Released

REGIONAL PUBLIC HEALTH Under ANNUAL REPORT FOR THE

TheMIN ISTRY OF HEALTH 1 July 2017 – 30 June 2018 Official Contract: 353575 Provider: 102501

Information

Act 1982

CONTENTS

Introduction ...... 3 ReleasedAction Plan reports 1.3: Building healthy social environments ...... 7 1.5: Promote the health of refugees (includes Schedules B and C) ...... 10 1.6: Work with schools to identify and address health needs (not MoH contract) ...... 12 1.7: Improving vision and hearing (not MoH contract) ...... 12 1.8: SupportUnder for Work and Income clients to improve their health outcomes (not MoH contract) .... 13 2.1: Smokefree Nation 2025 ...... 13 3.1: Nutrition and physical activity ...... 16 4.1: Alcohol and other drugs ...... 21 4.2: CAYAD (non-core MoH contract)The ...... 25 5.1: Communicable diseases ...... 26 5.2: Promote and facilitate immunisation ...... 36 5.3: Deliver Year 7 and 8 Boostrix and GardasilOfficial vaccination programmes (not MoH contract) ...... 37 5.5: Sexual health promotion ...... 37 5.6: Deliver neonatal BCG vaccination (not MoH contract)...... 38 6.1 Minimise environmental hazards promote safe drinking water sustainable resource management ...... Information...... 39 6.2: Promote safe and healthy urban environments ...... 57 6.4: Health Promoting Schools (non-core MoH contract) ...... 59 6.6: Border health and response to emergency events...... 59 7.1: Business support ...... 65 7.2: Maori action plan ...... 66 7.4: Public health infrastructure ...... 68 7.6: Public health analytical services ...... Act.... 69 7.8: Communications support and health information dissemination ...... 70 7.9: Central region public health advice (Schedule D) ...... 711982

Financial summary ...... 74

INTRODUCTION

On behalf of Regional Public Health (RPH) I am pleased to present this report on our activities funded by the Ministry of Health for the past year. It documents RPH’s progress using the measures Releasedagreed in our Annual Business Plan under our core contract with the Ministry of Health.

It should be noted that reporting for activities that are funded from contracts other than the core public health contract, are not included.

Highlights from January to June 2018 have been included, with reference to the full year, as well as comments on relevant issues, challenges and risks.

During this Underreporting period RPH undertook an organisational change process in response to the changes around us with an eye to the future and returning RPH to a viable, fiscally neutral population health influencer and provider for the greater Wellington region.

I believe that overall RPH has met the requirements of the contract and has performed commendably in the period 1The July 2017 to 30 June 2018.

Peter Gush Service Manager Official

Information

Act 1982

Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 3 HOW THE REPORT IS STRUCTURED

Our services are grouped into action plans made up of a set of related activities. For the purposes of aligning with the terminology used in the Ministry’s planning and reporting guidelines for 2017- Released2018, an action plan is a ‘service grouping/programme.’ For a summary description of each action plan, refer to the RPH 2017-2018 Annual Plan (www.rph.org.nz/about-us/our-publications/).

We are working towards understanding and following the Ministry’s direction for planning and reporting of public health services using an approach based on Results Based Accountability (RBA). The Ministry’s approach to RBA, focuses an annual report on measuring an organisation’s annual ‘provider performance.’ It is not focused on measuring the attributable contribution to ‘higher level’, population health outcomes. Identifying and agreeing practicable and meaningful accountability measures isUnder work in progress.

The activity tables include three performance accountability measures, based on RBA and the Ministry’s guidelines for PHU planning. These measures cover the three dimensions of performance accountability:  How many did we do?The (quantity of effort): # (number)  How well did we do it? (quality of effort): % (percentage)  Is anyone better off? (quantity and quality of effect): # and %. Official From the Ministry’s guidelines: “ ’Is anyone better off’ equates to ‘client outcomes’. ‘Client’ in Public Health means ‘the people, organisations, settings, partners who engage with or receive benefit/services from working with a public health service provider’.” Four categories are required to identify the direct/indirect ‘client’ outcome or ‘effect’ of the activities provided – i.e. ‘is anyone better off’: Information  SK: change in skills/ knowledge  AO: change in attitude/opinion  BC: behavioural change  CC: circumstance change Also required is:  S: subjective data  O: objective data

Act 1982

Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 4 Table 1. MoH core contract issues mapped to MoH core contract activities

MOH ISSUE ACTION PLAN ACTIVITIES Alcohol and other drugs 4.1 1-7 Communicable disease 5.1 1-8 Released 5.2 5 Mental health 1.3 2,3 Nutrition and physical activity 3.1 1-8 Physical environments 1.3 4,6 6.1 1-21 6.2 1,2 Under 6.6 1-5 Generic/Public health infrastructure 7.4 1-4 7.6 1,2 7.8 1-3 Sexual and reproductive health 5.5 1-3 Social environments The 1.3 1,5,7,8 Tobacco control 2.1 1-3 Schedules B and C: Refugee and other asylum seekers 1.5 1-5 Schedule D: Central region public health adviceOfficial 7.9 1-5

Table 2. Core public health functions mapped to MoH core contract activities

CORE PUBLIC HEALTH FUNCTION ACTION PLAN ACTIVITIES Health Assessment and Surveillance 4.1 3,4,7 Public Health Capacity Development Information1.5 2,5 5.1 5 7.4 1-4 7.6 1,2 7.8 1,2,3 Health Promotion 1.3 1-9 1.5 1,4 2.1 2-4 Act 3.1 1-8 4.1 5,6 5.5 1-3 1982 6.2 1,2 Health Protection 1.5 3 2.1 1 4.1 1,2 5.1 1-4,6-8 5.2 5

Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 5 CORE PUBLIC HEALTH FUNCTION ACTION PLAN ACTIVITIES 6.1 1-21 6.6 1-5 Preventive Interventions - - Released Table 3. MoH non-core contracts mapped to action plans and activities

CONTRACT ACTION PLAN ACTIVITIES Community Action on Youth and Drugs (CAYAD) 4.2 1-4 Drinking Water Assistance Programme Facilitation 6.1 5 Health Promoting Schools 6.4 1 Public HealthUnder Clinical Network Secretariat 8.1 1

Table 4. DHB contracts mapped to action plans

SERVICE WDHB HVDHB CCDHB ACTION PLAN Porirua Mobile Ear Nursing Service  1.7 Primary Healthcare Nursing InnovationThe – Public Health 1.8  Nurse in WINZ, Porirua DHB NIR Administration Services  5.2 Outreach Immunisation Coordination Official  5.2 Public Health Nurse - Healthy Housing  6.2 Hutt Valley DHB Tobacco Control  2.1 Wairarapa DHB Tobacco Control  2.1 BCG Nurse Services   5.6 Healthy Housing Programme Information   6.2 HPV and Boostrix Immunisation Programme    5.3 Vision and Hearing Technicians    1.7 School Based Public Health Nursing    1.6

Table 5. Other contracts mapped to action plans

OTHER CONTRACTS ACTION PLAN Central Region Registrar Supervision 8.1 MidCentral Medical Officer of Health Act8.1

Table 6. Action plans across all contracts 1982 ACROSS ALL CONTRACTS ACTION PLAN Business support 7.1 Māori action plan 7.2

Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 6 Released

ACTION PLAN 1.3: BUILDING HEALTHY SOCIAL ENVIRONMENTS

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 1.3.1 Health Social LeadUnder and coordinate work 30 community groups or 90% identified community 30/100% community groups Promotion environments across RPH to strengthen individuals engaged with issues driven by Māori or involved in initiatives of public community led action as a identified an issue of public Pacific. health significance (BC,O). means to improving the health significance. delivery of service to Māori, Pacific and low socio-economic families. The 1.3.2 Health Mental health Lead coordinated multi- 36 RPH responses to 100% completed suspected Promotion disciplinary response to all completed suspected suicides suicides or sudden deaths suicides in the HVDHB and or sudden deaths in the Hutt responded to according to CCDHB areas. OfficialValley DHB and CCDHB areas. protocol. 1.3.3 Health Mental health Attend meetings on suicides 36 deaths RPH responds to are Brief narrative report on RPHs Promotion for HVDHB and CCDHB, for the reviewed by the Child and contribution to the Child and Youth Mortality Youth Mortality Review committees (AO,S). Review Committees. Committees. RPH contributes information Information gained during a response to a sudden death as requested at Child and Youth Mortality Review Committees. 1.3.4 Health Physical Increase wellness in early 11,020 hits on the RPH 100% feedback received from 100% early childhood services Promotion environments childhood centres. website when outbreaks of early childhood services report changing their illness arise. provided with advice and practice/behaviour based on support for an outbreak the advice they are given by indicated they were satisfied RPH (BC,O). with RPH input. 1.3.5 Health Social Strengthen partnerships and 45 stakeholders engaged. Act 40/90% external stakeholders Promotion environments communication with external and/or community report stakeholders and communities 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 7 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% on community identified being well supported by RPH issues of public health teams (AO,O). significance.Under 1.3.6 Health Physical Support Kōhanga reo kaimahi 12 Kōhanga reo RPH engages 97% Kōhanga reo who #/% Kōhanga reo reporting a Promotion environments to build a healthier with for the purpose of participate in workshops change of practice or environment for mokopuna. building healthier report satisfaction about the behaviour as a result of RPH environments for mokopuna. advice they receive (i.e. a engagement (BC,O). rating of 4 or 5 on Likert scale The 1 to 5). This information was not collected. 1.3.7 Health Social Coordinate organisational 5 community events with high 100% organising committees 5/100% event organising Promotion environments involvement in community-led Māori and Pacific attendance where RPH is a member. committees report being events with high Māori and Officialsupported by RPH. better informed on public Pacific attendance. health issues through RPH involvement.

1.3.8 Health Social Implement the WorkWell 5 new workplaces registered 40% workplaces that have high 1/20% workplaces reported Promotion environments programme in the sub-region, for WorkWell. numbers of Māori and/or positive behaviour change in initially working with Healthy Pacific workers. relation to priority wellbeing Families Lower Hutt and Te 1 registered workplacesInformation areas (BC,S). Awakairangi Health Network supported to implement and (PHO) in the Hutt Valley. achieve WorkWell accreditation. 1.3.9 Health Not MoH core A health promotion, education 34 high-medium need centres % early childhood centres 90% early childhood centres Promotion contract and prevention focus in the RPH actively working with (15). indicate satisfaction (Likert verbally report having changed Wairarapa early childhood Scale) with RPH service practice/behaviour as a result sector, particularly in high provision. of RPH engagement (BC,O). needs centres and their respective communities. Information not collected due to other positive reportsAct of services delivered by RPH. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 8 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Highlights Te Awakairangi Health Network (TAHN) used WorkWell as their workplace wellbeing framework. TAHN WorkWell Advisor was supported by the Lead WorkWell organisation (RPH) to achieve Bronze accreditation. THAN, with RPH support, is developing activitiesUnder towards achieving Silver accreditation in February 2019.

RPH has successfully implemented the following initiatives with communities:  Provision of community confidence kai (Cannons Creek and Titahi Bay);  Hearing checks in Porirua Kōhanga reo; first aid training for Kōhanga reo (HVDHB and CCDHB);  UnderstandingThe the Food Act 2014 and how to manage outbreaks of gastroenteritis for Kōhanga reo;  Otago University implemented the Health Promotion Agency’s Social Supply of Alcohol project;  Pomare Community House implemented a Meth drop in service for whanau who need support with whanau members using meth;  Suicide postvention trainingOfficial for community;  Co-ordinated the Wainuiomata suicide prevention group to provide infrastructure support for Wainuiomata community to develop strategies to support their wider community with the high number of sudden deaths in Wainuiomata;  Nutrition sessions for Mothers Group in Porirua;  Safer Porirua with Wellness Safety promotion pop up hub;  Smoking cessation incentivised program for Kōhanga reo alongside Wellington Regional Stop Smoking Service;  Kokiri Health Services with a funding applicationInformation for an additional sexual health advisor (male);  Nurturing Mind and Body workshops for early childhood staff (2);  Lead multi-disciplinary response to all suicides.

