Tobacco realignment: workshop summaries

In May and June 2015, the Ministry of Health ran a series of workshops with existing and potential tobacco control providers.

We conducted ten structured engagement and design workshops across the country to gather market information on design elements for a suite of tobacco control services. The market information was gathered to assist the Ministry with decisions to inform the next phase of the tobacco services realignment process from August 2015 onward. A further three workshops were scheduled upon request from the sector. The final engagement workshop was held on Friday 19 June 2015.

Please note the wording of the summaries reflects the language used by participants at the workshops.  

Available summaries:

Te Tairawhiti – 19 May 2015

  • Realignment process is an opportunity
  • Greater emphasis on “C” required
  • Better integration, communications and cross sector work
  • Fund outcomes not outputs
  • Localisation of national strategies and programmes
  • Target whānau/fanau/families
  • Services to be aligned to need
  • Better and more transparent information
  • One size does not fit all
  • Better use of technology
  • Improve access (e.g. not 9-5)
  • Different funding model needed
  • Community and cultural connection important
  • Better use of Māori/Pacific settings
  • Knowledge skills and capability of workforce
  • Understand the consumer to better meet their needs

Rotorua – 21 May 2015

  • Communications between the DHBs and the Ministry to providers needs to be more effective
  • One size doesn’t fit all
  • There is variation of access to smokers in the region
  • Smoking is a social marker of stress
  • Design services to meet the needs of the people in the region ie Rotorua, Waikato, Bay of Plenty and Taranaki
  • Local people part of the landscape therefore need to have input in the new world
  • National plan for smoking is needed that is centred on the community and then work a strategy from there
  • No patch protection
  • Find local champions for Health Promotion, Advocacy and Leadership
  • Use hotspots where there are Māori and Pacific peoples, ie church, marae, kohanga reo, WINZ, Corrections
  • Marae specific programmes to be used
  • More nicotine replacement therapy products and medications should be subsidised
  • Training for health professionals needed
  • More presence in schools, workplaces and businesses
  • All services to deliver Champix
  • Employ smoking cessation co-ordinators
  • Funding outcomes require a narrative behind the baseline
  • Whole system approach needed (referral system to smoking specialist)
  • Funding one pot in the region
  • Funding to include Māori models of care
  • Māori and Pacific Provider Development requires an integrated plan of capability and capacity for each group
  • Services need to be wrapped around the people (smokers and their whānau), and not the individual going to the service

Hastings – 22 May 2015

  • Organisations need qualified cessation workers
  • Cessation treatment involves education from GP, nurse, pharmacy on treatment
  • Clinics need a range of staff to choose from to work hours when consumers are available
  • Need professional and educated staff
  • Generic and user friendly data is needed where information can be shared
  • Digital technology needed for outreach, promotional work and work amongst providers
  • Getting data for key points in the journey of the consumer needs to be documented
  • Framework needed to show process of care from entry to exit. What support is given after a consumer exits?
  • Incentives and choice of treatment providers and tools: other nicotine replacement therapy options and alternative treatment options should be made available i.e. traditional/kaupapa Māori treatment (holistic approach)
  • Treat reason for smoking and connecting them to additional support
  • What other support services are available to help smokers i.e. employment and driving licensing?
  • Incorporate prevention
  • Education in schools, i.e. curriculum, and allow AKP in schools
  • Communication tools to help workers with whānau
  • Health promotion messages need to be positive and consistent
  • Incorporate Māori health models
  • Incorporate best practice
  • Consumers need to know where to access treatment
  • Services need to go to the consumer and be flexible
  • Non-judgmental approach to smokers needed
  • Region needs confidence in providers from the sector to GPs and consumers
  • Knowledge of your client base
  • Go to where smokers are ie community events and work places
  • Build capacity of workforce and train more people in ABC
  • Funding is based on the needs of the targeted groups in the region:
  • Maraenui and Wairoa
  • Leave it to Hastings to design a plan that achieves the Ministry's outcomes
  • Whānau based approach needed for a comprehensive smokefree environment including other issues involving Māori
  • Measuring more than just the numbers
  • DHBs should not take overheads for this funding
  • Regional data, surveys, research needed
  • Training and development funding needed
  • Integration of funders coalition of providers working together: a plan that is: collaborative, jointly owned and strength based
  • Focus on need of consumer and their communities
  • Health promotion – enabling communities to look after their health
  • National activity scattered and not focussed on local activities
  • kaumātua leadership needed
  • Advocacy: need national guidance
  • Too many mixed messages, emails, newsletters. Need one consistent message delivery to say ‘what do we do?'
  • Local coalition will be effective
  • Need leadership and champions to advocate for 2025
  • Māori Development requires wrap-around service for wahine hapu, mental health and kaumātua support
  • Māori cultural awareness of our communities and other cultures
  • Application of the Treaty of Waitangi needed
  • Māori people in decision making roles needed
  • Integrated services needed
  • Whānau Ora approach needed
  • Cultural safety
  • Iwi leadership needed in this sector
  • Workforce is consistent to the population we serve

