Provider: 102501 Released Core Contract: 353575/00 including financial summary

Under

RegionalThe Public Health

annualOfficial report for the Ministry of Health

1 July 2015 – 30 June 2016 Information

Act 1982

Contents

Introduction ...... 4 ReleasedHow the report is structured ...... 4 Mapping of action plans to service specifications/contract ...... 5

Action Plan reports Action Plan 1.3 Building healthy social environments ...... 7 Action Plan 1.4 Community liaison: Porirua and Hutt Valley ...... 9 Action Plan Under1.5 Promote the health of refugees (includes Schedule B & C) ...... 12 Action Plan 1.6 Work with schools to identify and address student health needs (non MoH contract) ...... 16 Action Plan 1.7 Improving vision and hearing (non MoH contract) ...... 16 Action Plan 1.8 Support for children,The youth and Work & Income clients (non MoH contract) ...... 16 Action Plan 2.1 Smokefree Nation 2025 ...... 16 Action Plan 3.1 Nutrition and physical activityOfficial ...... 20 Action Plan 4.1 Alcohol and other drugs ...... 23 Action Plan 4.2 CAYAD (Hutt Valley) (non-core MoH contract) ...... 27 Action Plan 5.1 Communicable diseases...... 27 Action Plan 5.2 Promote and facilitate immunisation (non-MoHInformation contract) ...... 34 Action Plan 5.3 Deliver Year 7 & Year 8 Boostrix and Gardasil vaccination programmes (non- MoH contract) ...... 34 Action Plan 5.5 Sexual health promotion ...... 34 Action Plan 5.6 Deliver neonatal BCG vaccination (non-MoH contract) ...... 37 Action Plan 6.1 Minimise environmental hazards, promote safe drinking water, sustainable resource management ...... 37 Action Plan 6.2 Promote safe and healthy urban environments ...... Act 42 Action Plan 6.3 Early childhood ...... 43 Action Plan 6.4 Health Promoting Schools (HPS) (non-core MoH contract) ...... 461982 Action Plan 6.6 Border health and response to emergency events ...... 47 Action Plan 7.1 Business support ...... 50 Action Plan 7.2 Māori action plan ...... 53 Action Plan 7.3 Pacific Peoples action plan ...... 57 Action Plan 7.4 Strengthen public health governance...... 59

Contract: 353575/00 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2015 – 30 June 2016 Page 2 Action Plan 7.6 Public health analytical services ...... 60 Action Plan 7.8 Communications support and health information dissemination ...... 62 Action Plan 7.9 Central region public health advice (Schedule D) ...... 64 ReleasedSchedule B – Promote the health of refugees ...... 67 Schedule C – INH services for refugees...... 67 Schedule D – Central region public health advice and support ...... 67

Financial reporting Financial summary ...... 68 Financial breakdownUnder for schedules B, C and D ...... 70

Appendix School Health and Immunisation Group Action Plan Report...... 71 The

Official

Information

Act 1982

Contract: 353575/00 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2015 – 30 June 2016 Page 3 Introduction On behalf of Regional Public Health (RPH) I am pleased to present this report on our activities for the past year. It documents RPH’s progress using the measures agreed in our Annual Business Plan under our core contract with the Ministry of Health. Released This whole-of-year report informs the Ministry whether key performance measures have been achieved for each service grouping (action plan) that is funded by the core public health contract. If a performance measure has not been achieved, we have provided an explanation.

Highlights and achievements from January to June 2016 have been included, with reference to the full year, as well as comments on relevant issues, challenges and risks. Where relevant to future service delivery,Under summary findings of substantial service audits, reviews or evaluations completed during the year, have been included.

I believe that overall RPH has met the requirements of the contract and has performed commendably in the period 1 July 2015 to 30 June 2016. The Peter Gush Service Manager

How the report is structuredOfficial 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 MoH planning and reporting guidelines for 2015-2016, an action plan is a ‘service grouping/programme.’ NB: Some action plans that are not funded by the core MoH public health contract are included in the appendix. Information We are working towards understanding and following the MoH’s direction for planning and reporting of public health services using an approach based on Results Based Accountability. RBA focuses an annual report on measuring an organisation’s annual performance in providing the funded services.

Identifying and agreeing practicable and meaningful accountability measures is work in progress.

The ‘performance story’ for a service grouping is told through each action plan. For each Actactivity within an action plan, quantity performance measures indicate the quantity of our effort (‘how much service did we deliver?’). Quality performance measures indicate the quality of our effort for each activity within the action plan (‘how well did we perform the activity/service?’). One or more 1982 one-year-short- term outcome indicators measure the immediate effect of the activities, for our stakeholders (‘is anyone better off?’).

For a summary description of each action plan, refer to the RPH 2015-2016 Business Plan (www.rph.org.nz/what we do/business plan). To sort or filter our activities by criteria such as core public health function, core public health contract issues (e.g. nutrition, communicable disease), refer to the Activities E-tool on our website (www.rph.org/nz/what we do/activities e-tool ).

Contract: 353575/00 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2015 – 30 June 2016 Page 4

Mapping of action plans to service specifications/contract Ministry of Health Service Specification RPH Action Plans Central Region Public Health Advice 7.9 Central region public health advice Released(Schedule D) (Schedule D) Communicable Diseases Services T2 5.1 Communicable diseases Healthy Physical Activity And Nutrition Service T2 3.1 Nutrition and physical activity 6.3 Early childhood Infrastructure Services T2 7.4 Strengthen public health governance 7.6 Public health analytical services 7.8 Communications support and health information dissemination Injury PreventionUnder Service T2 - - Mental Health Promotion Service T2 1.3 Building healthy social environments Physical Environment Health Services T2 6.1 Minimise environmental hazards, promote safe drinking water, sustainable resource management 6.2 Promote safe and healthy urban environments The 6.3 Early childhood 6.6 Border health and response to emergency events Prevention of Alcohol And Other Drug RelatedOfficial 4.1 Alcohol and other drugs Harm T2 Refugees and Migrant Health Programme T3 1.5 Promote the health of refugees (Schedule C Comm Disease INH) (Schedule B Comm Disease Refugee) Sexual Health Promotion Services T2 5.5 Sexual health promotion Social Environments and Health Promoting 1.3 BuildingInformation healthy social environments Schools T2 1.4 Community liaison: Porirua and Hutt Valley 6.2 Promote safe and healthy urban environments Tobacco Control Services T2 2.1 Smokefree Nation 2025

All the above service specifications are available here: http://nsfl.health.govt.nz/service- specifications/current-service-specifications/public-health-service-specifications

Ministry of Health Non-Core Contracts RPH Action Plans Community Action on Youth and Drugs (CAYAD) 4.2 CAYAD Act Drinking-water Assistance Programme 6.1 Minimise environmental hazards, promote Facilitation safe drinking water, sustainable resource management Health Promoting Schools 6.4 Health Promoting Schools 1982 Health For Life 8.1 Standalone contract Public Health Clinical Network Secretariat 8.1 Standalone contract Rheumatic Fever Prevention: Healthy Homes 6.2 Promote safe and healthy urban environments System

Contract: 353575/00 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2015 – 30 June 2016 Page 5 Funding Service RPH Action Plans DHB CCDHB Porirua Mobile Ear Nursing Service 1.7 Improving vision and hearing CCDHB Primary Health Nursing Innovation – 1.8 Support for children youth and Work and WINZ, Porirua Income clients to improve their health Released outcomes CCDHB Rheumatic Fever Nursing (throat 1.6 Work with schools to identify and address swabbing & treatment) - Porirua health needs HVDHB DHB NIR Administration Services 5.2 Promote and facilitate immunisation HVDHB Outreach Immunisation Coordination 5.2 Promote and facilitate immunisation HVDHB Public Health Nurse - Healthy Housing 6.2 Promote safe and healthy urban environments HVDHB Smokefree DHBs 2.1 Smokefree Nation 2025 WaiDHB Wairarapa DHB Tobacco Control 2.1 Smokefree Nation 2025 HV & BCGUnder Nurse Services 5.6 Deliver neonatal BCG vaccination CCDHBs Wai, HV HPV and Boostrix Immunisation 5.3 Deliver year 7 & 8 Boostrix and Gardasil & Programme vaccination programmes CCDHBs Wai, HV Vision and Hearing Testers 1.7 Improving vision and hearing & The CCDHBs Wai, HV Public Health Nursing 1.6 Work with schools to identify and address & health needs CCDHBs Official

Other contracts RPH Action Plans Central Region Registrar Supervision 8.1 Standalone contract MidCentral Public Health Medicine 8.1 Standalone contract Specialist/Medical Officer of Health Services Information Across all contracts RPH Action Plans 7.1 Business support (including workforce development) 7.2 Māori action plan 7.3 Pacific Peoples action plan

Act 1982

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Action Plan 1.3 Building healthy social environments

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Increased community input into local The numberUnder of community - There were eight community-generated submissions of which three (40%) resulted in and national decision making. generated submissions as a result of recommendations being adopted. RPH engagement. The proportion (percentage) of community- generated submissions (resulting from RPH engagement) that have recommendation/s adopted by the recipient. The Increased number of effective, high Number and details of community The three community action activities initiated, as a result of RPH engagement, were the quality and sustainable community action activities initiated or action initiatives, particularly for supported as a result of RPH St Pius School Malaga Programme; The Wellington Fruit and Vegetable Co-operative Māori and communities that have engagement with identified collectiveOfficial co-ordinated by community groups; and the development of a community inequities in health outcomes. communities. garden at Titahi Bay Intermediate in partnership with the GROW Project.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.3.1 Promotion / Strengthen Number of key issues for Four key issues wereInformation documented in each of the two prioritised communities: food Social community action. Māori, Pacific peoples and environments child health identified for security, housing, use of tobacco in motor vehicles and family violence were identified for Arakura and Titahi Bay Arakura/Wainuiomata. Non-attendance of children at local schools, alcohol harm, food (prioritised communities). security and housing were identified in Titahi Bay.

Percentage of identified 100% of identified Māori, Pacific peoples and child health leaders for Arakura and Titahi Māori, Pacific peoples and child health leaders for Bay had working relationships with RPH. Arakura and Titahi Bay, who have working relationships with RPH (evidenced by Act documentation). 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.3.2 Capacity Support Healthy RPH is a member of the RPH attended regular meetings with Healthy Families NZ Lower Hutt and Te Awakairangi Development / Families NZ Lower Healthy Families NZ Lower PHO every six weeks. Social Hutt. Hutt Prevention environments UnderPartnership. Percentage of meetings of RPH attended four meetings (100%) with Healthy Families NZ Lower Hutt since July 2015. Healthy Families NZ Lower Hutt Prevention Partnership meetings attended (target 80%).The 1.3.3 Promotion / Lead co-ordinated Number of RPH responses RPH responded to 53 completed suicides in total across CCDHB and HVDHB (provisional). Mental health multidisciplinary to completed suicides in response to all the Wellington region. suicides in the sub- region to prevent All completed suicides are AllOfficial completed suicides were responded to by RPH as per protocol. further deaths by responded to by RPH as suicide. per protocol. 1.3.4 Promotion / Influence the policy The number of deaths RPH Over time the balance of child and youth cases has changed, requiring a focused single Mental health recommendations responds to that are also that the Child and reviewed by the Child and DHB approach. CCDHB are now moving towards establishing a stand-alone review group Youth Mortality Youth Mortality Review that will consider both the child (under 14yrs) and youth (14 – 24yrs) deaths together as Review Committee Group. will the HVDHB. CCDHBInformation have had one meeting this year reviewing three cases from 2013. provide for the Minister of Health. Cases cannot be reviewed until the case has been before the Coroner. Percentage of reports on There has been one meeting this financial year of the Child and Youth Mortality Review regional and national recommendations Group and no feedback reports have been received if any recommendations were accepted by clinical head accepted. of department.

Highlights RPH has adopted a Community Action and Neighbourhood (CAN) approach in its preventive health and health promotionAct work, as a result of a review of how services were delivered in 2014-2015. This was introduced into two communities (Wainuiomata/Akarua and Titahi Bay) in 2015-2016 and will continue to be developed. The work has a 10+ year timeline. 1982

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RPH is networking with Healthy Families NZ Lower Hutt to improve population health outcomes in Lower Hutt.

Issues, challenges, risks and actions taken The CAN approach work involves listeningUnder to communities, engaging with them and generating trust. This phase cannot be rushed and has positive outcomes in its own right for community empowerment.

For the suicide post-vention work, over time the balance of child and youth cases has changed, requiring a focused single DHB approach. CCDHB are now moving towards establishing a stand-alone review group that will consider both the child (under 14yrs) and youth (14 – 24yrs) deaths together as will the HVDHB. CCDHB have had one meeting this year reviewingThe three cases from 2013. (Cases cannot be reviewed until the case has been before the Coroner.)

How might services be improved in the coming year Continue with the CAN approach and integrating this with the communityOfficial liaison work (see Action Plan 1.4 report).

Action Plan 1.4 Community liaison: Porirua and Hutt Valley

Short term outcomes Short term outcome indicators Whole-of-year progress andInformation achievement against outcome indicators RPH is visible and our presence is RPH is involved in at least two RPH, across the region, is specifically involved with the Titahi Bay Community Group, the valued in each community. community initiatives in each Titahi Bay GROW Project and the Hutt Valley Fruit and Vegetable Co-operative. community.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.4.1 Capacity Establish, develop Number of RPH team The community liaisons have attended in excess of four meetings for RPH staff to Development and maintain meetings attended to / Social internal RPH engage teams in encourage engagement in community activities in the Porirua and the Hutt Valley areas. environments relationships that community activities These meetings have been held at not only team levels,Act but with management as well. will support external (estimated: 4). relationship building as a means to Percentage of teams who 80% of RPH teams are engaged in a community activity in Porirua1982 or the Hutt Valley.

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

improving the engage in a community delivery of service to activity in Porirua or Hutt Māori, Pacific and Valley, following low socioeconomic Undercommunity liaison staff families. attending a team meeting. 1.4.2 Surveillance / Scope and complete Project brief for focus A project brief for focus areas of interest was developed by December 2015. Priority has Social an environmental areas of interest by been given to developing strong relationships in Titahi Bay and Wainuiomata in line with environments scan of needs, issues December 2015. and opportunities for our new Community Action Neighbourhood Approach. RPH to working in The Porirua and the Hutt Project brief is signed off The project brief was signed off by the team leader Valley areas. by senior advisor and team leader. 1.4.3 Promotion / Connect RPH teams Number of RPH staff that StaffOfficial from five RPH groups/teams have been connected to community stakeholders. Social with stakeholders are connected to their environments that require RPH focus area of interest, in services. the project brief. Percentage of 100% - RPH responded to all community concerns/issues. stakeholders’ requests for RPH services, via the community liaison staff, Information that are responded to by RPH teams. 1.4.4 Capacity Develop and Number of initiatives with RPH was involved with 12 initiatives: Healthy Families NZ Lower Hutt, Safer Porirua, Safer Development maintain network groups that have / Social partnerships and public health components Hutt Valley, Porirua Social Sector Trial, Whānau Centre, Wesley Community Action, environments communication with from RPH involvement eg Wairarapa Social Sector Trial, Porirua Kids Project, Type 2 diabetes and obesity external Safer Porirua, Healthy prevention network, Wellington nutrition and physical activity network. stakeholders and Families NZ Lower Hutt, communities. Safer Hutt Valley (estimated: 2). Percentage of 100% of editorials/articles were reviewed by RPH communicationsAct advisor and approved editorials/articles that are reviewed by RPH by management. communications position 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

as well as approved by management. 1.4.5 Promotion / Coordinate and UnderNumber of community RPH was part of nine events including Creekfest, Te Rā o Te Raukura, Christmas in the Social support RPH events in Porirua Hood, Naenae Festival, Pasifika Choice Day, the Queen of the Pacific, Orongomai Marae environments involvement with (Creekfest) and the Hutt community Valley (Te Rā o Te Open Day, Tumeke Taita and Pink-a-licious Day. events/programmes Raukura) (target: 2). led by stakeholders. Percentage of community 100% of events where RPH are part of the organising committees have a strong health events that maintain a strong health componentThe focus. These are Te Rā o Te Raukura and Creekfest. (evidenced by health related policy/guidelines/survey data collection compared Official to previous year).

Highlights RPH is part of the organising committees for two community events: Te Rā o Te Raukura and Creekfest. RPH provides food and beverage guidelines including sugar free events. Both events have been well supported around these guidelines.Information The focus for our community liaison and community action staff is to listen to the community and work out how RPH can best support their needs. This focus has made RPH more visible and valued in the community, particularly in the two Community Action and Neighbourhood communities of Titahi Bay and Wainuiomata (see Action Plan 1.3 report).

Issues, challenges, risks and actions taken The community liaison role has been part of the RPH community approach for several years. In 2015-2016 an additional community action and neighbourhood approach has been developed. This has brought issues for staff to focus their attention on two communitiesAct while still servicing the rest of the region. Staff have responded well to this challenge. 1982

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How might services be improved in the coming year Maintaining the positive refocusing of efforts as started in 2015-2016.

