healthy eating
                                                 Mission On workshops to improve nutrition in childhood centres
                                             133 Drinking water transgressions monitored




14   Auckland District Health Board
Money
Where does the money come from?
                                                    $m        $m
                                                2006/07   2007/08
Crown Revenue from Ministry (ADHB Population)      765       852
From Other DHBs                                    448       501
Other Health Funders                                95        91

Total Patient Care Revenue                       1,308     1,444
Other Revenue                                       98        86
Total Revenue                                    1,406     1,530

What is it spent on?
Hospital and related Health Services               875       998
Public Health                                       16        17
Pharmaceuticals                                     93        93
Primary Care                                        63        69
Rest Homes                                          30        32
Private Hospitals                                   43        48
Mental Health (Incl other DHBs)                     57        46
Laboratories                                        76        71
Home Support                                        12        15
Other DHBs (non mental health)                      58        77
Other                                               96        62
Total Expenditure                                1,419     1,528




                                                                    Annual Report 2008   15
                                      Our sites
                                      ADHB Community Sites

                                                     Hobson
                     Western bays
                                                                 Eastern bays
      Eden-Albert




         Avondale-Roskill                  Tamaki-Maungakiekie

              Hospitals                   Chemists

              GP’s                        Rest Homes




16   Auckland District Health Board
Auckland City Hospital




Starship Children’s Health




Greenlane Clinical Centre




Pt. Chevalier Site
Buchanan Rehabilitation Centre
Maori Mental Health
Rehab Plus




                      Annual Report 2008   17
     SECTION 2.

      Highlights:
      Healthy Communities, Quality
      Healthcare
      To achieve our vision of healthy communities, quality healthcare our priority
      goals for the 2007/08 year were: Lift the Health of the People in Auckland
      City, Lead Performance Improvement, and Live Within Our Means.

      We have made significant achievements against all these goals.




18    Auckland District Health Board
Annual Report 2008   19
     Goal One: Lift the Health of the People of
               Auckland City
                                      Focus on Healthy Eating, Healthy Action (HEHA) Initiatives:

                                      HEHA is the Ministry of Health’s strategic approach to improving nutrition, increasing
                                      physical activity and achieving healthy weight for all New Zealanders.

                                      At the ADHB, there has been a major focus on HEHA activities over the past
                                      12 months. These have been integrated across the community and hospital
                                      environments and in service-specific areas.

                                      The ADHB continues to promote healthy food in our campuses and to our staff. Eat
                                      Healthy-Be Active was the theme for the ADHB Round the Bays team. Nearly 600
                                      staff took part in the event.

                                      The HEHA team works closely with various community groups including various low
                                      decile schools and early childhood centres, Sport Auckland, Cancer Society, Child
                                      Youth and Family, National Heart Foundation, Auckland Regional Public Health
                                      Service and public health nurses.

                                      This year, the ADHB awarded $350,955 from the Nutrition Fund to 72 Auckland
                                      schools and early childhood centres.

                                      863 people registered and participated in the Green Prescription Community
                                      Programme delivered by Sport Auckland and funded by the ADHB.




20   Auckland District Health Board
Stories from the community - HEHA
Mt Albert Kids Go Bananas Over Lunch Box Launch
The students at Owairaka District School in Mt Albert had happy tummies when their new healthy
eating programme ‘Lunch Box Launch’ was introduced.

Each student was provided with a lunch box labelled ‘Owairaka School promotes healthy eating.’
Included with the lunch box was a copy of the school food and nutrition policy plus the children
were treated to a healthy food buffet that demonstrated all the different types of healthy foods that
could be brought from home for lunch.

The Lunch Box Launch was made possible by an Auckland District Health Board HEHA (Healthy
Eating - Healthy Action) Nutrition Fund grant.

ADHB HEHA District Coordinator, Ada Cheung, says Owairaka District School was awarded a
nutrition fund grant because the school was committed to educating their students on healthy
eating and had developed the innovative Lunch Box Launch project as a way to reach both students
and parents.

“It’s fantastic when schools embrace the importance
of a healthy lifestyle and are committed to helping
children make positive long term sustainable
changes that will also have an impact on the health
and wellbeing of the whole school community.“

“With 35% of the Auckland population falling in the
overweight category, including 21% in the obese
category, nutritional education from an early age has
never been more important.”

Owairaka School Principal, Diana Tregoweth, says
the Lunch Box Launch project is taking a holistic
approach to healthy eating.

“To support the Lunch Box Launch changes have
also been made to the school tuck-shop menu
and the school is working with the National Heart
Foundation of New Zealand towards the Gold
Heart Beat Award.”                                      Photo: (L to R) Maddison Wyllie-Papalie (10), Safia Tariqi (10), Minister
                                                        of Education - Rt. Hon. Chris Carter, Chelsey Mariner (11), Segun Rotimi
“We are delighted to have received a nutrition fund     (10) enjoy their healthy lunch and new lunch boxes thanks to an ADHB
grant to help us implement this important school        nutrition fund grant.
project”.

Minister of Education Chris Carter and Dancing with the Stars celebrity and SPARC Ambassador
Krystal Stuart also attended the launch.

Examples of other projects that have received a Nutrition Fund grant include water fountain
installation, planting of vegetable gardens and fruit trees and purchase of food preparation
equipment for schools and early childhood centres.




                                                                                                               Annual Report 2008   21
                                      Working with PHOs
                                      ADHB has made significant progress in enhancing its relationship with primary care.
                                      The primary healthcare sector plays a crucial role in keeping the population well
                                      and coordinating their care. Better access to a wider range of primary care activities
                                      within the community will make a difference to the health of our population. Working
                                      with primary care in collaboration with our PHOs is therefore key to any strategy
                                      aimed at improving health and well-being.

                                      For the first time in the history of ADHB, a Primary Healthcare Plan plotting a course
                                      for primary care development across the district is being developed.

                                      The five Auckland PHOs and the ADHB have worked together since October 2007
                                      and consulted with various professionals, organisations and other individuals to draft
                                      the Primary Healthcare Plan (2008 -2010).

                                      Although the plan has now been drafted, the intention is to encourage widespread
                                      consultation and feedback to ensure that the ADHB is choosing the right areas to
                                      focus on and have not missed out key areas or concerns.

                                      This plan will focus on keeping people well - a stance consistent with the DHB
                                      imperative to ‘Lift the Health of People in Auckland City’. Increasingly this has meant
                                      that focus has shifted away from the treatment and cure of disease in hospitals, to
                                      providing the community with the education and resources to help them live healthier
                                      lifestyles.

                                      The ADHB is committed to fulfilling its eight commitments. The commitments are:

                                      1. Promote resilience among communities, their families and individuals.
                                      2. Work with Maori to build on health gains already achieved and reduce health
                                         inequalities.
                                      3. Address health inequalities for high needs groups.
                                      4. Establish a ‘neighbourhood’ approach.
                                      5. Develop inter-disciplinary primary healthcare capability and capacity.
                                      6. Reorient the healthcare system to achieve locally accessible services with
                                         appropriate specialist support at all times.
                                      7. Implement an integrated approach to the prevention and management of people/
                                         whanau with long term conditions and/or primary mental health issues
                                      8. Work with Primary Health Organisations and primary care practices to ensure
                                         there is a robust process for quality improvement.




22   Auckland District Health Board
Annual Report 2008   23
                                      Homelessness Taskforce
                                      The ADHB is committed to building equality in health status
                                      between population groups. In order to do this we need to
                                      make sure the needs of our homeless people are met, and
                                      that we limit the impact of homelessness on our city.

                                      Currently, there are up to 100 rough sleepers in Auckland
                                      City and an estimated 300-400 people living without
                                      permanent or secure housing. As the city grows so will the
                                      homeless population, if we do not do something to stop it.

                                      With a view to improve the lives of some of our most
                                      vulnerable people, the ADHB has partnered with the
                                      Committee for Auckland and eight other government
                                      agencies, including the Ministry of Social Development,
                                      Housing NZ, Accident Compensation Corporation,
                                      Waitemata District Health Board, NZ Police, Department
                                      of Corrections, St John and the Auckland City Mission to
                                      set up the Auckland Regional Homelessness Taskforce.
                                      The Committee for Auckland is an independent, neutral,
                                      cross-sector group of senior Auckland leaders. They work
                                      to identify issues, generate good ideas, and move these
                                      ideas into action.

                                      CEO Garry Smith is the chair of the taskforce’s Steering
                                      Group.

                                      This project has the potential to improve the lives of some
                                      of our most vulnerable people, and in doing so, show that
                                      a very successful Auckland has the passion to include care
                                      of these citizens within its embrace.

                                      The taskforce will work toward planning to use resources
                                      more effectively and resolve the issue of homelessness in
                                      Auckland.

                                      ADHB has been very committed to the project and to date
                                      has:

                                      •	Established	a	PHO/Community	organisation	health	
                                        clinic at Auckland City Mission premises, enhancing
                                        services and expanding contact with the homeless
                                        community;
                                      •	Homelessness	has	been	added	as	a	new	focus	of	
                                        strategic planning under the auspices of Health
                                        Inequalities portfolio;
                                      •	New	intersectoral	relationships	for	strategic	planning	are	
                                        being formed.




24   Auckland District Health Board
Stories from the community
ADHB Funds New Primary Healthcare Service at
Auckland City Mission
A new initiative between Auckland District Health Board (ADHB), Auckland Primary Health
Organisation and Auckland City Mission will see new and improved healthcare services being
offered to those using City Mission services.

At present Auckland City Mission provides a range of social services to vulnerable Aucklanders
including the homeless, elderly, families in crisis and people with dependencies.

But until recently its half day a week GP service meant that users of the City Mission, who often
have high levels of physical and mental illness, were frequently being turned away due to high
demand.

Recent funding from ADHB however has meant that the City Mission has been able to extend its
GP service, which now operates for three days a week at the Mission’s Calder Clinic, named after
the first City Missioner, Jasper Calder.

Deirdre Maxwell, Manager of Planning and Funding for Primary Health Organisations and
Primary Care at ADHB says, “Those visiting Auckland City Mission often have extremely high
health needs. With a client group of over 300 people, and only a half day GP service, there was a
large amount of unmet need.

“Funding from ADHB was granted to this initiative as it was recognised that those using Auckland
City Mission services are a priority population who would benefit from low cost services that are
easily accessible”, she says.

“Over the next three years ADHB funding will help towards the set up of the new service and
eventually it is hoped also to move towards the development of integrated nursing, dental and
optometry services” says Deirdre.

This is something that Auckland City Mission GP, Dr Nikki Turner agrees with. ”Our clients have
a huge range of unmet health needs from physical conditions such as untreated skin, respiratory
and cardiovascular conditions to significant mental health, drug and alcohol conditions.

“Many have not had regular access to a GP, often due to cost barriers and the challenges of their
living conditions. A quality, well integrated primary healthcare service operating within the City
Mission is therefore capable of considerably improving the health of these people”, she adds.

Funding for the primary healthcare service comes at a time when the Auckland City Mission is in
the development stages of a major onsite building project.

The building project titled “Mission in the City” will allow the City Mission to provide more
comprehensive services including structured activities and supportive accommodation, as well as
providing a dedicated space for the provision of the newly improved primary healthcare service.

Barbara Stevens, Chief Executive of Auckland PHO, who works with the City Mission to
coordinate the primary health service, says “The funding from ADHB means that this project has
considerable potential to address existing health inequalities.

“It is well documented that access to high quality primary healthcare is associated with better
health outcomes, improved preventative care and reduction in hospitalisations,” she adds.




                                                                                                     Annual Report 2008   25
     Healthy Village Action Zones (HVAZ)
     A Framework for Success

     HVAZ programme is a unique venture in the NZ health sector.
     The initiative brings together the strengths and passions of Pacific
     communities, with primary healthcare and health promotion
     activities, to lift the health of Pacific peoples living in the ADHB area.

     To tackle the problem head on, the ADHB Pacific Health team
     initiated the HVAZ which is a church based community programme
     targeted at Pacific communities in the Auckland district.

     Fundamental in the design and implementation of the HVAZ
     framework is the role of the church as the nucleus of Pacific
     communities in urban New Zealand. According to Statistics New
     Zealand more than 80 percent of Pacific people belong to a
     Christian church.

     To date 30 churches supported by five Auckland PHOs have
     signed up to HVAZ. The project works by grouping these churches
     into “villages” so that they can work with PHOs to develop a
     collaborative approach to improving the health of their church
     communities.

     HVAZ established seven geographic action zones or “villages” in the
     ADHB area, covering Avondale, Mt Roskill/Mt Albert, Grey Lynn/
     Ponsonby, Otahuhu, Onehunga, Glen Innes and Panmure are all
     areas with high numbers of Pacific peoples with strong networks of
     Pacific churches. Each HVAZ houses many different church groups
     and denominations.

     These villages are working extremely well, but the next step is to get
     the villages working together so that best practice and innovative
     ideas can be shared. HVAZ really is about providing a framework
     for the development of an effective and innovative healthy culture
     within our Pacific communities.

     The vision of HVAZ is a healthy Pacific community with access to
     quality healthcare. At the core of the programme is an integrated
     model that is owned by Pacific communities, takes a holistic
     approach and delivers comprehensive primary healthcare, to
     address inequalities in health.

     In the longer term, HVAZ will provide a platform for bringing
     agencies outside the health sector under the HVAZ umbrella to
     tackle determinants of health and improve the effectiveness of
     services to Pacific peoples.

     Why use a church?
     “The church has become the surrogate village for most Pacific
     people in New Zealand, making it a great place to start
     disseminating messages about health,”
     Aseta Redican, GM Pacific Health, ADHB.



26   Auckland District Health Board
Stories from the community - HVAZ “villages”
            HEHA Fono a Huge Success
            It may have been a cold, wet blustery night on Thursday 31 July 2008 but that didn’t stop more
            than 200 people coming together for a colourful Healthy Eating, Healthy Action (HEHA)
            community fono [workshop].

            The ADHB organised fono brought together Pacific church members from the Healthy Village
            Action Zone (HVAZ) churches to consult on ways to improve nutrition and levels of activity in
            their community. The three hour fono was held at the Ellerslie Convention Centre in Auckland..

            ADHB HEHA Manager, Kate Sladden, says the HEHA fono was about coming together to
            find solutions and priorities for improving nutrition and increasing physical activity in Pacific
            communities.

            “The format of the evening included presentations on the importance of healthy eating,
            information on the ‘Healthy Eating Churches’ project, fun physical activity options and a healthy
            buffet dinner with lots of vegetables plus fruit for dessert.

            Participants were then broken up into their Healthy Village Action Zones for small discussion
            groups and given a list of questions to help identify ways to support families and church members
            to eat healthily and be more active. This enabled churches from the same zone to meet each other
            and share learnings

            “The fantastic turn out of numbers reflects the commitment of the HVAZ parish community
            nurses who promoted the HEHA fono to their churches,” says Kate.

            Also present at the HEHA fono was ADHB Chief Executive Garry Smith and members of the
            ADHB Pacific Health Advisory Committee.

            Through the HEHA programme the ADHB has implemented a range of initiatives including
            encouraging churches to adopt a healthy eating policy with goals and awards, providing seed
            HEHA funding for churches to start healthy eating and physical activity projects and working with
            Sport Auckland to encourage exercise programmes including the Green Prescription Community
            Programme.

            Pacific Island church members from the seven HVAZ areas, Avondale, Mt Roskill, Glen Innes,
            Otahuhu, Ponsonby/Grey Lynn, Panmure and Onehunga, attended the fono.




                                                                                               Annual Report 2008   27
           Goal two: Lead Performance Improvement
                                           Lead Performance Improvement is our commitment to ensuring that all health and
                                           support services are integrated and have effective organisation wide systems and
                                           processes and all decision making is evidence and values-based.

ABC +NRT                                   Smokefree Services improve referral rates
Ask about smoking
status and document                        Over the past year a lot of work has gone into implementing programmes in ADHB
Brief Advice given to                      hospitals to address smoking by patients. As a result the numbers of referrals being
patients that smoke to                     sent to smoking cessation programmes has increased. The programmes are based
stop smoking, the risk of                  on the memory aid ABC + NRT
smoking and benefits of
being smokefree                            In Adult Health the Smoking Assessment and Referral Programme has been
                                           implemented in the majority of wards. Nursing staff have attended two brief
Cessation support                          education sessions, the first on the ABC + NRT process and the second on the harm
offered and arranged if                    caused by smoking, nicotine dependence and NRT.
accepted
+NRT all inpatients                        Over 50 nurses have also attended the National Heart Foundation course to become
that smoke offered                         cessation practitioners and quit card providers.
Nicotine Replacement
Therapy to manage their                    Total number of referrals received from Auckland City Hospital (ACH) and Greenlane
nicotine withdrawal                        Clinical Centre (GCC) by the ADHB Smoking Cessation Service and Quitline in
                                           the 2007/08 financial year was 659 compared to 480 the previous year – a 27%
                                           increase.

                                           There has been a 40% increase from the 2005/2006 to 2007/2008 financial years
                                           during which the Smoking Assessment and Referral Programme was rolled out in
Buchanan                                   Adult Health and the ADHB Cessation Service was opened up to all Adult Health
Rehabilitation                             services.
Centre becomes
smokefree                                  Financial Year                       2004/05      2005/06     2006/07   2007/08
                                           No. of referrals                     325          390         480       659
ADHB Buchanan
                                           % increase from
Rehabilitation Centre                                                                        17%         18%       27%
                                           previous year
based at Pt Chevalier
was one of the first large
rehabilitation centres
in the country to make
their entire premises                                                       Total Number of Smoking Cessation Referrals
smokefree on 31 May
                                                                           Received from ADHB Provder Arm 2004 - 2008
2008.                                                                700
Hard work over the last                                              600                                           659
                                               Number of Referrals




18 months resulted in
                                                                     500
a smokefree future for
our patients and staff at                                            400                                480
BRC.                                                                                      390
                                                                     300
                                                                             325
                                                                     200
                                                                     100
                                                                       0
                                                                            2004/05       2005/06       2006/07    2007/08
                                                                                             Financial Year



28        Auckland District Health Board
ADHB pioneers i-bleep After Hours model of care system

iBleep was introduced as one of the initiatives under the After Hours Model of Care project. It is a
communication tool which replaces locator calls to Resident Medical Officers (RMO) and Clinical Nurse
Advisors (CNA) at night.

iBleep is a communication tool that is used to improve communication between wards and doctors after hours.

It enables the ward staff to quickly input details of the signs and symptoms of the patient they need a response
to. This has a traffic light system and Early Warning Score that alerts the receiver to the severity of the patient
and therefore response time. Calls are triaged by the Clinical Nurse Advisor (CNA) who is equipped to contact
the most appropriate clinical staff to respond. The patient is then advised that the doctor is on their way. iBleep is
currently used on all wards in Adult Health. It does not replace urgent code calls.

Introducing iBleep has been beneficial for patients, doctors and nurses. A survey in May 2008 which attracted
200 responses showed that 78% of ward nurses thought that doctors respond more quickly to iBleep calls than
pager calls. iBleep has reduced the volume of calls to House Officers with only calls appropriate to their training
being forwarded to them, the more routine calls being undertaken by the CNAs. Often this means that a patient
is seen more quickly. In addition, all doctors reported a reduction in ‘inappropriate’ calls when using iBleep.
77% of ward nurses, 80% of doctors and 100% of CNAs have indicated that they would want to continue using
iBleep.




                                                                                                    Annual Report 2008   29
                                      ADHB gets Baby Friendly Accreditation

                                      ADHB’s National Women’s Maternity Service was
                                      awarded Baby Friendly accreditation on Monday 17th
                                      March.

                                      A Baby Friendly Hospital (BFH) is a healthcare facility
                                      where the practitioners who provide care for women and
                                      babies adopt practices that aim to protect, promote and
                                      support exclusive breastfeeding from birth.

                                      The award was presented to Garry Smith, CEO, Kay
                                      Hyman, Women’s Health Manager, and Ann Yates,
                                      Midwifery Leader, by World Health Organisation (WHO)
                                      representative, Mrs Saadeh, and Julie Stufkens, Executive
                                      Officer for the New Zealand Breastfeeding Authority.

                                      The WHO/UNICEF Global Assessment tool forms the
                                      basis of the assessment and accreditation procedure in
                                      all countries. In areas where there were Baby Friendly
                                      Hospitals it has been shown to make a difference to
                                      breastfeeding rates, and infant and child health have
                                      improved.

                                      The New Zealand Breastfeeding Authority administers
                                      the Baby Friendly Hospital Initiative.

                                      The National Women’s maternity service has
                                      nearly 8,000 births a year and met the standards
                                      by implementation of the Ten Steps to Successful
                                      Breastfeeding, compliance with the International Code of
                                      Marketing of Breast-milk Substitutes and having exclusive
                                      breastfeeding rates at discharge of more than 75%.


                                      The team at ADHB’s Maternity service have done a
                                      brilliant job in becoming a centre for excellence where
                                      the practitioners who provide care for women and
                                      babies adopt practices that aim to protect, promote and
                                      support exclusive breastfeeding from birth. At the same
                                      time, they have ensured that women who choose not to
                                      breastfeed are supported in their decision and provided
                                      with unbiased information and advice.
                                      Mrs Saadeh, World Health Organisation.




30   Auckland District Health Board
Auckland City Hospital (ACH) first NZ hospital to join
International Stroke Rehabilitation Research

A new stroke rehabilitation research programme, called AVERT (a very early
rehabilitation trial), that provides early exercise therapy within 24 hours of a stroke,
commenced at ADHB.

Stroke is the leading cause of serious long-
term disability in New Zealand. Twenty-two
New Zealanders have a stroke every day
and just over half of surviving patients have
ongoing problems with disability.

In the past people believed that stroke
patients could not exercise immediately after
having a stroke as it might be dangerous.

“We have found that exercise therapy
(with a focus on mobilisation) can be
started very early,” said Dr Julie Bernhardt,
physiotherapist and AVERT programme
director.

ACH has been selected to take part in the
research that will test the effectiveness of
very early rehabilitation for patients who
have had a stroke. The trial has already
commenced testing the benefits of AVERT in
Australia, and ACH is the first New Zealand
hospital to join the trial.

There is the potential for less disability and
a better quality of life after stroke, just by
getting patients up and about earlier and
more often. The early intensive exercise
therapy also offers hope for the 80% of
stroke patients not suitable for clot-busting
drugs.

AVERT is a large multi-centre randomised trial that aims to recruit over 2000 stroke
patients over the next three years. The programme is to be delivered by ADHB
physiotherapy and nursing staff. People, who get to hospital as soon as possible,
within 24 hours of a stroke, may be eligible for the trial.

The trial involves over 2000 stroke patients from more than 20 hospitals. Patients
are drawn from a broad range of ages, all races, both genders, and rural and urban
environments.

It is designed like a drug trial to allow comparison of results with other proven
interventions. Low equipment requirements make it readily transferrable.




                                                                                           Annual Report 2008   31
     WHO pilot takes flight at Auckland City Hospital (ACH)

     ACH was selected as one of eight hospitals from across the globe to pilot a new World Health Organisation
     (WHO) initiative called Safe Surgery Saves Lives.

     The aim of the initiative is to provide strategies and tools for reducing incidence of deaths and complications
     from surgery worldwide.

     As part of the scheme, the WHO has produced a Surgical Safety Checklist. The checklist has been developed
     to ensure that patients receiving surgical care anywhere in the world undergo the right operation at the correct
     body site, with safe anaesthesia, established infection-prevention measures and effective teamwork for safer
     care.

     While a checklist may seem like a simple answer to a complex issue, Auckland University’s Professor of
     Anaesthesiology, Alan Merry, who is helping to implement the scheme at the hospital, says it is hoped to
     significantly reduce surgical mistakes.

     “While incidents of things not going to plan in surgery are rare, they do happen. It is important that we do not
     hide behind a blame culture when looking into the reasons why mistakes are made, but instead look at ways we
     can support surgical staff,” says Alan.

     The checklist requires the nurse to confirm that 20 matters are in order, some of them straightforward, like
     identity, some complex, like asking if the surgeon has reviewed the “critical or unexpected steps”.

     Alan used the difficulties of giving antibiotics accurately as just one example of the benefits of the checklist.

     “The administration of antibiotics is not straight forward. If they are not given at the right time in exactly the
     right way then the risk of postoperative infection goes up. Research published in the New England Journal of
     Medicine proved that doctors can halve the infection rate in patients by following a checklist.”

     Eight hospitals in places from Toronto to Tanzania were selected to pilot the checklist.

     “For the checklist to work globally we need to ensure that it works across cultural and economic boundaries. As
     such, large hospitals in London and Seattle have been selected to trial the scheme as well as medical facilities in
     areas such as Amman in Jordon and Ifakara in Tanzania,” he says.

     “Auckland was chosen as a site as New Zealand provides a quality healthcare system to a smaller population,
     therefore meaning that it does not have the same budgets as some healthcare systems in larger countries.”

     Alan hopes that the pilot scheme will provide statistical data to prove that the checklist is enhancing patient
     safety. This can then be used to help the implementation of the scheme globally.

     “We are more aware that getting all hospitals in every continent to use the checklist is a huge target. However, I
     am sure that over time the checklist will become a national and indeed a global standard.”

     Bill Berry, who is part of the team leading the project in Boston, America, came to Auckland in late April to see
     how the schemes implementation was going.

     “It is clear that staff at ACH are of a very high calibre and clearly do everything they can for their patients.
     It is very pleasing to see them use the checklist, and I would like to thank them all for playing a vital roll in
     supporting a scheme that could benefit millions of patients across the globe.”




32   Auckland District Health Board
Health Information from 74 ADHB Services is Available to
the General Public on Healthpoint

In the past, GPs, Accident and Emergency
Doctors, patients and caregivers have had
little comprehensive information about services
available at the ADHB.

This has now changed with the advent of
Healthpoint.

Over 70 ADHB services have published
information on the website www.healthpoint.co.nz
outlining both public and professional information
necessary to inform interested parties of services
that are available.

Healthpoint is a nationwide portal that brings
together in one place information directly from the
provider to patients, caregivers and referring doctors.

Currently over 30,000 people are accessing
information each month, and all Auckland primary
care providers have direct access into secure referral
information.

Each service is supported by ADHB and Healthpoint systems to ensure quality,
accuracy, integrity and accessibility of information.

•	Each	page	displays	the	date	of	the	latest	review	or	update.
•	Staff	in	each	service	can	edit,	change	and	add	brochures	or	links.
•	Each	site	is	set	up	and	reviewed	by	a	medical	editor.
•	Each	service	has	a	person	responsible	for	the	information.
Dr John Henley at ADHB says, “The Healthpoint system has provided information
to both the public and referring doctors which is likely to improve the accuracy and
utility of referrals, with resulting improvement in health outcomes.”

 Sue Harvey, Manager of the ADHB Health Information Service, has managed the
implementation of Healthpoint at ADHB.

She says that the ADHB services have found the system very easy to use, and keep
the information current. Healthpoint has also been very helpful answering any
queries when setting up service sites.

Healthpoint is a nationwide portal that brings together (in one place) information
directly from the provider to patients, caregivers and referring doctors.

www.healthpoint.co.nz




                                                                                       Annual Report 2008   33
                                      ADHB and A+ Trust join forces to launch health
                                      scholarship
                                      The ADHB has joined forces with the A+ Trust to launch a prestigious health
                                      scholarship to students from selected Auckland schools.

                                      Speaking at the launch recently ADHB Chief Executive Garry Smith says, “This
                                      is a unique opportunity for Auckland students who are interested in pursuing
                                      a career in health science. The health scholarships will play an important part
                                      in creating a stronger workforce for the future and we appreciate the initiative
                                      taken by the A+ Trust.”

                                      The scholarships are funded through a joint partnership between the A+
                                      Charitable Trust and ADHB.

                                      There are up to five scholarships of $4000 each per annum for secondary
                                      school students who wish to study for a tertiary qualification in healthcare (with
                                      the exception of medical training).

                                      “The A+ Trust offers several different kinds of scholarships. The secondary
                                      school scholarships are part of the A+ Trust programme focussing on research
                                      and education. This programme seeks to encourage teenagers from low
                                      decile schools in the ADHB catchment area to embark on a healthcare related
                                      degree. Ultimately the hope is that ADHB will encourage more people from
                                      our area to take up a health related profession and we would like to think
                                      that the scholars who have been helped by the Trust will be future ADHB
                                      employees,” says Dr Richard Frith, Chairman, A+ Charitable Trust.

                                      Taima Campbell, Executive Director of Nursing and chair of the Workforce
                                      Development Committee says that this scholarship programme is one of the
                                      strategies for attracting secondary school students into a health career and part
                                      of the ADHB Workforce Plan.

                                      “We spend a lot of time going overseas and talking about having a ‘home
                                      grown’ workforce, but unless we are proactive and work with our schools, we
                                      won’t be able to compete with the range of other career options which students
                                      have to choose from,” she says.