In March 2018 RPH hosted the Food Safety training. 17 individuals attended from 10 kōhanga reo and the course gave the attendees more of an understanding of the Food Act 2014 and National Programmes. The unit standards completed at the course were accredited food safety standards; therefore each Kōhanga reo now has a certified person. An example of resulting change is Te Awa Kairangi Kōhanga Reo updated their policies/procedures to include more stringent processes to align with the food safety guidelines. This included introducing a hazard register for the kitchen to identify and eliminate risks when preparing and serving food. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 9 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Issues/challenges/risks and actions Early childhood professional development provider is duplicating the RPH Nurturing Mind and Body workshops, which poses a risk taken to the delivery of our service and confusion for the early childhood sector. RPH is working through a resolution with this provider. Under ACTION PLAN 1.5: PROMOTE THE HEALTH OF REFUGEES (INCLUDES SCHEDULES B AND C)

Performance measures Core MOH Issue Activity # Function How many = # How well = % Is anyone better off = #/% The 1.5.1 Health Refugees/ Active involvement in the 51 intersectoral meetings 100% actions assigned to RPH Refer to highlights section. Promotion Other Asylum planning of regional and attended by RPH staff. within regional and national seekers national health services for refugee plans completed. refugees, in collaboration with Official partner agencies.

1.5.2 Public Health Refugees/ Build capacity across health 12 training opportunities 100% positive feedback from 100% of those training Capacity Other Asylum and social services to respond facilitated by RPH. sessions evaluated. participants who were Development seekers to identified refugee health 3 meetings facilitated by RPH. surveyed report an increase in needs. Information skills and knowledge (SK,S). 1 x Interpreting Workshop 1 x Primary Care Study Day 3 x Ad hoc refugee education sessions for primary care 6 x Red Cross volunteer education sessions 1 X Wellington Interpreting Services, Interpreter education session Dietitian Conference, presentation related to refugee general and oral health Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 10 Released

Performance measures Core MOH Issue Activity # Function How many = # How well = % Is anyone better off = #/%

1.5.3 Health Refugees/ Assess and plan health care 240 refugee families and/or 95% quota refugees who 100% refugee clients Protection Other Asylum services for refugee individuals supported by RPH. receive at least one home connected and engaged with seekers populationsUnder (quota, asylum transition visit from RPH. health services within the and family support category Internal audit to assess visits region and with health needs refugees). completed within 6-10 weeks. addressed (BC,O).

1.5.4 Health Refugees/ Promote good health 7 collaborative workshops 100% identified key public This population group have Promotion Other Asylum messaging to refugee facilitated with our health concerns covered in the english as a second language, seekers populations, includingThe stakeholders. workshop, these include: therefore a workshop teaching sessions and refugee diet/nutrition/obesity; dental evaluation cannot be community workshops in and oral health; food storage; administered. collaboration with other immunisation; smoking, Well providers. Official Homes and Family Planning Services and navigating the NZ health system. 1.5.5 Public Health Refugees/ Enhancing RPHs capacity and 6 public health and SHIVERS II 100% staff who have Capacity Other Asylum capability to improve and nurses within the Disease completed identified training. Development seekers deliver refugee population Control team identified for staff health services (staff development. Identified training included professional development). InformationCALD and interpreting training. Orientation to Mangere Refugee Resettlement Centre (MRRC) was not able to occur due to several staff changes at MRRC. Highlights Refugee Nutrition Programme RPH has funded NZ Red Cross, Wellington Service Centre to provide a refugee nutrition programme, in partnership with Common Unity and Kaibosh. The programme has initiated a cooking group in Lower Hutt for women with a refugee background participating alongside women from migrant and New Zealand backgrounds. The aims are to promote social connectedness and social cohesion, engage women to learn more about how to cook, eat and shop for healthy affordable food,Act and to facilitate leadership skills and confidence among the participants. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 11 Released

Performance measures Core MOH Issue Activity # Function How many = # How well = % Is anyone better off = #/%

Dental Hutt Valley DHB (HVDHB) RPHUnder in collaboration with HVDHB Strategy, Planning and Outcomes team has established a one off funded dental service for all adult newly arrived refugees in the Hutt Valley region. This service will continue until funding is exhausted.

Issues/challenges/risks and actions 3DHB Health Pathways for Refugee Health taken The process of developing a 3DHB Health Pathway was initiated in early in 2017, including the Health Pathway Coordinator at Te Awakairangi Health Network. Due to a change of staff, this was delayed to August 2017. Unfortunately, there were further delays which were outside theThe control of RPH, however the pathway remains a priority and we continue to discuss its development with the Health Pathways Coordinator.

WRAP (Wellington Regional RefugeeOfficial Wellbeing and Health Action Plan) Changemakers officially disestablished the WRAP working group in November 2017. We discussed the possibility of continuing our health strand meetings with our network members, and all were keen for it to continue, as it is an important way of communicating and planning with the key members who support refugee health across the region. The meeting has been renamed the Regional Refugee Wider Health Network. It meets six monthly, our action plans and goals remain the same.

Primary Care Resourcing Information HVDHB continues to struggle to find general practices willing to register refugee families. Te Awakairangi Health Network continues to work proactively with GPs, and refugee patients are rotated through those practices willing to register these patients. RPH continues to support general practice and offer training as needed. RPH is supporting Whai Oranga o Te Iwi Health Centre in Wainuiomata who have recently registered a refugee family.

ACTION PLAN 1.6 WORK WITH SCHOOLS TO IDENTIFY AND ADDRESS HEALTH NEEDS (NOT MOH CONTRACT) Act ACTION PLAN 1.7 IMPROVING VISION AND HEARING (NOT MOH CONTRACT) 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 12 Released

ACTION PLAN 1.8 SUPPORT FOR WORK AND INCOME CLIENTS TO IMPROVE THEIR HEALTH OUTCOMES (NOT MOH CONTRACT) Under ACTION PLAN 2.1: SMOKEFREE NATION 2025

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 2.1.1 Health Tobacco control Increased compliance and 57 retailer education visits 37 tobacco retailers included 36/97% tobacco retailers that Protection awareness of the SmokefreeThe completed (Note: one visit in CPOs. are compliant at time of CPO Environments Act 1990 with a equals one visit to one (BC,O). key focus in Māori and Pacific retailer). communities. Official2 controlled purchase operations (CPOs) completed (Note: one CPO equals one total operation that targets a number of premises).

2.1.2 Health Tobacco control Increase public support for 5 organisations supported to 5 smokefree kōhanga reo in Promotion Smokefree Aotearoa 2025. develop or review SmokefreeInformation- RPH area (BC,O). Auahi Kore policies. Refer to highlights section.

5 smokefree workplaces reporting fully implementing their Smokefree-Auahi Kore Policy (BC,O). Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 13 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 2.1.3 Health Tobacco control Strengthen operational 43 alliances and networks 100% projects/programmes 43/100% alliances and Promotion alliances and interagency engaged with for the purpose targeted at Māori and Pacific networks that report positive networks to support achieving of achieving Smokefree communities. feedback on RPH involvement SmokefreeUnder Aotearoa 2025. Aotearoa 2025. and input.

13 Smokefree project/ programmes introduced together with other alliances The and networks. 2.1.4 Health Not MoH core Promotion contract Highlights 2.1.2 Te Kōhanga Reo Auahi KoreOfficial Policy reviews: As reported at the six-month period RPH is committed to strengthening networks with Te Kōhanga Reo (TKR) to review smokefree policies and to move to kaupapa Tupeka Kore. This was delayed as communication between RPH and the TKR National Trust needs to occur to decide on the best culturally appropriate process. However, to help address the smoking of the whānau attending TKR a quit smoking incentivised project is currently in development between Tākiri Mai Te Ata and RPH, to support whānau to quit (HVDHB and CCDHB areas). A review process of the smokefree policies will occur if feasible.

2.1.2 Smokefree Rugby Club Information The launch of the Wainuiomata Rugby Football Club Inc. Smokefree and Vapefree policy is a positive highlight. The policy is being led by the committee, coaching staff and management. The club has over 300 children registered and has a key focus on ensuring they provide them with a ‘safe, happy and healthy’ environment. A policy review was carried out before the start of the season. The Vapefree aspect was included in the policy as it was felt that having people vape around young people would normalise it.

2.1.2 WorkWell The Smokefree Coordinator is engaged with HVDHB to reinforce existing smokefree/vape policies that apply to the campus. HVDHB is developing an engagement survey with HVDHB staff as part of a review process. Act 2.1.3 Tākiri Mai Te Ata (TMTA) 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 14 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% The relationship between TMTA and RPH continues to strengthen. RPH staff are members of the TMTA steering group. This helps with joint planning and setting direction, with both agencies promoting quitting. Examples include coordinating attendance at communityUnder events including Te Rā o Te Raukura Festival, Creekfest Porirua, Waitangi Day Celebration (Wairarapa) as well as Pre- Golden Shears and Golden Shears in Wairarapa; and collaboration in the promotion of World Smokefree month.

2.1.3 Healthy Families Lower Hutt. RPH have continued to build on the relationship with Healthy Families Lower Hutt. RPH have supported Healthy Families Lower Hutt in the development of the Smokefree Town Centre policy in Wainuiomata. RPH has the smokefree knowledge and relationships and links to this community.The RPH has co-presented and supported Healthy Families Lower Hutt at all the Wainuiomata Community Board meetings and with other stakeholders during the development of the policy. This relationship extends across smokefree projects in Lower Hutt. Official 2.1.3 Smokefree Mokopuna (Wairarapa) In collaboration with a number of agencies a pilot project was developed and launched on World Smokefree Day to encourage wāhine to quit smoking for their mokopuna. Collaborative work with Masterton District Council, Wairarapa Times Age, Kura Kaupapa Māori o Wairarapa, Aratoi Museum of Arts and History and a number of other organisations who will be displaying the portraits and posters. Information 2.1.3 #TAG’s Wainuiomata School youth group RPH coordinate a group of high school children from Wainuiomata High who champion Auahi Kore 2025. This group is known as #TAG’s and they are utilised by various agencies to advocate for Smokefree 2025. This year the group’s activities were:  The #TAG’s were guests at the ASH Year 10 Report launch at Parliament House, former Prime Minister Helen Clark invited #TAG members to share their views on the report and vaping. Clark commented on their honesty and recommended organisations to include youth voices in their decision making and ensure robust consultation process.  Presented their Smokefree Car legislation submission to the Māori and Health Select committee, which the Chairperson supported and recommended that the committee progress this work. Committee members also asked for their opinions on vaping. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 15 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/%  Invited to the Wellington Cancer Society Tobacco Retail Regulatory submission to the Māori Select Committee which was held to celebrate World Smokefree Day. The #TAG’s had the opportunity to present a gift to the Chairperson and a Underreminder that they will be anticipating a positive outcome for smokefree car legislation. Issues/challenges/risks and actions 2.1.1 Controlled purchase operations. taken RPH had planned more tobacco controlled purchase operations. These were planned and organised however close to the operation the volunteers withdrew and they were unable to be completed. A request has been made to one of the high schools for volunteers and hopefully this will assist in future operations. The 2.1.2 Vaping regulations: With the popularisation of vaping and HEETS (heats sticks), and the fact that the Smokefree Environments Act 1990 does not address the issues of vaping in workplaces etc. it has been difficult for staff to answer questioning from premises and the public. RPH is pleased to hear that considerationOfficial is being given to address this under legislation. It is acknowledged that vaping is a legitimate cessation tool as outlined by the MOH however, action need to be taken to ensure it is not being normalised in workplaces and public spaces.