Action Plan 1.5 Promote the healUnderth of refugees (includes Schedule B & C)

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Improved primary care access for Ensure all health concerns are The services that RPH delivers are influenced by the nature of the refugee population refugees resettling into the greater followed up appropriately withThe settling in the sub-region. We align our refugee programmes to national and regional Wellington region. primary care and other relevant resettlement strategies. These strategies aim for better resettlement outcomes for newly health services as required. resettled refugees through a proactive and coordinated approach. RefugeeOfficial health requires an experienced and committed multi-disciplinary model of health care. RPH works closely with Mangere Refugee Resettlement Centre, Red Cross Refugee Services, primary care and Refugee Trauma Recovery to ensure positive health outcomes for all refugees resettling in the region, as many come to New Zealand with a number of acute and chronic health problems that require on-going treatment. Initial engagement with refugee families requires considerable effort and clinical expertise to build a relationship ofInformation trust and integrity. In some instances more than one health transitional visit will be required for a refugee/family with complex health issues. The transition visit provides refugees with the opportunity to discuss their specific health needs in their own home where they are likely to feel most comfortable and without the typical time constraints and structure of an appointment in primary health care. All health concerns identified at Mangere Refugee Resettlement Centre are followed up with primary care and other relevant health services as required.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measuresAct MoH issue area 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.5.1 Promotion / Active involvement Number and nature of Two meetings were organised and facilitated by RPH to progress the Wellington Refugee Refugees and in the planning of meetings facilitated and Health and Wellbeing Action Plan (WRAP). Refer to the highlights section. other asylum regional and national attended. seekers health services for Under refugees, in collaboration with Develop an annual report A stakeholder annual/summary report for the Wellington Refugee Health and Wellbeing partner agencies. for the Wellington Refugee Health and Wellbeing Action Plan (WRAP/Health Strand) was completed for the working group. Action Plan (WRAP) Refer to the highlights section. working group regarding the health strand Theof the WRAP. 1.5.2 Capacity Build capacity across One primary care seminar One primary care refugee seminar was held in November 2015. Development health and social held in 2015. / Refugees services to respond Official and other to identified refugee Evaluation of the seminar The evaluation demonstrated the workshop participants had increased their knowledge demonstrates improved asylum health needs. of the refugee resettlement process/refugee health needs and would use this knowledge seekers health sector awareness of the needs of the refugee to implement changes that would improve the health care provided to refugee clients at communities resettled throughout the greater their practice. Wellington region. Information 1.5.3 Protection / Assess and plan Facilitate at least one RPH facilitated at least one home transition visit with identified agencies for each Refugees and health care services home transition visit with other asylum for refugee identified agencies for refugee/family group resettling in the region. Refugees with complex physical and seekers populations (quota, each refugee/family psychological health issues identified by Mangere Refugee Health Resettlement Centre asylum and family group. often require up to five home visits to ensure that RPH has identified and addressed their support category refugees). acute health needs. 100% of quota refugees 100% of quota refugees received at least one home transition visit from a RPH public have received at least one home transition visit from health nurse. RPH. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.5.4 Promotion / Promote the health Number and nature of 10 Refugee Orientation Programmes. Refugees and of refugee health promotion activities One Refugee Community Day. other asylum populations. undertaken with seekers Understakeholders and refugee Monthly primary care meetings in Porirua, Hutt and Wellington. communities. Continually improving the RPH webpage for refugee health.

Work plan developed to A work plan was developed to capture all scheduled health promotional activities capture all scheduled health promotional throughout the 2015-2016 period. All activities in the work plan were completed. activities throughout the 2015/2016 period.The All activities on the work plan completed. 1.5.5 Capacity Enhancing RPHs Annual training plan An annual training plan is developed for staff working with refugee clients (part of their Development capacity and developed for staff Official / Refugees capability to improve working with refugee appraisal process). and other and deliver refugee clients. asylum population health seekers services across the All identified training has Wellington culturally and linguistically diverse (CALD) training was cancelled, therefore been completed by staff. region (staff this training opportunity was not completed. All other training identified for the public professional development, quality health nurses in the InformationDisease Control team was complete d. initiatives and development of refugee resources).

Highlights Stakeholder engagement RPH has increased the level of clinical engagement on a national and regional level with refugee stakeholders. Examples include streamlining mental health referrals to ensure those refugees with acute mental health needs are promptly assessed, followed up and involved services are well informed at all stages. Primary health care is often unable to facilitate this immediate engagement due to time lapses with enrolment and electronicAct transfer of clinical notes. RPH has actively engaged with new practices enrolling refugees and we see our involvement as a vital link in the initial transition period between Red Cross, primary, secondary and tertiary health care. The health session of the Refugee Orientation Programme has been expanded to 1982include Bee Healthy Dental

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Service, Smoking Cessation, and Family Planning.

Wellington Refugee Health and Wellbeing Action Plan (WRAP) – Health Strand As of December 2015, RPH was appointed the lead agency for the WRAP Health Strand, which due to staff changes in a variety of organisations, had not been operational for approximately twoUnder years. At the end of 2015, RPH contacted providers that are actively involved in refugee health and invited them to attend a meeting in January 2016. These providers include Red Cross, Refugee Trauma Recovery, primary health care, mental health services, Changemakers, Service Integration Development Unit (SIDU) and Interpreting NZ. The first meeting was well attended and the action plan was reviewed and decisions made on what work activities needed updating. Other organisations were identified as important stakeholder to the strand, and we have since invited and engaged with Bee Healthy Dental Service, Plunket, and school public health nurses. The action plan identified several areas of work, some of which have been rolled over from the previous actionThe plan together with areas of new work. Current work streams include interpreting workshops, cultural training, sub regional meetings, primary care workshops, mental health training, and support with refugee orientation. The new work streams include improved dental referrals, vision and hearing referrals, and health promotion around nutrition, exercise and smoking cessation. The 2016-2017 action plan is now complete and has been forwarded to ChangemakersOfficial to collate with the other WRAP Strands. The health strand working group meets quarterly.

Issues, challenges, risks and actions taken Large Syrian quota refugee intake RPH receives six intakes, comprising 35-45 persons and/or family groups, of UNCR quotaInformation refugees from the Mangere Refugee Resettlement Centre per calendar year. In March 2016, 85 Syrian quota refugees were resettled in the greater Wellington region, a 50% increase in refugee resettlement workload in a six week period. To enable RPH to cope with this sizeable increase and also continue with the follow up of notifiable diseases, forward planning and identification of additional staffing resource and/or a different way of working was identified. Currently there are very limited support services established for this population group across the Wellington region. Medical centre availability (particularly low cost) was also limited. The Syrian ethnic refugees presented with new and complex health issues that required more than one transitional home visit and extensive public health nurse input. RPH developed a strong multi-agency focus to help this community resettle in the region and engage with primary care and other health services as required. RPH worked closely with selected primary care practices to increase their capacity to enrol and provide quality primary health care to these newly arrived Syrian refugees. Our linkages to, and attendance at regular refugee stakeholder liaison meetings, were vital to the successful integration of this community. Act Primary care access for refugees 1982

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Over the past six month period it has come to RPHs attention that primary care in the Hutt Valley and Porirua region does not have the capacity/funding to enrol and follow up refugee families resettled in their region. Due to the number of large Syrian families housed in the Porirua region, this has led to capacity issues in low cost primary care in Porirua and therefore a barrier to refugee families accessing primary care in their area. RPH is working in partnership with the 3DHB Service Integration and Development Unit (SIDU), Te Awakairangi and Compass PHOs and Red Cross Refugee Services to facilitate a solution. RPH raised the aboveUnder concern with the Ministry of Health and Ministry of Business Innovation and Employment in December 2015.

Action Plan 1.6 Work with schools to identify and address student health needs (non MoH contract)

Refer appendix. The

Action Plan 1.7 Improving vision and hearing (non MoHOfficial contract)

Refer appendix.

Action Plan 1.8 Support for children, youth and Work & Income clients (non MoH contract) Information Refer appendix.

Action Plan 2.1 Smokefree Nation 2025

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Decrease in the number of pregnant Decrease in percentage of women Unknown. 100% of pregnant women who smoke, and are seen by Obstetric in Hutt women who smoke. who smoke through their pregnancy. Hospital, have been given advice to quit. 91.4% of pregnant women who smoke and have been seen by a community midwife have been givenAct advice to quit. 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Decrease in number of premises Number and percentage of tobacco Achieved. 119 (81%) tobacco retailers visited are compliant with Smoke-free selling tobacco to minors. retailers visited that are compliant Environments Act 1990. with Smokefree Environments Act 1990. Under

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 2.1.1 Protection / Increased Number of retailer  147 retailer education visits completed. Tobacco compliance and education visits completed  12 controlled purchase operations visiting a total of 136 retailers. control awareness of the (Note: one visit equalsThe one Smokefree visit to one retailer).  17 retailers sold tobacco to the underage volunteers during the operations. Environments Act Number of controlled 1990 (please note we purchase operations must continue to (CPOs) completed (Note: allocate at least 40 one CPO equals one total Official percent of tobacco operation that targets a control budget number of premises). towards regulatory Number of tobacco budget). retailers visited during the CPOs. Number of positive sales in CPOs. Information 5% of tobacco retailers in 29% of tobacco retailers in the greater Wellington region were visited in a CPO. greater Wellington region included in a CPO. 2.1.2 Promotion / Increase public Number of organisations 103 organisations were supported, of those 21 adopted Smokefree-Auahi Kore messages Tobacco support for supported to develop and policies. control Smokefree Aotearoa Smokefree-Auahi Kore 2025. policies. Percentage of 22% of organisations worked with by RPH have adopted Smokefree-Auahi Kore messages organisations in the targeted settings that and policies. adopt Smokefree-Auahi Act Kore messages (e.g. Te Kōhanga Reo, community groups, churches and 1982

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sports clubs. i.e. where higher numbers of Māori and Pacific communities located). 2.1.3 Not MoH core contract Under 2.1.4 Promotion / Strengthen strategic Number and types of 26 partnerships and projects supported as outlined below: Tobacco alliances and collaborative relationships  Continued to participate in the National Smokefree Working Group meetings. control interagency or projects developed with networks. key stakeholders.  Presented on smokefree and smoking cessation services at Red Cross Syrian refugee orientation. The  Supported the Te Rau Matatini registration of interest to become a national coordinator of Māori smoking cessation services.  Submission to the Finance and Expenditure Select Committee on increase of tobacco Officialtax.  World Smokefree Day (WSFD)activities:  Supplied promotional material to 105 services.  Supported Wellington City Council, Hutt City Council, Rimutaka Prison, Smokefree Coalition Flash Mob and Te Awakairangi Health in their WSFD activities. Information  Coordinated Wellington region Stoptober activities.  Contributed in the consultation process for the Wellington City Council smokefree action plan.  Contributed to the consultation process Hutt City Council on the extension of Smokefree outdoor areas.  Jointly hosted the Smokefree Retailer Symposium with the Smokefree Coalition.  Provided a submission on the Pharmacy Strategy.  Facilitating the relationship between Te Awakairangi Health Network, Aukati Kaipaipa and Pacific Health Service Porirua, aboutAct the establishment of smoking cessation clinics within GP Practices.  Supported the Waikato Tairāwhiti Kōhanga launch of the1982 Tupeka Kore tikanga.

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 Continued support of phase two of Smokefree Cars in Wainuiomata.  Supported Get Your Talent On Youth Festival in Wainuiomata.

Under Continued support of the following Smokefree projects occurred:  Bikes in Schools – Lakeview school (Wairarapa)  Pre Shears Wairarapa (Wairarapa)  Golden Shears Championships (Wairarapa)  REAP Wairarapa (Wairarapa) The  Breast Friends (Wairarapa)  Wāhi Reka Kōhanga Reo (Wairarapa)  Ngāti Hamua Kōhanga Reo (Wairarapa) Official Mauriceville School (Wairarapa)  Masterton Intermediate School (Wairarapa)  Makoura College (Wairarapa)

Wairarapa incentivised All Wairarapa incentivised programme milestones have been completed on time. The programme milestones are completed on time. programme is now completed and has been evaluated. The Growing Love evaluation showed a quit rate ofInformation 27% at 4 weeks. 2.1.5 Not MoH core contract

Highlights Although not as well resourced and promoted as previous years, this year’s World Smokefree Day (WSFD) produced a significant number of activities and events that brought media and public attention to the possibility of an increasingly smokefree future for Aotearoa.  This year Wellington City Council (WCC), as a part of their WSFD activity, announced that they would be increasing smokefree places in the city in an effort to become possibly the world’s first smokefree capital. The WCC have extended their smokefree places to include Civic Square, the Botanical Gardens and more parks and playgrounds. The launch of these smokefree places was given by the Mayor, Celia WadeAct-Brown, and supported by several dignitaries. RPH has been heavily involved in developing the WCC Smokefree Action Plan. Work continues to implement the action plan.  Hutt City Council also extended their smokefree areas policy to include parks and sports grounds, train stations, bus shelters,1982 beaches, outdoor dining

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on pavements, outdoor areas in town centres and outdoor public areas around council buildings and facilities. RPH worked closely with Health Families Lower Hutt to support this policy shift.

Wairarapa Pre Golden Shears was our biggest and Undermost successful collaborative community event. Bringing smokefree and other health services to the mostly Māori and women wool handling community.

Mass Open Area Audit (MOAA) Staff audited the outdoor smoking area of licensed premises in the Wellington CBD. Forty-two premises were visited over the month of June and we found that 38 were not compliant. We then communicated the assessment back to the premises. Subsequently we have had staff out for two nights of monitoring. Of the 38 that were not compliant we have foundThe that 19 are now compliant. An educative approach is being taken to try and bring premises on board to comply. Should premises continue to be non-compliant a graduated response will be taken with them, concluding with a prosecution. The success of this project will determine if it is taken further out into otheOfficialr Wellington areas .

Issues, challenges, risks and actions taken This year the Ministry of Health has undertaken a realignment of tobacco control and smoking cessation services. Several existing organisations have lost their contract to provide community smoking cessation services and others may have been left in an uncertain position regarding how they move forward. We are now in a transition period and RPH is working alongside the new stop smoking Informationservices in our region.

Action Plan 3.1 Nutrition and physical activity

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Increase in environments that Number and percentage of A relationship with three workplaces has been maintained. These are Feltex, The support healthy behaviour. workplaces targeted that have a workplace health and wellness Warehouse and NZ Buses. RPH is also working with Healthy Families NZ on their Hutt initiative. Valley focused workplace wellness programme.

Increased number of healthy and Number and percentage of DHB food Phases 2 and 3 of the 3DHB Healthy Food & BeverageAct Guidelines have been implemented sustainable public and organisational policy phases implemented in 3 policies and practices. DHBs. in three DHBs. Phase 4 was scheduled for 6 July 2016. 100% of DHB food policy phases planned for this period, were1982 implemented in 3 DHBs.

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Increased access for targeted Number and percentage of new fruit Twenty one Fruit and Vegetable Co-operative hubs established with eight packing and 13 communities to fruit and vegetables. and vege cooperative hubs established (% of communities distribution hubs. This will be used as a baseline number for the 2016-2017 period. approached by RPH). 100% of communities that RPH has worked with have established a cooperative hub Number and percentage of orders (distribution and/or packing hub). that hubsUnder receive (% = 2015 -16 order number/2014-15 order number i.e. 32,829 orders from July 15 2015 – June 14 2016. This will be used as a baseline number % increase comparing 2014/15 to for the 2016-2017 period. 2015/16).

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area The 3.1.1 Promotion / To build healthy A scoping paper outlining A scoping paper outlining ways to optimise food provision in the community and Nutrition and public policy. ways to optimise food physical provision in the voluntary sector has been developed and will be disseminated in August 2016. activity community and voluntary Official sector is developed and disseminated to key stakeholders by June 2016. 3DHB management 3DHB management approval was gained for implementation of the 3DHB Healthy Food agreement is gained for implementation of a 3DHB and Beverage Guidelines. food policy. Information 3.1.2 Promotion / To create supportive Relationships have been A relationship with three workplaces has been maintained. These are Feltex, The Nutrition and environments. maintained with at least physical activity three workplaces (with Warehouse and NZ Buses. high number of Māori and Pacific employees). Percentage of workplace 100% of workplace key partner relationships were maintained. key partner relationships maintained (evidenced by regular contact and collaboration). Act 3.1.3 Promotion / Work with Pacific At least 50% of Pacific 88% of Pacific early childhood centres were represented at the Pacific Early Education Nutrition and early childhood early childhood centres Community Conference in August 2015. physical activity centres. attend a RPH supported 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

Wellington Pacific Early Education Community (WPEC) conference in June Under2016. Conference evaluation The evaluation showed that respondents improved knowledge, awareness and shows that attendees’ awareness on topics is confidence. 75% reported improved knowledge. 68% reported increased confidence in improved. sharing child health information. 68% reported a very good level of awareness of the role health plays in education. 73% reported they were very confident in making decisions The about the children’s health and wellbeing, following the conference.