                                      She says that the programme is unique in that it works with low decile schools.

                                      “Many of these students may not have access to the role models or support
                                      that would enable them to consider a health career. We also need to be talking
                                      to students, teachers, career guidance counsellors about the subject choices
                                      students need to be making as early as year 10 (before the start of yr 11) so
                                      that they have the right pre-requisite topics such as science, maths and english
                                      at achievement standard level,” says Taima.

                                      The scholarship programme will be overseen by Gill Naden, Executive Officer
                                      of the A+ Trust and Taima Campbell, the Executive Director of Nursing and
                                      chair of the Workforce Development Committee.

                                      The programme will be coordinated on a daily basis by the Scholarship
                                      Coordinator Catherine Waetford and supported by the ADHB Career Centre.



34   Auckland District Health Board
Smile! ADHB celebrates one century of hospital dentistry

The ADHB recently hosted the Annual NZ Society of Hospital and Community
Dentistry conference. The three day conference was held at Ellerslie Convention
Centre from 24-26 July 2008 and was officially opened by Health and Disability
Commissioner, Ron Paterson and attended by ADHB Chief Executive Garry Smith.

This year’s conference was extra special for the ADHB as 2008 marks one century of
ADHB providing hospital dentistry care. The 100 year milestone was celebrated with
a lunch at the conference and a presentation featuring historic images of the ADHB
hospital dentistry unit.

Clinical Director of the ADHB Oral Health Unit, Dr Clive Ross, has worked in
hospital dentistry at ADHB for almost 30 years and says he has seen many changes
in the field.

“Hospital dentistry services provided by the ADHB today include complex oral care,
care for special needs patients, specialist dental services such as cleft palate and the
treatment of medically compromised patients.

“I have seen the Oral Health Unit go from an oral emergency clinic to becoming a
service that caters for patients with complex medical conditions.

“Our staff must have a high mix of skills to meet the day-to-day demands of the Unit
as well as being on call to treat trauma and accident related patients with acute
facial injuries.”

The Oral Health Unit has many inter-relationships within the ADHB and interacts
with a wide range of services including the pain clinic, cardiology/haematology
department, renal transplant team, liver transplant team, dermatology, respiratory,
Starship Children’s Health, emergency departments and intensive care unit.

Currently the ADHB treats more than 29,000 hospital dentistry patients each year.




                                                                                           Annual Report 2008   35
                                      Goal three: Live Within Our Means
                                      Overview
                                      ADHB closed the year with a sound performance for June, to give an audited year-
                                      end result of $2,393k on a turnover of $1.53 billion

                                      In aggregate, contract volumes were achieved for our referring DHBs with variations
                                      in the mix. There was a shortfall in MoH and ADHB funded electives. It was,
                                      however, a commendable performance, as notwithstanding the impact of industrial
                                      action, (ADHB, being paid on throughput is impacted more than other DHBs),
                                      production increased by 3% with staff numbers lifting by 2%.

                                      This is a very good outcome and confirms a trend in increasing productivity that has
                                      been a feature of ADHB’s financial recovery. The delivery of a breakeven result also
                                      confirms the 06/07 result, which showed a very big improvement over the 05/06
                                      year, with a deficit of $14.3m for 06/07. The 07/08 result has been achieved on a
                                      sound trading basis i.e. without the benefit of the budgeted

                                      - land sales of $4.2m
                                      - one-off Starship Foundation donation of $3.5m (now 08/09 year)

                                      Provider Performance (Hospital and Related Services)
                                      Relative to its peers, ADHB has performed well. Recent national costing work would
                                      confirm Provider Arm cost increases as a growing issue for the sector, with increases
                                      in FFT (CPI for the Health Sector) lagging behind real cost increases. The bulk of
                                      the ADHB services are to be congratulated for superb performances, meeting or
                                      exceeding budget.

                                      ADHB has done particularly well to absorb wage increases across its total Provider
                                      Arm, which are not fully reflected in the IDF prices paid to ADHB for approximately
                                      half of its Provider Arm work. This issue is subject to ongoing dialogue with the
                                      MoH and within the Sector.

                                      Labour, as a percentage of revenue for 07/08, was 42.4% against a budget of
                                      42.5%, (last year 42.3%). Unbudgeted wage increases were compensated for
                                      by vacancies not filled. To meet some contracts there was a lift in outsourcing
                                      to compensate for staffing and capacity issues. In times of wage pressures, it is
                                      nevertheless a good result. Increased labour costs (rates) above those budgeted,
                                      $14.9m, have been partially absorbed, by staff numbers being lower than budget
                                      by 67 FTE, with a saving of $5.5m. In the 08/09 year management is committed
                                      through the Partnership Agreement process to once again absorbing wage increases
                                      in excess of FFT through further productivity gains.

                                      Direct treatment costs, as a percentage of revenue for 07/08, were 12.5% (last
                                      year 12.2%) against a budget of 11.8%. The budget was aggressive, and with the
                                      increase in outsourcing in 07/08 ADHB has done well to come in within 0.3% of
                                      06/07.




36   Auckland District Health Board
Annual Report 2008   37
                                      From a financial perspective, the manner and timing of how the three
                                      major neighbours build and repatriate services will be crucial to ADHB’s
                                      continuing performance. Under current settings it is evident that ADHB
                                      needs to run close to capacity to break even. The pricing on which it is
                                      paid represents the (time lagged) average costs of production across all
                                      DHBs, producing on an “efficient” basis. These prices take no account
                                      for the severe inefficiencies that arise as work is repatriated and this has
                                      been amply demonstrated with the Neurosurgery and Cardiology work.
                                      Health Sector labour is in short supply, is increasingly specialised, and
                                      has costs not as flexible as the pure price modelling, done for National
                                      Pricing, would have them to be.

                                      There is always room for continuous improvement. The June result
                                      highlighted this with bed blockages mid-month in the Adult Services (the
                                      largest service) area, with adverse impacts on surgical performance.
                                      There has been much work done on identifying tools for improving
                                      workflows in a very complex environment and computer programmes to
                                      aid in forecasting requirements would possibly have assisted in predicting
                                      the growing issue, and allowed planning and rostering to help alleviate
                                      the situation. The introduction of such tools should be built upon with
                                      a very necessary introduction of a comprehensive rostering system, to
                                      allow managers to see hospital-wide capacity, staffing constraints and
                                      opportunities. The organisation focus on the Clinical Leadership Structure
                                      and the Quality Framework (whole of system) using methodology to drive
                                      out variation and eliminate unnecessary steps in processes plus wastage
                                      and rework, will be the driver for sustaining our breakeven position.

                                      Many parts of the Provider Arm are running up against capacity
                                      restraints. Rostering, Planning and Scheduling can solve some issues
                                      and there is scope to increase bed numbers and theatres. Changing
                                      work arrangements will be one of the two most difficult, but most critical,
                                      challenges. The MECA wage increase do not reflect the underlying
                                      automatic step movements and compounding effects of holiday leave
                                      and rate increases, and means growth in productivity must continue to
                                      increase just to stand still. The crude lever in ADHB has been to accept
                                      ever increasing acute volumes while running tight budgets. This crude
                                      lever has reached its limit as the ‘safety valve’ of outsourcing has been
                                      turned on progressively. More sophisticated planning tools and more
                                      flexible work practices are needed and is being investigated as a matter
                                      of urgency.

                                      Funder
                                      Careful management of the funding budget has contributed to ADHB’s
                                      financial break even position.

                                      Whilst the range of new services possible substantially exceeded ADHB’s
                                      ability to fund, we used an efficient prioritisation process to determine
                                      new initiatives which would make the strongest contribution to lift the
                                      health of the people of Auckland.




38   Auckland District Health Board
As a result of these prioritisation processes, during the year ADHB funded $8m of
services, including:

•	An	aged	residential	care	quality	improvement	programmes.
•	School-based	health	services.
•	Heart	failure	management	programmes.
•	Primary	options	for	acute	care.
•	Healthy	Village	Action	Zones.
•	Maori	cardiac	rehabilitation	and	lifestyle	programmes.
•	South	Asian	community	diabetes	programmes.


As mentioned above, ADHB along with all other DHBs, faced unbudgeted wage
increases to service its population, but ADHB’s Funder was required to cover the
additional wage costs of other DHBs for work they had done at ADHB, amounting
to $5m. There has also been an allowance made by ADHB, in the Funder, for
$3.7m to be repaid, mainly to Counties, Waitemata, Waikato and Midland and
other DHB’s. This is for under delivery of volumes, various adjustments through
Regional Service Planning (repatriation) issues and the transfer of Cardiology and
Neurosurgery work to Waitemata and Waikato, respectively. There were no major
unfunded variances in the Funder. Significant under spends came, ultimately of
necessity, from slow start ups to the Health 2020 initiatives.


Region
DHBs are required to breakeven and do the “best” for their population. IDF prices
are set on production configurations, volumes and costs, 2-3 years old, uplifted by
FFT (at times less than inflation).

With ADHB hovering around breakeven, skills in short supply and volumes needed to
cover unfunded wage growth, it is illogical for ADHB not to maximise its volumes and
run at capacity. This driver, however, hinders decision-making in the region, as it is
a logical decision for regional DHBs to repatriate work if it can be done at less than
the national price (IDF price).

Add to this volume increases, (acute and elective), capital restraints and a labour
force with a strong bargaining position, and the rationale for regional co-operation
becomes, however, more urgent. ADHB has learnt that you can’t easily cover the
cost of new assets built for future growth under PBF funding. Nor can you repatriate
services, provide cover and expect to have 100% variable cost savings or extract
compensating efficiencies in other services to cover lost contribution. It is difficult
in a commercial world; it is near impossible with the averaged and time lagged
national pricing regime.

The region’s results have to be seen as a whole, with service distribution to make
the best use of people and assets, without the imperative of a DHB being all things
to its people or clinically driven service expansion. Auckland region should be no
different to the issues and debates being aired around Wellington, Palmerston North
and Hawkes Bay, where travel challenges are significant also. Currently the region is
bidding against itself to attract labour and resources. It should be shifting production
to lower costs in the short term and increase capacity at lowest marginal cost.




                                                                                           Annual Report 2008   39
                                      Cash Position
                                      The cash position at 30 June 2008 has improved by $83.15m from the position
                                      as at 30 June 2007. In July 2007, ADHB, as a result of its performance in 2007,
                                      improved its monetary position with the Ministry of Health. In recognising this,
                                      payment of revenue relating to Auckland’s population moved to being paid in
                                      advance rather than arrears which resulted in a one-off cash improvement of
                                      $41.9m. Revenue has also exceeded budget, with increases in a number of funding
                                      streams which has allowed $60m to be held on deposit on a semi-permanent
                                      basis. In addition $20m was received in June 2008, to fund costs that will come
                                      to charge in the next year, as a result of revaluation of assets as at 30 June 2008.
                                      This has been placed on short term deposit. This improvement in cash position was
                                      achieved while still repaying $10.5m in long term debt as part of the Board’s long
                                      term commitment to repaying the borrowings required for the new hospital block at
                                      Grafton.




40   Auckland District Health Board
Our staff




Upskilling
The A+ Trust offers scholarships for ADHB employees who wish to up-skill under the
Internal ADHB Scholarship Programme scheme. Each recipient receives $5000 per
annum contribution to tertiary fees. This scheme is available for an ADHB employee
wishing to study for their first undergraduate degree in a health related field.


Appreciating and acknowledging staff
The NOVA Awards is one way we recognise employees and teams whose values
align with the four ADHB adopted values: integrity, respect, innovation and
effectiveness. It works by nomination – anyone can submit a story of an individual or
a team who has demonstrated our values ‘above and beyond’ that expected in the
workplace.


Celebrating people
The ADHB takes many opportunities to recognise its staff with events such as
Celebration Week - which honours people, education, research and achievements
and the X Factor Talent Show.


Staff honoured nationally
Drs Les Galler, Chelleraj Benjamin, John Lewis Edwards, and Senior Dietitian Lyn
Gillanders were honoured during the Queen’s Birthday Awards this year.




                                                                                        Annual Report 2008   41
     SECTION 3.
      Good Employer Obligations Report
      2007/08
      Under sections 118 and 151 of the Crown Entities Act 2004, ADHB is required to
      report on the extent to which it complies with “good employer” policies.


      Auckland District Health Board’s (ADHB) vision:
      ”To recruit, develop and maintain a sustainable, responsive, collaborative and skilled
      health and disability workforce focused on the health needs of the population of
      ADHB now and into the future”.

      Auckland District Health Board (ADHB) applies the following “Good Employer
      Principles” to support our vision.


      Principles
      ADHB believes that a good employer is one who operates a Human Resources
      policy containing provisions generally accepted as necessary for the fair and proper
      treatment of employees in all aspects of their employment and encompasses the
      provisions of the Health & Disability Services Act 1993.

      ADHB is committed to this principle and will seek to actively uphold any legislative
      requirements in this regard and will put in place such systems and programmes to
      support this principle.

      ADHB has a true commitment to its employees and its services. Regardless of the
      minimum requirements of legislation, ADHB will continue to promote and protect
      the welfare and management of employees to the mutual benefit of employees,
      consumers and the organisation.

      Providing equal employment opportunities by eliminating any barrier that may
      deny a potential or existing employee the opportunity to be equitably considered
      for employment of their choice and the chance to perform to their maximum is a
      key principle practised by all representatives of ADHB in the execution of activities
      relating to the recruitment and management of employees (or potential employees).
      This includes:
      •	Recruitment
      •	Pay	and	other	rewards
      •	Career	development
      •	Work	conditions
      ADHB’s Human Resources policies and practices will be free from any discriminatory
      element that has the potential to deny a person equal opportunity.




42    Auckland District Health Board
Annual Report 2008   43
              Organisation Values and Culture
              As a large organisation and employer we think it is important that we use and promote management
              and organisational practices that are effective and efficient in the way we operate and deliver health
              care. We believe a high performance organisation starts with having an organisational culture where
              everyone is able to contribute to the way the organisation develops and adapts to change. For ADHB
              establishing this culture starts with having clearly articulated values. Consequently, all of ADHB’s
              activities are underpinned by key values that define the way we behave and inform all of our decision
              making. These organisational values are:

              •	Integrity – this means being open, fair, honest and transparent in everything we do
              •	Respect – this means being responsive to the needs of our diverse people and communities
              •	Innovation – this means providing an environment where people can challenge current processes and
                generate new ways of learning and working
              •	Effectiveness – this means we will apply our learning and resources to achieve better outcomes for our
                communities

              ADHB also recognises and respects the Treaty of Waitangi as the founding document of New Zealand.
              The Treaty of Waitangi is the fundamental relationship between the Crown and Iwi. It provides the
              framework for Maori development, health and wellbeing.

              ADHB shall ensure that employees maintain proper standards of integrity and conduct in accordance
              with ADHB’s “Values” and the State Services Commission “Code of Conduct”.

              Complaints
              ADHB supports the right of all employees to seek resolution of any complaint through the procedures
              contained in relevant legislation (e.g. Employment Relations Act (2000), Human Rights Act (1993)).


              Health and Safety
              ADHB are committed to and responsible for providing a healthy and safe workplace for all employees,
              students, volunteers and contractors whilst they are at the ADHB workplace for the purpose of ADHB
              work and to patients and visitors in relation to safe use of the facilities. ADHB takes all practicable steps
              to:
              •	Comply	with	relevant	legislation,	regulations,	code	of	practice	and	safe	operating	procedures
              •	Provide	a	safe	and	healthy	workplace,	equipment	and	conditions
              •	Establish	and	insist	on	safe	work	practices
              •	Provide	training	in	health	and	safety	requirements
              •	Ensure	accurate	reporting	and	recording	of	workplace	accidents
              •	Ensure	all	managers	have	an	understanding	of	health	and	safety	and	are	reviewed	against	their	
                designated responsibilities
              •	Support	employee	participation	in	health	and	safety	management.		
              ADHB strives to continuously improve the management of health and safety at all levels and within all
              areas of the organisation by reviewing, developing and maintaining systems that provide the framework
              for health and safety management (e.g. hazard management, accident reporting and investigation, staff
              induction and training, employee participation in health and safety committees).




44   Auckland District Health Board
Good employer report 2007-08
The Human Rights Commission has suggested that Crown entities should report under the following seven key
“elements” relating to recruiting, developing, managing and retaining staff.

Element/
Measurement       Policies & Procedures                                 Programmes
Leadership        •	Organisational	values                               •	Management	assessment	and	development	process	
accountability    •	Regular	Union-employer	meetings		                   •	Clinical/managerial	partnership
& culture         •	CEO	“State	of	the	Nation”	addresses	to	all	staff	   •	ADHB	Welcome	Day	–	initial	address	to	participants	by	CEO	
                  •	Integrated	management	structure                     •	Individual	Service	Planning	Days	–	multidisciplinary	involvement	
                  •	Clinical	Quality	and	Professional	Governance	       •	Nova	Magazine	(newsletter	for	staff)
                    model                                               •	Goodwill Meet & Greet (Senior Management Team serve
                  •	Bi-cultural	policy	                                   festive treats to all staff)
Recruitment,      •	Intranet	based	guides	for	recruitment	&	selection   •	Induction	guides	for	managers	
selection and     •	In-house	Careers	Centre	                            •	Support	of	Overseas	Candidates	social	evenings
induction         •	Staff	have	access	to	intranet	based	recruitment	    •	Work	Experience	Days
                    site                                                •	Open	Days	at	Children’s	and	Women’s	services
                  •	Wide	media	coverage,	advertising                    •	Career	Development	Advisor	on	Site
                  •	Overseas		and	local	recruitment	expos	              •	Careers	Centre	evening	for	local	candidates	to	meet	and	talk	
                                                                          about job opportunities
                                                                        •	Careers	Centre website accessible internally & externally
Employee      •	Guides	to	training	and	coaching	staff                   •	Alumni	programme	in	place	
development, •	Documented	exit	procedures                               •	Annual	Performance	Development/Management	Process
promotion and •	Majority	of	staff	on	MECAs	have	continuing	             •	Individual	Performance	Planning	
exit            education provisions                                    •	Sabbaticals	for	Senior	Medical	Officers
              •	Other	staff	have	the	ability	to	negotiate	specific	     •	Exit	interviews
                training & development opportunities
Flexibility &     •	Flexible	rostering	practices	subject	to	clinical	   •	Participation	in	pay	and	employment	equity	review	
work design         requirements                                        •	Review	of	family	friendly	initiatives	
                                                                        •	Staff Crèche on each site.
Remuneration      •	Majority	of	staff	on	transparent	MECAs              •	Nova	awards	–	peer	recognition	of	individuals	or	teams	living	
recognition &     •	Annual	review	of	IEA	remuneration	based	on	           the organisational values
conditions          market data                                         •	Long	service	awards
                  •	Clinical	staff	embedded	in	integrated	              •	Celebration	week	–	a	week	of	activities	celebrating	clinical,	
                    management structure                                  teaching and research achievements
                                                                        •	Staff	benefits with external providers
Harassment        •	Harassment	policy	in	place                          •	Formal	and	informal	processes	documented,	and	available	for	
& bullying        •	Workplace	Violence	Prevention	Policy	in	place	        response to harassment
prevention
Safe and          •	Dedicated	Occupational	Safety	&	Health	             •	ACC	Partnership	Programme		-	Tertiary	accredited.	Good	
healthy             department                                            relationships with third party provider
environment       •	Health	&	Safety	Policy	in	place                     •	Staff	leadership	of	service-based	Health	&	Safety	committees
                  •	Harassment	Policy	in	place                          •	Staff	Wellness	initiatives
                  •	Workplace	Violence	Prevention	Policy	in	place       •	DV-Free	(domestic	violence)	free	programme	available	to	staff	
                                                                          (staff contact people trained and awareness session run for all
                                                                          staff to attend)
                                                                        •	Support	material	available	for	staff	and	managers	to	understand	
                                                                          and manage workplace stress
                                                                        •	Patient	Handling	project	including	staff	training	and	equipment	
                                                                          acquisition
                                                                        •	Free	influenza	vaccine	programme	for	staff
                                                                        •	EAP	services	provided	free	to	staff
                                                                        •	Healthy	Eating	Healthy	Action	initiatives	for	staff
                                                                        •	Involvement	in	Feetbeat		
                                                                        •	Annual	ADHB	team	in	Round	the	Bays
                                                                        •	Free	work-related	Occupational	Health	assessments	for	staff
                                                                        •	Workstation	assessments
                                                                        •	Work	area	safety	checks
                                                                        •	Staff	Breastfeeding	policy	&	facilities
                                                                        •	Weight	Watchers	meeting	on	site	weekly
                                                                        •	Pilates	programmes	available	on	site


                                                                                                                 Annual Report 2008           45
                                               Workforce Demographic Indicators
                                               Turnover
                                               Staff turnover for year ended 30 June 2008 was 14.7%


                                               Employee Diversity
                                               It is not mandatory for employees to disclose their ethnic group and some employees
                                               choose not to do so. A number of employees have a mixture of ethnic background
                                               and some believe it is not respectful to identify one ethnic group over another.
                                               The table below identifies all ethnic groups that represent greater than 1% of our
                                               workforce. We are fortunate to have many other ethnic groups within our workforce
                                               and this individually account for less than 1% of our workforce.

               30%
              25%
              20%
              15%
              10%
                5%
                0%




                                                                                                                                                                                                                NIUEAN
                                                                                                                                                                  PACIFIC ISLANDR

                                                                                                                                                                                    BRITISH

                                                                                                                                                                                              COOK ISLD MAORI
                                                                                                 CHINESE
                                                             INDIAN

                                                                      OTHER




                                                                                                                      FIJIAN

                                                                                                                                SAMOAN

                                                                                                                                         TONGAN

                                                                                                                                                  NEW ZEALANDER
                        EUROPEAN

                                   NOT KNOWN

                                               NZ EUROPEAN




                                                                              NZ MAORI

                                                                                         ASIAN



                                                                                                           FILIPINO




                                               Gender
                                                     Count of the # of employees by self-identified race or gender / count of the # of employees.
                                                                                          Includes all employees, multiple appointments excluded

             100%
              90%
              80%
              70%
              60%
              50%
              40%
              30%
              20%
              10%
                0%
                         Administrative                         Household                  Medical                     Nursing             Technical Patient Technical Support
                             Staff                                Staff                     Staff                       Staff                 Care Staff           Staff
                                                                              Female                                           Male




46   Auckland District Health Board
Distribution of employees by age group

•	ADHB	total	FTE	=	approx	7540                                                                    Age profile
•	Total	staff	by	headcount	=	approx	           1800
  9286                                         1600
•	Nursing	largest	part	of	workforce
                                               1400
•	71%	of	the	workforce	is	female
•	43%	of	the	medical	workforce	is	             1200
                                   Headcount




  female                                       1000
•	Average	age	=	40+
                                                800
•	81%	of	employees are
  permanently employed with a                   600
  flexible workforce of 19%
                                                400
       * Note: Excludes contractors,            200
  employees on fixed term contract
and employees on parental leave or                0
                                                      15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84
        long term leave without pay.                                                               Age Groups
     Source: HR Information System
                            (Leader)                     Generation Y          Generation X               Boomers                            Matures




Total Number of Employees (heads) Full and Part Time by
Occupational Group
100%
 90%
 80%
 70%
 60%
 50%
 40%
 30%
 20%
 10%
  0%
          Administrative      Household                 Medical                   Nursing             Technical Patient Technical Support
              Staff             Staff                    Staff                     Staff                 Care Staff           Staff
                                               Full Time                               Part Time

 Count of the # of employees (heads) full time & part time by occupational group. Includes all
                                 permanent employees only, excludes multiple appointments




                                                                                                                                           Annual Report 2008           47
                                      Statement of Responsibility for the Year
                                      Ended 30 June 2008
                                      1. The Board and management of ADHB accepts responsibility for the preparation of
                                        the financial statements and the judgements used in them;
                                      2. The Board and management of ADHB accepts responsibility for establishing and
                                        maintaining a system of internal control designed to provide reasonable assurance
                                        as to the integrity and reliability of financial reporting; and
                                      3. In the opinion of the Board and management of ADHB, the financial statements
                                        for the year ended 30 June 2008 fairly reflect the financial position and operations
                                        of ADHB.




      .
     P N. Snedden                        H. J. Burkhardt                       G. R. Smith                  29 October 2008
     Chair                               Chair Audit Committee                 Chief Executive




                                      Statutory Information
                                      In respect of the financial year ended 30 June 2008 the Board members of ADHB
                                      submit the following report:


                                      Members of the Board - Current
                                      Board member                                        Experience with ADHB
                                      Patrick Nesbit Snedden (Chair)                      From December 2007
                                      Harry Jacques Burkhardt (Deputy Chair)              From June 2003
                                      Joanne Margaret Agnew                               From December 2007
                                      Susan Margaret Buckland                             From December 2007
                                      Dr. Christopher John Wesley Chambers                From December 2001
                                      Robin John Cooper                                   From December 2007
                                      Dr. Brian Joseph Fergus                             From December 2007
                                      Dr. Ian Kevin Scott                                 From December 2001
                                      Rt. Hon. Robert James Tizard                        From December 2007
                                      Seiuli Dr. Juliet Maria Walker                      From December 2007
                                      Ian Ronald Ward                                     From December 2007


                                      Members of the Board - Ceased
                                      Wayne Kelvin Forrest Brown (Chair)                  December 2007
                                      Ross Barry Keenan (Deputy Chair)                    December 2007
                                      Barry Joseph de Geest                               December 2007
                                      Dr. Virginia Theresa Hope                           December 2007
                                      Dr. Diane Mary Nash                                 December 2007
                                      John Retimana                                       December 2007




48   Auckland District Health Board
Board Committees as at 30 June 2008
 - Statutory Committees
Community and Public Health Advisory Committee
 .
P N. Snedden (Chair)             Dr. B. J. Fergus
H. J. Burkhardt (Deputy Chair)   Rev. A. Ngaro
J. M. Agnew                      Dr. I. K. Scott
S. M. Buckland                   Rt. Hon. R. J.Tizard
Dr. C. J. W. Chambers            Seiuli Dr. J. M. Walker
R. J. Cooper                     I. R. Ward


Disability Support Advisory Committee
B. J. de Geest (Chair)           M. E. M. Hull-Brown
J. M. Agnew                      D. A. Kirton
S. M. Buckland                   M. Tan
 .
P Druskovich                     Rt. Hon. R. J. Tizard
Tunumafono A. Fa’amoe

Hospital Advisory Committee
 .
P N. Snedden (Chair)             Prof. I. Martin
J. M. Agnew                      Dr. I. K. Scott
S. M. Buckland                   Dr R. Tapsell
H. J. Burkhardt                  Rt. Hon. R. J.Tizard
Dr. C. J. W. Chambers            Seiuli Dr. J. M. Walker
R. J. Cooper                     I. R. Ward
Dr. B. J. Fergus




Board Committees as at 30 June 2008
 - Board Established Committees
Audit Committee
H. J. Burkhardt (Chair)           .
                                 P N. Snedden
Dr. B. J. Fergus                 I. R. Ward
Dr. I. K. Scott


Quality Committee
 .
P N. Snedden (Chair)             Dr. B. J. Fergus
J. M. Agnew                      Dr. I. K. Scott
S. M. Buckland                   Seiuli Dr. J. M. Walker
Dr. C. J. W. Chambers


Maori Health Advisory Committee
 .
P N. Snedden (Chair)             T. Kingi
H. J. Burkhardt                  L. Mitchelson
Dr. C. J. W. Chambers             .
                                 P Rameka
R. J. Cooper                     T. Stewart




                                                           Annual Report 2008   49
                                      Pacific Health Advisory Committee
                                      Rev. A. Ngaro (Chair)             Aufa’amulia A. Lole - Taylor
                                      Dr. C .J. W. Chambers             M. Maka
                                      R. J. Cooper                      B. McCarthy
                                       .
                                      P N. Snedden                      Seiuli Dr. J. M. Walker
                                      Tafilelea F. Gagamoe              I. R. Ward
                                      L. Halatau


                                      Principal Activities
                                      The ADHB functions are set out in section 23(1) of the New Zealand Public Health
                                      and Disability Act 2000. It is responsible for the funding of health services.
                                      ADHB provides its own hospital and health services at:

                                      •	Auckland	City	Hospital
                                      •	Greenlane	Clinical	Centre	
                                      •	Community	and	Mental	Health	Service	sites		


                                      Review of Operations
                                                                                                   Group         Parent
                                      Results for the year ended 30 June 2008                       $000          $000
                                      Operating surplus                                            2,359         2,004
                                      Share of net surpluses of associates                             34                0
                                      Net surplus                                                  2,393         2,004

                                      Equity of ADHB as at 30 June 2008
                                      Current assets                                            184,134        169,671
                                      Non-current assets                                        945,726        940,511
                                      Total assets                                            1,129,860      1,110,182
                                      Current liabilities                                       277,236        268,572
                                      Non-current liabilities                                   303,493        303,493
                                      Total liabilities                                         580,729        572,065
                                      Total equity                                              549,131        538,117


                                      Capital Charge
                                      The capital charge for the year ended 30 June 2008 was $38.405 million (to 30
                                      June 2007: $25.559 million) and is treated as an operating expense – note 15.


