It’s a nickname the nurses of Waikato Hospital’s Patient Blood Management (PBM) team can laugh about as one part of their job is to ‘sniff out’ and reduce blood product wastage.
But the service’s wider mission is ‘promoting and supporting everything blood’ and its ethos is that every drop of blood – whether a patient’s own or donated – is a valuable resource and should be respected as such.

Russelle Westleigh, one of the three senior nurses working for Waikato District Health Board’s thought-to-be-unique PBM service, says they see themselves as advocates for the people who donate blood, the patients needing blood support, and the DHB that spends about $13 million a year on blood products.

The team was founded in 2015 under the clinical lead of anaesthetist Dr Scott Robinson and works closely with the New Zealand Blood Service to try and reduce unnecessary blood transfusions and keep staff informed about ‘everything blood’. The team’s work includes pre-operative anaemia (POA) assessment to help boost patients’ haemoglobin and iron stores; educating doctors and nurses on transfusion best practice; and looking for ways to minimise blood loss.

The ‘bloodhounds’ have been effective. Julie Retter, a senior nurse who has been with the team since it started, told the recent Clinical Nurse Specialist Society conference that in its first year the team’s work saved the DHB around $2.4 million.

Treating pre-operative anaemia

Transfusions are one of the most overused treatments in modern medicine, says Retter.
The former midwife and women’s health nurse says research shows that people do much better if they “keep their own blood in their own veins”. Unnecessary transfusions not only increase the risk of adverse transfusion reactions or infections, but also use up the limited, and costly, resource that is donated blood.

So ensuring that a patient’s blood is as good as it can be before elective surgery in order to reduce the need for blood transfusions is a major role for the team’s nurses because alongside the increasing numbers of older patients requiring hip and knee surgery is an increase in anaemia.

Patients at risk of pre-operative anaemia are identified at the anaesthetic assessment clinic and the PBM team ensures that those with anaemia are put on oral iron – and sometimes IV iron – so they have boosted haemoglobin and ferritin levels before they go into theatre.
“So the chances of them requiring a blood transfusion just because they are anaemic is really quite reduced,” says Retter.

And the research shows that getting through surgery without needing a transfusion shortens patients’ lengths of stay and reduces their risks of readmission through infections and other complications.

Fast-track cancer patients are usually given iron infusions of ferric carboxymaltose, as they need to be ready for surgery within a month, but hip and knee patients are often given oral iron for the two months or so before their surgery is scheduled.

In 2016 the PBM team had 1,153 patients go through its pre-operative anaemia service, with 146 receiving some form of treatment and monitoring before their surgery. An average of 66 patients every three months had their GPs contacted regarding their anaemia and some patients had surgery delayed due to more life-threatening conditions being diagnosed.

‘Why use two, when one will do?’

The aim is not only to keep people’s own blood in their veins, but also not to waste blood that other people have donated.

So now blood products having to be ‘binned’ will see a PBM team nurse turning up on a ward to find out why.

This led to the nickname ‘bloodhound’ and sometimes being seen as a “little bit precious”, says Westleigh, a former orthopaedic nurse.

But Westleigh and Retter stress that their job is not about blaming busy nurses on the ward but about taking a patient-centred approach to educating staff about good transfusion practice and making the point that donated blood is precious in more ways than one.
“Some person has walked off the street and given that blood in good faith that it will be used to help someone,” says Retter.

Blood is also a substantial cost to the DHB. ‘Why use two, when one will do?’ – a slogan adopted by a 2010 Auckland DHB evidence-based project to promote the use of single unit transfusion of red blood cells (RBC) rather than the formerly routine two – is also being used by Waikato. The DHB now has a policy that, apart from critical or trauma patients, the norm should be a single unit transfusion and the patient then being clinically reassessed before deciding whether a second unit is needed.

Not only does the research indicate that the risk of adverse effects increases with every unit transfused but, if a transfusion for any reason does not go ahead, the blood bank only allows a half-hour window for ‘redepositing’ a blood unit back in the bank – otherwise it is discarded. “If you are a minute over, you’re a minute over and the unit gets discarded,” says Retter. (Blood units can be safely transfused within four hours of leaving blood bank refrigeration.)