2.1.3 National tobacco control strategy: Guidance in the form of a national strategy would be helpful in establishing a cohesive and coordinated approach to achieving Smokefree 2025. Information

ACTION PLAN 3.1: NUTRITION AND PHYSICAL ACTIVITY

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 3.1.1 Health Nutrition and Build healthy public policy to 0 organisations agreed to 2/22% organisations have Promotion physical activity address obesogenic provide us with baseline data actively worked towards environments. for the purpose of writing a policy which is to implementing a food and Act follow due process for beverage policy adoption by the organisation. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 16 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/%

Refer highlights section. Upper Hutt City Council, 3DHB Under policy

3.1.2 Health Nutrition and Strengthen community action 16 newly established fruit and 50% growth of hubs over 47% reported increase in Promotion physical activity to improve the availability of vegetable packing and/or 2017/18. volumes of fresh fruit and healthy food in areas of high distribution hubs. vegetables through the Fruit Māori and Pacific populations.The Numerator: 16 newly and Vegetable Co-operative Paraparaumu Baptist Church established fruit and vegetable over the level in 2016-2017 Parparaumu Salvation Army packing and/or distribution (BC,O). Raumati Beach hubs. OfficialKelson Denominator: 16 packing 47% reported increase in Arakura Primary Wainuiomata and/or distribution hubs at 30 orders of fresh fruit and Fernlea Primary Wainuiomata June 2017. vegetables through the Fruit Wainuiomata Primary and Vegetable Co-operative Maungaraki during 2017-2018 across each Massey University distribution hub (BC,O). Te Kura Māori o Porirua Porirua City Council Information Refer highlights section. Tawa-Johnsonville Trentham Victoria Uni Kelburn Victoria Uni Pipitea Victoria Uni Te Aro 3.1.3 Health Nutrition and Maintain relationships and 2 collaborative meetings % network members surveyed Promotion physical activity interagency networks that aim organised and attended. report satisfaction with the to reduce the impact of Wellington NPA Network obesogenic environments. Collaborative meetings have meetings (ie rating of 4 or 5 for been replaced by google doc Likert scale of 1 to 5). updates, after a review. These Act meetings were superseded by 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 17 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% a wider collaborative meeting Network members were not run by the CCDHB Dietitians surveyed due to the meeting which includes researchers, changing to a google docs Under nurses and students. This update instead of a face to network encompasses all face meeting. stakeholders RPH is working with. 3.1.4 Health Nutrition and Increase access to physical # schools who receive recycled #% schools reported that the Promotion physical activity activity for children. The sports equipment. recycled equipment they received was useful. Decile 1-3 schools in Lower Hutt received recycled sports This information is not Officialequipment from Hutt City available as Hutt City Council Council. This information is not are the lead provider and hold available as Hutt City Council the data. are the lead provider and hold the data. 3.1.5 Health Nutrition and Facilitate the implementation 4 Breastfeeding Wairarapa 70% stakeholder/partner 95% agencies reporting they Promotion physical activity of the Wairarapa meetings held. attendance at Breastfeeding are actively working towards Breastfeeding Plan 2016-2019. InformationWairarapa meetings and the Wairarapa Breastfeeding activities. Plan (BC). 3.1.6 Health Nutrition and Increase consumption of fruit 6 fruit and vegetable co-op 2 fruit and vegetable co-op Promotion physical activity and vegetables by developing communities were engaged communities who reported personal skills through with, for the purpose of implementing cooking lessons community led cooking adopting community led that began in April 2018 in lessons. cooking lessons. Titahi Bay and Cannons Creek.

3.1.7 Health Nutrition and Review the role that food 0 public health nurses receive 0 public health nurses who Promotion physical activity charity plays in the school the environmental scan report finding the environment. recommendations. Act recommendations useful.

1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 18 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% No environmental scan was No environmental scan was Under carried out. carried out. 3.1.8 Health Nutrition and Support public health and 0 newsletters produced % public health nurses #/% public health nurses Promotion physical activity primary health nurses by however nutrition staff have surveyed who report report using the information providing nutrition and supported PHNs’ requests for satisfaction with the provided in the newsletter. physical activity updates via a information and attended newsletters (ie, a rating of 4 to newsletter. workshops run by PHNs in 5 on a Likert scale 1 to 5). 100% PHNs used the The schools. information provided. 100% PHNs were satisfied with the advice and support provided on request. Highlights 3.1.1. A workshop on developing aOfficial healthier food and drink environment was organised for Wellington region councils facilitated by Auckland Regional Public Health Service. The workshop provided guidance for developing a food and beverage policy and the steps that councils can follow. Upper Hutt City Council was the only council at the time to progress towards a food and drink policy for their organisation and the facilities they own that are accessed by their population.

3.1.2. The following is the growth for each hub: Eastern Suburbs 127%, Naenae 78%, Upper Hutt 82%, Waiwhetū 52.5%, Titahi Bay 18% and Wainuiomata 29%. No data was recorded forInformation Victoria and Massey University and Kāpiti hubs. Hub volumes are impacted during the close down over the Christmas holidays and when the universities break between terms.

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 19 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Weekly Total Number of Orders Under January-June 2018 1400

1200

1000

800The

600 400 Official 200

0 3-Jul 5-Jun 3-Apr 6-Feb 10-Jul 17-Jul 6-Mar 1-May 8-May 30-Jan 12-Jun 19-Jun 26-Jun 10-Apr 17-Apr 24-Apr 13-Feb 20-Feb 27-Feb 13-Mar 20-Mar 27-Mar 15-May 22-May 29-May Information Fruit and Vegetable Co-operative growth from January – July 2018. Data collection in this format began January 2018. The overall growth in the number of orders from the Fruit and Vegetable Co-operatives was a 47% increase, compared to the total for 2016/17. A new packing hub was established at Massey University in March. The new packing hubs are Victoria University, Massey University and Kapiti (Paraparaumu Baptist, Salvation Army and Raumati Beach). Note also that both established and new packing hubs gained new distribution hubs during the year).

3.1.5. Pepe Ora data analysis report: This report was also integrated with the ‘Nau Mai e Pepe’ research recommendations completed by the Māori Women’s Welfare League. This document gives detailed information and feedback from over 300 women residing in the Wairarapa informing us on local pre-natal and post-natal care and activities, for children up to five years of age. The Pepe Ora Working Group was then established with key stakeholders to focus on the keyAct recommendations from this analysis and its outcomes, they are: 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 20 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% • More women are aware of the Wairarapa low to no cost services provided to them. • Mothers living within the Wairarapa feel less isolated and know where and how to access local information. Under• There is an increase of mothers and babies attending local service groups and activities. Key activities are two annual Pepe Ora Expos; scoping for a Pepe Ora website with Wairarapa Maternity; a Pepe Ora resource for Lead Maternity Carers based on the Four Pillars of Maternal Care; and extra funding from the WDHB Māori Health Directorate to hold a Professionals Breastfeeding Training.

3.1.6. Titahi Bay, Cannons Creek, Wainuiomata, Naenae, Massey University and Victoria University Fruit and Vegetable Co- operatives engaged forThe the purpose of adopting community led cooking lessons to teach participants how to cook their produce therefore increasing the consumption of fruit and vegetables. Issues/challenges/risks and actions 3.1.5. The Peer Counsellor Programme Administrator for Breastfeeding Wairarapa who facilitates the Breastfeeding Training is taken moving out of area. The AdministratorOfficial has agreed to complete the final training programme in 2018/19. 3.1.7, 3.1.8. Capacity issues and organisational constraints on recruitment resulted in a change to the activity that was delivered or no delivery on these activities.

How might services be improved in 3.1.5. Breastfeeding Wairarapa will hold a hui with partnering stakeholders to look at future direction of a Breastfeeding Plan post the coming year 2019. Information ACTION PLAN 4.1: ALCOHOL AND OTHER DRUGS

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 4.1.1 Health Alcohol and Inquire, report on and prepare 1581 applications received for 100% application inquiries 26/100% matters (reports) in Protection other drugs briefs of evidence/submissions all licence types (on, off, club, completed in the required 15 opposition made by RPH that for all alcohol licensing special). working days. are accepted by the receiving matters. authority (DLC and/or ARLA). 1581 applications inquired into. Act 5/19% matters (reports) in opposition negotiated with the 26 applications that had 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 21 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% matters in opposition or applicant that resulted in the recommendations made. withdrawal of the opposition. Under Refer to issues section.

4.1.2 Health Alcohol and Collaborate in police led 8 CPO events conducted (i.e. 1 74% CPOs focused on 113/94% premises that are Protection other drugs controlled purchase event equals 1 evening). communities with high Māori compliant at the time of the operations (CPOs) to reduce 7 sales were made. populations or areas of high CPO (BC,O). the sale of alcohol toThe minors. deprivation. (Reported in Vital Few RBA 120 premises visited specifying report). # of - on, off visited. - 97 off licences Official - 23 on licences (Reported in 'Vital Few RBA report). 4.1.3 Health Alcohol and Undertake sub-regional and 29 occasions data presented 100% peer reviewed reports as Narrative report on anecdotal Assessment other drugs local analysis of alcohol to agencies/services. per RPH protocols. feedback regarding usefulness and Surveillance related health data of the health data. (Wellington ED, hospital health data) along with other Information Community networks and relevant information e.g. agencies have been extremely demographics and use the positive in their feedback. The analysis/reports to influence information/reports are being other parties at a local and well circulated through the sub-regional level. community and being used to support evidence based decisions. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 22 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 4.1.4 Health Alcohol and Conduct yearly audit of alcohol 1 audit report completed. 100% reports completed to 5/100% team leaders and Assessment other drugs licence applications, CPOs, and internal specifications, medical officers of health and Surveillance compliance visits from RPH including peer review. report the data analysis is of databaseUnder HealthScape. value i.e. useful for planning Complete a report to inform work load and strategy strategic direction and internally (AO,S). workload planning. (A review was completed on hearing outcomes using Healthscape information. This The is assisting in setting strategic direction). 4.1.5 Health Alcohol and Strengthen alliances and 16 alliances and networks 100% alliances and networks 15/94% alliances and Promotion other drugs interagency networks to Officialengaged with. whose activities support networks that exhibit a reduce alcohol and other drug communities with high Māori, stronger commitment to related harm. 21 collaborative Pacific peoples or young addressing alcohol and other activities/projects. persons. drug related harm or risk factors associated with that 100% projects support harm (BC,S). communities with high Informationpopulations of Māori, Pacific peoples and young persons.

4.1.6 Health Alcohol and Work with territorial 3 policy submissions. 100% RPH submissions or Narrative report on the Promotion other drugs authorities (TAs) and other policy reviews that are peer outcome of the submissions agencies to develop policies 1 policy developed. reviewed. (BC,S). that support reducing alcohol and other drug related harm. The written and oral submissions to the Select Committee for the Sale and Supply of Alcohol Act - renewal of off licences were Act very well received. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 23 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 4.1.7 Health Alcohol and Work with communities and 2 community and other 100% community and other Assessment other drugs other stakeholders to develop stakeholders groups supported stakeholder groups supported, and Surveillance evidence-based public health to reduce alcohol related that are in areas of high actionUnder which supports the harm. alcohol related harm. This may reduction of alcohol-related include areas with low socio- harm, including providing up 4 key activities facilitated or economic status/high Māori to date evidence-based delivered (e.g. presentations, population. information. training sessions). Highlights 4.1.1. Several oppositionsThe were withdrawn following negotiation with the applicant. Negotiated changes included reduced trading hours and remodelling of the single alcohol area layout in supermarkets/grocery.

Two new off licence applications did not gain a licence following opposition by the MOoH, other reporting agencies and the public. One was declined by the DLC. In Officialthe other, the applicant withdrew partway through the hearing. In a third instance an applicant choose not to proceed with an application after meeting with the MOoH representative and learning more of the concerns with the proposed location.

The High Court Decision Lion Liquor Retail Limited CIV-2017-485-506[2018] NZHC1123 was in our favour. This decision asserts the primary importance of public health analysis in the assessment of the potential future risk of a licence. An assessment rightly includes known harm indicators and demographics of Informationan area, that information is not too general and therefore inadmissible or of limited weight.

The outcome underscores the importance of regulating trading hours as a strategy to minimise alcohol related harm. Importantly it allows the reduction of trading hours one licence at a time. This successfully counters the opposing argument, that a reduction in hours in an area can only be addressed through a Local Alcohol Policy unless it can be proven that the premises is a contributing cause to the harm. Although a reduction in hours of one premises might lead some people to make substitute purchases at another premises, the statutory focus is squarely upon the challenge of harm "minimisation" and levels of harm might well justify a reduction in hours despite potential substitution effects. Act The High Court's endorsement of the “precautionary principle” will greatly assist the MOoHs’ efforts to reduce harm. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 24 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/%

Liquor King Kent TerraceUnder - High Court - Analysis.pdf

Issues/challenges/risks and actions 4.1.1. As reported in 2016-17 the complexity of District Licensing Hearings, which are increasingly having discussions on legal taken interpretation and lawyers representing clients, proves to be a challenge to regulatory officers and Medical Officers of Health. This has not changed. The cost of legal representation restricts the amount of expert guidance that can be obtained. Hearing decisions can take a number ofThe years to reach a resolution. A good example of this is the Liquor King Kent Terrace decision that relates to an opposition started back in 2015.

