2017/18 Annual Plan Guidance for Public Health Units

2017/18 Annual Plan Guidance for Public Health Units -

Guidance Overview

About the Guidance Overview

This document sets out the 2017/18 Annual Plan Guidance for DHB Public Health Units (PHUs) to support them to develop their PHU Annual Plan with their DHB(s). The guidance,which forms part of the 2017/18 Planning Package for DHBs, has been developed by the Ministry-sector working group in consultation with Ministry and sector colleagues. Ministry and sector feedback on the draft 2017/18 Annual Plan Guidance for PHUs has been incorporated into the final version. We wish to thank our Ministry and sector colleagues for their time and commitment in the process.

Please consider the whole document carefully. Section 1 of the Guidance Overview outlines alignment with Results Based Accountability™ (RBA)and the core functions approach asyou still have the option of using the core functions approach if you find that useful.

Section 2 is focused on general guidance while section 3 is about the ‘mechanics’ of the 2017/18PHU Annual Plan and its templates. Advice on the timeline for the PHU Annual Plan and its endorsement by your DHB(s) is provided at the end of the document.

This 2017/18 Annual Plan Guidance is very similar to the previous 2016/17 guidance but below is a summary of changes made to the2017/18 Annual Plan Guidance, which consists of thisGuidance Overview andseven appendices.

Summary of changes to the 2017/18 Annual Plan Guidance for PHUs

• Advice that you still have the option of using the core functions approach if you find that useful.
• Advice that an Environmental and Border Health and Alcohol exemplar have been included in the package.
• Advice that the Vital few report has been expanded.

• Requirements have been updated.

• You still have the option of using the core functions approach if you find that useful.
• There is an option to add additional rows/columns to enable the geographic coverage area to be documented if you find that useful.

• Annual Plan Budget and Financial Reporting templates are set in three options - an issues only, issues-core function, or core function-issues matrix.The templates will support your financial accountabilityevery six months, assessed against issues and/or core functions as a minimum requirement.

• Requirements have been updated.

• Appendix 5A and 5B are the same as in 2016/17 (you still have the option of using the core functions approach if you find that useful.)
• Appendix 5Cthe Vital Few report has been expanded as follows:
• Four additional performance measures have been added to the alcohol section. These are all related to your regulatory/health protection work.
• An environmental and border health section has been added which is based on the environmental and border health exemplar. This contains a total of nine ‘Is anyone better off’ performance measures. These measures are reported on annually.

• Exemplars on Environmental and Border Health(Appendix 6A) and Alcohol (Appendix 6B) have been developedand align with theRBA framework.
• All activities in the Environmental and Border Health exemplar are related to legislation and are deemed to be ‘health protection’ activities and as such are expected to be delivered by PHUs although there is a degree of flexibility. The ‘Is anyone better off’ performance measures in this exemplar will be reported in the ‘Vital Few’ report.
• The health protection activities and performance measures in the Alcohol exemplar are mandatory and should be carried out. Some of theperformance measures relating to health protection workwill be reported in the ‘Vital Few’ report.

• The Evaluation criteria template has been modified so that PHUs can use it to assess their draft Plan against the criteria in the ‘Strategic Priorities and Guidance for PHUs’ template (Appendix 1) before submitting their Plan to the Ministry for approval

Contents

Contents

Introduction to core public health services

1 The 2017/18 Annual Plan Guidance for PHUs

1.1 Alignment with Results Based Accountability™

1.1.1 Population versus performance accountability

1.1.2 Direct versus indirect ‘clients’

1.2 Alignment with public health core functions approach

Table 1: Core function, overview and boundaries

2 Improving population health and equity and alignment with Ministry of Health strategies and policies

2.1 Improving Māori health

2.2 Improving equity for all

2.3 Strengthening focus on wellness and prevention

2.4 Strong sustainable PHU workforce

2.5 Continuous quality improvement

2.6 National population health outcomes and indicators

3 PHU Annual Plan for 2017/18

3.1 Structure of PHU Annual Plan for 2017/18

3.2 Templates to support PHU Annual Planning and Reporting

3.2.1 Appendix 1: Public Health Strategic Priorities

3.2.2 Appendix 2: PHU Annual Plan Template

3.2.2a Activities

3.2.2b Performance Measures

3.2.2c Examples of performance measures

3.3 Appendix 3: Financial Planning and Reporting Templates

3.4 Appendix 4: All Reporting Requirements as per core public health services contract

3.5 Appendix 5: Reporting Templates

3.5.1 Appendix 5A: Summary Progress Report

3.5.2 Appendix 5B: Whole-of-year Report

3.5.3 Appendix 5C: Vital Few RBA Reporting

3.6 Appendix 6: Exemplars

3.7 Appendix 7: Evaluation Criteria for Reviewing PHU Annual Plans

4 Endorsement of the PHU Annual Plan

5 Annual Plan Timeline......

Introduction to core public health services

In accordance with Section 22 of the New Zealand Public Health and Disability Act 2000, every District Health Board (DHB) has a statutory objective:

• to improve, promote and protect the health of people and communities
• to seek the optimum arrangement for the most effective and efficient delivery of health services in order to meet local, regional and national needs
• to reduce health disparities by improving health outcomes for Māori and other population groups.

