Business Plan and Annual Operational Plan for 2015/16

Transcription

1 Te ora O Tamaki Makaurau Health for all People of Auckland Business Plan and Annual Operational Plan for 2015/16 1

2 Table of Contents 1. SECTION ONE INTRODUCTION PLANNING FRAMEWORK ALIGNMENT WITH KEY EXTERNAL ORGANISATION S OUTCOMES, PRIORITIES AND TARGETS ARPHS STRATEGIC PRIORITIES SECTION TWO POPULATION ACCOUNTABILITY - BUSINESS PLAN LONG AND MEDIUM-TERM OUTCOMES OUTCOME 1: THE ADVERSE EFFECTS OF ENVIRONMENTAL HAZARDS ARE MINIMISED OUTCOME 2: THE INCIDENCE AND IMPACT OF NOTIFIABLE COMMUNICABLE DISEASES IS MINIMISED OUTCOME 3: THE HARMS ASSOCIATED WITH HAZARDOUS COMMODITIES IS MINIMISED OUTCOME 4: THE ENVIRONMENTS IN WHICH PEOPLE LIVE, WORK AND PLAY PROMOTE HEALTH AND WELLBEING SECTION THREE ANNUAL OPERATIONAL PLAN 2015/ OUTCOME 1: THE ADVERSE EFFECTS OF ENVIRONMENTAL HAZARDS ARE MINIMISED Built Environments Border Health Protection Burial and Cremation Drinking Water Quality Hazardous Substances and New Organisms (HSNO) Waters and Wastes Early Childhood Education Centres Resource Management Public Health Emergency Planning and Response OUTCOME 2: THE INCIDENCE AND IMPACT OF NOTIFIABLE COMMUNICABLE DISEASES IS MINIMISED Notifiable Infectious Disease Tuberculosis (TB) Disease Investigation Complex HIV BCG Authorisation Programme Independent Vaccinators Refugee Health Screening Service (RHSS) OUTCOME 3: THE HARMS ASSOCIATED WITH HAZARDOUS COMMODITIES IS MINIMISED Enforcement of Psychoactive Substances Act Alcohol Tobacco OUTCOME 4: THE ENVIRONMENTS IN WHICH PEOPLE LIVE, WORK AND PLAY PROMOTE HEALTH AND WELLBEING Social Environments Workplace Health Vulnerable Communities- Migrants & Migrants of Refugee background Nutrition Information and Advice Healthy Early Childhood Education Settings ECES- (Nutrition) ORGANISATIONAL ENABLER: SUITABLE WORKFORCE, INFRASTRUCTURE AND CLINICAL GOVERNANCE (QUALITY) Healthy Public Policy Workforce Development Communications Informatics Intelligence, Planning and Quality Resource Centre

3 3.5.7 ARPHS Facilities Afterhours Service SECTION FOUR NON-CORE PROGRAMMES (CONTRACT SERVICES) SECTION FIVE SECTION SIX

4 1. Section One Introduction Planning Framework Alignment with external outcomes, priorities and targets Strategic Priorities 4

5 1.1 Introduction Auckland Regional Public Health Service (ARPHS) provides public health services to people residing in the three metro Auckland DHB regions as defined by the Health Act (1956). ARPHS is planning and service delivery is working to achieve its vision of Te Ora O Tamaki Makaurau: Health for all People of Auckland. With this year s plan, we are introducing the first stage of an outcomes-based framework, fully aligned with the Results-Based Accountability (RBA) model promoted by the Ministry of Health. We are adopting a three-layered outcome model: short (1 year), medium (3+ years) and long term (10+ years) outcomes. A high level framework is presented in section 2. At this stage, this section is work in progress. Further development and refinement is required and will be prioritised during the next financial year. As per the RBA model, our short term outcomes will be reported under the section Performance Accountability which includes short-term outcome measures and quality & quantity performance indicators. This section of the plan constitutes our Annual Operational Plan (AOP) for the financial year 2015/16 (Section 3). Our Business Plan and accompanying Annual Operational Plan 2015/16 have been developed in alignment with the Ministry of Health s reviewed service specifications and the New Zealand Public Health Clinical Network s document Core Public Health Functions for New Zealand. For the year 2015/16, we are partially implementing the public health core functions model established by the Public Health Service Specifications. We have classified our services using this framework for this year s plan and full implementation, including the financial application of the core functions, is expected to be completed for the financial year 2016/17. In developing this plan, we have actively engaged with our key stakeholders. More information about the consultation can be found in section 1.3. Detailed alignment with other government and sector priorities can also be found in Section 1.3 Additional organisational strategic information is provided under section 1.4. This section describes the ARPHS Service s priorities. 5

6 Auckland s Population Profile ARPHS provides public health services to the population residing in the Auckland regions District Health Boards (Waitemata, Auckland and Counties Manukau). According to the Census 2013, the Auckland region population accounts for a third of the New Zealand population. While the Auckland regional population presents similar demographic trends to those of the national population, e.g. growth, aging and reducing smoking prevalence, its absolute size, degree of urbanisation and ethnic diversity creates some unique features. While about a third of the New Zealand population at the 2013 Census lived in Auckland, the proportion of ethnic groups living in the region varied widely. Auckland had a significantly higher proportion of residents of Asian, Pacific and Middle Eastern, Latin American and African (MELAA) ethnicities than the rest of New Zealand. Based on the data from the Census 2013, below are a few key facts that highlight some of the key demographic facts about our Auckland population: Population Growth Māori Aging Diversity Infant growth Deprivation Smoking 1,501,150 people reside in Auckland one third of New Zealand s population 8.8% growth in the Auckland population between This was greater than the population growth for the rest of New Zealand outside of the Auckland region 25% of the population that identified as Māori live in Auckland +65 year old Māori group growth rate was higher than total Auckland population The proportion of residents of Asian, Pacific and MELAA ethnicities was significantly higher in Auckland than in the rest of New Zealand while the proportion of European/Other and Māori was considerably lower The proportion of infant residents of Asian, Pacific and MELAA ethnicities was significantly higher in Auckland than in the rest of New Zealand while the proportion of European/Other and Māori was considerably lower Auckland has a higher proportion of the population living in both the least and most deprived neighbourhoods than the rest of New Zealand, 39% of those living in decile 10 areas are in Auckland In 2013, Auckland had 33% fewer smokers than in 2006 while New Zealand had 22% fewer smokers 6

7 Performance Accountability Population Accountability 1.2 Planning Framework One of ARPHS significant commitments to improving, promoting, and protecting the health of people in the region is to move to a planning and monitoring model with population health and service performance outcomes based on: Long-term indicators (10+ years, multisectoral, collective population accountability among key stakeholders) Medium term indicators (3+ years, partially attributable to ARPHS) Short-term measures and performance indicators (1 year, attributable to ARPHS) An outcomes-focused planning model will support ARPHS to fulfil its vision by: Linking our day-to-day activities and outputs with the contributions we make towards the realisation of societal health outcomes Ensuring consistency with current strategic health planning frameworks Allowing us to communicate more clearly with a range of stakeholders (for example Auckland Council). We are making the transition to this type of planning by aiming to fully develop a Results-Based Accountability (RBA) model. We are adapting the RBA framework for our long, medium and short term planning, monitoring and reporting using the following three-layered model: Long-term Outcomes years Long-term Outcome Indicators Medium-term Outcomes - 3+ years Medium -term Outcome Indicators What do we aspire to? Short-term Outcomes - 1 year Short-term Outcome Measures Performance Measures: Quality & Quantity How are we performing? 7

8 1.2.1 What do we aspire to? Overall and long-term outcomes In order to fulfil ARPHS vision: Te ora o Tamaki Makaurau: health for all the people of Auckland We have adopted two overall long-term outcomes and four supporting long-term outcomes: Increased Life Expectancy and Quality of Life Overall longterm Outcomes The adverse effects of environmental hazards are minimised The incidence and impact of notifiable communicable diseases is minimised The harms associated with hazardous commodities is minimised The environments in which people live, work and play promote health and wellbeing Long -term Outcomes Māori Health Gain and Equity for All Overall longterm outcomes ARPHS two overall long term outcomes reflect societal outcomes: Increased life expectancy and quality of life Māori health gain and equity for all As population accountability outcomes, these reflect the complementary roles that key regional stakeholders play in supporting Auckland s population and its wellbeing and ARPHS commitment to its role in collective responsibility. These outcomes align with key strategic stakeholders planning and monitoring documents, e.g. the Auckland region DHB Annual Plans and Auckland Council s Auckland Plan monitoring framework, providing a platform for collaborative action. At this stage, work on long-term indicators to support the outcomes framework has not yet commenced. Further refinement of outcomes and indicator development will be taking place during the 2015/16 financial year in order to support the development of ARPHS planning document for the year 2016/17. 8

9 Medium-term outcomes In the past, ARPHS has worked on developing a set of medium-term outcomes and indicators to contribute to the achievement of two of our long-term outcomes (environmental hazards and communicable diseases). Further development is required on the medium indicators for long-term outcomes 3 and 4 (hazardous commodities and social environments) These medium-term outcomes are more directly attributable to the activities of ARPHS than long-term outcomes. Section 2 provides detailed information relating to medium-term indicators Long-term outcome Medium-term outcome Indicator The burden of environmental infectious disease 1 cases is reduced 1.The adverse effects of environmental hazards are minimised Risks of domestically acquired vector-borne disease (VBD) 2 are monitored to ensure early identification The burden of lead notifications resulting from non-occupational exposure is reduced Rate of confirmed and probable environmental infectious disease cases per 100,000 persons per year Rate of confirmed and probable environmental vector- borne disease cases likely overseas acquired per 100,000 persons per year Rate of cases with elevated serum lead and with confirmed nonoccupational exposure per 100,000 persons per year 2. The incidence and impact of notifiable communicable diseases is minimised The burden of communicable notifiable diseases 3 in the population is reduced Aucklanders are free of infections that are preventable by vaccination 4 The rate of TB in children under 5 years of age is reduced The burden of enteric disease 5 cases is reduced Rate of confirmed and probable notifiable communicable disease cases per 100,000 persons per year Rate of confirmed and probable vaccine preventable diseases per 100,000 persons per year Age-specific incidence rate of TB notifications in children under five years per 100,000 persons under five years per year Rate of confirmed and probable enteric disease cases per 100,000 persons per year 1 Including Leptospirosis, Marine typhus, Rickettsial disease and Legionellosis. 2 Arboviral and Malaria 3 These exclude environmental health related notifications: Vector-borne disease (VBD), Leptospirosis, Murine typhus, Rickettsial disease, Legionellosis, Lead absorption, Chemical poisoning from the environment, Decompression sickness, and Hazardous substances injury. 4 Includes notifiable vaccine preventable diseases on the National Immunisation Schedule: Pertussis, Measles, Mumps, Rubella (congenital and not congenital), Haemophilus influenzae type b, Invasive pneumococcal disease, Hepatitis B, Tetanus, Polio, Diphtheria 5 Including: Campylobacteriosis, Cholera, Cryptosporidiosis, Acute gastroenteritis (unknown cause & foodborne intoxication), Giardiasis, Typhoid fever, Paratyphoid fever, Salmonellosis, Shigellosis, Yersiniosis, Cronobacter species, Listeriosis, Listeriosis perinatal, and VTEC/STEC infection 9

10 Long-term outcome Medium-term outcome Indicator Children of quota refugees are fully immunised as per NZ immunisation schedule within one year of arrival Children of quota refugees receiving immunisations 6 and 12 months after arrival *NZ Refugee Resettlement Strategy national indicator 3.The harms associated with hazardous commodities are minimised 4. The environments in which people live, work and play promote health and wellbeing To be developed during the financial year 2015/16 To be developed during the financial year 2015/16 To be developed during the next financial year 2015/16 To be developed during the next financial year 2015/ How are we performing? Annual Operational Plan Short-term outcomes and performance measures (outputs) Our short-term outcomes, short term impact and performance measures (quantity and quality) are presented using the performance accountability section of the RBA framework as per the Ministry s requirements. This set of measures constitutes ARPHS Annual Operational Plan. In section 3, we present short-term outcomes and performance measures for our core services. This includes activities aimed at improving Māori health gain and achieving equity for all. Core functions model implementation Public Health Units are required to implement the Public Health Core Functions model. In order to integrate this model into our outcomes framework, we are incorporating the five functions under the performance section of the RBA as they are closely related to our service delivery activities. With the integration of the core services, we are complementing our planning framework as follows: 10

11 Performance Population Long-term Outcomes years Long-term Outcome Indicators Medium-term Outcomes - 3+ years Medium -term Outcome Indicators What do we aspire to? Short-term outcomes - 1 year Short-term outcome measures Performance Measures: Quality &Quantity Assessment & Surveillance Capacity Development Preventive Interventions Health Promotion Health Protection How are we performing? With the classification of our services by the five core functions, ARPHS is initiating the implementation of this model for the year 2015/16. We have broken down our service areas by core function and have developed new service taxonomy (see page 41). In order to complete the transition to the core functions model, the application of this model to financial information is expected to be completed by the year 2016/17. How Māori health gain and equity for all are dealt with within the proposed framework Improving Māori Health Gain in accordance with ARPHS commitment to the Treaty of Waitangi and achieving equity for all are integral components of the work we do. We plan to report outcome indicators by an equity dimension (e.g. ethnicity and deprivation index) where possible. 11

12 1.3 Alignment with key external organisation s outcomes, priorities and targets Consultation on the Plan We will continue engaging with our stakeholders on the development of our planning documents. Active consultation was undertaken during the development of this plan. A planning workshop took place in late February with representatives from DHBs, Hāpai Te Hauora and Auckland Council. The current Head of School of Population Health from the University of Auckland and a Pacific DHB Planning and Funding Manager also participated in the workshop. The plan and key stakeholders expectations on service delivery were shared and discussed; feedback was collected and incorporated into the plan where applicable. In addition, feedback from DHBs funding and planning and Clinical Specialists was also sought Improving Māori Health Maintaining effective partnership with Mana Whenua is a priority for ARPHS. During 2015/16, ARPHS Māori Liaison Advisor will continue to lead this work focussing on strengthening the partnership though specific programmes and areas of work across the Service (activities are identified across the plan as: Māori Health Gain - Partnership with Mana Whenua) This line of work aligns well with Te Ara Tuarua, pathway two of He Korowai Oranga (2014) strategy Māori participation in the health and disability sector. In terms of service delivery and in alignment with Te Ara Tuatoru, pathway three of He Korowai Oranga Effective health and disability services, some of our services support DHBs key priorities as per their Māori health plans: Addressing risk factors for cardiovascular disease ((Nutrition Information & Social Environments - Healthy Auckland Together; Healthy Early Childhood Education Settings) Smoking (Tobacco: Enforcement Smoke-Free Environments Act and Health Promotion) Immunisation (BCG) Rheumatic Fever (Notifiable Infectious Disease) Workforce (Workforce Development). Lastly, the work that our policy team does (Healthy Public Policy) and the work with the Auckland Intersectorial Health Group (Social Environments) help give effect to Te Ara Tuawhā, pathway four of He Korowai Oranga Working across sectors Ensuring equity for all (Including Māori, Pacific, refugees and other communities) 12