Thinking twice about taking blood samples

Educating doctors and nurses to think twice about whether blood tests are appropriate is another plank of the team’s work.

A blood test takes up to 5ml of blood a time and Retter says some of its ICU patients can have 15–20ml a day taken from them.

“That 15–20ml can drop your haemoglobin quite dramatically – particularly in some of our elderly patients,” says Retter. “If you keep taking blood tests off patients, then all of a sudden you may have a patient with anaemia you’ve got to treat.”

She says historically such tests were just done without a second thought and the team’s job is to encourage people to stop and think, “Do they really need all that blood?” or “Is that test necessary?”

“We are challenging those historic practices.”

And if a patient is anaemic, they may encourage clinicians to do a ‘micro-collect’ which involves taking a much smaller amount of blood, as they would for a baby. “It [a micro-collect] is not the ideal, but sometimes we need to go outside the ideal for a patient. It is doable, but we wouldn’t expect them to do it for every patient.”

But there are some patients that require clinicians to look outside the norm – including, adds Westleigh, Jehovah’s Witness patients who have indicated they won’t accept some blood products, which puts limitations on the treatments available if the patients become severely anaemic. “So we try and prevent them from becoming anaemic in the first place, like preventing too much blood-taking.”

It’s all part of the brief for nurses whose job is ‘everything blood’. The results to date have been a steady downward trend since the service began in RBC usage per patient discharge – saving both dollars and drops of that precious donated blood for patients who need them.

SOME BLOOD FACTS

• There are around 147,000 donations a year.
• About 111,000 people are active donors.
• Hospitals need 3,000 donations a week to meet medical demands.
• Around 29,000 people a year are helped by blood donations.
• There has been a national reduction in the demand for red blood cells since 2010.
• There has been an increased demand for blood products made from plasma, including fresh frozen plasma, cryoprecipitate and intravenous immunoglobulin.
• Blood products are used for: accident victims 18 per cent; orthopaedic surgery 7 per cent; other surgery 11 per cent; heart disease 8 per cent; liver and kidney disease 6 per cent; other medical conditions 12 per cent; babies and pregnant women 6 per cent; and children 3 per cent.

Source: New Zealand Blood Service website: www.nzblood.co.nz.

In 2015 the Waikato District Health Board clinical nurse specialist received a Heart Foundation research grant to undertake a study alongside co-investigator Debbie Chappell on the link between health professional empathy and patient self-care.

In June she leaves the Coromandel, where she works as part of Waikato DHB’s nurse-led integrated heart failure service, to present the findings at the EuroHeartCare congress in Dublin.

The Wintec-trained nurse, who has a Master of Science and a PhD from Berlin’s Charité University Hospital, says heart failure care is about supporting people’s self-care skills.

“People need to know what to do to keep themselves well,” Inkrot says. “When a patient becomes unwell, education and support are key [to] getting well again.

“We know that in combination with medical treatment self-care can play a major role in preventing deterioration and hospitalisation for people with a chronic condition such as heart failure. What we’re not sure on is what ingredient it is that makes or breaks a person’s ability to self-care.”

Inkrot’s research examines the levels of empathy perceived during consultations between health professionals and their patients. “Is there a correlation? My hypothesis was that higher perceived empathy leads to higher self-care ability.”

Patients were asked to rank their ability to self-care, as well as whether they thought their health practitioner was empathetic towards them. She also asked practitioners to complete the survey to see if a patient’s perceived ability to self-care matched the practitioner’s thoughts.

Data on Māori patients was also analysed during the cross-sectional study. “We know that, statistically speaking, Māori patients generally have lower healthcare outcomes, so that part of the research was very important,” she says.

Inkrot believes her research has the potential to benefit many New Zealanders, not just those living with heart failure.

“Every New Zealander is likely to have encounters with healthcare providers at some point in their lives. I’m hoping to encourage clinicians to use the power of interpersonal connections in their interactions with patients.”