DHB Public Health Units (PHUs) deliver public health services that aim to support healthy people in healthy communities. These services focus on communities and the environment, rather than at a personal level. Public health services cover a broad range of diseases and risk factors, and include services provided at the population level (eg, investigation of disease outbreaks, emergency planning and management) and support of the individual level (eg, immunisation, breast/cervical screening).

PHUs provide an integrated multi-disciplinary workforce withexpertise to work across the spectrum of public health and respond to emerging and re-emerging public health risks and emergencies. They undertake regulatory functions and health promotion/improvement services, and deliver services that enhance the effectiveness of prevention activities in other parts of the health system (eg, primary or secondary care services).

SECTION 1

1The 2017/18 Annual Plan Guidance for PHUs

Over recent years, the Ministry of Health (Ministry) has been working with PHUs to develop nationally consistent planning and reporting templates, and strengthen alignment of PHU/DHB planning and reporting processes.

The 2017/18 Annual Plan Guidance for core public health services delivered by PHUs (alternatively called the PHU planning package), which forms part of the 2017/18DHBPlanning Package,has been developed by the Ministry-sector working group in consultation with Ministry and sector colleagues. We wish to thank our Ministry and sector colleagues for their time and commitment in the process.

You are advised to consider the total DHB/PHU planning package for service planning/delivery, and reporting to the Ministry.

The key objectives of the 2017/18 Annual Plan Guidance for PHUs are to support:

• DHBs to plan and provide Better, Sooner and More Convenient health services for all New Zealanders
• DHBs and PHUs to strengthen regional collaboration, and deliverintegrated and value-for-money services
• DHBs and PHUs to plan their services together and manage the business
• good quality PHU service performance information.

The 2017/18 Annual Plan Guidance for PHUs consists of the following:

• Guidance Overview
• Public HealthStrategic Priorities (Appendix 1)
• PHU Annual Plan Template (Appendix 2)
• PHU Financial Planning and Reporting Templates (Appendix 3)
• List of all PHU reporting requirements to the Ministry of Health as per Core Public Health Services Contract (Appendix 4)
• PHU Reporting Templates(Appendices5A, 5B, 5C)
• Exemplars (Environmental and Border Health: Appendix 6A and Alcohol: Appendix 6B)
• Evaluation Criteria for PHU review of their Annual Plan (Appendix 7).

The 2017/18 Annual Plan Guidancefor PHUs shows alignment with Results Based Accountability™ (RBA).You still have the option of using the core functions approach if you find that useful.

1.1 Alignment with Results Based Accountability™

You are advised to continue to use RBAin your PHU Annual Plans for 2017/18, as it is aligned with the Streamlined Contracting Framework[1] (SCF) that government purchasing agencies have adopted in their contracting with non-governmental organisations (NGOs). While the initial focus of the SCF project is on NGOs, the Ministry is keen to support all the providers it funds (DHBs and PHUs included) to embed RBA in practice.

RBA is not a new concept. DHBs, PHUs and other providers have been introduced to RBA in recent years as there are distinct advantages for funders, planners and providers to use a common language for contracting and service delivery. There may be opportunities to measure ‘collective impact’ in the near future. RBA is a useful tool for team/provider/programme review, in addition to being used for planning and reporting.

We think it’s useful toremind you ofthe following RBA concepts:

1.1.1 Population versus performance accountability

There are two types of accountability: population versus performance accountability.

Population accountability is about whole populations (eg, All young people in the Te Tai Tokerau region). This is shared accountability; not the sole responsibility of any one agency or programme – it’s about people, communities and partnerships coming together to change the quality of life of a whole population.

Performance accountability is about client groups, and could be at different levels: teams, providers, programmes, agencies and service systems – of particular interest is whether programmes and services that are provided or delivered are working as well as possible to achieve results.

1.1.2 Direct versus indirect ‘clients’

The concept of direct and indirect ‘clients’ is important because it speaks to contractual accountability.

In Public Health, direct ‘clients’ are the people, organisations, settings, partners who engage directly with or receive benefit/services directly from working with a public health service provider. Therefore, community representatives could be a provider’s direct ‘clients’ if the provider is working with community representatives to, for example, equip them with health promotion knowledge and skills to implement projects to support healthy eating and physical activity. Direct ‘clients’ are relatively easy to identify. Indirect ‘clients’ are those that the provider does not directly engage with but may receive a benefit from what the provider delivers.

