2014/15 Annual Plan Guidance for Public Health Units
In accordance with Section 22 of the New Zealand Public Health and Disability Act 2000, every 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.
District Health Board (DHB) owned Public Health Units (PHUs) deliver public health services that aim to achieve healthy people in healthy communities. These services focus on communities and the environment, rather than individuals. Public health services cover a broad range of disease risk factors and diseases, and include services provided at the population level (eg, investigation of disease outbreaks, emergency planning and management) and at the individual level (eg, immunisation, breast/cervical screening).
PHUs provide an integrated multi-disciplinary workforce with the expertise to work across the spectrum of public health, and to respond to emerging and re-emerging public health risks and emergencies. They undertake regulatory functions and health improvement services, and deliver services that enhance the effectiveness of prevention activities in other parts of the health system (eg, primary or secondary care-initiated services).
The 2014/15 Annual Plan Guidance for core public health services delivered by PHUs has been developed in consultation with the sector. This guidance material forms part of the 2014/15Planning Package for DHBs. You are advised to consider the total package for service delivery planning and reporting to the Ministry.
The key objectives of the 2014/15 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 focus on regional collaboration, integrated care and value for money services
- DHBs and PHUs to plan their services together and manage the business
- Good quality PHU service performance information.
The 2014/15 Annual Plan Guidance for PHUs consists of the following:
- Guidance Overview
- Public Health Issues Update (Appendix 1)
- Annual Plan Template (Appendix 2)
- Financial Planning and Reporting Templates (Appendix 3)
- All Reporting Requirements to the Ministry of Health as per Core Public Health Services Contract (Appendix 4)
- Six-Monthly Reporting Templates (Appendix 5)
- ‘Information Supporting the Estimates of Appropriation’ (ISE) Reporting Template (Appendix 6).
1 Context: Ministry review
1.1Public Health Services Assessment 2013-15 (the assessment)
The assessment, which will be undertaken in consultation with the sector, includes the following:
- Work-stream one:Review of NSFL Public Health Service Specifications–to identify what public health services should be purchased in line with five core public health functions.A revisedTier 1 specification will be available shortly for your use in 2014/15.The review of Tiers 2/3 is underway with finalisation planned for use in 2015/16.
- Work-stream two:Optimal configuration of public health services–to identify the best option for the design/delivery/funding of appropriate public health services at local, regional and national levels of the system (where and how).
- Subject to outcomes of the above work, consideration will be given to the best possible funding arrangements(amount and distribution) for public health services.
The assessment recognises that the five core public health functions provided by PHUs are:
- Health assessment and surveillance
- Public health capacity development
- Health promotion
- Health protection
- Preventive interventions.
Other public health providers also deliver one or some of these core functions.
1.2 Implicationsof Ministry review for PHU annual planning
Because the outcomes of the above review are likely to influence and affect PHU planning and service delivery, we are asking that an annual plan for 2014/15 for PHUs be submitted to the Ministry, instead of a two-year service plan for 2013-15 (as agreed in our core public health services Agreements with the host DHBs). We are mindful that your service planning will continue to be directed towards the needs of your population over a three to five year period. The annual plan requirement for PHUs is aligned with the DHBs’ requirement to provide an annual plan for approval by the Minister of Health.
The Ministry/PHU project subgroup has agreed that exemplars will not be provided for 2014/15 because the outcomes of the Public Health Service Assessment may impact on the way public health services are defined. However, various exemplars (chosen from the 2013/14 PHU Annual Plans) have been provided to sub group members and are available from them if you consider they will be beneficial to your planning.
2 Priority Populations and Targets
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 in achieving this, and how you will measure your success in improving Māori health. This level of information is expected for each service grouping of your Annual Plan.
2.2 Reducing health inequalities
Reducing health inequalities 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 and other vulnerable communities within your area of coverage), why your chosen approach will succeed in achieving this, and how you will measure your success in reducing health inequalities.
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 health inequalities (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 and Whānau Ora Health Impact Assessment).
2.3 Priorities and targets
Your services/activities are expected to be aligned with:
- key government targets, health targets/priorities/policies/strategies, including the current Public Health Service Specifications in the Nationwide Service Framework Library, the Ministry’s Statement of Intent (2012-2015), He Korowai Oranga (2002) and ‘Ala Mo’ui (2010-2014)
- DHB priorities, District Annual Plans, Maori Health Plans, Regional Service Plans and other relevant plans of the DHB(s) served by the PHU.