                                      Equity Comparisons
                                      Equity of $106k has been received from the Crown (to 30 June 2007 $35 million
                                      repaid and $608k received).




50   Auckland District Health Board
Financial statements
The financial statements of ADHB and the Group for the year ended 30 June 2008
are included separately in this report. The Group consists of ADHB, the Auckland
District Health Board Charitable Trust (beneficial control) and associated entities,
Auckland Regional RMO Services Ltd (33% owned), Northern DHB Support Agency
Limited (33% owned) and Treaty Relationship Company Limited (50% owned)


Interests register
During the year the following entries were recorded in the Interests Register of ADHB:
                                                Year ended 30/6/08
(a) Board Members’ Fees                                  $
 .
P N. Snedden (Chair)                                         48,266
H. J. Burkhardt (Deputy Chair)                               35,452
J. M. Agnew                                                  17,468
W. K. F. Brown                                               36,719
S. M. Buckland                                               17,468
Dr. C. J. Chambers                                           30,063
R. J. Cooper                                                 16,229
Dr. B. J. Fergus                                             18,718
B. J. de Geest                                               12,565
Dr. V. T. Hope                                               12,565
R. B. Keenan                                                 11,389
Dr. D. M. Nash                                               13,077
J. Retimana                                                  12,042
Dr. I. K. Scott                                              32,000
Rt. Hon. R. J.Tizard                                         18,718
Seiuli Dr. J. M. Walker                                      16,468
I. R. Ward                                                   18,218
Fees paid to Board Members                                  367,425

(b) Board Members use of ADHB information
No notices were received from the Board members requesting the use of ADHB
information, received in their capacity as Board Members, which would not otherwise
have been available to them.
                                                Year ended 30/6/08
(c) Committee Members’ Fees                              $
S Dylan                                                          750
Tunumafona A. Fa’moe                                             500
B. J. de Geest                                                   625
M. Maka                                                          500
Rev. A. Ngaro                                                  1,000
 .
P Rameka                                                       1,000
 .
P Roseman                                                      1,250
Prof. A. Woodward                                              1,000
Dr. D. Wu                                                      1,250
Fees paid to Committee Members                                 7,875




                                                                                         Annual Report 2008   51
     (d) Board Members’ interests
                             The Board Members have declared that they may benefit from any contract that may
                             be made with the entities listed below by virtue of their directorship or memberships of
                             those entities:
     Board Member            Interest
      .
     P N. Snedden            Consultant, Ngati Whatua o Orakei Maori Trust Board; Director, Watercare Services
     (Chair)                 Ltd; Chairman, Housing New Zealand; Chairman, Tamaki Establishment Board;
                             Chairman, Quality Improvement Committee
     H. J. Burkhardt         Owner/Managing Director, Replas Ltd; Owner/Director, Matta Products Ltd;
     (Deputy Chair)          Shareholder/Director, Remat Group Ltd; Shareholder/Director, Burkhardt Investments
                             Ltd; Shareholder/Director, Burris Ltd; Director, Reco Ltd; Trustee, ADHB Charitable Trust;
                             Chairman, NZ Maori Arts & Craft Institute; Shareholder/Director, Matt I Ltd; Trustee,
                             Matta LLC
     J. M. Agnew             Employee, Counties Manukau District Health Board
     S. M. Buckland          Self employed, Writing, Editing & Public Relations; Committee Member, Medical
                             Council of New Zealand
     Dr. C. J. W. Chambers Employee, ADHB; Wife employed by Safekids; Associate, Epsom Anaesthetic Group;
                             Member, ASMS; Shareholder, Ormiston Surgical
     R. J. Cooper            Chief Executive, Ngatihine Health Trust; Board Member, New Zealand Research Centre
                             for Growth & Development; Advisory Trust Board Member, James Henare Research
                             Centre, University of Auckland; Board Member, Manaia PHO Whangarei
     Dr. B. J. Fergus        Nil
     Dr. I. K. Scott         Nil
     Rt. Hon. R. J.Tizard    Nil
     Seiuli Dr. J. M. Walker Locum General Practitioner, Mangere - PHO TAPasefika, Grey Lynn - PHO Procare;
                             Member, National Breast Screening Advisory Committee; Member, Counties Manukau
                             Breast Screening Advisory Committee; Facilitator, RNZCGP General Practice Education
                             Programme Stage ll; Employee, ADHB
     I. R. Ward              Nil


     (e) Previous Board Members’
     Board Member          Interest
     W. K. F. Brown        Chairman, Coastlines Group Companies; Owner/Director, Waahi Paraone Ltd;
     (Chair)               Owner/Director, Alderton Construction Ltd; Owner/Director, Brown Consulting Ltd;
                           Chairman, Kordia Limited; Deputy Chair, Transpower Ltd
     R. B. Keenan          Chairman, Cabletalk Group Ltd; Chairman, Southern Travel Holdings Ltd; Chairman,
     (Deputy Chair)        Allied Workforce Ltd; Director, Metrowater Services Ltd; Director, Ngai Tahu Holdings
                           Corporation; Deputy Chairman, Waitemata District Health Board; Deputy Chairman,
                           Counties Manukau District Health Board
     B. J. de Geest        Director, Renaissance Consulting Ltd; Director One2One Homecare Ltd; Director,
                           Keane Group Ltd; Involvement with Disabled Persons Assembly
     Dr. V. T. Hope        Public Health Physician (AFPHM); Member, Royal Fellow Australasian College of Health
                           Administrator; Member, Management Committee National Centre for Bio Security
                           & Infectious Diseases, Employee, Institute of Environmental and Scientific Research;
                           Member, Ministry of Health Technical Advisory Group – Southern Saltmarsh Mosquito;
                           Member, Biosecurity Ministerial Advisory Committee; Member, ASMS
     Dr. D. M. Nash        General Medical Practitioner; Member, NZ Labour Party Policy Council; Chair &
                           Convenor, NZ Labour Party Health Policy Committee
     J. Retimana           Director Wakaieretere Ltd; Consultant Advisor to Territorial Authorities, Ngati Whatua
                           Trust Board and Te Ure O Hau Investments; Director, Whangai Investments Ltd




52   Auckland District Health Board
Auckland District Health Board Charitable Trust
Auckland District Health Board Charitable Trust administers the donations, bequests
and research funds to ADHB with the exception of funds held on behalf of patients
and the Ngati Whatua Trust Board, which are still held by ADHB and will be
distributed as required.


Trustees of the Trust at 30 June 2008
Trustee                              Experience with A+ Charitable Trust
Dr. R. Frith (Chair)                 Appointed 9 October 2003
H. J. Burkhardt*                     Appointed 7 April 2005
T. Campbell                          Appointed 8 April 2004
Dr. J. Henley                        Appointed 7 November 2002
R. Jarrold*                          Appointed 7 April 2006
Dr. S. Macfarlane                    Appointed 11 March 2005
Dr. D. Sage*                         Appointed 3 August 2003
G. R. Smith*                         Appointed 7 April 2006

*Appointed as Ex Officio Trustees from 7 April 2006 when new Deed of Trust effected.




                                                                                       Annual Report 2008   53
                                      Employee Remuneration
                                      During the year, the following numbers of employees of ADHB received remuneration
                                      over $100,000.
                                                                                                                  Number of
                                      Remuneration Range              Medical             Non- Medical            Employees
                                      $520,000-$530,000                                        1                      1
                                      $440,000-$450,000                   1                                           1
                                      $390,000-$400,000                   3                                           3
                                      $380,000-$390,000                   1                                           1
                                      $360,000-$370,000                   3                                           3
                                      $350,000-$360,000                   1                                           1
                                      $340,000-$350,000                   4                                           4
                                      $330,000-$340,000                   5                                           5
                                      $320,000-$330,000                   7                      1                    8
                                      $310,000-$320,000                  13                                          13
                                      $300,000-$310,000                  11                                          11
                                      $290,000-$300,000                  18                                          18
                                      $280,000-$290,000                  12                                          12
                                      $270,000-$280,000                  20                      1                   21
                                      $260,000-$270,000                  18                                          18
                                      $250,000-$260,000                  15                      1                   16
                                      $240,000-$250,000                  26                      1                   27
                                      $230,000-$240,000                  21                      2                   23
                                      $220,000-$230,000                  21                                          21
                                      $210,000-$220,000                  27                      1                   28
                                      $200,000-$210,000                  28                      1                   29
                                      $190,000-$200,000                  19                                          19
                                      $180,000-$190,000                  24                      1                   25
                                      $170,000-$180,000                  32                      3                   35
                                      $160,000-$170,000                  37                      4                   41
                                      $150,000-$160,000                  47                      3                   50
                                      $140,000-$150,000                  45                     10                   55
                                      $130,000-$140,000                  38                     11                   49
                                      $120,000-$130,000                  58                     25                   83
                                      $110,000-$120,000                  77                     38                  115
                                      $100,000-$110,000                  62                     82                  144
                                      Total                             694                    186                  880

                                      Note:
                                      Of the 880 employees shown above, 694 are or were medical or dental employees and 186
                                      are or were neither medical nor dental employees. If the remuneration of part-time employees
                                      were grossed-up to a full time equivalent basis, the total number of employees with full time
                                      equivalent salaries of $100,000 or more would be 1,186 compared with the actual total
                                      number of employees of 880.

                                      The remuneration received by the Chief Executive during the year ended 30 June
                                      2008 falls within the salary band $520,000-$530,000.




54   Auckland District Health Board
Employee Termination payments
Termination payments                                    Payment $     Employees
Total                                                   1,619,369       106

During the year ended 30 June 2008, termination payments were made in respect of
106 employees (102 payments in year ended 30 June 2007). Termination payments
consist of settlements and redundancy payments made during the year.



Auditor
The Controller and Auditor-General is appointed under section 43 of the New
Zealand Public Health and Disability Act 2000. Ernst & Young has been contracted
to provide these services.

Remuneration to auditor                                                     $000
Audit fees                                                                   248



Donations
ADHB did not make any donations during the year.



For and on behalf of the Board Members who authorised the issue of
this annual report.




 .
P N. Snedden                                                       29 October 2008
Chair




                                                                                     Annual Report 2008   55
                                      Statement of Financial Performance
                                      for the Year Ended 30 June 2008
                                                       Group           Group Actual                    Parent Actual
                                                       Budget
                                          Notes         2008              2008          2007           2008            2007
                                                        $000              $000          $000           $000            $000
     Revenue
     Patient care revenue                          1,361,364        1,444,412 1,308,103          1,444,412       1,308,103
     Other revenue                                   110,235           85,866    99,036             78,074          88,829
     Total Revenue                            2    1,471,599        1,530,278 1,407,139          1,522,486       1,396,932

     Expenses
     Employee benefit cost                   3a     624,697           640,016       594,322        636,917         589,807
     Direct treatment cost                          174,267           188,745       171,196        187,925         169,909
     Funder payments                                490,255           489,308       471,069        489,308         471,069
     Indirect treatment costs                3b      29,287            34,468        32,203         30,950          28,967
     Property, equipment &
                                             3c       51,199           49,894        48,732          49,894         48,732
     transport costs.
     Other operating expenses                3d       17,325           20,414        20,847          20,414         20,847
     Capital charge                          3e       17,453           38,405        21,559          38,405         21,559
     Depreciation and amortisation
                                             3f       45,094           44,651        44,306          44,651         44,306
     expenses
     Finance costs                           3g       21,969           22,018    19,899             22,018          19,899
                                                   1,471,546        1,527,919 1,424,133          1,520,482       1,415,095
     Share of net surpluses of joint venture &
                                                             0               34             4               0              0
     associates
     Net surplus/ (deficit) before and after tax           53            2,393      (16,990)          2,004        (18,163)




                                                   The accompanying notes form an integral part of these financial statements.




56   Auckland District Health Board
Statement of Changes in Equity
for the Year Ended 30 June 2008
GROUP                                Notes Public Equity      Accumulated          Other        Trust /         Total
                                                                    surplus      reserves      Special         equity
                                                                  /(deficit )                   Funds
                                                    $000             $000          $000          $000          $000
Balance as at 1 July 2006                        635,375        (463,501)       290,119         9,124       471,117
Movement in revaluation of
                                                         0                 0         (43)            0           (43)
land and buildings
Contributions from /
                                                 (34,392)                  0            0            0      (34,392)
(repayment to) the Crown
Total income and expense for
the period recognised directly                   (34,392)                  0         (43)            0      (34,435)
in equity
Profit/(loss) for the period                             0        (18,159)              0       1,169       (16,990)
Total income and expense for
                                                 (34,392)         (18,159)           (43)       1,169       (51,425)
the period
Balance as at 30 June 2007                       600,983         (481,660)      290,076        10,293       419,692

Balance as at 1 July 2007                        600,983         (481,660)      290,076        10,293       419,692
Movement in revaluation of
                                                         0                 0    126,940              0      126,940
land and buildings
Contributions from /
                                                      106                  0            0            0           106
(repayment to) the Crown
Total income and expense for
the period recognised directly                        106                  0    126,940              0      127,046
in equity
Profit/(loss) for the period                             0           2,039              0         354          2,393
Total income and expense for
                                                      106            2,039      126,940           354       129,439
the period
Balance as at 30 June 2008               6       601,089         (479,621)      417,016        10,647       549,131




                 The accompanying notes form an integral part of these financial statements.




                                                                                                     Annual Report 2008   57
     Statement of Changes in Equity
     for the Year Ended 30 June 2008 (continued)
     PARENT                               Public Equity   Accumulated          Other          Trust /          Total
                                                                surplus      reserves        Special          equity
                                                              /(deficit )                     Funds
                                                $000             $000          $000            $000           $000
     Balance as at 1 July 2006               635,375        (463,829)       290,119                0       461,665
     Movement in revaluation of
                                                     0                 0         (43)               0           (43)
     land and buildings
     Contributions from /
                                             (34,392)                  0            0               0      (34,392)
     (repayment to) the Crown
     Total income and expense for
     the period recognised directly          (34,392)                  0         (43)               0      (34,435)
     in equity
     Profit/(loss) for the period                    0        (18,163)              0               0      (18,163)
     Total income and expense for
                                             (34,392)         (18,163)           (43)               0      (52,598)
     the period
     Balance as at 30 June 2007              600,983         (481,992)      290,076                 0      409,067

     Balance as at 1 July 2007               600,983         (481,992)      290,076                 0      409,067
     Movement in revaluation of
                                                     0                 0    126,940                 0      126,940
     land and buildings
     Contributions from /
                                                  106                  0            0               0           106
     (repayment to) the Crown
     Total income and expense for
     the period recognised directly               106                  0    126,940                 0      127,046
     in equity
     Profit/(loss) for the period                    0           2,004              0               0         2,004
     Total income and expense for
                                                  106            2,004      126,940                 0      129,050
     the period
     Balance as at 30 June 2008       6      601,089         (479,988)      417,016                 0      538,117




                                           The accompanying notes form an integral part of these financial statements.




58   Auckland District Health Board
Statement of Financial Position
as at 30 June 2008
                                                   Group            Group Actual                    Parent Actual
                                                   Budget
                                      Notes          As at            As at    As at                As at         As at
                                                30/06/08          30/06/08 30/06/07             30/06/08      30/06/07
                                                    $000              $000     $000                 $000          $000
Current Assets
Cash and cash equivalents                 7        10,912           80,831         1,450          80,831         1,450
Trust/special funds                      8a         2,675           12,905        10,071               0             0
Patient & restricted trust funds         8b           964              983           910             983           910
Trade & other receivables                 9        26,271           78,552       125,698          76,994       124,153
Inventories                              10         9,826           10,763        10,407          10,763        10,407
Property held for sale                  11c             0              100            78             100            78
Total Current Assets                               50,648          184,134       148,614         169,671       136,998

Non-Current Assets
Trust/special funds                     8a          2,250            4,850         6,000               0             0
Property, plant and equipment          11a        673,837          929,589       814,467         929,589       814,467
Intangible assets                      11b          6,515            9,195         8,769           9,195         8,769
Derivative financial instruments        19              0            1,726            21           1,726            21
Investments in joint venture &
                                          5            328              366           332               1              1
associates
Total Non-Current Assets                          682,930          945,726       829,589          940,511      823,258
Total Assets                                      733,578        1,129,860       978,203        1,110,182      960,256




                  The accompanying notes form an integral part of these financial statements.




                                                                                                        Annual Report 2008   59
                                      Statement of Financial Position
                                      as at 30 June 2008 (continued)
                                                        Group            Group Actual                    Parent Actual
                                                        Budget
                                             Notes        As at            As at    As at               As at           As at
                                                     30/06/08          30/06/08 30/06/07            30/06/08        30/06/07
                                                         $000              $000     $000                $000            $000
     Current Liabilities
     Bank overdraft                             7           0             1,650         4,800          1,650           4,800
     Trade and other payables                 13a     130,803           142,772       128,241        134,108         120,919
     Employee benefits                        13b      96,303           116,148        94,349        116,148          94,349
     Provisions                               13c         350                99           350             99             350
     Interest-bearing loans and
                                            14,18       15,534           15,584        15,791          15,584         15,791
     borrowings
     Derivative financial instruments          19         542                 0           423              0             423
     Patient & restricted trust funds          8b         964               983           910            983             910
     Total Current Liabilities                        244,496           277,236       244,864        268,572         237,542

     Non-Current Liabilities
     Employee benefits                        13b       14,031           21,063        20,938          21,063         20,938
     Interest-bearing loans and
                                               14     282,413           282,430       292,709        282,430         292,709
     borrowings
     Total Non-Current Liabilities                    296,444           303,493       313,647        303,493         313,647
     Total Liabilities                                540,940           580,729       558,511        572,065         551,189
     Net Assets                                       192,638           549,131       419,692        538,117         409,067

     Equity
     Public equity                             6a     520,983          601,089 600,983               601,089        600,983
     Accumulated deficit                       6b    (482,892)        (479,621) (481,660)           (479,988)      (481,992)
     Other reserves                            6c     145,540          417,016 290,076               417,016        290,076
     Trust/special funds                       6d       9,007           10,647    10,293                   0              0
     Total Equity                                     192,638          549,131 419,692               538,117        409,067


     For and on behalf of the Board Members who authorised the issue of this annual report.




                                       .
                                      P N. Snedden                      H. J. Burkhardt                     29 October 2008
                                      Chair                             Chair Audit Committee




                                                     The accompanying notes form an integral part of these financial statements.




60   Auckland District Health Board
Statement of Cash Flows
for the Year Ended 30 June 2008
                                                  Group
                                                                  Group Actual                    Parent Actual
                                                  Budget
                                    Notes          2008              2008          2007           2008            2007
                                                   $000              $000          $000           $000            $000
Cash Flows from Operating
Activities
Cash was provided from:
Cash receipts from Ministry of
                                             1,539,082         1,556,640 1,392,605            1,549,722    1,384,432
Health and patients
Interest received                                2,230             8,874     4,061                8,359        3,277
                                             1,541,312         1,565,514 1,396,666            1,558,081    1,387,709
Cash was applied to:
Cash paid to employees                          616,440          614,705       572,983         567,691       572,983
Cash paid to suppliers                          758,319          779,453       744,929         821,023       743,035
Interest paid                                    21,926           25,140        17,863          25,140        17,863
Net goods and services taxes
                                                 (1,822)           (2,383)         (681)        (2,688)           (859)
paid/(refunded)
Capital charges paid                            16,059            20,532    25,767               20,532       25,767
                                             1,410,922         1,437,447 1,360,861            1,431,698    1,358,789
Net cash inflow from operating
                                        7       130,390          128,067        35,805         126,383        28,920
activities
Cash Flows from Investing
Activities
Cash was provided from:
Proceeds from sale of property,
                                                   4,248              165         2,529            165            2,529
plant and equipment
Decrease/ (Increase) in
                                                        0          (1,757)      (6,951)            (73)            (66)
restricted trust funds
                                                   4,248           (1,592)      (4,422)              92           2,463
Cash was applied to:
Purchase of property, plant and
                                                (45,558)         (33,550)      (23,717)        (33,550)      (23,717)
equipment
Net cash (outflow) from
                                                (41,310)         (35,142)      (28,139)        (33,458)      (21,254)
investing activities
Cash Flows from Financing
Activities
Cash was provided from:
Proceeds from loans raised/
                                                (10,500)         (10,500)      (34,392)        (10,500)      (34,392)
(repaid)
Proceeds from capital
                                                (80,000)              106       34,500             106        34,500
contributed/ (repaid)
Net cash inflow / (outflow)
                                                (90,500)         (10,394)           108        (10,394)            108
from financing activities
Movement in cash and cash
equivalents
Opening cash and cash
                                                 12,332            (3,350)     (11,124)         (3,350)      (11,124)
equivalents
Net cash inflow / (outflow)                      (1,420)           82,531         7,774         82,531            7,774
Closing cash and cash
                                        7        10,912            79,181       (3,350)         79,181        (3,350)
equivalents

                The accompanying notes form an integral part of these financial statements.


                                                                                                      Annual Report 2008   61
                                      Notes To And Forming Part of the
                                      Financial Statements
                                      for the Year Ended 30 June 2008
       Note 1 Significant Accounting Policies
                     Reporting entity
                     The reporting entity is the Auckland District Health Board (ADHB) which was created by the New Zealand
                     Public Health and Disability Act 2000. ADHB is a reporting entity for the purposes of the New Zealand
                     Public Health and Disability Act 2000, the Financial Reporting Act 1993, and the Public Finance Act 1989
                     and the Crown Entities Act 2004.

                     ADHB is a Public Benefit Entity (PBE), as defined under NZ IAS 1.

                     ADHB’s activities range from delivering health and disability services through its public provider arm to
                     shared services for both clinical and non-clinical functions eg laboratories and facilities management, as
                     well as planning health service development, funding and purchasing both public and non-government
                     health services for the district.

                     The consolidated financial statements include ADHB and its subsidiaries and interest in associates and
                     jointly controlled entities.


                     Statement of compliance
                     The consolidated financial statements have been prepared in accordance with Generally Accepted
                     Accounting Practice in New Zealand (NZGAAP). They comply with New Zealand equivalents to
                     International Financial Reporting Standards (NZ IFRS), and other applicable Financial Reporting Standards,
                     as appropriate for Public Benefit Entities (PBE).

                     These are ADHB’s first NZ IFRS financial statements and NZ IFRS 1 has been applied. An explanation of
                     how the transition to NZ IFRS has affected the reported financial position and financial performance of
                     ADHB is provided in note 23.


                     Basis of preparation
                     The financial statements are presented in New Zealand Dollars (NZD), rounded to the nearest thousand.
                     The financial statements are prepared on the historical cost basis except that the following asset and
                     liabilities are stated at their fair value: derivative financial instruments (foreign exchange and interest rate
                     swaps), financial instruments and land and buildings.

                     The accounting policies set out below have been applied consistently to all periods presented in these
                     consolidated financial statements and in preparing an opening NZ IFRS Statement of Financial Position at
                     1 July 2006 for the purposes of transition to NZ IFRS.

                     The preparation of financial statements in conformity with NZ IFRSs requires management to make
                     judgements, estimates and assumptions that affect the application of policies and reported amounts of
                     assets and liabilities, revenue and expenses. The estimates and associated assumptions are based on
                     historical experience and various other factors that are believed to be reasonable under the circumstances,
                     the results of which form the basis of making the judgements about the carrying values of assets and
                     liabilities that are not readily apparent from other sources. Actual results may differ from these estimates.

                     The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting
                     estimates are recognised in the period in which the estimate is revised if the revision affects only that
                     period, or in the period of the revision and future periods if the revision affects both current and future
                     periods.

                     Judgements made by management in the application of NZ IFRSs that have significant effect on the
                     financial statements and estimates with a significant risk of material adjustment in the next year are
                     discussed in note 22.

62   Auckland District Health Board
Note 1 Significant Accounting Policies (continued)
        Basis for consolidation
        Subsidiaries
        Subsidiaries are entities controlled by ADHB. Control exists when ADHB has the power, directly or
        indirectly, to govern the financial and operating policies of an entity so as to obtain benefits from
        its activities. ADHB is the main beneficiary of the Auckland District Health Board Charitable Trust.
        Accordingly, the assets and liabilities of the ADHB Charitable Trust are included in the consolidated
        financial statements of ADHB from the date that control commences until the date that control
        ceases. Consistent accounting policies have been used for both ADHB and the Charitable Trust.

        Subsidiaries are consolidated from the date on which control is obtained by the group and cease
        to be consolidated from the date on which control is transferred out of the group.

        In preparing the consolidated financial statements, all intercompany balances and transactions,
        revenue and expenses and profit and losses resulting from intra -group transactions have been
        eliminated in full.

        Joint Venture
        A joint venture is an entity over whose activities ADHB has joint control, established by contractual
        agreement. The consolidated financial statements include ADHB’s joint interest in the joint venture,
        using the equity method, from the date that joint control commences until the date that joint control
        ceases.

        Treaty Relationship Company Ltd is a joint venture company (50% owned) with Te Runanga O
        Ngati Whatua. Originally created as a vehicle through which to channel joint health related
        activities, it has not undertaken any business for some years. The assessment of the two
        shareholders is that it should now be wound up.

        Associates
        Associates are those entities in which ADHB has the power to exert significant influence, but not
        control, over the financial and operating policies. ADHB holds shareholdings in the following
        associates: Auckland Regional RMO Services Limited (previously The Northern Clinical Training
        Network Limited) (33% owned) and Northern DHB Support Agency Limited (33% owned).

        Associates are accounted for at the original cost of the investment plus ADHB’s share of the
        change in the net assets of associates on an equity accounted basis, from the date that the power
        to exert significant influence commences until the date that the power to exert significant influence
        ceases. When ADHB’s share of losses exceeds its interest in an associate, ADHB’s carrying amount
        is reduced to nil and recognition of further losses is discontinued except to the extent that ADHB
        has incurred legal or constructive obligations or made payments on behalf of an associate. There
        are no differences in accounting policies between the parent and associate entities.

        Auckland Regional RMO Services Limited is a joint venture company with Counties-Manukau
        and Waitemata DHBs, which exists to support and facilitate employment and training for Resident
        Medical Officers across the three Auckland regional DHBs.

        Northern DHB Support Agency Limited with Counties-Manukau and Waitemata DHB exists to
        provide a shared services agency to the three Auckland regional DHB boards in their roles as
        health and disability service funders, in those areas of service provision identified as benefiting from
        a regional solution.




                                                                                              Annual Report 2008   63
       Note 1 Significant Accounting Policies (continued)
                     Transactions eliminated on consolidation
                     All inter-entity transactions are eliminated on consolidation.


                     Foreign Currency
                     Both the functional and presentation currency of ADHB and Group is New Zealand dollars
                     (NZD). Transactions in foreign currencies are translated at the exchange rate ruling at the date
                     of the transaction. Monetary assets and liabilities denominated in foreign currencies at 30 June
                     2008 are translated to NZD at the rate ruling at that date. Foreign exchange differences arising
                     on translation and settlement are recognised in the Statement of Financial Performance. Non-
                     monetary assets and liabilities that are measured in terms of historical cost in a foreign currency
                     are translated using the exchange rate at the date of the transaction. Non-monetary assets and
                     liabilities denominated in foreign currencies that are stated at fair value are translated to NZD at
                     foreign exchange rates ruling at the date the fair value was determined.


                     Budget Figures
                     The budget figures are those approved by the Board in its District Annual Plan and included in
                     the Statement of Intent tabled in Parliament. The budgets have been prepared using the same
                     accounting policies as those used in the preparation of these financial statements.


                     Equity
                     Equity comprises Contributions from the Crown, Accumulated surpluses/deficits and Reserves
                     Crown contributions are recognised at the amount received, accumulated surpluses/deficits in
                     accordance with the financial results using generally accepted accounting principles, and reserves
                     from changes in the value of land and buildings.

                     Property, Plant and Equipment (PPE)
                     The major classes of PPE are as follows:
                     •	     Freehold	Land
                     •	     Freehold	Buildings	and	fitouts
                     •	     Plant,	equipment	and	vehicles
                     •	     Leased	assets
                     •	     Work	In	Progress

                     Owned Assets
                     Except for land and buildings (as well as the assets vested from the hospital and health service –
                     see below), items of PPE are stated at cost, less accumulated depreciation and impairment losses.

