Strategic Plan 2013-2025
Toi Te Ora Public Health Service (Toi Te Ora) is one of 12 public health units funded by the Ministry of Health and is the public health unit for the Bay of Plenty and Lakes District Health Boards (DHBs). Toi Te Ora s role is to plan and deliver services that promote, protect and improve population health, prevent ill health and minimise the risk of disease and injury through population based interventions. Toi Te Ora suggests the idea of enduring wellbeing. Toi is the name of a celebrated ancestor in the Eastern Bay of Plenty and Ora is to be alive, well and healthy. Review Date: July 2015 1
Executive Summary Purpose Toi Te Ora s purpose is to improve and protect the health of the population in the Lakes and Bay of Plenty DHB districts with a focus on reducing inequalities in health. Toi Te Ora aligns its work to the Bay of Plenty and Lakes DHBs respective strategic visions of Healthy Thriving Communities - Kia Momoho Te Hapori Oranga and Healthy Communities Mauriora. Priority Populations Toi Te Ora s priority populations are Māori, Children (including maternal health), and Youth 1. Long Term Goals Toi Te Ora has adopted five high-level goals aimed to improve public health in the Bay of Plenty and Lakes DHB s districts. Goals 1-3 are public health goals and goals 4 and 5 are internal goals which guide Toi Te Ora s service delivery. 1 2 To reduce childhood admission to hospital from acute rheumatic fever, respiratory infections and skin infections, each by 2/3 in five years.*. To reduce childhood obesity by 1/3 in 10 years.* 5 To reduce the proportion of year 10 students smoking by 2/3 in five years.* Toi Te Ora will deliver on its contractual and statutory responsibilities within a quality framework. Toi Te Ora will rate within the top 5% of staff satisfaction results within the Bay of Plenty DHB. 3 4 *From 2013 While the goals are selected to prioritise activity focusing on these outcomes, the public health approach to interventions is in addressing the underlying determinants of health. 1 Children and Youth are 0-18 years of age. 2
Background Strategic Fit The World Health Organisation has provided considerable leadership for a settings based approach to public health provision. Toi Te Ora s service delivery model reflects this approach and its programmes of work are based around a number of public health settings including: the physical environment; the wider health sector; social environments; workplaces; education settings. Challenges for Public Health The Government is committed to its Better, Sooner, More Convenient policy direction for Health, which creates an environment where health professionals are encouraged to work together across services to deliver health care in a co-ordinated and co-operative manner. The outcome aims to deliver more services in the community, so that people wait less time for services and are kept healthier. Aligned to this policy direction is a set of health targets that provide performance measures for the health sector to improve health outcomes and service quality at local and national levels. In the Ministry of Health s Statement of Intent 2013 to 2016, one of the three high-level outcomes is that New Zealanders are healthier and more independent. Additionally, within the current fiscal environment there is a need to work more efficiently and effectively to achieve priority goals and targets. There is also a need for more prevention and reducing demand on treatment services. Population trends At the last census (2013) there were 205,971 people living in the Bay of Plenty DHB district, and 98,187 people living in the Lakes DHB district, accounting for approximately 4.9% and 2.3% of the national population respectively. Over the next two decades the population of the Bay of Plenty DHB is projected to increase at a similar rate to the national population while Lakes DHB is expected to have a slower population growth. Overall, Māori and Pacific peoples are projected to have the highest percentage increases in both district health board areas. The proportion of Māori in the Eastern Bay of Plenty and Lakes populations are significantly higher than in the national population. Approximately 25% of the Bay of Plenty DHB and 36% of the Lakes DHB populations live in high deprivation areas (NZDep2006 Quintile 5). In line with the national trend, the population in both district health board areas is ageing, with the highest percentage increase in both districts occurring in the 65+ age group. A slightly higher proportion of the Bay of Plenty DHB population is aged over 65+ years compared with New Zealand as a whole, and Bay of Plenty is also projected to experience a higher percentage increase in the population aged zero 14 years than New Zealand as a whole. 3
Health issues New Zealand, along with many other countries, is experiencing a higher incidence of chronic conditions such as diabetes and heart disease. These conditions are placing an increasing burden on both the health system and the wider community. In addition New Zealand has seen a re-emergence in a number of communicable diseases, particularly in children. These include rheumatic fever, skin infections and respiratory infections. The trends in both chronic and communicable diseases highlight areas where public health units can work with society to address factors that contribute to this health burden. Māori Health Improving Māori health is a key priority for Toi Te Ora and aligns with current Government targets, the Ministry of Health and both Lakes and Bay of Plenty DHB s values and goals. Toi Te Ora has confirmed the health of Māori as one of its three population priorities. Toi Te Ora is committed to the principals of Whānau Ora and embeds them at both a service and programme delivery level. The Whānau Ora lens will be applied across all programmes to help create a platform for greater effectiveness of initiatives which