NZ’s only nurse-led community heart failure service

Inkrot has also recently heard that she has been nominated by European Society of Cardiology (ECS) as a finalist for the ESC Nursing and Allied Professions Investigator Award and in August will get to present some of her results at the ESC congress in Munich – one of the largest of its kind in the world.

The research that she’s sharing on the world stage was carried out while doing her day job as a CNS offering heart failure clinics across the Coromandel Peninsula.
She is one of six CNS working for the Waikato Integrated Heart Failure Service’s nurse-led service, established in 2009, which aims to increase access to heart failure services in the community.

Inkrot first worked in cardiology and internal medicine at Waikato Hospital after graduating from Wintec in 2002. The bilingual nurse grew up in Germany and in 2004 went to Germany to work as a district nurse and then on to agency nursing in London – mainly in cardiology, oncology and A&E.

She moved to Berlin in 2007 to take up a Charité University Hospital research position in cardiology as lead nurse trial coordinator, during which she completed her Master of Science in Nursing and started her PhD (which she completed when back in New Zealand). In 2012 she returned to help develop the Waikato heart failure service, including setting up the service on the Coromandel Peninsula.

Inkrot says the service is the only one of its kind in the country. “While most DHBs have heart failure services, we’re the only one out there in the community, where the people are.”

The nurse-led service’s home is Waikato Hospital’s cardiology department but offers CNS services – including expert care, support and education – in the wider Waikato community. Only the three CNS serving the Hamilton city area are based at Waikato Hospital with the other three based in Tokoroa, Te Kuiti Hospital and Inkrot at Thames Hospital.

“We want to improve outcomes for patients. GPs can refer to us, and we work with patients that have already been admitted too.”

While Inkrot is unable to prescribe medication, she says she works in collaboration with the patient’s doctors and specialists and makes suggestions to help with diagnoses and management plans.

Self-care skills important

Teaching self-care skills is an important part of the nurse specialists’ clinical monitoring and management role, as is working with families and whānau.
“We want to reduce hospitalisation and teach people how to recognise the warning signs of a bad day,” says Inkrot.

Self-care for patients includes following a healthy diet, managing their weight, getting rest as well as regular exercise and taking their medication as prescribed.

Inkrot says there is no “typical patient” that she works with. “Generally though, those that we see are in their late 60s to early 70s. Patients’ experiences of heart failure can differ vastly too.

“Heart failure isn’t just one thing. There are symptoms in common though; fatigue, breathlessness, swollen legs. It can be tricky to do everyday things.”

She says heart failure is complicated and there is no single trajectory. “It can be something of a rollercoaster. You can have bad days and good days.”

Inkrot’s aim is to reduce hospitalisation by teaching patients how to recognise the warning signs of a bad day. “We want to prevent and avoid hospitalisation. It’s about empowering patients to look after themselves.”

While there is no cure for heart failure, there is plenty that can be done to help. “It is true that there is no cure. But we can improve both heart function and quality of life. Early treatment and support is so important.”

Inkrot says patients using the service are generally discharged within six months, once they have the support and tools needed. “We do have a small number who need palliative care, and we support them and their families with that too.”

The prevalence of heart failure is rising. “We have an aging population so it is becoming more common. Better health care also means the numbers are increasing.”

The importance of collaborative education

Education is also an important part of Inkrot’s collaborative work with both primary and secondary health professionals and community teams.

“The service is not possible without the support of the cardiologists, the general practitioners, the nurses. They are integral to this. It’s a multi-disciplinary effort where we
work together.”

She is also excited about the future of the sector.

“Five to 10 years ago, heart failure was in the too-hard basket. It wasn’t sexy, it was super-complicated and hard.”

Having a patient with heart failure was a challenge when she first trained as a nurse. “But now, we’ve worked out how to improve things significantly for the patient. We’ve worked out how to reduce costs and how to decrease mortality.

“I’m so passionate about this work because I can make a difference.”