13 Although a significant part of the work that ARPHS does uses population level interventions, we endeavour to deliver complementary targeted services and programmes without exacerbating existing health inequities. As part of an interwoven net of health providers, ARPHS works to support the health of the families of Pacific peoples, quota refugees, vulnerable migrants (e.g. from refugee backgrounds) and people living in low socio-economic areas. The organisation takes a holistic approach when delivering population interventions related to on emergency outbreaks such as measles and investigations related to notifiable diseases (e.g. tuberculosis and BCG) involving health promotion staff in the delivery of education on other areas such as `Smokefree. We align our business plan with key strategic priorities of other external stakeholders: Pacific Health In alignment with the Pacific Health Action Plan (ADHB & WDHB), our main priorities for Pacific health are: Nutrition and physical activity (Nutrition Information & Social Environments - Healthy Auckland Together; Healthy Early Childhood Education Settings) Supporting Smokefree environments (Tobacco: Enforcement Smoke-Free Environments Act and Health Promotion) Warm houses that are not overcrowded (Healthy Public Policy; Social Environments e.g. AIHG group) Our work also aligns with areas prioritised in the Ala Mo ui 2014/18 Pacific strategy: Pacific peoples are better supported to be healthy (Alcohol Health promotion) Pacific peoples experience improved broader determinants of health (Intelligence; Healthy Public Policy; Social Environments) and Counties Manukau Pacific Health Development Strategy and its associated Pacific Health Development Plans Refugee and Migrants of Refugee background Our work with refugees aligns with goal 3 of the National Refugee Resettlement Strategy (NRRS) Health and wellbeing: refugees and their families enjoy healthy, safe and independent lives (Refugee Health Screening Service; Refugee Health Promotion; Vulnerable communities) Workforce Development ARPHS workforce team used the Te Uru Kahikaketa (Public Health Workforce Plan) and the Taeao o Tautai to develop ARPHS Workforce Development Plan 2014 to 2017 and an implementation plan. Relevant content has been incorporated into the Workforce Development section in our AOP 2015/16. 13

14 1.3.5 National and regional priorities Our plan also takes into account national and regional priorities as well as the revised version of the He Korowai Oranga and the Ala Mo ui strategies. The alignment of our business plan is presented below: 14

15 ARPHS Outcomes Framework alignment with key external organisation s outcomes GOV POLICY Better, sooner, more convenient health services MINISTRY S HEALTH SYSTEM OUTCOMES New Zealanders live longer, healthier and more independent lives The health system is cost effective and supports a productive economy MINISTRY S HIGH LEVEL OUTCOMES New Zealanders are healthier and more independent Health services are delivered better, sooner and more conveniently Sustainability OHER GOV PRIORITIES Vulnerable Children Healthy Families NZ Living within our means Increased immunisation Reduced Rheumatic Fever Increased ECE Participation HEALTH TARGETS Increased immunisation Smoking Reduction More Heart and Diabetes Checks OTHER MINISTRY S PRIORITIES / IMPACTS Environmental and disease hazards are minimised The Public is supported to make health-related informed decisions Physical Activity and Nutrition Suitable infrastructure and workforce NORTHERN REGION OBJECTIVES Population Health Service cost and productivity Regional Population Accountability Overall Long-Term Indicators (10+ y) (non- attributable, multisectoral) Te ora o Tamaki Makaurau: Health for all people of Auckland: Increased life expectancy and quality of life Māori Health Gain and Equity for All ARPHS Pop. Long -term Outcomes Medium-Term (partially attributable) 1. The adverse effects of environmental hazards are minimised 2. The incidence and impact of communicable diseases is minimised 3. The harms associated with hazardous commodities is minimised 4. The environments in which people live, work and play promote health and wellbeing Suitable workforce, infrastructure and clinical governance (Quality) ARPHS Organisational Key Outcomes Living within our means (Financial Sustainability) 15

16 1.4 ARPHS Strategic Priorities ARPHS 2015/16 operational plan focuses on nine key strategic priority areas. These are: 1. Maori health gain working in partnership to support Mana Whenua aspirations for health, well-being and achieving equity 2. Achieving equity of health outcomes for all populations 3. Healthy Auckland Together. Work collaboratively with health and other sectors to reduce obesity and unhealthy weight, improve nutrition and increase physical activity 4. Reducing harm from alcohol, including work in compliance and regulatory settings, supporting strategic development and community engagement 5. Contribute to Smokefree 2025 target through developing and supporting the smokefree action plan collaboratively with regional partners 6. Public health leadership and organisational development through development of a communications and engagement strategy, provision of public health intelligence, and further development of ARPHS public health information Management system (PHiMS) 7. Leading public health input into the development of a regional health in all policies approach to achieve improved health related public policy 8. Excellence in core delivery ensuring Management of emergent public health issues 9. Emergency Management and preparedness. To support this work these areas have been consulted on with key stakeholders and are aligned with the key priority areas for the public health sector set in strategic documents such as the Ministry's Statement of Intent, DHB plans, and He Korowai Oranga and Ala Mo'ui strategies (see section 1.3 for additional details). To successfully progress these strategic areas ARPHS will be lead and collaborate with the key stakeholders in the region. In 2015/16 ARPHS will review these strategic priority areas to inform its strategic planning for the next three-five years. This work will be supported by the results based accountability and outcomes framework that ARPHS is introducing. Improving Maori health gain and achieving equity is fundamental to the ARPHS s work. To support this focus ARPHS works in partnership with Mana Whenua across three domains to deliver these priorities: Excellence in core delivery Goal 1: Deliver effective and efficient public health services Goal 2: Build effective relationships with communities and stakeholder organisations Goal 3: Develop and strengthen the public health workforce Leadership and advocacy Goal 4: Be an innovative leader in public health Goal 5: Work collaboratively to address inequalities in health status 16

17 Future focussed Goal 6: Actively influence the sustainable development of the Auckland Region. Goal 7: Be responsive to emerging public health challenges. This is further illustrated in ARPHS Strategic Framework. Finance The budget process is still in progress at ADHB and will be completed mid- April Once this is complete we will be in a position to identify resource allocation for ARPHS for the 2015/16 year. This will include an estimate of projects identified from 2014/15 funding that will be delivered in 2015/16. 17

18 2. Section Two Population and Organisational Accountability: Long and medium-term Outcomes 18

19 2. Population Accountability - Business Plan Long and medium-term Outcomes ARPHS has identified four key health outcomes it seeks to contribute to or influence in the long-term. ARPHS four outcomes are: The adverse effects of environmental hazards are minimised The incidence and impact of communicable diseases is minimised The harms associated with hazardous commodities are minimised The environments in which people live, work and play promote health and wellbeing Under each long-term outcome, a set of key medium-term outcomes will be developed and tracked through medium-term indicators. At this stage of the process, medium-term outcomes and indicators have been developed for the first two outcomes: The adverse effects of the environmental hazards are minimised The incidence and impact of communicable diseases is minimised In relation to the indicators for these two outcomes, we have used the financial year 2013/14 as baseline. The indicators will be monitored annually so we can map trends over a period of at least three to four financial years. The outcome for year 1 will be presented in 2015/16 using data for the year 2014/15, year 2 will be presented in 2016/17 for the year 2015/16 and finally, year 3 will be reported in 2017/18 for the year 2016/14. We have also identified the most relevant Public Health Core Function under which, the activities to achieve our outcomes are delivered, although, at this level, the overlapping between core functions is significant 19

20 2.1 Outcome 1: The adverse effects of environmental hazards are minimised Medium-term indicators Medium Term Outcomes (What we aspire to in 3+ years) Population Health Outcomes Indicators The burden of infectious diseases 6 caused by environmental exposure is reduced Risks of domestically acquired vectorborne disease (VBD) 7 are monitored to ensure early identification The burden of lead notifications resulting from non-occupational exposure is reduced Medium Term Outcome Indicators Partially Attributable Rate of confirmed and probable cases of infectious diseases caused by environmental exposure per 1,000 persons per year Rate of confirmed and probable environmental VBD disease cases likely overseas acquired. Rate of cases with elevated serum lead and with confirmed non-occupational exposure per 100,000 persons per year Baseline [13/14] Year 1 Year 2 Year 3 Core Function Health Protection & Assessment. and Surveillance. 6 Including Leptospirosis, Murine typhus, Rickettsial disease and Legionellosis. 7 Arboviral and Malaria 20

21 2.2 Outcome 2: The incidence and impact of notifiable communicable diseases is minimised Medium-term indicators Medium Term Outcomes (What we aspire to in 3+ years) Population Health Outcomes Indicators The burden of communicable notifiable diseases 8 in the population is reduced Diseases that are preventable by vaccination 9 are minimised in Aucklanders. The rate of TB in children under 5 years of age is reduced Medium Term Outcome Indicators Partially Attributable Rate of confirmed and probable notifiable communicable disease cases per 100,000 persons per year Rate of confirmed and probable vaccine preventable diseases per 100,000 persons per year Baseline [13/14] Age-specific incidence rate of TB notifications in children under five per 100,000 persons per year 5 Year 1 Year 2 Year 3 Core Function Health Protection, Prevention & Assessment and Surveillance. The burden of enteric disease 10 cases is reduced Children of quota refugees are fully immunised as per NZ immunisation schedule within one year of arrival Rate of confirmed and probable enteric disease cases per 100,000 persons per year Children of quota refugees receiving immunisations 12 months after arrival *NZ Refugee Resettlement Strategy national indicator %* *Baseline 12/13, Source: MoH 8 These exclude environmental health related notifications: Vector-borne disease (VBD), Leptospirosis, Murine typhus, Rickettsial disease, Legionellosis, Lead absorption, Chemical poisoning from the environment, Decompression sickness, and Hazardous substances injury. 9 Includes notifiable vaccine preventable diseases on the National Immunisation Schedule: Pertussis, Measles, Mumps, Rubella (congenital and not congenital), Haemophilus influenzae type b, Invasive pneumococcal disease, Hepatitis B, Tetanus, Polio, Diphtheria 10 Including: Campylobacteriosis, Cholera, Cryptosporidiosis, Acute gastroenteritis (unknown cause & foodborne intoxication), Giardiasis, Typhoid fever, Paratyphoid fever, Salmonellosis, Shigellosis, Yersiniosis, Cronobacter species, Listeriosis, Listeriosis perinatal, and VTEC/STEC infection 21

22 2.3 Outcome 3: The harms associated with hazardous commodities is minimised )Medium Term Outcomes (What we aspire to in 3+ years) Medium Term Outcome Indicators Partially Attributable Baseline [Year] Year 1 Year 2 Year 3 Core Function Population Health Outcomes Indicators To be developed during the financial year 2015/ Outcome 4: The environments in which people live, work and play promote health and wellbeing Medium Term Outcomes (What we aspire to in 3+ years) Medium Term Outcome Indicators Partially Attributable Baseline [Year] Year 1 Year 2 Year 3 Core Function Population Health Outcomes Indicators To be developed during the financial year 2015/16 22

23 3. Section Three Performance Accountability: Annual Operational Plan 2015/16 23

24 3. Annual Operational Plan 2015/16 Performance Accountability: Short-term outcome, quantity and quality measures, and activities How are we performing? ARPHS Annual Operational Plan describes short-term outcomes, performance measures and activities for our core services (section 3.1). Where appropriate, this section includes activities with a focus on Māori health gain (highlighted in light blue) and achieving equity for all (highlighted in light green). To reflect the introduction of our outcomes framework and the core functions model, we have updated our service taxonomy. We have listed activities/programmes/services delivered under each of ARPHS key outcomes and have broken down health issues by core function. Organisational Enabler In addition to population accountability outcomes (health outcomes), we have identified one organisational enabler to reflect the importance of work areas such as Workforce Development, Intelligence, Planning, Quality, Informatics, Communications, etc., which all contribute to supporting ARPHS to achieve its vision. All teams within ARPHS both front line and those in support functions work together to ensure and promote the health of the population of Auckland. ARPHS organisational enabler is: Suitable workforce, infrastructure and clinical governance (quality). ARPHS programmes and work areas which support this enabler, have been placed together and associated indicators will be reported against (See service taxonomy below) 24

25 Core Contract Services Taxonomy Key Outcomes 1. The adverse effects of environmental hazards are minimised 2. The incidence and impact of communicable diseases is minimised 3.The harms associated with hazardous commodities is minimised ARPHS Programmes (Service Grouping) Built Environments (Air Quality, Noise Management and Contaminated land) Border Health Protection Burial & Cremation Drinking Water Quality Hazardous substances, including Ionising radiation/ non-ionising fields Waters and Wastes Early Childhood Education Centres Resource Management Public Health Emergency Planning and Response Notifiable infectious diseases Tuberculosis Disease Investigation Complex HIV BCG Independent Vaccinators Refugee Health Screening Service Refugee Health Promotion Enforcement of Psychoactive Substances Act Alcohol: - Enforcement Sale and Supply of Alcohol Act - Health Promotion Core Function A&S CD Prom Prot Prev 4. The environments in which people live, work and play promote health and wellbeing Organisational Enabler: Suitable workforce, infrastructure Tobacco: - - Enforcement Smoke-Free Environments Act - Heath Promotion Social Environments Workplace Health Vulnerable Communities (Migrants & migrants of refugee background) Nutrition and physical activity Information and Advice Healthy Early Childhood Education Settings Healthy Public Policy Workforce Development Communications 25

26 and clinical governance (Quality) Intelligence and Informatics Planning and Quality Resource Centre ARPHS Facilities Afterhours Service Key - ARPHS Internal Teams Health Protection Health Improvement Systems, Intelligence and Planning Note: ARPHS medical team delivers services across all service areas 26

27 3.1 Outcome 1: The adverse effects of environmental hazards are minimised 11 Strategic objectives 2015/16: Engage with external stakeholders (Ministry for Primary Industries, Auckland Council, etc.) to work collaboratively to reduce the impact of environmental hazards on health Key operational developments are: Detect, assess risks, notify and respond to all environmental incidents and emergencies as per Legislation, protocols Ensure that adverse health conditions from the environment are investigated in a timely way and to provide public health advice to avoid, remedy or mitigate adverse effects 11 All work will be carried out in accordance with the Ministry s Environmental Health Protection Manual and other relevant Manual and Guidelines 27