3.1.4 Promotion / To strengthen Number of members There are 630 members and 140 orders per week being provided by East Porirua Fruit Nutrition and community action. (target 300) and number and Vegetable Co-operative as at 30 June 2016. physical activity of weekly orders (target Official 200) for East Porirua Fruit and Vege cooperative, at 30 June 2016. Feasibility of an extension The feasibility of an extension to council social housing in Miramar/Strathmore and to the Fruit and Vegetable Cooperative in the Wellington City Council was scoped with Wellington City Council. We are awaiting Miramar and Wellington progress from WCC. InformationTo deliver to this community, we established a hub with St Aidan’s City Council church in February 2016. accommodation areas scoped (evidenced by documented communication with local agencies and community groups). 3.1.5 Promotion / Serve as the Two breastfeeding events ‘Big Latch On’ held in August 2015 and ‘Nurturing Baby’ held in March 2016. Both were Nutrition and backbone for the are held in the Wairarapa physical activity Wairarapa Baby region by June 2016. very well attended (90 mums and 21 mums respectively) and feedback suggests they Friendly Community were successful events. Initiative through Act coordinating Percentage of partnership 100% of partnership activities facilitated by RPH. participating activities facilitated by agencies. RPH. 1982

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Highlights Over a period of 12 months RPH have supported the establishment of 21 co-operative hubs across the Wellington region. Examples include Cannons Creek, Titahi Bay, Waiwhetū, Wainuiomata, Naenae,Under Upper Hutt, Stokes Valley, Pomare, Timberlea and Māori Bank with a total of 32,829 packs of fruit and vegetables provided. We have maintained a fully integrated partnership with Wesley Community Action (a social sector NGO). Three hubs are finalists in the Wellington regional community awards (Porirua, Naenae and Upper Hutt).

The three workplaces with which we have relationships (Feltex, The Warehouse and NZ Buses) have indicated they would like to be a distribution hub of the Wellington Regional Fruit and Vegetable Co-operative collectiveThe to enable their staff to access fresh fruit and vegetables regularly. 3DHB management approval was gained for implementation of the 3DHB Healthy Food and Beverage Guidelines; and the first three phases were successfully implemented. Along with several other PHUs, RPH formed a working group to align this work, nationally. This resulted in the drafting of national guidelines for DHB food and beverage policies, which wereOfficial provided to the M oH.

Issues, challenges, risks and actions taken Fundamentally the Wellington Regional Fruit and Vegetable Cooperative work is a community led style of work. Communities work at different paces and RPH has to match the pace of the community. RPH has a presence at the packing hubs and distribution hubs and are there to be approached about a range of issues. At times the community rely on RPH to do the ‘doing’ but the strength of theInformation programme is that it is community led. One of the hubs has taken leadership and has split off from the main collective. It is still being supported by RPH and we work in partnership with them.

How might services be improved in the coming year The Wellington Regional Fruit and Vegetable Co-operative collective has enabled RPH to move freely within several high need communities providing advice and support on public health issues. The community feel they are able to interact more openly with public health advisors. This will be built on in the coming years beyond just the issue of food supply. Act Action Plan 4.1 Alcohol and other drugs 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Licensees understand the Evidence in licensing applications Achieved. RPH worked closely with licensees to ensure they understand their roles and communities they serve. indicates increased understanding. responsibilities in regards to the Sale and Supply of Alcohol Act (SASAA). Communities are actively engaged in Communities are increasingly Achieved. Communities submitted on a wide range of Liquor Licence applications. harm reduction. involvedUnder in the Sale and Supply of Alcohol Act.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 4.1.1 Protection / Alcohol licensing Number of applicationsThe RPH reported on a total of 1,472 applications – 794 Specials Licences, 401 On Licences, Alcohol and including monitoring and renewals received for 163 Off Licences and 114 Club Licences. other drugs , risk assessment and each license type. risk communication Number of applications with licensees; and renewals received  RPH reported on a total of 1,472 applications. controlled purchase that were inquired into. Official operations; input Of premises inquired into,  73 oppositions. into alcohol number of premises that  73 reports. regulatory networks; had matters in opposition  267 On, Off and Clubs were visited during this reporting period. and regular audit of identified.  13 CPOs conducted, 142 Premises visited – 53 On Licences and 89 Off Licences. alcohol database Of the premises where (priority to matters in opposition were  9 premises sold to minors during this reporting period. geographic areas and identified, number of communities that reports provided to the Information have high Māori, licensing committee within Pacific peoples 15 days. and/or low Number of on-, club- and socioeconomic off- licenses visited. populations). Number of CPOs conducted. Number of premises per CPO (specifying number of on-, club-, special- and off- licenses visited). Number of failures for CPOs. Act Alcohol CPO events are Some CPO events have taken two weeks to enter onto the database following a CPO recorded in the database 1982

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within one calendar week being completed. of the event and are tabled in the monthly report. 4.1.2 Protection / Support the adoption Number of written and There has been no policy submissions made. Alcohol and of policies that Underoral submissions made. other drugs reduce the level of alcohol and other Accurate records Not applicable as there has been no policy submissions made. drug related harm maintained of engagement (priority to process and outcome. geographic areas and communities that have high Māori, The Pacific peoples and/or low socioeconomic populations). Official 4.1.3 Capacity Strengthen strategic Number of National Public Six (includes four face to face and two teleconference meetings). Development alliances and Health Alcohol Working / Alcohol and interagency Group meetings attended. other drugs networks to reduce alcohol and other Significant developments Planning of the two national workshops this year focused on feedback from the previous drug related harm. or outcomes are reported monthly. year’s workshops:  Providing an updateInformation on case law/gathering and recording evidence/a recap on the theory of the case/preparing a brief of evidence/evidence in chief/ cross examination/increasing confidence with litigations skills  Medical Officers Alcohol Regulatory Advisory Group update 4.1.4 Surveillance / Build surveillance Number of organisations Seven separate organisations worked with: Alcohol and and analytical engaged with, including other drugs capacity for number of Māori and  Te Awakairangi PHO assessing alcohol Pacific organisations, to  Child Youth and Family related harm. increase local agency  Family Violence Clearing House support for gathering alcohol data.  Trauma Intel Group Wellington Act  Wellington City Council NEC technology project  Capital and Coast District Health Board Emergency Department1982

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 SIDU the Planning and Funding Section of the 3 District Health Boards (Capital and Coast, Hutt Valley and Wairarapa)

Alcohol Impact Paper written regarding staff roles in CPO’s as part of a funding and capacity review. This Assessment report peer Underreviewed and informs paper confirmed the need for us to continue our involvement. regulatory work in that community.

Highlights Over the past year there have been significant gains bothThe with working with District Licensing Committees and working collaboratively with our reporting agencies. There have been some very positive decisions that have guided our work and set new case law. This was especially relevant to the Johnsonville opposition which was set around an applicant’s obligation to understand the community. Other highlights include: Official  The availability of health data through the national minimum data set and the Wellington Emergency Department data. This data has been used and received positive comments at several hearings. This data has helped inform decisions.  The Trauma Intel group is regrouping to improve information outcomes for members. A key work stream is centralising core information through shared access to support technology.  With 73 oppositions lodged by the Medical Officer of Health there have been someInformation good public health gains. Some of these being; Hours of operation, reduced signage and advertising, refusal of new applications, declined renewal of some dairy and convenience store off-licenses and the adoption of the single sales conditions.  RPH worked with the The Whānau Centre in Cannons Creek to support resident’s views in the Porirua Local Alcohol Policy (LAP). No new off licences will be able to be established in the area.  RPH worked with local health services and the local politician to support residents’ opposition to a new bottle store in Wainuiomata. The application was withdrawn by the applicant once the residents’ concerns were understood.  The Wainuiomata community through vigorous opposition has convinced the Hutt City Council that the LAP is not reflective of their views and Council is now considering options for review.  NPHAWG also provided a Submission to the Justice and Electoral Committee on the Sale and Supply of Alcohol (DisplayAct of low alcohol beverages and other remedial Matters) Amendment Bill. 1982

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Issues, challenges, risks and actions taken Core health promotion activities have been reduced this year, and focus increasingly moved to regulatory work resulting from the implementation of the new Act.

A combination of implementing the changesUnder under the Act and the high number of licensing oppositions has presented a challenge to staff capacity and capability. There has been a need for up skilling in legal process both written and oral. The other challenge is that a growing number of applicants are now being represented by the legal profession. This is challenging our skill base.

Action Plan 4.2 CAYAD (Hutt Valley) (non-coreThe MoH contract)

Refer to separate CAYAD contract report 353248/00. Official Action Plan 5.1 Communicable diseases

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Disease burden in Māori and Pacific Pilot of outbreak management tools A workshop on outbreak management was completed with Pacific early childhood communities is reduced. for Māori and Pacific early childhood Information centres that facilitates early centres. The workshop was held during the Wellington Pacific ECE Collective Conference intervention and reduced in August 2015. The attendees were very engaged in the workshop, asking questions and hospitalisations. demonstrating improved outbreak knowledge. The next workshop with Māori early childhood education centres is scheduled to be completed in July 2016.

Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

5.1.1 Protection / Respond promptly to Total number of cases 2014-15 rate per 2015-16 rate per % Disease Name p-value Sig. Communicable cases and outbreaks entered onto EpiSurv by 100,000 pop. 100,000 pop change disease of communicable, disease (suspected, Campylobacteriosis 178.5 134.3 -25 0.012 * waterborne and Underprobable, confirmed, not a Chikungunya fever 2.4 0.9 -64 0.401 n/s foodborne diseases. case). Cryptosporidiosis 12.1 11.4 -5 0.894 n/s Dengue fever 3.5 5.0 44 0.602 n/s Gastroenteritis - unknown cause 22.0 20.3 -8 0.791 n/s Gastroenteritis / foodborne 39.9 4.3 -89 0.000 *** intoxication The Giardiasis 43.2 41.0 -5 0.814 n/s Invasive pneumococcal disease 11.0 10.8 -2 0.963 n/s Latent tuberculosis infection 19.6 9.3 -53 0.054 n/s Legionellosis 1.7 5.2 200 0.189 n/s OfficialLeptospirosis 1.3 0.2 -83 0.380 n/s Listeriosis 0.4 1.3 200 0.511 n/s Measles 0.2 0.4 100 0.788 n/s Meningococcal disease 0.2 1.9 800 0.240 n/s Paratyphoid fever 0.2 1.1 400 0.448 n/s Pertussis 27.6 21.8 -21 0.407 n/s Rheumatic fever - initial attackInformation 2.2 1.3 -40 0.642 n/s Salmonellosis 17.9 22.7 27 0.456 n/s Shigellosis 4.3 1.9 -55 0.343 n/s Tuberculosis disease - new case 7.6 5.4 -29 0.549 n/s Typhoid fever 0.6 0.2 -67 0.642 n/s VTEC/STEC infection 2.2 1.7 -20 0.827 n/s Yersiniosis 17.3 26.6 54 0.161 n/s Zika virus 0.0 2.2 0.142 n/s

n/s = not statistically significant; * = Significant; *** = Highly significant

Percentage of serious 100% of serious enteric disease investigations wereAct initiated within 24 hours of enteric disease investigations are initiated notification. within 24 hours of 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

notification. 5.1.2 Protection / Facilitate successful Number of TB clients Each of the 25 TB clients notified during the reporting period were compliant with their Communicable completion of drug Undercompliant with their TB TB drug regimen. disease regimens for drug regimens. tuberculosis (TB) and Number of TB clients on Seven (7) TB clients received Directly Observed Therapy (DOT) during the reporting latent tuberculosis Directly Observed Therapy period. infected (LTBI) (DOT) for the reporting clients. period. 100% of Pacific TB clients 100% of Pacific TB clients who were due to complete their TB treatment during the in the Wellington Theregion complete TB treatment. reporting period completed treatment. 5.1.3 Protection / Work collaboratively Number of meetings with Four meetings with rheumatic fever outreach nurses from Te Awakairangi and Compass Communicable with primary care to rheumatic fever outreach Health (Target: 4, 1 per quarter). disease improve secondary nurses (target: 4, 1 per Official prophylaxis quarter). treatment for rheumatic fever 100% of all non-compliant 100% of all non-compliant clients identified are followed up with a RPH letter clients are followed up. clients. encouraging monthly bicillin compliance.

5.1.4 Protection / Work collaboratively Number of household Of the six (6) confirmed acute rheumatic fever cases/one recurrent rheumatic fever case Communicable to achieve a contacts identified and Information disease reduction in the screened for GAS (number notified, 35 household contacts were identified and screened for GAS via a throat swab. incidence of of throat swabs). Only one throat swab was positive for group A streptococcus and received the rheumatic fever in appropriate antibiotic. the greater Wellington region, Percentage of household 100% of household contacts were provided with culturally appropriate rheumatic fever particularly in Māori contacts provided and Pacific culturally appropriate health education in accordance with RPH standard operating practices. communities. rheumatic fever health education in accordance with RPH standard operating practice. Act 5.1.5 Protection / Undertake weekly Number of surveillance 44 surveillance meetings were held. surveillance of meetings held. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Communicable notified diseases and Percentage of variable 100% of monthly variable reports provided to surveillance meetings analysed data by disease outbreaks in EpiSurv reports provided to with the aim to surveillance meetings that ethnicity. identify vulnerable Underare analysed by ethnicity. groups (i.e. Māori, Pacific and children/youth) and target public health interventions accordingly. The 5.1.6 Capacity RPH is able to Number of RPH staff with 16 RPH staff completed CIMS Level 4 training. Development / mobilise and staff an CIMS level 4 training. Communicable emergency disease operations centre Percentage of staff in 73% of RPH Leadership (service manager, medical officers of health, group managers, positions expected to be (EOC) at short notice teamOfficial leaders and health protection officers) have attained CIMS Level 4. with regards to a trained in CIMS level 4, pandemic response. who have received Link to action plan training (current status as at 30 June 2016). 6.6.

5.1.7 Protection / Improve best Draft plan developed to As reported in the six month report, the focus of activity 5.1.7 changed from the tattoo Communicable practice and reduce improve best practice for disease the likelihood of the tattoo and beauty and beauty industriesInformation to focusing solely on the nail bar industry. A project plan has been serious skin infection industry by June 2016. drafted to survey manicure/pedicure businesses within the greater Wellington region. in skin piercing, Refer to comments. tattoo and beauty industries within the Key tattoo artists within 155 nail bars have been identified across the greater Wellington region. Each of these greater Wellington the sub-region work in region. partnership with RPH. nail bars will be invited to participate in our survey. Participation in the survey is entirely voluntary.

5.1.8 Promotion / Continue with the Number of pharmacies, One Māori/Pacific health care provider (Whai Oranga Health Centre) agreed to promote Communicable implementation of Māori and Pacific health disease the sub regional plan providers who have the rehydration resource to their patients. Pharmacy cooperation is in progress. to reduce agreed to promote the Wairarapa, Hutt Valley and Capital & Coast DHB EmergencyAct Departments are promoting hospitalisation rates rehydration resource. the rehydration resource with parents of unwell children. The resource has been added caused by gastroenteritis and to the 3D Health Pathways. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area dehydration for the RPH has approached Healthline to determine if they would be prepared to promote the 0-4 year age group in the greater rehydration resource. Wellington region. Under Feedback from one Māori Feedback from Whai Oranga Health Centre included: and Pacific health provider and one pharmacy  Rehydration resource clear and easy to follow regarding the value of the  Concise/informative, all information in one place resource. The information in the resource easily enabled parents to quickly understand the The required fluid intake for their unwell child. 5.1.9 Protection / Reduce the burden Increased notifications of No outbreak notifications were received from kohanga reo in 2015. Communicable of outbreaks in outbreaks in Kōhanga Reo disease Māori and Pacific based on notification early childhood numbers in 2014. centres (ECCs). Decreased attack rate in Official outbreaks in Kōhanga Reo based on notification numbers in 2014. Te Kohanga Reo workshop Activity 5.1.9 planned to focus on working with te kōhanga reo within the greater kit is developed from the general model that is Wellington region during the reporting period; however an opportunity arose for RPH to acceptable to Te Kohanga work with Pacific LanguageInformation Nests (ECC) to provid e an outbreak management workshop Reo staff. for centre managers and staff. As a result, the focus changed to Pacific Language Nests. The focus for the 2016-2017 Action Plan will be on outbreak management within te kōhanga reo. The current te kōhanga reo outbreak kit is being reviewed and changed to reflect acceptable te kōhanga reo practices.

5.1.10 Capacity Build capacity and Number of Māori and RPH facilitated workshops included invites to health professionals from primary, Development / capability in the Pacific care providers Communicable health sector to attending workshops. secondary and tertiary care, Primary Health Organisations and NGOs. The number of disease improve the follow Māori and Pacific health professionals attending workshopsAct was not counted; however up of serious there was attendance from these providers. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area notifiable diseases. Percentage of workshop From the evaluations completed it was demonstrated that the workshop participants had attendees that provided a rating of 4 or 5 out of 5. increased their public health knowledge and would use this knowledge to implement Under changes that would improve the health care provided to clients in their practice.

Highlights

Free influenza vaccination for vegetable co-op hub volunteers within our health district The RPH ‘Change It Up’ week enabled the Disease ControlThe team to think outside the square and identify activities that would positively impact disadvantaged communities within our health district. One activity identified was the provision of free influenza vaccination to volunteers who pack at the fruit and vegetable-co-op hubs within their community setting. At the time of reporting, 18 volunteers located at four hubs across the greater Wellington region had been visited by the mobile immunisation clinic supportedOfficial by the RPH public health nurses. This initiative has enabled vulnerable persons in the community who would not usually receive the influenza vaccination to be vaccinated in their workplace by a mobile vaccination clinic.