                     Land and buildings are revalued to fair value as determined by an independent registered valuer
                     with sufficient regularity to ensure the carrying amount is not materially different to fair value,
                     and at least every 5 years. The latest revaluation was done on 30 June 2008. Any increase in
                     value of a class of land and buildings is recognised directly to equity unless it offsets a previous
                     decrease in value recognised in the Statement of Financial Performance in which case the increase
                     is recognised in the Statement of Financial Performance. Any decreases in value relating to a class
                     of land and buildings are debited directly to the revaluation reserve, to the extent that they reverse
                     previous surpluses and are otherwise recognised as an expense in the Statement of Financial
                     Performance.




64   Auckland District Health Board
Note 1 Significant Accounting Policies (continued)
        Additions to PPE between valuations are recorded at cost.

        Where material parts of an item of PPE have different useful lives, they are accounted for
        separately.

        Property, Plant and Equipment vested from the Hospital and Health Service
        Under section 95(3) of the New Zealand Public Health and Disability Act 2000, the assets of
        Auckland Healthcare Services Limited (a hospital and health service) vested in ADHB on 1 January
        2001. Accordingly, assets were transferred to ADHB at their net book values as recorded in the
        books of the hospital and health service. In effecting this transfer, the Board has recognised the
        cost and accumulated depreciation amounts from the records of the hospital and health service.
        The vested assets will continue to be depreciated over their remaining useful lives.

        Disposal of PPE
        Where an item of PPE is disposed of, the gain or loss recognised in the Statement of Financial
        Performance is calculated as the difference between the net sales price and the carrying amount of
        the asset.

        Leased assets
        Leases where ADHB assumes substantially all the risks and rewards of ownership are classified as
        finance leases. The assets acquired by way of finance lease are stated at an amount equal to the
        lower of their fair value and the present value of the minimum lease payments at the inception of
        the lease, less accumulated depreciation and impairment losses. Minimum lease payments are
        apportioned between the finance charge and the reduction of the outstanding liability. The finance
        charge is allocated to each period during the lease term on an effective interest basis.

        Operating lease payments are recorded as an expense in the Statement of Financial Performance
        on a straight-line basis over the lease term.

        Subsequent costs
        Subsequent costs are added to the carrying amount of an item of PPE when that cost is incurred if it
        is probable that the future economic benefit embodied within the item will flow to ADHB. All other
        costs are recognised in the Statement of Financial Performance as an expense as incurred.

        Depreciation
        Depreciation is charged to the Statement of Financial Performance using the straight line method.
        Land is not depreciated. Depreciation is set at rates that write off the cost or fair value of the assets,
        less their estimated residual values, over their useful lives. The estimated useful lives of major
        classes of assets and resulting rates are as follows:

        Asset Class                                   2007/08                     2006/07

        Freehold Buildings and fitouts                1-89 years                  1-89 years
        Plant, equipment and vehicles                 2-20 years                  2-20 years
        Leased assets                                 4-8 years                   4-8 years

        The residual value, useful life and depreciation method of assets is reassessed annually.

        Work in progress is not depreciated. The total cost of a project is transferred to PPE on its
        completion and then depreciated.




                                                                                                Annual Report 2008   65
       Note 1 Significant Accounting Policies (continued)
                     Intangible Assets
                     Computer software not an integral part of the related hardware is treated as an intangible asset.
                     Such intangible assets are acquired separately and are capitalised at cost less accumulated
                     amortisation and impairment losses.

                     Subsequent expenditure on computer software is capitalised only when it increases the service
                     potential or future economic benefits embodied in the specific asset to which it relates.

                     Amortisation of computer software is charged to the Statement of Financial Performance on a
                     straight line basis over its estimated useful life. The useful life of computer software is calculated
                     over 4 years from the date that the software is available for use. Impairment losses are provided for
                     on a continuing basis as required.


                     Interest-Bearing Loans and Borrowings
                     Interest-bearing capital borrowings are initially recognised at fair value net of transaction costs
                     that are directly attributable to the issue. After initial recognition, capital borrowings are measured
                     at amortised cost using the effective interest method. Amortised cost is calculated by taking into
                     account any issue costs, and any discount or premium on settlement.

                     Crown Health Financing Agency borrowings are recorded at nominal or “face” value.


                     Derivative financial instruments
                     ADHB uses foreign exchange and interest rate swap contracts to manage its exposure to foreign
                     exchange and interest rate risks arising from operational, financing and investment activities. Such
                     derivatives are accounted for as trading instruments, and are stated at fair value.

                     The fair value of forward exchange contracts is their quoted market price at the balance sheet date,
                     being the present value of the quoted forward price. The fair value of interest rate swaps is the
                     estimated amount that ADHB would receive or pay to terminate the swaps at balance date taking
                     into account the current interest rates and the current credit worthiness of the counter-party.


                     Trade and other receivables
                     Trade and other receivables are recognised and carried at original invoice amount less
                     impairment. An impairment is recognised when there is objective evidence of impairment.
                     Impairment is calculated in accordance with the Board’s credit management policy. Bad debts are
                     written off during the period in which they are identified.


                     Inventories
                     All items are valued at the lower of cost, determined on a first-in first-out basis, and net realisable
                     value. Net realisable value is the estimated selling price in the ordinary course of business, less
                     the estimated costs of completion and selling expenses. Standard costs are reviewed at least once
                     a year and revised in the light of current conditions as required. A provision for slow moving or
                     obsolete stock is made.

                     Inventories held for distribution
                     Inventories held for distribution are stated at the lower of cost and current replacement cost.




66   Auckland District Health Board
Note 1 Significant Accounting Policies (continued)
        Cash and cash equivalents
        Cash and cash equivalents comprise cash and call deposits with an original maturity of less than 3
        months. Bank overdrafts that are repayable on demand and form an integral part of ADHB’s cash
        management are included as a component of cash and cash equivalents for the purpose of the
        Statement of Cash Flows.


        Properties held for sale
        Properties held for sale are measured at the lower of carrying amount or fair value less costs to sell.


        Impairment
        The carrying amounts of ADHB’s assets are reviewed at balance date to determine whether there
        is any indication of impairment. If such an indication exists, the assets’ recoverable amounts are
        estimated. If the estimated recoverable amount of an asset is less than its carrying value, the asset
        is written down to its estimated recoverable amount and an impairment loss is recognised in the
        Statement of Financial Performance.

        Calculation of recoverable amount
        The estimated recoverable amount of assets, other than Trade Debtors above, is the greater of their
        fair value less costs to sell and value in use. In assessing value in use, the estimated future cash
        flows are discounted to their present value using a discount rate that reflects market assessments
        of the time value of money and the risks specific to the asset. For non-cash generating assets that
        are not part of a cash generating unit, eg land and buildings, value in use is based on depreciated
        replacement cost.

        An impairment loss on property, plant and equipment revalued on a class of asset basis is
        recognised directly against any revaluation reserve in respect of the same class of asset to the
        extent that the impairment loss does not exceed the amount in the revaluation reserve for the same
        class of asset.

        Reversals of impairment
        Impairment losses are reversed when there is a change in the estimates used to determine the
        recoverable amount.

        An impairment loss on items of PPE carried at revalued amounts is reversed through the relevant
        reserve to the extent that the impairment loss was previously recognised directly against any
        revaluation surplus. All other impairment losses are reversed through the Statement of Financial
        Performance.

        An impairment loss is reversed only to the extent that the asset’s carrying amount does not exceed
        the carrying amount that would have been determined, net of depreciation or amortisation, if no
        impairment loss had been recognised.


        Financial instruments
        Non-derivative financial instruments comprise investments in trade and other receivables, cash and
        cash equivalents, interest bearing loans and borrowings, and trade and other payables.

        A financial instrument is recognised if ADHB becomes a party to the contractual provisions of the
        instrument. Financial assets are de-recognised if ADHB’s contractual rights to the cash flows from
        the financial asset expire or if ADHB transfers the financial asset to another party without retaining



                                                                                              Annual Report 2008   67
       Note 1 Significant Accounting Policies (continued)
                     control or substantially all risks and rewards of the asset. Regular way purchases and sales of
                     financial assets are accounted for at trade date ie, the date that ADHB commits itself to purchase
                     or sell the asset. Financial liabilities are de-recognised if ADHB’s obligations specified in the
                     contract expire or are discharged and cancelled.

                     Restricted trust funds are initially recognised at cost, being the fair value of the consideration given.
                     After initial recognition, these investments are classified at fair value through profit and loss and
                     are measured at fair value.

                     Gains or losses on restricted trust funds are recognised in the Statement of Financial Performance.


                     Employee benefits
                     Defined Contribution Plan (DCP)
                     Obligations for contributions to DCPs are recognised as an expense in the Statement of Financial
                     Performance as incurred. ADHB makes contributions on behalf of staff to the National Provident
                     Fund which are recognised in the Statement of Financial Performance as incurred - see disclosure
                     note 13d.

                     Retiring Gratuities and Long Service Leave
                     ADHB’s net obligation in respect of Retiring Gratuities and Long Service Leave is the amount of
                     future benefit that employees have earned in return for their service in the current and prior periods
                     calculated on an actuarial basis.

                     Annual Leave, Sick Leave, Continuing Medical Education Leave and Expenses
                     Annual Leave is a short-term obligation and is calculated on an actual basis at the amount ADHB
                     expects to pay when staff take leave or resign.

                     Sick leave is a short-term obligation which represents the estimated future cost of sick leave
                     attributable to the entitlement not used at balance date calculated as the amount expected to be
                     paid.

                     Continuing medical education leave and expenses are calculated based on a discounted valuation
                     of the estimated 3 years non-vesting entitlement under the current collective agreement with Senior
                     Medical Officers based on current leave patterns.


                     Provisions
                     A provision is recognised when ADHB has a present obligation (legal or constructive) as a result
                     of a past event, it is probable that an outflow of economic benefits will be required to settle
                     the obligation and a reliable estimate can be made. If the time-value of money is material the
                     obligation is discounted to its present value, at a rate that reflects the current market assessment of
                     the time value of money and the risks specific to the liability.

                     Restructuring
                     A provision for restructuring is recognised when ADHB has approved a detailed and formal
                     restructuring plan, and the restructuring has either commenced or has been announced publicly.
                     Future operating costs are not provided for.




68   Auckland District Health Board
Note 1 Significant Accounting Policies (continued)
        Revenue
        The majority of revenue is provided through an appropriation in association with a Crown Funding
        Agreement. Revenue is received monthly in accordance with the Crown Funding Agreement
        payment schedule, which allocates the appropriation equally throughout the year.

        Revenue from services provided is recognised to the proportion that the transaction is complete,
        when it is probable that the payment associated with the transaction will flow to ADHB and that
        payment can be measured or estimated reliably, and to the extent that any obligations and all
        conditions have been satisfied by ADHB.

        ADHB is required to recognise and expend all monies appropriated within certain contracts, eg the
        mental health ring-fence on mental health services, during the year in which it was appropriated.
        Should this not be done, ADHB may be required to repay the money or, with the agreement of the
        funder, to expend it on health services in subsequent years. Such revenue is included in Payables
        and Accruals in the Statement of Financial Position until the time this obligation is discharged.

        Trust and special fund donations received are treated as revenue on receipt, in the Statement
        of Financial Performance. These funds are administered by the Auckland District Health Board
        Charitable Trust. Trust and special funds from third party trusts are recognised as revenue only
        when actually receipted.

        Interest income is recognised using the effective interest method.


        Expenses
        Payments made under operating leases are recognised in the Statement of Financial Performance
        on a straight-line basis over the term of the lease. Lease incentives received are recognised in
        the Statement of Financial Performance over the lease term as an integral part of the total lease
        expense.

        Leases where ADHB assumes substantially all the risks and rewards of ownership are classified as
        finance leases. Minimum lease payments are apportioned between the finance charge and the
        reduction of the outstanding liability. The finance charge is allocated to each period during the
        lease term on an effective interest basis.


        Income Tax
        ADHB is a Crown Entity under the New Zealand Public Health and Disability Act 2000 and is
        exempt from income tax under section CB3 of the Income Tax Act 1994.


        Goods and Services Tax (GST)
        All amounts are shown exclusive of GST, except for receivables and payables that are stated
        inclusive of GST. Where GST is irrecoverable as an input tax, it is recognised as part of the related
        asset or expense.


        Borrowing Costs
        Borrowing costs are recognised as an expense when incurred.




                                                                                             Annual Report 2008   69
       Note 1 Significant Accounting Policies (continued)
                     New standards adopted and interpretations not yet adopted
                     Certain new standards, amendments and interpretations to existing standards have been published
                     that are not yet effective for the year ended 30 June 2008, and have not been applied in preparing
                     these Consolidated Financial Statements, as follows:

                     •	NZ	IAS	1,	Presentation	of	Financial	Statements	(revised)	–	effective	from	annual	periods	
                       beginning on or after 1 January 2009. Changes in this area are in relation to presentation only
                       and will not have a direct impact on the measurement and recognition of amounts under the
                       current NZ IAS 1. It is proposed to adopt the revisions from the effective date.
                     •	NZ	IAS	23,	Borrowing	costs	(revised)	–	(effective	from	annual	periods	beginning	on	or	after	1	
                       January 2009). This revision proposes inclusion of funding costs in the valuation of land and
                       buildings. ADHB will be guided by any Treasury policy before adopting this standard as well as
                       consideration of the additional funding stream to cover any consequential costs.
                     •	NZ	IAS	27,	Consolidated	and	Separate	Financial	Statements	(amended	2008)	(revised)	
                       –(effective from annual periods beginning on or after 1 July 2009). The impact of this change is
                       not known.
                     •	NZ	IFRS	3,	Business	Combinations	(amended	2008)	–	(effective	from	annual	periods	beginning	
                       on or after 1 July 2009). The impact of this change is not known.
                     •	NZ	IFRIC	14,	NZ	IAS	19	–	The	limit	on	a	Defined	Benefit	Asset,	Minimum	Funding	Requirements	
                       and their interaction – (effective from annual periods beginning 1 January 2008). The impact of
                       this change is not known.

                     Cost of Service (Statement of Service Performance)
                     The Cost of Service Statements, as reported in the Statement of Service Performance, report the net
                     cost of services for the outputs of ADHB and are represented by the cost of providing the output
                     less all of the revenue that can be allocated to these activities.


                     Cost Allocation
                     ADHB has arrived at the net cost of service for each significant activity using the cost allocation
                     system outlined below.

                     Cost Allocation Policy
                     Direct costs are charged directly to output classes. Indirect costs are charged to output classes
                     based on cost drivers and related activity and usage information.

                     Criteria for Direct and Indirect Costs
                     Direct costs are those costs directly attributable to an output class. Indirect costs are those costs
                     that cannot be identified in an economically feasible manner with a specific output class.

                     Cost Drivers for Allocation of Indirect Costs
                     The cost of internal services not directly charged to outputs is held in central overhead pools, for
                     example, the cost of building accommodation. The exceptions to this are ring-fenced services
                     Mental Health and Public Health where an allocation of overheads is made, and some services
                     that sell to third parties, for example LabPlus.


                     Comparatives
                     Where necessary, comparative information has been reclassified to achieve consistency in
                     disclosure with the current year. The most significant item arises from the revaluation of land and
                     buildings.

70   Auckland District Health Board
                                                           Group Actual            Parent Actual
                                                           2008         2007       2008          2007
                                                           $000         $000       $000          $000
Note 2   Revenue
         Patient care revenue                          1,444,412   1,308,103   1,444,412   1,308,103
         Interest received – other                         9,192       3,277       9,192       3,277
         Interest received – Charitable Trust              1,419         784           0           0
         Donations and bequests                            6,373       9,423           0           0
         Gain on disposal of assets                            0       2,138           0       2,138
         Gain on derivatives - financial instruments       2,034       1,333       2,034       1,333
         Other revenue                                    66,848      82,081      66,848      82,081
         Total Revenue                                 1,530,278   1,407,139   1,522,486   1,396,932

Note 3   Expenses
     a   Employee benefit costs
          Wages and salaries                            609,504     568,188     606,405      563,672
          Contributions to defined contribution
                                                          8,588       7,826       8,588         7,826
         plans (i)
          Increase/(decrease) in liability for
                                                         21,924      18,308      21,924       18,308
         employee benefit
         Total employee benefit costs                   640,016     594,322     636,917      589,806

     b   Indirect treatment costs
         Bad debts written off                            3,829       3,230       3,829         3,230
         Increase (decrease) in estimated doubtful
                                                            544       1,065         544         1,065
         debts
         Other indirect treatment costs                  30,095      27,908      26,577       24,672
         Total indirect treatment costs                  34,468      32,203      30,950       28,967

     c   Property, equipment & transportation cost
         Rental and operating lease costs                 6,310       7,252       6,310         7,252
         Other property, equipment &
                                                         43,584      41,480      43,584       41,480
         transportation cost
         Total property, equipment & transportation
                                                         49,894      48,732      49,894       48,732
         cost

     d   Other operating expenses
         Remuneration of auditor
         - audit fees: statutory accounts                   248         218         248           218
         - advisory fees: IFRS accounts                       0          91           0            91
         - other services (assurance and
                                                               0          4            0             4
         consultancy fees)
                                                            248         313         248          313
         Board Members’ fees                                367         314         367          314
         Loss on disposal of assets                         109           0         109            0
         Loss on derivatives                                  0       4,017           0        4,017
         Research costs                                   6,550       6,242       6,550        6,242
         Other expenses                                  13,140       9,961      13,140        9,961
         Total other operating expenses                  20,414      20,847      20,414       20,847



                                                                                      Annual Report 2008   71
                                                                        Group Actual                Parent Actual
                                                                        2008         2007           2008          2007
                                                                        $000         $000           $000          $000

               e      Capital charge (note 15)                        38,405        21,559        38,405        21,559
                      Depreciation and amortisation expenses
                      Depreciation                                    44,380        44,306        44,380        44,306
                      Impairment loss/(gain) – software (note
                                                                          271              0          271                0
                      11b)
                      Total depreciation and amortisation
                                                                      44,651        44,306        44,651        44,306
                      expenses

                f     Finance costs
                      Interest expense                                22,041        19,920        22,041        19,920
                      Foreign currency loss/(gain)                       (23)          (21)          (23)          (21)
                      Total finance costs                             22,018        19,899        22,018        19,899

                      Note
           3a(i)      ADHB makes contributions to the National Provident Fund on behalf of some of its employees
                      and is permitted under NZ IAS 19 (30) to use defined contribution reporting in relation to these
                      (see note 13d).

     Note 4           Taxation
                      ADHB is a Crown Equity under the New Zealand Public Health and Disability Act 2000 and is
                      exempt from income tax under Section CB3 of the Income Tax Act 1994.

     Note 5           Investments in Joint Venture & Associates
                      Results of joint venture & associates
                      Share of post acquisition surplus                    34              4             0               0
                      Share of net surpluses of joint venture &
                                                                           34              4             0               0
                      associates
                      Carrying amount at the beginning of the
                                                                          332           328              1               1
                      year
                      Carrying amount at end of year                      366           332              1               1
                      Represented by:
                      Shares in joint venture & associates
                                                                             1             1             1               1
                      (unlisted at cost)
                      Share of post-acquisition retained
                                                                          365           331              0               0
                      surpluses
                                                                          366           332              1               1




72   Auckland District Health Board
                                                                                      2008          2007
                                                                                  % Interest    % Interest
         Name of joint venture (Principal activity)
                                                                                       held          held
         Treaty Relationship Company Ltd (joint venture for
                                                                                         50             50
         health initiatives with local iwi)
         Name of associates (Principal activity)
         Auckland Regional RMO Services Ltd (co-ordinates
                                                                                         33             33
         trainee medical personnel)
         Northern DHB Support Agency Ltd (management of a
         number of regional contracts on behalf of the Auckland                          33             33
         region DHBs.)

         All the above related parties have balance dates of 30 June.
         ADHB does not have a share in any contingent liabilities or capital commitments of these related
         parties.

                                                         Group Actual                Parent Actual
                                                          As at       As at           As at        As at
                                                      30/06/08   30/06/07         30/06/08    30/06/07
Note 6   Capital and Reserves                             $000        $000            $000         $000
     a   Public equity
         Opening balance                               600,983       635,375       600,983       635,375
         Contributions from /(repayment to) the
                                                            106      (34,392)           106      (34,392)
         Crown
         Balance at end of year                        601,089       600,983       601,089       600,983

     b   Accumulated deficits
         Opening balance                              (481,660)     (463,501)     (481,992)    (463,829)
         Operating surplus/(deficit)                     2,393        (16,990)       2,004       (18,163)
         Transfer to trust/special funds                  (354)         (1,169)          0             0
         Balance at end of year                       (479,621)     (481,660)     (479,988)    (481,992)

     c   Other Reserves
         Revaluation Reserve
         Opening balances                              290,076       290,119       290,076       290,119
         Net Movement                                  126,940           (43)      126,940           (43)
         Balance at end of year                        417,016       290,076       417,016       290,076

     d   Trust/special funds
         Opening balances                                10,293         9,124             0              0
         Transfer from accumulated deficits (Note
                                                            354         1,169             0              0
         6a)
         Balance at end of year                          10,647       10,293              0              0




                                                                                          Annual Report 2008   73
                      Other reserves
                      Revaluation reserve
                      The revaluation reserve relates to the independent valuation by Telfer Young (Auckland Ltd) of
                      land and buildings at 30 June 2008 of $852m - see note 11.

                      Trust / special funds
                      Trust/special funds are funds donated or bequeathed for a specific purpose. The use of these
                      assets must comply with the specific terms of the sources from which the funds were derived.
                      The revenue and expenditure in respect of these funds is included in the statement of financial
                      performance. An amount equal to the expenditure is transferred from the Trust fund component of
                      equity to retained earnings. An amount equal to the revenue is transferred from retained earnings
                      to Trust funds.

                      All trust funds are held in bank accounts that are separate from ADHB’s normal banking facilities.

                      Trust / special funds                                                         2008           2007
                                                                                                   Actual         Actual
                                                                                                    $000           $000
                      Balance at beginning of year                                                10,293          9,124
                      Transfer from retained earnings in respect of:
                      Interest received                                                             1,420           847
                      Donations and funds received                                                  6,371         9,423
                      Transfer to retained earnings in respect of:
                      Funds spent                                                                 (7,437)       (9,101)
                      Balance at end of year                                                      10,647        10,293

                                                                          Group Actual             Parent Actual
                                                                           As at       As at        As at        As at
                                                                       30/06/08   30/06/07      30/06/08    30/06/07
     Note 7           Cash And Cash Equivalents                            $000        $000         $000         $000
                      Current assets
                      Bank balance                                          831       1,450          831         1,450
                      Short term deposits                                80,000           0       80,000             0
                      Cash & cash equivalents                            80,831       1,450       80,831         1,450
                      Bank overdrafts                                    (1,650)     (4,800)      (1,650)       (4,800)
                      Cash & cash equivalents in the statement
                                                                         79,181      (3,350)      79,181        (3,350)
                      of cash flows

                      Banking facility limit
                      Revolving cash facility:
                      CBA                                                65,000      65,000       65,000        65,000




74   Auckland District Health Board
Working capital facility
ADHB has a working capital facility supplied by Commonwealth Bank of Australia, New Zealand
(CBA), which was established in February 2004. The facility consists of a bank overdraft and
revolving bank multi-option credit facility. The facility was used at 30 June 2008.

The CBA working capital facility is secured by a negative pledge. ADHB cannot perform the
following actions:
	 •	 create	any	security	over	its	assets	except	in	certain	circumstances,
	 •	 lend	money	to	another	person	or	entity	(except	in	the	ordinary	course	of	business	and	then		
       only on commercial terms) or give a guarantee,
	 •	 make	a	substantial	change	in	the	nature	or	scope	of	its	business	as	presently	conducted	or		
       undertake any business or activity unrelated to health, and
	 •	 dispose	of	any	of	its	assets	except	disposals	at	full	value	in	the	ordinary	course	of	business.

ADHB must also meet a cash flow cover covenant, under which the annual cash flow must be
greater than zero. At all times since the facility was established the covenant has been met. The
CBA facility has a limit of $65m.

Reconciliation of Reported Operating Surplus/(Deficit) After Taxation
With Net Cash Inflow (Outflow) From Operating Activities
                                      Notes        Group Actual               Parent Actual
                                                    As at       As at          As at        As at
                                                30/06/08   30/06/07        30/06/08    30/06/07
                                                    $000        $000           $000         $000
Reported net surplus/(deficit)
                                                   2,393      (16,990)         2,004      (18,163)
for the year                                6
Add non-cash items:
Depreciation and impairment loss                  44,651       44,306        44,651         44,306
Joint venture & associates                  5        (34)          (4)            0              0
(Increase)/Decrease in derivative financial
                                                  (2,128)        6,279       (2,128)         6,279
instruments
Add items classified as investing activities:
Net loss/(gain) on disposal of fixed assets          108       (2,138)           108        (2,138)
Add movements in working capital items:
(Increase)/Decrease in receivables                42,433      (13,321)       42,494       (12,069)
(Increase)/Decrease in inventories                  (356)       (1,179)        (356)        (1,179)
Increase/(Decrease) in payables                   40,927       18,786        39,537        11,818
Increase/(Decrease) in funds held in trust            73            66           73             66
Net cash inflow/(outflow) from operating
                                                 128,067       35,805       126,383         28,920
activities




                                                                                   Annual Report 2008   75
                                                                      Group Actual              Parent Actual
                                                                       As at       As at         As at        As at
                                                                   30/06/08   30/06/07       30/06/08    30/06/07
     Note 8a          Trust/Special Funds
                      Current assets
                      Bank balances (restricted)                        251          104              0              0
                      Short term deposits (restricted)               12,654        9,967              0              0
                                                                     12,905       10,071              0              0
                      Non – current assets
                      Long term deposits (restricted)                 4,850        6,000              0               0
                                                                     17,755       16,071              0               0

                      The above assets are Trust funds and are held by the ADHB Charitable Trust, comprising donated
                      and research funds.

     Note 8b          Patient and Restricted Trust Funds
                      Current assets
                      Patient trust                                       8            11            8               11
                      Restricted fund deposit                           975           899          975              899
                                                                        983           910          983              910
                      Current liabilities
                      Patient trust                                       8            11            8               11
                      Restricted fund deposit                           975           899          975              899
                                                                        983           910          983              910


                      Patient trust
                      ADHB administers certain funds on behalf of patients. These funds are held in separate bank
                      accounts and interest earned is allocated to the individual patients.

                      Restricted fund deposit
                      This interest earning fund was from sale proceeds on an endowment property, to be used in
                      conjunction with ADHB Treaty partner, Ngati Whatua.


      Note 9          Trade And Other Receivables
                      Trade receivables due from non-related
                                                                     12,058       14,808        11,406       13,774
                      parties
                      Trade receivables due from Ministry of
                                                                     45,708       85,585        45,708       85,585
                      Health
                      Trade receivables due from related parties
                                                                        219            26          219              26
                      (note 17)
                      Provision for doubtful debts                   (8,465)      (9,972)       (8,465)      (9,972)
                                                                     49,520       90,447        48,868       89,413
                      Accrued income Ministry of Health              15,609       16,030        15,609       16,030
                      Accrued income                                 10,920       16,682        10,014       16,171
                      Prepayments                                     2,503        2,539         2,503        2,539
                                                                     78,552      125,698        76,994      124,153




76   Auckland District Health Board
                                                            Group Actual                Parent Actual
                                                             As at       As at           As at        As at
                                                         30/06/08   30/06/07         30/06/08    30/06/07
 Note 10   Inventories
           Pharmaceuticals                                     759          696            759           696
           Surgical and medical supplies                     9,972        9,672          9,972         9,672
           Other supplies                                       32           39             32            39
                                                            10,763       10,407         10,763        10,407

           The amount of inventories recognised as an expense during the year ended 30 June 2008 was
           $79,533k (2007 $62,768k).

           The carrying amount of inventories held for distribution carried at current replacement cost at
           30 June 2008 was $10,763k (2007 $10,407k). Write-down/ (up) of inventories amounted to
           ($602k) for 2008 (2007 $92k).