28 3.1.1 Built Environments 12 Goal: Minimise the impact of environmental hazards by developing strategies to prevent or control the adverse impacts of built environments on public health. Target Population: General Population Core Func. H Prot Performance Accountability Short Term Outcomes Activities Key Performance Measures 1. ARPHS works collaboratively with key stakeholders 13 to discuss built environment impacts on public health The impacts of the built environment on health are minimised. This includes contaminated land issues, insanitary housing Record and assess all reported environmental notifications and enquiries from members of the public Review ARPHS built environment protocols in a timely manner and at least every three years to ensure they remain current and technically accurate Quantity Estimate / Target per year Total number of built environment events and public enquires received and assessed Baseline 13/14: 92 Quality Percentage of events and enquiries closed Baseline 13/14 100% Percentage of built environment protocols that are up to date Target: 100% Short Term Outcome Measure Policy submissions include and address implications for the built environment See Healthy Public Policy H Prot 2. Manage environmental diseases likely to be acquired in New Zealand 14 Receive, investigate and Manage environmental disease notifications Total number of environmental infectious disease notifications Completeness of EpiSurv risk factors data fields for Legionellosis. Number and percentage of Legionella cases (confirmed and 12 Including environmental diseases and strategic environmental health; air quality (indoor and outdoor); environmental noise management and contaminated land 13 Including Auckland Council, Fire NZ, etc. 14 Including Leptospirosis, Murine typhus, Rickettsial disease and Legionellosis. Note: Biotoxin and Jellyfish are reported separately. See Recreational Water. Arboviral and Malaria are reported separately. See Border Health section. 28

29 Core Func. Performance Accountability Short Term Outcomes Activities Key Performance Measures Work closely with Auckland Council to improve the accuracy of the cooling towers register across the region. Participate in the DHB Technical Advisory Group (TAG) for Management of Legionella Quantity Estimate / Target per year received Baseline 12/13: /14: 213 Number of environmental infectious disease notifications investigated found to be a confirmed or probable case Baseline 12/13: 50 13/14: 50 Quality Target: 100% Short Term Outcome Measure probable) where the source was identified. Number and percentage of Legionella cases where public health advice was provided 15. Estimate 100% 15 Excluding compost 29

30 3.1.2 Border Health Protection Goal: Minimise the impact of settings-based environmental health issues. Target population; General population Core Func. H Prot Performance Accountability Short Term Outcomes Activities Key Performance Measures 1. Border Health: To detect, assess, notify and respond to public health threats arriving into NZ which are of national or international concern Timely response to interceptions of potential disease vectors e.g. mosquitoes, rats. ARPHS works collaboratively with border agencies 16 to support border health protection Undertake investigation and Management of interceptions at Ports of Auckland, Auckland International Airport and Whenuapai Airport. Conduct routine sentinel surveillance at Ports of Auckland and Auckland International Airport Undertake site surveys at Ports of Auckland, Auckland International Airport and Whenuapai Airport. Support Auckland Airport and other border stakeholders (e.g. NZ Customs) to maintain a biosecure border by maintaining active communications (four- Quantity Estimate / Target per year Number of interception notifications 18 responded to. Baseline 12/13: 31 13/14: 29 Trap servicing undertaken twice a week. Yes/No Number of site surveys conducted at Ports of Auckland, Auckland International Airport, and Whenuapai Airport. Baseline 12/13: 31 13/14: 28 Quality Percentage (and number) of reports provided to MoH within two hours of identification of exotic mosquitoes of public health significance Baseline 2012/13: 100% Border Health related protocols are up to date (including Exotic Mosquito Interception Response, Ship Sanitation Inspection and Pratique & Quarantine) Short Term Outcomes Measures Number and percentage of events where exotic mosquitoes of public health significance were identified. Baseline 12/13:5.2% 13/14: 5.4% Narrative on outcomes 16 Ministry Primary Industries, Customs, Ports of Auckland, AIAL 18 Including mosquitoes and rodents 30

31 Core Func. Performance Accountability Short Term Outcomes Activities Key Performance Measures monthly face to face meetings) Enhance surveillance to detect and respond to international diseases and environmental threats 17 Quantity Estimate / Target per year Quality Short Term Outcomes Measures H Prot 2. Rapid detection of overseas acquired vector-borne diseases 19 Correlate extreme weather events from NIWA data with health data Respond to suspected or confirmed cases of vector borne disease to determine the likely country in which infection occurred (i.e. NZ or overseas acquired) Total number of environmental VBD notifications Baseline 12/13: /14: 197 Number of confirmed and probable environmental VBD Baseline 12/13: 79 13/14: 181 Percentage of vector borne disease with a completed travel history Target: 100% Arboviral Diseases protocol is up to date Number and percentage of confirmed and probable VBD notifications assessed as being acquired overseas H Prot 3 Ensure that the international points of entry into Auckland comply with the International Health Regulations (IHR) 2005 in order to minimise the risk of Respond to ill traveller notifications received to as per protocol Participate in quarterly Number of ill traveller notifications that meet IHR criteria from all points of entry into Auckland Baseline 12/13: Nil Percentage (and number) of reports submitted to the MoH within 24 hours of events of public health significance Number and percentage of ill traveller events requiring isolation/quarantine 17 Including maintaining a watching brief on impacts of climate change 18 Arboviral and Malaria 31

32 Core Func. Performance Accountability Short Term Outcomes Activities Key Performance Measures importation of infectious diseases of international significance into New Zealand regional interagency liaison meetings 20 Complete annual HIR point of entry assessment report (Ports of Auckland, Auckland International Airport and Whenuapai Airport) 21 Lead and maintain an ill traveller protocol in collaboration with multiple agencies for international points of entry into Auckland Quantity Estimate / Target per year 13/14: Nil Number of notified events of public health significance 22 (interceptions are reported above) Baseline 13/14:Nill Number of confirmed events of public health significance 23 Baseline 13/14:Nill Quality Ill Air Traveller Protocol is up to date Points of Entry Emergency Response plan and PHU Border Emergency Health Plan meet Ministry and 2005 IHR requirements. Yes/No Short Term Outcomes Measures Baseline 12/13: Nil 13/14: Nil 4.Point of Entry (PoE) assessment for specified Maintain IHR 2005 Point of Entry Designation Annual IHR point of entry assessment report completed as per MoH reporting template. Yes/No An implementation follow up section is included into Annual IHR point of entry assessment report submitted by the 28 th of February each year as per MoH schedule. Yes/No Percentage of recommendations from Narrative on amendments (as required) made to the Ill Traveller Protocol as outcome of interagency discussions. Yes/No Number and percentage of points of 20 MPI, Auckland International Airport. 21 Activities include: issuing pratique, sanitation inspections of ships, seaports and airports, disinfection or decontamination, application of control measures to any conveyance, interception responses and maintenance of effective contingency arrangements. Report can be provided on request. 22 Events that have the inter-district, national or international implications 23 Events that have the inter-district, national or international implications 32

33 Core Func. Māori Health Gain Partner ship with Mana Whenua Performance Accountability Short Term Outcomes Activities Key Performance Measures marine Ports of Auckland is completed in order to comply with IHR Biosecurity strategies involve Mana Whenua as a stakeholder in biosecurity consultations. compliance at Ports of Auckland 24 Establish relationships with local Mana Whenua with support from ARPHS Māori Liaison Advisor Quantity Estimate / Target per year the Annual IHR point of entry annual report (see above) and is completed. Yes/No Number and type of key stakeholders identified and engaged with Quality PoE assessment (agreed with Ports of Auckland) implemented as per timeline. Yes/No Brief description on the extent Mana Whenua was involved in planning and implementing activities Short Term Outcomes Measures entry comply with IHR 2005 Narrative on results of engagements with Mana Whenua, including successes and challenges 24 Excluding: Viaduct (Waterfront Commission), Chelsea sugar and Davenport Naval Base 33

34 3.1.3 Burial and Cremation Goal: Minimise the impact of environmental hazards by ensuring the lawful, hygienic and dignified disposal of human remains. Target Population: General population Core Func. H Prot Māori Health Gain Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.To ensure the correct Investigation and Number of Air Transport Quarterly audit of Air procedures are used for Management of issues Certificates issued. Transport Certificate disposal of the dead and any related to burial and Baseline 12/13: 94 database completed. subsequent movement of cremations 13/14: 134 remains 2.ARPHS improve networking with Māori agencies to raise the profile of public health work as per the Burials and Cremations Act Provide advice to public (industry and community) on enquires about burials and cremations Burials protocol is reviewed in a timely manner and at least every three years to ensure it remains current and technically accurate Identify key contacts and networks with Māori agencies and iwi with regards public health responsibilities in relation to burials and cremation (e.g. Te Puni Kokiri and local iwi) Number of disinterment s supervised Baseline 12/13: 7 13/14:12 Number of times advice is provided. Baseline 12/13: 13 13/14: 22 Number and list of relevant Māori agencies/groups Percentage of air transport certificates issued within 24 hours. Target: 100% Burials Protocol is up to date Brief description of the extent Mana Whenua was involved in planning and implementing activities Short Term Outcome Measures Number of disinterment reports submitted to the MoH (disinterment under unusual circumstances) Baseline 13/14: 0 Narrative on results of engagement with Mana Whenua, including successes and challenges 34

35 3.1.4 Drinking Water Quality Goal: Minimise the impact of environmental hazards by promoting the availability of adequate supplies of safe drinking water. Target Population: General Population Core Func. H Prot Performance Accountability Short Term Outcomes Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.To optimise the safety and Undertake duties as required Number of registered Response rate for annual quality of all drinking water by the Health Act 1956 suppliers surveyed that review (initial information available for public including carrying out comply with the relevant request). consumption in the Auckland inspection and audit provisions of the Health Act Estimate: 30% region functions ARPHS works with Auckland Council to promote and support on-going fluoridation of Auckland s Water supply. See Healthy Public Policy Conduct regulatory role relating to fluoride levels in Auckland reticulated drinking water supply as per NZ Drinking Water Standards. Any variations to be noted as a non-compliance against the Standards Work with Auckland council and other relevant suppliers to support ongoing fluoridation of supplies. See Healthy Public Policy DWSNZ suppliers surveyed 25 (including both water suppliers that are and are not required to comply with legislation). Baseline 2013/14: 263 Quarterly meeting with Watercare to discuss updates and issues on drinking water. Yes/No Six-monthly Management meetings including Auckland Council to Percentage water suppliers that require additional follow up. Estimate: 70% 100% entry of survey responses on WINZ 6.0 are closed within MoH s timeframe (31 July each year). Percentage of DWSNZ survey-related reports provided to water suppliers within 60 working days Baseline Target: 100% Short Term Outcome Measures Proportion of water safety plans accepted that are approved by DWAU-Auckland. Target: 100% 25 As per Health Act 1956: large supplies (more than 10,000 people); medium (5,001 to10, 000); minor (501-5,000); small ( ). 35

36 Investigation and response to drinking water related incidents and complaints maintain an on-going working relationship Yes/No Number of Water Safety Plans assessed. Baseline 12/13: 27 13/14:15 Number of Tankered Drinking Water (TDW) suppliers compliance assessments. Baseline 12/13: 67 13/14: 40 Number of drinking water incidents and complaints responded to. Baseline 12/13: 27 13/14: 43 Percentage of Water Safety Plans Assessment reports provided to water suppliers within 20 working days Target: 100% Number and percentage of Water Safety plans that are implemented by water suppliers Estimate: 100% Number of serious drinking water incidents and complaints required to be reported to the Ministry of Health Baseline 12/13: 3 13/14: 3 Percentage of reports on serious drinking water incidents provided to MoH within 24 hours of the event. Target 100% Percentage of serious drinking water incidents and complaints required to be reported to the Ministry of Health Baseline 13/14: 7% 36

37 2.DWAU IANZ accreditation is maintained Undertake annual IANZ assessment of DWAU- Auckland Annual IANZ assessment completed Yes/No % IANZ assessment completed on time and to standard. % DWAUs with IANZ accreditation Hazardous Substances 26 Goal: Minimise the impact of environmental hazards by reducing the adverse health effects of hazardous substances on people and communities. Target population: General population Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Estimate / Target per year Quality Short Term Outcome Measures 26 Including radiation, hazardous substances, and ionising/non I ionising radiation. 37

38 H Prot 1.1To protect the Auckland residents by minimising the harm from hazardous substances 1.2. Manage lead notifications resulting from nonoccupational exposure Maintain effective risk Management and investigation strategies for the investigation of lead absorption cases Number of lead notifications received. 27 Baseline 13/14: 73 (70 persons) Number of unique confirmed cases that occur as a consequence of occupational exposure. Baseline 13/14: 23 (23 persons) Number of unique confirmed cases that occur as a consequence of nonoccupational exposure. Baseline 13/14: 30 (30 persons) Percentage of lead cases (occupational exposure) with probable source identified Baseline 12/13: 79.5% 13/14: 95.6% Percentage of lead cases (non-occupational exposure) with probable source identified Baseline 12/13: 69.5% 13/14: 93.3% ARPHS completes activities as per HSNO Action Plan and completes annual HSNO intentions report to the MoH HSNO annual intentions report timely submitted 29 Continued engagement with the regional Hazardous Substance Technical Liaison Committee (HSTLC) Some notifications are for repeated cases relating to lead levels 28 Key stakeholders: Fire, Police, Auckland Council, WorkSafe NZ and other 29 Including: Compliance/Enforcement activities, VTAs, Graphics, Spray drift, Chemical injuries, and Consumer products, PCBs and Emergency Management and Incidents. The report can be provided on request. 38

39 H Prot 2. ARPHS will collaborate with other parties to investigate Clandestine P Labs in the region Participate in the Auckland Regional Methamphetamine Working Group (ARMWG) 30 Public health input is provided at the quarterly ARMWG and ARMWG - subgroup meetings. Yes/No Evidence of increased coordination through networking and collaboration 31 Record and assess all public reports of potential methamphetamine exposure Maintain and implement process to investigate Clandestine P Labs in the region Number of investigations. Baseline 12/13: 5 13/14: 6 Percentage of investigations reviewed by Medical Officer of Health. Target 100% All reports of potential exposure to methamphetamine that require medical assessment are referred to a medical practitioner. Target: 100% Māori Health Gain Partners hip with Mana Whenua 3. Give effect to Section 6(d) of the HSNO Act: The relationship of Māori and their culture and traditions with their ancestral lands, water, sites, waahi tapu, valued flora and fauna, and other taonga. Review of Vertebrae Toxic Agent (VTA) applications to ensure operators have consulted with Mana Whenua Number of VTA applications reviewed. Percentage of VTA applications checked for engagement with Mana Whenua. Estimate: 100% ManaWhenua consulted and concerns addressed by applicants 30 Key stakeholders: Community Alcohol and Drug Services (CADS), Auckland Council, Police, WorkSafe NZ, Housing NZ, community groups and private individuals 31 By detailing how the collaboration has reduced duplication, increased consistent messages and increased unified learning and progress. 39