improve Māori health outcomes. Toi Te Ora s strategic goals have a strong equity focus on issues where Māori experience disproportionate harm, including tobacco, rheumatic fever, skin and respiratory infections and childhood obesity. To achieve its goals Toi Te Ora will continue to work closely with Māori Health Services within both district health boards and will align its service delivery with their respective Māori health plans. Improving Māori responsiveness will also build on the recommendations of the He Ritenga Treaty of Waitangi Principles Health Audit. Child Health and Youth Concern around the level of child poverty in New Zealand, the Government s focus on vulnerable children, and the need to reduce inequalities have signalled a need for Toi Te Ora to prioritise the health of children in its work. New Zealand s poor child health outcomes are of concern and are an anomaly when compared with other developed countries. There are worsening trends, an example of which is communicable diseases, which account for a significant number of avoidable hospital admissions. It is important that our tamariki and rangatahi grow up in supportive environments which encourage and nurture positive health outcomes. The potential health gain for children is life long and will have a positive benefit for the community as a whole. This must start with a focus on maternal health. 4
Goal Setting Toi Te Ora has set long-term goals to address population health challenges, concentrate on priority populations and complete its business as usual work. As a public health unit covering a large geographic region and diverse demographic spread, the goals will help address gaps in service and enable Toi Te Ora to work with and support other groups. The goals will enable prioritisation of skills, knowledge, partnerships and funding to achieve them. In conjunction with the Lakes and Bay of Plenty Population Advisory Group it was agreed that Toi Te Ora s priority populations would be Māori, Children (including maternal health) and Youth; and that public health goals focusing on childhood infections, obesity prevention, and reducing tobacco use would have the greatest impact on improving the health of children and reducing inequalities within these populations. In addition, the goals needed to have strong alignment with national and local health priorities and targets including the Better Public Services goal covering rheumatic fever and the Smokefree Aotearoa 2025 goal. Both district health boards will be monitored against their own rheumatic fever targets, and achievement against the tobacco goal will be measured using results from the annual national Year 10 survey. The prevention of childhood skin and respiratory infections fits with the two district health boards drive to lower ambulatory sensitive hospitalisation (ASH) rates which are monitored on an ongoing basis. These goals cannot be achieved by Toi Te Ora alone. They will require collaboration with other health providers and agencies. All Toi Te Ora s work will be of a high quality and delivered within a quality framework, based around the Bay of Plenty DHB s Care Improvement Recognition Criteria Awards (CIRCA) model. Finally, the staff satisfaction goal reflects the management team s agreement that a high level of staff satisfaction is an important contributor to achieving the public health goals. This goal will be assessed using the existing Bay of Plenty DHB staff survey. Goals The following section outlines further detail on the five goals and the high-level outcomes for each. Toi Te Ora s goals and priorities are in line with the Ministry of Health s direction, the Midland region focus, the Bay of Plenty and Lakes DHBs goals and priorities, and Māori health plans. Further detail can be found in Appendix One. Toi Te Ora s strategic direction has been endorsed by both Bay of Plenty and Lakes district health boards. 5
Goal 1 To reduce childhood admission to hospital from acute rheumatic fever, respiratory infections and skin infections, each by 2/3 in five years Rationale Acute rheumatic fever (ARF), respiratory infections and skin infections are more common in New Zealand than in comparable OECD countries. All disproportionately affect children living in lower socioeconomic circumstances, and Māori and Pacific children. A significant proportion of all hospital admissions are potentially preventable through addressing a range of risk factors, health literacy and access to healthcare. Definitions For this goal childhood is defined as aged zero to 14 years for ARF and aged zero to five years for respiratory and skin infections. High-level outcomes to achieve this goal are: 1. Improved housing; 2. Improved hygiene and self-care; 3. Improved healthcare; 4. Improved health literacy; 5. Improved non-household childhood settings; 6. Reduced smoking; 7. Improved nutrition. Goal 2 To reduce childhood obesity by 1/3 in 10 years Rationale Obesity is a major risk factor for a number of non-communicable diseases including ischaemic heart disease, type 2 diabetes, stroke, musculoskeletal conditions and some cancers. In children, obesity can be a factor in psychological issues, muscle and joint problems, hypertension and type 2 diabetes. Children who are obese have a much higher risk of being obese as adults and developing a non-communicable disease in later life. Definitions For this goal childhood is defined as aged zero to 14 years. High-level outcomes to achieve this goal are: 1. Increased physical activity and reduced sedentary behaviour; 2. Improved nutrition. 6