4.1.1. A number of premises are worked with and negotiated changes are made before an opposition is submitted by the MOoH. Examples of these are reduced hoursOfficial or changes to the single alcohol area. The complexity of recording these changes makes it difficult to capture however RPH is looking at what can be done to improve information capture and extraction.

How might services be improved in The rise in illegal drug harm, particularly synthetic drugs, has resulted in new networks being developed to address concerns. With the coming year the Institute of Environmental Science and Research and the National Drug Intelligence Bureau we are looking to ensure our communities are more quickly informed about the drugs circulating and the potential risks they present. Other comments A MOoH representative attended a number of DLC hearingsInformation with strong public opposition, but no reporting agency opposition. Our purpose in attending was to provide a public health view point for the area should the committee or the public wish to question this.

ACTION PLAN 4.2: CAYAD (NON-CORE MOH CONTRACT)

Refer to separate CAYAD contract report 353248 Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 25 Released

ACTION PLAN 5.1: COMMUNICABLE DISEASES

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.1.1 Health Communicable UnderRespond promptly to cases # disease notifications and % significant disease #/% case and outbreak Protection disease and outbreaks of outbreaks reported by disease. investigations initiated within investigations successfully communicable, waterborne 24 hours of notification. completed and audited on and foodborne diseases. Refer to tables in Appendix 1 EpiSurv/Concerto (CC,O). and 2. For the reporting period there were 571 significant disease 100% - timely public health The investigations of the 2134 follow-up of cases and notifications received. outbreaks by RPH staff ensures appropriate control measures 100% of all serious food, water are put in place to reduce the Official and environmental notifiable incidence of secondary cases disease, vaccine preventable and/or further spread of (measles, mumps, rubella, disease. Refer to highlights meningococcal, hepatitis) and section(Typhoid Outbreak). tuberculosis investigations are initiated within 24 hours of laboratory notification. 5.1.2 Health Communicable Facilitate successful # notified TB, LTBI Informationand leprosy 4/100% clients that report via #/% clients who completed Protection disease completion of drug regimens cases. a client satisfaction survey their treatment in the for tuberculosis (TB), latent their clinical support was of a reporting year (BC,O). tuberculosis infected (LTBI) 44 TB notifications (including 1 high standard and they were Complementary narrative on and leprosy clients. reactivation), 10 later supported to complete their identified treatment success denotified. treatment. stories. 43 LTBI and 0 leprosy notifications. NB Completing the client 40 cases of TB and 37 cases of satisfaction survey is optional, LTBI successfully completed not mandatory. treatment. Refer to highlights section (TB) for example of Act treatment success. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 26 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.1.3 Health Communicable Work collaboratively with 158 active rheumatic fever 34/100% bicillin non- #/% rheumatic clients Protection disease primary care to improve clients are on the rheumatic compliant rheumatic fever compliant with bicillin secondary prophylaxis fever register supported by clients followed up by RPH to timeliness and compliance Undertreatment for rheumatic fever RPH. encourage and facilitate (BC,O). clients. Respond to and bicillin compliance and regular manage notifications of health reviews by their Refer to table in Appendix 3. rheumatic fever from DHBs specialist. and primary care. 5.1.4 Health Communicable Work collaborativelyThe with 6 health professional groups 6/100% health professional #/% health professionals that Protection disease health professionals to achieve supported by RPH to notify groups verbally reported they report they have implemented a reduction in the incidence of acute and/or recurrent will implement a process to processes to ensure timely acute and/or recurrent rheumatic fever cases within improve their RF notification. notification of acute rheumatic rheumatic fever, particularly in Officialseven working days. fever as a result of RPH Māori and Pacific A one page notification engagement (BC,S). communities. process was provided to the participants. This information was not collected.

15 acute rheumatic fever cases Information notified.  13 cases notified within 7 days  2 cases notified >7 days 5.1.5 Public Health Communicable Refer activity 6.6.5 report. Capacity disease Development

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 27 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.1.6 Health Communicable Reduce the burden of disease 0 early childhood centres 0 ECEs participated in a 0 ECCs who have changed Protection disease outbreaks in institutional (ECCs) and 3 aged residential disease outbreak workshop. their outbreak management settings. care facilities (ARC) invited to a practice/behaviour as a result Under disease outbreak workshop. Numbers of ARC participating of RPH engagement (BC,O). not reported to RPH as the RPH staff participated in 3 workshops were not run by #/% ARCs who have changed outbreak workshops for aged RPH . their outbreak management residential care facilities (ARC), practice/behaviour as a result facilitated by 3DHB Infection of RPH engagement (BC,O). The Control. Information was not collected as the workshops were not run by RPH. Official 0 ECCs who reported they have an increased knowledge about how to identify, notify and manage an outbreak (SK,O).

Information #/% ARCs who reported they have an increased knowledge about how to identify, notify and manage an outbreak (SK,O).

Information was not collected as the workshops were not run by RPH. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 28 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.1.7 Health Communicable Maintain a working 2 visits/reviews of needle 100% needle exchange 2/100% needle exchange Protection disease relationship with managers of exchange facilities. facilities that receive an annual facilities that have their annual needle exchange services review of their facility. authorisation approved by the Underwithin our health district to medical officer of health facilitate an annual review of (CC,O). their service, ensuring the service is operating in accordance with their authorisation documentation.The 5.1.8 Health Communicable Legionnaire's disease 4 legionellosis longbeachae 100% attendees rate the #% attendees acknowledge an Protection disease awareness programme - cases notified. education sessions as 'good' or increase in their knowledge of promote safer and healthier 'very good'. legionellosis disease and a gardening in the community. Official3 education sessions change in gardening facilitated by RPH/or provided practice/behaviours at the by RPH. completion of the educational session (BC,O). Refer to highlights section. Highlights Australasian Tuberculosis Conference 2018 RPH is leading the organisation of the 2018 AustralasianInformation Conference in Wellington, 30 -31 August 2018. The two-day conference themed, “Winds of change: tools for TB elimination”, aims to address clinical, public health, microbiological and scientific aspects of the disease and its management.

5.1.1 Typhoid Cluster A cluster of four confirmed cases of typhoid was identified in Lower Hutt in May 2018. All cases were linked by close family connections and lived in three separate households. The cluster of cases was linked to travel from Samoa, as the first-identified case in the cluster had been in Samoa during their incubation period. Management of the cluster involved screening household members of all three households for typhoid symptoms and testing faecal specimens for typhoid bacteria carriage; in total, 27 contacts were investigated, and of these, one (the mother of the index case) was found to have asymptomatic shedding of typhoid bacteria. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 29 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Investigation and management also involved working with Naenae Pacific Health Services, Hutt Valley DHB Pacific People’s Directorate and the church attended by the cases and their households; a very productive relationship was established with church Underleaders who, with RPH support, communicated the situation to the congregation and supported the collection of faecal specimens from household contacts. One of the cases had been working in a long-term care facility (LTCF) while symptomatic; the risk of transmission in this context was assessed and considered low, and the LTCF was informed and advised.

To support each of the households an infection control package containing cleaning and disinfection equipment was delivered to prevent the spread of illness in the family. Additionally, one household was provided with a supermarket voucher for some financial aid for the large family,The as the main income earner was unable to work for a significant period.

MoH and DHB senior management were briefed about the typhoid cluster. A small incident control team at RPH was established to manage the increased workload.Official Overall, the management of the cluster proceeded with no issues of concern.

Image: Members of the church community participate in an education session

Information

5.1.2 Tuberculosis (TB) Treatment Success A case of multi-drug-resistant (MDR) TB received (and has since completed) treatment in the reporting period. The 30 year old of Korean ethnicity completed an 18-month treatment course. Of note, a multi-disciplinary approach was required, with infectious diseases physicians, public health nurses and community district nurses working in collaborationAct to successfully complete an intensive treatment of intravenous and oral medications under directly observed therapy (DOT) daily.

1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 30 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.1.8 Legionnaires Disease Programme – Safety in the garden As part of RPHs seasonal disease promotion, RPH staff were involved in promoting safety in the garden, specifically Legionnaires Underdisease, to comm unity groups in Porirua. Health protection officers visited Cannons Creek School, Titahi Bay Intermediate and the Salvation Army Women’s Group, to raise awareness of Legionnaires’ disease, risks while handling store bought potting mix/compost and educating participants on how to protect themselves while in the garden. On a return visit to these groups with a koha (masks, gloves, garden plants, herbs, compost, potting mix etc.) we observed the groups had taken our advice and put protective measures in place. An article ‘Stay safe in the garden this summer’ was published in the Kapi- Mana newspaper in November 2017.

Image: Titahi Bay IntermediateThe School students illustrate how to protect yourself while gardening Official

Information Challenges/risks 5.1.6 Outbreak Workshops Early Childhood Centres (ECCs) did not receive any outbreak workshops, as it had been identified that participants from the 2017 workshops were not distributing outbreak information to operational staff at their centre. RPH is currently reviewing how we deliver outbreak management workshops to ECCs to ensure information is being circulated across all operational staff. RPH is working with tertiary institutions and creating short YouTube videos to be used for ECE staff orientation to infection control.

5.1.1 VTEC/STEC Notifications Changes to Wellington Southern Community Laboratories’ community enteric testing contributed to a significant increase in VTEC/STEC notifications received by RPH. The previous culture-based testing for VTEC/STEC was oriented towards detection of the presence of E. coli 0157. In addition to E. coli 0157 the PCR method also identifies theAct shiga toxins stx1 and stx2; therefore there has been a significant increase in detection of the shiga toxins. The implications of this diagnostic change have had a significant impact 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 31 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% on current disease investigation follow-up and the personnel required to ensure we continue to deliver a high quality service. RPH is developing triage and response processes to ensure timely and effective case and contact management. Under The table below shows the significant increase in VTEC/STEC notifications.

Disease Notifications 01/07/2016 – 01/07/2017 – Comments received 30/06/2017 30/06/2018 STEC/VTEC 14 114 Significant increase. This equates to an 8 fold increase in notifications, the majority of which were investigated by HPOs. This caused immense stress The to HPOs and MOoH to provide a high quality and consistent response.

How might services be improved in RPH is working with Hawke’s Bay PHU to develop a Central Region approach to electronic follow up of common enteric illness via the coming year RedCap. This initiative is one of our ‘working smarter’ projects currently piloted at RPH. Official

Information

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 32 Released

APPENDIX 1: ANNUAL NOTIFIABLE DISEASE STATISTICS FOR THE PERIOD 01 JULY 2017 TO 30 JUNE 2018

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Source: EpiSurv as of 3 July 2017 and Statistics New Zealand DHB: Hutt Valley, Capital and Coast, and Wairarapa DHBs only Population denominator: 505100 in 2017, 496200 in 2016 (derived from the 2017 mid- year population estimates published by Stats NZ)

Significant Disease Increases in 2017/2018: a Cases of acute gastroenteritis from a common source or foodborne intoxication e.g., *Cryptosporidium: Outbreak associated with the Raumati Splash Pad and the laboratory change to staphylococcal intoxication. PCR testing b = significant decrease, = significant increase, = not significant decrease, = not *Giardia: PRC change to diagnostic testing significant increase. Act *Mumps: National increase in mumps. Mumps outbreak in Auckland c Fisher’s exact tests were used to determine statistical significance. Results are considered *Pertussis: National outbreak of pertussis statistically significant when the P-value is less than or equal *STEC/VTEC: Increase due to PCR diagnostic testing *Yersinia: Increase due to PCR testing 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 33 Released

APPENDIX 2: ANNUAL NOTIFIABLE DISEASE OUTBREAK STATISTICS FOR THE PERIOD 1 JULY 2017 TO 30 JUNE 2018

Under Exposure Setting

Condition ECC LTCF Camp Hostel School bakery The Hospital Grand Total Hotel/motel delicatessen Supermarket Other setting Restaurant cafe Cryptosporidiosis 3Official 1 4 Gastroenteritis - unknown cause 27 2 2 18 1 2 52 Gastroenteritis / foodborne intoxication 1 8 2 1 1 18 1 2 1 35 Influenza A 3 3 Shigellosis 1 1 Typhoid fever Information 1 1 Grand Total 1 39 4 1 3 39 2 2 4 1 96

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APPENDIX 3: BICILLIN COMPLIANCE AND TIMELINESS FOR THE 12 MONTH PERIOD 01 JULY 2017 TO THE 30 JUNE 2018

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ACTION PLAN 5.2: PROMOTE AND FACILITATE IMMUNISATION

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.2.1 Preventive Not MoH core Under Interventions contract

5.2.2 Preventive Not MoH core Interventions contract 5.2.3 Preventive Not MoH core Interventions contract The 5.2.4 Preventive Not MoH core Interventions contract

5.2.5 Health Communicable Maintain infrastructure for 16 IMAC education sessions 100% currently authorised 67/23% increase in vaccinators Protection disease immunisation delivery Official(at least 4 annually). vaccinators who have authorised by MOoH. including participation in the attended a vaccinator training Baseline: 296 vaccinators Regional Immunisation 363 vaccinators authorised by update in the last 2 years. authorised by MOoH 2016-17. Committee; authorisation of MOoH. vaccinators by the Medical Officer of Health; and 40 LIPs approved by MOoH. workforce development, advice and support for Local Information Immunisation Programmes (LIPs). Highlights The percentage of males being immunised with HPV vaccine remains greater than females, a trend for 2017 and continued in 2018.

