This Project Has Been Assisted by the Department for Health and Ageing (SA Health)

Acknowledgments

This Information Paper has been prepared by the Local Government Association of SA (LGA) with the assistance of AECOM Australia Pty Ltd, for the guidance of and use by member Councils. The LGA is the statutory peak body for Local Government in South Australia, representing all 68 Councils in the State.

This project has been assisted by the Department for Health and Ageing (SA Health).

This Paper was first issued in June 2016.

Enquiries regarding this publication should be directed to the LGA on 8224 2000

Table of Contents

Executive Summary 3

Background 3

Findings 4

Recommendations 5

1.0 Introduction 6

2.0 Workshop Summary 7

2.1 Governance 7

2.2 Communication 10

2.3 Implementation 12

2.4 Monitoring and reporting 14

3.0 Key Findings 17

4.0 Recommendations 19

Attachment A

List of participating Councils (and subsidaries) 20

Executive Summary

Background

South Australian Councils commenced preparing for their first Regional Public Health Plans (RPHPs) in 2012 and having completed them, are now working toward implementation. The majority of the 68 Councils in South Australia have chosen to work in groups to develop a Public Health Plan for their combined communities.

The decision by Councils to jointly prepare RPHPs was intended to create efficiencies, reduce duplication of effort and lead to greater cooperation between Councils in areas of public health priority. For some Councils it was also a practical decision to share the costs associated with developing the RPHP.

A Regional Public Health Planning Workshop held on 9 May 2016 brought together representatives from Councils that have prepared a joint RPHP, and are now focused on developing effective mechanisms to address public health priorities and report on their progress. The purpose of the workshop was to share the experiences of the various regional groups and explore the successes and challenges they have faced. The learnings from this workshop are relevant for all Councils for the implementation of Regional Public Health Plans.

Findings

The feedback from this workshop highlights the importance of Councils taking a proactive and organised approach to public health planning. The groups of Councils that have established formal organisational governance structures, involving senior managers and staff representatives from a range of different disciplines have generally experienced greater success in their public health planning and implementation.

Other experiences reported in the workshop suggest that some groups of Councils have not established the organisational capacity to effectively implement their RPHPs. In some cases, the initial structures that were used to develop the plans need to evolve in order effectively support their implementation.

The engagement with and endorsement of the Plan by Elected Members and senior managers has been highlighted as a critical factor for successful implementation of RPHPs.

Councils that have reported the greatest success in implementing and monitoring their RPHPs have developed an action plan, with reporting mechanisms and actions embedded in a performance monitoring system to build in accountability.

It is important to acknowledge that most Councils are still in the early days of implementing their Plans, and there is plenty of scope to address the barriers and challenges that have been identified during the workshop.

All Councils reported that individually they continue to undertake activities which support health and wellbeing through public infrastructure, community services, and other core local government business.

Councils have highlighted the need for ongoing support from the Local Government Association (LGA) and SA Health to engage Council leadership and strengthen their support for the RPHP. Some Councils also require assistance to understand their reporting responsibilities and potentially refine the range of issues they collect data and report on.

The important role of public health partner authorities to support Councils to deliver results in areas of regional public health priority was also highlighted. Some Councils would like to engage directly with partners to jointly progress some of the actions identified in their Plans.

Recommendations from participating Councils

The following recommendations are based on the key findings arising from the workshop discussion.

Recommendations for Councils:

· Assign a senior manager to be responsible for implementing and reporting on the RPHP;

· Identify staff from various Council departments to be RPHP ‘champions’ and provide them with training and support for fulfil this role;

· Develop priorities and an action plan, ideally for each Council;

· Integrate RPHP into formal communications and governance structures such as Council meeting agendas;

· Identify whether implementation actions are within existing resources or if additional resources are required; and

· To improve the monitoring of implementation of RPHPs, increase regularity of internal reporting, or include implementation actions on quarterly reports.

Recommendations for the LGA

· Ongoing partnership with SA Health to show Council leadership the benefits of public health planning and to lift the profile of RPHP within Councils; and

· Continue to work with SA Health to support Councils to streamline reporting processes in regional groupings in relation to RPHP reporting and environmental health reporting.

· Provide training and support for RPHP ‘champions’ within Councils

Recommendations for SA Health

· Profile the role of public health partner authorities and benefits to local government to address public health priority areas;

· To continue to provide Councils with information about state-wide trends and public health issues, key themes, and the status of public health partnerships; and

· In partnership with the LGA provide further information about reporting expectations on RPHPs with the aim of streamlining the process so that reports can be readily prepared.

1.0 Introduction

South Australian Councils commenced preparing their first Regional Public Health Plans (RPHPs) in 2012 and having completed them, are now working toward implementation. The majority of the 68 Councils in South Australia have chosen to work in groups to develop a public health plan for their combined communities. Twenty Councils have individually developed their initial RPHP.

This report summarises the workshop discussion under the key headings of:

· Governance;

· Communication;

· Implementation; and

· Monitoring and reporting.

Under each heading the main discussion points are summarised in relation to:

· What are Councils doing in the area;

· What has worked well;

· What hasn’t worked;

· Barriers to achieving better outcomes; and

· Opportunities to overcome the barriers and improve outcomes overall.

A list of participant Councils are included in Attachment A.

2.0 Workshop Summary

2.1 Governance

What are Councils doing?

Governance of public health planning includes compliance with the legislative and policy frameworks, organisational structures, and monitoring and reporting of Public Health Plans and their proper implementation.