We encourage you to continue to engage in regional planning processes led by your DHB(s). You may include activities that contribute to regional public health priorities, agreed with DHBs, in your Annual Plan. You are also encouraged to integrate your service delivery as appropriate to deliver efficient and effective services. You may choose to trial your service planning using the core public health functions approach.
3 Public Health Issues Update
A set of activities and the population targeted are provided under each issues area in the Public Health Issues Update (Appendix 1). This is intended to serve as a further guide to your service planning for 2014/15. The information is gathered from Public Health Issues Leads and colleagues across the Ministry.
Please use the information as appropriate. We are mindful that not all activities outlined in the Public Health Issues Update will be relevant or appropriate for your population of coverage and that you may be required to prioritise some activities over others to ensure that existing resources are used most efficiently and effectively. It is important for you to ensure that your service delivery is aligned with the strategic priorities of the Government, the Ministry and your DHB(s), and that all regulatory requirements are fulfilled.
Considering the needs of your population and the outcomes you want to achieve are a good starting point in developing your PHU Annual Plan, followed by activities, key performance measures (quantity and quality) and short term outcome indicators.
4 PHU Annual Plan for 2014/15: what information is required
As explained in section 1.2 above, you will only need to complete an annual plan for 2014/15. The PHU Annual Plan Template for 2014/15 has been modified following further feedback by PHUs (Appendix 2).
Further guidance on the Annual Plan Template for 2014/15 is provided below:
4.1 Structure of PHU Annual Plan for 2014/15
Your Annual Plan will include an introduction followed by completion of the agreed Annual Plan Template.
In the introduction, provide a brief context on:
- the operating environment you are in
- how you have prioritised your service delivery according to Government/Ministry/DHB targets and priorities
- any proposed major changes in your PHU’s strategic direction
- your financial state and any significant pressures/risks you are facing
- the structure of your organisation, if there are any significant changes.
Use the agreed PHU Annual Plan Template (see Table One below) to demonstrate:
- Short Term Outcomes: What we want to achieve
- Short Term Outcomes Indicators: How we will monitor progress towards outcomes
- Activities: What we will do to achieve outcomes
- Key Performance Measures: What are key measures of quantity and quality of our activities.
The Ministry expects you to explicitly demonstrate how you plan to deliver services for Māori and vulnerable communities, and how you plan to monitor your progress against agreed performance measures and short term outcome indicators for these priority population groups.
Table One: PHU Annual Plan Template for 2014/15Short Term Outcomes
(What we want to achieve) / Short Term Outcome Indicators
(How we will monitor progress towards outcomes) / Activities
(What we will do to achieve outcomes) / Key Performance Measures
(What are key measures of quantity and quality of our activities)
Quantity / Quality
NB: Show how improving Māori health and reducing inequalities are embedded in your service delivery.
It will be useful to clearly show the link (eg, using a numbering system) between Activities and their Short Term Outcomes. This will help Ministry Portfolio Managers with reading PHU performance monitoring reports and collating information to look for improvement over time (ie, over several reporting periods).
4.2 PHU Annual Plan Template Labels
The four labels used in the Annual Plan Template are defined as follows:
Short Term Outcomes
Short Term Outcomes describe the expected outcomes we want to achieve. They are the immediate results or outcomes most attributable to the PHU’s activities. We recommend language/words that denote results.
Short Term Outcome Indicators
Short Term Outcome Indicatorsdescribe how we will monitor progress towards outcomes. While many of the short term outcomes may not be within the direct control of PHUs, it is desirable that PHUs aim for and, where possible, develop appropriate outcome indicator/s to measure and track progress against achieving these short term outcomes.
Activities describe what we will do to achieve the Short Term Outcomes; thus ‘action words’ or ‘verbs’ are recommended. Most PHUs have detailed project plans, and would only need to include information that summarises their activities under this column.
Key Performance Measures
Choose key measures to demonstrate whether the activities that will be carried out under each service grouping, considering dimensions of quantity and quality, showing “how much will be done” and “how well activities will be done” respectively. Ensure these performance measures are as attributable to PHU service delivery as possible.