40 3.1.6 Waters and Wastes Goal: Minimise the impact of environmental hazards associated with recreational waters and gaseous, liquid & solid waste. Target population: General population Core Func. H Prot Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Short Term Outcome Estimate / Target per year Measures Help reduce or prevent any Engage at a strategic level Number and type of potential health risks with lead agencies such as agencies engaged with. SoP or similar associated with Auckland Council in an (clarifying and recreational waters, and effort to improve agreeing roles and wastes (liquid and solid) recreational water quality responsibilities) and Management of waste agreed and implemented. Input into submissions to the consenting authority as required See Healthy Public Policy Recreational Water Participate in review of any approved recreational water /solid waste bylaws, standards and guidelines. 40

41 H Prot To minimise or prevent the risk of disease associated with the public use of recreational waters Respond to recreational water incidents and inquiries as required Provide public and stakeholders, e.g. Auckland Council, with appropriate advice relating to recreational water e.g. Public health fact sheets and advice, press releases Number of public complaints/enquiries received, advice given and/or followed up when required. Baseline 12/13: 61 Number of significant events responded to relating to contamination or other public health risks associated with recreational water quality. 32 Baseline 12/13: 3 All complaints are investigated within the timeframes set by the Ministry of Health guidelines Yes/No Number of notifiable disease cases possibly linked to recreational water 33 Baseline 12/13: 11 13/14: 9 Number of gastroenteritis outbreaks associated with recreational water Baseline: 13/14: 2 Build relationships with Auckland Council to encourage Council/Watercare Services to take appropriate action as a result of Council s Safeswim website surveillance (to identify unsafe swimming areas) Weekly internal infectious disease surveillance summaries of Safeswim beaches (during swimming season only) are completed and provided to portfolio lead Yes/No 32 Significant events includes marine bio toxin and jellyfish 33 This measure only includes suspected cases and does not imply association of source with health outcome. The measure includes Cryptosporidium and Giardia 41

42 Māori Health Gain Minimise the risk of recreational water bodies becoming contaminated by discharge of pollutants, or by naturally occurring contaminants. A number of traditional Māori activities involve water, including fishing and swimming. Sewage treatment & disposal H Prot ARPHS will work collaboratively with Watercare services to reduce or prevent any potential health risks from sewage treatment or disposal. Waste Management (solid waste) H Prot To reduce or prevent any potential health risks from solid waste disposal. In significant adverse recreational water events, communication strategies actively target Māori stakeholders especially where subsistence gathering is suspected Liaise with Watercare Services to verify that overflows that pose a significant public health risk are responded to 34 Engage with Watercare Services on reducing overflows to high risk areas Respond to solid waste complaints and queries from members of the public. Meet annually with key staff at Auckland Council to discuss current issues. Brief narrative of Māori stakeholders targeted during significant events. Number of waste water overflow notifications received. Baseline 12/13: /14: 249 Number of notifications assessed as high risk. 35 Baseline 12/13: 4 13/14: 13 Number of solid waste complaints or queries responded to. Baseline 12/13: 1 Baseline 13/14: 1 Meeting is attended by the Waters and Wastes team. Yes/No Number and percentage of Maori stakeholders report increased understanding and knowledge about risk of recreational water contamination Quarterly audits for sewage overflows database is checked for completeness are undertaken. Yes/No. Waste water protocol is reviewed in a timely manner and at least every three years Percentage of notified overflows assessed to be of high risk 34 The Auckland Council is the lead agency in respect to ensuring the provisions of sanitary works under the Health Act 1956 as related to sewage disposal 35 Overflows that will potentially contaminate sensitive areas (creek, beach, playgrounds, etc.). High risk notifications are immediately followed up with Watercare regarding actions required for remediation and Auckland Council s Environmental Health Officers for erection of public health warning signs 42

43 3.1.7 Early Childhood Education Centres Goal: Healthy and safe physical environments for children attending Early Childhood Education Centres (ECEC). Target population: Children who attend ECECs Core Func. H Prot Māori Health Gain Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Estimate / Target per year Quality Short Term Outcome Measures To promote the health and Undertake and complete Number of ECEC Health wellbeing of children Pre-licensing assessments and Safety assessments 36. attending early childhood (Health and Safety) Baseline 2012/13: 44 centres. Baseline 2013/14: 36 Identify networks in this sector, such as Māori language centres (Kohanga Reo and Puna Reo) Carry out investigations undertaken at: request of Ministry of Education or investigations undertaken as part of a disease investigation Respond to enquiries from the public or organisations Build networks with agencies with an aim to raise the profile of public health work and to share public health advice relating to ECECs Number of joint disease investigations 37 undertaken. Baseline 2013/14: 7 Number Assessment Management Team (AMT) calls responded to and closed Baseline 12/13: 93 13/14: 98 Number of network engagements Reports are completed and submitted to the Ministry of Education and the licensing centre within 7 working days. Baseline 12/13: 100% Early Childhood Education Centres protocol is up to date Documentation of issues raised at networking engagements Narrative report ARPHS provides timely, comprehensive assessments that enable licensing process to proceed and supports investigations as requested 36 Including those conducted at the request of the Ministry of Education 37 Investigations are conducted with the Disease Investigation team. The investigation of a notification includes any interview with the notifier. 43

44 3.1.8 Resource Management. Goal: Help minimise the impact of environmental hazards by ensuring public health issues are identified and addressed in decisions made on the sustainable Management of natural and physical resources. Target population: General population Note: Activities are described under the Healthy Public Policy section in conjunction with RMA-related work and healthy public policy strategic work Public Health Emergency Planning and Response Goal: Minimise the impact of environmental hazards on communities and individuals in the event of a public health or other emergency. Target Population: General Population Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures 1. ARPHS maintains organisational capability to respond effectively to public health surge and emergency situations Participate in operational and table top exercises, requested by and conducted with, external agencies (regional or national) Design, develop and deliver technical and scenario-based training to strengthen specialist knowledge and maintain competency for staff Maintain ARPHS Health Emergency Plan, Business Continuity Plan and Quantity Estimate / Target per year Number of external exercises emergency exercises participated in. Target reliant on availability of suitable regional exercises minimum 2 Number of internal exercises, training and instructions held 1 major and minimum 2 other Number of plans and supplementary plans developed/revised. Quality Assessment of sufficient staffing capability across each CIMS area Assessment and evidence of action against lessons learned from internal/external exercises and incidents Narrative: organisational intelligence, including surveillance, used to determine response planning priorities Short Term Outcome Measures Narrative: outcomes of major service-wide exercise Number/percentage of key staff who complete refresher and scenario-based training. Yes/No 44

45 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures supplementary plans Engage directly with teams to develop scenario and hazard-based plans and protocols Quantity Estimate / Target per year Target 4 Quality Alignment of Emergency Plan and supplementary plans and protocols with regional Hazardscape Short Term Outcome Measures Cap Dev 2. ARPHS staff are adequately prepared for a response through training (CIMS and core competency training and exercises) International/National/Region al best practice planning and emergency evaluations used to inform organisational capability improvements Deliver and review basic public health emergency and business continuity training for new staff Deliver and review advanced public health emergency training for suitable staff Develop and deliver EMIS basic training to relevant staff Number of training planned, developed and delivered to ensure staff are prepared and competent Percentage of staff members who achieved the emergency competencies (score higher than 4, being 1=lowest, 5=highest scores) ARPHS is capable of maintaining an extended response using the CIMS structure 38. Yes/No Number and percentage of staff that have had basic public health emergency training. Target 100% within first 6 months of employment Number and percentage of relevant 38 As per National Health Emergency Plan 2008 requirement, page 11 45

46 Core Func. H Prot Performance Accountability Short Term Outcome Activities Key Performance Measures 3. ARPHS response to business disruption, operational surge or emergency events and/or public health incidents of significance are undertaken as per plan, protocol, legislation and guidelines Maintain Single Point of Contact arrangements for formal public health emergency notifications Assess and coordinate activities to increase organisational business continuity resilience Confirm and maintain notification procedures for potential public health incidents at Points of Entry as per International Health Regulations 2005 Quantity Estimate / Target per year Number of identified communicable disease events related to Annex 2 of IHR Number of reports on events or emergencies with inter-district, national or international implications identified. Number of disruptive events where business continuity plan was activated Quality Percentage of formal alerts and test messages acknowledged and actioned within target timeframes. Target 100% Percentage of required debriefs completed Narrative: evidence of assessment and action on lessons learned from formal operational debriefs Number of communicable disease events reports provided to MoH within 24 hours (Annex 2 of IHR) Number of reports provided to MoH for declared public health emergencies, within required timeframes Acknowledgement, risk Short Term Outcome Measures staff have access to EMIS and basic knowledge Target 100% 46

47 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Estimate / Target per year Quality assessment and escalation (as required) to business disruptions and/or public health emergencies/incidents Short Term Outcome Measures Cap Dev. 4. ARPHS Reduction, Readiness and Recovery actions contribute to regional emergency preparedness and resilience Confirm stakeholder involvement and include these groups in review and sign-off of relevant ARPHS plans Ensure ARPHS planning activities aligned with those of key partners. Number of internal plans where regional support was sourced Number of external plans reviewed for potential public health feedback on emergency Management 39 For formal feedback/ Submissions. See Healthy Public Policy section Appropriate Management and clinical sign off process is followed for all feedback and consultation. Yes/No Narrative: contribution to regional/national emergency analysis, and integration of lessons learned into organisational planning. Māori Health Gain 5. Improve engagement. As well as supporting the contact with vulnerable communities for emergency resilience messages, key Māori and Mana Whenua stakeholders can directly support the Identify and engage with key stakeholders involved in emergency planning Number and up to date list of relevant Māori and stakeholders engaged with. Brief description on the extent Mana Whenua was involved in planning and implementing activities 39 Target is 100% of plans where review of public health emergency impacts was sought by external agency 47

48 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures emergency response and recovery efforts in an emergency Quantity Estimate / Target per year Quality Short Term Outcome Measures 48

49 3.2 Outcome 2: The incidence and impact of notifiable communicable diseases is minimised Strategic objectives 2015/16: During this year, the Communicable Disease Control team (Health Protection) team will continue to revise and enhance systems and procedures including working with key regional and national stakeholders to: Improve early identification of notifiable diseases in the Auckland region Respond in a timely and efficient manner to control notifiable disease outbreaks Key operational developments are: Enhance ARPHS core capability in surveillance and provide the evidence base for public health response, policy and planning by evaluating the graded response cube and considering it for implementation. In addition we will be producing a comprehensive Annual Surveillance report. Build on ARPHS reputation as a leader in communicable disease surveillance by providing up-to-date information on disease trends to health providers 49

50 3.2.1 Notifiable Infectious Disease Including Rheumatic Fever and the Needle Exchange Programme Goal: Minimise the public health risk from notifiable communicable diseases. Target Population: General Population Performance Accountability Core Func. H Prot Short Term Outcome Activities Key Performance Measures 1.To minimise public health risk from notifiable communicable diseases 40 Receive, investigate and Manage notified communicable diseases aligned to the MoH s Communicable Diseases Control Manual and ARPHS internal protocols. Quantity Estimate / Target per year Total number of communicable disease notifications. Baseline 12/13: 5,597 13/14: 6115 Number of notifications investigated a Baseline 12/13: 5,356 13/14: 5807 Number notifications investigated and found to be not a case. Baseline 12/13: /14: 866 Quality Percentage of notifications with case status recorded Target:100% Short Term Outcome Measures Rate of confirmed and probable notifiable communicable disease cases per 100,000 persons per year 40 These include all notifiable diseases with the exception of environmental health related notifications: Vector-borne disease (VBD), Leptospirosis, Murine typhus, Rickettsial disease, Legionellosis, Lead absorption, Chemical poisoning from the environment, Decompression sickness, and Hazardous substances injury. Selected notifiable infectious diseases are also broken down and reported separately including vaccine preventable diseases, acute rheumatic fever, tuberculosis and enteric diseases 50

51 Asses & Surv ARPHS surveillance actively informs early identification of changing trends and outbreaks Provide a comprehensive surveillance strategy that meets ARPHS needs Standard internal surveillance reports for portfolio leads are provided weekly. 41 Yes/ No Weekly community surveillance of Gastroenteritis and Influenza by DHB using Health Stat data is provided to the Assessment and Management Team (AMT). Yes/No A&S Reduc ing Inequit ies Development of an annual surveillance report of notifiable disease data by month, by age, ethnicity and deprivation where applicable Develop systems and platforms for dissemination of surveillance information through PHO, SIPHAN (Canterbury DHB), NZ BUG and DHB) Number of weekly surveillance triggers reached over 12 months by disease group 42 Report developed. Yes/No Information is shared by an agreed platform with health providers. Yes/No Report analysed re further development needed. 41 Surveillance categories: International surveillance, Community surveillance, Hospital surveillance, Laboratory surveillance, Notifiable disease surveillance, Animals/ Vector surveillance, Food & water surveillance, Recreational water surveillance, Chemical Injury surveillance, Environmental hazard surveillance and Climate indices. 42 Reported by: Vector-borne disease, Food-borne disease, Airborne Disease, Vaccine Preventable Disease (VPD), Hepatitides, Environmental, TB 51

52 In order to provide a consistent public health response, evaluate the graded response cube for surveillance triggers Identify populations at risk of notifiable communicable disease through the collection of complete ethnicity data Evaluation is completed and decision on its implementation is made by ARPHS Clinical Director and Senior Medical Officers of Health Completeness of ethnicity data: 43 Percentage of completeness (blanks): Baseline 12/13: 93.9% 13/14: 94.2% Percentage of completeness (ethnicity not stated): Baseline 12/13: 89.6% 13/14: 90.4% H Prot 2.To minimise public health risk from vaccine preventable diseases 44 Receive, investigate and Manage notified vaccine preventable diseases Total number of vaccine preventable disease notifications Baseline 12/13: /14: 1431 Percentage of vaccine preventable notifications with case status recorded Target:100% Rate of confirmed and probable vaccine preventable diseases per 100,000 persons per year Number of vaccine preventable notifications investigated Baseline 43 Ethnicity data is automatically taken from NHI. This measure excludes the unknown ethnicity category 44 Includes notifiable vaccine preventable diseases on the National Immunisation Schedule: Pertussis, Measles, Mumps, Rubella (congenital and not congenital), Haemophilus influenzae type b, Invasive pneumococcal disease, Hepatitis B, Tetanus, Polio, Diphtheria 52