For further information regarding Regional Public Health Plans Governance Options for Partnership / Cooperative Arrangements, please go to www.lga.sa.gov.au/publichealth.

There is considerable variation in the governance arrangements groups of Councils have put in place when jointly preparing RPHPs, as shown in Table 2.1.
Table 2.1 – Examples of RPHP Governance Structures

Structure / Councils
Regional Subsidiary
under existing Local Government Association (LGA) framework / Southern and Hills LGA
Advisory Committee
Advisory Committee (one staff and elected member from each Council), Terms of Reference / Eastern Health Authority
Working group
Governance model involving standing committees, stakeholder reference group and staff advisory group. / Unley & Mitcham
Barossa, Light and Lower Northern Region

Some groups have utilised existing regional subsidiaries as part of their local government organisational structures, which workshop participants indicated have been most effective during the implementation of their plans. Others have created joint Council committees during the development phase of their plans but, note these structures have been less effective during the implementation phase.

It is important to note that not all joint RPHPs have the aim of working jointly, some Councils have acknowledged that whist there were efficiencies in jointly developing their plan, the implementation may be better undertaken at the individual Council level.

A common theme arising from the workshop was the importance of having at least one person from each Council who is an advocate for the RPHP within their own organisation to ensure it remains relevant to Council business.

What has worked well?

Participants provided feedback that successful governance arrangements have involved managers and staff with a strategic role in the development and implementation of the RPHP. Having the support and ‘buy in’ from Elected Members and CEOs is a critical success factor. Councils reported that having a person whose role is to ‘champion’ the RPHP ensured it isn’t forgotten once completed. Overall, this has led more successful implementation of their Plan.

Groups of Councils with a more formal organisational governance structure appear to have achieved better outcomes consistently through the planning and implementation phases.

Key success factors:

· Support from decision makers in each Council;

· Having a ‘Champion’ within each Council;

· Formal organisational governance structures; and

· Budget allocation for projects.

What hasn’t worked?

Councils reported that not assigning someone with responsibility for the RPHP has reduced the momentum for putting the RPHP into action and developing monitoring and reporting mechanisms.

Using a regional LGA structure involving a larger number of Councils can mean that the size of the region is potentially too challenging to plan across.

Participants noted the role of consultants in assisting Councils to prepare RPHPs has often left groups of Councils unprepared to take over the implementation phase of the plan. In these cases, the use of consultants in the development phase has not enabled sufficient capacity to be built within Councils to oversee their implementation. In particular, it was reported that there tends to be a loss of momentum where a formal arrangement has not been established to guide the implementation of the RPHP.

Some participants reported that the mechanisms established for planning the RPHP have not been as effective for its implementation. For example, some RPHPs were developed by Environmental Health Officer (EHO) representatives from each Council. This proved effective in developing the Plan but has meant that staff from the other disciplines within Council does not share a sense of ownership over it.

Key learnings:

· Where possible, assign a person to take responsibility and be accountable for the RPHP;

· When using consultants, Councils need to build capacity internally to implement the RPHP; and

· An action plan is required for each Council to guide their role in the implementation of the RPHP.

What are the barriers?

The barriers to effective governance identified by workshop participants can be grouped into several broad areas: political will, competing priorities, addressing public health through core business and staff resourcing.

There may be a lack of political will on behalf of a Council to hand over decision making (for RPHP) to subsidiaries. This means that even where groups of Councils have strong governance arrangements such as the use of an existing regional LGA structure, without delegated powers under Section 44 of the Local Government Act 1999, this group cannot make decisions on behalf of individual Councils. The result is that new initiatives must be formally agreed by each individual Council. This requirement slows decision-making as the timing of Council meetings varies and creates delays in putting the RPHP into action. An ability to delegate decisions and potentially funding this would create a more effective governance structure. Further advice on Regional Subsidiaries and the ability to delegate powers or functions can be found at Regional Public Health Plans Governance Options for Partnership / Cooperative Arrangements, located at www.lga.sa.gov.au/publichealth.

Regional Public Health Plans compete with other Council plans for resources and priority within broader Council strategies. In some cases, the RPHP is one of a number of plans or strategies for which a council is responsible. Many of the directions in the RPHP may be addressed through other strategies, but the documents have not been specifically prepared with reference to each other. In some cases, other regional priorities take precedence over health and wellbeing which may not be seen as core Council business

Public health planning is more likely to be prioritised by Councils where staff resources are allocated to implementing the RPHP and there is someone to ‘champion’ the Plan against other competing priorities.

Other barriers that were identified include staff changes, staff being committed to other work, and ongoing perceptions that EHOs are responsible for preparing and implementing RPHPs.

Some participants commented that the initial governance structure that was established with their Council partners to develop the RPHP is not working as well during the implementation phase and will need to be reviewed.

How could the barriers be overcome, and how can we improve overall?

Participants identified that, for those planning under a regional subsidiary, delegation of powers and functions to a Regional Subsidiaries (for RPHP) is likely to create greater efficiencies in the administration of RPHPs, and would also create a basis for ongoing and better collaboration between Councils to provide other services and initiatives.

There is opportunity to create greater awareness by Council leadership of the role of public health planning in local government and opportunities to gain outside resources through the implementation of RPHPs. Involving senior managers, and ideally engaging a person in a senior management role to champion the RPHP was seen as a key way to implement more effective governance of RPHPs.

Key opportunities:

· Continue to promote public health planning as whole of Council business rather than a ‘stand-alone’ issue or an extension of the current EHO role;