Prostitution project Medical officers of health have powers under the Prostitution Reform Act 2003 (PRA) to promote adherence to safer sex obligations under the PRA and to inspect brothels to determine compliance with these obligations. This creates a responsibility to follow-up complaints or concerns suggesting non- compliance. In April 2015 RPH become aware that some brothels in the Wellington regionInformation may be tacitly promoting unprotected sex services and therefore in breach of the PRA. In response, RPH developed and implemented a project to assess steps Wellington brothel operators have taken to meet their PRA obligations, and to advise on improvements. The project was well-received by the operators, many of whom welcomed the opportunity to have their compliance with sections 8 and 9 of the PRA assessed and to receive guidance. Additional benefits included improving working relationships with the NZ Prostitutes’ Collective, and enhancing RPH capacity for undertaking compliance assessments.

RPH 2016 influenza communications plan Members of the Disease Control team developed a 3DHB communications plan to facilitate all RPH influenza health promotion activities across the sub- region. This plan promoted immunisation and increased knowledge on how to prevent winter illnesses in our communities. Viral gastro and respiratory infections spread quickly in the winter months resulting in primary care and emergency department services in the 3DHBsAct to experience an increase in presentations during the winter period. Reducing winter illnesses by promoting influenza vaccination and ensuring key health messaging is readily available, ensures well families/communities and can reduce pressure on health care services across the sub-region. 1982

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Issues, challenges, risks and actions taken National legionnaires’ disease case finding study (LegiNZ) Legionella notifications increased over the 12 month period as a result of the LegiNZ study. It was predicted that RPH would see a 4-fold increase in legionella cases during the study period.Under For the reporting period (1 June 2015- 30 June 2016) RPH received 25 legionella notifications compared to seven for the same period 2014/2015 and two for the same period 2013/2014. This created a significant increase in workload for the Disease Control team. The majority of notified legionella cases were Legionella longbeachae; therefore RPH proactively involved itself in a number of health promotion community events (Te Ra o Te Raukura and Creekfest festivals) to raise awareness of safe and healthy gardening across the sub-region. The LegiNZ Study Report from Health Research Council should be available in 2016. On receipt of the report RPH will implement recommended changes in practice if required.

The Health (Protection) Amendment Bill The The Health (Protection) Amendment Bill passed its third reading on 30 July 2016. Once the bill has Royal Assent the Ministry of Health will have a six month lead in period, therefore potentially early 2017 the Bill will be enacted. This Bill proposes amendments to the Health Act 1956 to improve the tracing of people who may have an infectious disease, or may have been exposedOfficial to one; increase the range of infectious diseases that are notifiable, and provide incremental options for the management of individuals with significant infectious diseases. The Bill also proposes introducing a ban on the provision of commercial artificial UV tanning services to people under 18 years of age and seeks to make a number of administrative changes to streamline legislation including the inclusion of tuberculosis as a notifiable infectious disease under the Act and the consequent repeal of the Tuberculosis Act 1948. This is an important Bill for New Zealand health and it will significantly assist health professionals in limiting the spread of infectious disease, and prevent cases of skin cancer. It is unknown at the time of reporting how much additional work this will Informationgenerate for the RPH workforce, hence a challenge for 2017.

How might services be improved in the coming year RPH participated in the Ministry of Health (MoH) led national audit of rheumatic fever client files. This audit took place over a one day period; however there were many hours of preparation and data extraction that followed the audit. The auditors were impressed with RPHs level of knowledge and our data capture systems. One auditor in particular commended Barbara Eddie (public health nurse) on her knowledge and invited her to take part in the Ministry’s audit team in the future. To-date we have not received an audit report; however it is our intention to implement the MoH audit recommendations if they apply to RPH. Act Other comments 1982

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Other comments 5.1.7 A project plan has been drafted to survey manicure/pedicure businesses within the greater Wellington region. The survey is to assess the level of operator knowledge, training of owners/operators and what processes these businesses have in place to prevent infections in their clients and/or staff. As part of the project we are inviting environmentalUnder health officers (EHOs) at each of the local authorities to participate in face-to-face visits/interviews at the business premises in their district. Due to competing work priorities the local authorities have indicated they would like to initiate and participate in these visits post September 2016. The information collected in the survey will help RPH get a better understanding of other similar establishments in our area and support work to reduce health risks to the general public. If any inadequate infection control practices are observed whilst at the premises, RPH staff will advise the owner of the correct practice and will follow up with a letter. The Action Plan 5.2 Promote and facilitate immunisation (non-MoH contract)

Refer appendix. Official

Action Plan 5.3 Deliver Year 7 & Year 8 Boostrix and Gardasil vaccination programmes (non-MoH contract)

Refer appendix. Information

Action Plan 5.5 Sexual health promotion

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Improved awareness, prevention and - Increased confidence in accessing Increased client confidence in accessing sexual health services has occurred through management of sexually transmitted sexual health services. students’ accessing sexual health and general health checks as feedback by school nurses. infections. - Better prevention and management STIs. They are asking for more information on contraception therefore better prevention and - Increased parental support and management of STIs. understanding of sexual health issues Parental support and understanding of sexual healthAct issues and needs is provided and needs. through community events and one-on-one parent evenings where they can ask - More schools have appropriate questions about sexual health for their teenagers. policies and protocols in place. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 5.5.1 Promotion / Provide sexual health Work with three schools Work undertaken with Wellington East Girls, Te Ara Whānui Te Kura Kaupapa Māori, Sexual and workshops to on sexual health education reproductive students from Underby June 2016. Porirua College and Naenae College. health schools and alternative education Percentage of schools Feedback provided to public health advisor displayed they were satisfied with the (kaimahi/tumuaki) providers with high information provided. Māori and Pacific provided positive feedback enrolments. that they are satisfied with the information provided to students at sexualThe health education sessions. 5.5.2 Promotion / Provide public health Public health experts are Sexual health information and other public health subjects such as rheumatic fever, Sexual and information by radio invited to speak on He Tifa reproductive to Māori and Pacific Ola and Pomare in the nutrition,Official influenza, family violence and immunisations are promoted on the radio health audiences. Hood radio programme programme to Māori and Pacific audiences. Note: ‘Pomare in the Hood’ radio once a month. programme was cancelled.

The public request more Requests go to He Tifa Ola director (a trained nurse) who either answers questions or information on public health topics promoted on refers requests onto their GP or PHO for further support. He Tifa Ola and Pomare in Note: ‘Pomare in theInformation Hood’ radio programme was cancelled. the Hood radio programmes. 5.5.3 Promotion / Provide sexual health Public health advisor The public health advisor attended eight events: Te Rā o Te Raukura 2016, Creekfest Sexual and promotion through attends four community reproductive events that support events in the greater 2016, Pomare in the Hood 2015, Naenae Festival 2016, Pink-a-licious Day, Queen of the health areas of high Māori Wellington region by June Pacific International Women’s Boxing, Pasifika Choice Day and White Ribbon Day. and Pacific 2016. populations. Percentage of community Attended 100% of all targeted events. Public health advisor spoke to a number of people events that generate requests for either further at these events for example at ‘Pomare in the Hood’ over 200 people were engaged by sexual health information the advisor. Act or requests for further assistance. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 5.5.4 Promotion / Provide sexual health Four sexual health sessions Two sexual health sessions were delivered to lead community members. Sexual and sessions for lead are delivered for lead reproductive community members community members by health who work closely UnderJune 2016. with community to increase knowledge Percentage of participants 100% of lead community members have reported that the information has helped the from all four sexual health and capacity of wider community. communities. sessions that report the information helps them to help others in the wider community. The 5.5.5 Promotion / Provide sexual health Deliver one school based This has not been delivered as it was not considered a priority for the workplan. Sexual and workshops to workshop in each of the reproductive support workers in CCDHB and HVDHB health schools with high regions. Official Māori and Pacific enrolments. Percentage of participants N/A. from all school based workshops that report the information was useful in informing how best to work with students in schools who need advice Information in sexual health issues.

Highlights The public health advisor attended eight events: Te Rā o Te Raukura 2016, Creekfest 2016, Pomare in the Hood 2015, Naenae Festival 2016, Pink-a-licious Day, Queen of the Pacific International Women’s Boxing, Pasifika Choice Day and White Ribbon Day. Public health advisor spoke to a number of people at these events for example at ‘Pomare in the Hood’ over 200 people were engaged by the advisor.

Issues, challenges, risks and actions taken Act Continually assessing needs in the community and prioritising RPH response. 1982

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The ‘Pomare in the Hood’ radio programme has been disestablished.

How might services be improved in the coming year Maintaining a presence through on-goingUnder sexual health sessions within the community allows for continued information sharing opportunities and improvements to the delivery of the programme.

Action Plan 5.6 Deliver neonatal BCG vaccination (non-MoH contract) The Refer appendix.

Action Plan 6.1 Minimise environmental hazards, promoteOfficial safe drinking water, sustainable resource management

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Environmental health threats are Risk communication strategies are Risk communication strategies are in place for hazardous substances incidents, drinking identified and assessed, and developed and used for significant water transgressions, recreational water bathing alerts, sewage and/or waste water appropriate risk communication public health hazards. Information strategies are used to ensure the overflows and unplanned discharges and sunbed operators. Risk assessment and relevant agencies are engaged and communication is integral to health protection activities. the public is kept safe.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.1.1 Protection / Influence national, Number of interagency 24 interagency meetings were attended. Physical regional and local meetings attended environments policies, plans and (Porirua Harbour Strategy documents that have Working Group, Regional significant Pollution Officers meeting Act implications for etc). 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area sustainable resource Percentage of submissions 100% of submissions were submitted on time. management and submitted on time. public health. Under 6.1.2 Protection / Undertake drinking Number of annual reviews Annual reviews were completed for 33 drinking water zones and 10 drinking water Physical water functions as undertaken for all environments required by Part 2A registered drinking water plants. All support populations of 100 or more people. of the Health Act and supplies supporting a maintain work population of 100 or more, standards and excluding self-supplies. systems to ensure Annual review undertakenThe compliance with for all registered drinking inspection body water supplies supporting requirements (IANZ). a population of 100 or more, excluding self- supplies. Official Audit of Drinking Water Audit records indicate 100% of requirements have been met. Assessment Unit indicates 100% of inspection body requirements have been met and Drinking Water Assessors maintain criteria for statutory appointment. Information

6.1.3 Not MoH core contract

6.1.4 Protection / Provide advice on Number of times RPH has Advice on fluoridation of drinking water was provided four times during the 2015-2016 Physical the benefits of provided fluoride related environments drinking water advice. year. fluoridation when the matter becomes Percentage of fluoride All advice was reviewed internally. a significant issue in information provided that the community. is peer reviewed. 6.1.5 Protection / Undertake public Number of VTA Nine vertebrate toxic agent applications were assessed. health functions permissions assessed. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Physical relating to Percentage of assessment 100% of vertebrate toxic agent applications demonstrated adequate consultation with environments vertebrate toxic of VTA applications that agents (VTAs) in include adequate Māori. accordance with Underconsultation with Māori. Section 95A of the Hazardous Substances and New Organisms Act 1996 and Ministry of Health guidelines. The 6.1.6 Protection / Monitor, assess and Number of risk 61 risk assessments were completed following water quality alerts at bathing sites. Physical respond to assessments completed environments significant following receipt of recreational water recreational water bathing quality issues in the alerts. Official greater Wellington region. Percentage of risk 100% of risk assessments were undertaken to required standard. communications undertaken in accordance with risk communication protocol. 6.1.7 Protection / Attend and Percentage of HSTLC Three out of four HAZMATInformation (formerly HSTLC) meetings were attended. One meeting was Physical participate in the meetings attended. environments Hazardous Substance not attended due to a mis-communication of dates. Technical Liaison Relationship with HSTLC Committee (HSTLC) Relationships with HAZMAT participants were maintained between meetings through members are maintained meetings. between meetings. attendance at incidents and emergency management coordination meetings. 6.1.8 Protection / Maintain a database Number of PCB audits One PCB audit was undertaken. Physical of premises storing carried out. environments polychlorinated biphenyls (PCBs) and 100% of PCP audits carried 100% of audits were carried out in accordance with approved procedures. audit compliance of out in accordance with premises with relevant standard Act conditions of operating procedures. exemption. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.1.9 Protection / Use Hazardous Number of chemical injury There were 102 chemical injury notifications entered into HSDIRT. Physical Substances Disease notifications entered into environments and Injury Reporting HSDIRT within 5 working Tool (HSDIRT) to Underdays. record chemical injury cases and Percentage of chemical 100% were entered appropriately. utilise reports injury notifications provided by the entered appropriately into Centre for Public HSDIRT. Health Research. The 6.1.10 Protection / Carry out Number of No issues were identified or complaints received. Physical surveillance under issues/complaints environments the Hazardous followed up and/or Substances New referred to Worksafe NZ. Organisms Act 1996, Official investigate breaches 100% of complainants N/A. of, and carry out receive feedback. enforcement action where necessary. 6.1.11 Protection / Identify and visit all Number of solaria/sunbed In December 2015, all 19 known sunbed operators were contacted and 18 were visited. Physical commercial operators visited or One operator was not on site at the arranged time. In June 2016, 33 operators of environments solaria/sunbed contacted every six Information operators every six months. sunbeds were contacted (potential new operators were identified and contacted) and 21 months and provide were visited. The remainder no longer operated sunbeds. information on best practice to reduce Percentage of 94% of solaria operators were visited in December 2015 and 63% were visited in June the public health solaria/sunbed operators risks. visited every six months. 2016. Of note is that only three out of the additional 10 business we were provided with from the University of Otago actually operated solaria, so the actual percentage is 91%.

6.1.12 Protection / Take a multi-agency Number of disinterment, Two disinternments, 19 repatriations and three other burial and cremation matters were Physical approach to applying repatriation and other environments public health burial and cremation processed during the 2015-2016 year. legislation to matters followed up. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area identify, assess and Percentage of applications 100% of applications were processed with 15 working days and in accordance with manage risks arising for disinterments and from the physical repatriations processed standard operating procedures. environment, e.g. air Underwithin 15 working days quality, and in accordance with environmental noise, relevant standard disinterments, infirm operating procedures. and neglect, lead paint and asbestos, contaminated sites, spray drift and The ionising and non- ionising radiation. 6.1.13 Protection / Maintain a 24/7 on- A roster of two on-call A roster of two on-call health protection officers was maintained throughout the year. Physical call response. health protection officers Official environments and one medical officer of health is maintained throughout the year. Annual report to the Annual report verifies all health protection officers and medical officers of health remain Ministry of Health verifies competency of health competent. protection officers and Information medical officers of health.

Highlights During the 2015-2016 year the Greater Wellington Regional Council (GWRC) published its Natural Resources Plan for public consultation. RPH had been involved in many pre-consultation meetings, along with other agencies, assisting the GWRC to finalise the draft document. RPH submitted on a range of matters, in particular, where contaminant discharges may impact on air and water quality and potentially on the health of the public. We have since commented on third party submissions to the plan screening for possible impacts on public health and to further refine our position on specific resource management rules. This has been a large piece of work over two years, with pre-hearing on specific topics the next partAct of the process.

Issues, challenges, risks and actions taken 1982

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Issues, challenges, risks and actions taken RPH has been managing an on-going drinking water assessor (DWA) capacity issue. We currently have one DWA (0.4FTE) and two trainee DWAs. Our 0.4 FTE DWA is inexperienced and unable to adequately train the trainees or keep up with the work plan. We have been managing this situation by contracting Matt Molloy as a DWA 50 hours per month.Under This has enabled us to keep our work plan up to date and to fast track one of the DWA trainees training programme. At this point in time, unless something unplanned occurs, we are expecting that we should have a second DWA designated in March 2017.

Action Plan 6.2 Promote safe and healthy urban environments The Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Increase capability and skill of the Primary and secondary healthcare In the 2015-2016 year RPH has presented to seven primary healthcare groups and five health workforce to address housing workers have attended housing secondary heath care groups. We also presented to the Orongomai Marae social services related health issues. assessment training and accessed Official the Housing Advice Service. staff, Lions club, Citizens Advice Bureau twice, and Whitireia Polytechnic second year nursing students, as well as presenting at Creekfest/Te Ra and the Refugee community day. All together, we presented to 140 healthcare professionals and more than 169 social workers, trainee nurses and members of community groups.