Porirua – 26 May 2015

  • Government back tracking on 2025
  • End of AKP
  • Staff may lose their jobs
  • Competition promotion versus advocacy
  • No strategy
  • Innovation not considered, focus on numbers rather than on how Pacific and Māori provides get there
  • Future of rangatahi (Māori youth?)
  • Workload versus outcome - more collaboration, innovation of service delivery needed
  • consistency of service delivery needed
  • Sector becoming fragmented over last 10 years ie political environment, funding, transparency and communication between the Ministry and providers
  • One size does not fit all
  • Strategic thinking around 85% not smoking i.e. cultural capital - health promotion - marketing and health promotion
  • Staff employed have to have completed the NZQA training.
  • Is there a process to evaluate and monitor NZQA training?
  • Cultural competency not highly valued in training or valued in the primary care space
  • No providers for Pacific in some areas
  • Models of care needed to meet needs of clients
  • More staff to meet the client’s needs
  • More nicotine replacement therapy options and more tools needed
  • More collective work in the regions
  • Need a more seamless system to work together
  • One stop shop in all regions/areas
  • Linkages to community groups eg. church, sports, marae
  • After hours access for clients
  • Consumers comprehensive care ie health, social, and educational
  • ABC need C results
  • Access data to understand where population of high need are
  • Alignment of DHBs and national organisations needed
  • Better relationship between funder-provider ie the Ministry to be removed. Need local fund-holders
  • Better pay and conditions for workers and practitioners
  • Find efficiency via national admin body to free up resource and time
  • Better working relationship with DHB colleagues
  • Outputs and outcomes information needed
  • Need link with Te Puni Kōkiri and Whānau Ora
  • Better co -ordination of cessation services
  • Leadership driven: Māori, Pacific and Mainstream to act as a hub - information, resources
  • Cessation and health promotion declining together in regional funding
  • Need to know strategy
  • Health Leadership and advocacy – government policy intent required
  • Regional coordinator needed
  • Pacific have seven ethnic specific groupings from governance to workers. Knowledge of languages and cultures of all seven ethnic specific Pacific nations
  • Māori for Māori for Māori development
  • Provision of a holistic service for Māori and Pacific
  • Mobile services used
  • Attendance to all community fono and hui
  • Listening to the voice of the Māori and Pacific community
  • Upholding the Treaty of Waitangi
  • Cultural competency needed to work with Māori and Pacific peoples
  • Smokefree Pacific and Māori workforce

Palmerston North – 27 May 2015

  • Iwi realignment needed now with changes ie how credible will it be to sit with the Ministry?
  • Strength based approach can’t be measured on outcomes but must include people of the area.
  • The Ministry needs a ten year strategy for 2025
  • Where does Whānau Ora fit in this? Whānau Ora type could be considered
  • Whānau Ora collectives should hold the funding
  • Model of care needs to be whānau centered and, understanding how to deliver to whānau health
  • Addiction approach not addressed in current model ie stress management, depression, and anxiety and trauma — or, use concept of rahui
  • Practitioners to be SF, be present at where the people at, sports/shearing, national event day – go to them, mobile, confident practitioners, willing to engage, knowledge
  • Iwi boundaries for funding are complex
  • Funders require ‘mana enhancing’ incentives for the consumer and their whānau and communities
  • Strong leadership and management needed
  • Referrals through regulation needed
  • Learning from other AOD and gambling services including community based programmes
  • Plan needed for funding
  • Need to avoid replication of service and be financially effective
  • Health leadership and advocacy needs ie education, engagement, support, manaakitanga and passion.
  • Providers need to walk the talk
  • Compulsory for all people who smoke to do the ABCs. Focus on measure for “C”
  • Language of messaging needs consistency
  • Alliances need
  • Need for effective leadership
  • Māori and Pacific Development is determined largely by whānau/fanau
  • Māori competency framework needed
  • Māori and Pacific workers walk in two worlds
  • Cultural frameworks needed
  • Strong leadership needed
  • Iwi leadership needed
  • Kaimahi leadership needed
  • No AKP leadership apparent — regional/local groupings doing the work
  • Increase medical support to increase skills we bring to whānau
  • High turnover of staff
  • There is no Pacific service in Palmerston North
  • Health Promotion invisible