Cheryl Atherfold, associate director of nursing for the DHB’s Professional Development Unit that manages the PDRP and other programmes, said the Nursing Council audit result “spoke volumes” for the work done by the the PDRP team in recent years.  She said the PDRP was awarded five years approval with no corrective actions or recommendations required.

The Waikato DHB PDRP is one of more than 25 programmes offered by DHBs, private hospitals, Plunket, and community health providers that are regularly audited by the Nursing Council to ensure that nurses assessed under the PDRPs meet the Council’s continuing competence requirements.

Atherfold said the unit had four staff members directly responsible for the PDRP programme but it also relied on the support of nurse and midwife educators and assessors across the DHB.

Nursing Council comments included “strong leadership” in managing quality improvement over the previous two years and the “courage” to move to eportfolio submission for PDRPs and the benefits that had brought to both applicants and assessors.  It said the eportfolios were of a “high standard and clearly demonstrate the Council continuing competence requirements are met”.

PDRPs are voluntary programmes that are also used by their parent organisations to develop and recognise the expertise of nurses in clinical practice and – in the case of DHBs – can also be linked to salary allowances. Nurses that are part of a Nursing Council-approved PDRP are exempt from the recertification audit which about 1000 nurses are randomly chosen to undergo each year.

The interim chief executive at Waikato District Health Board has spent most of his career in health managing broken situations back to repair.

As the replacement for Dr Nigel Murray, who resigned in October amid an expenses scandal, Wright is arguably tasked with his biggest challenge yet.

That is; change the culture, create a workplace people are proud of, get Waikato Hospital to the top of its game, and turnaround the DHB’s financial problems.

The 63-year-old has set himself a one year deadline to achieve the transformation.

He doesn’t want to commit for too much longer than that for two reasons – he gets bored easily which turns to “mischief”, and he wants the next chief to hunker down for five years and lead the embattled DHB into a period of stability, security and ultimately, growth.

And it should be noted, Wright – previously the health board’s mental health and addictions executive director – was given the seal of approval for the important interim job by the senior doctors at Waikato Hospital.

This is no mean feat, particularly given the dysfunctional relationship Murray created with clinicians during his three year tenure, and the loss or partial loss of training accreditation in different units at the tertiary hospital.

Wright says there’s no secret to being a good leader.

“It’s not rocket science. I think it’s about having that focus, having that visibility. I’m really clear that I make decisions everyday that impact on the work that staff do and unless I’m informed then I might be making the wrong decisions.”

Relating to people from all walks of life comes naturally to Wright.

Born in Scotland and raised in Fife, north of Edinburgh, Wright fell into health at 19 when his neighbour offered him a job at the local hospital as an orderly.

“I started at the bottom basically.”

The football-mad teenager earned just 10 pounds per week, about $200 by today’s standards, graduating to 15 pounds a week after he trained to be a nurse.

That was 1978. He specialised in surgery and crossed into mental health, working his way up from a staff nurse to a charge nurse.

He moved to Newcastle in 1984 at the time when major health reforms were underway with an emphasis on turning clinicians into managers.

Wright was offered a spot at Birmingham University to study health management and moved into general management shortly after.

By then he was married to Elizabeth – who he met in the nurses’ home of a psychiatric hospital – and together with their two children in 1992 the couple upped-sticks and moved to New Zealand on a health industry exchange for one year.

Wright swapped jobs with the manager at Auckland mental health services based at Waitemata.

“During that year I also got asked if I would take on the role of project manager for the closure of Kingseat [Hospital] and Carrington [Hospital].

“I think it was because, ‘new guy, if it doesn’t work then he’s out of here and if it does then he’s out of here anyway and we can take the credit’.”

Wright closed the two former mental hospitals – Kingseat took longer than a year – and back in the UK he and Elizabeth decided, thanks to a bitterly cold winter, they would make New Zealand home permanently.

He managed mental health and drug and alcohol services at Waitemata from late 1993 before becoming general manager of North Shore Hospital for four years.

That was followed by a stint as the first mental health regional director for the northern region before Wright was headhunted in 2007 to be director of operations in South Australia.