Increased use of public health Public health evidence on housing RPH has submitted on planning documents and on matters of public health interest at a information around housing and and urban environments is provided Information urban environments by local and to local and/or central Government local, regional and national level. We have also improved our networks with council central government. through consultation processes. politicians and planners, other Government agencies, lobby groups with similar interests and with consultant planners. This has broadened our ability to influence others.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.2.1 Promotion / Assess relevant Public health input We provided input into more than three urban design, transport and policy processes. Physical planning processes provided to at least three environments or community urban environments, Examples are: Resource Management Amendment Bill, Productivity Commission – Better initiatives for their transport planning or Urban Planning, Hutt Road Cycleway and WellingtonAct City – Resilient Cities programme. likely built policy making processes. environment impact on key populations Evidence of utilisation of Evidence that public health advice was used is demonstrated1982 in the Hutt City Reserves

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area and key health public health evidence in Strategy, Wellington City – Resilient Cities Programme and Porirua City Council – Shared outcomes, and local or central determine level of Government documents Cycleway proposals. RPH engagement. Underand processes. 6.2.2 Promotion / Develop and At least four opportunities We moved to an influencing model this year with less reliance on submissions. In doing Physical promote public (presentations, environments health intelligence workshops, information this we worked with city councils, lobby groups interested in urban design and transport, that supports papers) to promote and with urban design consultants. We found providing lobby groups with evidence to healthy urban healthy urban support sustainable city planning, backing up the Centre for Sustainable Cities with a environments in environments withThe urban areas of high planners and decision public health focus, and working with planning consultants to be particularly useful. socioeconomic makers. deprivation through information papers, RPH evaluation tool shows The RPH evaluation tool was not used. We did find through feedback and through high level of local research and reviewingOfficial completed planning documents that our work is having a positive impact for workshops. government satisfaction with RPH. public health.

6.2.3 Not MoH core contract

6.2.4 Not MoH core contract Information Highlights This year RPH made a decision to actively expand its networks with council politicians and planners, with active lobby groups seeking similar outcomes to us, and working more closely with planning consultants. We have found this particularly effective in getting invites to participate in urban design and transport forums. A lot of these forums are working on issues that have yet to become part of planning documents but it is clear that other agencies and council staff are interested in public health and urban design and transport options that will positively impact public health.

Action Plan 6.3 Early childhood Act

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Strengthened working relationships Receive more requests for support There have been more requests for support from te kōhanga reo and Pacific early with Te Kōhanga Reo and Pacific and each centre attends an childhood centres during and following an education initiative. Early Childhood Centres. education initiative that is provided. Reduction in gastroenteric outbreaks IncreasedUnder access to our website and There has been increased access to the RPH website over the winter months for illness at Early Childhood Centres. email address. information.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.3.1 Promotion / Reduce the incidence All illness factsheetsThe are Illness factsheets were updated and uploaded to the website from July - June 2016. Physical of illness in early updated and uploaded to environments childhood centres the website by September 2015. All factsheets have been AllOfficial factsheets uploaded to the website were reviewed by a medical officer of health. reviewed by a Medical Officer of Health. 6.3.2 Promotion / Work with Te At least 50% of Te 80% of te kōhanga reo attended the workshop. Physical Kōhanga Reo. Kōhanga Reo attend the environments workshop. Workshop evaluation Evaluations showed Informationthat te kōhanga reo kaimahi awareness of topics improved and shows Te Kōhanga Reo kaimahi awareness of implementation of changes have been made. topics has improved. 6.3.3 Promotion / Increased health Number of completed 22 of Wairarapa early childhood centre profiles were completed. Physical promotion focus on profiles of Wairarapa Early environments Wairarapa Early Childhood Centres. Childhood Centres and early childhood Feedback from Feedback from engagement with public health advisors and early childhood centres is engagement with Early community-led collected and used in monthly reporting. health priorities for Childhood Centres, public Māori, Pacific and health nurses, public vulnerable health advisors is collected Act communities. as part of monthly reporting. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.3.4 Protection / Conduct regulatory Reports are completed 18 licensing inspections were completed. Only one report was not completed within five- Physical work in all early within five days of a environments childhood centres as licensing inspection. days. required by Ministry Under of Education. Licensing inspections are All licensing inspections were carried out in accordance with Education (Early Childhood carried out in accordance with Education (Early Centre) Regulation 2008. Childhood Centre) Regulation 2008. The Highlights Kaimahi in te kōhanga reo have looked at changing their practices both in the workplace and in their own homes following workshops on nutrition and physical activity. Some kaimahi realised how both the children of teOfficial kōhanga reo and at home have no ability to decide on the type of food they eat. It challenged the thinking of kaimahi who were present at workshops to consider what they are providing and is that the best option for learning and growth of a child.

Although illness in early childhood centres (ECC) can happen unexpectedly RPH is aware that typical childhood illnesses are a seasonal occurrence. RPH proactively sends health information emails on subjects such as gastro enteric illness to ECCs. These emails provide information to enable an ECC to confidently and competently reduce the spread of an illness. ECCs are encouraged to contactInformation RPH if their seasonal illness impacts on 30% of the ECC enrolled population for support. When they contact RPH they are sent a form (available on the RPH website) that asks all information which helps in saving both the ECC and RPH time and ensures the best possible support can be given, quicker.

RPH ran a well-being workshop for ECC staff in November 2015. The purpose was to provide knowledge, tools, and resources to support staff to make informed decisions about their self care, and in turn help them be positive role models for the children in their care. Feedback provided by a participant shows how successful and influential it was: “I just want to offer my feedback on the wellness course that you offered in Nov 2015. I found the workshops absolutely wonderful. It was very well organised, set up for total social interaction with the other attendees. We were made to feel very welcome and the group activities really gave us an opportunity to chat and get to know each other quickly. It was a warm and welcoming environment, informal and feltAct like a wel l organised family gathering. The speakers were very well chosen. All their presentations were well organised, clearly communicated, very engaging, human, delivered with a great deal of empathy and understanding of people’s weaknesses and needs. I just found them very real. 1982

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[The Keynote speaker] talked about how to deal with workplace problems personally and ways in which we can manage the emotional challenges these can present to remain professional and productive……..I gained so much from what she said. She talked about being accountable and responsible and how shifting your thinking about issues towards this can really make you feel so much better………. Under This workshop made me stronger and braver at work. I believe it made me a better teacher and most certainly a better person. I thoroughly recommend it to everyone and I believe it would be well worth all managers paying for their staff if necessary.”

Issues, challenges, risks and actions taken The RPH has made a change to personnel in this area of work. This has meant that RPH no longer has a Pacific focussed public health advisor for Pacific early childhood centres. This is being addressed by working with the Wellington Pacific EEC collective and supporting their annual education and health conference. Official

How might services be improved in the coming year RPH recommends that future workshops provided to the early childhood education sector have a focus on promoting wellness and role modelling. Messages are heard more clearly and come across as less judgemental and acceptable.Information

Other comments RPH has taken the stance of promoting wellness and role modelling behaviours which have been well received rather than just talking about combating illness and what staff should and should not be doing.

Action Plan 6.4 Health Promoting Schools (HPS) (non-core MoH contract)

Refer to separate Health Promoting Schools database report 353309/00. Act

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Action Plan 6.6 Border health and response to emergency events

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Response to multi-agency events at RPH hasUnder facilitated a successful RPH was unable to coordinate an exercise during this reporting period, although Wellington’s international points of multi-agency exercise at one of entry will be strengthened. Wellington’s international points of procedures have been tested in real life situations. Exercises are currently being entry. discussed with both the Wellington International Airport Limited and CentrePort for 2016-2017.

Improved alignment of RPHs RPHs major incident plan has been It was identified that RPH had three emergency management plans that did not align and response to emergencies and major updated and is compatible withThe the incidents with the region’s three response plans for the region’s three were overdue for review. During this reporting period the plans have been reviewed and District Health Boards. District Health Boards. it was identified they required significant amendment. RPH is in the process of developing a modular approach to one comprehensive emergency management plan that willOfficial align to the 3DH B emergency plans.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.6.1 Protection / International point of Complete core Core capacity verification assessments were completed during December 2015 and Physical entry designations competency audits for environments under the Wellington International January 2016. Information International Health Airport and CentrePort. Regulations 2005 are maintained. Core competency audits Both the Wellington International Airport Limited and CentrePort demonstrated show compliance with international health compliance with the International Health Regulations 2005. regulations. 6.6.2 Protection / RPH to investigate Number of RPH were involved in six mosquito detections. All were notified to the Ministry of Health. Physical mosquito incursions/interceptions environments interceptions and reported to Ministry of incursions. Health. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Percentage of 100% of interceptions were investigated and laboratory results reported to the Ministry interceptions and incursions responded to in within 24hrs. Internal procedures are being updated to reflect the Environmental Health Underaccordance with the Manual. Environmental Health Manual and RPH procedures. 6.6.3 Protection / RPH to develop and At least one emergency RPH participated in six multi agency emergency response exercises. Physical maintain response exercise environments relationships with completed. The key stakeholders involved in Evaluation of emergency 100% of all exercises were evaluated by a multi-agency debrief. Exercises debriefs were a response exercise shows emergency response positive learning experience for all attendees. within the greater positive response to the Wellington region. exercise. Official 6.6.4 Protection / RPH to work Relationships with Te Puni The focus of this activity changed for RPH as the Ministry of Civil Defence and Emergency Physical collaboratively to Kokiri and at least three environments improve regional marae have been Management are the lead agency tasked with establishing welfare centres in marae as welfare planning and established. part of community resilience. resilience for vulnerable Feedback sought from Refer to the comments section of this report. populations including marae indicates positive Information Māori and Pacific result. communities. 6.6.5 Protection / RPH to maintain up Business continuity plan It was identified that RPH had three emergency management plans that did not align and Physical to date emergency complete and major environments management and incident plan reviewed. were overdue for review. During this reporting period the plans have been reviewed and business continuity it was identified they required significant amendment. RPH is in the process of plans. developing a modular approach to one comprehensive emergency management plan.

Business continuity plan Aspects of the RPH modulated Emergency Management Response Plan will be tested and major incident plan during Exercise Tangaroa (August/September 2016). tested in desk exercise. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 6.6.6 Protection / RPH to maintain the At least one emergency One emergency response exercise completed in June 2016 (refer to highlights). Physical capacity to respond management exercise for environments to any emergency central region complete. which may impact onUnder public health. Evaluation of RPH service RPH staff evaluation confirmed they have a good understanding of the role of RPH in an wide training confirms that staff have a good emergency. understanding of the role of RPH in an emergency. The Highlights Jon Lambert, health protection officer, has been appointed to a national group focussed on improving border health processes, including mosquito surveillance. Previously Jon has taken a lead on behalf of RPH in proposingOfficial improvements to Ships Sanitation Certificate processes, documentation and training.

6.6.6 Central Region HealthEMIS (Health Emergency Management Information System) Training Exercise. Staff from RPH, MidCentral Public Health Unit and Hawkes Bay DHB Population Health participated in a joint training exercise. The aim of the exercise was to familiarise staff with using HealthEMIS to manage a Civil Defence emergency. HealthEMIS is a national web based system that provides a secure database for use by the Ministry of Health, District Health Boards, public health units, AmbulanceInformation and Civil Defence to assist in coordinating a response in the event of an emergency. There were 22 participants across the three public health units who were provided with the opportunity to become more familiar with this system, and test capabilities.

Interagency relationships The focus of the Emergency Management Portfolio Lead for the 2015-2016 year was to foster existing relationships with stakeholders across the sub-region and with our Central Region PHUs. These relationships have enabled meaningfull interactions, and formed relationships prior to working together in an emergency situation.

How might services be improved in the coming year Act 1982

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How might services be improved in the coming year

Exercise Tangaroa RPH has made a commitment to participate in Exercise Tangaroa run by the Ministry for Civil Defence and Emergency Management. The Exercise will take place over three days – 31 August, 14 September,Under and 28 September 2016 and will be based on a regional source tsunami scenario. Using a realistic scenario with limited warning time, Exercise Tangaroa is a great opportunity to test our preparations for, response to, and recovery from, a national tsunami impact in and outside our health district. Learnings from this exercise will be incorporated into our plan.

Other comments The 6.6.4 Te Mangungu Marae, Naenae has been identified by Wellington Regional Emergency Management Office as a welfare hub in the event of an emergency. A hui with key marae personnel was held to discuss and identify any support and/or guidance RPH could offer to prepare their marae as a hub. This opportunity to kōrero with Te Mangungu Marae has given MarieOfficial Gibson (health protection officer) opportunities to strengthen RPH linkages with the marae and also the potential to network with other local marae in the Hutt Valley with regard to emergency management preparedness.

Action Plan 7.1 Business support

Core function Information # / MoH issue Activity Key performance measures Whole-of-year progress and achievement against performance measures area 7.1.1 Capacity Maintain and develop Create at least five Four auditing queries have been created to track and maintain HealthScape’s data Development / the information queries to track and Internal systems that underpin maintain HealthScape’s integrity. allocation for good public health data integrity all contracts service delivery. Collect feedback from Feedback was given verbally to the trainer following training sessions. users to gauge effectiveness of training workshops. Act 1982

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Core function # / MoH issue Activity Key performance measures Whole-of-year progress and achievement against performance measures area 7.1.2 Capacity Coordinate and Project plan completed by Planning was completed by the due date. Planning documents used did not include a Development / facilitate the RPH 30 October 2015. project plan. They included a spread sheet of detailed actions that provides a baseline of Internal annual planning Under allocation for processes. actions for business planning, action planning, reporting, finance and planning all contracts infrastructure that cycle over the financial year (this is regularly revised); a daily log of issues arising; and regular business support cluster meeting notes.

The project plan meets See above. The needs and expectations of the leadership team were met as evidenced the needs and The expectations of the by verbal feedback to the business support cluster from the leadership team and some leadership team (as seen team leaders. by endorsement). 7.1.3 Capacity Financial planning Financial reports are FourOfficial quarterly reports were provided to the leadership team. Development / systems are aligned to provided to leadership Internal meeting business team, quarterly. allocation for needs and regularly all contracts monitored to ensure 100% of contractual 100% of contractual reports requiring financial information are completed within reports requiring financial the service is aware of expected timeframes. its financial trajectory. information are completed within expected timeframes. Information 7.1.4 Capacity Maintain appropriate 90% of reports are 87% (97/111) reports were submitted within one working day of the due date. Development / systems to monitor submitted on or before Internal RPH reporting their due date. allocation for requirements, facilitate all contracts servicewide reporting All reports receive 100% reports receive approval from RPH leadership team members prior to being approval from RPH and ensure that RPH submitted. meets all contractual leadership team members reporting requirements prior to being submitted. including DHB monitoring/governance reporting. Act 1982

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Core function # / MoH issue Activity Key performance measures Whole-of-year progress and achievement against performance measures area 7.1.5 Capacity Produce annual Report completed by 31 The Bold Goal report was completed in April 2016. The report was delayed and cannot Development / internal monitoring October 2015. be compared to the first monitoring report completed in 2014. This is because, in 2015, Internal reports of the baselineUnder allocation for indicators for the RPH the MoH made a number of changes to the way Ambulatory Sensitive Hospital (ASH) all contracts Bold Goal (to halve the rates are calculated and reported, which have had an impact on the bold goal monitoring rate of avoidable hospital admissions for programme. Māori, Pacific and children by 2021) . Bold Goal monitoring The Bold Goal monitoring report was peer reviewed for user readability. report peer reviewedThe for user readability. 7.1.6 Capacity Monitor and report on Interactive activities tool The interactive activities tool (now known as the RPH Activities E-Tool) was uploaded Development / the number of planned uploaded by 30 June onto the RPH website in December 2015. The E-tool could not be updated until the RPH Internal activities in the annual 2016. Official allocation for business plan that 2015-2016 Business Plan was approved by the MoH in October 2015. all contracts focus on our priority areas (Māori, Pacific Analysis of activities that Analysis of activities that focus on our priority populations in the 2015-2016 business peoples and children). focus on our priority populations in the 2015- plan were peer reviewed by team leaders rather than those group managers who are 2016 business plan peer also action plan line managers. reviewed by action plan line managers. Information 7.1.7 Capacity Management of the All issues raised are All issues have been logged and actioned appropriately. Development / office spaces occupied logged and actioned Internal by RPH staff. appropriately. allocation for all contracts Issues are repaired within Issues are repaired within the expected timeframes. Issues that require action from the the expected timeframes landlords are raised with them, and we continue to follow up outstanding issues.

7.1.8 Capacity RPH meets minimum Number of Māori and Five Māori and Pacific scholarships were awarded to RPH staff to undertake tertiary Development / standards for Pacific scholarships Internal workforce awarded to RPH staff to training in public health. allocation for development; including undertake tertiary Act work to increase RPH training in public health. 1982

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Core function # / MoH issue Activity Key performance measures Whole-of-year progress and achievement against performance measures area all contracts staff public health Percentage of staff with a As at September 2014, 49% of staff considered in scope for the Ministry of Health qualifications towards public health qualification qualification goal, have completed a public health qualification (a further eight staff were the MoH goal of 75% Under(broken down by and the offering of Māori/non-Māori) in training making 59% in scope staff either having completed or in the process of scholarships to Māori completing a public health qualification). We will be re-running this survey in August and Pacific staff. 2016.

7.1.9 Capacity Development of Resources developed and Carried over to 2016-2017. Development / resources to assist line loaded onto theThe RPH Internal managers when intranet page by August allocation for orientating new staff. 2015. all contracts Peer reviewed by line Carried over to 2016-2017. managers. Official 7.1.10 Capacity Influence and support Number of 13 meetings were attended (3DHB: Immunisation: 2; HVDHB: LTC: 4; Child Health: 4; Development / DHB and primary care DHB/PHO/Service Level Internal to take public health Alliances meetings Acute Demand: 3). allocation for approaches. attended. all contracts Percentage of Primary 82% (9/11) Primary Health Organisation Advisory Group meetings were attended. Health Organisation Advisory Group meetings Information attended.