Goal 3 To reduce the proportion of Year 10 students smoking by 2/3 in five years Rationale Smoking harms almost every organ in the body and is responsible for the deaths of nearly 5,000 New Zealanders per annum. Tobacco use is the single biggest preventable cause of death in New Zealand; at least 50% of all regular cigarette smokers die from a smoking related condition. Smoking initiation is very unusual beyond childhood. The mean age of smoking initiation among New Zealand youth is 14.6 years. Definitions For this goal Year 10 students are aged 14 and 15 years. High-level outcomes to achieve this goal are: 1. Reduced smoking initiation rates; 2. Reduced harm to non-smokers from second-hand smoke; 3. Non-smoking and smokefree becomes the norm; 4. Increased smoking cessation rates. Goal 4 Toi Te Ora will rate within the top 5% of staff satisfaction results within the Bay of Plenty DHB Rationale Toi Te Ora strives to build and maintain high levels of job satisfaction through acknowledging the efforts of staff and helping ensure Toi Te Ora is a fun and rewarding place to work. High-level outcomes to achieve this goal are: 1. Strong leadership practices; 2. Bay of Plenty DHB achieves WorkWell Gold Standard Accreditation. Definitions This goal focuses on all Toi Te Ora staff based in each of its Tauranga, Whakatane, Rotorua and Taupo offices. 7
Goal 5 Toi Te Ora will deliver on its contractual and statutory responsibilities within a quality framework Rationale The Bay of Plenty DHB has developed values that all staff contribute and adhere to. As a service of the district health board, the values apply to Toi Te Ora: C - Compassion A - Attitude R - Responsiveness E - Excellence The CARE improvement programme was designed to develop structured activity resulting in measurable and sustainable improvements to cost and quality. As a result, the CIRCA Awards were developed to recognise excellence in performance, and consistency in providing excellence in healthcare. Definitions Contracted responsibilities are those covered by any contract held by Toi Te Ora or by Bay of Plenty DHB on behalf of Toi Te Ora, including those with the Ministry of Health, Bay of Plenty DHB, Western Bay of Plenty District Council and Ministry of Primary Industries. Statutory responsibilities include the responsibilities that Toi Te Ora, or any of its staff, has pursuant to Acts and Regulations of Parliament. The high-level outcome to achieve this goal is: High performing teams meet and exceed agreed customer and contractual expectations. Implementation This strategic plan sets a clear direction and represents a significant change to Toi Te Ora s current approach. Annual plans will accompany this strategic plan to provide detailed strategies and activities that support each goal. Implementation of this strategic plan commences in July 2013. Reporting on outcomes will be aligned to annual plans and other reporting requirements. 8
Appendix One Ministry of Health - National Level Health and Disability System Outcomes New Zealanders lead longer, healthier and more independent lives New Zealand s economic growth is supported Ministry of Health Intermediate Outcomes Good health and independence are protected and promoted A more unified and improved health and disability system People receive better health and disability services The health and disability system and services are trusted and can be used with confidence Overarching Health Sector Goal Better, Sooner, More Convenient Health Services for all New Zealanders National Health Targets 2013/2014 Increased immunisation Better diabetes and cardiovascular services / more heart and diabetes checks Better help for smokers to quit Better Public Services Results - Supporting vulnerable children 5 Year Targets Result 3: Increase infant immunisation rates and reduce the incidence of rheumatic fever Result 4: Reduce the number of assaults on children Midland group - Regional Level Midland regional service plan and public health working groups 2013/2014 Rheumatic fever Better public services for rheumatic fever reduction Midland Tobacco Control Plan Four public health working groups - Workforce development - Communicable disease - Business continuity - Public health intelligence 9
Toi Te Ora - Public Health Service - Regional Level Our Vision Healthy Thriving Communities - Kia Momoho Te Hapori Oranga Our Population Priorities Māori health Children (including maternal health), and Youth Our Emphasis Reducing inequalities Our Goals Reduce childhood admissions to hospital from acute rheumatic fever, respiratory infections and skin infections each by 2/3 in five years Reduce childhood obesity by 1/3 in 10 years Reduce the number of Year 10 students smoking by 2/3 in five years Deliver on contractual and statutory responsibilities within a quality framework Rate within the top 5% of staff satisfaction results within the Bay of Plenty DHB Our Programme Areas Health Improvement Health Services Development Environmental Health Our Focus Areas Social Environments Education Workplaces Public Health Infrastructure Environmental Health Communicable Disease 10
Bay of Plenty DHB - Local Level DHB Vision Healthy Thriving Communities - Kia Momoho Te Hapori Oranga DHB Strategic Outcomes People take greater responsibility for their health People stay well in their homes and communities People receive timely and appropriate care DHB Focus Areas Health Targets Māori Health / Disparities Health of Older People Primary Health Wellness / Chronic Conditions Māori Strategic Priorities 2012/2013 Respiratory Health Access to Services Oral Health Cardiovascular Disease Lakes DHB - Local Level DHB Vision Healthy Communities, Mauriora! DHB Strategic Outcomes People are supported to take greater responsibility for their health People stay well in their homes and communities People receive timely and appropriate care DHB Focus Areas Child and youth health Mental health and addiction services Health of older people Primary and community health services Managing long term conditions He Tohu Oranga Māori Strategic Focus 2012/2013 Achieving Health Equity Creating and maintaining supportive and positive child and youth health services that promote good parenting and available, accessible and responsive health care 11