Issues/challenges/risks and actions With the transition over the next three years to a co-delivery of Boostrix and HPV in year 7, this may reduce the numbers of taken student’s parents consenting to school based immunisations. We will endeavour to ensure that the transition is monitored and any risks identified dealt with promptly. The aim is to have this process be a natural one, were the expectation that year 7 will receive two immunisations Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 36 Released

ACTION PLAN 5.3: DELIVER YEAR 7 AND 8 BOOSTRIX AND GARDASIL VACCINATION PROGRAMMES (NOT MOH CONTRACT) Under ACTION PLAN 5.5: SEXUAL HEALTH PROMOTION

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 5.5.1 Health Sexual and Deliver sexual health 25 sexual health education 100% youth fed back that they Narrative report on anecdotal Promotion reproductive education sessions thatThe sessions provided to youth of learnt new information from feedback following sexual health support youth of Māori and Māori and Pacific descent. the session. health education sessions Pacific descent with their Refer highlights section. decision making for sexual and reproductive health related Official issues. 5.5.2 Health Sexual and Provide sexual health 0 sexual health information #/% participants from sexual Promotion reproductive information sessions for sessions were delivered to health information sessions health influential community people communities with high Māori report that the information to increase knowledge and and Pacific populations. helps them in their work with capacity of communities of Information the wider community (AO,S). high Māori and Pacific This information was not populations. collected as no sessions were provided in a community setting. 5.5.3 Health Sexual and Provide sexual health 25 sexual health education 100% youth of Māori and Narrative report on anecdotal Promotion reproductive education sessions to youth of sessions including information Pacific descent more aware of feedback indicating Māori and health Māori and Pacific descent to on available services provided services that can support them Pacific youth are more raise awareness of available to youth of Māori and Pacific with sexual health related confident to use services that services to support their descent. issues. provide support for sexual decision making. health related issues. Act Refer highlights section. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 37 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Highlights Feedback from sexual health education sessions at Salvation Army, included: “Clients, aged from 18 – 70 years, enjoyed the sessions because the style of delivery was easy to understand.” Their clients felt empowered to access a sexual health check-up. Of the classesUnder that are provided for clients, “this class is the most popular.”

Following a full day with year 11 students at Wellington East Girls College, two students approached the RPH Public Health Advisor as one student was concerned about her sexual well-being. The session provided the student with sufficient information and in a style that enabled her to approach the RPH Public Health Advisor, directly. Subsequently, the student accessed a health service.

RPH is training the newThe sexual health advisor (0.75 FTE) based at Kokiri Health and Social Services, Seaview.

Issues/challenges/risks and actions Heterosexual males are a main cause of the spread of sexually transmitted infections as they take a long time to seek medical taken assistance, as outlined in the statistics presented at the 2017 Sexual Health Conference, Christchurch. One potential strategy is to increase the small number of heterosexualOfficial males providing sexual health education to youth. RPH has suggested HVDHB consider an additional male sexual health advisor.

ACTION PLAN 5.6: DELIVER NEONATAL BCG VACCINATION (NOT MOH CONTRACT) Information

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ACTION PLAN 6.1 MINIMISE ENVIRONMENTAL HAZARDS PROMOTE SAFE DRINKING WATER SUSTAINABLE RESOURCE MANAGEMENT

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITYUnder FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.1 Health Physical Encourage and assist territorial 13 applications/plans/ 100% submissions completed Narrative reporting: Protection environments authorities to develop and statements/standards that include a public health Submissions and presentation implement policies through assessed for public health risk assessment to ensure at oral hearing for Long Terms processes, such as the review issues. submission is (expected Plans have been successful in of district plans, includingThe 100%): achieving post hearing variations or plan changes or 13 submissions made. - evidence based discussions with some territorial authorities' Long - proportionate to the public councils. The main foci of Term Plans that address the 14 hearings where evidence health risk submissions were food wider determinants of health. Officialpresented. - peer reviewed. environments and drinking water. Make timely and professional Narrative reporting: submissions on national Hearings for the Greater (including national policy Wellington Regional Council statements, national Natural Resources Plan have environmental standards and come to an end. Submitting or guidelines) and regional on this plan has beenInformation a major plans and policy statements, piece of work over the last 2 district long term and annual years. plans and, where appropriate, resource consent applications to ensure that the public health effects are considered and managed of: - adverse air quality - the disposal of the dead - environmental noise - ionising radiation (in Act consultation with the Office of Radiation Safety) 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 39 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% - non-ionising fields - recreational waters - gaseous, liquid and solid wasteUnder - urban design/form - sewage collection, treatment and disposal - drinking water (cross reference with the separate drinking water sectionThe) - other environmental health issues. 6.1.2 Health Physical Monitor decisions made under Official15 submissions made. 100% submissions completed Narrative reporting: Protection environments the Resource Management Act that include a public health Where consents are granted 1991 to ensure that the health 0 hearings where evidence risk assessment to ensure there are to be adequate impacts of environmental presented. submission is (expected conditions to protect the hazards have been considered. 100%): health of people and Follow up with regional Narrative reporting: RPH has - evidence based communities. All consents councils and territorial been working closely with the - proportionate to the public issued have included authorities where this has not South Wairarapa DistrictInformation health risk conditions as requested by occurred. Council on their proposal for - peer reviewed. RPH. discharge of treated waste Make timely and professional water to land. submissions on local government assessments of sanitary works to ensure that the public health aspects are considered.

Comment, as appropriate, on territorial authority plans for Act sanitary works infrastructure planning. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 40 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/%

Liaise and, where appropriate, undertake joint projects with consentUnder authorities and affected communities to ensure that public health aspects of planning and resource management are considered. The Provide technical advice and information to regional councils and territorial authorities. Official

Inform other agencies and the public on the public health aspects of matters relating to sustainable resource management. Information 6.1.3 Health Physical Maintain accreditation of 1.0 Drinking Water Assessor 100% Drinking-Water Narrative reporting: Protection environments Drinking-Water Assessors and FTEs. Assessors that maintain RPH has had limited staff Drinking Water Assessment accreditation. capacity for drinking water Unit. work. The cycle of drinking water work has meant that the 2017/18 year has had less scope item work than previous years. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 41 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.4 Health Physical Identify and investigate 20 investigations related to 100% networked water Complimentary narrative Protection environments incidents, complaints and incidents, complaints and supplies (by class of water reporting. notifications of adverse notifications. supply) where timely response drinkingUnder water quality (or was provided by PHU to 3 of the 20 investigations were adequacy) of networked, 3 ecoli transgressions, contamination ecoli transgressions tankered and temporary 17 complaints or interruption in accordance (Paraparaumu, Lower Hutt and drinking water supplies. with drinking water legislation Wainuioru). and standards. Report serious drinking water incidents to the MinistryThe of 100% large water supplies. Health within 24 hours. Report 100% minor water supplies. suspected or confirmed There were no incidents in waterborne disease outbreaks medium or small water to the Ministry of Health Official supplies. within 2 hours. 6.1.5 Health Physical Undertake all duties and 40 water supplies surveyed in 2.5% drinking water register #/% networked water supplies Protection environments functions required by the the annual review. entries (network supplies) (broken down by class ie. Health Act 1956, including: verified or updated. large, medium, minor, small - Register drinking-water 0 temporary drinking water and rural agricultural) suppliers and water carriers as supplies assessed andInformation % networked water supplies compliant with sections 69V required. approved. (by class of water supply) and 69Z of the Health Act 1956 - Routinely go through the receiving at least one (BC,O). drinking water register each Complimentary narrative compliance inspection per year and verify or update reporting: annum with findings 15/100% Large water supplies details of network supplies. confirmed in writing. 7/100% medium water - Promote compliance with the For the purposes of report we 100% large water supplies supplies drinking-water requirements have used appendix one of the 100% medium water supplies 13/100% minor water supplies of the Health Act 1956 to 2016/17 Annual Report on 92% minor water supplies 2/50% small water supplies drinking-water suppliers and Drinking Water Quality. 80% small water supplies 0 rural agricultural water carriers. 0% rural agricultural - Conduct the annual review of Act Complimentary narrative drinking-water supplies reporting. serving more than 100 people 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 42 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% and report to water suppliers This is the number of supplies as required by Scope 1. that do not comply and do not - Assess water supplies’ water have a WSP. safetyUnder plans as required and provide a report to the water supplier within 20 working days. - Assess and process applications as required for the use of temporaryThe drinking water supplies. - Ensure water-suppliers have plans and PHU responds in a timely manner to Official transgressions, water supply contamination or interruptions to the supply, including taking appropriate measures to protect and advise the community. Information Ensure activities are integrated with the drinking water technical advice services for networked supplies serving up to 5000 people.

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 43 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.6 Health Physical Certify the implementation of 2 water safety plans assessed. 100% water suppliers’ water Complimentary narrative Protection environments water safety plans. (SWDC and Carterton). safety plans reported on reporting. within 20 working days. AuthoriseUnder organisations for the 0 authorisations. While only two WSPs have purposes of ensuring 95% networked water been assessed with reports compliance with the Act, 3 assessments related to suppliers serving more than issued, several other WSP drinking water standards, and requirements of the Drinking- 100 people with approved have been assessed and water safety plans. Water Standards. water safety plans. subsequently withdrawn. Two other WSPs were received Implement the requirementsThe Complimentary narrative 26% of network drinking water prior to 30 June 2018 but not of the Drinking-Water reporting. supplies with an approved fully assessed within the Standards for New Zealand as RPH had limited staff capacity WSP that have had an report period. required (e.g. P2 assignments, for drinking water work. The implementation completed in catchment risk assessments, Officialcycle of drinking water work the last 3 years (expected secure ground water has meant that the 2017/18 100%). assessments). year has had less scope item work than previous years. Narrative report: Why it isn’t Carry out public health grading 100% (if it isn’t). of drinking-water supplies at RPH has been working with the request of drinking-water severely depleted drinking suppliers. Informationwater staff capacity. While building capacity and capability we have been undertaking only essential work. Unfortunately we do not have the capacity to keep up to date with scope two and four audits. A second person will be designated in December 2018. 6.1.7 Health Physical Undertake enforcement 0 investigations related to Act Protection environments activities in consultation with, enforcement (please specify in and at the direction of, the narrative). 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 44 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Ministry of Health. Complimentary narrative: Refer issues and concerns with RPH is now in a position to selfUnder-supplies to territorial undertake investigations after authorities as required. establishing our investigation procedure. One investigation Provide technical advice and started in July 2018. We are information on public health planning to escalate significant aspects of drinking water non-conformances during supplies, including theThe 2018/19. implications of the Health Act 1956 and the Drinking Water Standards for New Zealand, to water suppliers, councils, the Official public and organisations on issues of public health significance in respect to drinking water supplies.