“The day I arrived, they had 74 psychiatrists and 40 of them resigned. Nothing to do with me. It was all to do with pay negotiations they were having with the state but that was my introduction to South Australia.”

Five years later Wright returned to New Zealand. He worked for a non-government organisation and was made redundant.

He set up a consultancy, doing strategic planning, restructures and service reviews, including a mental health review for Northland.

Wright initially turned down the opportunity to apply for the mental health director role at Waikato, but eventually succumbed to a persistent recruitment agent.

He joined the DHB in February 2016, during the middle of a Ministry of Health Section 99 review of its mental health unit, following the death of patient Nicky Stevens.

Among other things, the review identified the need for an experienced senior executive in the DHB’s mental health team, a position left vacant during a restructure of the executive leadership by Murray.

The DHB had also been in the spotlight for allowing fake psychiatrist Mohamed Siddiqui to work there for six months in 2015 on a salary of $165,000.

“There was lots to do but there was a really good team and me never having worked in Waikato before, I came in with fresh eyes. We made lots of changes. There was already lots happening – I just hopefully provided some leadership to the team.”

Wright has already been outspoken on some issues. He previously said he believed New Zealand had too many district health boards.

Twenty for a population of 4.5 million is out of kilter he reckons, and he believes there should be one linked IT system for all DHBs so that health records follow patients.

He also wants to see real change come from the ministerial mental health inquiry launched last month, not just “a tinker and throwing money” at the problem because as it stands our mental health system is unsustainable, Wright says.

Plus there’s room for better training, Wright suggests. Much of his training was on the wards compared to today’s student nurses, some of whom get all the way through a nursing degree only to find the profession is not for them once they get properly into a hospital.

“I think the pendulum has gone too far. I think probably when we trained in the ’70s we were a cheap workforce. I think here there’s too much of the academic side of it and not enough of how do you deal with people.”

Nowadays Wright says there are lots of expectations from health that didn’t exist 40 years ago.

“In the early ’70s, if you were a patient and you needed a hip replacement and you were 65, you didn’t get it done.

“Whereas we operate on 90 year olds now because the expectation is you get it done.”

For now though Wright will concentrate on the job at hand – restoring public confidence in Waikato DHB.

He has set about doing this with a number of initiatives including recently proposing to trim his executive leadership team, to dismantle the 18-strong group Murray put in place and re-assemble it so only 11 executives report directly to him.

Wright also returned the executives to Waikato Hospital after Murray moved them to an ivory tower in the city, away from the coalface clinicians felt.

There’s a 10-year plan being developed focusing on prevention and working smarter, and staff at the $1.4 billion organisation have rallied behind it.

He’s confident of regaining the lost training accreditation in obstetrics and gynaecology and is working on creating a workplace free of bullying and where targets feel they can speak out.

Wright will continue visiting the DHB’s 7000 staff including those at hospitals in Taumarunui, Tokoroa, Te Kuiti and Thames, and he is tackling the way the DHB communicates, both internally and externally.

It’s undoubtedly damage control after the DHB was accused of keeping information secret during the Murray affair, but making himself available to the media and sending out fortnightly intranet updates to staff, complete with jokes, is a good start.

“I’ve hopefully brought some consistency to the organisation. I do a lot of management by walkabout. It’s a slightly different culture I’m trying to bring to the organisation. I guess I’m just trying to humanise management.”

Kathleen Archibald won $20,000 compensation, a severance payout, and legal costs after the DHB lost an appeal on the case in October.

The case was approved for appeal by the former chief executive Dr Nigel Murray – who quit in October amid an expenses scandal.

Archibald initially won an Employment Relations Authority case against the DHB earlier this year for the unjustified dismissal and the DHB was ordered to pay her $10,000 and redundancy.

The case, believed to have cost the DHB tens of thousands of dollars in legal fees, fines and a severance payout, was approved for appeal by the former chief executive Dr Nigel Murray – who quit last month amid an expenses scandal.

Kathleen Archibald won an Employment Relations Authority case against the DHB this year for unjustified dismissal and the DHB was ordered to pay her $10,000 and redundancy.