Note 11a   Property, Plant And Equipment
                                              Freehold
                                              buildings
                                   Freehold    & fitouts      Plant,
                                    land (at         (at equipment        Leased        Work in
            Group and Parent      valuation) valuation) and vehicles       assets      progress          Total
                                     $000       $000          $000         $000           $000          $000
           Cost
           Balance at 1 July
                                  198,706 568,292         214,852          4,012         2,504      988,366
           2006
           Additions                       0    4,906       14,804              0        2,026        21,736
           Disposals                       0     (315)      (7,186)             0            0        (7,501)
           Revaluations                    0       43            0              0            0            43
           Balance at 30 June
                                  198,706 572,926         222,470          4,012         4,530    1,002,644
           2007

           Balance at 1 July
                                  198,706 572,926         222,470          4,012         4,530    1,002,644
           2007
           Additions                       0    6,370       22,966           594          (747)       29,183
           Disposals                       0        0       (8,202)         (143)            0        (8,345)
           Transfer to current
                                           0      (22)           (0)            0             0          (22)
           assets held for sale
           Revaluations            47,108      26,970             0             0             0       74,078
           Balance at 30 June
                                  245,814 606,244         237,234          4,463         3,783    1,097,538
           2008




                                                                                             Annual Report 2008   77
     Note 11a           Property, Plant And Equipment (continued)
                                                          Freehold
                                                          buildings
                                               Freehold    & fitouts      Plant,
                        GROUP AND               land (at         (at equipment          Leased        Work in
                        PARENT                valuation) valuation) and vehicles         assets      progress          Total
                                                $000       $000            $000          $000           $000          $000
                        Depreciation and impairment losses
                        Balance at 1 July
                                                    0 (18,383)        (135,566)        (2,638)              0    (156,587)
                        2006
                        Depreciation charge
                                                    0 (16,792)          (21,615)          (312)             0      (38,719)
                        for the year
                        Disposals                   0       116            7,013              0             0        7,129
                        Revaluations                0         0                0              0             0            0
                        Balance at 30 June
                                                    0 (35,059)        (150,168)        (2,950)              0    (188,177)
                        2007

                        Depreciation and impairment losses
                        Balance at 1 July
                                                    0 (35,059)        (150,168)        (2,950)              0    (188,177)
                        2007
                        Depreciation charge
                                                    0 (17,760)          (22,541)          (274)             0      (40,575)
                        for the year
                        Disposals                   0       0              7,841           143              0        7,984
                        Revaluations                0 52,819                   0             0              0       52,819
                        Balance at 30 June
                                                    0       0         (164,868)         (3,081)             0    (167,949)
                        2008

                        Carrying Amounts
                        At 1 July 2006        198,706 549,909            79,286          1,374         2,504      831,779
                        At 30 June 2007       198,706 537,867            72,302          1,062         4,530      814,467

                        Carrying Amounts
                        At 1 July 2007        198,706 537,867            72,302          1,062         4,530      814,467
                        At 30 June 2008       245,814 606,244            72,366          1,382         3,783      929,589

                        Valuation Information
                        Land, buildings and associated fitouts and services were independently valued on 30 June 2008
                        by Telfer Young (Auckland) Ltd (a firm registered with Valuers of New Zealand), at $852m (2007
                        $824m). This valuation includes land subject to restrictive covenants that previously the Board
                        had not included.

                        Surplus land prior to disposal, is subject to due process with regard to the New Zealand Public
                        Health and Disabilities Act 2000, including Ministerial approval, Public Works Act 1981, S.40,
                        the mechanism for protection of Maori interests in Crown owned land, and any other interests
                        registered on the title or under any other applicable legislation (e.g. Reserves Act 1977). It is
                        held as property held for sale.




78     Auckland District Health Board
           GROUP AND PARENT
Note 11b   Intangible Assets
           Group and Parent                                                                              Total
           Software & development costs                                                                 $000
           Cost
           Balance at 1 July 2006                                                                    50,571
           Additions                                                                                  1,981
           Disposals                                                                                   (276)
           Balance at 30 June 2007                                                                   52,276

           Balance at 1 July 2007                                                                    52,276
           Additions                                                                                  4,502
           Disposals                                                                                      0
           Balance at 30 June 2008                                                                   56,778

           Amortisation & Impairment Losses
           Balance at 1 July 2006                                                                   (38,196)
           Amortisation charge for the year                                                           (5,587)
           Impairment losses                                                                               0
           Reversal of impairment losses                                                                   0
           Disposals                                                                                     276
           Balance at 30 June 2007                                                                  (43,507)

           Amortisation & Impairment Losses
           Balance at 1 July 2007                                                                   (43,507)
           Amortisation charge for the year                                                           (3,805)
           Impairment losses                                                                            (271)
           Reversal of impairment losses                                                                   0
           Disposals                                                                                       0
           Balance at 30 June 2008                                                                  (47,583)

           Carrying Amounts
           At 1 July 2006                                                                            12,375
           At 30 June 2007                                                                            8,769

           At 1 July 2007                                                                              8,769
           At 30 June 2008                                                                             9,195

           Impairment Loss
           An impairment loss of $271k (2007 Nil) was recognised as an expense in the Statement of
           Financial Performance.

Note 11c   Property Held For Sale
           This property is the net book value of land, freehold buildings & fitouts on Greenlane Road that
           the Board had budgeted to sell during the 2006 financial year. Due to the improved financial
           performance from its operations the Board did not sell the land during the period and are
           reviewing strategies in the next 12 months.




                                                                                             Annual Report 2008   79
      Note 12           Contingent Assets
                        ADHB benefits from grants from the Greenlane Research and Educational Fund Trust (GREFT).
                        This fund was set up for the purpose of administering funds to further the services in the
                        cardiothoracic surgical and cardiology units at Greenlane Hospital. The assets of the fund have
                        not been consolidated in the financial statements because ADHB does not exercise control over
                        the GREFT in terms of NZ IAS 27 “Consolidated and separate financial statements”. Furthermore
                        ADHB is unable to control the timing and amount of any distribution of funds, consequently it is
                        not possible to estimate the future economic benefit to ADHB.

                                                                                       ,
                        ADHB has commenced proceedings against an Auckland GP claiming overpayments assessed
                        at $1.4m have been made. These civil proceedings can not be set down for a hearing until
                        after the related criminal case, probably late 2009. Under NZ IAS 37 paragraph 31-35, there
                        is a requirement for virtual certainty of the economic inflow for an asset to be recognised. As
                        there has been no judicial consideration of either the quantum or the legal substance of ADHB’s
                        claims, that is not the case with these proceedings.

                                                                        Group Actual               Parent Actual
                                                                         As at       As at          As at        As at
                                                                     30/06/08   30/06/07        30/06/08    30/06/07
                                                                         $000        $000           $000         $000
     Note 13a           Trade And Other Payables
                        Current
                        Trade payables to non related parties          31,403        23,875        30,792        23,528
                        Trade payables due to related parties
                                                                           474           164          474           164
                        (note 17)
                        ACC levy payable                                3,974         2,956         3,974        2,956
                        Income in advance                              23,826        22,775        17,814       17,078
                        ACC Partnership programme liability             1,268         1,489         1,268        1,489
                        Capital charge due to Crown                    19,984        13,080        19,984       12,954
                        GST,PAYE & FBT payable                         18,770         2,111        18,949        2,111
                        Other payables and accruals                    43,073        61,791        40,853       60,639
                                                                      142,772       128,241       134,108      120,919

     Note 13b           Employee Benefits
                        Current
                        Liability for long service leave                2,035           327         2,035           327
                        Liability for sabbatical leave                    500           500           500           500
                        Liability for retirement gratuities             2,938         2,526         2,938         2,526
                        Liability for annual leave                     58,108        54,834        58,108        54,834
                        Liability for sick leave                          450         1,019           450         1,019
                        Liability for continuing medical leave and
                                                                       15,158          7,395       15,158         7,395
                        expenses
                        Salaries and wage accrual                      36,959        27,748        36,959        27,748
                                                                      116,148        94,349       116,148        94,349

                        Non Current
                        Liability for long service leave                  834         1,414           834         1,414
                        Liability for retirement gratuities            20,229        19,524        20,229        19,524
                                                                       21,063        20,938        21,063        20,938


80     Auckland District Health Board
                                                              Group Actual                 Parent Actual
                                                               As at       As at            As at        As at
                                                           30/06/08   30/06/07          30/06/08    30/06/07
Note 13c   Provisions                                          $000        $000             $000         $000
           Litigation Provision
           Opening balance                                       150             0            150              0
           Additional provisions made during year                  3           150              3            150
           Charged against provision for the year                  0             0              0              0
           Unused amounts reversed during year                  (150)            0           (150)             0
           Closing balance                                         3           150              3            150

           Restructuring Provision
           Opening balance                                       200           388            200            388
           Additional provisions made/(released)
                                                                  96              0             96                0
           during year
           Charged against provision for the year               (200)         (188)          (200)          (188)
           Unused amounts reversed during year                     0             0              0              0
           Closing balance                                        96           200             96            200
           Total provisions                                       99           350             99            350

           Notes
           Litigation
           The provision relates to unpaid legal fees at year-end.

           Restructuring
           The provision relates to expected costs arising from specific service reviews in progress at year-
           end. It is anticipated that all expenditure will be incurred in the next financial year.

           During the year ended 30 June 2008, a provision of $95k ($123k total less $27k paid out
           during June) was made to cover the costs of redundancy payments necessitated by exiting the
           cochlear implant service at 30 June 2008. The costs are based on provisions in the employees’
           employment agreements.

Note 13d   Defined Contribution Plan (DCP)
           The DCP (with National Provident Fund) is a multi-employer defined benefit scheme. At 30 June
           2008 ADHB contributions to the fund were fully paid - see Note 3a for details.

           The DCP is a multi-employer defined benefit scheme. Insufficient information is available to use
           defined benefit accounting as it is not possible to determine, from the terms of the scheme, the
           extent to which any surplus or deficit will affect future contributions by employers, as there is no
           prescribed basis for allocation. If any of the other participating employers ceased to participate
           in the scheme, ADHB could be responsible for financing a share of any shortfall in the fund in
           meeting its obligations.

           As at 31 March 2007, the scheme had a past service surplus of $33.7m (11.4% of the liabilities).
           This amount is exclusive of Specified Superannuation Contribution Withholding Tax (SSCWT).
           This surplus was calculated using a discount rate equal to the expected return on the assets, but
           otherwise the assumptions and methodology were consistent with the requirements of NZ IAS 19.

           The Actuary to the scheme has recommended the employer contribution reduces from 2.0 times
           contributors’ contributions to 1.0 times contributions. The 1.0 is inclusive of SSCWT.

                                                                                                 Annual Report 2008   81
     Note 14          Interest-Bearing Loans and Borrowings
                                                                      Group Actual            Parent Actual
                                                                       As at       As at       As at        As at
                                                                   30/06/08   30/06/07     30/06/08    30/06/07
                                                                       $000        $000        $000         $000
                      Current
                      Secured loans
                      Crown Health Financing Agency                  10,500      10,500      10,500       10,500
                      Interest on Borrowings                          5,084       5,291       5,084        5,291
                                                                     15,584      15,791      15,584       15,791

                      Non Current
                      Secured loans
                      Crown Health Financing Agency                 163,500     174,000     163,500     174,000
                      15 year Capital Bonds, maturing 15
                                                                     50,000      50,000      50,000       50,000
                      September 2015
                      10 year Capital Bonds, maturing 15
                                                                     70,000      70,000      70,000       70,000
                      September 2010
                      Unexpired set up cost on borrowings            (1,070)     (1,291)     (1,070)     (1,291)
                                                                    282,430     292,709     282,430     292,709

                      Secured loans
                      The details of terms and conditions are as
                      follows:
                      Borrowings are repayable:
                      Less than one year                             15,584      15,791      15,584      15,791
                      One to two years                               13,500      10,500      13,500      10,500
                      Two to five years                             148,930     103,500     148,930     103,500
                      Over five years                               120,000     178,709     120,000     178,709
                                                                    298,014     308,500     298,014     308,500

                      Interest rate summary                          % pa        % pa        % pa        % pa
                                                                   6.095 to    6.095 to    6.095 to    6.095 to
                      Crown Health Financing Agency
                                                                     7.03        7.30        7.03        7.30
                      Capital Bonds                                  7.75        7.75        7.75        7.75

                      Borrowing facilities
                      Crown Health Financing Agency                 174,000     184,500     174,000     184,500
                      Capital Bonds                                 120,000     120,000     120,000     120,000
                      Working capital CBA                            65,000      65,000      65,000      65,000




82   Auckland District Health Board
Crown Health Financing Agency
The loan facility is provided by the Crown Health Financing Agency, which is part of the Ministry
of Health.

Capital bonds
In September 2000, ADHB issued $120m of “credit-wrapped” bonds to the private sector. The
subscribers to this issue were institutional investors. The bonds were issued with a coupon rate of
7.75%.

Working capital facility
ADHB has a working capital facility supplied by Commonwealth Bank of Australia, New Zealand
(CBA), which was established in February 2004. The facility consists of a bank overdraft and
revolving bank multi-option credit facility.

Security and terms
ADHB borrows funds based on covenants in a Negative Pledge Deed. This includes the covenant
that security cannot be given over assets of ADHB without prior written consent of the Crown.
Financial assets are part of Total Tangible Assets defined in the Negative Pledge Deed that
secures funding from the three borrowing facilities.

ADHB cannot perform the following actions:
 •	 create	any	security	over	its	assets	except	in	certain	circumstances,
 •	 lend	money	to	another	person	or	entity	(except	in	the	ordinary	course	of	business	and	then	
    only on commercial terms), or give a guarantee,
 •	 make	a	substantial	change	in	the	nature	or	scope	of	its	business	as	presently	conducted	or	
    undertake any business or activity unrelated to health; and
 •	 dispose	of	any	of	its	assets	except	disposals	at	full	value	in	the	ordinary	course	of	business.

ADHB must also meet the following covenants:
 •	 debt	to	debt	plus	equity:	interest	bearing	debt	is	less	than	65	per	cent	of	the	total	of	interest	
    bearing debt plus equity.
 •	 a	cash	flow	cover	covenant,	under	which	the	annual	cash	flow	must	be	greater	than	zero.

The covenants have been complied with at all times since the facility was established. The
Government of New Zealand does not guarantee term loans.




                                                                                      Annual Report 2008   83
                                                                         Group Actual                  Parent Actual
                                                                           As at         As at          As at        As at
                                                                      30/06/08     30/06/07        30/06/08     30/06/07
                                                                          $000          $000           $000          $000
     Note 15          Capital Charge                                    38,405        21,559         38,405        21,559
                      All DHBs are required to pay a capital charge to the Crown based on their shareholder funds.
                      The charge is set at 8 percent for fiscal year 2008 (8 percent for fiscal year 2007) on shareholder
                      funds based on the monthly closing balance. ADHB has not paid a capital charge on donations
                      received into the ADHB Charitable Trust. The increase in the capital charge for 2008 is related to
                      the revaluation of land and buildings.

     Note 16          Commitments
                      a Capital commitments
                      Approved and contracted                          10,595          9,940        10,595         9,940
                      Approved and to be contracted                    10,457         12,304        10,457        12,304
                                                                       21,052         22,244        21,052        22,244
                      Term classification of commitments
                      Less than one year                               21,052         22,244        21,052        22,244
                      One to two years                                      0              0             0             0
                      Two to five years                                     0              0             0             0
                      Over five years                                       0              0             0             0
                                                                       21,052         22,244        21,052        22,244
                      b Operating lease commitments
                      Term classification of commitments
                      Less than one year                               62,294        80,234         62,294        80,234
                      One to two years                                  6,647        35,854          6,647        35,854
                      Two to five years                                 2,923         3,677          2,923         3,677
                      Over five years                                     558           118            558           118
                                                                       72,422       119,883         72,422       119,883

     Note 17          Transactions With Related Parties
               a      Subsidiary
                      ADHB owns 100% shareholding in Auckland District Health Board Charitable Trust. The ADHB
                      Charitable Trust has a balance date of 30 June and was incorporated under the Charitable Trusts
                      Act 1957. Details of transactions with the ADHB Charitable Trust are disclosed in note 6 under
                      Trust/special funds.
                                                                                                    2008          2007
                      PARENT
                                                                                                   Actual        Actual
                                                                                                    $000          $000
                      Sales to ADHB Charitable Trust                                               6,128         2,131
                      Purchases from ADHB Charitable Trust                                            286            87
                      Outstanding balance receivable from ADHB Charitable Trust                       546          486
                      Outstanding balance payable to ADHB Charitable Trust                               0            0

               b      Joint Venture and Associates
                      ADHB has a related party relationship with its joint venture & associates and with its executive
                      officers.
                      Joint venture and associates identified in note 5 are related parties. The transactions with related
                      parties during the year were as follows:


84   Auckland District Health Board
Note 17   Transactions With Related Parties (continued)
                                               Note        Group Actual                Parent Actual
                                                            As at       As at           As at        As at
                                                        30/06/08   30/06/07         30/06/08    30/06/07
          GROUP AND PARENT                                  $000        $000            $000         $000
          Sales to related parties
          Treaty Relationship Company Ltd (joint
                                                                 0             0             0               0
          venture)
          Auckland Regional RMO
                                                              229           142           229              142
          Services Ltd (associate)
          Northern DHB Support Agency
                                                              470         1,421           470          1,421
          Ltd (associate)
                                                              699         1,563           699          1,563
          Purchases from related parties
          Treaty Relationship Company Ltd (joint
                                                                 0             0             0               0
          venture)
          Auckland Regional RMO
                                                            4,011         3,711         4,011          3,711
          Services Ltd (associate)
          Northern DHB Support Agency
                                                            2,071         3,152         2,071          3,152
          Ltd (associate)
                                                          6,082           6,863         6,082          6,863
          Outstanding balances receivable from related parties
          Treaty Relationship Company Ltd (joint
                                                                0              0             0               0
          venture)
          Auckland Regional RMO
                                                               10             22            10              22
          Services Ltd (associate)
          Northern DHB Support Agency
                                                             209               4          209                4
          Ltd (associate)
                                                  9          219              26          219               26
          Outstanding balances payable from related parties
          Treaty Relationship Company Ltd (joint
                                                                0              0             0               0
          venture)
          Auckland Regional RMO
                                                                0              0             0               0
          Services Ltd (associate)
          Northern DHB Support Agency
                                                             474            164           474              164
          Ltd (associate)
                                                13a          474            164           474              164

          These transactions were made on commercial terms and conditions, and at market rates. No
          related party debts have been written off or forgiven during the year. No trading transactions
          were made with Treaty Relationship Company Ltd during 2008 and 2007

      c   Compensations
                                                                                        2008           2007
          The key management personnel compensations are as follows:
                                                                                        Actual         Actual
          GROUP AND PARENT                                                               $000           $000
          Short - term employee benefits                                                  378            218
          Long - term employee benefits                                                    44             97
                                                                                          422            315




                                                                                             Annual Report 2008   85
     Note 18          Financial Instruments
                      Credit Risk
                      Financial instruments, which potentially subject the health board to concentrations of risk, consist
                      principally of cash, short-term deposits and accounts receivable.
                      The Board places its cash and short-term deposits with high-quality financial institutions and has
                      a policy that limits the amount of credit exposure to any one financial institution.
                      Concentrations of credit risk from accounts receivable are limited due to the large number and
                      variety of customers. The Ministry of Health is the largest single debtor (approximately 78 per
                      cent). It is assessed to be a low risk and high-quality entity due to its nature as the Government
                      funded purchaser of health and disability support services.
                      The status of trade receivables at the reporting date is as follows:
                                                                           Gross                          Gross
                                                                      Receivable Impairment Receivable Impairment
                                                                            2008           2008            2007        2007
                      GROUP                                                 $000           $000            $000        $000
                      Trade receivables
                      Not past due                                       51,617         (4,316)         51,358      (8,267)
                      Past due 0-30 days                                   2,333        (1,815)          3,342         (176)
                      Past due 31-120 days                                 2,560           (394)         1,880         (214)
                      Past due 121-360 days                                1,245           (472)         1,890         (232)
                      Past due more than 1 year                              230        (1,468)         41,949      (1,083)
                      Total                                              57,985         (8,465)       100,419       (9,972)
                      PARENT
                      Trade receivables
                      Not past due                                       51,083         (4,316)         50,327      (8,267)
                      Past due 0-30 days                                   2,215        (1,815)          3,335         (176)
                      Past due 31-120 days                                 2,560           (394)         1,884         (214)
                      Past due 121-360 days                                1,245           (472)         1,890         (232)
                      Past due more than 1 year                              230        (1,468)         41,949      (1,083)
                      Total                                              57,333         (8,465)         99,385      (9,972)
                      In summary, trade receivables are determined to be impaired as follows:
                      Trade receivables
                      Gross trade receivables                            57,985        100,419          57,333      99,385
                      Individual impairment                              (4,743)        (1,767)         (4,743)     (1,767)
                      Collective impairment                              (3,722)        (8,205)         (3,722)     (8,205)
                      Net total trade receivables                        49,520         90,447          48,868      89,413
                      Movement in the provision for impairment loss
                                                                          Group           Group           Parent      Parent
                                                                           2008            2007            2008        2007
                                                                          Actual          Actual         Actual      Actual
                                                                            $000           $000            $000        $000
                      Opening balance                                      9,972          2,702          9,972       2,702
                      Increase/(decrease) in doubtful debts
                                                                             544          1,065             544      1,065
                      (note 3)
                      (Increase)/decrease in patient care
                                                                         (2,051)          6,205         (2,051)      6,205
                      revenue (note 2)
                      Closing balance                                      8,465          9,972          8,465       9,972
                      At the balance date there were no significant other concentrations of credit risk. The maximum
                      exposure to credit risk is represented by the carrying amount of each financial asset, including
                      derivative financial instruments, in the Statement of Financial Position.


86   Auckland District Health Board
Note 18 Financial Instruments (continued)
Liquidity
Liquidity risk represents ADHB’s ability to meet its contractual obligations. ADHB evaluates its liquidity requirements on
an ongoing basis. In general, ADHB generates sufficient cash flows from its operating activities to meet its obligations
arising from its financial liabilities and has credit lines in place to cover potential shortfalls.
Liquidity risk
The following table sets out the contractual cash flows for all financial liabilities and for derivatives that are settled on a
gross cash flow basis.

GROUP
2008                          Balance  Contractual 6 Months or              6-12        1-2 Years       2-5 YearsMore than
                               Sheet   Cash Flow       less                Months                                 5 years
                               $000      $000         $000                 $000           $000           $000      $000
Interest-bearing loans         298,014   393,200        10,253               20,695        33,222        190,745   138,285
and borrowings
Trade and other payables        142,772       142,772        142,772              0             0              0              0
Bank overdraft                    1,650         1,650          1,650              0             0              0              0
Total                           442,436       537,622        154,675         20,695        33,222        190,745        138,285
Forward exchange
contracts
Inflow                                94             0              0               0             0              0                0
Outflow                                0         3,023          3,023               0             0              0                0

2007                           Balance  Contractual 6 Months or             6-12        1-2 Years       2-5 YearsMore than
                                Sheet   Cash Flow       less               Months                                 5 years
                                $000      $000         $000                $000           $000           $000      $000
Interest-bearing loans          308,500   424,935        10,621              21,115        30,948        152,008   210,243
and borrowings
Trade and other payables        128,241       128,241        128,241              0             0              0              0
Bank overdraft                    4,800         4,800          4,800              0             0              0              0
Total                           441,541       557,976        143,662         21,115        30,948        152,008        210,243
Forward exchange
contracts
Outflow                                0             0              0               0               0               0             0
Inflow                               423         3,764          3,497               0               0               0             0
PARENT
2008                           Balance  Contractual 6 Months or             6-12        1-2 Years       2-5 YearsMore than
                                Sheet   Cash Flow       less               Months                                 5 years
                                $000      $000         $000                $000           $000           $000      $000
Interest-bearing loans          298,014   393,200        10,253              20,695        33,222        190,745   138,285
and borrowings
Trade and other payables        134,108       134,108        134,108              0              0             0              0
Bank overdraft                    1,650         1,650          1,650              0              0             0              0
Total                           433,772       528,958        146,011         20,695         33,222       190,745        138,285
Forward exchange
contracts
Inflow                                94             0              0               0               0               0             0
Outflow                                0         3,023          3,023               0               0               0             0

2007                           Balance  Contractual 6 Months or             6-12        1-2 Years       2-5 YearsMore than
                                Sheet   Cash Flow       less               Months                                 5 years
                                $000      $000         $000                $000           $000           $000      $000
Interest-bearing loans          308,500   424,935        10,621              21,115        30,948        152,008   210,243
and borrowings
Trade and other payables        120,919       120,919        120,919              0              0             0              0
Bank overdraft                    4,800         4,800          4,800              0              0             0              0
Total                           434,219       550,654        136,340         21,115         30,948       152,008        210,243
Forward exchange
contracts
Outflow                                0             0              0               0            0                  0             0
Inflow                               423         3,764          3,497               0          267                  0             0

                                                                                                           Annual Report 2008         87
     Note 18          Financial Instruments (continued)
                      Interest Rate Risk and Currency Risk
                      Exposure to interest rate and currency risks arise in the normal course of ADHB’s operations.
                      Derivative financial instruments are used to manage exposure to fluctuations in foreign exchange
                      rates and interest rates.

                      The Audit Committee, composed of Board members, provides oversight for risk management and
                      derivative activities. This committee determines the ADHB’s financial risk policies and objectives,
                      and provides guidelines for derivative instrument utilisation. This committee also establishes
                      procedures for control and valuation, risk analysis, counterparty credit approval, and ongoing
                      monitoring and reporting.

                      Interest Rate Risk
                      Interest rate risk is the risk that the fair value of a financial instrument will fluctuate, or the cash
                      flows from a financial instrument will fluctuate, due to changes in market interest rates.

                      ADHB adopts a policy of ensuring that between 40 and 60 per cent of its exposure to changes
                      in interest rates on borrowings is on a fixed rate basis. Interest rate swaps, denominated in NZD,
                      have been entered into to achieve an appropriate mix of fixed and floating rate exposure within
                      ADHB’s policy. The swaps mature over the next six years following the maturity of the related
                      loans (see the following table) and have fixed swap rates ranging from 6.02 per cent to 7.75 per
                      cent. At 30 June 2008, ADHB had interest rate swaps with a notional contract amount of $100m
                      (2007 $100m).

                      The net fair value of swaps at 30 June 2008 was $1,632k (2007 $20k) comprising of assets
                      only. These amounts were recognised as fair value derivatives.

                      Foreign currency risk
                      Foreign exchange risk is the risk that the fair value of future cash flows of a financial instrument
                      will fluctuate because of changes in foreign exchange rates.

                      ADHB’s policy is to identify, define, recognise and record foreign exchange risks by their
                      respective types and then to manage each risk under predetermined and separately defined risk
                      control limits.

                      The Group had entered into a foreign exchange contract at balance date covering $US
                      2,365,586 at a cost of $NZ 3,023,337 (2007: $US 2,349,711 at a cost of NZ$ 3,498,057).
                      The contract was for purchase of a linear accelerator which required the payment of US dollars
                      to settle.