Action Plan 7.2 Māori action plan

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.2.1 Capacity Whanaungatanga - Hui annually with Iwi RPH Leadership Group is to explore and initiate; contacts have been established through Development / Relationships: leaders. Act Internal Working closely with the Māori governance Boards for each of our three DHBs. allocation for all Māori critical to RPH contracts Utilise feedback from hui contributing to To be met once initial Hui with Iwi leaders is completed. to inform on-going improving Māori 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

health and reducing programmes, approaches, inequities. As an funding streams, events organisation RPH and planning. wants to be Under dependable and reliable in relationships with Māori. Existing relationships with Iwi and Māori health networks are a vital The and valuable taonga to be cherished and nurtured. 7.2.2 Capacity Workforce All employment ToOfficial date, all RPH vacancies are now promoted through Māori specialist websites. The Development / development - Being opportunities are Internal comfortable and promoted directly to Iwi Workforce Development Plan is currently under review with an expectation that this allocation for all confident working and Māori health provider practice can be incorporated into future practices. contracts with Māori and networks. making practical connections is Ensuring recruitment All RPH vacancies are now promoted through Māori specialist websites. Discussions to processes encourage important to improve templates on job advertising to include te reo Māori mihimihi (greeting) is effective public Māori to work at RPH. Information health practice. RPH progressing. wants us all to grow and be empowered. Providing a platform of information, guidance, training and opportunities to learn from others will help everyone to work more effectively with Māori and will Act strengthen relationships. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.2.3 Capacity Accountability - RPH A Hui-a-RPH is held Has been delayed and to be considered by the RPH Leadership Group. Development / wants to deliver annually to critically reflect Internal great services, all of on and improve RPH allocation for all the time. Part of performance for the Māori contracts Under achieving this community. includes having effective RPH set stretch goals and Has been delayed and to be considered by the RPH Leadership Group. mechanisms to targets for our encourage and performance, and monitor strengthen the our progress. accountability for The Māori health. In particular, seeking feedback from Māori on RPH services and improving RPH Official practice as a result will enhance relationships and increase understanding of how RPH might make a tangible difference. Information 7.2.4 Capacity Communication - Quarterly communications The decision was made to move from quarterly to weekly communications on Māori Development / RPH wants a are sent to RPH staff. Internal cohesive service issues, articles, news and research. Communications have been regularly emailed to staff allocation for all where staff trust one over the past four months. contracts another and work with each other to Sharing and promoting Information is regularly shared from hui attended by RPH staff through reporting or other information from our achieve outcomes feedback mechanisms. for Māori. RPH wants Māori stakeholders across to be transparent, the service. inclusive and accountable to each other and for Māori Act health. To support this, strong and proactive internal 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

communication and feedback mechanisms are essential. Under 7.2.5 Capacity RPH - The intention Highlight quarterly a Reporting is currently progressed through internal staff seminars, meetings and special Development / of this action plan is positive change made Internal to implement and within RPH. focus weeks. allocation for all embed service-wide contracts components of the Feedback from RPH staff Feedback from RPH staff has come through two channels. The first was through a demonstrates the Māori Strategic Plan. The comprehensive Staff Engagement Survey that specifically featured the Māori Strategic The initial action plan integration of the Māori will focus on Strategic Plan Plan for feedback. The second opportunity happened through ‘Change It Up Week’ that establishing an operationally. looks to staff making changes in work practice. Again the Māori Strategic Plan was internal discussed during this week. organisational Official cultural change that will integrate with future action planning.

Highlights Information Communications: The weekly Māori specific articles, items of interest and research. Wairarapa RPH staff develop the newsletter Pitopito Kōrero that highlights work.

Workforce development: Discussions to improve templates on job advertising to include te reo Māori is progressing. The Workforce Development Plan is currently under review.

RPH Māori name: Initial discussions have been held with Māori staff post external advice (HVDHB Māori Unit and Te Taura Whiri – Māori Language Commission) regarding an appropriate name. Talks will be held with external advisors to look at a process of integrating the name into full use. Act Issues, challenges, risks and actions taken Iwi and Māori health service providers: A planned schedule to facilitate meetings with Iwi leadership and Māori health service1982 providers is required.

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How might services be improved in the coming year Workforce development:  Discussions to improve templates Underon job advertising to include te reo Māori is progressing.  Refreshing the Workforce Development Plan will provide a positive platform to include Māori specific requirements.  More frequent engagement with the Māori governance Boards for the three DHBs will grow our understanding of issues for Māori in each district.

Action Plan 7.3 Pacific Peoples action plan The

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Increased understanding of the RPHs Number of action plans that clearly Not a compulsory requirement for RPH staff to integrate into plans. work with Pacific peoples. identify how their work impacts Official Pacific peoples. Public health workforce Number of RPH staff completing 34 staff completed Pacific cultural training in 2015-2016 financial year. strengthened to work with diverse cultural training. populations including Pacific communities. Information Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.3.1 Capacity Deliver Pacific Deliver or support two Second training session was postponed from April to June due to reduced Pacific staff Development / cultural Pacific cultural Internal competencies competency training capacity. allocation for all training for RPH sessions for RPH and/or contracts staff. DHB staff and/or other stakeholders by April 2016. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Evaluation feedback from Evaluation feedback from RPH Pacific cultural awareness training indicated an increase in RPH Pacific cultural awareness training cultural awareness amongst staff and other participants. Underindicates increased cultural awareness amongst staff and other participants. 7.3.2 Capacity Annual stocktake of Descriptive analysis on Activities completed. Development / servicewide activities pacific prioritisation Internal that affect Pacific allocated to all RPHThe allocation for all communities. activities completed by contracts December 2015. Percentage of descriptive Unable to complete as there was a reduction in Pacific staff capacity. analysis used in a concept Official paper (on strengthening responsiveness to Pacific communities) to RPH Leadership team.

Highlights Information The stocktake work has led to the development of an online portal for public enquiries about a range of RPH work including its work with Pacific communities.

The Wairarapa Pacific Cultural Training session in August 2015 received very positive feedback from all staff who participated.

Issues, challenges, risks and actions taken The number of resignations of experienced and qualified Pacific staff over the last five-years continues to be a risk to the service. Proactive recruitment of appropriately experienced and/or qualified Pacific staff. Act

How might services be improved in the coming year 1982

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How might services be improved in the coming year A commitment to improving our responsiveness to the health needs of Pacific people should be made more visible. Suggest the following changes: 1) Our standard recruitment approach includes advertising on Pacific websites as well as mainstream options, and seeking applications from appropriately experienced or qualified Pacific staff, Under 2) Continuing to offer Pacific cultural competency training to all staff, and 3) Quality assurance standards and/or audit tools to include a Pacific responsiveness measure for service delivery. The Pacific action plan is a service-wide plan that relies on comprehensive systematic support from across the whole service for it to be effective over time.

Action Plan 7.4 Strengthen public health governanceThe

Short term outcomes Short term outcome indicators WholeOfficial-of-year progress and achievement against outcome indicators RPH has in place a quality The leadership team agree that the Four quality improvement projects were completed including (1) revised Standard improvement programme that is completed quality improvement informed by the RPH public health projects have resulted in tangible Operating Procedure (SOP) for completing a RPH Standard Operating Procedure; (2) governance framework and improvements to the quality of the revised SOP for Vertebrate Toxic Agent Document Management System; (3) Seven comprises assessment against public related services provided by RPH. revised School Health and Immunisation group SOPS; and (4) a report on the use of the health standards; identification of areas for improvement, and HealthScape data system by the PHCD Group. A further five projects are in still in completion of quality improvement progress. Information projects.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.4.1 Capacity Implement a three- Performance assessment A further three performance assessment tools were completed. There are six remaining Development / yearly quality tools completed for the 10 MoH core assurance domains by 30 June 2016. tools to be revised from the American CDC versions. contract generic programme to assess RPH performance Reports, produced from A quality assurance report was accepted by the RPH leadership team on the assessment assessment of selected against public health area ‘Diagnose and investigate health problems and health hazards’. standards (standards domains, are accepted by Act and assessment tools RPH leadership team. adapted from the 'National Public 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

Health Performance Standards of America'). Under 7.4.2 Capacity Implement quality At least one quality Nine quality improvement projects were identified from the RPH groups and the medical Development / improvement improvement project is MoH core projects that address identified for each RPH team. contract generic gaps identified in the group and the medical assessment of RPH's team (minimum of five level of achievement projects in total) by 30 against the standards September 2015. The of public health practice. Quality improvement Nine projects were initiated to address identified gaps, and were agreed with the public projects address identified gaps and are agreed with health governance working group. 44% (4 of the 9) of these were completed. It is likely the working group. theOfficial majority of these will be completed in the 2016-2017 year. 7.4.3 Capacity Align RPH continuous Number of joint RPH and Two joint RPH and DHB quality alignment meetings were attended. Development / quality improvement DHB quality alignment MoH core activities to DHB meetings attended. contract generic quality and risk systems. Evidence of alignment Examples of alignment between RPH and DHB quality systems include: March 2016 between RPH and DHB presentation to 3DHB Clinical Governance Board; and RPH included in roll out of quality systems e.g. Information initiatives submitted for upgraded electronic 3DHB event reporting system. HVDHB certification audits were DHB annual quality focused on the hospital setting only and therefore did not include RPH. account; nominations for DHB quality awards, participation in DHB certification audits.

Action Plan 7.6 Public health analytical services

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicatorsAct 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators The Business and Analytical Support Feedback from user survey shows The BASU analytical team carried out a user survey in June 2016. 88% of respondents Unit (BASU) will have a valued role service is valued by the organisation within RPH with a reputation for and contributing to service delivery. who had used a BASU service or product rated it as useful or very useful (mean of 4 on a providing good quality analytical scale of 1 to 5). 50% of respondents were very satisfied or extremely satisfied with the support, making things easier, Under service. A further 36% were satisfied (mean of 3.5 on a scale of 1 – 5). The team are still in anticipating service needs, supplying what is needed and developing the process of analysing the results, to learn how we can continue to improve our service. innovative solutions.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area The 7.6.1 Capacity Use evidence based A major analytical project A major analytical project for the team this year was the Hutt Valley Youth Survey. The Development / research and which focuses on RPHs MoH core evaluation to priority areas is identified survey was completed by more than 4000 young people in the Hutt Valley and analysed contract generic develop and improve by August 2015. Evaluation toOfficial learn about knowledge, attitudes, behaviours and priorities of our local youth. The public health project completed by June overall (peer reviewed) report was launched at the end of March to a large turnout of programmes and 2016. interventions. youth provider networks, Hutt Valley councils and NGOs. We are in the process of finalising tailored reports to local schools.

Selected project is clearly The Hutt Valley Youth Survey is clearly aligned with our RPH priorities and the report was aligned to RPH priorities Information and report is peer peer reviewed and published as per our RPH SOP. reviewed. 7.6.2 Capacity Develop appropriate Number of processes and Two processes/tools were identified. The team developed an Incubation Calculator for Development / information tools identified and MoH core technology strategies implemented to the team investigating and responding to measles outbreaks. We have nearly completed contract generic to enable effective streamline service a resource for RPH staff who are contemplating surveys or evaluations, including a communication, delivery. section on streamlining the process of carrying out community event evaluations. monitoring and reporting of public Client feedback that new Feedback from clients about the Incubation Calculator is that the tool has been very health information. process supports service useful and is now “fundamental to their response”. delivery/work. Act 7.6.3 Surveillance / Contribute to New community profile The new profile template (which includes Māori non Māori comparisons) has been MoH core regional and local template developed by developed. We are in the process of looking at ways to further streamline the process of contract generic understanding of December 2015. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area population health populating the template with data, and developing an interactive interface to allow users status, health needs and risk factors with to build their own profiles. a particular focus on UnderProfiles will include Māori health equity and the The new profile template includes Māori vs. non Māori comparisons for housing health indicators (and health f Māori. have a greater emphasis ownership. on understanding Māori health status). 7.6.4 Surveillance / Transform data into At least one project The team are working with clients on the format for a user friendly small area version of MoH core useable public health identified and underwayThe contract generic intelligence products by December 2015. the Hutt Youth Survey results. The intention is that this product will support community to meet the needs of groups with their planning and policy processes. relevant end users. Project process and TheOfficial development of the small area profile involves active consultation with Community development involves active and on-going Action Youth And Drugs advisors. consultation with stakeholders. 7.6.5 Capacity Develop analytical Number of skills We delivered a series of four two hour training sessions to RPH staff about how to use Epi Development / capacity and development activities Info 7 to analyse data. Our senior analyst also worked with two members of the Schools MoH core capability. provided. Information contract generic and Early Childhood team to develop their skills in qualitative data analysis as part of an evaluation.

Positive evaluation There was very positive feedback from all the sessions and a request for the programmes feedback from training sessions. to be offered again.

Action Plan 7.8 Communications support and health information dissemination

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicatorsAct 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Wellington's population can access Evidence show that an increasing The health information service received 1,713 requests either via the Health Ed website health information. number of people are accessing public health information via either or by visiting the resource centre. Visitors to our website are tracked using Google the RPH website or the health analytics. This grows steadily each month. informationUnder service.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.8.1 Capacity Support RPH staff Contact lists are updated, Contact lists for all schools (primary and secondary), early childhood centres and te Development / with all accurate and availableThe on MoH core communication HealthScape. kōhanga reo have been integrated into HealthScape and are being used to disseminate contract generic activities. public health alert information.

Staff are aware of how to Pre-defined lists have been created in HealthScape so staff can easily access the list they access and use the RPH Official contact lists via require. Staff have also been advised via the RPH weekly notices, how to create their HealthScape. own customised lists.

7.8.2 Capacity Maintain the RPH Statistical analysis on the A report is provided each month, using Google analytics. This report shows the number of Development / website. RPH website measuring MoH core traffic will be provided visitors to the RPH website and the number of page views. contract generic through Google analytics. Information Google analytics shows the Visitors to the RPH website have been increasing steadily each month throughout the website is being used to access public health period. Page views relating to topical information are consistent with the current information. environment (i.e. during the recent measles outbreak, measles related information on the RPH website featured in the top 5 most visited pages).

7.8.3 Capacity Distribute resources A minimum of 10 Nine newsletters have been distributed via email to our stakeholders. Development / within the greater newsletters are MoH core Wellington region distributed. contract generic and update stakeholders on All resources are All resources have been distributed to stakeholders within five working days. distributed to stakeholders revised, deleted and Stakeholders are notified if the resource requestedAct is on backorder. new resources. within five working days, or notified that resources are on back order. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 7.8.4 Capacity Maintain an effective Weekly resource stocktake Stocktakes are completed weekly to maintain a fully stocked resource centre. Development / and efficient health identifies what resources MoH core information service. are to be ordered. contract generic Under The resource centre The resource centre is fully stocked and restocked with up-to-date resources. maintains an adequate level of health information resources.

Action Plan 7.9 Central region public healthThe advice (Schedule D)

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Official 7.9.1 Capacity Provide specialist Number of instances No requests for support have been made. RPH was on standby to provide staff for the Development / and technical public where support has been MoH core health advice for requested and provided in Mid Central measles outbreak. contract central region public response to outbreaks. schedule D health units. Requester reports N/A. satisfaction with the response provided from Information RPH. 7.9.2 Capacity Facilitate and lead RPH actively supports the RPH supported and attended 100% of the six monthly Heath Protection managers Development / collaboration with Central Regional Health MoH core the central region Promotion/Protection meeting and quarterly Health Promotion managers meeting. contract public health units Manager Network through schedule D through Central supporting and attending Region Public Health at least 80% of network Clinical Network meetings. (CRPHCN) including active participation CRPHCN endorses the This network work is on the CRPHCN work plan which is reviewed during the monthly work of this network. on the health teleconference. Act protection and health promotion manager’s networks 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

and the smokefree network. 7.9.3 Capacity Provide specialist UnderRPH represented at 80% of RPH were represented at 100% of NPHCN meetings. Development / public health advice National Public Health MoH core and/or Clinical Network meetings. contract representation to schedule D the Ministry of RPH actively supports the RPH maintains the coordination contact. Our service manager is an active member of the National Public Health Health or other steering group and we also have two clinical staff members on the Alcohol regulatory relevant central Clinical Network. government The working group and the long term conditions working group. agencies. 7.9.4 Capacity Take a lead in joint Facilitate the delivery of at RPH facilitated the delivery of a Central Region Health EMIS training which was delivered Development / central region public least one annual training 11 June 2016. MoH core health unit's course for the central Official contract capability planning region public health units. schedule D for emergency response, including Course evaluations show Course evaluations are currently being reviewed. providing annual that participants were training to other ‘satisfied’ or ‘very public health units. satisfied’ that the course achieved its objectives. Information 7.9.5 Capacity Finalise framework Central region health Framework has been trailed and currently is being implemented for all health protection Development / for assessing health protection officer MoH core protection officer competencies framework officers. To date RPH and Hawkes’ Bay have submitted their portfolios. contract competencies within trialled by December 2015 schedule D the central region. and implemented for all health protection officers in the central region by June 2016. Framework is signed off by As per above. the CRPHCN. 7.9.6 Capacity Lead the e-referral Electronic form developed This project is now being led by ESR and the pilot isAct expected to be run in February 2017. Development / project to develop an by December 2015. MoH core electronic contract notification system Project successfully piloted See above. with selected primary care 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

schedule D between primary providers and receives care and public their on-going support to health units for all move into widespread roll- notifiable diseases. Underout. 7.9.7 Capacity Build regional Number of primary health One Māori/Pacific health care provider (Whai Oranga Health Centre) agreed to promote Development / collaborations and providers for which RPH MoH core enhance consistency has promoted the the resource to their patients. contract in use of key public gastroenteritis resource. Wairarapa, Hutt Valley and Capital & Cost DHB Emergency Departments are promoting schedule D health messages and the resource with parents of unwell children. The resource has been added to the 3D information systems. The Health Pathways.