Archibald was 67 and had been a nurse for 50 years including working as a health promoter for two decades with Waikato DHB when she was told in March last year she would have to travel from Thames to Hamilton every day for six months under a restructure.

Living on a large section of forest, Carol put her “very rural” weatherproof jacket on over her Waikato DHB uniform for the journey.

Traffic was busier with school holidays, and just north of Te Kuiti traffic started to slow to a halt. A fatal accident had occurred and they needed Carol’s help.

As she approached the accident site, she’d removed her jacket by this stage and said “I’m a registered nurse at Waikato Hospital on my way to work, do you need my help?” Carol will never forget the look of relief on peoples’ faces when they saw her uniform.

“The accident was horrific” said Carol. “It was pouring with rain; there was no hospital emergency bell, other medical staff or equipment – clinically, I was it.”

Carol naturally became the leader of this heartbreaking scene. She was very apprehensive at first but once she focused on what was there that all disappeared completely. She utilised her nursing experience, especially from trauma and ED, and skills developed from previous roles that included time in the Royal New Zealand Nursing Corps covering Army, Air force and Navy, and as a prison nurse in the Department of Corrections, where she was often first responder to incidents.

“There were pieces of car all over the road, I had to step over an exhaust system and work my way around broken glass that was everywhere,” she said.

“After ensuring 111 had been called and delegating people to divert traffic, I first went to a vehicle with a casualty laying outside of it; described to me as having a sore foot, the injury was a horrendous fracture.

“The car had the windscreens smashed, and inside was another poor casualty looking absolutely shocked. I climbed inside the car and triaged her and conducted a primary survey to assess injuries where I found a large dent in her chest. The person was surrounded by a mess of broken glass and deployed airbags.

“We realised the car was a fire risk, but being electric we could not turn the engine off, so I had to back her out of the car, being conscious of a possible chest fracture.”

To access the second vehicle involved, Carol had to climb down because it was stuck in a drain.

“It only took one look to see it was too late for them,” she said sadly, having known the occupants from her hometown.

“I also took responsibility for the scene coordination and risk management as I didn’t want others to see what had happened to this couple and informed other people it was now a scene for the coroner that could not be disturbed.

“Although few people seemed to know this, they were amazingly cooperative, and when I went back to check on the other casualties an off-duty paramedic had turned up, which allowed us each to care for the two remaining injured.”

Carol says everything may have been different if she hadn’t been in her Waikato DHB uniform. “I may have had problems getting people to listen to my advice and wouldn’t naturally have become their leader in a way. As a nurse, in our uniforms this is what we do every day on the job – lead, care and comfort people.

“At all times I was very conscious of the fact I was a registered nurse and an employee of the DHB and I had to work within my scope of practice.

“It was a relief when the medical, police and fire crew arrived. They also saw my uniform and at times thought I’d brought my medical equipment, with some asking if I had a stethoscope and a cannula,” she smiled.

“When the scene started to clear and I was left alone to provide my statements with a police officer, I noticed I’d lost my glasses, I was cold, I was thirsty, I was also in a bit of shock. I’ve seen lots of accidents and odd events on these roads but nothing like this.

“Maybe because I was in my uniform I didn’t get victim support offered straight away either, and I didn’t have my work colleagues to debrief with, which was quite hard,” she said.

Carol’s advice to anyone in a first-response situation is that as you can’t prepare for what will happen next, work well with what you know and do it well. Don’t make decisions that you don’t think you have the experience or training to do, unless you absolutely have to. Delegate just one task at a time and request immediate feedback when it is completed, stay calm and always thank everyone for their help and input.

Interim chief executive Derek Wright has called for an external and independent review of HealthTap, the American company which powers SmartHealth and which the DHB has a contract with.

“The contract by which the Waikato DHB uses HealthTap expires in May 2018,” Wright says in the board agenda for tomorrow’s monthly meeting.

“In order to prepare for decision-making around renewal of the contract it is necessary to undertake a review of where we have got to. We envisage the review being an independent external one.”