88   Auckland District Health Board
                     GROUP                                Note   Held for   Designated      Loans and    Available for Financial      Carrying     Fair Value
                     2008                                        Trading    at Fair Value   Receivable       Sale      Liabilities at Amount
                                                                               through                                  Amortised 2008 Actual
                                                                            Profit & Loss                                  Cost




                                                                                                                                                                                                                                                                             Note 18
                                                                  $000          $000          $000          $000          $000         $000          $000
                     Trade and other receivables            9           0               0      78,552                0              0   78,552        78,552
                     Cash and cash equivalents              7           0               0      80,831                0              0   80,831        80,831
                     Trust / Special Funds                 8a      17,755               0           0                0              0   17,755        17,755
                     Patient and restricted trust funds    8b         983               0           0                0              0       983           983
                     Interest rate swaps:                               0               0           0                0              0          0            0
                       Assets                              19       1,632               0           0                0              0     1,632         1,632
                       Liabilities                                      0               0           0                0              0          0            0
                     Forward exchange contracts:                        0               0           0                0              0          0            0
                                                                                                                                                                 position are as follows

                       Assets                              19           0               0          94                0              0         94           94
                       Liabilities                                      0               0           0                0              0          0            0
                                                                                                                                                                 Classification and fair values




                     Secured bank loans                    14           0               0           0                0 (298,014))     (298,014)     (294,481)
                     Trade and other payables             13a           0               0           0                0   (142,772)    (142,772)     (142,772)
                     Bank overdraft                         7           0               0      (1,650)               0              0    (1,650)       (1,650)
                                                                   20,370               0     157,827                0   (440,786)    (262,589)     (259,056)
                                                                                                                                                                                                                                                                             Financial Instruments (continued)




                     Unrecognised (gains)/losses                                                                                                       (3,533)

                     GROUP                                Note   Held for   Designated      Loans and    Available for Financial      Carrying     Fair Value
                     2007                                        Trading    at Fair Value   Receivable       Sale      Liabilities at Amount
                                                                               through                                  Amortised 2007 Actual
                                                                            Profit & Loss                                  Cost
                                                                  $000          $000          $000          $000          $000         $000          $000
                     Trade and other receivables            9           0               0     125,698                0              0  125,698       125,698
                     Cash and cash equivalents              7           0               0       1,450                0              0     1,450         1,450
                     Trust / Special Funds                 8a      16,071               0           0                0              0   16,071        16,071
                     Patient and restricted trust funds    8b         910               0           0                0              0       910           910
                     Interest rate swaps:                               0               0           0                0              0          0            0
                       Assets                              19          21               0           0                0              0         21           21
                       Liabilities                                      0               0           0                0              0          0            0
                     Forward exchange contracts:                        0               0           0                0              0          0            0
                       Assets                              19           0               0           0                0              0          0            0
                       Liabilities                                      0           (423)           0                0              0      (423)         (423)
                     Secured bank loans                    14           0               0           0                0   (308,500)    (308,500)     (299,984)
                     Trade and other payables             13a           0               0           0                0   (128,241)    (128,241)     (128,241)




Annual Report 2008
                                                                                                                                                                 The classification and fair values together with the carrying amounts shown in the statement of financial




                     Bank overdraft                         7           0               0      (4,800)               0              0    (4,800)       (4,800)
                                                                   17,002           (423)     122,348                0   (436,741)    (297,814)     (289,298)
                     Unrecognised (gains)/losses                                                                                                       (8,516)




89
90
                                 PARENT                               Note   Held for    Designated      Loans and    Available for Financial      Carrying     Fair Value
                                 2008                                        Trading     at Fair Value   Receivable       Sale      Liabilities at Amount
                                                                                            through                                  Amortised 2008 Actual
                                                                                         Profit & Loss                                  Cost
                                                                              $000           $000          $000          $000          $000         $000          $000
                                 Trade and other receivables            9            0               0      76,994                0              0   76,994        76,994




                                                                                                                                                                                                                           Note 18
                                 Cash and cash equivalents              7            0               0      80,831                0              0   80,831        80,831
                                 Trust / Special Funds                 8a            0               0           0                0              0          0            0
                                 Patient and restricted trust funds    8b          983               0           0                0              0       983           983
                                 Interest rate swaps:                                0               0           0                0              0          0            0




Auckland District Health Board
                                   Assets                              19         1632               0           0                0              0     1,632         1,632
                                   Liabilities                                       0               0           0                0              0          0            0
                                 Forward exchange contracts:                         0               0           0                0              0          0            0
                                   Assets                              19            0               0          94                0              0         94           94
                                   Liabilities                                       0               0           0                0              0          0            0
                                 Secured bank loans                    14            0               0           0                0   (298,014)    (298,014)     (294,481)
                                 Trade and other payables             13a            0               0           0                0   (134,108)    (134,108)     (134,108)
                                 Bank overdraft                         7            0               0      (1,650)               0              0    (1,650)       (1,650)
                                                                                 2,615               0     156,269                0   (432,122)    (273,238)     (269,705)
                                 Unrecognised (gains)/losses                                                                                                        (3,533)
                                                                                                                                                                              Classification and fair values (continued)
                                                                                                                                                                                                                           Financial Instruments (continued)




                                 PARENT                               Note   Held for    Designated      Loans and    Available for Financial      Carrying     Fair Value
                                 2007                                        Trading     at Fair Value   Receivable       Sale      Liabilities at Amount
                                                                                            through                                  Amortised 2007 Actual
                                                                                         Profit & Loss                                  Cost
                                                                              $000           $000          $000          $000          $000         $000          $000
                                 Trade and other receivables            9            0               0     124,153                0              0  124,153       124,153
                                 Cash and cash equivalents              7            0               0       1,450                0              0     1,450         1,450
                                 Trust / Special Funds                 8a            0               0           0                0              0          0            0
                                 Patient and restricted trust funds    8b          910               0           0                0              0       910           910
                                 Interest rate swaps:                                0               0           0                0              0          0            0
                                   Assets                              19           21               0           0                0              0         21           21
                                   Liabilities                                       0               0           0                0              0          0            0
                                 Forward exchange contracts:                         0               0           0                0              0          0            0
                                   Assets                              19            0               0           0                0              0          0            0
                                   Liabilities                                       0           (423)           0                0              0      (423)         (423)
                                 Secured bank loans                    14            0               0           0                0   (308,500)    (308,500)     (299,984)
                                 Trade and other payables             13a            0               0           0                0   (120,919)    (120,919)     (120,919)
                                 Bank overdraft                         7            0               0      (4,800)               0              0    (4,800)       (4,800)
                                                                                   931           (423)     120,803                0   (429,419)    (308,108)     (299,592)
                                 Unrecognised (gains)/losses                                                                                                        (8,516)
Note 18   Financial Instruments (continued)
          Estimation of fair values analysis
          The following summarises the major methods and assumptions used in estimating the fair values
          of financial instruments reflected in the table.

          Derivatives
          Forward exchange contracts are either marked to market using listed market prices or by
          discounting the contractual forward price and deducting the current spot rate. For interest rate
          swaps, broker quotes are used. Those quotes are back tested using pricing models or discounted
          cash flow techniques.

          Where discounted cash flow techniques are used, estimated future cash flows are based on
          management’s best estimates and the discount rate is a market related rate for a similar
          instrument at the balance date. Where other pricing models are used, inputs are based on
          market related data at the balance date.

          Interest-bearing loans and borrowings
          Fair value is calculated based on discounted expected future principal and interest cash flows.

          Trade and other receivables / payables
          For receivables / payables with a remaining life of less than one year, the notional amount is
          deemed to reflect the fair value. All other receivables / payables are discounted to determine the
          fair value.

          Interest rates used for determining fair value
          The ADHB uses the Government yield curve as of 30 June 2008 plus an adequate constant credit
          spread to discount financial instruments. The interest rates used are as follows:

                                                                                         2008           2007
                                                                                        Actual         Actual
          GROUP AND PARENT                                                                   %              %
                                                                                      6.015 to       6.015 to
          Derivatives
                                                                                          7.75           7.75
                                                                                      6.095 to       6.095 to
          Loans and borrowings
                                                                                          7.03           7.30




                                                                                             Annual Report 2008   91
     Note 18          Financial Instruments (continued)
                                                                                  GROUP
                      Interest Rate Repricing Schedule                         Maturity Periods
                                             Weighted
                                              Average     0–1         1–2        2 – 5 More than 5       Total
                                               Interest   Years       Years      Years        Years
                                                Rate %
                                                       $000           $000      $000          $000      $000
                      As at 30 June 2008
                      Current and Non Current Monetary Assets
                      Cash and cash
                                             8.76% 80,831                0          0             0    80,831
                      equivalents
                      Restricted / special
                                             8.74% 12,905             4,850         0             0    17,755
                      funds
                      Patient and
                                             8.18%      983              0          0             0       983
                      restricted trust funds
                      Total Monetary Assets          94,719           4,850         0             0    99,569

                      Current and Non Current Monetary Liabilities
                      Bank Overdraft             8.50%  1,650            0          0             0     1,650
                      Interest–bearing loans and
                      borrowings
                      Crown Health
                                                 6.41% 10,500        13,500    80,000       70,000    174,000
                      Financing Agency
                      Bonds                      7.75%      0            0     70,000       50,000    120,000
                      Interest on borrowings            5,084            0          0            0      5,084
                      Unexpired set up cost on
                                                            0            0     (1,070)            0    (1,070)
                      borrowings
                      Total Monetary Liabilities       17,234        13,500   148,930      120,000    299,664

                      As at 30 June 2007
                      Current and Non Current Monetary Assets
                      Cash and cash
                                             6.90%     1,450             0          0             0     1,450
                      equivalents
                      Restricted /special
                                             8.07% 10,071             6,000         0             0    16,071
                      funds
                      Patient and
                                             7.80%       910             0          0             0       910
                      restricted trust funds
                      Total Monetary Assets          12,431           6,000         0             0    18,431

                      Current and Non Current Monetary Liabilities
                      Bank Overdraft             8.25%  4,800            0          0             0     4,800
                      Interest–bearing loans and
                      borrowings
                      Crown Health
                                                 6.53% 10,500        10,500    33,500      130,000    184,500
                      Financing Agency
                      Bonds                      7.75%      0            0     70,000       50,000    120,000
                      Interest on borrowings            5,291            0          0            0      5,291
                      Unexpired set up cost on
                                                            0            0          0       (1,291)    (1,291)
                      borrowings
                      Total Monetary Liabilities       20,591        10,500   103,500      178,709    313,300



92   Auckland District Health Board
Note 18   Financial Instruments (continued)
                                                                         PARENT
          Interest Rate Repricing Schedule                            Maturity Periods
                                 Weighted
                                  Average     0–1          1–2          2–5         Over 5           Total
                                   Interest   Years        Years        Years        Years
                                    Rate %
                                           $000            $000         $000          $000          $000
          As at 30 June 2008
          Current & Non-Current Monetary Assets
          Cash and cash
                                 8.76% 80,831                  0            0             0      80,831
          equivalents
          Patient and
                                 8.18%       983               0            0             0          983
          restricted trust funds
          Total Monetary
                                         81,814                0            0             0      81,814
          Assets

          Current and Non Current Monetary Liabilities
          Bank Overdraft             8.50%  1,650              0            0             0        1,650
          Interest–bearing loans and
          borrowings
          Crown Health
                                     6.41% 10,500        13,500       80,000        70,000      174,000
          Financing Agency
          Bonds                      7.75%      0              0      70,000        50,000      120,000
          Interest on borrowings            5,084              0           0             0        5,084
           Unexpired set up cost on
                                                0              0      (1,070)             0      (1,070)
          borrowings
          Total Monetary Liabilities       17,234        13,500      148,930      120,000       299,664

          As at 30 June 2007
          Current & Non Current Monetary Assets
          Cash and cash
                                 6.90%     1,450               0            0             0        1,450
          equivalents
          Patient and
                                 7.80%       910               0            0             0          910
          restricted trust funds
          Total Monetary Assets            2,360               0            0             0        2,360

          Current & Non Current Monetary Monetary Liabilities
          Bank Overdraft             8.25%     4,800             0          0             0        4,800
          Interest–bearing loans and
          borrowings
          Crown Health
                                     7.30% 10,500         10,500       33,500     130,000       184,500
          Financing Agency
          Bonds                                    0             0     70,000       50,000      120,000
          Interest on borrowings               5,291             0          0             0        5,291
          Unexpired set up cost on
                                                   0             0          0       (1,291)       (1,291)
          borrowings
          Total Monetary Liabilities         20,591       10,500      103,500     178,709       313,300
          The Crown Health Financing Agency has undertaken to provide funding when the bonds mature.
          They will also refinance their advances when they are due. ADHB has undertaken to repay
          $10.5m of advances per annum.



                                                                                         Annual Report 2008   93
     Note 18          Financial Instruments (continued)
                      Capital Management
                      ADHB’s capital is its equity which comprises Crown equity, reserves, Trust funds and retained
                      earnings. Equity is represented by net assets. ADHB manages its revenues, expenses, assets,
                      liabilities and general financial dealings prudently in compliance with the budgetary processes
                      and Board financial policies.

                      ADHB’s policy and objectives of managing the equity is to ensure that it achieves its goals and
                      objectives, whilst maintaining a strong capital base. Capital is managed in accordance with the
                      Board’s Treasury policy and is regularly reviewed by the Board.

                      There have been no material changes in ADHB’s management of capital during the period other
                      than that arising from the revaluation of land and buildings as at 30 June 2008 as separately
                      disclosed in this report.

                      Sensitivity Analysis
                      In managing interest rate and currency risks ADHB aims to reduce the impact of short-term
                      fluctuations on ADHB’s financial performance. Over the longer-term, permanent changes in
                      foreign exchange rates and interest rates would have an impact on this performance.

                      At 30 June 2008, it is estimated that a general increase of 1% in interest rates would decrease
                      ADHB’s financial performance by approximately $2.6m (2007 $2.8m). Interest rate swaps have
                      been included in this calculation. It is estimated that a general increase of one percentage point
                      in the value of the NZD against other foreign currencies would have decreased ADHB’s financial
                      performance by approximately $31k (2007 $29k). Forward exchange contracts have been
                      included in this calculation.

                      At 30 June 2008, it is estimated that a general decrease of 1% in interest rates would increase
                      ADHB’s financial performance by approximately $2.7m (2007 $3.0m). Interest rate swaps have
                      been included in this calculation. It is estimated that a general decrease of one percentage point
                      in the value of the NZD against other foreign currencies would have increased ADHB’s financial
                      performance by approximately $31k (2007 $30k). Forward exchange contracts have been
                      included in this calculation.

                                                                       Group         Parent        Group         Parent
                                                                       Actual        Actual        Actual        Actual
                                                                        As at         As at         As at         As at
                                                                    30/06/08      30/06/07      30/06/08      30/06/07
     Note 19          Derivative Financial Instruments
                      Non Current Assets
                      Interest rate swaps in gain (mark to
                                                                        1,632             21        1,632               21
                      market)
                      Foreign currency contracts - gain                    94              0           94                0
                                                                        1,726             21        1,726               21

                      Current Liabilities
                      Foreign currency contracts - loss                      0          423              0           423
                                                                             0          423              0           423




94   Auckland District Health Board
Note 20   Major Variations From Budget
          ADHB recorded a surplus of $2m which was $2m favourable to budget. Major favourable
          variances were patient care revenue $55m, including capital charge funding in relation to the
          revaluation of land and buildings, and other income $3m. Major unfavourable variances were
          employee costs $15m, direct treatment costs $15m, indirect treatment costs $5m and capital
          charge $21m that included costs in relation to the revaluation of land and buildings.

Note 21   Events Subsequent To Balance Date
          No events have occurred subsequent to balance date that requires adjustment or disclosure in
          these financial statements.

Note 22   Key Sources of Estimated Uncertainty
          As indicated in Note 1, the preparation of financial statements in conformity with NZ IFRSs
          requires management to make judgements, estimates and assumptions that affect the application
          of policies and reported amounts of assets and liabilities, revenue and expenses.

          Management has identified the following critical accounting policies for which significant
          judgements, estimates and assumptions are made:

          Accrual of continuing medical education leave and expenses in employee benefits
          The provision for the above is $15.2m as at 30 June 2008 (2007 $7.4m). The calculation of this
          accrual assumes that the utilisation of this annual entitlement, that can be accumulated over 3
          years, will be 65% of the full entitlement (2007 - 50%). A difference of 5% in the utilisation rate
          represents a financial effect of $1.2m on the accrual.

          Estimation of useful lives of assets
          The estimation of the useful lives of assets has been based on historical experience as well as
          manufacturers’ warranties (for plant and equipment), lease terms (for leased equipment) and
          turnover policies (for motor vehicles). In addition, the condition of the assets is assessed at least
          once per year and considered against the remaining useful life. Adjustments to useful lives are
          made when considered necessary.

          Debtors impairment
          The Board has a credit management policy in place that regularly reviews debts and makes
          provision for impairment based on the risk assigned to each customer category.

          Fair value of Property, Plant and Equipment (PPE)
          The value of PPE, apart from land and buildings, is stated at cost less accumulated depreciation
          and impairment losses. The useful lives of assets is determined as outlined above. Buildings
          assets are specialised and have been valued based on optimised depreciated replacement cost.
          Land has been valued with regard to market values applying in the locality and to any special
          circumstances that may exist in respect of the land valued.




                                                                                                 Annual Report 2008   95
     Note 23          Transition to NZ IFRS
                      In December 2002 the New Zealand Accounting Standards Review Board (ASRB) announced
                      that New Zealand entities, required to comply with NZ GAAP under the Financial Reporting Act,
                      would be required to apply International Financial Reporting Standards (IFRS) for financial periods
                      commencing on or after 1 January 2007 with earlier adoption permitted from 1 January 2005.
                      The new standards that have been approved by the ASRB for application in New Zealand are
                      referred to as New Zealand equivalents to International Financial Reporting Standards, (NZ IFRS)
                      as certain adaptations have been made to reflect New Zealand circumstances.

                      These are ADHB’s first consolidated financial statements prepared in accordance with NZ IFRS.

                      The accounting policies are set out in the notes to the financial statements for the year ended 30
                      June 2008, the comparative information presented for the year ended 30 June 2007 and in the
                      preparation of an opening NZ IFRS Balance Sheet at 1 July 2006 (ADHB’s date of transition).

                      In preparing its opening NZ IFRS Balance Sheet and reinstating the 2007 financial instruments,
                      ADHB has adjusted amounts reported previously in financial statements prepared in accordance
                      with its old basis of accounting (previously GAAP). An explanation of how the transition from
                      previous GAAP to NZ IFRS has affected ADHB’s financial position and financial performance is
                      set out in the following tables and the notes that accompany the tables.




96   Auckland District Health Board
                     Note 23   Transition to NZ IFRS (continued)
                               Reconciliation Of The Equity
                                                                                                                                               GROUP                                                                                                                                                                PARENT
                                                                                      Transition Balance Sheet                                                         Transition Balance Sheet                                                            Transition Balance Sheet                                                           Transition Balance Sheet
                                                                                                1 July 2006                                                                  30 June 2007                                                                            1 July 2006                                                                    30 June 2007




                                                              Notes
                                                                                                                                           NZ IFRS
                                                                                                                                                                                                                            NZ IFRS
                                                                                                                                                                                                                                                                                                                NZ IFRS
                                                                                                                                                                                                                                                                                                                                                                                                   NZ IFRS




                                                                                               to NZ IFRS
                                                                                                                                                                                to NZ IFRS
                                                                                                                                                                                                                                                                    to NZ IFRS
                                                                                                                                                                                                                                                                                                                                                       to NZ IFRS




                                                                      Previous GAAP
                                                                                                                                                       Previous GAAP
                                                                                                                                                                                                                                           Previous GAAP
                                                                                                                                                                                                                                                                                                                              Previous GAAP




                                                                                                                      land valuation
                                                                                                                                                                                                       land valuation
                                                                                                                                                                                                                                                                                           land valuation
                                                                                                                                                                                                                                                                                                                                                                              land valuation




                                                                                                                      Recognition of
                                                                                                                                                                                                       Recognition of
                                                                                                                                                                                                                                                                                           Recognition of
                                                                                                                                                                                                                                                                                                                                                                              Recognition of




                                                                                           Effect of transition
                                                                                                                                                                            Effect of transition
                                                                                                                                                                                                                                                                Effect of transition
                                                                                                                                                                                                                                                                                                                                                   Effect of transition




                                                                      $000                    $000                      $000               $000        $000                    $000                      $000               $000           $000                    $000                      $000               $000          $000                    $000                      $000               $000
                               Current Assets
                               Cash and cash equivalents                   4,074                                  0                    0     4,074          1,450                                  0                    0     1,450             3,626                                  0                    0     3,626            1,450                                  0                    0     1,450
                               Trust/special funds                         6,487                                  0                    0     6,487      10,071                                     0                    0    10,071                         0                          0                    0             0                    0                          0                    0             0
                               Patient and restricted trust                      844                              0                    0         844              910                              0                    0         910                 844                              0                    0         844                910                              0                    0         910
                               funds
                               Trade and other                        109,664                                     0                    0   109,664     125,698                                     0                    0   125,698        109,526                                     0                    0   109,526       124,153                                     0                    0   124,153
                               receivables
                               Inventories                                 9,228                                  0                    0     9,228      10,407                                     0                    0    10,407             9,228                                  0                    0     9,228        10,407                                     0                    0    10,407
                               Property intended for                             141                              0                    0         141                   78                          0                    0             78              141                              0                    0         141                     78                          0                    0             78
                               resale)
                               Total Current Assets                   130,438                                     0                    0   130,438     148,614                                     0                    0   148,614        123,365                                     0                    0   123,365       136,998                                     0                    0   136,998
                               Non-Current Assets
                               Trust/special funds                         2,250                                  0                    0     2,250          6,000                                  0                    0     6,000                         0                          0                    0             0                    0                          0                    0              0
                               Property, plant and             a, g   699,344               (12,375)                   144,810             831,779     678,426                   (8,769)                144,810             814,467        699,344               (12,375)                   144,810             831,779       678,426                   (8,769)                144,810             814,467
                               equipment
                               Intangible assets                  a                    0        12,375                                 0    12,375                      0            8,769                              0     8,769                         0        12,375                                 0    12,375                        0            8,769                              0     8,769
                               Derivative financial               b                    0            5,374                              0     5,374                      0                    21                         0             21                    0            5,374                              0     5,374                        0                    21                         0             21
                               instruments
                               Investments in associates                         329                              0                    0         329              332                              0                    0         332                       1                          0                    0             1                    1                          0                    0              1
                               Total Non-Current Assets               701,923                       5,374              144,810             852,107     684,758                               21         144,810             829,589        699,345                       5,374              144,810             849,529       678,427                               21         144,810             823,258
                               Total Assets                           832,361                       5,374              144,810             982,545     833,372                               21         144,810             978,203        822,710                       5,374              144,810             972,894       815,425                               21         144,810             960,256




Annual Report 2008
97
98
                                 Note 23   Transition to NZ IFRS (continued)
                                           Reconciliation Of The Equity (continued)
                                                                                                                                                         GROUP                                                                                                                                                               PARENT
                                                                                                Transition Balance Sheet                                                           Transition Balance Sheet                                                         Transition Balance Sheet                                                           Transition Balance Sheet
                                                                                                          1 July 2006                                                                    30 June 2007                                                                         1 July 2006                                                                    30 June 2007




Auckland District Health Board
                                                                        Notes
                                                                                                                                                     NZ IFRS
                                                                                                                                                                                                                                        NZ IFRS
                                                                                                                                                                                                                                                                                                                         NZ IFRS
                                                                                                                                                                                                                                                                                                                                                                                                            NZ IFRS




                                                                                                         to NZ IFRS
                                                                                                                                                                                            to NZ IFRS
                                                                                                                                                                                                                                                                             to NZ IFRS
                                                                                                                                                                                                                                                                                                                                                                to NZ IFRS




                                                                                Previous GAAP
                                                                                                                                                                   Previous GAAP
                                                                                                                                                                                                                                                    Previous GAAP
                                                                                                                                                                                                                                                                                                                                       Previous GAAP




                                                                                                                                land valuation
                                                                                                                                                                                                                   land valuation
                                                                                                                                                                                                                                                                                                    land valuation
                                                                                                                                                                                                                                                                                                                                                                                       land valuation




                                                                                                                                Recognition of
                                                                                                                                                                                                                   Recognition of
                                                                                                                                                                                                                                                                                                    Recognition of
                                                                                                                                                                                                                                                                                                                                                                                       Recognition of




                                                                                                     Effect of transition
                                                                                                                                                                                        Effect of transition
                                                                                                                                                                                                                                                                         Effect of transition
                                                                                                                                                                                                                                                                                                                                                            Effect of transition




                                                                                $000                    $000                      $000               $000          $000                    $000                      $000               $000        $000                    $000                      $000               $000          $000                    $000                      $000               $000
                                           Current Liabilities
                                           Bank overdraft                        14,750                                     0                    0    14,750            4,800                                  0                    0     4,800      14,750                                     0                    0    14,750            4,800                                  0                    0     4,800
                                           Trade and other payables         c   127,698                  (1,231)                                 0   126,467       225,001               (96,760)                                   0   128,241     127,499                  (1,231)                                 0   126,268       217,679               (96,760)                                   0   120,919
                                           Employee benefits                d    72,876                           789                            0    73,665                        0        94,349                                 0    94,349      72,876                           789                            0    73,665                        0        94,349                                 0    94,349
                                           Provisions                                      388                              0                    0         388                      0                350                            0         350              388                              0                    0         388                      0                350                            0         350
                                           Interest-bearing loans and       e                    0            3,495                              0     3,495        10,500                      5,291                               0    15,791                      0           3,495                               0     3,495        10,500                      5,291                               0    15,791
                                           borrowings
                                           Derivative financial                                  0                          0                    0             0                    0                423                            0         423                    0                          0                    0             0                    0                423                            0         423
                                           Instruments
                                           Funds held in trust                             844                              0                    0         844                910                              0                    0         910              844                              0                    0         844                910                              0                    0         910
                                           Total Current Liabilities            216,556                       3,053                              0   219,609       241,211                       3,653                              0   244,864     216,357                       3,053                              0   219,410       233,889                       3,653                              0   237,542


                                           Non-Current Liabilities
                                           Employee benefits                d    16,445                       6,869                              0    23,314        13,949                       6,989                              0    20,938      16,445                       6,869                              0    23,314        13,949                       6,989                              0    20,938
                                           Interest-bearing loans and       e   270,000                  (1,495)                                 0   268,505       294,000                  (1,291)                                 0   292,709     270,000                  (1,495)                                 0   268,505       294,000                  (1,291)                                 0   292,709
                                           borrowings
                                           Total Non-Current                    286,445                       5,374                              0   291,819       307,949                       5,698                              0   313,647     286,445                       5,374                              0   291,819       307,949                       5,698                              0   313,647
                                           Liabilities
                                           Total Liabilities                    503,001                       8,427                              0   511,428       549,160                       9,351                              0   558,511     502,802                       8,427                              0   511,229       541,838                       9,351                              0   551,189
                                           Net Assets                           329,360                   (3,053)                144,810             471,117       284,212                   (9,330)                144,810             419,692     319,908                   (3,053)                144,810             461,665       273,587                   (9,330)                144,810             409,067
                     Note 23   Transition to NZ IFRS (continued)
                               Reconciliation Of The Equity (continued)
                                                                                                                                          GROUP                                                                                                                                                          PARENT
                                                                                 Transition Balance Sheet                                                       Transition Balance Sheet                                                       Transition Balance Sheet                                                            Transition Balance Sheet
                                                                                          1 July 2006                                                                30 June 2007                                                                        1 July 2006                                                                     30 June 2007




                                                     Notes
                                                                                                                                      NZ IFRS
                                                                                                                                                                                                                     NZ IFRS
                                                                                                                                                                                                                                                                                                     NZ IFRS
                                                                                                                                                                                                                                                                                                                                                                                         NZ IFRS




                                                                                         to NZ IFRS
                                                                                                                                                                        to NZ IFRS
                                                                                                                                                                                                                                                        to NZ IFRS
                                                                                                                                                                                                                                                                                                                                            to NZ IFRS




                                                                 Previous GAAP
                                                                                                                                                Previous GAAP
                                                                                                                                                                                                                               Previous GAAP
                                                                                                                                                                                                                                                                                                                   Previous GAAP




                                                                                                                land valuation
                                                                                                                                                                                               land valuation
                                                                                                                                                                                                                                                                               land valuation
                                                                                                                                                                                                                                                                                                                                                                   land valuation




                                                                                                                Recognition of
                                                                                                                                                                                               Recognition of
                                                                                                                                                                                                                                                                               Recognition of
                                                                                                                                                                                                                                                                                                                                                                   Recognition of




                                                                                     Effect of transition
                                                                                                                                                                    Effect of transition
                                                                                                                                                                                                                                                    Effect of transition
                                                                                                                                                                                                                                                                                                                                        Effect of transition




                                                                 $000                   $000                      $000               $000       $000                   $000                      $000               $000       $000                    $000                      $000               $000           $000                    $000                      $000               $000
                               Equity
                               Public equity                     635,375                                    0                    0   635,375    600,983                                    0                    0   600,983    635,375                                     0                    0   635,375        600,983                                     0                    0   600,983
                               Accumulated deficit           f (460,448)                 (3,053)                                 0 (463,501) (472,330)                  (9,330)                                 0 (481,660) (460,776)                   (3,053)                                 0 (463,829) (472,662)                       (9,330)                                 0 (481,992)
                               Other reserves            g       145,309                                    0    144,810             290,119    145,266                                    0    144,810             290,076    145,309                                     0    144,810             290,119        145,266                                     0    144,810             290,076
                               Trust/special funds                    9,124                                 0                    0      9,124    10,293                                    0                    0    10,293                     0                          0                    0              0                    0                          0                    0              0
                               Total Equity                      329,360                  (3,053)                144,810             471,117    284,212                 (9,330)                 144,810             419,692    319,908                  (3,053)                 144,810             461,665        273,587                  (9,330)                 144,810             409,067


                               IFRS Transition Notes
                               a. Intangible assets – this is the value of computer software not deemed to be an integral part of computer hardware reclassified as Intangible Assets, as required by NZ
                                 IAS 38.
                               b. Derivative financial instruments – NZ IAS 39 requires derivatives to be recognised in the statement of financial position at their fair value.
                               c. Trade and other payables – this movement is principally made up of a re-classification to employee benefits. It also includes the re-classification of accrued interest
                                 receivable and payable
                               d. Employee benefits – this movement arises from a re-classification from Trade and Other Payables. It includes employee leave and retirement gratuities entitlements, sick
                                 leave, sabbatical leave and entitlements for continuing medical education.
                               e. Interest-bearing loans and borrowings – this movement arises from the reclassification of accrued interest payable on Crown Health Financing Agency borrowings and
                                 the revaluation of capital bonds at amortised cost




Annual Report 2008
99
100
                                 Note 23   Transition to NZ IFRS (continued)
                                           Reconciliation Of The Equity (continued)
                                                                                                                                                                              GROUP & PARENT
                                                                                                                                                                 Transition Balance               Transition Balance
                                                                                                                                                                      Sheet                           Sheet