Kerikeri – 4 June 2015

  • Northland: high unemployment
  • For Māori to Māori stop smoking services, providing holistic approach, for example hapu mama anti natal care; Māori focussed education
  • Competition vs collaboration?
  • Will the RFP allow for collaboration?
  • How do we bring an overall plan together?
  • For a geographic region do we want one provider?
  • Smoking quit rate model needed.
  • Referral process needs to be underpinned by a respectful relationship between referrer and provider
  • Access database, icloud and telehealth
  • Best model to meet needs of consumer
  • Outside standard of working hours evenings, weekends
  • A good service for Māori (tikanga, te reo Māori, Whānau Ora and cultural training)
  • Know community/partners at all levels
  • Mobile services to outreach service clinics with promotion of the service clinics with promotion of the service and AC
  • Champions recruiting and smokers will listen to iwi 
  • Treatment of the client with whānau focus
  • Databases linked to all health providers
  • Providing quality service
  • Funding model – allocation
  • Alliance funding model is the way forward for this region
    • Population numbers Māori and Pacific smokers,
    • Geographic coverage weighting formula, urban + rural need
  • National funding bodies not all delivering and supporting our area.
  • Every smoking cessation service to have own health promoter
  • Kaimahi to have dual role: treatment, HP
  • Local to reflect the needs at local
  • Working with WINZ
  • Appropriate training of high quality for Māori needed
  • Māori frameworks
  • Māori science is best practice: Tikanga, leadership (within the constraints of all contracts) Māori philosophy, Māori way
  • Having community champions
  • Professional development and secondments to other organisations
  • Point of difference knowing your community and knowing your people

Auckland – 9 June 2015

  • What is the role for research and priorities? 
  • How can we strengthen support for pregnant mums that smoke? 
  • Resources need to be directed towards populations and organisations that are best placed to address inequities
  • Will the DHB health services be included in this process? Transform to promote abc?
  • Does this assume policy and targets will change?
  • Centralised model for smoke free services
  • A specialist LGBTQI service in Auckland needed
  • Is mental health and addictions included as a high need population?
  • Is there a role for e-cigs/harm reduction strategies?
  • Moving to a more outcome focused health target especially for primary care
  • How do you plan to address barriers for hard to reach populations ie. Māori and mental health
  • Current model has numerous stages/processes focus is on health rather than social which can be a barrier in itself
  • Keep good learnings + introduce innovation for Māori and Pacific
  • How do we best engage with Pacific?
  • Can small NGOs compete against DHB/PHO when applying for RFP initiatives?
  • What are we not connecting with Pacific smokers? How are we going to ensure we connect?
  • What’s happening with money?
  • Loss of knowledge and experience through process
  • Currently contract is prescriptive eg FTEs. Will the new direction allow for innovative delivery?
  • What’s happening to existing services?
  • How to maintain good leaders and invest in future tobacco control leadership?
  • Will the Ministry be monitoring only current new services or innovations to inform
  • Māori and Pacific is approximately 70% of the issue therefore 70% of solution
  • What messages do our Pacific people want and need to hear?
  • Being prepared to make the difficult decisions in the interest of kaupapa
  • Expanded languages services Asian and Arabic cultures
  • Asian speakers on Quitline