53 12/13: /14: 1403 Communication plan implemented for Immunisation Week. Yes/No H Prot Promote and collaborate with DHBs on vaccine preventable diseases and immunisation Contribute to Midwives Immunisation Education Days run by IMAC on request. Yes/No Attendance (as participant) to strategic immunisation meetings (including the Northern Regional Immunisation Group and the Joint ADHB/WDHB Immunisation Governance Group). Yes/No H Prot 3.ARPHS contributes to achieving the better public services rheumatic fever target of reducing the national incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June 2017 Screen household contacts of acute rheumatic fever cases for group A streptococcus and treat when found. Provide health education to households with acute rheumatic fever about sore throat Management. Number of contacts of confirmed and probable ARF cases identified. Baseline 12/13: /14: 354 Number of contacts of ARF swabbed for group A streptococci (GAS). Baseline 12/13: /14: 298 Proportion of ARF cases in which contact tracing was undertaken 45 Baseline 12/13: 97.5% 13/14: 62.1% Proportion of ARF contacts swabbed Baseline 12/13: 92.5% 13/14: 84.2% GAS carriage rate in asymptomatic contacts of cases of Acute Rheumatic Fever (ARF) Baseline 12/13: 15.3% 45 Excludes 3 cases that were notified >3 months after hospital admission who were not eligible for contact tracing 53

54 Support regional DHBs to to implement their rheumatic fever prevention plans and to undertake case review Support the Rheumatic Fever case control study Number of positive swabs. Estimate: 35 Baseline 12/13: 60 13/14: 67 Report quarterly to each metropolitan DHB on time to notification of ARF hospitalised cases. Yes/No H Prot 4.Needle Exchange Programme (NEP): Maintain relationships with NEP head office and authorised NEP outlets in the Auckland region as required Assess Needle Exchange Programme applications for outlets requiring MOH authorisation. Assess any complaints related to authorise NEP outlets as required. A system is in place for data entry of root cause analysis data into EpiSurv. Yes / No Number of applications assessed. Estimate 0 1 Liaison with NEP head office and authorised NEP outlets in the Auckland region as required. Yes/No Number and percentage of needle and syringe exchanges that meet authorisation standards 54

55 3.2.2Tuberculosis (TB) Goal: Successful completion of Drug Regimens to treat Tuberculosis (TB) cases, reduce transmission of TB in the community and prevent secondary cases. Target Population: General population with focus on high risk groups. Performance Accountability Core Func. H Prot Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year Minimise transmission of TB in the community Provide supervision of treatment for TB and LTBI cases. Provide contact tracing Undertake quality assurance and improvement activities: - Random quarterly patient record quality audits. Total number of TB disease cases (new and relapsed) 46 notified. Baseline 12/13: /14: 170 Number of confirmed and probable TB disease cases (new and relapsed) Managed Baseline 12/13: /14: 149 Total number of latent TBI/cases on preventative treatment notified Baseline 12/13: /14: 251 Number of TB contacts followed up Baseline 12/13: /14: 1,080 Percentage of TB and LTBI cases who have started treatment and have a recorded start date for treatment. Baseline 12/13: 81% 13/14:83.6% Four (quarterly) random TB patient record audits are performed. Yes/No. All issues identified in the random quarterly audits are investigated and addressed. Yes/No Short Term Outcome Measures Percentage of TB cases that are contacts of a case. Baseline 13/14: 31% Target: 27% Age-specific incidence rate of TB notifications in children under five per 100,000 persons per year 46 ARPHS manages all notifications of TB disease cases 55

56 3.2.3 Disease Investigation Goal: Minimise the impact of enteric diseases. Target Population: General Population.Performance Accountability Core Short Term Outcome Activities Key Performance Measures Func. Quantity Quality Estimate / Target per year H Prot Minimise the burden of enteric diseases Manage enteric disease outbreaks (including waterborne and food borne) Receive, investigate and Manage enteric disease notifications Total number of enteric disease notifications 47 Baseline 12/13: /14: 3633 Number of enteric disease notifications investigated and found to be a confirmed or probable case. Baseline 12/13: /14: 3633 Number of gastrointestinal outbreaks (OB) reported Baseline 12/13: /14: 211 Percentage of high risk enteric disease cases responded within 4 hours (VTEC/STEC) Baseline 12/13: 93.1% 13/14: 89.36% Percentage of high risk enteric disease cases responded to within 1 working day (Typhoid, Paratyphoid, Shigella and Listeria) Baseline 12/13: 83.6% 13/14: ARPHS disease investigation protocols are up to date Short Term Outcome Measures Percentage of low risk 48 enteric cases investigated and closed within 19 days Baseline to be determined Average gastrointestinal outbreak size Baseline 2012/13: 11 cases 47 Including: Campylobacteriosis, Cholera, Cryptosporidiosis, Acute gastroenteritis (unknown cause & foodborne intoxication), Giardiasis, Typhoid fever, Paratyphoid fever, Salmonellosis, Shigellosis, Yersiniosis, Cronobacter species, Listeriosis, Listeriosis perinatal, and VTEC/STEC infection. 48 Giardiasis, Cryptosporidiosis, Salmonellosis 56

57 3.2.4 Complex HIV Goal: ARPHS contributes to reducing the transmission from high risk HIV cases. Target Population: HIV positive individuals Performance Accountability Core Short Term Outcome Activities Key Performance Measures Func. Quantity Quality Estimate / Target per year H Prot ARPHS contributes to Chair and coordinate ADHB Six/eight-weekly meetings reducing population risk of HIV HIV high risk advisory group or as required for specific transmission case discussion Attend national HIV forum 49 Attend national HIV/AIDS clinical update Work with key stakeholders (including MoH) to improve public Health regulatory frameworks for HIV/AIDS 6 monthly national multisector forum attended Annual meeting attended Effective working relationships with of stakeholders (e.g., ADHB HIV clinical team, Ministry of Health, NZ AIDS Foundation, Body Positive, Positive Women) enabling appropriate Public Health action to be taken when necessary. Short Term Outcome Measures Number of cases where there is an identified need or issue and where appropriate Public Health action has been taken. 49 ARPHS, DHB representatives of HIV clinical teams, Sexual Health Services, Ministry of Health, NZ AIDS Foundation, Body Positive, Positive Women, INA (Indigenous HIV/AIDS Foundation), Needle Exchange, Prostitutes Collective, etc. 57

58 3.2.5 BCG Goal: Deliver the BCG neonatal immunisation programme. Target Population: Eligible infants (those at increased risk of TB) Performance Accountability Core Func. Prev Interv Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1. Help reduce the incidence of Eligibility assessment forms Percentage of eligible severe Tuberculosis disease in provided to hospitals infants vaccinated before infants and young children six months of age. through immunisation Baseline 12/13: 96.8% 13/14: 97.2% Eligibility information sent out to the parents of neonates not assessed in hospital Review all completed eligibility assessment forms Vaccination provided to eligible neonates Conduct three-yearly BCG clinic satisfaction survey Ethnicity breakdown for BCG vaccination measures is provided. Number of infants vaccinated by ethnicity (see below breakdown by setting). Baseline 13/14: Total = 4613 Māori = 42 Pacific = 146 Asian = 3224 European/Other = 1201 Number of infants vaccinated in community clinics Number of infants vaccinated in hospital Percentage of booked appointments that were not attended. Baseline 12/13: 6% 13/14: 6% Percentage of neonates who Did Not Attend an appointment at least once and were eventually vaccinated Baseline 12/13: 84.8% 13/14: 84.4% Short Term Outcome Measures Percentage of eligible infants vaccinated by ethnicity Baseline 13/14: Total=98.3% Māori = 87.5 % Pacific = 91.3 % Asian = 99.1% European/Other = 97.5% Percentage of caregivers of infants receiving a BCG who strongly agree and agree that the overall experience of ARPHS services was positive 58

59 3.2.6 Authorisation Programme Independent Vaccinators Goal: Safe administration of vaccines. Target Population: General Population Performance Accountability Core Func. Prev Interv Short Term Outcome Activities Key Performance Measures Quantity Estimate / Target per year Quality Short Term Outcome Measures 1. Ensure vaccinators, clinics Receive and process Number of independent Percentage of and programmes are applications by vaccinators and vaccinator applications independent vaccinators appropriately authorised programmes for authorisation processed: approved: Approve vaccinators and local programmes to improve update/coverage (including outreach) -Approval (new). Baseline 12/13: /14: 307 -Re-approval. Baseline 12/13: /14: 501 Number of local immunisation programme applications processed Baseline 12/13: 28 13/14: 17 Number of International Health Regulations (IHR) applications processed (yellow fever vaccinator and yellow fever vaccination centre approvals) Baseline 12/13: 19 13/14: 16 Percentage of independent vaccinator applications processed within 2 weeks Baseline 13/14: 89.2% -Approved (new). Baseline 12/13: 95.7% (181 vaccinators ) 13/14: 95.8% (294 vaccinators) -Re-approved. Baseline 12/13: 97.0% (511 vaccinators) 13/14: 95.8% (501 vaccinators) -Percentage of local immunisation programmes approved Baseline 12/13: 92.8% (26 immunisation programmes) 13/14: 82.3%(14 immunisation programmes) Percentage of vaccinators and centres 59

60 that meet International Health Regulations (IHR) approved/re-approved Baseline 12/13: 57.9%(11 centres) 13/14: 81.2% (13 centres and vaccinators) 60

61 3.2.7 Refugee Health Screening Service (RHSS) Goal: Act in accordance with UNHCR/NZ/WHO and NZ MoH in terms of screening of quota refugees & asylum seekers arriving in NZ. Target Population: Quota refugees and asylum seekers Core Func. Prev Interv Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1. Assess and improve the Provide health screening Number of quota refugees health status of quota refugees services for refugee and screened per intake. 50 & asylum seekers asylum seekers Baseline 13/14: 778 Numbers of detained asylum seekers screened per year. 51 Baseline 13/14: 9 Percentage adult refugees with identified abnormal CXRs are referred to the Respiratory Service (Auckland City Hospital) and a follow up plan is received Target 100% Short term Outcome Measures All QR`s will be screened and that all QR`s will receive vaccination as per the NZ immunisation schedule. Numbers of community asylum seekers clinically seen per year 52 Baseline 13/14: 85 All quota refugees screened Baseline 13/14: 100% Number of quota refugees receiving vaccination as per NZ immunisation schedule 2. Reduce the transmission of communicable diseases between refugees & asylum Provide TB & Hepatitis B screening as part of RHSS screening for refugee and Number of Hepatitis B carriers identified Baseline 13/14: 22 Percentage of identified Hepatitis B carriers have been informed and Number and percentage of adult refugees with identified abnormal 50 NZ Quota figure 750 per year, +/ 10% 51 Estimate 20 per year 52 Estimate 80 per year 61

62 seekers and the general population of New Zealand asylum seekers educated Target 100% Percentage of susceptible Hepatitis B contacts have been vaccinated or have proven immunity prior to leaving Mangere Refugee Resettlement Centre Target 100% CXRs referred to the Respiratory Service (Auckland City Hospital) received a follow up plan 53 Baseline 13/14: 100%. (11.7% of the adult refugees) Number and percentage of Hepatitis B carriers within the quota refugee group report they have increased knowledge and understanding about the risks of being carriers And ways to prevent spread of hep B 3. To facilitate resettlement in the Auckland region including engagement with mainstream services Facilitate refugees settling in Auckland to register with a PHO Refer refugees and detained asylum seekers to the Dental Number of refugees settling in Auckland registered with a PHO by 8 weeks after leaving the Mangere Refugee Resettlement Centre. 54 Baseline 13/14: 221 people Number of refugees and detained asylum seekers Percentage of quota refugees resettling in the Auckland region visited by transition nurse. Target 100% Baseline 13/14: 100%. (2.8% of quota refugees Percentage of quota refugees settling in Auckland registered with a PHO within 8 weeks of leaving the Manger Refugee Resettlement Centre Baseline 13/14: 28.4% 53 Note: Receiving a follow up plan is dependant on the Auckland Respiratory Service. RHSS works to ensure that this is done 54 Estimate 240 per year 62

63 Prev Interv Māori Health Gain 4. ARPHS collaborates with key stakeholders to inform strategic development to address issues relating to refugees and asylum seekers Refugee Health Promotion H 6.Create a setting that Prom promotes health and wellbeing for staff and quota and convention refugees at Mangere Refugee Resettlement Centre (MRRC) Service Liaise with key stakeholders 56 via participation in relevant National Refugee Resettlement Strategy (NRRS) meetings and consultations Participation in the Powhiri organised by Tainui to welcome quota refugees to New Zealand 57 Support the development and implementation of site wide (MRRC) health and wellbeing activities including participation in Safety and Wellbeing Committee Undertake an audit of tobacco use for intake(s) cohort seen by onsite dental service 55 Baseline 13/14: 510 Brief narrative will be provided on the liaison with key stakeholders on strategic issues relating to refugees and asylum seekers through the NRRS participating both nationally and regionally ARPHS participates in all Powhirii to welcome quota refugees intakes (6 times annually) Safety and Wellbeing Committee re-established. Yes/No Implementation started of health policies (Tobacco and Nutrition). Yes/No 6 monthly audit reports complete. Yes/No Policy action plans implemented against timeline. Yes/No Audit report is shared with MRRC agencies Brief narrative on client outcomes as a result of contributions to the implementation of NRRS Action plan indicators achieved. Yes/No Audit report informs future policy and programme development (internal and external). Yes/No 55 Estimate 420 per year 56 NRRS Key stakeholders: MoH, RHSS, NRA, CMDHB, WDHB/ADHB, MSD(WINZ), Auckland Council, TEC, MoE and Refugee/Language Education Providers, NZ Police, community and refugee provider NGOs including NZ Red Cross and Refugees As Survivors 57 In partnership with Tainui, ARPHS, together with fellow onsite stakeholders, welcomes all refugees into the Mangere Refugee Resettlement Centre by way of Powhiri as previously arranged by the centre with ARPHS assistance. 63

64 3.3 Outcome 3: The harms associated with hazardous commodities is minimised Strategic objectives 2015/16: On the priority areas of Alcohol and Tobacco, the Health Improvement team will focus its efforts on participating in further development of an outcomes based framework (RBA-based) for our areas of work, including indicator development. For alcohol, this work will build on the WHO Global Strategy to Reduce the Harmful Use of Alcohol and for Tobacco; this will build on the national programme logic for Smokefree Aotearoa Key operational developments in these priority areas are: Alcohol: Develop an ARPHS Alcohol Reduction Strategic Plan and an associated action plan in alignment with the regional Action on Alcohol Plan Tobacco: Develop an ARPHS Smokefree Action Plan 64