Ensure that the public health effects of drinking water Information supplies are considered and managed by making timely submissions on: - regional and district plans and policies including giving effect to the National Environmental Standard for drinking water catchments - territorial authority assessments of drinking water supplies Act - resource consent applications. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 45 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.8 Health Physical Provide advice on the benefits 26/79% water supplies serving Protection environments of water fluoridation when the 1000 people that are issue becomes a significant fluoridated (CC,O). issueUnder in the community by: - supporting health Complimentary narrative professionals who are reporting. promoting the extension or The non-fluoridated water maintenance of fluoridated supplies are Otaki, Paekakariki, water supplies Greytown, Martinborough, - ensuring appropriateThe Featherston, Carterton and education material is available Opaki. to institutions, health professionals, territorial authorities, community groups Official and the public - ensuring that messages on fluoridation and oral health are consistent and current, and keep all health providers well informed - making timely submissions Information on water fluoridation when appropriate. 6.1.9 Health Physical Report all notifications of 4 public health HSNO 100% debriefs/audits that Narrative reporting: Protection environments hazardous substances injuries, enforcement officers. show responses have been Promotion of the HSDIRT including agrichemical spray- consistent with the Ministry’s reporting process to GPs, drift complaints, lead 95 cases of hazardous advice and guidelines, hospitals and others. poisoning and poisoning substances injuries that are including the National Hazmat Nil promotion of HSDIRT to arising from chemical notified by GPs, hospitals and Response Plan, Major GPs however RPH works contamination of the others. Response to Fires; guidelines closely with the hospitals’ environment, to the science for public health unitsAct (Revised Emergency Departments. provider in the format 2014), Investigation and required, including GP Surveillance of Agrichemical 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 46 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% notifications. Spraydrift Incidents: guidelines for public health units. Promote hazardous substancesUnder injury notifications by GPs.

Participate in the Hazardous Substances Injury Surveillance System and other notifiable condition surveillanceThe systems, including GP notifications via the HSDIRT system and according to Ministry of Health guidelines and direction. Official

Investigate notifications of lead poisoning, poisoning from chemical contamination of the environment, and hazardous substances injuries as required. Information 6.1.10 Health Physical Process applications for 23 applications for Vertebrate 100% routine applications for 4/22 = 18% audited VTA Protection environments Vertebrate Toxic Agent (VTA) Toxic Agent (VTA) permission VTA permissions processed operations compliant with operations that require public received. within 20 working days. permit approval conditions health permissions. Includes 13 applications, 7 re- (BC,O). issues and 3 amended permits. 100% 1080 operations with 2 VTA operations for 2016/17 Ensure that the conditions permissions (and completed) were added to the total imposed by the public health 20 applications for VTA audited, either by desktop or number of permits for audit HSNO enforcement officer permission issued. field audit, for compliance purposes. Not all 22 granting permits for the use of 3 permissions received have with permission conditions operations have been started controlled vertebrate toxic not been approved as at 20 (expected 100%). Act and/or completed. agents are complied with. June 2018. 2 operations from 2016/17 Field or desktop audits of all audited during 2017/18. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 47 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% permissions are required to 0 desk top audits of 1080 ensure compliance, as operations. appropriate. Under 2 field audits of 1080 operations.

2 desk top or field audits of non 1080 operations.

The 3 VTA complaint investigations received and investigated.

0 VTA complaints referred to Officialanother agency. 6.1.11 Health Physical Audit compliance with, Narrative report: Protection environments investigate breaches of, and During 2017 nails bars were where appropriate, enforce visited in the greater the relevant Acts and Wellington region to Regulations, including: determine if disinfection - attending hazardous practices were appropriate.Information substances incidents The draft report is being - monitoring storage and reviewed by the Clinical Head display of hazardous of Department. substances and products for retail sale - surveillance of hazardous substances injuries and reporting via the HSDIRT system. 6.1.12 Health Physical Work with other HSNO 8 hazmat incidents or Narrative reporting: Outcomes Protection environments enforcement agencies to emergencies attended. Act of hazmat meetings and support their regulatory roles exercises. and manage potential public 2 hazmat exercises attended. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 48 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% health risk, for example, Due to staff changes at Fire through assisting with recalls 1 response plans reviewed and and Emergency NZ there were and public warnings as revised, if necessary, following fewer meetings than the required.Under responses and exercises. previous year. There is now a new chairman and renewed Receive annual reports on 3 area hazmat coordination momentum. Members are methyl bromide fumigations. committee meetings attended. considering running small exercises during meetings. Maintain effective risk Complimentary narrative management strategiesThe and reporting. response plans for hazmat RPH is concerned that we do incidents and emergencies, not always get called to including deliberate chemical significant events, especially contamination and chemical Officialfires. This will be addressed at fires, and including at the next Hazmat meeting. designated points of entry. Responses are required to be consistent with the Ministry’s advice and guidelines including the National Hazmat Response Plan, Major Response to Fires; Information guidelines for public health units (Revised 2014), Investigation and Surveillance of Agrichemical Spraydrift Incidents: guidelines for public health units.

Represent public health interests at meetings of the Area Hazmat Coordination Committee. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 49 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.13 Health Physical Advise, encourage and/or Narrative reporting: Protection environments assist territorial authorities Greater Wellington Regional and regional councils to: Council are leading perimeter - identifyUnder potentially monitoring work at the old contaminated sites in the Miramar gasworks site that is region and identify now residential housing. RPH contaminants (including clan was an integral part of the labs) planning and community - implement health impact communication process. assessment systems toThe ensure Outcomes of the monitoring contaminated land is will not be known for some remedied, where appropriate, time. and to minimise adverse effects on human health Official - determine appropriate land use controls for contaminated sites to minimise the risk to the public - ensure appropriate advice is provided to manage any public health risk from sites and Information during any remediation processes. 6.1.14 Health Physical Promote public knowledge on 1 investigations/activities Protection environments the risks of environmental and undertaken, by type (e.g. non-occupational exposures to crayons, face paint, chemical hazardous substances and spills). products, including asbestos in the non-occupational Complimentary narrative environment by: reporting. - providing public health An investigation was Act advice and information on undertaken into a child’s ball hazardous substances and 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 50 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% products to the public, health being sold in a dollar type professionals and store. organisations - adUndervising on the safe management of hazardous substances and products, including their removal and disposal from contaminated areas - advising on the safeThe management of asbestos in the non-occupational environment according to the Ministry of Health’s guidelines Official and direction - advising on the safe management of products containing lead, including lead- based paint and mercury (including its removal and disposal). Information 6.1.15 Health Physical For the following public health 1 ionising radiation source 0% (no such advice given) Protection environments issues: transports overseen. activities and advice related to - air quality ionising radiation undertaken - the disposal of the dead 8 requests for advice or in consultation and with - environmental noise information responded to. approval of the Ministry’s - ionising radiation Office of Radiation Safety - non-ionising fields 1 complaints referred to the (expected 100%). - recreational waters appropriate agency for action - gaseous, liquid and solid (where it is outside PHU’s waste responsibility). Act - other environmental health issues 0 complaints investigated 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 51 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% (where it is within PHU’s Undertake the following: responsibility). - provide information and adviceUnder to other agencies, organisations and the public on their adverse effects - take appropriate action to minimise risks and to protect the public health from environmental exposuresThe to these issues - monitor territorial authorities’ actions on these issues to ensure health Official impacts are minimized - respond to public enquiries and investigate and/or redirect public complaints and queries on these issues - support local government implementation of national Information policy statements and national environmental standards. 6.1.16 Health Physical Ensure applications for Protection environments approvals are complete, and include the health protection officer’s covering report and recommendations before they are forwarded to the Ministry of Health for action, including: - disinterments Act - burials in special places - medical referee 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 52 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% appointments - other burial and cremation approvals. Under Supervise disinterments as required.

Advise and assist applicants to export cadavers, as required, to ensure public healthThe concerns are addressed. (Note that costs may be recovered for this activity.) Official 6.1.17 Health Physical Conduct six-monthly visits to 16 commercial solaria visited 94% visits to commercial 1/6% July-Dec 2017 and Protection environments commercial solaria to in each six-month period. solaria operators six monthly. 2/13% Jan-June 2018 known encourage compliance with (There are currently 17 solaria) Complimentary narrative commercial solaria operators best practice guidelines. reporting. who report they are aware of the under-18 age ban (SK,S). Conduct and report on pre- 13 pre-licensing inspections of 64 early childhood centres licensing inspections of early early childhood centres.Information were provided advice during Information on awareness of childhood centres, including outbreak investigations into age ban was not collected. compliance by the licensee of 1 early childhood centre hand - foot and mouth, giardia Reported is #/% of known the premises with the inspection undertaken as a and gastroenteritis. Early commercial solaria operators Education (Early Childhood result of complaints. childhood staff generally called where it is uncertain under 18s Centres) Regulations 2008. to ensure all required are excluded. measures were being taken Investigate/inspect and report and where to find written on early childhood centres in information for parents. response to complaints.

Provide advice to schools and Act early childhood centres during 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 53 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% an outbreak investigation and response.

6.1.18 Health Physical SurveyUnder the availability of high- Protection environments power laser pointers at retail outlets, provide advice on compliance and take compliance action as required by the Ministry of Health. 6.1.19 Health Physical Encourage local authoritiesThe to 0 sanitary surveys conducted Protection environments clearly identify, and publically by PHU (if it is within the notify, existing or potential PHU’s responsibility). recreational waters, which do not meet minimum Official microbiological water quality guidelines in the Ministry of Health/Ministry for the Environment Microbiological Water Quality Guidelines for Marine and Freshwater Recreational Areas. Information

Encourage the grading of bathing beaches, as outlined in the Microbiological Water Quality Guidelines for Marine and Fresh Water Recreational Areas.

Respond to recreational water incidents and inquiries as required. Investigate cases of Act suspected or confirmed toxic 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 54 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% shellfish poisoning.

Provide input into regional and localUnder activities associated with recreational water quality. Provide public and stakeholders with appropriate advice relating to recreational waters (e.g. public health fact sheets, media releases,The updated website information).

Encourage territorial authorities and pool managers Official (including school pools) to implement the requirements of NZS5826: 2010 Pool Water Quality to avoid or reduce public health risks. 6.1.20 Health Physical Conduct routine evaluation of 0 sanitary surveys conductedInformation Protection environments the performance of controlling by PHU (if it is within the authority management of PHU’s responsibility). public health aspects of sewage collection and disposal with reference to statute, guidelines, standards, resource consent conditions and accepted public health practice.

Investigate and assess the Act public health need for sewerage systems in areas not 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 55 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% adequately serviced.

Undertake sanitary and waste surveysUnder as required. Provide a system for monitoring of significant public health risks in waste management.

Undertake surveys of representative wasteThe management facilities in the region as resources allow.

Liaise with councils to verify Official that sewage overflows that pose a significant public health risk are adequately responded to, engage with sewage collection and disposal providers to ensure overflows are appropriately managed Information and reduce overflows to high risk areas.

Promote improvements in public sewage collection and disposal systems where this is considered necessary.