Auckland District Health Board
                                                                                                                                                                   1 July 2006                    30 June 2007
                                                                                                                                                            Effect of transition to NZ       Effect of transition to NZ
                                                                                                                                                                        IFRS                             IFRS
                                                                                                                                                                       $000                             $000
                                           f . Accumulated deficit – this movement is made up principally of the revaluation of sick leave,
                                              long service leave and retirement gratuities included in employee benefits and movements in
                                              derivative financial instruments as below.
                                           (i) Gain / (loss) on derivatives
                                              Interest rate swap closeouts (mark to market)                                                                                     1,313                                     0
                                              Interest rate swaps (mark to market)                                                                                              4,061                                  21
                                              Interest rate swaps (accrued interest)                                                                                           (2,264)                          (2,202)
                                              Foreign currency risk (mark to market)                                                                                                     0                        (423)
                                              Total gain / (loss) on derivatives                                                                                                3,110                           (2,604)
                                           (ii) Sick leave related expenses: accrued excess sick leave – non vesting                                                             (789)                          (1,019)
                                           (iii) Increased retiring gratuities liability: change in basis of estimation                                                        (6,869)                          (6,998)
                                           (iv) Bond set-up costs: revaluation of bonds                                                                                         1,495                            1,291
                                           Accumulated deficit adjustments                                                                                                     (3,053)                          (9,330)


                                           g. Other Notes
                                             Recognition of land valuation - this is the value of land subject to restrictive covenants based on an independent valuation by Telfer Young (Auckland) Ltd on 30 June
                                             2005 that had previously not been included in the fair value of land.
                     Note 23   Transition to NZ IFRS (continued)
                               Reconciliation of the deficit for the year ended 30 June 2007
                                                                                                            GROUP                                         PARENT
                                                                                    Notes   Previous         Effect of     NZ IFRS       Previous         Effect of     NZ IFRS
                                                                                             GAAP          transition to                  GAAP          transition to
                                                                                                             NZ IFRS                                      NZ IFRS
                                                                                               $000             $000          $000          $000              $000       $000
                               Revenue
                               Patient care                                                 1,308,103                  0   1,308,103     1,308,103                  0   1,308,103
                               Other revenue                                           a       100,735          (1,699)      99,036        90,528            (1,699)      88,829
                               Total revenue                                                1,408,838           (1,699)    1,407,139     1,398,631           (1,699)    1,396,932
                               Total expenses
                               Employee benefit cost                                   b       593,963              359     594,322       589,447                359     589,806
                               Direct treatment cost                                           171,196                 0    171,196       169,909                   0    169,909
                               Funder payments                                                 471,069                 0    471,069       471,069                   0    471,069
                               Indirect treatment costs                                         32,203                 0     32,203        28,967                   0     28,967
                               Property, equipment & transport costs.                           48,732                 0     48,732        48,732                   0     48,732
                               Capital charge                                                   21,559                 0     21,559        21,559                   0     21,559
                               Depreciation and amortisation expenses                   c       44,306                 0     44,306        44,306                   0     44,306
                               Finance costs                                           d        19,695              204      19,899        19,695                204      19,899
                               Other operating expenses                                e        16,830           4,017       20,847        16,831             4,017       20,848
                               Total expenses                                               1,419,553            4,580     1,424,133     1,410,515            4,580     1,415,095
                               Share of net surpluses of associates                                    4               0             4              0               0             0
                               Net surplus/(deficit)                                           (10,711)         (6,279)     (16,990)      (11,884)           (6,279)     (18,163)




Annual Report 2008
101
102
                                 Note 23   Transition to NZ IFRS (continued)
                                           Reconciliation of the deficit for the year ended 30 June 2007 (continued)
                                                                                                                                                          GROUP & PARENT
                                                                                                                                                           30 June 2007




Auckland District Health Board
                                           Notes                                                                                                          Effect of transition
                                                                                                                                                              to NZ IFRS
                                           a. Other revenue                                                                                                      $000
                                             Gain on derivatives – represents net gain on financial instruments
                                             Realised cost of interest rate swap closeout                                                                                 (1,720)
                                             Gain on fair value of interest rate swaps                                                                                           21
                                                                                                                                                                          (1,699)
                                           b. Employee benefit costs – represents movement in sick leave provision and retiring gratuities entitlements
                                             Sick leave related expenses: accrued Excess sick leave - non vesting - 30 June 2007                                                 230
                                             Increased retiring gratuities liability: change in basis of RG estimation - 30 June 2007                                            129
                                                                                                                                                                                 359
                                           c. Depreciation and amortisation expenses
                                             Amortise Intangible Asset: reclassify computer software depreciation                                                           5,588
                                             Depreciation: reclassify computer software depreciation                                                                      (5,588)
                                                                                                                                                                                   0
                                           d. Finance costs – being amortisation of bond set-up costs
                                             Amortisation of bond set-up costs: revalue bonds                                                                                    204
                                           e. Other operating expenses
                                             Loss on derivatives – being adjustment to valuations of interest rate swaps and forward exchange contracts
                                             Loss on revaluation of interest rate swaps (mark to market)                                                                    3,594
                                             Foreign currency risk ( mark to market)                                                                                             423
                                                                                                                                                                            4,017
                                             Total Adjustments to net surplus / (deficit)                                                                                 (6,279)


                                           Statement of Cash Flows
                                           There have been no material adjustments to the statement of cash flows on transition to NZ IFRS.
                                            Appendix A - Statement of Service Performance
                     Area of Activity Targets                                                       Performance Recorded for 2007- 08                                          Degree of Achievement
                     4.1.1 Reduce the impact of heart disease, diabetes and cancer
                     Reducing lifestyle     Progress to achieving MoH Breastfeeding targets:        Breastfeeding rates (Plunket data July07 – Dec07):                         Partially achieved.
                     related risk factors
                                             increase the breastfeeding rate at 6 weeks to 71         •	64%	at	6	weeks
                                             percent
                                             increase the breastfeeding rate at 3 months to 57        •	56%	at	3	months
                                             percent
                                             increase the breastfeeding rate at 6 months to 21        •	29%	at	6	months
                                             percent
                                            2005-06 ADHB Breastfeeding rate at 6 weeks was          A breastfeeding Action Plan was submitted to the MoH in June 2008.
                                            68% (data provided by Plunket).                         Criteria for evaluating performance will be developed with the MoH in
                                                                                                    2008/09.
                                            Support the achievement of Baby Friendly Hospital       We were surveyed for Friendly Hospital Initiative Accreditation in         Achieved.
                                            Initiative accreditation.                               December 2007 and received confirmation of Accreditation in March
                                                                                                    2008.
                                            Work with Auckland City Council to implement the        We have worked through our Child Health Stakeholders Advisory Group        Partially achieved, work done
                                            Baby Friendly Community Initiative.                     to progress the Baby Friendly Community Initiative.                        through different agencies.
                                                                                                    We have not specifically worked with ACC.
                                            Proportion of adults (15+):                             56% of the ADHB population are consuming an adequate vegetable             Partially achieved.
                                                                                                    consumption and 62% are consuming an adequate fruit consumption
                                              70% consuming at least 3 servings of vegetables
                                                                                                    (2006/07 Health Survey). It is acknowledged that many determinants of
                                              per day.
                                                                                                    fruit and vegetable consumption lie outside the health sector. Promotion
                                              62% consuming at least 2 servings of fruit per day.
                                                                                                    of fruit and vegetables was a key component of all healthy eating
                                                                                                    programmes implemented in 2007-08.
                                            57% of year ten students have never smoked (ASH         The 2007 ASH survey shows the ADHB rate of 62.5% year 10 students          Achieved.
                                            year ten survey data).                                  never smoked.
                                            85% of ADHB schools are health promoting schools.       All 146 schools within the ADHB programme have been approached to          Partially achieved.
                                                                                                    gauge interest in participating in Health Promoting Schools. The results
                                                                                                    for Term 2 2008 in terms of the measurement in the contract with MOH
                                                                                                    are: Not interested - 93, Interested - 27, Committed - 4, Active - 19
                                                                                                    and Sustainable - 3. In this term there has been upward progress in 22
                                                                                                    schools and backward steps in 14 schools.




Annual Report 2008
103
104
                                   Area of Activity       Targets                                                 Performance Recorded for 2007- 08                                              Degree of Achievement




                                                        Implement the Look Good Kai programme into 26           The ‘Look Good Kai’ programme was not implemented in 2007-08 as               Not Applicable.
                                                        ADHB secondary schools.                                 it was superseded by ‘Mission On’ in all schools. ADHB and ARPHS
                                                                                                                facilitated 16 Mission On workshops which were attended by 82 early
                                                                                                                childhood education services (ECE) and 35 schools and supported
                                                                                                                schools and ECE to meet the National Administrative Guideline of




Auckland District Health Board
                                                                                                                providing only healthy foods on site. ADHB administered the Nutrition
                                                                                                                Fund; 65 schools and ECE received grants.
                                                        Increase by 10, the number of retailers involved in     Nine out of 10 eligible retailers are participating in the Glen Innes         Partially achieved.
                                                        Healthy Kai initiatives in Glen Innes.                  Healthy Kai programme.
                                 Improved care for      > 65% patients meeting criteria have had a Get          64% of people with diabetes meeting criteria had a Get Checked                Partially achieved.
                                 people with heart      Checked assessment.                                     Assessment.
                                 disease and diabetes
                                                        People with heart failure receive evidenced based      Integrated Heart Failure team commenced systematic care process for            Partially achieved.
                                                        care.                                                  people admitted to hospital. General practice participation in programme
                                                                                                               commencing July 2008.
                                                        Implement electronic screening tool PREDICT in 90% Five PHO’s have installed Predict with three PHO’s using this as their             Partially achieved.
                                                        of PHOs.                                               only CVD risk screening tool. One PHO is using a combination of this
                                                                                                               and another electronic tool while the fifth is using an alternative tool. 85




Appendix A
                                                                                                               general practices are using the Predict tool in some capacity.
                                                        10% of eligible population screened for CVD and        13,817 (11%) people screened for CVD and diabetes by general                   Achieved.
                                                        diabetes.                                              practitioners with 4034 having a subsequent management assessment.
                                                        5% increase in screening rate for Maori and Pacific    A specific Kaupapa Maori cardiac rehabilitation was not available              Not achieved.
                                                        communities.                                           in 2007-08 due to an inability to readmit suitable staff. Current
                                                                                                               data collected by the Auckland City Hospital service does not group
                                                                                                               information by ethnicity. Work has continued through out 2007-08 to
                                                                                                               allow this to commence in 2008-09.
                                                        Community based self management programmes in Self management programmes have been established for diabetes and                       Achieved.
                                                        place for chronic care.                                cardiac rehabilitation. Two providers had enrolled 432 people newly
                                                                                                               diagnosed with diabetes with 372 substantially completing the course.
                                                                                                               Six new diabetes support groups have also been established. The Heart
                                                                                                               Guide Aotearoa cardiac rehabilitation has been established in the second
                                                                                                               half of the year with increasing usage by people who have experienced
                                                                                                               acute coronary syndrome.
                                                        30% of eligible people (total, Maori, Pacific) engaged 1348 patient contacts where made through cardiac rehabilitation                Partially Achieved.
                                                        in and completing cardiac rehabilitation support.      community programmes in 2007-08. Work has been undertaken to
                                                                                                               improve reporting on this service with ethnicity data due to be collected
                                                                                                               from quarter 1 2008-09. A % analysis is not yet available.
                     Free annual check:                                                         % annual check                                  Partially achieved.

                     Maori                67%                            Maori                  32%
                     Pacific              67%                            Pacific                100%
                     Other                67%                            Other                  63%
                                                                         Total                  67%
                     Free annual check:                                                         Haemoglobin A1c (HBA1C) % achieved
                                                                         Maori                  59%                                             Not achieved.
                     Maori                70%
                     Pacific              70%                            Pacific                50%
                     Other                85%                            Other                  82%
                                                                         Total                  71%
                     Retinal screening:                                                         % retinal screen
                     Maori                83%                            Maori                  64%
                                                                                                                                                Not achieved.
                     Pacific              83%                            Pacific                73%
                     Other                83%                            Other                  74%
                                                                         Total                  73%




Appendix A
                     BACKGROUND TREND
                     Diabetes: Case Detection (trend data 2003-2006)     Case detection data for 2007 is based on the calendar year using 2007 Partially Achieved.
                     Percent of people known to have their free annual   population estimate of 12,222 provided by the MoH. The data above
                     diabetes ‘get check’ visit:                         covers the financial year. This data has been correlated on behalf of the
                                                                         local diabetes team and provided to the ADHB. Over 2007-08 diabetes
                               2003 2004 2005 2006 2007                  get checked processes have changed at some PHO’s with inclusion of the
                                                                         electronic process within Predict, streamlining workflow for the general
                     Maori 14.5       19.2   24.9   31.3   32            practitioners.
                     Other 28.3       36.5   44.3   64.9   72
                     Pacific 71       80.3   90.8   104.5 102
                     Total     33.7   42.1   50.2   67.7   72




Annual Report 2008
105
106
                                   Area of Activity      Targets                                               Performance Recorded for 2007- 08                                     Degree of Achievement

                                                      Diabetes: Case Management
                                                      Percent of people who have had their free annual
                                                      diabetes	‘get	check’	with	HBa1c<=8:
                                                       Maori 53       61.9 60.8 67.1 65
                                                      Other 72.4       74      74.6    77.2    83
                                                      Pacific 55.3     52.4    52.7    63.9    62
                                                      Total    65.4    65.8    67.5    72.7    76




Auckland District Health Board
                                                      Diabetes: Retinal Screening
                                                      Percent of people who have had their free annual
                                                      diabetes ‘get check’ with retinal screening recorded
                                                      within the last 2 years:
                                                       Maori 64.5 64           43.9 68         59
                                                      Other 68.2       66.4    53.6    75.9    60
                                                      Pacific 52.9     51.6    40.2    70.3    67
                                                      Total    62.7    61.1    48.5    73.7    62

                                 Reduced Impact of     Increase current breast screening rates for all groups PHO Performance Management Programme figures to April 08.            Achieved.
                                 some cancers         by 5%.




Appendix A
                                                      Breast screening rate (Sept. 06 figures)
                                                        •	‘High	needs’	38.6%	                                43% 'High needs' and
                                                        •	Overall	38.27%                                     43% 'Overall'
                                                      Increase current cervical screening rates for all      Screening numbers have increased from approximately 60% to 70% for    Achieved
                                                      groups over past years’ performance.                   eligible women. The high needs percentages for the same periods are
                                                                                                             50% to 58%
                                 Improved Treatment
                                 of cancers
                                                      Improved waiting times for CT scans and MRI                            Average wait    Average wait     Average wait time
                                                      imaging.                                                                   time            time             oncology
                                                      Acutes /Therapy course /Standard protocols/suspect                      oncology         oncology              all
                                                      tumour, CT scans and MRI imaging must be done                             urgent        non urgent            days
                                                      within the timeframe designated by the clinician.                          days            days
                                                      Non-urgent CT scan and MRI imaging waiting times
                                                                                                                  MRI               5              23                14            Not Achieved.
                                                      for CT scan - absolute maximum of 12 weeks waiting
                                                      and absolute maximum MRI of 16 weeks.                        CT               10             40                28            Achieved.
                                           All patients wait less than 8 weeks between First           Volumes for CT scans are higher than for MRI.
                                           Specialist Assessment and the start of Radiation            ADHB has capacity problems with both of these modalities.
                                           Oncology treatment (where appropriate and
                                           excluding Category D).




                     4.1.2   Improved child and youth health
                     PHO enrolment         90% of high needs groups enrolled with a PHO.         97% enrolment achieved.                                                     Achieved.
                     Immunisation cover    Provide information on ADHB Birth cohort and          The NIR datamart was unable to provide an immunisation coverage             Partially achieved.
                                           maintain NIR                                          report as at 30 June 2008 due to technical difficulties so this report is
                                                                                                 coverage as at 31 July 2008 compared to 31 July 2007.




Appendix A
                                           Work towards the target of 95% of 2 year olds fully                                                                               Partially achieved.
                                           immunised:
                                           70% children fully immunised at 6 months              59% at 6 months (42% Maori and 53% Pacific)
                                           80% children fully immunised by age 12 months         82% at 12 months (72% Maori and 82% Pacific)
                                           65% children fully immunised by age 18 months         66% at 18 months (52% Maori and 63% Pacific)
                                           80% children fully immunised by 2 years               74% at 2 years (65% Maori and 72% Pacific).
                                           80% DTaP vaccine dose three at one year of age        83%
                                           70% of children have received MMR dose 1 by 18        74%
                                           months
                                           Improved rates for Maori and Pacific over 2006-07     Compared to coverage at 31 July 2007, there have been some gains in
                                           figures.                                              coverage particularly at 2 years - an overall increase of 8% (7% Maori
                                                                                                 and 10% Pacific). However coverage at 6 months shows a 6% overall
                                                                                                 decrease. It is likely that this decrease is a result of a change to the
                                                                                                 Childhood Immunisation Schedule during the year.




Annual Report 2008
107
108
                                   Area of Activity        Targets                                                  Performance Recorded for 2007- 08                                         Degree of Achievement

                                 Oral health            Percentage of children caries free at 5 years:           Caries free at 5                                                          Partially achieved.
                                                        Total: 60%                                               Total 60%
                                                        Maori: 44%                                               Maori 45%
                                                        Pacific: 35%                                             Pacific 30%
                                                        Asian: 59%                                               Asian 58%
                                                        European: 80%                                            European 79%
                                                        Other: 80%                                               Other 66%.




Auckland District Health Board
                                                        Teeth of year 8 children decayed, missing or filled      Year eight DMFT                                                           Partially achieved.
                                                        (DMFT)
                                                        Asian: 1.1                                               Asian 0.9
                                                        European: 0.8                                            Euro 0.7
                                                        Maori: 1.5                                               Maori 1.6
                                                        Pacific: 1.8                                             Pacific 1.6
                                                        Other: 1.1                                               Other 1.0
                                                        Total: 1.1                                               Total 1.0
                                                        Progress towards 46% young people use of oral            For the calendar year ended 2007 we have 54.91% of the young people       Achieved.
                                                        health services.                                         using oral health services.




Appendix A
                                                        Ensure Auckland water supplies continue to be            ADHB is working closely with ARPHS on this issue and continues to seek    Partially achieved.
                                                        fluoridated with Onehunga targeted for fluoridation.     and engage in opportunities to keep Auckland's water fluoridated and to
                                                                                                                 get Onehunga's water fluoridated.
                                 4.1.3   Improve the health and independence of older people
                                 Ambulatory sensitive Remain below the national average.                         In the 07-08 year ADHB was 6% above the national average for ASH        Not achieved.
                                 hospitalisations (ASH) Reduction in ambulatory sensitive hospitalisations (by   admissions in the 65-74 year old age group. The actual figures were 71
                                                        International Classification of Disease (ICD10) codes    per 1,000 population. No national average target for this age group was
                                                        for 65-74 year olds.                                     set in 2006-07.
                                 Matching services to 10% reduction in number of assessments per person          4% reduction in number of assessments per person.                       Partially achieved.
                                 needs                  65+ requiring help.
                                                        Increase in number of people 85+ remaining in their      5% increase from previous year.                                           Achieved.
                                                        own homes.                                               ADHB has seen an increase in the number of assessments undertaken
                                                                                                                 in the past year, but given that this encompasses screening assessments
                                                                                                                 undertaken in primary care we consider this to be a favourable outcome.
                                                                                                                 ADHB has achieved a 1% reduction in admissions to residential aged
                                                                                                                 care in the past year which we attribute to various ageing in place
                                                                                                                 initiatives and an increased focus on the provision of home based care
                                                                                                                 and support.
                     4.1.4   Improved services for people with mental illness
                     Work towards Ministry                                                           Actual Access % for period 1 April 2007 to 31 March 2008.                Partially achieved.
                     of Health annual      Child and youth (for total: Maori and others) 1.8         1.42% - Children and Youth
                     access targets        Adults (for total: Maori and others)          2.6         2.79% - Adults
                                           Older people (for total: Maori and others)    3.15        3.11% - Older People
                     Results for people     90% of long-term clients have plans in place to help     Relapse Plans – compliance figure of 83% to the MoH at the end of 07-    Not achieved.
                     with enduring severe   prevent a relapse of the illness.                        08 financial year.
                     mental illness
                                            Reduction in percentage of adults with enduring          % of Adults with enduring serious mental illness and >2y since first     Not achieved.
                                            serious mental illness (after two years or more of       contact – at the end of 07-08 financial year 38% (06-07 37%) of all
                                            treatment since the first contact with a mental health   adults with open cases within our MH services met this criteria.
                                            service).
                                            Increasing number of long-term clients involved in   Recognising the importance of work in enhancing mental health and             Achieved.
                                            paid work or education/training.                     quality of life for all service, ADHB is working in partnership with Workwise
                                                                                                 Employment Agency. Workwise is a registered charitable trust that
                                                                                                 operates in six New Zealand regions. The project, which commenced
                                                                                                 Sept-06, involves Workwise Employment Agency providing a range of
                                                                                                 employment services initially to service users at Buchanan Rehabilitation
                                                                                                 Centre (BRC), and now in the four Community Mental Health Centres
                                                                                                 (CMHCs), and in Lotofale (Pacific Community Mental Health Service).
                                                                                                 This involves dedicated Employment Specialists employed by Workwise




Appendix A
                                                                                                 being attached to the services. Importantly, as clients move from BRC
                                                                                                 into community services, the employment specialist will maintain close
                                                                                                 collaborative relationships with their CMHC colleagues with a view to
                                                                                                 providing a seamless service for clients. Among the range of services
                                                                                                 provided through the project are practical help for clients in areas such as
                                                                                                 CV writing, applying for work and preparing for interviews.
                                            Implement some of the national KPIs within the 2006- KPI implementation has been subsumed within a broader ADHB                    Not applicable.
                                            07 KPI project.                                      indicators project.
                     Blueprint spend        Allocate 100% Blueprint funding as per the Annual    100% fully allocated per DAP initiatives for 2007-08.                         Achieved.
                                            Plan initiatives for 2007-08.




Annual Report 2008
109
110
                                   Area of Activity       Targets                                                  Performance Recorded for 2007- 08                                          Degree of Achievement

                                 4.1.5   Respond to high needs groups
                                 Implement the Treaty   Evidence of Tihi Ora Mapo and Maori Health               MHAC continues to meet monthly to provide governance and advice to         Achieved.
                                 of Waitangi            Advisory Committee involvement in all Planning and       the organisation. The MHAC is the mechanism of engagement with our
                                                        Funding initiatives to improve health gain.              Iwi partners – Te Runanga o Ngati Whatua.
                                                        Involvement of Treaty Partners in prioritising funding   Treaty partners involved in prioritisation planning and in Board and all   Achieved.
                                                        allocations                                              Committees.
                                                        Board members undertake Treaty of Waitangi training      An orientation day was held on 24 January 2008                             Achieved.
                                 Systematic approach    Update the Health Needs Assessment with 2006            Auckland DHB health needs assessment, web based, is in a constant           Achieved




Auckland District Health Board
                                 to inequalities        census data and reassess the inequalities identified    process of being updated and analysed so that inequalities and gaps in
                                                                                                                many areas are identified and parties alerted to these inequalities.
                                                                                                                Census 2006 data and many statistics reports were incorporated. New
                                                                                                                sections on Maori health, Pacific population and Asian population were
                                                                                                                developed and accessible on the web.
                                                                                                                To address the above identified inequalities in a systematic way, ADHB
                                                                                                                has formulated the “Inequalities group”.
                                                        Apply the national equity tool to address inequalities. The Inequalities group in year 07-08 was the major driver behind
                                                        Improved ethnicity reporting across all Auckland DHB incorporating the usage of health equity assessment tools (HEAT) in
                                                        services and the workforce                              our prioritisation tools. All proposals were scored against an agreed
                                                                                                                score sheet which included specific reference to how the proposal would
                                                                                                                address inequalities and how these were assessed using the HEAT tool.
                                                                                                                It is an expected routine for all managers to ensure any service they




Appendix A
                                                                                                                contract for addresses inequalities. This in an ongoing process. During
                                                                                                                07-08 the Inequalities group had identified that some of the workforce
                                                                                                                lack the understanding on how to use the HEAT tools.
                                                                                                                To ensure the HEAT tool be available, accessible and utilisable, the
                                                                                                                Inequalities group has decided to address this issue through training
                                                                                                                programmes in year 08-09.
                                                                                                                Non-specific NHI Ethnicity: ADHB is continuing to improve performance Partially achieved
                                                                                                                in this area through staff education and enhancement of our patient
                                                                                                                administration system which improved functionality used for ethnicity data
                                                                                                                capture. The ADHB 2007 non-specific ethnicity average was 5.9%, the
                                                                                                                2008 first quarter average was 3.7%, and the most recent data (May 08)
                                                                                                                was 3.1.
                                                                                                                ADHB ethnicity data will be required to align with Statistics New Zealand
                                                                                                                Statistical Standard for Ethnicity 2005. At present staff are asked to
                                                                                                                provide this information at the commencement of employment, but this
                                                                                                                is optional, making it difficult to know if ethnic participation rates have
                                                                                                                improved.
                     Maori health     All contracts due to expire in 2007-08 reviewed to    Ongoing funding and monitoring of Maori services to ensure agreed             Achieved.
                                      ensure service specifications address Maori health    objectives and contracts are met.
                                      need.
                                      Funding for Maori health and disability initiatives   The measures have changed between the years and we have just                  Not applicable.
                                      increased by 7%.                                      completed analysing current data to determine baseline expenditure.
                                                                                            There has however been new services funded and future funding track
                                                                                            (FFT) applied to current contracts on a portfolio basis.
                                      Establish a family violence prevention programme.     The Family violence Project (Hohou Rongo) has been approved and               Not achieved.
                                                                                            implementation is due to commence 2008-2009. Although not
                                                                                            achieved in the year, substantial progress was made.
                                      Maori cardiac rehabilitation initiative and Healthy   The Healthy Lifestyle program is fully operational and demand for the         Achieved.
                                      Lifestyle Planners (Ahua Ora) programme.              service is increasing.
                                                                                            There was some difficulty recruiting a nurse specialist for the Maori
                                                                                            Cardiac Rehab Initiative program, however this was filled late July 08.
                                                                                            The Community Health Worker employed earlier has been kept busy
                                                                                            working with Healthy Lifestyle Planners in the interim.
                                      All PHOs have Maori health plans approved.            All PHOs have produced Maori Health Plans, with Langimalie (Tongan            Achieved.
                                                                                            Health Society) and ProCare Network Auckland recently having updated
                                                                                            theirs.
                                      5% reduction in DNAs for Maori using provider arm     Work is ongoing with the Did Not Attend (DNA) Project, and the final          Not achieved.
                                      services.                                             report and implementation plan is expected in 2008-09.
                     Pacific Health   Parish Community Nursing services underway            The Auckland Pacific community project conducted four screenings with         Achieved.




Appendix A
                                      with cardio-vascular disease (CVD) and diabetes       104 risk assessments preformed through the PREDICT electronic decision
                                      screening programmes in place in churches.            support tool.
                                                                                            100 of these people received management advice. The final report for
                                                                                            this pilot project is due in September 2008. Information from this report
                                                                                            will be used to guide and develop screening activity within the Healthy
                                                                                            Village Action Zone project.
                                                                                            Additional screening has been conducted by one of the Healthy Village
                                                                                            Action Zones contractors providing extensive health screening for all
                                                                                            ages. This contractor is working to understand how this supports both
                                                                                            the Healthy Village Actions Zones and general practices within its service
                                                                                            structure. Feedback on this activity is provided through the HVAZ Joint
                                                                                            Management Team meeting.
                                      Improved rates of smoking cessation, breast and       A new Pacific Smoking Cessation service is in place. It will take some time   Partially Achieved.
                                      cervical cancer screening.                            before we have data to report against.
                                                                                            Cervical screening rates have increased.
                                                                                            January 2007 cervical screening rate 47%, June 2008 cervical screening
                                                                                            rate 55.5%.




Annual Report 2008
                                                                                            Breast screening rates have increased.




111
112
                                 Area of Activity     Targets                                              Performance Recorded for 2007- 08                                         Degree of Achievement

                                                                                                        January 2007 breast screening rate: 35.7%, June 2008 breast screening
                                                                                                        rate 43%.