Dr Murray has been on leave since July 22. It is believed concerns about his expenses were first raised by staff last year.

The inquiry identified that Dr Murray had spent “more than the agreed $25K allocated for relocation costs, and other unauthorised expenses involving potential financial breaches of the Chief Executive’s obligations”.  

In a statement, the board of Waikato DHB said it accepted Dr Murray’s resignation with immediate effect, on the basis that he repaid all outstanding amounts.

“The Board acknowledges that this has been a challenging time for Waikato DHB staff and the Waikato community,” said the statement.

The New Zealand Herald reported last night that a special meeting was to be called today to hear the outcome of an investigation into alleged unexplained spending by a district health board chief executive.

Waikato District Health Board members were to hear a report into the two-month-long investigation of chief executive Dr Nigel Murray’s expenses at the special board meeting .

The Herald understood the meeting was to determine Murray’s future at the DHB, after he went on leave on July 22 amid concerns over alleged unauthorised and unexplained spending.

A source close to the DHB told the Herald the meeting had been called to consider an “employment matter”, but the board is only responsible for employing the chief executive.

The investigation, conducted by an Auckland barrister, looked at Murray’s expenses dating back to July 2014 when he took up the $560,000 a year post.

An Audit New Zealand review of the DHB’s management of the process, including the authorisation and payment of the expenses, occurred simultaneously.

It’s believed concerns about Murray’s expenses were first raised by staff last year.

In December Murray came under fire by government watchdog the State Services Commission after the Herald revealed he had not filed expenses for his first two financial years in the role.

When they were finally disclosed in January this year, the expenses showed Murray had spent $108,000 of taxpayers’ money on international and domestic travel for the job.

By comparison, his predecessor at Waikato DHB, former chief executive Craig Climo, spent $17,670 in a two-year period.

When the Herald asked chairman Bob Simcock about Murray’s comparatively high expenses in February, Simcock said he was comfortable with them and that they included $36,000 worth of relocation costs from Murray’s former job in Canada to Hamilton, which skewed the total.

The relocation costs included $11,710 for early arrival accommodation costs because Murray finished his role at Fraser Health in British Columbia earlier than expected.

It’s understood these costs were a focus of the investigation, and accounted for three months’ accommodation.

When the investigation was first launched Simcock told the Herald its outcome would first be reported to the board’s remuneration committee, and then to the board with the public excluded.

Simcock has not responded to repeated questions from the Herald around the progress of the investigation and whether the remuneration committee has met.

Acting chief executive Neville Hablous said in late September that the remuneration committee, which includes Simcock, deputy chair Sally Webb, and board members Sally Christie, Tania Hodges and Crystal Beavis, last met on August 4 and only meets at the behest of the chair.

“The committee is concerned primarily with the payment and performance of the chief executive.”

The Herald understands the committee was to meet last week, but questions on the issue yesterday went unanswered.

A DHB spokeswoman previously refused to answer further questions on the subject and said the DHB would not comment while the investigation is ongoing.

Multiple requests made by the Herald under the Official Information Act for information relating to Murray’s expenses have been declined by the DHB.

The board said today in its statement that it would commence a search as soon as possible for a new chief executive.

Sue Hayward, director of nursing at Waikato DHB, said the DHB was presented with the award at the recent Health Roundtable Nursing Improvement meeting in recognition of achievement in the area of “sustainable and sustained leadership development and career progression”.

Waikato’s leadership development includes a programme launched in 2013 of shoulder-tapping new nurses with leadership potential to join a leadership programme run in league with the University of Auckland that involves mentoring, postgraduate study and practice-based research projects.

Hayward said its overall nursing leadership framework was underpinned by local and regional DHB leadership programmes and also included access to postgraduate learning as there was a “fundamental expectation that each individual nurse – regardless of expertise level or designated role – must lead where they stand”.

“The involvement and active participation in ward-based quality improvement activities, peer support, preceptering and delivering learnings from an event are all seen as leadership and recognised as such,” said Hayward. “Confidence builds and of course that can be a great springboard into other nursing roles.”