Investigate clusters and cases of illnesses associated with non-occupational exposure to Act sewage or other waste. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 56 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.1.21 Health Physical Maintain a 24/7 on-call 15 health protection officers 100% HPOs and MOoHs that Protection environments response. (HPOs) and medical officers of have maintained the required health (MOoHs) that carry out competency. Under on-call duties. Highlights After three years of completing the National Drinking Water Assessors Diploma, Barbara Stevenson was assessed by IANZ and subsequently designated as a Drinking Water Assessor (DWA). Prior from 0.4 FTE, Barbara’s designation significantly increased our capability and capacity. Issues/challenges/risks and actions Building capacity for drinkingThe water work takes 2-3 years. This length of time is a major barrier for HPOs to consider becoming a taken DWA. Without experienced DWAs in our team, we rely on DWAs from other branches of the Central North Island Drinking Water Assessment Unit or contractors to mentor our trainees. Contractors are expensive and have to be used carefully. RPH is awaiting the MoH response to our applicationOfficial for 2018/19 volume pressure adjustment funding for contracting drinking water expertise. ACTION PLAN 6.2: PROMOTE SAFE AND HEALTHY URBAN ENVIRONMENTS

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.2.1 Health Physical Assess relevant planning or 8 evidenced based publicInformation 83% identified urban design or 6/66% territorial authorities Promotion environments community initiatives for likely health advice to urban design transport planning processes that report that they have public health impact and or transport planning and/or policy making utilised public health advice influence planners and processes and/or policy processes responded to. (BC,S). developers to improve health making processes (minimum outcomes through sustainable 3). (these measures exclude and community centred consultation and submissions design. on TAs’ Long Term Plans - refer 6.1.1 Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 57 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.2.2 Health Physical From a Health in all Policies 8 public health intelligence 6/66% territorial authorities, Promotion environments approach, develop and initiatives completed. private planners and/or promote public health community groups that RPH intelligenceUnder that supports has engaged with, that have healthy urban environments in obviously used public health areas of high socioeconomic input (BC,S). deprivation through information papers, research and workshops. The 6.2.3 Health Not MoH core Promotion contract 6.2.4 Public Health Not MoH core Capacity contract Development Official 6.2.5 Health Not MoH core Promotion contract

Highlights Regional Healthy Housing Response Group: RPH has actively supported the reestablishment of a sub-regional, collective focus on housing issues. Since July 2017 a group has met quarterly with representation from RPH, Greater Wellington Region Council (the chair of this regional council also chairs this group), fiveInformation local councils, central government agencies (e.g. MBIE), housing specific agencies (EECA, BRANZ), HVDHB CCDHB, the University of Otago and community organisations (Asthma Foundation, Well Homes partner providers) In addition to information sharing, the group has developed a shared vision and scope: vision – ‘Everyone in the Wellington region lives in warm, dry and safe housing by 2025’; and scope – housing quality, energy hardship, healthy housing literacy. Next steps include engagement with more key players (such as MSD, HNZ and ACC), and developing a stocktake of housing related data/research for the sub-region. An example of RPH action: RPH raised awareness of homelessness and housing issues. Hutt City Council (HCC) is developing a homelessness strategy. RPH’s contribution to the homelessness strategy, as well as other communication, add influence in the collective approach of the Regional Healthy Housing Response Group of which HCC is also a participant. Trusting relationships have resulted. HCC have also indicated their intent to develop a housing strategy. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 58 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% Contributing to the development of a PHU healthy public policy network: This is a network comprising public health advisors across 5 PHUs. This will expand to all PHU’s later in 2018. The aim is to share information (position statements, submissions etc.), avoid duplicationUnder, and ensure national consistency thereby enabling more time to concentrate on local issues. Issues/challenges/risks and actions Capacity for urban design, transport and housing matters has been lower than expected. Recruitment took longer than expected in taken 2017. Additionally, early in 2018, we needed to recruit again for parental leave cover.

The ACTION PLAN 6.4: HEALTH PROMOTING SCHOOLS (NON-CORE MOH CONTRACT)

ACTION PLAN 6.6: BORDER HEALTH AND RESPOOfficialNSE TO EMERGENCY EVENTS

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.6.1 Health Physical Undertake surveillance of 7 interceptions. 100% responses initiated 0 exotic mosquitoes that have Protection environments mosquitoes at appropriate within 30 minutes of crossed the border and frequency (weekly over 0 incursions. Informationnotification. established in the Wellington summer and fortnightly over sub-region (CC,O). winter) at international sea 0 responses to other organisms. Surveillance is undertaken and airports or monthly weekly during summer months audits of surveillance and fortnightly during winter. undertaken by the air or sea port.

Provide mosquito interception response situation reports to the Environmental and Border Act Health team using the template in the biosecurity 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 59 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% section of the Environmental Health Protection Manual.

RespondUnder promptly to interceptions of pests with a human health significance e.g. rats, ticks, poisonous spiders and cases of imported disease. The

6.6.2 Health Physical Ensure designated points of 6/11 HPOs are authorised or Narrative report on 2/100% international points of Protection environments entry achieve and maintain accredited persons under the requirements of a competent entry that meet requirements core capacities as required BiosecurityOfficial Act 1993. authority met by PHU. of annual verification by the International Health assessment under Regulations 2005; audit core 2 intersectoral meetings at WIAL. 100% current staff members International Health capacities annually as involved in ship sanitation Regulations 2005 (BC,O). required by the Ministry of 3 intersectoral meetings at inspections have completed Health. CentrePort, including one the WHO on-line ship 2/100% international points of exercise. sanitation course. entry that have contingency Identify and monitor border Information plans to deal with ill travellers health protection risks from 10 responses to border public and other border health biological (including pests health incidents. responses that are inter- and diseases), chemical and (ill travellers on aircraft (8) and operable with public health physical (including ionising cruise ship outbreaks (2)) response plans (CC,O). radiation) hazards. 70 maritime pratiques issued. Develop/maintain contingency plans to deal 0 maritime pratiques issued on with border health risks arrival. including surveillance, ill traveller protocols, and 0 aircraft met on arrival. Act border emergency response plans; work with border 15 ships sanitation exemption 0 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 60 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% stakeholders to support the extension or 0 control certificates inclusion of public health issued. response plans within sea andUnder airport emergency 2 public health training (advice, response plans. update, training) to air and sea port staff. Respond promptly to requests for pratique, inspections and certification (e.g. ship sanitation).The

Attend border and other intersectoral meetings with relevant agencies and Official organisations on matters relating to border health protection.

Provide sound technical and professional advice on public health issues that are Information related to border health protection objectives in relation to imported risk goods, disease vector surveillance and control, preparation of contingency plans for emergency response, preparation of submissions as appropriate on proposed pest management strategies. Act

Provide public health 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 61 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% training to air and sea port staff, as required, on border health protection risks and theirUnder management.

Contribute to or lead (when required) the preparation of health impact assessments in relation to border health protection threats andThe eradication and control activities.

Maintain on-call roster to Official ensure appropriately trained staff are available at all times for any border responses. 6.6.3 Health Physical Maintain, exercise and 8 exercises. Narrative reporting: Outcomes Protection environments regularly review plans for Information of exercises. responding effectively to a RPH participated in 8 multi- range of public health agency exercises. RPH was the Large multi-agency maritime emergencies, including lead in 2 exercises. pandemic exercise identified national, regional and local lead role training and meetings, exercise and communication resources training opportunities. required. Development of these is in progress.

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 62 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 6.6.4 Health Physical Maintain civil defence and 5 staff completed CIMS 4 25/19% RPH staff trained in 15/100% health protection Protection environments public health emergency training. CIMS 2 and 4. officers and medical officers of planning and response health graduated from CIMS 4 capacity,Under and ensure there or CIMS (Health) training are appropriate numbers of (SK,O). staff trained in emergency management/CIMS. 6.6.5 Health Physical Carry out all emergency 15 responses. 50% PHU plans include 10/100% PHU Emergency Protection environments management planning,The Reduction, Readiness, Planning and Response Plan preparedness and responses Response, Recovery and interoperable with stakeholder in collaboration with other Resilience, and identify plans (i.e. TAs, DHBs, airport, relevant agencies and resources needed to support seaport (CC,O). according to Ministry of Official and carry out public health Health guidelines, plans and action (expected 100%). The Emergency response plan advice. is under development 100% plans and standard following review/testing of Maintain and review the operating procedures (SOPs) plans and gaps identified. The RPH Major Emergency updated each year (required update includes Response Plan. There must 100%). interoperability with be volumes covering the Information stakeholder plans. The revised following minimum areas: 100% plans tested, including plan involves 12 volumes * Border Health Response emergency communications (including the minimum areas * Communicable Disease – (required 100%). listed). Outbreak/Pandemic * Hazardous Substances 100% exercises and responses Monthly participation in (including radiation, and that are followed by a debrief satellite phone and VHF radio Chemical and Biological (required 100%). checks. Counter Terrorism Response) 100% debrief Following Maritime Pandemic * Civil Defence/National recommendations that are exercise, the response Disaster. incorporated into plansAct and plan/SOP was updated to SOPs. include lessons learnt and gaps Take appropriate emergency identified. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 63 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% actions as the need arises. This includes: * Liaison with and taking directionsUnder from other agencies involved in the emergency * Providing services for and/or be directed by * Report to Civil Defence authorities. The

Ensure key health messages are available in educational and promotional materials Official through collaboration with other agencies/organisations involved in emergency planning and response.

(Also links to activity 5.1.5) Information Highlights RPH, in collaboration with Wellington Region Emergency Management Office and Wellington Water, have developed consistent messages and resources in relation to making drinking water safe during emergencies.

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 64 Released

ACTION PLAN 7.1: BUSINESS SUPPORT

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.1.1 Public Health Internal MaintainUnder and develop the 5989 entries into HealthScape 94% locations geo-coded in Capacity allocation for all information systems that for this period. Healthscape. Development contracts underpin good public health service delivery. 7.1.2 Public Health Internal Coordinate and facilitate the 73 reports submitted to Capacity allocation for all RPH annual planning and funders. Development contracts reporting processes (linksThe to 7.4.1). 7.1.3 Public Health Internal Provide administrative 6 significant design projects 100% client satisfaction with Capacity allocation for all support, desktop publishing carried out. work done. Development contracts Official and maintenance of the office work environments for the four bases. 7.1.4 Public Health Internal Influence and support DHB 4 DHB/PHO/Service Level 90% DHB/PHO/Service Level Capacity allocation for all and primary care to take Alliances meetings attended. Alliances meetings attended. Development contracts public health approaches. Information

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 65 Released

ACTION PLAN 7.2: MAORI ACTION PLAN

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.2.1 Public Health Internal TeUnder Ara Tuatahi: Relationships - % staff satisfied with work 16 engagements are available Capacity allocation for all Maintaining and developing being undertaken with Māori through HealthScape reporting Development contracts our operational relationships workplaces, communities, (BC,O). with Māori stakeholders is whānau and individuals (Likert critical to improving Māori Scale 1-5). Results are limited by data health outcomes as is the issues e.g. information not sharing of those experienceThe This information was not entered. with RPH colleagues. collected. 7.2.2 Public Health Internal Te Ara Tuarua: Workforce # employment opportunities 100% recruitment 1/7% increase in the number Capacity allocation for all development - In selecting promoted directly to iwi and advertisements actively used of Māori staff recruited to RPH Development contracts new staff, we will place a high OfficialMāori health service provider to recruit Māori. (BC,O). value on their ‘fit’ with our networks and partnerships. organisational aspirations. Our All advertisements are placed 1 new Māori staff was workforce reflects the sub- This information was not on two websites that target recruited. regional demographic for collected. Māori jobseekers. Māori. 51/37% RPH staff enroll in # internal training training opportunities (SK,S). Equipping staff with the opportunities offeredInformation to RPH information, guidance and staff. training they need to improve their work with Māori. This information was not collated due to current database limitations. 7.2.3 Public Health Internal Te Ara Tuatoru: Accountability 1 RPH consultation hui held in % feedback from RPH #/% RPH workforce recognise Capacity allocation for all - RPH is accountable for June 2017. management and staff their contribution to improving Development contracts improving Māori health. The demonstrates engagement Māori health outcomes (BC,S). opportunity to critically reflect with the Māori community on and improve our (Likert Scale 1-5). Act This information was not performance regarding Māori collected. health is required. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 66 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% This information was not collected. 7.2.4 Public Health Internal TeUnder Ara Tuawha: 47 dedicated communications 100% increase of sharing and #/% increase in the number of Capacity allocation for all Communication - RPH wants sent to RPH staff showcasing Māori specific RPH staff exposed to Māori Development contracts well informed staff that has (weekly/quarterly). stories, research and specific stories, research and access to Māori-related information from Māori information on a weekly or stories, research and stakeholders and nation-wide quarterly basis (SK,S). information (national, sources. regional, local). To supportThe This information was not this, strong and pro-active collected. internal communication and feedback mechanisms are essential. Official 7.2.5 Public Health Internal Māori Strategic Plan 2017-20 - 0 RPH consultation hui are % feedback from RPH #/% RPH Māori Strategic Plan Capacity allocation for all The intention of this activity is held. management and staff tasks operationalised in Development contracts to revise the current Māori demonstrates consultation practice. Strategic Plan (2014-2017). engagement on the Māori Strategic Plan (Likert Scale 1- This information was not 5). collected. Information This information was not collected. Highlights As reported in the six month report, after internal and external consultation (notably with Iwi Te Ati Awa ki Waiwhetū) RPH has introduced a te reo Māori name for the service: Hauora ā Iwi o Te Ūpoko o te Ika a Maui. New logo/branding has been completed.