Dunedin – 15 June 2015

  • One model doesn’t fit all
  • Meet needs of the community ie shearing gangs, ageing population, huge rural area, high-smoking areas and neighbourhoods
  • Links needs to be better to support the client ie telephone, Facebook, scan for support, mobile applications and even incentives that is, IT based support with real people back-up
  • Website with triage to get help wherever the client is ie there is one number to ring with referral provided by a very good local provider. That is, telephone services completely updated with outreach and mobile services to local areas and can get local people connected with locally based services
  • Distinct differences between Otago and Southland DHBs
  • Staff employed need to be smokefree
  • Group staff needs continues and to build further. Pooled funding needed to support each other
  • Pooled co-operative model of shared services needed
  • It would be helpful that funding is accessed through one funder. Current system shows a high turnover of staff.
  • Funding needs to address actual demographics of the district and rural adjuster needed
  • Funding needed for mobile clinics
  • Whānau ora collective needed in the district
  • One data source needed
  • Health promotion
    • founded on Ottawa charter and principles of the treaty and reducing inequalities
  • Advocacy
    • Advocacy difficult to do within DHB. Need to hear and meet national Māori leadership
    • Better communication needed
    • Incentives base research
    • Contractual obligations to attend local coalition needed
  • Māori and Pacific Development
    • Based on relationships, process of engagement, knowing and serving your community, working with others, working long hours and being flexible
    • Client feedback needed ie how we can improve our service
    • Whānau referrals should be considered
    • Staff need accreditation, external and internal supervision, education and training, and understand marae process and their roles
    • Staff need to be equipped with the best equipment and mobility ie. cars  and wireless laptops with data programming included

Christchurch – 16 June 2015

  • The earthquakes of 2010 still have an impact on the population. Issues are broader and bigger than health and stop smoking. These have impact on finances and stress of people and their whānau (families) still living from the earthquakes. This causes distinct differences between suburbs in Christchurch ie eastern and western suburbs
  • One model doesn’t fit all
  • Model responsive to community needs
  • Accessibility to services and choices
  • Getting kaumātua support in services
  • Awareness of services
  • Central and easy referral system needed
  • Centre of excellence for group and peer treatment needed
  • Midwives require a standard practice for referrals. There’s currently no accountability
  • Framework needed for cessation services
  • Care pathway across system needed
  • Seamless services for clients
  • One database needed to capture everything and to decrease paperwork
  • Services to be available outside standard work hours
  • Group cessation to be flexible on numbers
  • Mobile applications needed
  • Work in schools, youth justice and prisons to target clients needed
  • Different types of models of care needed
  • Ability for client to feedback on services
  • Cessation services to sit within a broader range of services to meet client needs
  • Share quitter journey on radio
  • An alliance model with the Ministry could be considered with outcome indicators consistent with data collection, adaptive services, consistent local and national information and an effective integrated system
  • Expand funding base to be responsive to local ie population need, demographics, and socio-economic, high needs Māori and Pacific pregnancy, Māori and Pacific
  • Health Promotion, Leadership and Advocacy needs a national direction with a local flavour.
  • Use health promoters as a gateway and focus is the client and not service
  • Canterbury wants campaigns to be local
  • Social support for hapu mama to engage in services. There is no advocacy for hapu mama
  • Regionalise national health promotion to the local level
  • Māori and Pacific working collaboratively ie. triaging
  • Excellence is demonstrated by staff who are culturally and clinically competent to work with Māori and Pacific peoples

Nelson – 19 June 2015

  • One model doesn’t fit all
  • Services should allow choice, accessibility, and cultural appropriateness for the client and their whānau but only to those services that are respected and known ie highly skilled staff, no financial barriers, staff with a non-judgemental attitudes with strong links to GP and prescriber
  • Hook into networks of the region ie work places, community events, success stories - local press, competitions, easy referral systems, service provider 0800 Quit smoking (not Quitline), more technology needed for example need skype and virtual support. Also connect with people who have quit.
  • Health promotion should be mana enhancing, awareness raising, opening positive opportunities with a multi- cultural focus that is tailored resourced and age appropriate
  • Local promotion of tobacco control will involve iwi and locality ie schools, kohanga reo, events run locally, whānau incentives and not nationally
  • Health promotion driven from a national level but delivered locally
  • Use client stories in local media
  • Group approaches to quitting should used
  • Advocacy needs to be promoted by a local leader
  • Māori provider development requires iwi/marae base services ie whakawhānaungatanga, kaumātua presence, kaupapa Māori, mobile service and building relationships with whānau including having an extended whānau referral approach.
  • Use marae as part of the care plan where protocols are adhered to
  • Principles and philosophies of a service must have a strong Māori/Pacific influence
  • Māori and Pacific development must have strong governance and leadership
  • Cultural training for all staff regarding cultural competencies
  • Professional development includes accredited training and career pathways
  • Services must have quality staff
  • Pacific service needed
  • Use funding approach an incentive to achieve. That is, establish smoking priorities by identifying key objectives to determine outcome. This should reduce reduplication and gaps in service through collaboration. Allows for flexibility in meeting unmet need with robust and alliance funding.
  • Promoting consumer entitlement needed