Evaluation on uptake of A formal evaluation of the resource has not occurred. However feedback from Whai the resource. OrangaOfficial Health Centre has said the resource is: • Clear and easy to follow • Concise/informative, all information in one place The information in the resource easily enabled parents to quickly understand the required fluid intake for their unwell child.

7.9.8 Capacity Support Central RPH resources the Unit RPH resources the unit manager role. Development / North Island Drinking manager role. Information MoH core Water Assessment contract Unit administration Central North Island Achieved. 16 June 2016 RPH completed the audit for on-going accreditation. schedule D centre. Drinking Water Assessment Unit maintains is IANZ accreditation.

Highlights

Annual IANZ Assessment of the Central North Island Drinking Water Assessment Unit (CNIDWAU) The annual IANZ Assessment once again reflected the commitment and passion of its members. The auditor spent twoAct weeks visiting/auditing five of the six branches and also undertook the initial signatory assessment of two Drinking Water Assessor trainees and the signatory reassessment of two current Drinking Water Assessors (DWAs). The auditor did not identify any major issues at any of the branches or the Inspection Body,1982 in fact CNIDWAU was

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complimented by the auditor for stepping up to the next level and demonstrating a highly efficient and effective drinking water assessment unit, supported by the commitment of the six PHU Managers and the passion of the units members. The auditor was very complimentary of all hosting branches and commended the knowledge and experience of the units DWAs including the two newly assessed Trainee DWAs. Under Schedule B – Promote the health of refugees

Refer to action plan 1.5. The Schedule C – INH services for refugees

Refer to action plan 1.5. Official

Schedule D – Central region public health advice and support

Refer to action plan 7.9. Information

Act 1982

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Financial summary (Core contract – Schedules A, B, C and D)

Regional Public Health (RPH) completedUnder the 2015-2016 financial year with an overall negative variance (overspend) of 1.6% against total Ministry of Health funding. The overall variance equates to $135,144 and consists of a $90,103 positive variance (underspend) against core contracts, and a $225,247 negative variance (overspend) against non-core contracts.

This result can be understood as follows: The With the signing of a new three year contract for 2016-2018, the Core contract schedule A has been realigned to reflect RPH’s planned activities.

With respect of the schedules B and C Refugee – a surplus has been returned because additional funding has been provided to address the additional costs for Public Health services to support Syrian refugees and migrants. OfficialIt has been difficult to separate out some refugee costs from the Communicable Disease services line which shows a significant negative variance.

While there are limitations to the degree of precision achievable in allocating FTEs and staff costs against individual funding lines, we continue to invest significant resources in ensuring accurate financial reports across the variety of funding lines RPH receives. We remain confident that the reports on the following pages demonstrate responsible and appropriate use of public funds. This is consistentInformation with our goal of developing and delivering a wide range of health promotion and health protection programmes to influence decision-makers to consider public health outcomes for people in the greater Wellington region.

Act 1982

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Health Year-to-date Public health Year-to-date Year-to-date assessment Health Health Preventive Service line contracted capacity spend variance and promotion protection interventions funding development surveillance Physical Environment Under$633,730 $939,740 -$306,010 $939,740 Communicable Disease $1,785,754 $2,117,826 -$332,072 $2,117,826 Social Environment $79,851 $0 $79,851 Alcohol and Other Drugs $706,528 $661,829 $44,699 $661,829 Tobacco Control $1,576,486The $1,195,217 $381,269 $1,195,217 Nutrition and Physical Activity $60,000 $0 $60,000 Sexual Health $746,860 $575,119 $171,741 $298,274 $276,845 Mental Health Promotion $134,083 $147,507Official -$13,424 $147,507 Injury Prevention $874,895 $858,290 $16,605 $295,413 $562,877 Public Health Infrastructure $483,237 $621,928 -$138,691 $621,928

Sub Total - MOH Core contract Schedule A $7,081,424 $7,117,458 -$36,034 $298,274 $572,258 $1,994,141 $4,252,784 $0 Refugee and Asylum Seeker Health $275,344 $226,231 $49,113 $226,231 INH -Wellington Region - Refugee Health Information Central Region Public Health Advice $114,470 $37,446 $77,024 $37,446

Sub Total - MOH Core contract Schedule B, C and D $389,814 $263,677 $126,137 $0 $37,446 $0 $226,231 $0 Total - MOH Core Contract $7,471,238 $7,381,135 $90,103 $298,274 $609,705 $1,994,141 $4,479,015 $0

FTE per Programme - MOH Core Contract 63.55 2.65 5.33 17.54 38.03 0.00

Total - MOH Non Core Contracts $1,198,977 $1,424,224 -$225,247 $0 $160,490 $849,009 $117,903 $296,821

FTE per Programme - MOH Non Core Contracts 8.14 0.00 1.34 4.99 0.31 1.50

Total - MOH All Contracts $8,670,215 $8,805,359 -$135,144 $298,274 $770,195 $2,843,151 $4,596,918 $296,821

FTE per Programme - MOH All Contracts 71.69 2.65 6.67 Act22.53 38.34 1.50

1982

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Financial breakdown for schedules B, C and D

Schedule B and C: Refugee and asylum seeker health and INH services

UnderActual Budget Variance

Personnel cost $136,921 Direct cost $43,939 Indirect cost $45,371 Total Schedules B and C $226,231The $275,344 $49,113

Schedule D: Central region public health advice Official Actual Budget Variance

Personnel cost $30,428

Direct cost -$46 Indirect cost $7,064 Information Total Schedule D $37,446 $114,470 $77,024

Act 1982

Contract: 353575/00 Provider: 102501 Regional Public Health annual report for Ministry of Health 1 July 2015 – 30 June 2016 Page 70 Released APPENDIX

Regional Public Health School Health and Immunisation Group Action Plan Report Under 1 July 2015 – 30 June 2016

Action Plan 1.6 Work with schools to identify and address health needs

Short term outcomes Short term outcome indicators The Whole-of-year progress and achievement against outcome indicators Work closely with Whanau Ora Improved access to health care and Health Education delivered specifically to Te Kura Kaupapa in Porirua and the Hutt Valley. groups. health literacy for Māori children and Relationships strengthened with Māori Health providers. whanau.

New entrant assessments offered for Identify children's un-met health 80%Official of children in decile 1-3 schools who did not complete a B4SC were offered the children who have not completed a needs and refer to appropriate Before School Check (B4SC), with a service providers (recorded in public health nurse New Entrant Assessment. There is on-going contact and health focus on decile 1-3 schools and other Concerto). intervention to address unmet health needs in this group of children. vulnerable children, including Māori, Pacific and refugee children.

Proactive health approaches with Projects (recorded in HealthScape). PHNs engaged with community action programmes focussing on the health needs of Māori, Pacific and refugee/migrant Intervention that addresses and/or Information and other vulnerable communities. improve gaps in service for Māori, vulnerable communities e.g. Wainuiomata and Titahi Bay. A joined up approach with Pacific and refugee/migrant disease control nurses to address the health needs of new refugees and migrants. communities.

Engagement and collaboration with Referrals from Māori/Pacific Regular meetings and developed relationships with NGOs and education staff result in Māori providers, nongovernment providers (NGOs), SWIS and schools organisations (NGOs), Social Workers leading to early improved outcomes. In Schools (SWIS), Child, Youth and intervention/prevention (recorded in Family, Porirua Social Sector Trial, Concerto). PHO outreach and Pacific providers. Whanau supported by Māori/Pacific providers leading to increased attendance at scheduled health- related appointments. Act

1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.6.1 Preventive Personal health Provision of time to school Weekly PHN visits to decile 1-3 schools result in personal health referrals which are Interventions referrals received as per the SHIG needs actioned appropriately. / Not MoH and health concerns based delivery models. core contract addressed. Under There were 2175 new referrals for the Wellington region: CCDHB – 1108 HVDHB – 912 WDHB - 155

Feedback from individual At time of E3 Appraisal, feedback from schools is requested for each PHN. Consistent schools, regardingThe quality of SHIG service, is positive feedback is received. collected by team leaders. 1.6.2 Preventive Raising awareness, All consented children X 2 weekly throat swabbing and supply of treatments in the 12 Eastern Porirua schools Interventions / throat swabbing and with sore throats who self- Official Not MoH core treatment for group refer to public health continued until late Term 2, followed by the transition process to free community based contract A strep (GAS) in nurses/community health clinics available all year round. These schools also received “Sore Throats Matter” class twelve East Porirua workers have their throat room education and notices in school newsletter. Key messages were displayed in local schools provided swabbed. Treatment is through a primary supplied by the public swimming pool, Porirua District Court and local libraries. care partnership health nurse or the child is model with Compass referred to primary care. Health. Information All children with +GAS 144 courses of antibiotic treatments for Group A Strep were supplied. 16 children with throat swabs are supplied with antibiotics by the multiple positives were referred to GP for assessment and treatment. These were public health nurse as per delivered at a home visit, within the timeframe, along with a sticker chart and the protocol and within information to reinforce adherence. the 48 hour time frame. 1.6.3 Promotion / The rheumatic fever Public health nurses have All schools in the Hutt Valley were provided with rheumatic fever prevention messages in Not MoH core awareness raising key rheumatic fever contract programme in the messages and provide newsletters. All decile 1-3 schools in the Hutt participated in classroom activities Hutt Valley involves rheumatic fever promoting “Sore Throats Matter”. working with primary awareness raising. Act and secondary services to support Improving community At least four engagements with Te Awakairangi Health Network to collaborate in education and awareness and 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area information. collaboration resulting in promotion with Hutt pharmacies around the rapid response clinics. children accessing sore throat clinics. All Hutt Underpublic health nurses are skilled to deliver rheumatic fever messages. 1.6.4 Preventive New entrant 80% of children in decile 1- The percentage of New Entrants Assessments completed was lower in CCDHB due to the Interventions / assessments offered 3 schools who did not Not MoH core to children in decile attend B4SC are offered a prioritised work with the rheumatic fever throat swabbing programme. contract 1-3 schools who do new entrant assessment.The not complete a B4SC. New entrant assessments 58 New Entrant Assessments in decile 1-3 schools were completed in the Wellington are documented in Concerto. region, with the majority from the Hutt Valley. Referrals to external Official providers are completed for children with un-met health needs. 1.6.5 Promotion / Health promotion Population health focused 2 local community events attended - Te Ra in the Hutt Valley, and Creekfest in Porirua, Not MoH core and population health promotion activities contract health focused provided by public health and at least 20 parent/teacher evenings across the Wellington region. activities support nurses are documented on Information and address public HealthScape. health priorities. Key health messages are In Porirua, the PHNs work closely with the Porirua Social Sector Trial reinforcing 5 key reinforced within the school and community. health messages – hand washing, healthy skin, sore throats matter, tooth brushing, and the use of the 0800 Healthline.

1.6.6 Preventive Integration and SHIG staff reporting, using HealthScape captures health promotion and networking opportunities. Personal health Interventions / collaboration with HealthScape and RPH Not MoH core Māori, Pacific, Concerto, documents referrals are captured on Concerto patient management system. contract refugee and other engagement and providers. collaboration. Act Feedback obtained from Positive feedback on collaborative work received from services e.g. Te Awakairangi providers about positive Health Network, Compass Health, Paediatric departments, Child Development Service, and meaningful 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area engagement. dental and audiology.

1.6.7 Preventive Prevention, Concerto documentation All personal health referrals for skin infections are documented in Concerto patient Interventions / identification and Underof referrals for skin management system. Not MoH core treatment of skin infections. contract infections in children in decile 1-6 schools Review of all skin standing Issuer for the Standing Orders for treatment of skin infections reviews each use of the order nursing notes by and other vulnerable Standing Orders. children in higher standing order issuer for decile schools. children with skin Annual review and submission to the Medicines Committee of Standing Orders infections. AnnualThe completed. education update for public health nurse users New PHNs have successfully completed Massey modules online. of skin standing orders. All public health nurses successfully complete Official Massey University online education modules and tests prior to approval of use of standing orders. 1.6.8 Preventive Child advocacy and All public health nurses All 27 PHNs including team leaders and clinical nurse specialist have Section 125 Interventions / protection. have Section 125 Not MoH core authority. Reports of authority. Reports ofInformation Concern have been documented in Concerto. RPH is represented contract concern are documented by PHNs in CYF Community panels in CCDHB (Central Wellington and Porirua) and HVDHB on Concerto. Public health (Hutt City). nurses contribute to government initiatives that protect children e.g. White paper and VIKI and the Hub. Selected public health nurses attend CYF community review panel meetings in each area. VIP training completed by All staff including new PHNs have completed the HVDHBAct VIP training. Group updates also SHIG staff. Family violence screening is completed provided by the VIP nurse specialists. PHNs screen for family violence when appropriate. when appropriate and Often children are present; therefore screening is not completed1982 at this time. This is

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area audited by clinical nurse reflected in the audit results. The audit was completed with SHIG clinical nurse specialist specialist and VIP coordinator. Staff have and Expert Level 4 PHN. Underknowledge of CYF referral At least 4 audits for family violence screening completed. processes and child 21 Report of Concern notifications were made to CYF by the SHIG Group. protection networks. A whanau ora approach facilitates effective intervention. The Highlights Staff presentations of our work at New Zealand Paediatric Society Conference and New Zealand Nurses Organisation Conferences. Work of staff also highlighted in the MSD “Rise” magazine. Official

On-going work with the Porirua Social Sector Trial, focussing on reducing hospitalisation.

Two successful “Connecting the Valley’s Children” Hui in the Hutt Valley, with 70-90 participants from a wide range of community services.

Rheumatic fever awareness raising in the Hutt Valley promoted “Sore Throats Matter” message on the back of two Hutt Valley buses for a month. The bus routes were through high needs communities e.g. Wainuiomata, Stokes Valley, Taita, Naenae,Information and Epuni.

Issues, challenges, risks and actions taken In decile 1-3 schools, children who have completed a B4SC with the Plunket programme often start school without identified health needs addressed. PHNs actively follow up referrals that were made prior to starting school.

Completion of the rheumatic fever throat swabbing programme in schools. Provision of a smooth transition towards free community clinics with emphasis on health knowledge of the community and on-going “Sore Throats Matter” awareness.

Staff identify gaps in referral criteria to specialist services e.g. CYFS, Child Development and Child Mental Health services.Act To address these challenges, team leaders and staff have been working with other providers to ensure actions are taken to support vulnerable children. 1982

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How might services be improved in the coming year An audit on the Child Protection “concerns” in the nursing referrals.

Further development on the Care PathwaysUnder for Referrals to align with 3DHB Pathways and other community service provider pathways.

Potential for growth of the PHN in preschool settings if there is FTE or contracts to support this early intervention opportunity.

Other comments The Potential for growth of the PHN role in preschool settings if there is FTE or contracts to support this early intervention opportunity.

Action Plan 1.7 Improving vision and hearing Official

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Porirua Children's Ear Van is well Survey shows knowledge of the Survey timeframe extended until June 2017. Survey questionnaire is in process of being known to the community. service. sent out. Regular referrals receivedInformation by GPs. Target schools with high Māori and School visiting target met for Māori Regular visits to Māori and Pacific preschools are scheduled and delivered. Pacific children. and Pacific.

Year 7 vision checks. Completed Year 7 screens. The school year begins early February and ends mid December. In 2015, all schools with Year 7 students were visited by the vision hearing technicians.

