2018/19 Annual Plan Guidance for Public Health Units

Guidance Overview

About the Guidance Overview

This package of documents sets out the 2018/19 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 2018/19 Planning Package for DHBs, has been developed by the Ministry of Health (Ministry)-PHU working group in consultation with Ministry and sector colleagues. The Ministry and sector feedback on the draft guidance has been incorporated into the final version.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 package(including appendices) carefully. Please also refer to appropriate guidance in DHB planning package (nsfl.health.govt.nz).

Section 1 of the Guidance Overview outlines alignment with Results Based Accountability™ (RBA)and the core functions approach. Section 2 is focused on general guidance while Section 3 is about the ‘mechanics’ of the 2018/19PHU 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.

Please find a summary of key points and changes made to the2018/19 Annual Plan Guidance, which consists of thisGuidance Overview andthreeappendices.

Summary of key points and changes to the 2018/19 Annual Plan Guidance for PHUs

No. / Item / Key points and changes as compared with last (ie, 2017/18) Annual Plan Guidance for PHUs
1 / Guidance Overview /
  • PHUs to plan with their DHB/s – DHB Annual Plan to include high level PHU activities.
  • PHUs to plan based on level of existing funding; PHU may negotiate with the Ministry of Health (Ministry) the strategic priorities, and range and level of services to be delivered by the PHU.
  • Rationale provided on differing levels of detail in DHB and PHU Annual Plans (greater level of detail for regulatory services compared with non-regulatory services).
  • Use of RBA encouraged; to focus on PHU’s role and value add when telling the performance story at PHU service/programme level; it’s not necessary to use extensive surveying unless deemed useful by the PHU.
  • Public Health Service Specifications Tiers 1, 2 and 3 clarified.
  • Further guidance on section relating to “Strong sustainable PHU workforce”, including reporting to the Ministry on workforce development.
  • PHU Annual Plan template, financial and reporting templates, the reporting requirements and the review tool have not been included in the 2018/19 Annual Plan Guidance for PHUs because these documents are essentially the same as those used for the 2017/18 PHU Annual Plan and reporting. The Ministry can send these documents to PHUs, if required.
  • The option of sharing Final PHU Annual Plans on SIPHAN.
  • The Ministry’s offer of planning support to individual PHUs.
  • Contracts with DHBs for core public health services are expiring on 30 June 2018; the Ministry will communicate about contract renewal soon.

2 / Appendix 1: Strategic Priorities and Guidance for PHUs /
  • Guidance has been updated, issues lead contacts included for PHUs to make direct contact with respective people in the Ministry, as appropriate.

3 / Appendix 2: Vital Few Reporting Template /
  • Same Vital Few reporting template and additional Vital Few measures.
  • Purpose and use of Vital Few reporting are clarified.

4 / Appendix 3: Exemplars /
  • The exemplar on Environmental and Border Health(Appendix 3A) has been updated; the exemplar on Alcohol (Appendix 3B) has been reviewed (some of the Vital Few measures have been reworded for clarity, and a new Better Off measure added); an exemplar for Communicable Diseases (Appendix 3C) isunder development, and will be shared with PHUs when ready.
  • A data dictionary (performance measures library) to support national consistency of data collection and analysis is in developmentbyappropriate Ministry-PHU working groups.The data dictionary will be shared with PHUs, and placed on SIPHAN when ready.

Contents

Contents

1 The 2018/19 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 core public health functions approach

Table 1: Core function, overview and boundaries

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

2.2 Improving Māori health

2.3 Improving equity for all

2.4 Strengthening focus on wellbeing and prevention

2.5 Strong sustainable PHU workforce

2.6 Continuous quality improvement

2.7 System Level Measures

3 PHU Annual Plan for 2018/19

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 PHU Annual Plan Template

3.2.2a Key Activities

3.2.2b Performance Measures

3.2.2c Examples of performance measures

3.3 Financial Planning and Reporting Templates

3.4 All Reporting Requirements as per core public health services contract

3.5 Appendix 2: Vital Few Reporting Template

PHU annual reports will be shared on SIPHAN ( for PHUs that are agreeable to their report being shared.

3.5.3 Appendix 2: Vital Few RBA Reporting

Note that the performance measures reported in your Vital Few report do not need to be re-reported in your Whole-of-year Report.

3.6 Appendix 3: Exemplars

3.6.1 Appendix 3A: Environmental and Border Health Exemplar

3.6.2 Appendix 3B: Alcohol Exemplar

4 Endorsement of the PHU Annual Plan

5 Annual Plan Timeline

Introduction to core public health services

DHB-based 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 servicesat the individual level (eg, immunisation, breast/cervical screening).

PHUs provide an integrated multi-disciplinary workforce withexpertise to work across the whole spectrum of public health, and respond to emerging and re-emerging public health risks and emergencies. They undertake regulatory functions, health assessment and surveillance, public health capacity development, health promotion and preventive intervention services that enhance the effectiveness of the prevention and wellness system, thus reducing downstream costs of the whole health system (eg, primary or secondary care services).