Māori hui – 5 June 2015

Māori Strategy for 2025

  • A Māori strategy is developed and implemented for 2025. The forty-two recommendations submitted to the Māori Affairs Select Committee in 2010 should underpin the Māori strategy from which the Treaty of Waitangi and equity principles are central
  • The Realignment is between Māori and the Crown
  • The Māori strategy sits independently of the MoH
    • A Māori strategy will determine the direction forward
    • A higher level strategy incorporates kaupapa Māori and allows for differences in services and programmes for populations and communities
  • An outcomes framework is needed based on data allowing for a common agenda and understanding of Whanau Ora, Family Start and Hapu Mama
  • The RBA framework is not working in mainstream
  • Māori advocacy service needed
  • Development of leadership in the preventative level needed ie having a say at local level

Funding

  • Equitable funding given to Māori
  • Current contract specifications not working
  • National versus local funding needs consideration
  • National entity/grouping – regional grouping streamlines costs and efficiencies
  • National consistency needed
  • National Māori Tobacco Control entity needed
  • Procurement model – collective potential versus individual

Health Promotion, Advocacy and Leadership

  • What is the function of HP?
  • Objective is to be clear ie HP/Advocacy/Leadership and their definitions

Structural and Legislation

  • How many outlets of tobacco/alcohol/ supermarket/petrol stations and registrations of retailers are there?
  • Ensure the legislation is adhered to

Māori database

  • Māori database with a whānau ora approach is needed and tracking on data (systems) needed

Māori Services

  • Māori services need a holistic approach
  • Best practice for comprehensive tobacco services needed
  • When realignment changes are occur, put change process into an animation – “Te Ao Marama” so that Māori providers understand
  • Sciences versus programmes in RBA
  • Prevention versus treatment

Consumer

  • What choices are whanau making?

Tendering Process

  • Inform Māori providers of the tender process and give support where it is needed including timeframes

National Smokefree Working Group – 8 June 2015

Tobacco Strategy 2015

  • An overall strategy is required that includes the Ottawa Charter and Treaty of Waitangi
  • The forty-two recommendations given to the Māori Select Committee in 2010 need to be considered and it addresses leadership at all levels
  • An “Aukati Kaipaipa” AKP strategy is required based on Māori models and paradigms
  • An action plan is required to incorporate ie public support, focus on stopping people smoking “initiation”, unlimited scope, campaigns, strengthening legislation around supply and economics
  • The Realignment will need to address the economics

Structural and Policy

  • Structural changes and intervention is required for Māori and Pacific
  • Policy agenda needs to align with the Realignment process as there is a disconnect between policy and key priority areas (people)
  • Best return on tax regarding population needs, environment, sector, evidence, and those with vested interests if structural changes are made

Contract Specifications versus Contracts

  • Contracts specifications are disconnected and realignment required
  • A five year plan is needed to get Māori and Pacific to quit smoking
  • Services require cultural leadership and effectiveness Māori, and Pacific (Tonga, Samoa, Tokelau, Niue, Cook Islands,  Tuvalu and Fiji)
  • Outcomes need to be identified to measure effectiveness
  • Prevalence requires modelling and evidence

Pacific Provider Development

  • Current paradigm shift is required for Pacific Provider Development as it is labour intensive
  • Pacific providers are working across the board
  • Take into account ie geography,  environment and population needs of Pacific peoples

Local

  • Local engagement is required
  • Māori need to be listened to by the Ministry of Health

Public Health Units

  • Advocacy and leadership required

Asian Population

  • Asian needs are evident and consideration is required for this population group

Tendering Process

  • Information and advice is required once tendering is in placed

Pacific fono – 11 June 2015

Sector

  • Collaborative partnership with the Sector required
  • Pacific leadership needed across the Sector
  • Excellence require across this Sector
  • Apply Ottawa Charter and its five strands for Pacific peoples

Pacific Provider Development

  • Focus on total wellbeing, integrity and empathy for Pacific peoples
  • Practical approach is required
  • Trained workforce needed

Services

  • Pacific services needed in all regions
  • Funding model must enhance mana based on Pacific needs
  • Outcomes and monitoring framework needed
  • More Pacific staff needed
  • Services using Pacific language and understanding culture required
  • Group based therapy is potentially more effective and structured
  • Pacific partnership approach
  • Group cessation vs individual cessation required
  • Excellence required
  • Holistic eg Pacific health models
  • Understanding Pacific communities ie background, language, technical, medicines and institutional

Health Promotion

  • Consistent Pacific messaging across services required
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