Support Plunket to reach the B4SC Target met and new entrants Between January and December 2015 of the school year, all new entrants identified have targets as set by the Ministry of screened as required. Health. had a vision and hearing screening at school. Act Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.7.1 Preventive Deliver National Between 95-100% of 4 Between 1 July 2015 to 30 June 2016, at least 99% of four year olds that completed a Interventions / Vision Hearing year olds referred by Not MoH core Screening Plunket as part of the B4SC B4SC were referred to the VHT for vision and hearing screening. contract Programme. Underprogramme will be completed. Plunket report regular Vision hearing technicians (VHT) have attended Plunket B4SC Coordinators in Capital & attendance of vision and hearing technicians (VHTs) Coast and Hutt Valley DHBs at least 4 times. at B4SC clinics. The 1.7.2 Capacity VHTs will use the At least 90% VHT 90% of the VHT workforce completed the RPH peer review competency assessment tools Development / 2014 national workforce will complete Not MoH core protocols for initial peer review. for vision and hearing. All participants valued the review process. contract screening. VHTs report positive See above. experience of the peer Official review process. 1.7.3 Promotion / Closer links with At least four meetings per CCDHB and HVDHB VHTs attended at least 4 meetings. Not MoH core integrated care year with B4SC providers. contract partners i.e. public health nurses, B4SC providers report VHT Reports show evidence of VHT participation to at least 4 meetings. Plunket, PHOs, attendance at meetings. Tamariki Ora, Porirua Information Children's Ear Van, early childhood centres (ECC) and schools. 1.7.4 Surveillance / Evaluation of the 3 Report will be available by The 3 year tymping pilot evaluation was completed in August 2015, with group manager Not MoH core year old June 2015. contract tympanometry pilot and service manager sign off. in eight Kōhanga reo Group manager and in the Hutt Valley to service manager will sign assess effectiveness. off evaluation report. Act 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.7.5 Preventive Provide free mobile At least three ear nurse A minimum of 3 ear nurse clinics per week have been provided. Interventions / ear van service, clinics per week during the Not MoH core located in identified school term. contract high needs Under communities in Community is aware of Ear nurse clinics are well utilised. Porirua. regular ear nurse clinics. 1.7.6 Capacity Public health nurses Ear health training is This was not achieved. As a result of workloads, the PHNs have found it difficult to spend Development / are supported to delivered at least twice Not MoH core increase their ear yearly, with at least 50% time in the ear van to increase ear health knowledge. contract health knowledge RPH public health Thenurses and assessment spending time in the ear skills. van. Public health nurse 21 PHN referrals, all appropriate, were received in this last year. referrals to the ear van or Official other services are PHNs have been attending additional ear training with TOLBECs – Ears Made Easy, as well appropriate. Team leaders as hands on experience in the Ear Van. will identify ear health training as a priority. 1.7.7 Promotion / Establish strong links Monthly reports will show Kohanga reo visits have been established and are on-going. All Aoga Amata in the Porirua Not MoH core with Kōhanga reo evidence of engagements area have had 1 ear nurse visit with the second round of visits starting soon. Weekly visits contract and Aoga Amata with language nests. Information Pacific language Evidence of regular visits are provided to kohanga reo and Aoga Amata. nests in Porirua. to Kōhanga reo and Aoga Amata. Increased awareness from At each visit the ear van service is promoted and ear van service leaflets are being left at teaching staff and whanau/fanau of the ear preschools to help promote the service to parents. van service. 1.7.8 Promotion / Ear nurses to Meetings with The ear nurses have collaborative relationships with both B4SC and Tamariki Ora services. Not MoH core establish closer coordinators will occur at These informal meetings occur on a fortnightly bases. One of the ear nurses works as a contract working relationships least four times per year. with B4SC and Well Tamariki Ora nurse in her other position. Cross serviceAct employment supports client Child Tamariki Ora knowledge base. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area services in Porirua B4SC coordinators will Regular referrals received from the B4SC team. report positive engagement with ear Undernurses.

Highlights The implementation of Concerto has made it easier to track children across different venues, e.g. kindy, clinics and school. The implementation of Web pas that administers the earThe van service as a hospital clinic ensures children are followed up and therefore improve health outcomes. Creation of the VHT Competency Assessment tool to review practice.Official B4SC targets in HVDHB for Quintile 5 children were met for all quarters. CCDHB have met Quintile 5 target in quarters three and four.

Eight VHTs attended the biennial Vision Hearing Technicians Training Seminar hosted by Counties Manukau in February 2016.

Close working relationship with local te kohanga reo and VHTs to complete the 3 year tympanometry pilot. Planning and coordination of National Ear Nurse Study days in Lower Hutt (September Information2016) is in progress. An internal and external make-over of the Porirua ear van.

Issues, challenges, risks and actions taken Public health nurses (PHN) find it difficult to take time from their busy schedule to spend time in the ear van. Recommend that PHN identifies ear health knowledge gaps at annual performance review.

How might services be improved in the coming year Act Provide clinical opportunities for GP registrars in the community ear van. 1982

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Other comments Limitations of funding block replication of this successful early intervention service in Hutt Valley and Wellington City which also have similar identified needs. Under

Action Plan 1.8 Support for Work and Income clients to improve their health outcomes

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area The 1.8.1 Promotion / Develop links with Two marae meetings per Links made with Maraeroa , Horouta and Ngatitoa Marae. Not MoH core local marae. year. Documentation on contract HealthScape of Horouta – focus on social needs of clients. engagement and MaraeroaOfficial and Ngatitoa – focus on health needs of clients. attendance at other community events. Ongoing relationships that Porirua Social Sector Trial resources made available to Horouta to support health of support positive outcomes for clients and whanau Whanau. health and wellbeing. Horouta supported when housing local families at the time of a police siege . Maraeroa involved inInformation the annual Work and Income Health Expo. Individual Whanau supported with access to housing and health care. Individual clients linked for on-going health care services at Ngatitoa.

1.8.2 Promotion / Develop and Invite the three main Breast screening team have a strong link with Work and Income. Cervical screening also Not MoH core maintain a monthly screening programmes contract calendar of health (breast, cervix and promoted. events for the Work prostate) to set up Men’s health, in collaboration with the cancer society, invited to set up prostate and Income Porirua information at Porirua screening information for clients. Links office. Community Links. The screening providers Arthritis and gout services attend monthly. Act contribute to the monthly calendar of events and Breast screening attend monthly. engage with WINZ clients. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 1.8.3 Promotion / Develop and Meeting attendance PHN attends the Work and Income “Wednesday Brief”. This is a national meeting pattern Not MoH core maintain links with reported on HealthScape within the Ministry of Social Development (MSD). contract Work and Income and monthly reports. staff, management Under Monthly reporting includes connections with external agencies. and clients. Feedback from other Local PHOs affirming of the conduit provided by Work and Income PHN for their health providers of engagement. vulnerable clients. School based PHNs give positive feedback regarding additional support for families.

1.8.4 Capacity Support the work of Monthly reportingThe of On-going support of the Porirua Social Sector Trial documented. Development / the Porirua Social Porirua Social Sector Trial Not MoH core Sector Trial. stakeholder engagement. contract Porirua Social Sector Trial Work has included: supports public health Official nurse activities in the  support for targeted Whanau community.  promotion of medication pre-payment at pharmacies  access to funding for medication  review of court services in the family violence court  strengthening the Community links in Court (CLIC) worker health questions. 1.8.5 Promotion / Work with Work and Annual planning day to Annual planning dayInformation to reduce the number of job seekers attended and update Not MoH core Income staff to reduce the number of job knowledge of benefit changes and trends. contract reduce the number seekers. of job seekers by providing health Provide health input to Clients linked to health services, improving their work readiness. input. resolve health barriers to work.

Highlights A strong link with Whitireia nursing school has resulted in student’s growth of knowledge and experience of primary health care and public health. Presentation of Work and Income nursing role provided at Victoria University and for National Primary Health Care NursingAct Con ference. Work also highlighted in MSD Rise magazine and Kai Tiaki nursing journal. The relationship with Housing NZ has resulted in positive outcomes for clients. 1982

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Issues, challenges, risks and actions taken This is a 0.5 position and only in one site in the Wellington region. Expanding the role would expand the positive impact on the community. Under Action Plan 5.2 Promote and facilitate immunisation

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Robust infrastructure to support Increased numbers of authorisedThe All Authorised Vaccinators are recorded on a spread sheet and advised prior to the end regional vaccination delivery. vaccinators. date of the need to submit supporting evidence of on-going learning for re-authorisation. This year a further 50 health professionals have been awarded Authorisation for Hutt ValleyOfficial DHB. Effective immunisation promotion Datamart reports will show targets Overall for this year, all targets have been achieved or just below the target rate, which and delivery with a focus on high achieved. needs communities. has occurred for various reasons including; holiday periods, Influenza campaign, winter illness.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Information 5.2.1 Preventive Promote national Record the number of Interventions / immunisation targets events attended. Not MoH core through contract collaboration with Report actions taken to The acting immunisation coordinator has worked tirelessly to improve immunisation key stakeholders. achieve this task in monthly reports. rates within the DHB. Offering immunisation services to some GP practices that were unable to meet targets, as well as working with the practice staff to ensure that children are offered immunisation opportunistically. She has worked with the Paediatric ward of the hospital to ensure that children admitted and are overdue for immunisations are immunised before discharge. Act The immunisation coordinator has met with various stakeholders including PHO’s, Outreach Immunisation Services, Plunket, pharmacies and other1982 agencies to ensure that

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area better uptake has occurred.

5.2.2 Preventive Maintain Monthly reports will The immunisation coordinator has attended and presented at: Interventions / infrastructure for Underdocument attendance at Not MoH core immunisation immunisation education or 7 IMAC education sessions for vaccinators (nurses and pharmacists). contract delivery including training. 6 updates for primary health nurses, Occupational Health nurses and pharmacists. Local Immunisation 6 immunisation sessions for staff at HVDHB, Paediatric wards and SCBU. Programme (LIP). The coordinator has attended a 6 hour IMAC workshop, and 2 regional immunisation The coordinator meetings. Increased number of 50 extra authorised vaccinators have been approved in the last year. health professionals promoting immunisation and administrating Official immunisations. 5.2.3 Preventive Maintain cold chain 75% of vaccines fridges in All vaccine fridges in the Hutt Valley are either Cold Chain accredited or compliant. Cold Interventions / accreditation checks the Hutt Valley have Not MoH core for all HVDHB and receive cold chain Chain Compliances is used when fridges are new but awaiting the 12 weekly monitoring contract those with in the accreditation. requirements OR in the influenza season – this generally applies to Occupational Health Hutt Valley that providers, OR require follow up. provide Information immunisation. Fewer or nil cold chain Cold Chain excursions are reported. 1 Cold Chain failure occurred in December 2015 – issues have been reported. fridge expired – all vaccine stock was returned.

Highlights Establishing improved working relationships with all stakeholders – this includes DHB, PHO, GP and Outreach services as well as Plunket, Māori Health Unit, and hospital wards including – Paediatrics, SCBU, MAU, ED. Supporting MAU – Maternity Assessment Unit to establish Cold Chain requirements, policy and process – this includedAct purchase of a vaccination fridge and staff support. 1982

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Paediatric ward – daily communications with the ward. Advise ward of inpatients overdue for vaccination events. Support and encourage staff to vaccinate patients prior to discharge. The same applies for SCBU. Increasing numbers of nursing staff completing the Vaccinator Authorisation process. Similarly immunisation is promoted. Immunisations are administered prior to discharge or when the child is well enough. This contributes to increase DHB target rates for immunisation. Under

Issues, challenges, risks and actions taken Cold chain refrigerators and data loggers aging, to address these issues practice owners have been advised. Outreach service being understaff at times which impactsThe on the quarterly outcomes.

How might services be improved in the coming year It is frustrating that at times the DHB doesn’t meet targets, althoughOfficial so much work is done to reach the small numbers of children who are overdue. The coordinator is working with PHO managers to ensure that all practices are working to a given process, to offer support and advice in order to reach the targets.

Action Plan 5.3 Deliver Year 7 and 8 Boostrix and Gardasil vaccination programmes Information

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Improved awareness, prevention and Education sessions and Education sessions are offered to the majority of schools on Boostrix and Gardasil management of communicable and prevention/promotional immunisations. For the period 01/07/2015-30/06/2016 90 education sessions have been notifiable sexually transmitted programmes have been delivered. disease. delivered to school enrolled in the programme

Effective immunisation promotion Immunisation targets for high need Overall immunisation rates for high needs areas meet and often exceed targets. and delivery particularly in high communities will be met. needs communities Act 1982

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Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators

Improved understanding of the Increased numbers of children In the period July 2015-December 2015, Wellington school based programme met or immunisations intent to prevent receiving the immunisation via the cervical cancer in later years school based programme. exceeded targets for all three doses of HPV immunisation. However from February to July 2016 targets have not been met. This is not solely a Wellington region problem but Under several DHBs nationally have also experienced this issue. This may be due to negative media reports etc. All efforts are made to ensure that the child is immunised at some point, either with the School Based Programme or with their GP.

Education sessions which cover Increase in consent to immunise via This has not been achieved as the above comment outlines. prevention and promotion the school based programme. programmes have been delivered. The

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Official 5.3.1 Preventive Ensure that data Education sessions in All education sessions are arranged with schools enrolled in the Programme prior to the Interventions / entered is correct schools are planned and Not MoH core and transferred to implemented throughout school year commencement. All education sessions are recorded in HealthScape data contract appropriate the year. These sessions programme used by the DHB. databases: SBVS, will be documented. Wairarapa Excel spreadsheets and Positive feedback from Feedback is received from schools either verbally or in emails. As the programme has schools. Information NIR. been running for several years in the Wellington region, good strong relationships have been built and maintained with schools and staff and on the whole the feedback has been positive. If a negative comment is made then every step is taken to ensure that the issue is dealt with appropriately.

5.3.2 Preventive Promotion of the Education sessions in Education sessions completed prior to all clinics held. Interventions / Year 7 Boostrix and schools will be planned Not MoH core Year 8 Gardasil and implemented contract vaccinations through throughout the school schools and year. community settings. Documentation of dates of Act delivery will be available. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area Feedback from schools will be positive. 5.3.3 Preventive Deliver Year 7 UnderEducation, All of these areas are documented at each clinical visit. Interventions / Boostrix and Year 8 documentation, Not MoH core Gardasil vaccinations vaccination, recovery, cold contract in schools. chain, outreach referral and clinic leader. Monthly reports to Monthly reports are in-depth and show movement towards targets, or if not achieving manager, School Health Immunisation GroupThe issues are identified with a suggested solution when practicable. (SHIG) will show targets on track for successful delivery of programmes. Official 5.3.4 Preventive Cold chain Written evidence of Cold chain readings are recorded every day from the Immunisation Fridge as well as 30 Interventions / monitoring of all completed cold chain minute recording once the immunisations are transported in the chilly bins. Once the Not MoH core vaccinations to be documentation. contract done on a daily basis team return to base the chilly bin loggers are downloaded and the data is stored for as per RPH auditing purposes. Data Loggers are monitored monthly. immunisation policy and procedures Cold chain incidents will be There have been no Cold Chain incidents in this reporting period. manual. few or nil. Information

Highlights RPH and the team have maintained their level of education sessions and immunisation clinics.

Issues, challenges, risks and actions taken Introduction of HPV for boys will see an approximate increase of 25% of students eligible for this vaccine to the programme. We are working through all the logistics of this move including staff requirements, resources and expected resistanceAct by schools who don’t want the team there for long periods, disrupting the school day. 1982

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How might services be improved in the coming year Ensuring that those students who prefer to attend the GP for this vaccine are identified and the appropriate GP informed. Audits have been run to check if the student has been to the GP and approximately 50% of those who prefer the GP have attended. Under Action Plan 5.6 Deliver neonatal BCG vaccination

Short term outcomes Short term outcome indicators Whole-of-year progress and achievement against outcome indicators Attend local immunisation meetings. Recorded in quarterly reports.The The Neonatal BCG nurses attend local and regional meetings on a quarterly basis. Website should be updated to reflect current evidence based practice.

Provide education sessions regarding Recording of attendance at The Neonatal BCG nurses attend various immunisation education sessions throughout BCG services to key stakeholders. education sessions in quarterly Official reports. the year, talking to primary health providers, LMCs and DHB staff.

Effective immunisation promotion 90% of eligible infants receive BCG Over 90% of eligible babies were immunised during this reporting period. Shortage of and delivery, especially in high needs within six months of being identified communities. by lead maternity carer (LMC) or vaccine for five months prevented some babies being vaccinated within the six month other health care provider. timeframe; however these six babies were offered a Mantoux and BCG vaccination when the vaccine became Informationavailable in April.

Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area

5.6.1 Preventive Promotion of BCG Report engagements in The Neonatal BCG nurses have attended several education sessions and a maternity Interventions / service to maternal reports. Not MoH core and child health symposium during this reporting period. contract providers. Increased completed There has been an increase of enrolment forms completed in comparison to previous enrolment forms with years. The BCG programme administrator is in contact with LMCs and hospital maternity essential information. Act providers regularly to ensure that the forms are completed and forwarded. 1982

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Core function / # Activity Key performance measures Whole-of-year progress and achievement against performance measures MoH issue area 5.6.2 Preventive Providing adequate Number of babies referred Adequate service is provided to ensure that eligible babies are vaccinated in a timely Interventions / service for the compare favourably with manner. When required other gazetted nurses are recruited to assist with large numbers Not MoH core number of referrals monthly birth lists. contract to the BCG service. Under of babies who need to vaccinated, as in April and May when vaccine became available for a short period of time.

Ensure open The Neonatal BCG nurses have good rapport with all maternity units in the region as well communication with LMCs to ensure all babies are as many of the LMCs. LMCs are contacted if there are errors or missing information on referred. The the enrolment forms.

Highlights The amazing work carried out in April and May 2016 when BCG vaccineOfficial became available after 5 months of no supply. In that two month period 576 babies were vaccinated in the Wellington region.

Issues, challenges, risks and actions taken The lack of vaccine is the biggest risk. The BCG nurses are highly professional and diligentInformation in their given field and are being utilised elsewhere until vaccine is available again.

How might services be improved in the coming year We have already made some changes including offering a clinic service rather than a bedside service, as we found that we have a better uptake of the vaccine at the clinics.

Act 1982

APPENDIX: Regional Public Health School Health and Immunisation Group Action Plan Report 1 July 2015 – 30 June 2016 Page 88