Differing levels of details for DHB and PHU Annual Plans and why

For the PHU Annual Plan, the Ministry of Health (Ministry) is requiring a similarlevel of detail in the area of Health Protection as in previous years– please refer to the Environmental and Border Health exemplar (Appendix 3A). For non-regulatory activities, you may set your PHU Annual Plan information at a ‘medium’ level – please refer to the Alcohol exemplar (Appendix 3B).

This is because the Ministry has leadership and oversight over how public health regulatory functions/services are delivered and achieved, as the statutory accountability for these functions/services rests with the Ministry. In accordance with Section 3 of the Health Act 1956, the Ministry is responsible for improving, promoting and protecting public health. Many regulatory functions, duties and powers are held by the Director-General of Health, the Director of Public Health or the Ministry. We are not separating out the regulatory services from other public health services to ensure the whole spectrum of public health is considered and delivered.

The information required in the DHB Annual Plan is set at a much higher level. The DHB planning regulations do not require such a high level of detail from the DHBs because the duty to provide appropriate health services is owed by the DHBs under the New Zealand Public Health and Disability Act 2000.

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.

Each DHB has a statutory responsibility to prepare:

  • an Annual Plan for approval by the Minister of Health (Section 38 of the New Zealand Public Health and Disability Act 2000) – providing accountability to the Minister of Health
  • a Statement of Performance Expectations (Section 149C of the Crown Entities [CE]Act 2004, as amended by the Crown Entities Amendment Act 2013) – providing financial accountability to Parliament and the public annually
  • a Statement of Intent (Section 139 of the CE Act) – providing accountability to Parliament and the public at least triennially.

SECTION 1

1The 2018/19 Annual Plan Guidance for PHUs

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

The 2018/19 Annual Plan Guidance for core public health services delivered by PHUs (alternatively called the “PHU planning package”), which forms part of the 2018/19DHBPlanning 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 both the DHB and PHU planning packages for service planning/delivery, and reporting to the Ministry.

The key objectives of the 2018/19 Annual Plan Guidance for PHUs are to support:

  • DHBs to plan and provide appropriate health services so all New Zealanders live well, stay well and get well (New Zealand Health Strategy 2016)
  • 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, demonstrating the value of PHU investment.

The 2018/19 Annual Plan Guidance for PHUs consists of the following:

  • Guidance Overview
  • Public HealthStrategic Priorities (Appendix 1)
  • PHU Vital Few Reporting Template(Appendix2)
  • Exemplars (Environmental and Border Health: Appendix 3A andAlcohol: Appendix 3B)

The 2018/19 Annual Plan Guidancefor PHUs shows alignment with Results Based Accountability™ (RBA), which you are encouraged to use.You have the option of using the core functions approach (see pages 7 to 8)if you find that useful.

1.1 Alignment with Results Based Accountability™

You are encouraged to continue to use RBAin your PHU Annual Plans for 2018/19, 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 focus of the SCF project is on NGOs, the Ministry is keen to support all the providers it funds and contracts with (DHBs 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, planning, service delivery and reporting. There may be opportunities to measure ‘collective impact’ in the future.

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 or outcomes.

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 thepeople, 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. You therefore 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 core public health functions approach

PHUs can group and display their activities according to what works best for them: whether service lines, settings, core functions, programmes, their internal service structure groupings or any grouping that the PHU has elected. In other words, PHUs have the option of using the core functions approach if you find that useful. The core functions approach is one 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 core functions approach was developed by the PHU sector. You may refer to the core functions report, Core public health functions for New Zealand: a report of the NZ Public Health Clinical Network, September 2011. The published article in the New Zealand Medical Journal can be accessed from:

If you opt 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 (eg, Smoke-free Compliance, Alcohol and Illicit Drugs, Communicable Diseases, Environmental and Border Health).

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

Table 1: Core function, overview and boundaries

No. / Core function / Overview / Boundaries
1 / Health Assessment and Surveillance / Understanding the health status, health determinants and distribution of disease /
  • Statutory roles are placed under Health Protection

2 / Public Health Capacity Development / Building a capable workforce and developing effective programmes. /
  • Training of own staff and other staff in wider public health sector (under human resources)
  • Networking and partnerships
  • Evaluations

3 / Health Promotion / Enabling people to increase control over and improve their health /
  • 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)

4 / Health Protection / Protecting communities against public health hazards /
  • Statutory roles are placed under Health Protection

5 / Preventive Interventions / Population programmes delivered to individuals /
  • Covers four main areas: immunisation, screening, stop smoking services, family violence prevention services.

Tiers 1, 2 and 3 Public Health Service Specifications

Nationwide service specifications describe the minimum national service requirements, and are jointly agreed between the Ministry and the DHBs. The nationwide service specifications must be used when contracting for or providing health services that have minimum national service requirements.Some services are not covered by a nationwide service specification where national consistency is not required.

The purpose of a nationwide service specification is to:

  • clarify the services to be funded/provided and list the purchase unit codes relevant to the services
  • agree on reporting requirements to collect information for service analysis and planning
  • ensure common understanding of the components of services and linkages between them and other services
  • ensure service specific requirements are applied consistently throughout the sector
  • allow for benchmarking and auditing of the services
  • ensure quality requirements are consistent.

The Public Health Service Specifications use a three-tiered structure. Each tier describes the service ata different level of detail.