65 3.3.1 Enforcement of Psychoactive Substances Act Goal: Retailer premises selling psychoactive products minimise related harm to Auckland communities and individuals. Target population: General Population Performance Accountability Core Short Term Outcome Activities Key Performance Measures Func. Quantity Quality Short Term Outcome Estimate / Target per year Measures H Prot Develop and define ARPHS role in relation to the Psychoactive Substances Act Number of requests from the regulatory authority responded to To be developed. Retail regulations are expected by mid H Prot Licensed retail premises comply with the Psychoactive Substances Act and regulations Respond to requests from the Office of the Psychoactive Substances Regulatory Authority (OPSRA), Police and members of the public Engagement with the OPSRA as required Develop an operational protocol once the retail regulations are available. Provide public health input into development and then implementation of the Auckland Council s Local Approved Products Policy (LAPP) Liaise with police regarding Control Purchase Operations (CPOs) as required. Number of queries from members of the public or external stakeholders responded to Public health input is provided as required. Yes/No Number of CPOs carried out with the Police, when required An indicator will be developed after retail regulations are approved and the role of PHUs is clarified Percentage of requests from the regulatory authority responded to in a timely manner. Percentage of queries from members of the public or external stakeholders responded to in a timely manner. Input reviewed and approved by the Medical Officer of Health An indicator will be developed after role clarity has been established with the Police. To be developed after regulations are approved and the role of PHUs is clarified 65

66 Refine and maintain the network of Police key contacts in the Auckland Region. Yes/No Alcohol a. Enforcement of the Sale and Supply of Alcohol Act: Goal: Auckland alcohol retailers provide safe environments for responsible drinking. Reduced alcohol related harm. Target Population: General Population b. Health Promotion: Goal: Create environments which are supportive of reduced alcohol-related harm. Target Population: Māori, Pacific, low socioeconomic, communities, youth, and women. Core Func. H Prot a. Enforcement Sale and Supply of Alcohol Act Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Premises with liquor licences comply with the Sale and Supply of Alcohol Act 2012 Applications for alcohol licenses are processed and risk assessed Report within 15 days to the District Licensing Committee (DLC) on all licence applications Estimate / Target per year Number of applications and renewals received Number of applications and renewals that are risk assessed. Target:100% Baseline 13/ On: 1222 Percentage of reports sent to DLC within 15 day timeframe.(reports are submitted for all applications and renewals) Target 100% Short Term Outcome Measures 66

67 Off: 398 Club: 88 Special: 2468 Of the applications and renewals inquired into, number that had any matters in opposition Baseline 13/14 80 H Prot Attend and present evidence at hearings where necessary On: 18 (10 retracted) Off: 46 (15 retracted) Club: 1 (1 retracted) Special: 15 (7 retracted) Number of hearings where evidence is presented to the District Licensing Committee or Alcohol Regulatory and Licensing Authority Baseline 13/14: 6 Percentage of briefs of evidence that are signed off by the Medical Officer of Health and Legal Counsel. Target 100% Number and percentage of hearings where public health opposition was upheld 67

68 Collaborate in police-led Controlled Purchase Operations (CPOs) to reduce the sale of liquor to minors Number of joint Controlled Purchase Operations (CPOs) conducted 58 Baseline 12/13: 30 Baseline 13/14 9 Number of premises visited during CPOs Baseline 12/13: 325 Baseline 13/ Percentage of premises in which alcohol is sold to minors during controlled purchase operations(cpos) Baseline 13/14: 6.7% Undertake night visits performed as part of ARPHS investigation process Undertake night visits in collaboration with Police and/or Liquor Licensing Inspectors Number of premises at which CPOs were conducted where sales were made to minors Baseline 12/13: 3 Baseline 13/14: 12 premises Number of night visits performed as part of ARPHS investigation process 59 Baseline 13/14: 21 night visits, visiting between 7-12 premises Number of night visits performed in collaboration with Police and/or Liquor Licensing Inspectors Baseline 12/13: 50 CPOs performed according to ARPHS guidelines Number and percentage of night visits with noncompliance identified 58 ARPHS is not the lead agency and only participates in CPOs as requested 59 A new internal system has been implemented recently that substantially altered our number and processes. Accurate estimate not available 68

69 Baseline 13/14: 11 night visits, each visiting between 7-25 premises Input into submissions on local authority or national alcohol-related polices and bylaws See Healthy Public Policy b. Alcohol: Health Promotion Performance Accountability Core Short Term Outcome Activities Key Performance Measures Func. Quantity Quality Estimate / Target per year Health Prom Contributing to regional outcomes for reducing alcohol harm 60 in collaboration with key regional stakeholders 61 Finalise an Alcohol Harm Reduction Strategic Plan 62 and an associated action plan in consultation with key stakeholders Alcohol Harm Reduction Strategic Plan finalised following stakeholders consultation. Yes/No Action Plan developed. Yes/No Strategic and the action plans reviewed and signed off by Senior Management Team Yes/No Short term Outcome Measures Narrative on contribution to regional outcomes as per Regional Action on Alcohol Plan 60 Regional Outcomes: Reduce accessibility and availability of alcohol, reduce exposure to alcohol marketing; reduce supply of alcohol to minors and others at risk; reduce intoxication on license premises in public places and events; improve access and effectiveness of treatment and early intervention; grow leadership and collaborative planning and communication; improve our capacity to monitor and report on levels of alcohol-related harm. 61 Alcohol Health Watch; NZ Police; Health Promotion Agency; CADS; Hapai and Auckland Council 62 In alignment with the regional Action on Alcohol Plan 69

70 Reduc Ineq. Cap Dev Māori Health Gain Reducing alcohol harm in identified at risk communities 2.Strengthen strategic alliances, interagency networks and public health alcohol workforce development Deliver our health promotion activities to prioritised population groups and areas with high number of Māori and Pacific youth and low socioeconomic communities Participate in regional and national alcohol-related project or advisory groups (e.g., Executive Planning Group for Alcohol Harm Reduction, National Public Health Alcohol Working Group (NPHAWG) Support the facilitation of the regional Waipiro Alcohol Harm Action Group Number of health promotion activities in prioritised population groups. Number of groups participated in Number of workshops delivered for NPHAWG Estimate: 2 Narrative on how prioritised populations groups (including Māori and Pacific youth and low socioeconomic communities) are supported to determine their priorities and actions Narrative on outcomes for client groups as per regional Action on Alcohol Plan Summary of key client outcomes as appropriate Narrative on client outcomes 70

71 3.3.3 Tobacco a. Enforcement Smoke-Free Environments Act: Goal: Auckland tobacco retailers comply with the Smoke-free Environments (SFE) Act. Target Population: General Population b. Health Promotion: Support the 2025 smokefree initiative in the region. Target Population: Smokers, Māori and Pacific populations, children Core Func. H Prot a. Enforcement Smoke-Free Environments Act Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality 1. Tobacco retailers have increased knowledge about the Smoke-free Environments (SFE) Act Pro-active Controlled Purchase Operations (CPO) 63 Process complaints as per the Smokefree Enforcement Officer Protocol Estimate / Target per year Number of CPOs conducted. 64 Baseline 13/14: 9 Number of retailers visited during the CPOs. Baseline 13/14: 227 Number of positive 65 sales during CPOs. Baseline 13/14: 6 Number of complaints processed investigating suspected breaches of the Smokefree Environment Summary of rationale for targeting tobacco premises Outcome of operation is recorded as per audit protocol Percentage of complaints which have an action completed within 5 days Estimate: 100% Short Term Outcome Measures Number and percentage of tobacco retailers visited during Controlled Purchase Operations (CPOs) in which tobacco is sold to minors Baseline 13/14: 3% Number and Percentage of complaints closed 63 All proactive tobacco retailer compliance checks and controlled purchase operations conducted within 1 km of transport hubs, malls and other areas where young people congregate with a deprivation index score of These areas have the highest rate of Māori, Pacific and low socioeconomic children who are more susceptible to initiating smoking at a younger age 64 One CPO equals one total organised operation that targets a number of premises. 65 COPs CPOs where tobacco is sold to minors 71

72 Core Func. Health Prom Health Prom b. Tobacco: Health Promotion Preparation of files for the Ministry of Health when prosecution possible Participation in hearings as required Act. Baseline 13/14: 60 Number of files requesting infringement notices for sale of tobacco to minors sent to MoH. Estimate: 7 Number of hearings where ARPHS staff presented evidence Performance Accountability Summary of quality of files received by MoH six monthly Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1. Contribute to regional Develop an ARPHS Smokefree Strategic Action outcomes for reducing tobacco Smokefree Strategic Action Plan developed. Yes/No related harm supporting Plan in consultation with key Smokefree Aotearoa 2025 stakeholders 2. Strengthen strategic alliances and interagency networks Reviewing health promotion activities to promote Smokefree awareness and support national tobacco initiatives (e.g., Pacifica Festival, Stoptober) Leading the facilitation of: - Regional Cessation Network - Smokefree coordinator 66 ARPHS uses an opportunistic approach to work collaboratively with other agencies Number and type of health promotion activities supported 66 Number of stakeholders engaged with in World Smokefree day Brief narrative will be provided Number and percentage of files requesting infringement notices for sale of tobacco to minors sent to MoH Brief narrative of outcomes of hearings participated in Short Term Outcome Measures Implementation proceeding as per plan Brief narrative of outcomes from activities Number and percentage of Alternative Education settings that have become Smokefree 72

73 meetings for Auckland and Northland Support Alternative Education settings to become Smokefree H Prom 3. Increase adoption of policies which support the reduction of tobacco related harm Undertake advocacy activities other than formal submissions to support smokefree environments Number and type of engagement/advocacy activities See H1.1 Healthy Public Policy for ARPHS formal submissions Summary of outcomes of advocacy activities other than formal submissions Input into submissions relevant to Smokefree environments In collaboration with the Work Place Health team, deliver Smokefree awards to exemplar workplaces See Work Place Health section See H1.1 Healthy Public Policy for submissions Reduc Ineq 4. Support high need populations to be Smokefree Provide support to the CMDHB Inter-sectoral smokefree project (See noncore contracts section Continue to work with selected New Zealand Federated Family Budgeting Services branches and other social providers :Number and percentage of organisations/communities report they have adopted Smokefree policies An increase in the quality/nature of smokefree commitment across budgeting services. 73

74 Māori Health Gain Active engagement with Mana Whenua and Māori communities to develop Smokefree policies in prioritised settings Number and list of Mana Whenua and Māori Smokefree providers engaged with Brief description on the extent Mana Whenua was involved in planning and implementing activities Narrative on results of engagements with Mana Whenua, including successes and challenges 74

75 3.4 Outcome 4: The environments in which people live, work and play promote health and wellbeing Strategic objectives 2015/16: The main focus of the Health Improvement team is to review and build on our strengths while revitalising our strategic direction and purpose. Two work streams have been prioritised at a team level for this financial year: Participate in further development of an outcomes based framework (RBA-based) for our areas of work, including indicator development. Strengthen key messages about the team s contribution to ARPHS organisational vision by building on the work ARPHS has done on refreshing its vision and developing its workforce (NextGen project) Key operational developments for particular work areas include: Nutrition Information and Advice & Social Environments: Support the implementation of the Healthy Auckland Together project and transitioning it to BAU Workplace Health: Complete a significant strategic development for enhancing the Workplace Health programme 75

76 3.4.1 Social Environments Goal: Work with allied agencies 67 to improve whole of government responsiveness to public health issues in Auckland. Target Population: Vulnerable population groups prioritised using as per section Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures ARPHS identifies and works collaboratively with key stakeholders to raise the profile of public health issues and their respective contributions to Public Health. Facilitate Auckland Intersectoral Health Group (AIHG) meetings to coordinate health sector input into inter-sectoral activities Work with Auckland Social Sector Leaders Group on Better Public Services (BPS) programme Quantity Estimate / Target per year Number of AIHG meetings facilitated Number of BPS interagency meetings attended Brief narrative describing inter-agency projects and health sector input Quality Maintain the level of AIHG membership. Yes/No Percentage of AIHG members who participate in meetings throughout the year. Short Term Outcome Measures Brief narrative of regional inter-sectoral issues Managed via AIHG Narrative on outcomes of collaborative work H Prom ARPHS provides leadership, working collaboratively across health and other sectors in obesity prevention, improved nutrition and physical activity Healthy Auckland Together: inter-agency regional plan for action Description of initiatives commenced Effectiveness of initiatives are monitored and reported against Interagency commitment to a joint framework established Number and percentage of partnership projects initiated as part of the regional plan 67 Auckland Council, Healthy Families NZ, Heart Foundation, national and regional NGO s 76

77 H Prom Supporting the implementation of the Healthy Families NZ (HFNZ) initiative Liaise with regional stakeholders involved in Healthy Families NZ Description of outcomes 77

78 3.4.2 Workplace Health Goals: Promote organisational change & strengthen workplace environments to reduce inequities and increase health and wellbeing within Auckland Region, currently focussing on five core areas: nutrition, physical activity, alcohol and other drug, Smokefree, and mental health promotion Promote prevention of chronic diseases by raising awareness of obesity, diabetes and other risk factors. Target Population: Workplaces with 50+ staff; of predominantly Māori, Pacific, South Asian or low income workforce, 68 (target groups as per section 1.3.3) Performance Accountability Core Func. H Prom Short Term Outcomes 1. The Workplace Health programme is enhanced Activities A Quality Improvement project to be delivered. The aim of the programme is developing a strategic plan for enhancing the Workplace Health programme in collaboration with key stakeholders Quantity Estimate / Target per year A Quality Improvement project includes the development of a Workplace Health framework and an action plan. Yes/No Key Performance Measures Quality The strategic plan includes the programme backbone (purpose, vision, values, etc.). Yes/No Percentage of key milestones achieved within timeline. Short Term Outcome Measure Proportion of key milestones achieved 68 Average income across the entire workplace less than 50k. 78

79 Performance Accountability Core Func. H Prom Short Term Outcomes 2. Create supportive environments to improve the health and wellbeing of Auckland workplaces Activities Programme delivery. Assist Hearth Beat Challenge (HBC) workplaces to achieve HBC Awards or Renewals of Award The HBC programme delivers activities within 5 domains and refers workplaces to providers according to their needs within those 5 domains: 2.1 Increased awareness of healthy eating 2.2 Workplace staff increase physical activity Quantity Estimate / Target per year Programme delivery: Number of new HBC workplaces. Estimate: 20 Number of current active HBC workplaces. Baseline 13/14: 114 Number of HBC awards achieved Number of HBC awards renewals achieved Key Performance Measures Quality Percentage of new workplaces that have achieved steps 1-4 of the HBC programme best practice checklist within the first 6 months. Target 75% Percentage of organisations/workplaces participating in HBC who have reported predominantly Māori, Pacific, or South Asian employees, and met the other selection criteria. Number and percentage of workplaces report improved quality of cafeteria food as a result of ARPHS recommendations Short Term Outcome Measure Increase (in percentage) in number of new workplaces participating in Heart Beat Challenge (HBC) and number of employees covered Estimate HBC workplaces15% (Baseline 107) Number and percentage of workplaces with nutrition policies Number and percentage of workplaces report they are participating in more physical activity Number of workplaces with HBC awards where HBC workplace evaluation indicates level of nutrition knowledge increased Number of workplaces with physical activity policies Number of workplaces with HBC awards where evaluation indicates increased levels of 79 physical activity