For example, you may deliver a public health education seminar to parents (your direct clients) on child oral health. However, you also have an indirect set of ‘clients’ (the children of those parents). All things being equal, we may see both ‘clients’ achieving improved outcomes over time (ie, improved skills and knowledge or positive behavioural change). For the purposes of this question, let’s say both ‘clients’ benefited from your service delivery. So, the question contractually is: Which ‘client’ outcomes will you be held solely accountable for? There are two main options:

• Option 1: you are accountable for direct ‘client’ outcomes only.
• Option 2: You are accountable for direct and indirect ‘client’ outcomes.

The answer lies in the discussion and negotiations between the Ministry and the provider.

In most cases, the Ministry’s focus is on monitoring the provider’s achievement of outcomes for its direct ‘clients’, as it seems appropriate in terms of the provider’s performance accountability. However, this does not preclude the Ministry from also tracking indirect ‘client’ outcomes if the indirect ‘client’ outcomes look to be useful and meaningful, and there is a means of collecting and tracking the indirect ‘client’ outcomes data.

1.2Alignment with public health core functions approach

Last year PHUs were asked to align their PHU Annual Planand reporting with the core functions approach, based onCore public health functions for New Zealand: a report of the NZ Public Health Clinical Network, September 2011 (thepublished article in the New Zealand Medical Journal can be accessed from:

This year the Ministry/PHU working group has decided that core functions are not required to be displayed in PHU Annual Plans but you still have the option of using the core functions approach if you find that useful. The core functions approach can bea useful way of grouping PHU activities, ensuring the breadth of activities under the five core functions is considered within a comprehensive public health approach. The original intent of the core functions approach was so 'envelopes of funding' could be assigned to core functions; however, this has not been approved to be implemented. Accordingly, it is not a 'bottom-line' for core functions to be matrixed within the PHU Annual Plans for 2017/18 onwards. PHUs can group and display their activities according to what works best for them: whether in service lines, settings, core functions, programmes, their internal service structure groupingsor any grouping that you have elected.

As for financial reporting, the Ministry continues to require financials to be reported along service lines (no need to provide core functions-service lines budget matrix as this has proven to be complicated for DHB financial systems).

If you do elect to continue to use the core functions there are a couple of useful overarching principles you can follow when mapping your service activities to core functions:

• Be guided by the activity, not who traditionally does the work (it is not about occupational group but activity). For example, health promotion activity might be delivered by a health protection officer.
• Activities relating to statutory roles are placed under the Health Protection core function for Tobacco, Alcohol and Other Drugs, Communicable Diseases and Environmental Health.

Please refer to table below on the ‘boundaries’ of the different core functions.

Table 1: Core function, overview and boundaries

• Statutory roles are placed under Health Protection

• Training of own staff and other staff in wider public health sector (under human resources)
• Networking and partnerships
• Evaluations

• Training of community members/leaders (under community action)
• “Training”, for example, social marketing workshops for "target groups" (under develop personal skills)
• Training of health professionals in "non-public health" services (under reorient health services)

• Statutory roles are placed under Health Protection

• Covers four main areas: immunisation, screening, stop smoking services, family violence prevention services.

SECTION 2

2Improving population health and equity and alignment with Ministry of Health strategies and policies

Improving population health and equity remains the overarching aim for PHUs. This requires you to be responsive to changing population health needs while operating within a constrained funding environment. We encourage you to continue to support your DHB(s) to adapt and transition to a system where:

• people are at the centre of everything we do and where individuals, whānau and communities have greater ownership of their health and wellbeing
• health responses are rebalanced toward keeping people well through early intervention and prevention at individual and population levels, and primary and community care are strengthened
• working with public/social sector colleagues to achieve better health, social and economic outcomes.

2.1 Improving Māori health

Improving Māori health remains a key focus. The Ministry expects your planning documents to show how your public health services are aligned with your respective DHB Māori Health Plans. Your PHU Annual Plan should clearly demonstrate what you intend to do to improve health outcomes for Māori, why your chosen approach will succeed and how you will measure your success in contributing towards improving Māori health. This level of information is expected for each service grouping of your PHU Annual Plan. Please refer to He Korowai Oranga (2014) for the Ministry’s overarching framework to achieve health outcomes for Māori.

2.2 Improving equity for all

Achieving health equity for all New Zealanders continues to be an overarching aim. Therefore, the Ministry expects that your PHU Annual Plan will clearly demonstrate what you intend to do to improve health outcomes for vulnerable communities (including Māori, Pacific, refugees, people with mental health conditions and disabilities, and other vulnerable communities within your area of coverage), why your chosen approach will succeed and how you will measure your success in contributing towards improving equity. Please refer to relevant strategies at the Ministry website (

To ensure a strong equity focus in service planning, you are encouraged to use tools that will enable you to assess your service delivery for their current or future impacts on achieving health equity [eg, using the Health Equity Assessment Tool (Ministry of Health June 2008) alongside other strategic, planning, implementation and evaluation tools, such as prioritisation frameworks, Health Impact Assessment, Whānau Ora Health Impact Assessment, and Equity of Health Care for Māori: A framework (2014)].