Issues/challenges/risks and actions The Māori Strategic Plan is currently being refreshed, led by a staff working group. This includes a draft evaluation report, from the taken RPH hui in June 2017. The evaluation was delayed and is less extensive than originally planned, due to public health analyst vacancies. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 67 Released

ACTION PLAN 7.4: PUBLIC HEALTH INFRASTRUCTURE

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.4.1 Public Health MoH core CoordinateUnder and facilitate the Capacity contract generic RPH annual planning and Development reporting systems and processes (links with 7.1.2).

7.4.2 Public Health MoH core RPH supports workforce 0 staff initiating study in public 10% staff working towards a 38/48% staff with a recognised Capacity contract generic development, includingThe health during the period. recognised public health public health qualification, Development working towards 75% of RPH qualification (those eligible as including breakdown of staff holding a public health 2 Māori and Pacific per RPH workforce survey) ethnicities (CC,O). qualification; and offering scholarships awarded to RPH scholarships to Māori and Officialstaff to undertake tertiary A survey was completed in Pacific staff. training. 2016. The report was provided along with the 2016/17 annual report. 7.4.3 Public Health MoH core Deliver Pacific cultural 0 Pacific cultural competencies % RPH staff who report #/% RPH staff who report Capacity contract generic competencies training for RPH workshops held by April 2018. positive feedback about increased awareness of Pacific Development staff. Informationdelivery and content of cultural values as a result of 2 staff attended Pacific Health workshops. the workshops (SK,S). Research, at the University of Otago Summer School. Refer to issues section. Refer to issues section. Refer to issues section. 7.4.4 Public Health MoH core Implement a public health 24 new quality improvement 0% reports completed for Capacity contract generic governance/quality projects identified. HVDHB Clinical Governance Development improvement programme Board quarterly meetings. including a three year cycle of quality assurance using public Refer to issues section. health standards adapted from the National Public Health Act Performance Standards of 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 68 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% America; implementing quality improvement initiatives and projects; and aligning to DHB qualityUnder and risk systems. Issues/challenges/risks and actions 7.4.3 The Pacific cultural competencies training was deferred until quarter four but has not achieved due to limited Pacific staff taken capacity. 7.4.4 The HVDHB Clinical Governance Board stopped meeting in August 2017. The 3DHB Community and Public Health Advisory Committee was also reconfigured in November 2017. RPH now reports to each DHB separately i.e. HVDHB to the Board; CCDHB to the Heath Systems CommitteeThe (formerly CPHAC and HAC); and via the WDHB CEO.

How might services be improved in 7.4.3 RPH will complete the next workforce survey in 2018/19. This will provide a progress update for the MoH goal of increasing the coming year the number of staff with relevant Officialpublic health qualifications. ACTION PLAN 7.6: PUBLIC HEALTH ANALYTICAL SERVICES

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.6.1 Public Health MoH core Research and evaluate public 22 projects that analyticalInformation 14/64% projects where 22/100% projects where Capacity contract generic health programmes and support was provided for. analytical support was results have been useful for Development interventions with a focus on provided that focus on Māori future planning or delivery improving Māori health and and/or vulnerable populations. (AO,S). achieving health equity. Support service delivery Some projects had a service Some of these projects are still through data extraction, improvement focus e.g. in progress. integration and analytics, logic Evaluation of the RPH Health modelling, GIS services and Act Training and development public health medicine of the RPH Survey Tool for specialist expertise. staff. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 69 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.6.2 Public Health MoH core Provide training to RPH staff, # skills development activities #/% attending training who Capacity contract generic peer review analytical work provided. report they have increased Development and mentor staff that are confidence/skills (SK,S). applyingUnder analytical techniques This information was not to their work. Strengthen collected. Refer to issues This information was not capacity in using interactive section. collected. Refer to issues analytic tools including R and R section. Shiny. Highlights RPH worked with theThe Porirua Whānau Centre (a community provider) to evaluate their ‘Ko wai au Programme’, which is delivered in primary and intermediate schools in the Porirua area, and aims to increase resilience of tāmariki in Years 4 to 8. The evaluation showed that tāmariki are engaged and learning new ways to manage conflict situations and there are signs this is resulting in positive changes in behaviour. Recommendations were that a stronger connection with the school as a whole and more resources to support teachers to reinforce theOfficial learning from ‘Ko wai au’ are key areas to develop which would increase the likelihood of ‘Ko wai au’ having a bigger impact on the overall school environment.

Issues/challenges/risks and actions RPH had insufficient capacity to undertake training for RPH staff due to recruitment constraints. Whilst vacancies have taken taken considerable time to fill, a senior public health analyst started in January and a public health analyst (quantitative) started in May 2018. Skills training is currently being developed and will be implemented in July 2018. Information ACTION PLAN 7.8: COMMUNICATIONS SUPPORT AND HEALTH INFORMATION DISSEMINATION

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.8.1 Public Health MoH core Provide media management RPH featured 24 times in print 2/100% proactive media Capacity contract generic for RPH staff and medical media proactively and pitches captured in printed Development officers of health. reactively. media. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 70 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.8.2 Public Health MoH core Continue to provide support to 21,656 new users All pages were reviewed in The top 5 pages: Capacity contract generic maintain and update the RPH 85,383 page views November – December 2017. Development 1. Home page websiteUnder and RPH's social 2. Fruit & Vege Co-ops media platforms. 3. Notifiable diseases 4. Housing | Well Homes 5. Ear Van 7.8.3 Public Health MoH core Distribute health information 1752 requests received for 100% requests for health Capacity contract generic resources and update health information resources. information resources are Development stakeholders on revised,The responded to within five deleted and new resources. working days.

Issues/challenges/risks and actions The communications position has been vacant for part of the reporting period, with recruitment expected in July 2018. taken Official

ACTION PLAN 7.9: CENTRAL REGION PUBLIC HEALTH ADVICE (SCHEDULE D)

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # InformationHOW WELL = % IS ANYONE BETTER OFF = #/% 7.9.1 Public Health MoH core Provide specialist, technical # instances where specialist, % public health units that #/% public health units who Capacity contract and analytical public health technical and analytical public receive specialist, technical received specialist and Development schedule D advice for regional public health advice provided to and analytical public health technical analytical advice who health units and central other public health units and advice within agreed report that their public health government agencies. Government agencies. timeframes. practice was strengthened Refer highlights section. Refer highlights section. through the advice (SK,S). Refer highlights section. Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 71 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% 7.9.2 Public Health MoH core Lead and participate in the 3 central region public health 100% central region public Central Region Surge Capacity Capacity contract Central Region and National clinical networks actively health clinical network Agreement agreed and signed Development schedule D Public Health Clinical Networks contributing to. attended. by the three PHU Managers. includingUnder active participation in the health protection, RPH Service Manager is the health promotion and public Central Region, and national, health nurses managers Public Health Clinical Network networks. Chair.

The Central Region Health Promotion Managers meeting adds value when sharing DHB priorities and programmes, Official discussing national trends and movements, and providing collegial support and guidance. 7.9.3 Public Health MoH core Participate in central region This project was terminated in Capacity contract panel on health protection 2017. Development schedule D officer competency assessments. Information 7.9.4 Public Health MoH core Support Central North Island 150 hours of staff time 100% Central North Island 9/100% offices that hold IANZ Capacity contract Drinking Water Assessment provided to support Drinking Water Assessment accreditation for drinking Development schedule D Unit administration centre. administrative functions of the Unit branches have a positive water work (CC,O). Central North Island Drinking working relationship with Water Assessment Unit. administration centre, as shown in correspondence on SIPHAN and the Annual Management Meeting. 7.9.5 Health MoH core Development and implement a 3 PHUs who have signed the 100% of PHUs have signed the The reviewed document Protection contract surge capacity agreement agreement. agreement. includes a framework for schedule D Act across central region public remote working on behalf of health units. another PHU, default roles and 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 72 Released

CORE PERFORMANCE MEASURES # MOH ISSUE ACTIVITY FUNCTION HOW MANY = # HOW WELL = % IS ANYONE BETTER OFF = #/% responsibilities and checklists for the deployment of staff. This should make it easier for Under the PHUs to support each other. Highlights 7.9.1 Some examples of national groups to which RPH public health physicians provide public health advice include: Immunisation subcommittee of Pharmac PTAC; National Microbiology Laboratory Schedule Review Subgroup; MOH group overseeing Direct Laboratory Notifications algorithms; NZ Microbiology Network MINISTRY Representative; MPI Technical Advisory Group; TB Technical Advisory Group;The National Regulatory (Sale and Supply of Alcohol Act 2012) Agencies Steering Group; Central Region representative for PHCN Working Group Alcohol Regulatory Advisory Group; Central Region representative PHCN Working Group on NCD Prevention; National Regulatory Agencies Steering Group; the Recreational Water ‘Freshwater Microbial Science Review’ Stakeholder Reference Panel; the Officialnational workshop to review the New Zealand Guidelines for Cyanobacteria in Recreational Fresh Waters; Cover provided for Napier Medical Officer of Health as required.

The Biowastes Programme (CBIR) Advisory Board have not meet in the last 12 month period, however RPH provided input into the draft Good Practice Guide for Beneficial Use of Organic Waste Products on Land with the Advisory Board supporting CBIR as one of the organisations involved in updating the existing NZ Biosolids Guidelines 2003. Information 7.9.3 Central North Island Drinking Water Assessment Unit Members of CNIDWAU continue to proactively support the inspection body to ensure continued quality improvement of administrative and quality systems. The 2018 CNIDWAU IANZ Surveillance Audit demonstrated that the CNIDWAU was able to meet the requirements of ISO/IEC 17020:2012 and the conditions of accreditation.

Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 73 Released

FINANCIAL SUMMARY - 1 JULY 2017 - 30 JUNE 2018

FUNDING LINES FTE FINANCE MOH ISSUE Under ACTUAL FTE BUDGET ACTUAL VARIANCE Alcohol and Other Drugs 6.83 $633,730 $931,242 -$297,512 Communicable Disease 13.79 $1,785,754 $2,038,470 -$252,716 Mental Health Promotion 0.77 $79,851 $96,960 -$17,109 Nutrition and Physical Activity The 5.94 $706,528 $766,236 -$59,708 Physical Environment 11.41 $1,576,486 $1,578,916 -$2,430 Public Health Capacity Development 6.06 $746,860 $744,182 $2,678 Sexual Health Official 1.11 $134,083 $132,546 $1,537 Social Environment 5.74 $874,895 $845,698 $29,197 Tobacco Control 1.67 $483,237 $215,862 $267,375 Volumes Pressures (Psychoactive Drugs Enforcement Act) 0.42 $60,000 $52,879 $7,121 SUB TOTAL - MOH CORE CONTRACT SCHEDULE A 53.74 $7,081,424 $7,402,991 -$321,567 Schedules B & C Refugee and Asylum Seeker Health & INH - Wellington Region - Refugee HealthInformation 1.99 $245,344 $276,448 -$31,104 Schedule D Central Region Public Health Advice 0.94 $114,470 $113,339 $1,131 SUB TOTAL - MOH CORE CONTRACT SCHEDULE B, C AND D 2.93 $359,814 $389,787 -$29,973 Volumes Pressures (Obesity Strategy) .54 $99,467 $93,903 $5,564 TOTAL - MOH CORE CONTRACT 57.2 $7,540,705 $7,886,681 -$345,976

Regional Public Health (RPH) completed the 2017-2018 financial year with an overall negative variance (overspend) of 4.6% against Ministry of Health core contract funding. The variance equates to $345,976 against the core contract (includes schedules B, C & D). Act This variance has arisen, primarily due to a significant unexpected increase in DHB overhead allocations signalled in June 2017, exit costs from our Thorndon base and staff costs associated with the RPH organisational change process. 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 74 Released

While there are limitations to the degree of precision achievable in allocating FTEs and staff costs against individual funding lines, we continue to ensure accurate financial reports across the range of funding lines RPH receives. We remain confident that the report demonstrates responsible and appropriate use of public funds. This is consistent with our goal of developing and delivering a wide range of public health programmes for the populations in the greater Wellington region. Under

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Act 1982 Contract: 353575 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2017 – 30 June 2018 Page 75