80 Performance Accountability Core Func. Short Term Outcomes Activities 2.3. Decrease number of workplace staff smoking Quantity Estimate / Target per year Key Performance Measures Quality Number of workplaces that have introduced, updated or altered wellbeing policies Short Term Outcome Measure Number and percentage of workplaces that are completely Smokefree 2.4.Increased awareness of alcohol and other drugs (AOD) related harm Number and percentage of HBC workplaces who have implemented AOD policies 2.5.Increased awareness of the concept of wellbeing Number and percentage of HBC workplaces who have implemented wellbeing policies 80

81 3.4.3 Vulnerable Communities- Migrants & Migrants of Refugee background Goal: Work with allied health and social sector agencies to promote health gains in targeted communities. Target Population: Vulnerable migrants and/or migrants of refugee background Core Func. H Prom Cap Dev. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.Improve healthy lifestyles Support the development, Number of community Percentage of requests and community capacity of implementation and requests received responded to that align refugee and migrant evaluation of community with programme priorities communities driven projects Implementation of recommendations from Healthy Eating Healthy Living (HEHL) review Perform evaluation of HEHL continuation modules delivered in 14/15 Number of requests directly dealt with Number of requests referred Number of recommendations implemented Evaluation completed. Yes/No Appropriate response including referrals to community requests. Yes/No Percentage of recommendations implemented Prioritisation of recommendations Percentage of HEHL leaders, trainers and community members report that community trainers had the knowledge to deliver programme content Short Term Outcome Measures Percentage of (Healthy Eating, Healthy Living) 2014/15 HEHL participants report they know more about healthy eating 81

82 Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 2.Enable multiagency support, Refugee sector action plan: partnership and networking Partnership documentation Regional working group that promotes health and (e.g. Terms of Reference - fully functional. Yes/No wellbeing for vulnerable TOR, action plan) communities developed. Yes/No Support/lead the development, implementation and collaboration of strategic projects with partner agencies: - Leading the regional refugee sector action plan. Establishing infrastructure and partnerships. - Supporting the Auckland regional refugee health network Lead the Multi Ethnic Health Network (MEHN) for refugee & migrant health & wellbeing service workers in the Auckland region Auckland regional refugee health network Number of expert advisory panel meetings Estimate: 3. Number of Primary Health Care forums delivered Estimate: 3. Numbers of meetings facilitated Estimate: 4 Number of membergenerated requests addressed Percentage of membergenerated professional development requests that meet prioritisation criteria Percentage of membergenerated prioritised and actioned at network meetings Short Term Outcome Measures More coordinated activities/delivery of services within the MEHN 82

83 3.4.4 Nutrition and Physical Activity Information and Advice Goal: Work with allied health social sector agencies to improve health and wellbeing and to reduce the burden of disease through better nutrition environments. Target Population: General Population with focus on vulnerable communities as defined in section Core Func. H Prom Performance Accountability Short Term Outcome Activities Key Performance Measures External stakeholders are supported with sound and robust nutrition advice Provide technical support and feedback on nutrition environment-related work requested by key external stakeholders 69 Quantity Estimate / Target per year Number of documents/requests where feedback was provided Quality Percentage of information requests responded to within 1 month Short Term Outcome Measures External stakeholders are supported with capacity and technical nutrition expertise Active contribution to external stakeholders project work around improvements in nutrition environments Number and type of project work and key stakeholders involved Narrative on outcomes of collaborative work Nutrition related internal work is supported with sound and robust nutrition advice Provide technical and delivery support to internal nutrition-related programmes Provide technical input into ARPHS submissions See Workplace Health, Vulnerable Communities and Early Childhood Settings. Contribution to the HAT collaborative action plans See the Healthy Public Policy section 69 For instance: Northern Region Diabetes Network; Heart Foundation; Dietitians New Zealand and Department of Corrections 83

84 3.4.5 Healthy Early Childhood Education Settings ECES- (Nutrition) Goal: Work with allied health and social sector agencies to strengthen environments that are supportive of health and wellbeing of 0-5 year olds. This programme will have a priority focus on nutrition and physical activity and other key public health priorities. Target Population: Prioritised Early Childhood Education Services (High enrolment of Māori and Pacific children and those living in low socioeconomic decile - target groups as per section 1.3.3) Core Func. Māori Health Gain Cap Dev H Prom Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.Improved early childhood Re-engage with Auckland Brief summary on progress Narrative on outcomes of education Regional Te Kohanga Reo describing re-engagement engagement environments/settings in high Trust to provide health with Auckland Regional Te need prioritised licensed ECES promotion support 70 Kohanga Reo Trust ARPHS leading inter-sectoral collaboration: Identify and engage with new prioritised high needs licenced ECES. Deliver health promotion professional development in collaboration with key stakeholders and licensed and prioritised ECES, (NZDep, 8, 9 and 10 & high enrolment of Māori and Number and type of prioritised ECES participating in the programme Baseline 13/14: 50 Estimate: 70 Ethnicity of children enrolled and staff in prioritised ECES Percentage of ECECs with high enrolment of Tamariki receiving the programme. Percentage of ECECs with high enrolment of Pacific children receiving the programme. Recommendations from Short Term Outcome Measures Future actions are agreed with the Trust. Yes/No Number and percentage of ECES that have improved their environments through development or review of ECES policies and or practice in nutrition, physical activity and other key public health issues 70 Note this activity is still dependent on the Trusts readiness to engage 84

85 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year Pacific children). Support prioritised ECES to develop and implement action plan and clear goals through Health Promotion Professional Development workshops for ECES staff Work in collaboration with ARPHS Environmental Health Team to implement Health Promotion Professional Development workshops and review of the Nga Kupu Oranga (MoH) National Health and Safety Resource for ECES Conduct Professional development pre and post evaluation Number of needs assessments completed with prioritised ECES Number of prioritised ECES who have developed a health promotion action plan the needs assessment report are incorporated into the development of the Health Promotion Professional Development workshops. Yes/No Reviewed Nga Kupu Oranga endorsed and rolled out by the MoH Yes/No Recommendations from the Professional Development evaluation are incorporated into next phases of project. Yes/No Short Term Outcome Measures Number and percentage of ECES who have implemented action plans post professional development workshops Number and percentage of ECES adopt policy related changes Evaluation(s) report completed for each training round. Yes/No 85

86 Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 2.Strengthen collaboration with Prioritisation framework key stakeholders for agreeing actions Coordinate the Early Childhood Health Promotion Regional Network Group for child health and wellbeing services who work within early childhood education settings. Develop and implement a collaborative action plan Number of actions developed and implemented Maintain the level of regional network stakeholder membership. Yes/No Short Term Outcome Measures Number and percentage of collaborative actions implemented Estimate: 50% of actions in the regional plan commenced or implemented Māori Health Gain Briefings reports (programme and evaluation summary) to Ngati Whatua (Naida Glavish) Six monthly briefings reports provided. Yes/No Feedback received and addressed. Yes/No 86

87 2.3 Organisational Enabler: Suitable workforce, infrastructure and clinical governance (quality) Strategic objectives 2015/16: The Systems, Intelligence and Planning (SIP) team will continue to revise and enhance systems and procedures including working with key regional and national stakeholders to: Improve early identification of potential avenues for policy involvement primarily within the Auckland region (Health in All Policies) Increase stakeholder communication focusing on Mana Whenua and local council with improved and focused census reports (Māori ; Pacific; and Determinants of Health) Key operational developments are: Enhance ARPHS core capability in health informatics and provide the operational base for public health response, focusing on developing new tools to better capture and utilise information within the Health Improvement team (focusing on the Alcohol and Tobacco areas) Developing information Te Ora a Tamaki Makaurau briefing/documents on key areas of public health interest 87

88 3.5.1 Healthy Public Policy Goals: To put public health awareness on the agenda of policy makers in all sectors and at all levels. Target Population: General Population Core Func. H Prom H Prot Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.Improved public policy Triage and make Number of submissions Implementation of new outcomes achieved through submissions on proposed made 72 screening process timely, evidence based legislation (bills and Baseline 12/13: 21 submissions and [policy regulations), policies, Baseline 13/14: 36 advice, with a special focus on strategies and projects that Māori Health gain and may impact on health achieving equity for all outcomes populations Key stakeholders are engaged throughout the policy development process Provide monthly reports to AIHG 71 on submissions screened and outcome of screening On-going active involvement with Auckland unitary plan process. Number of policy submissions RMA-related made Baseline 12/13: 4 Baseline 13/14: 2 Number of RMA consent applications responded to Baseline 12/13: 6 Baseline 13/14: 2 Number of policy activities reports provided to AIHG Percentage of submissions for which a final report or Act is available that are assessed within 3 months of the document publication. Baseline to be established. Percentage of submissions signed off by the Medical Officer of Health and the Service Manager. Target 100% Short Term Outcome Measures Percentage of submissions assessed that have negligible, moderate or high alignment with the final outcome Baseline 13/14: 22 evaluations High: 77% Moderate: 14% Negligible: 9% 71 Auckland Intersectoral Health Group 72 A list of submissions will be provided appended to the report 88

89 Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 2.Community water fluoridation Maintain a watching brief on Monthly media monitor (CWF) is retained in the CWF media activity and Auckland Region undertake proactive media activities as required Short Term Outcome Measures % TLAs maintain CWF status Complete and distribute revised CWF print resources (created in response to findings from social marketing research) Technically accurate and timely submissions are made Continue to coordinate regional health sector Fluoridation group meetings Quarterly DHB teleconference ARPHS actively promotes maintenance and extension of CWF when the Auckland Council consults on the regional water strategy. Number of evidence-based submission relating to CWF as part of regional water strategy development Number of print resources distributed to dental clinics, primary care and in other relevant outlets Cap Dev 3. Publications are developed to engage key stakeholders in understanding public health outcomes Produce briefings on key public health topics designed to engage with a wider variety of stakeholders A significant publication is completed. Yes/No Publications are quality reviewed by communications team Brief narrative on media monitoring and feedback from stakeholders Deliver associated activities 89

90 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year to the publication(s) (e.g. lectures, media activity other others) Short Term Outcome Measures Workforce Development Goal: Strengthen skills and knowledge within the ARPHS workforce. Target Population: ARPHS staff Performance Accountability Core Func. Cap Dev Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.ARPHS has a Develop and implement year Action plan 15/16 is comprehensive workforce two of the ARPHS strategic developed and development plan that workforce development implemented. Yes/No identifies and prioritises plan 73 in alignment with Te workforce development Uru Kahikaketa and Taeao o activities Tautai strategies. Number of internal Continuing Professional Development forums delivered per year. Estimate: 10 Percentage of staff who report they are satisfied or very satisfied with training fora (i.e., rating of 4 or 5 for Likert scale of 1 to 5). Implementation of activities scheduled for the year 2015/16, monitor through quarterly report to SMT. Yes/No Short Term Outcome Measures Number and percentage of staff report they can confidently apply training knowledge to their work. 73 ARPHS Strategic Workforce Development Plan includes: Recruitment strategy, Retention strategy, Tertiary opportunities strategy, Learning & development guidelines, Regulatory training requirements, CASP guidelines, Internship programme, Talent management programme, Leadership programmes, Mentoring programme, ARPHS Workplace Survey. 90

91 Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 2.Designated officers meet the Record of training and Ministry requirements to fulfil development for each their statutory roles officer Facilitate and support access to competency training and development opportunities Annual report on Competency of Designated Officers to MoH completed. Yes/No Short Term Outcome Measures Number and percentage of regulatory officers who maintain their designation Cap Dev 3.Increasing Public Health knowledge for our workforce Meet the MoH target of 60% by the end of 2016 for appropriate staff employed in public health roles that have or working towards agreed public health qualifications Actively plan to meet the target Number of staff in PHU with professional development plans Number of staff working toward a qualification in a public health related discipline. Estimate: To be defined Records of qualifications up-to-date Number and percentage of staff currently holding public health or relevant qualification (including a breakdown of ethnicities) Number and percentage of staff who have completed a qualification in a public health related discipline Clinical 74 Technical 75 Management PHMSs, Medical Officers and Nurses 75 HPOs, Health Promoters, Policy, Planning, Workforce Development, Trainer, Surveillance, Emergency (planning and logistics) 76 Managers level 3 & 4 and programme supervisors. 91

92 Core Func. Māori Health Gain Māori Health Gain Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 4.1 Development of cultural Conduct induction of new Number of training awareness for all staff. ARPHS staff, including the sessions Percentage attendance at and ADHB strengthen staff completion of an ADHB training. Māori cultural competencies delivered Treaty of Waitangi course 77 Conduct ARPHS orientation workshop for new staff, including the completion of an ARPHS Tangata Whenua training 78 Number of new staff completing the mandatory ADHB Treaty of Waitangi training per reporting period Number of new staff completing the ARPHS Tangata Whenua training per reporting period 79 Short Term Outcome Measures Number of staff report that the ARPHS Tangata Whenua workshop increased their level of competency 4.2.Māori Workforce Capacity Development Develop targeted recruitment and retention strategies that reflect service and population needs Up skill Māori staff with increased knowledge, skills and tertiary qualifications to support them in their role. Number of Māori staff participated in development opportunities annually reported to SMT. Number of Māori staff who participated in a leadership programme. Estimate: 2 per year Number and percentage (of Māori staff across ARPHS to meet Auckland demographics target 1.7% increase by 2017) Pilot Mentoring Programme 77 The majority of pre-existing staff completed the ADHB training pre Session is provided on the application of the Treaty of Waitangi in Public Health 79 This workshop is mandatory for all new staff as from

93 Core Func. Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year for Tuhauora members. Short Term Outcome Measures Number of staff participated in mentoring programme Reduc Ineq 5.1.Development of cultural awareness for all staff Conduct induction of new staff includes the completion of an ADHB delivered Pacific Best Practice course. ARPHS works with ADHB trainers to ensure that the training is tailored to a public health audience 80 Number and percentage of new staff who have completed the mandatory ADHB Pacific Best Practice course 5.2.Pacific Workforce Capacity Development: Develop targeted recruitment and retention strategies that reflect service and population needs. Number of Pacific staff participated in development opportunities annually. Number and percentage of staff that have increased Pacific cultural competency Pacific staff up skilled with increased knowledge, skills and tertiary qualifications to support them in their role. Number of Pacific staff participated in a leadership programme. Estimate: 1 per year Number and percentage of Pacific staff across ARPHS to meet Auckland demographics target 2.6% increase by 2017) 80 The majority of pre-existing staff completed a cultural core competencies workshop (replaced by the ADHB-delivered Best Pacific Practice training) pre