4.3 PHU workforce development component
To reduce the number of separate plans that arerequired of you, we ask that you display the staff workforce development component in the same PHU Annual Plan document by adding an extra row at the end of your PHU Annual Plan (using the Annual Plan Template for 2014/15 in Appendix 2), treating ‘staff workforce development’ as a service grouping or a component of a service grouping, such as Infrastructure. This means that a separate ‘stand-alone’ staff workforce development plan is no longer required.
The Ministry expects that you have the capacity and capability (including public health skills and competencies) to respond to the health needs of the population you serve, including the ability to mobilise staff to respond to legislative changes and public health emergencies, and that your staff workforce development component is consistent with the strategic goals and objectives of Te Uru Kahikatea: The Public Health Workforce Development Plan 2007-2016 (Ministry of Health, 2007).
Ensure that all staff providing core public health services will have:
- where relevant, registered with an appropriate statutory body and hold a current practising certificate
- knowledge, skills and training appropriate to their role
- knowledge, skills and training that will increase staff capability to be more responsive to Māori and Pacific peoples
- supervision and direction from appropriately qualified staff
- access to continuing education to support maintenance of on-going competence, enhance service delivery/clinical practice, and ensure that practice is safe and reflects knowledge of recent developments in service delivery.
We encourage you to support staff to undertake appropriate public health qualifications, such as the Certificate in Public Health and to share resources and staff workforce development opportunities at a regional level.
4.4 Continuous quality improvement
The Ministry expects you to build and review continuous quality improvement systems and processes into your service planning and business activities, and demonstrate these elements through quality performance measures in your PHU Annual Plan. It will also be useful to show how service reviews, audits and evaluations are being used to inform service planning and delivery. We encourage you to share exemplars and learnings with the Ministry (through your reporting to the Ministry) and/or with other PHUs.
4.5PHU Funding for 2014/15
Plan your services for 2014/15, based on the same level of funding allocated to your service in 2013/14. The Ministry will endeavour to communicate any changes to your funding as soon as we are able.
We are mindful that the Health Promoting Schools (HPS) component of your contract is due to expire on 30 June 2014. As you are aware, over the past year the Ministry has been conducting a review of HPS. The HPS review will inform how the current model of service delivery can operate more efficiently and effectively within available resources. It is anticipated that the review will be finalised by the end of December 2013, and that the revised model of service delivery will be implemented from 1 July 2014. We plan to communicate the initial findings of the HPS review to you in late 2013 and the final outcomes in early 2014 to allow sufficient time for you to plan your HPS services accordingly.
4.6Endorsement and review of PHU Annual Plan
Your PHU Annual Plan must be endorsed by your DHB(s). To support the DHB sign-off process:
- align your PHU planning cycle with that of your DHB(s)
- plan with your DHB(s)
- ensure your service delivery is aligned with Government/Ministry targets and priorities, and the DHB(s) Annual Plan (AP), Māori Health Plan (MHP) and Regional Service Plan.
4.7Annual Plan timeline
Please note the following timeline:
- Start the planning process with your DHB(s) after reviewing the total DHB package.
- Submit draft PHU Annual Plan for 2014/15 to your Ministry Portfolio Manager for the PHU contract by 31 March 2014.
- The Ministry to provide feedback on your Annual Plan by 30 April 2014.
- Incorporate feedback and seek DHB endorsement for your final draft.
- Submit final PHU Annual Plan for 2014/15 to the Ministry together with your DHB Annual Plan, Regional Services Plan and Māori Health Plan by 30 May 2014.
- Prepare for service delivery from 1 July 2014.
5 Financial accountability
Use the agreed financial budget template (Appendix 3) to demonstrate how you have apportioned core public health services funding from different service lines to the groupings of services you deliver. Show the revenue obtained through fees and charges that are related to your core activities. However, it is optional that you show the level of funding you receive from other Ministry of Health contracts and other funding agencies.
Use the financial reporting template (Appendix 3) to fulfil your financial accountability every six months.
6 Service performance monitoring
Your service performance will be assessed through six-monthly performance monitoring reports and ISE reportssubmitted to the Ministry, our regular meetings/visits to your premises and service audits/reviews/evaluations, as required. The Ministry currently has no plans to conduct service audits of PHU core contracts.