                                                    Increase in numbers of people involved in           Key components/activities that churches are using the HEHA grant for       Achieved.
                                                    programmes that improve nutrition and physical      include: purchasing water coolers and scales; establishing vegetable
                                                    activity.                                           gardens/fruit trees; nutrition and Community Coach training for church
                                                                                                        members; and weekly aerobic sessions.
                                                                                                        A nutritionist has been employed to work alongside Healthy Village Action
                                                                                                        Zones (HVAZ) Parish Community Nurses, Primary Health Organisations,




Auckland District Health Board
                                                                                                        HVAZ Church groups, ADHB HEHA Manager and ADHB HVAZ Manager
                                                                                                        to promote HEHA within the HVAZ Church communities. A number of key
                                                                                                        activities achieved to date include:
                                                                                                          •	Working	with	HVAZ	Church	Health	Committees	to	process	and	award	
                                                                                                             ADHB HEHA grants to 30 HVAZ Churches
                                                                                                          •	Building	and	developing	collaborative	relationships	within	these	HVAZ	
                                                                                                             church communities
                                                                                                          •	Developing	a	HVAZ	HEHA	strategy	plan	for	implementation
                                                                                                           •	Implementing	programs	in	the	HVAZ	setting	to	build	personal	and	
                                                                                                             community healthy eating capacity and skills
                                                                                                           •	Participating		in	meetings	held	by	the		Manukau	Institute	of	
                                                                                                             Technology, Community Certificate Health Course to develop a HEHA




Appendix A
                                                                                                             course
                                                                                                           •	Foundation,	Pacific	Islands	Heart	Beat	nutrition	programme	Support	
                                                                                                             HVAZ Church members to enrol in the National Heart
                                                    Increase in Well Child checks, immunisation, hearing Well Child checks                                                       Achieved.
                                                    and dental checks for Pacific children.
                                                                                                         An overall increase in Pacific providers Well Child checks have been
                                                                                                         experienced over the past 12months.
                                                                                                         Hearing                                                                 Not applicable.
                                                                                                        Data not available
                                                                                                        Dental
                                                                                                         Percentage caries-free 5 year old children in ADHB for the period        Partially Achieved.
                                                                                                         2002-2006
                                                                                                         Ethnicity  2002         2003       2004        2005      2006
                                                                                                         Pacific    45.4%       50.5%          47.5%   34.55%     29.71%
                                                                                            Percentage caries-free 5 year old children in the Auckland Region
                                                                                            for the period 2002-2006
                                                                                            Ethnicity    2002       2003       2004         2005      2006
                                                                                            Pacific    49.6%       49.7%      49.0%      35.93%      32.55%
                                                                                            Immunisation                                                             Achieved.




                     Health gain for       Updated regional data available on refugee and    a) ADHB has been contributing to the process of identifying health       Achieved.
                     refugees and people   migrant health needs.                               needs of South Asian populations related to diabetes and CVD,
                     from South Asia                                                           undertaken by Dr Geeta Gala, Public health registrar, for the Ministry
                                                                                               of Health. Data was drawn from information systems in each of the




Appendix A
                                                                                               Auckland Metro DHB’s to show patterns of health service use by the
                                                                                               Indian population, the most sizable of the South Asian ethnic groups
                                                                                               living in the Auckland region.
                                                                                             b) A review of the literature related to refugee and migrant health
                                                                                               needs has been produced through the Auckland Regional Settlement
                                                                                               Strategy Health Work strand Steering Group.
                                                                                             c) ADHB funded a South Asian community organisation SWAASTHH
                                                                                               to conduct a workshop with 80 South Asian community members
                                                                                               (representing 10 south Asian communities) to better understand the
                                                                                               modifiable risk factors contributing to high rates of CVD and diabetes
                                                                                               in those communities.
                                                                                             d) A process evaluation of the ProCare Network Auckland Muslim
                                                                                               Women’s Swimming Programme was conducted




Annual Report 2008
113
114
                                 Area of Activity     Targets                                              Performance Recorded for 2007- 08                                           Degree of Achievement

                                                    Improve refugee data collection in PHOs.             Some PHO / Practices have made changes to their information systems        Partially achieved.
                                                                                                         to enable them to capture information about their refugee populations
                                                                                                         and have made good progress in collecting that information. Others
                                                                                                         have been unable to change their systems for reasons related to cost
                                                                                                         and difficulties in getting these on the agenda of software vendors.
                                                                                                         People being unwilling to declare their refugee status to Practices is
                                                                                                         another issue, as is the lack of documentation being available to show
                                                                                                         this (particularly in the case of family reunion refugees who are granted
                                                                                                         Permanent Residency status in a way that is undifferentiated from




Auckland District Health Board
                                                                                                         migrants). Recent discussions with the Ministry of Health on this matter
                                                                                                         have highlighted the need for a different approach to improving refugee
                                                                                                         data collection, regarding which discussions are in the very early stages.
                                                    Expanded interpreter services available in primary   Funding was secured in May 2008 for a Primary Health Interpreting          Partially achieved.
                                                    care.                                                Pilot through a Budget Bid to Cabinet. The Pilot will run for 2 years, and
                                                                                                         is being rolled out to selected General Practices from 1 August 2008
                                                                                                         through the ADHB. A Primary Health Interpreting Pilot through a Budget
                                                                                                         Bid to Cabinet. The Pilot will run for 2 years, and is being rolled out
                                                                                                         to selected General Practices from 1 August 2008 through the ADHB
                                                                                                         Interpreter Service.
                                                                                                         Funding was also secured for a workforce development initiative targeting
                                                                                                         health professionals working in primary and secondary services, to
                                                                                                         increase their cultural competency to deal with clients from refugee and




Appendix A
                                                                                                         migrant backgrounds. Implementation planned for January 2009.
                                                    Improved rate of refugee and South Asian             ADHB held a forum with South Asian community members in February           Achieved.
                                                    involvement in detection and treatment of CVD and    2007 to highlight the high prevalence of CVD and diabetes in those
                                                    diabetes.                                            communities, and to develop with them an action plan to respond to
                                                                                                         those needs.
                                                                                                         A follow-up forum was held in August 2007, at which developments
                                                                                                         since the February 2007 Action Plan were presented to the community
                                                                                                         for comment and feedback. Developments in service delivery in ADHB
                                                                                                         provided and funded services were highlighted, A significant development
                                                                                                         was the funding for and appointment of a Diabetes Nurse Specialist
                                                                                                         charged with increasing the capacity and capability of the ADHB Diabetes
                                                                                                         Centre, and General Practice, to work with South Asian community
                                                                                                         members to better manage diabetes. A new diabetes self management
                                                                                                         programme was also profiled.
                                                                                                         In June 2008 another forum was held to again update South Asian
                                                                                                         communities about developments in matters related to South Asian
                                                                                                         Diabetes and CVD. Dr Geeta Gala’s CVD and diabetes related health
                                                                                                         needs assessment was presented.
                                                                                                         A series of 10 Healthy Cooking classes were funded and provided in
                                                                                                         2007 targeting refugee women. The classes were a vehicle for delivering
                                                                                                         key nutrition messages.
                                           Focus on actions under the Auckland Settlement         A project for Disability Support Services targeting children and adults      Not achieved.
                                           Action Plan; Goal 4. Improve Physical and Mental       in refugee and migrant communities is in the planning stages with
                                           Health Outcomes.                                       implementation anticipated in October 2008.
                     Disabled people       All planning, funding and service development work     Key partnerships have been strengthened and new partnerships                 Partially achieved.
                                           reflects a disability perspective.                     established including Lu’i Ola Pacific Disability Group, plus a funders
                                                                                                  group sponsoring extensive research and resulting activity with AUT and
                                                                                                  Auckland City Council.
                                            Research completed on the disabled population to      This research is on track to be released in late October 2008.                Not achieved.
                                            establish needs, barriers to service, service use, and
                                            gaps.
                                            Auckland DHB staff have opportunities for training     A training programme will be developed as a result of the research           Achieved.
                                            aimed at improved understanding of disability needs. findings, which focuses on disabled as users of health service and will
                                                                                                   inform and focus the training requirements.
                                            Funding and boundary issues resolved for people        Improved relationships between Disability Services Directorate DSD (MOH Partially achieved.
                                            under 65 years re service links and the provision of   funder) plus a shift in thresholds for access to equipment has assisted with
                                            equipment.                                             clearer processes and with faster resolution of exceptional circumstance
                                                                                                   cases.
                                                                                                   Issues in relation to non-devolved services have improved with the
                                                                                                   introduction of the Interim Funding Pool. Whilst this has improved access
                                                                                                   to services for those clients which were previously unclear due to the
                                                                                                   boundary, there remains outstanding definition and policy concerns which
                                                                                                   we hope will be resolved in the coming year.




Appendix A
                     4.1.6   Improve the rate of elective services
                     Match performance     Get more information to establish the right mix of     ADHB has developed initial information on levels of elective services that   Achieved.
                     to need               services for local need.                               are required to improve the elective surgical intervention rates closer
                                           Improve intervention rates for Maori and Pacific and   to the national rates. The Elective throughput volumes for the ADHB
                                           where other inequalities exist.                        population has improved by over 20% over the last 2 years (2006-07
                                                                                                  and 2007-08). The waiting times for access to outpatients and elective
                                                                                                  surgery have continued to improve as the impact of the increased
                                                                                                  elective throughput has occurred. We have analysed some specialities
                                                                                                  for interventions at the ethnicity level and this shows that access for
                                                                                                  Maori and Pacific people is higher than the national averages for those
                                                                                                  populations in those specialties. This would suggest that our increased
                                                                                                  elective intervention levels are reaching populations with poor health
                                                                                                  status or access to services.




Annual Report 2008
115
116
                                   Area of Activity       Targets                                                Performance Recorded for 2007- 08                                                Degree of Achievement

                                 Waiting times within   Meet elective services performance indicators for      ESPIs                              Threshold     ADHB           Actual          Achieved.
                                 guidelines             procedures under Ministry of Health guidelines.                                           for           Target
                                                        Maintain compliance in all Elective Services Patient                                      compliance
                                                        Flow Indicators (ESPIs).                               1. communication of
                                                                                                               referral acceptance/ or non-
                                                                                                               acceptance/triage status within        > 90%        > 90%           100%
                                                                                                               10 working days to patient and
                                                                                                               GP/referrer
                                                                                                               2. patients waiting longer




Auckland District Health Board
                                                                                                               than six months for their first         < 2%         < 2%            0.4%
                                                                                                               specialist assessment (FSA)
                                                                                                               3. patients waiting without
                                                                                                               a commitment to treatment
                                                                                                                                                       < 5%         < 5%            0.9%
                                                                                                               whose priorities are higher than
                                                                                                               actual treatment threshold (ATT)
                                                                                                               4. clarity, certainty of plan of
                                                                                                               care / no patients on residual             Nil            Nil             Nil
                                                                                                               waiting lists
                                                                                                               5. patients given a commitment
                                                                                                               to treatment but not treated            < 5%         < 5%            2.2%
                                                                                                               within six months




Appendix A
                                                                                                               6. patients in active review who
                                                                                                               have not received a clinical
                                                                                                                                                      < 15%        < 15%            5.5%
                                                                                                               assessment within the last six
                                                                                                               months
                                                                                                               7. patients who have not been
                                                                                                               managed according to their
                                                                                                                                                       < 5%         < 5%            1.5%
                                                                                                               assigned status and who should
                                                                                                               have received treatment
                                                                                                               8. percentage patients
                                                                                                               treated prioritised on national        > 90%        > 90%          96.6%
                                                                                                               recognised tool
                                                                                                               The table below illustrates ADHB’s performance against overall elective         Partially achieved.
                                                                                                               targets:
                                                                                                               ADHB Population                                                  Actual
                                                                                                                                           Base        Add        Total
                                                                                                               Elective CWDs               10,366      1,525      11,891        11,448
                                                                                                               Estimated elective          10,869      1,573      12,441        9,789
                                                                                                               discharges
                                              Introduce alternative service delivery options for      During 2007/8 the Regional Service Planning Ophthalmology project has Partially achieved.
                                              ophthalmology.                                          completed a review of intervention rates and access to acute and elective
                                                                                                      Ophthalmology services.
                                                                                                      Proposals will be taken to Regional CEOs to refine access to acute
                                                                                                      services, thus reducing the level of burden on the present acute service.
                                                                                                      Elective access within the Auckland Metro region is consistent with
                                                                                                      national averages. Demand will continue to grow due to the level of
                                                                                                      chronicity associated with a number of ophthalmic conditions such as
                                                                                                      glaucoma. Additional clinic and theatre capacity options are presently
                                                                                                      being evaluated to provide for the forecast growth in Ophthalmology
                                                                                                      services. This evaluation includes an operational and financial
                                                                                                      impact analysis of increased central capacity versus the provision of
                                                                                                      ophthalmology services locally by the regional provider. This business
                                                                                                      case will be to relevant DHB Boards by late 2008.
                     Initiatives              Total annual volume of 656 hip and knee joint           Joints 483                                                                Not achieved.
                                              replacements.
                                              Total annual 1038 cataract procedures.                  Cataracts 1146                                                              Achieved.
                     4.2.1     Service quality and safety
                     Clinical quality         Improve clinical governance of quality and safety       Reviewed all recent Root Cause Analysis events and have compiled a          Partially achieved.
                                              using clinical indicators.                              database of recommendations which will lead to implementation of
                                                                                                      specific quality improvement projects. Data from the data base will be




Appendix A
                                                                                                      reported to and reviewed regularly by the Clinical Board along with a set
                                                                                                      of key performance indicators.
                                              Improved management of reported incidents               The Sentinel Event Review committee has been launched and all Serious       Achieved
                                              including risk management strategies                    & Sentinel Events are reviewed regularly, including a monitoring of the
                                                                                                      outcomes
                                                                                                      Purchased and distributed additional licenses for the incident
                                                                                                      management system to include Clinical Directors.
                                                                                                      Have integrated a risk management framework against each reportable
                                                                                                      event where each risk is reviewed and scored.
                                                                                                      ADHB contributed to the national Sentinel Event review run by the MOH.
                                              Hospital Acquired Bloodstream Infections (per        Hospital Acquired Bloodstream Infections (per thousand inpatient               Achieved
                                              thousand inpatient admissions) <6.8                  admissions)		=	5.3
                     Number of falls in       Reduce numbers of falls while in care to under 1,000 Falls	in	hospital	2007-08	=	1,225                                              Not achieved
                     hospital                    2002-03 2003-04 2004-05                 2005-06
                                                       856        1082         1183            1164




Annual Report 2008
117
118
                                   Area of Activity        Targets                                                  Performance Recorded for 2007- 08                                             Degree of Achievement

                                 Customer satisfaction Overall weighted satisfaction per customer survey          Patient Satisfaction                                                          Achieved
                                                       >89%
                                                       Complaints resolved < 30 days                              =89%	Inpatients
                                                         >65.0%                                                   =91%	Outpatients
                                                                                                                  Complaints resolved < 30 days                                                 Not achieved
                                                                                                                  =	42%
                                 Medical indicators of   To improve triage times for category Four patients, to                                                                                 Partially achieved




Auckland District Health Board
                                 quality                 closer
                                                         to the Adult/Child Emergency Medicine (ACEM)
                                                         threshold rate.




Appendix A
                                                                                                                  Adult Emergency Medicine - There is a medium term project to improve
                                                                                                                  triage times for both category 4 and 5 patients through recruitment and
                                                                                                                  training of nurse practitioners
                                                                                                                  Child Emergency Medicine - Child Emergency Medicine experienced the
                                                                                                                  busiest winter for several years, with the added difficulty of reduced bed
                                                                                                                  availability for acute admissions due to construction/maintenance activity
                                                                                                                  and nursing staff shortages. This led to longer stays for children in Child
                                                                                                                  Emergency Department and reduced time for managing new arrivals in
                                                                                                                  the department.
                     Data provided to the    Less than or equal to 1% of NHI duplicates require      Duplicate	NHI’s	=	6.96%.                                                     Not Achieved.
                     National Collections    merging by NZHIS per DHB per quarter.
                     Systems
                                             Less than or equal to 3% of the total number of         “Other”	=	4.65%                                                              Not Achieved
                                             NHI records are created with ethnicity status of ‘Not   “Not	stated”	=	17.1%
                                             Stated’ or ‘Other’ per DHB per quarter                  High numbers of referrals to screening databases received without
                                                                                                     ethnicity details
                                          Less than or equal to 4% of the number of discharge        Error	DRG’s	=	0.25%                                                          Achieved.
                                          events with an error DRG
                     4.2.2   Human resource management
                     Staff recruitment and   Improve staff retention through targeted programmes. The following programmes were implemented to help improve Staff                 Partially Achieved.
                     retention                                                                    Retention in the 12 months to June 2008.
                                                                                                  X-Factor - June 2008– Internal Talent Show for Staff
                                                                                                     Celebration Week - Nov 2007 - a way to acknowledge the commitment
                                                                                                     and dedication of staff, while celebrating our achievements in education,
                                                                                                     research and innovation. The week aims to create a warm and positive
                                                                                                     atmosphere around ADHB in the lead up to the holiday season.
                                                                                                     Interdepartmental Pub Quiz Challenge in which teams were pitted against
                                                                                                     each other in a test of general knowledge
                                                                                                     Long Service Awards - Those who have been with ADHB more than 30
                                                                                                     years are acknowledged in a special ceremony.




Appendix A
                                                                                                     Goodwill Greet and Treat - staff receive a treat and add goodwill stars to
                                                                                                     the Christmas tree to be in to win a hamper for their department.
                                                                                                     Alumni Programme – for ex employees to join and continue to be part of
                                                                                                     ADHB
                                                                                                     Staff Benefits – special deals for all staff to participate in were put on
                                                                                                     website
                                                                                                     Value recognition NOVA awards – rewarding staff for going the extra
                                                                                                     mile.
                                                                                                     Networking functions for new employees.- building communities of
                                                                                                     employees
                                                                                                     State of Nation - To help communicate our organisation’s direction,
                                                                                                     successes and challenges, Garry Smith (CEO) hosts six-monthly 'State of
                                                                                                     the Nation' addresses to keep everyone updated on what's happening.




Annual Report 2008
119
120
                                   Area of Activity     Targets                                                Performance Recorded for 2007- 08                                          Degree of Achievement

                                                                                                            NOVA monthly printed magazine. The magazine features a Directions
                                                                                                            page from our Chief Executive and Board, a Getting to Know page for
                                                                                                            changes in the organisation, Inside Health with a column from our Chief
                                                                                                            Medical Officer, a Community page on our PHOs and other services,
                                                                                                            a Projects and Events page, and an ADHB people page featuring
                                                                                                            successes of our people. Distributed to staff and community/government
                                                                                                            stakeholders.
                                                                                                            International Nurses Day – To thank Nurses for their contribution to ADHB
                                                                                                            Orientation/Welcome Days – Full day of speakers and orientation to the




Auckland District Health Board
                                                                                                            organisation lead by the CEO
                                                                                                            Round the Bays – ADHB have a tent and supply refreshments to staff who
                                                                                                            enter Round the Bays.
                                                      Maintain voluntary staff turnover at or under 12%     Turnover 07-08:- 14.7%.                                                     Not achieved.
                                                      (turnover 12% for 2006-07).
                                 Manage leave and     Reduce the sick leave rate for high users (people     Sick Leave 07-08 - 3.3% - data not accessible on higher users.              Not achieved.
                                 lost time            using more than 50% of allocated sick leave
                                                      annually).
                                                      2006-07 sick leave rate 2.4% ( whole organisation
                                                      over 6 mths).
                                                      2005-06 sick leave rate 2.4% over all organisation.
                                                      Manage injury rates. Workplace injuries. Lost time    Lost time injury rate - 6.3.                                                Achieved.




Appendix A
                                                      injury frequency rate 7.0.
                     4.2.3   Productivity and efficiency
                     After hours model of    Increase in surgical bed turnover.                  Total surgical discharges in 07-08 increased by 3.9% from 06-07 (06-07 Achieved.
                     care,                                                                       discharges 42881 07/08 discharges 44574)..
                     Productivity planning   Reduced surgery cancellations and theatre downtime. Overall cancellations – no change @12.8%.                              Not achieved.
                     and Surgical process
                     review
                                             Reduced waiting lists, length of stay and DNA rates.   Waiting Lists:                                                        Not achieved.
                                                                                                    Overall number waiting June 07        5,471
                                                                                                    Overall number waiting June 08        6,058
                                                                                                    Length of Stay:                                                       Not achieved.
                                                                                                    All services
                                                                                                    ALOS 06-07 – 2.86
                                                                                                    ALOS 07-08 – 2.92
                                                                                                    DNA Rates:                                                            Achieved.
                                                                                                    2006-07 - 8.5
                                                                                                    2007-08 - 7.6
                                             Operating room (OR) internal efficiency measures       Number of cases per FTE: 67 in 07-08; 66 in 06-07; 63 in 05-06        Achieved.




Appendix A
                                             meet benchmarks.
                                                                                                    Number of OR mins per FTE: 5,665 in 07-08; 4,625 in 06-07; 4,512      Achieved.
                                                                                                    05-06
                                                                                                    OR utilisation overall:     89% (benchmark 80-85%)                    Achieved.
                                             Discharge forecasting is accurate.                     Discharge forecasting is undertaken by the 24 Hour Centre dedicated   Not Achieved.
                                                                                                    Analyst, forecasting is believed to be more accurate.


                                             Staff resources managed: Nursing and Clinical hours NHPPD for 1 July 07 – 30 June 08.                                        Achieved.
                                             per patient day (NHPPD).
                                                                                                                           Target NHPPD           Actual NHPPD
                                                                                                    Cardiac                6.66                   6.35
                                                                                                    Children               9.01                   7.50
                                                                                                    Medical                6.43                   6.08
                                                                                                    Surgical               7.19                   7.09




Annual Report 2008
121
122
                                    Area of Activity      Targets                                                  Performance Recorded for 2007- 08                                             Degree of Achievement

                                 4.3.1    Strong financial management
                                 Improve responsibility Adhere to debt repayment programme.                     $10.5 million was repaid to Crown Health Financing Agency 15 March            Achieved.
                                 in financial                                                                   2008 fulfilling the debt re payment obligation.
                                 management
                                 Staff Costs            Average of wage settlements agreed during 2007-08       Wage settlements during 2007-08 have largely been driven by the impact Not achieved.
                                                        to	have	‘headline’	increase	<=	FFT	(future	funding	     of the NZNO settlement in the first half of the financial year. This set a
                                                        track).                                                 benchmark above FFT and other settlements have followed.
                                                        Reduce overpayments to staff by 50% from 2006-07        Overpayments were reduced by 28%.                                          Not achieved.




Auckland District Health Board
                                                        levels.


                                                        Administration	costs	to	be	maintained	at	<=	10.5%	 Administrative	costs,	as	a	%	of	provider	revenue	for	07/08	=	9.5%.                 Achieved.
                                                        of provider revenue (Ministry benchmark).


                                 Demand driven costs    Manage demand driven community laboratory and           Community Labs and Pharmacy Costs:                                            Achieved.
                                                        pharmaceutical costs.
                                                                                                                                            Budget             Actual
                                                                                                                                              $m                  $m
                                                                                                                 Laboratories                72.5                72.5
                                                                                                                Pharmaceuticals              95.6                93.5




Appendix A
                                 Facilities             Environmental projects in place to reduce energy use Increase patient throughput, and increasing staff number has seen a              Not Achieved.
                                                        with energy costs to below 2006-07 costs.              related increase in utilities usage.
                                                                                                               Over the last 8 years ADHB has implemented many energy saving
                                                                                                               initiatives, further savings will be at the margin from new technology. eg.
                                                                                                               photo galvanic cells (solar to electric).
                                                                                                               We have been successful in negotiating a 20% reduction on cost of              Achieved.
                                                                                                               natural gas, and limited the increase of the price of electricity to 1.8% of
                                                                                                               Budget.
                                 Problems related to    Resolve problems associated with the Population        Participated actively in a National review process in conjunction with         Not applicable – outcomes not
                                 the funding formula    Based Funding Formula.                                 our Regional partners. Final outcomes will be issued by MoH after              yet known.
                                                                                                               consultation process completed and considered.
                                                        Resolve problems associated with the tertiary adjuster Participated actively in National Pricing Programme (MoH/DHBNZ                 Partially achieved.
                                                        to ensure tertiary hospitals are fairly recompensed,   project) over last two years to ensure IDF prices and Tertiary Adjuster are
                                                        retain the viability of specialty 24/7 services.       reasonable for major IDF providers. Partial success with no progress on
                                                                                                               timely uplift of prices for wage award increases.
                                                                                                               Work on 24/7 services not pursued as inconsistent with National Pricing
                                                                                                               approach.
                     4.3.2   Productivity and clinical effectiveness
                     Costing systems and     Improvements in the costing system and business       Significant improvement in patient event level data which was supplied         Achieved.
                     coding                  intelligence systems.                                 on non-inpatient purchase units this year to the MOH. Costing accuracy
                                                                                                   has also improved as a result of Decision Support’s ongoing audit and
                                                                                                   improvement program.
                                             100% accuracy of classification into ADHB             Inpatients are accurately defined by DHB and purchaser but Outpatients         Not Achieved
                                             population, DHB referrers, ACC and overseas           are still not 100% accurate. Work is continuing on getting the data
                                             patients.                                             necessary to define outpatients accurately.
                                             Refine our purchase unit reporting by revenue and     Profit and loss reports by purchase unit have been distributed for the first   Achieved
                                             cos                                                   6 months of 2007-08. The full year reports will be distributed after the
                                                                                                   12 month costing run is completed.
                     Revenue management Recommendations of the Coding Review to enhance            Recommendations were made on the following:
                                        decision making all implemented
                                                                                                   Address clinical coder workforce shortage
                                                                                                   Address incomplete discharge documentation
                                                                                                   Address inadequate record availability post discharge
                                                                                                   Address data quality issues
                                                                                                   Enable coding on discharge
                                                                                                   Documentation for accurate assignment of WIES




Appendix A
                                                                                                   Recommendations in all these areas are partially complete and ongoing.         Partially achieved
                     Procurement             40 key suppliers managed through quarterly business ‘Top 40’ continue to be managed through the business review process.          Achieved.
                                             review process.
                                                                                                 Reporting has yet to be concluded. An early draft has been developed
                                                                                                 however completion is awaiting:
                                                                                                   •	The	establishment	of	a	supplier	performance	reporting	process,	which	
                                                                                                      is currently being piloted with one supplier.
                                                                                                   •	A	strategic	review	of	which	suppliers	should	be	managed	through	this	
                                                                                                      business review process.
                                             Participate in DHBNZ purchasing initiatives.        ADHB Materials Manager, as a member of the Procurement Steering               Achieved
                                                                                                 Group, has been actively engaged and provided feedback to the
                                                                                                 initiative. In addition he has participated in the request for proposal (RFP)
                                                                                                 for National Procurement Strategy
                                                                                                 ADHB has participated in all the collaborative purchasing programmes
                                                                                                 through DHBNZ.




Annual Report 2008
123
124
                                   Area of Activity      Targets                                                 Performance Recorded for 2007- 08                                       Degree of Achievement

                                 New technology        All new technology introduced through the               New Technology progressed after a rigorous capital and expenditure      Achieved
                                                       prioritisation process and with funds attached (with    process involving services, general managers and finally the Board.
                                                       help from Clinical Practice Committee and SPNIA)        Services with National implications e.g. positron emitting tomography
                                                                                                               (PET) scanning was subjected to the National SPNIA process (still being
                                                                                                               evaluated).
                                                                                                               Bariatric Surgery went to SPNIA and our own Clinical Practice Committee
                                                                                                               continued its work (funded through WEIS system).
                                 4.3.3   Manage contracts and volumes




Auckland District Health Board
                                 Meet budget targets   Volumes within contracted levels with volumes split     Provider volumes exceeded contracted volumes for both ADHB and IDF
                                 for treatment         into                                                    cases.
                                                       1) ADHB residents.                                                                                                             1) Achieved.
                                                                                                               DRG Funded              Contract -WIES       Actual - WIES

                                                       2) Interdistrict flow volumes at 100% of contract and   ADHB                    53,700               53,839                    2) Achieved.
                                                       costs within budget.                                    Interdistrict Flows     53,491               54,224
                                                                                                               Non DRG Funded          Contract             Actual
                                                                                                                                       $m                   $m
                                                                                                               ADHB                    165                  166
                                                                                                               Interdistrict Flows     164                  165




Appendix A
                                                       Costs recovered from ACC and others                     ACC revenue was ahead of budget                                        Achieved.
                                                                                                                                      Budget        Actual
                                                                                                               ACC revenue           $13.0m         $14.3m
                                                       Monthly meetings to manage IDF customers and            Monthly relationship manager meetings have taken place throughout      Achieved.
                                                       variations agreed through the DHB of domicile           2007-08
Appendix A   Annual Report 2008   125
126   Auckland District Health Board
Annual Report 2008   127
Private Bag 92024
Auckland Mail Centre
Auckland 1142
New Zealand
www.adhb.govt.nz


EDITOR: Internal Communications (Sneha Paul)
GRAPHICS: Medphoto & Graphics (Aaron Pratt, Fiona Dorrell)
PHOTOGRAPHY: Medphoto & Graphics (Treve Dromgool, Steven Dakin)
ISSN NO: 1234 5678

				
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