94 3.5.3 Communications Goal: Provide timely, accurate and appropriate public health information to the Auckland population. Target population: General Population Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year ARPHS has a strategic Communications Plan approach to both internal and completed external communications Develop an overarching communications strategic plan for ARPHS including a plan for operational implementation Implementation Plan completed Communications Plan is peer reviewed and signed- off by Senior Management Team (SMT) Narrative on whether implementation occurs according to agreed milestones Short Term Outcome Measures Narrative on Media interactions assessed that are of negligible, moderate and high impact. Māori Health Gain ARPHS overall Communication Strategy and implementation plan include a specific section relating to Māori Health Gain Māori media list is updated six monthly. Yes/No Percentage of media releases sent to Māori stakeholders including Māori media Number and percentage of media interviews conducted for Māori media channels (as a percentage of all media interviews done). 94

95 Reduc Ineq ARPHS overall Communication Plan includes a section relating to improving equity for all. Brief narrative of new proactive communication initiatives Percentage of resources/information posted on the ARPHS website addressing the needs of particular populations in a language other than English or Te Reo Māori have been consulted with communities. Number and percentage of media interviews conducted for Pacific, Asian and any Culturally and Linguistically Diverse media (as a percentage of all media interviews done). ARPHS delivers effective external communications that inform key stakeholders of Public Health activities and issues Produce timely and accurate media statements reflecting the breadth of ARPHS work Current and up-to-date website Explore the potential for a consumer satisfaction survey Number of media requests Estimate: 100 Number of media releases. Estimate: 20 Development of a schedule to review website s pages. Yes/No Return all media calls and enquiries in a timely manner. Yes/ No Media Handling Protocol is up-to-date Yes/ No Timely and accurate media statements. Yes/ No Number and percentage of media releases/statements provided on areas of public interest and/or public health priority where ARPHS is the lead agency. Quarterly health sector communication Narrative of external relationships meetings 95

96 Regular communication to the health sector Effective external relationships including mainstream and ethnic media and other external stakeholders Number of visits to ARPHS main website: - Sessions Baseline 13/14: 58,396 - Users Baseline 13/14: 44,423 - Page views Baseline 13/14: 119,845 Number of likes - Facebook page Baseline 13/14: 427 Number of followers - Twitter 215 as of Feb

97 Provide efficient and effective internal communications Ensure the Hub 81 is accepted as the place to go for all internal communications Initiate a quality improvement programme for the Hub that increases its attractiveness for staff Number of page views on the Hub. Baseline 13/14: 211,455 Percentage of staff that rates the Hub as a good or very good source of information. Hub usage by all staff is 75% Baseline as per December 2014: Increased Staff knowledge about workplace information 8.Develop and maintain relationships with Māori, Pacific, Asian and any Culturally and Linguistically Diverse stakeholders for effective media communications Health Improvement: 40.5% Health Protection: 36.5% Medical: 39.5% Systems, Intelligence and Planning: 76.5% Senior Management Team: 27.8% Ensure these activities are included in the Communications strategic plan and external stakeholder engagement plan 81 Internal intranet for ARPHS staff 97

98 3.5.4 Informatics Goal: To support the application of business and clinical knowledge/data to inform and support service delivery. Target population: ARPHS Whole-of- Service Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1. ARPHS has systems that Implement TB Management TB and Rheumatic Fever Data quality reporting is collect, collate and produce and Rheumatic Fever and modules in NDCMS implemented high quality information for modules in NDCMS are developed and Yes/No public health action. implemented Data Quality Framework for NDCMS is implemented. Yes/No Short Term Outcome Measures Percentage and number of notifiable diseases able to be Managed in ARPHS Notifiable Case Management System Disease (NDCMS) Develop capacity to send electronic letters to General Practitioners summarising actions taken for notifiable diseases Develop capacity to record iwi data for clinical contacts in NDCMS Capacity developed. Yes/No Capacity developed. Yes/No Data collection aligned with NZ statistics protocols for data collection. Yes/No 98

99 3.Improved systems for data collection and reporting for Environmental Health Strengthen Environmental Health reporting out of the Assessment and Management Team(AMT) log: - Change AMT log and categorisation of EH work - User instructions development - Delivery of training Capacity developed. Yes/No User instructions developed. Yes/No User instructions signedoff by Health Protection Manager and clinical partners. Yes/No 4.Improved systems for data collection and reporting for the Health Improvement Team Scope, design and build a Health Improvement module in PHiMS - CRM Health Improvement module delivered. Yes/No Design documents signed-off by PHiMS project governance group Health Improvement team able to report from PHiMS - CRM or provide narrative 5. Business Continuity System (BCS) planning updated/improved. Update BCS road map for PHiMS - CRM Road map updated. Yes/No Road map signed-off by Systems, Intelligence and Planning Manager and clinical partner 99

100 3.5.5 Intelligence, Planning and Quality Goal: Overall effectiveness and efficiency of ARPHS service delivery continues to improve. Target population: ARPHS Whole-of-Service Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures 1.Planning and Reporting: Quality service performance information is provided Reporting processes to inform planning are improved Start the development of an outcomes-based framework that combines the Results- Based Accountability model and the Public Health Five Core Functions Quantity Estimate / Target per year A high level framework of outcomes is produced. Yes/No Quality Framework consulted with key internal and external stakeholders. Yes/No Short Term Outcome Measures ARPHS service plans support Government s and DHBs priorities Development of ARPHS service plans and reports in accordance with the 2015/16 Annual Plan Guidance for Public Health Units Completion of: Annual Plan for 2016/17; Six-monthly and Whole-of year reports; ISE report. Input into DHB s Statement of Performance Expectations (SOPE) 97% of plans and reports are submitted timely MoH contract Manager reports satisfaction with plans and reports. Asses &Surv 2.2 ARPHS uses data to inform public health action Analyse Census 2013 data for the production of targeted demographic reports: 100

101 Māori Health Gain Reduc Ineq. Produce a demographic report using Census 2013 data specific for Māori Produce a demographic report using Census 2013 data for regional: - Pacific population - Social Determinants of Health Report developed. Yes/No Reports developed. Yes/No Report peer reviewed by Māori Stakeholders Yes/No Reports are peer reviewed. Yes/No Narrative of the report produced Narrative of the reports produced Develop a geographic access analytical tool (e.g. to calculate access to liquor outlets, workability of urban environments) to support Health improvement programmes and projects (Alcohol, tobacco, Obesogenic Environments, and policy submissions, etc.) Analytical tool developed. Yes/No Narrative of the reports produced and applications 2.3 ARPHS has capacity and capability to be a producer of high value Public Health Intelligence Implement year two of Information Management Action Plan Public Health Information Management framework is implemented. Yes/No Report progress to Senior Management Team (SMT) Cap Dev 3. Quality ARPHS has a quality Framework which guides all quality activities within the Service Implement Quality Framework Develop and Implement a Quality Action Plan in line with the Framework Plan developed Yes/No Consultation carried out with key stakeholders internally and Signed off by SIPS Manager and Clinical Partner 101

102 3.5.6 Resource Centre Goal: ARPHS is an authorised provider responsible for the distribution of MoH resources. General Population Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.Provide and distribute resources as per MoH contract Develop an electronic file Management system to both Manage stock and provide more accurate reporting data. Maintain an effective and efficient health education resource distribution service to support public health programmes, individuals, and external organisations. 82 Total number of orders processed. Baseline 13/14: 3533 Total number of items despatched. Baseline 13/14: approx30,000 Percentage of orders processed within 5 days of receipt. Baseline 12/13: 96% Baseline 13/14: 99% Percentage of orders processed and distributed. Target: 100% Short Term Outcome Measures 82 Any health education resources developed will be done so in accordance with Rauemi Atawhai- A guide to developing health education resources in New Zealand Education guidelines 102

103 3.5.7 ARPHS Facilities Goal: The provision of on-going infrastructure support for the organisation so that systems and processes are in place to support public health action. Target population: ARPHS staff Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1. Ensure all staff members Timely responses to requests Number and type of Infrastructure processes have knowledge of systems and maintenance of of infrastructure requests 83 align with ADHB policy. and processes in place to infrastructure and support Yes/No ensure smooth running of the needs through: organisation. Accommodation Asset Management including IT hardware, phones, pool equipment etc. Purchasing Facilities Management Documentation of infrastructure request Training and guide documents provided to staff regarding common facilities actions Reporting process maintained Yes/No Number of guide documents created Percentage of Infrastructure requests actioned within target timeframe. Timeframe TBC after reviewing of reports from new logging system I procurement requests are actions within target timeframe. Short Term Outcome Measures 83 An infrastructure log is being developed. No estimate available yet 103

104 Ensure consideration is given to cultural and religious factors for the use of facilities 84 Any new project includes a component to check considerations have been made. Yes/No 2.Maintain relationships with key service providers to ensure smooth running of the organisation 3.Maintain centralised rostering systems and processes Support in review and development of service agreements with key suppliers Participation in discussions and forums around infrastructure/facilities projects that may have an impact on ARPHS Maintain relationships with individuals and agencies, to resolve emergent issues Develop and maintain systems and processes. Support the introduction of revised processes. Link with staff in teams tasked with creating rosters Train staff on centralised rostering systems. Business process improvements for infrastructure/facilities Management is supported Systems and processes for documentation of infrastructure support are aligned Documented and agreed processes for escalation of urgent issues Number of reports produced. Target: 100% of reports requested by Senior Management Team are provided. One full annual review of data Reporting framework is developed for centralised rostering. Yes/no Confirmation from ADHB that procedures align with DHB policy and resolution of identified issues Reports are accepted by SMT (Senior Management Team) following requests Reporting on usage and accuracy of data provided from centralised rostering processes ARPHS aligns with established stakeholder relations. 84 Assessment of cultural/religious factors should be scheduled in project plans. Staff also need information about how to use equipment and facilities in a culturally sensitive way 104

105 3.5.8 Afterhours Service Goal: Provision of afterhours support to ensure that relevant staff are able to fulfil their on-call duties to meet service provisions for Auckland population. Target population: ARPHS on-call staff Core Func. Cap Dev Performance Accountability Short Term Outcome Activities Key Performance Measures Quantity Quality Estimate / Target per year 1.Ensure staff appropriately Design, develop and deliver Number of after-hours trained in after-hours systems after-hours orientation and systems/processes training Percentage of staff and processes refresher training. sessions held. 2.Resolve issues reported by after-hours staff Align after-hours orientation and training with workforce development strategy. Skills updates and refreshers provided for staff taking oncall duties. Maintain and take action on items reported in after-hours Issues Log. New staff receives training before first on-call shift. Yes/No Number of issues completed. Target 100% receiving after-hours orientation before first oncall shift (target 100%). Percentage of issues actioned within next working day. Target 100% Short Term Outcome Measures Number and percentage of staff report they are confident to perform on call duties Evidence is available for follow-up actions to address systems/process gaps identified by issues. Yes/No. 3.Confirm after hours systems and processes Maintain After Hours Service Manual and supplementary processes. Lead a review of afterhours improvements as required. Percentage of systems & processes feedback actioned within specified timeframe (target 100%) 85 Improvements and Narrative on outcomes of review 85 Timeframe depends on scale potential change 105

106 systems processes are reflected in the After Hours Manual. 106

107 4. Section Four Non-core Programmes 107

108 4.1 Non-core Programmes (Contract Services) Work area Core Function Short Term Outcomes Activities (What we will do to achieve outcomes) Key Performance Measures Quantity Quality Physical Environment Drinking Water Assistance Programme (DWAP) Facilitation Health Protection Support communities, consultants, mentors & drinking water supplies to improve the quality of their drinking water Provide technical assistance to enable water supplies to meet the relevant requirements of the Health Act 1956 Provide ongoing support for community supplies which have received drinking water subsidies As per contract performance measures Tobacco Control 1.Pacific Smoking Cessation Service (PSCS) Preventive Intervention Reduced smoking rates in Pacific Island communities Pacific people have reduced exposure to second hand smoke This service is delivered under contracts with ADHB and WDHB Service delivered as per contract service specifications As per contract performance measures 2.CMDHB Inter-sectoral smokefree project Health Promotion Support smokefree environments in conjunction with allied agencies Support prioritised non-health sector government (i.e. WINZ) and nongovernment (i.e. Budget Advice) agencies to develop systems and policies that support their staff and client groups to be smokefree. Number of agencies targeted per year Estimate: 2-3 Agencies have developed smokefree policies and/or have set smokefree related targets. Yes/No 108

109 Workforce Development Public Health College: Registrar Supervision Screening/National Cervical Screening (NCS) NCSP Register Services Capacity Develop. Preventive Intervention Public Health Medicine Training Programme Supervisor role for Northern Region A secure effective system of registration, recall and follow-up of participating women on the National Cervical Screening Register ARPHS to provide supervisory role for PH Registrars Maintain the system for registration, recall and follow up of eligible women to the NCSP As per contract performance measures As per contract performance measures 109

110 5. Section Five Finance 110

111 5. Finance Auckland Regional Public Health Service Annual Plan Costing Estimate for the 2015/16 Financial Year BUDGET 2015/16 Core Contract Total Total FTE $000's 3.1 Environmental Hazards , Built Environments Border Health Protection Burial and Cremation Drinking Water Quality Hazardous substances and New Organisms (HSNO) Waters and Wastes Early Childhood Education Centres Resource Management Public Health Emergency Planning and Response Notifiable Communicable Diseases , Notifiable Infectious Diseases , Tuberculosis , Disease investigation , Complex HIV BCG Authorisation Programme (Independent Vaccinators) Refugee health Screening Service (RHSS) , Hazardous Commodities , Enforcement of Psychoactive Substances Act Alcohol , Tobacco Health Promoting Environments , Social Environments** Workplace Health Vulnerable Communities - Migrants & Migrants of Refugee background Nutrition Information and Advice Healthy Early Childhood Education Centres Capacity Development*** , Healthy Public Policy Workforce Development Communications

112 3.5.4 Informatics Intelligence, Planning and Quality Resource Centre ARPHS Facilities Afterhours Service**** ,368 Non-Core Contract Drinking Water Assistance Programme (DWAP) Facilitation Pacific Smoking Cessation Service Public Health College: Registrar Supervision NCSP Register Services Intersectoral Smokefree Project Other user pays programmes Total Non-Core Contract ,542 Total Auckland Regional Public Health Service ,910 * includes 20% indirect staff FTE working in cross service and cross team support roles Total Core Contract (incl. DHB PACT MECA & Capital charge funding) **** Supports services and programme delivery Funding for Public Health Core Contract Services 2015/16 comprises: $000 s MoH core contract funding ref /00 $15,806 DHB Capital Charge and PACT MECA jolt $1,538 Registrar Training endowments $24 Total funding for core contract activities $17,

113 6. Section Six Appendix List of Acronyms 113