PUBLIC HEALTH WORKFORCE DEVELOPMENT SURVEY 2012

Transcription

1 PUBLIC HEALTH WORKFORCE DEVELOPMENT SURVEY 2012 R E S E A R C H R E P O R T F O R HEAD STRATEGIC ON BEHALF OF THE MINISTRY OF HEALTH Revised July 2013 Authors: Dr Allan Wyllie Jo Howearth Ref: R5046

2 CONTENTS ACKNOWLEDGEMENTS SUMMARY DISCUSSION INTRODUCTION RESEARCH METHODS WHAT IS THE RESPONSE TO THE PROPOSED CERTIFICATE IN PUBLIC HEALTH? WHO ARE WE? WHAT ARE THE MOST IMPORTANT WORKFORCE ISSUES? HOW ARE WE DOING? EXPERIENCE, RECRUITMENT AND RETENTION HOW ARE WE DOING? QUALIFICATIONS AND TRAINING APPENDIX A: DETAILED TABLES FROM PHONE INTERVIEWS

3 LIST OF GRAPHS Graph 1: Recruitment difficulty Māori and Pacific dedicated positions Graph 2: Recruitment difficulty non-dedicated positions Graph 3: Retention difficulty Māori and Pacific dedicated positions Graph 4: Retention difficulty non-dedicated positions LIST OF TABLES Table 1: Number in target audience and number attending... 6 Table 2: Workforce issues... 7 Table 3: health qualifications: Overview Table 4: Type of organisation Table 5: Knowledge of Certificate in Health Table 6: How well delivery meets needs Table 7: Key to successful programme for organisation Table 8: Key to successful programme for staff Table 9: Knowledge/skills want graduates to obtain Table 10: Number in target audience and numbers attending course Table 11: Proportions attending Table 12: Proportion of target audience in each discipline Table 13: Proportion of those attending over first 3 years in each discipline Table 14: Barriers/risks that need to be addressed Table 15: How feel about strong Māori focus and some Pacific focus Table 16: What they can do to integrate course learnings into workplace Table 17: How well having all staff with public health qualifications fits with workforce devel opment planning Table 18: What support would require to meet Ministry's aspirational targets Table 19: Discipline working in Table 20: Dedicated role Table 21: Ethnicity Table 22: Age Table 23: Age by discipline Table 24: Workforce issues Table 25: Top three workforce issues Table 26: Years in public health, by discipline Table 27: Years in public health, by ethnicity Table 28: Employment status Table 29: Vacancies Table 30: Workforce planning Table 31: health qualifications: Overview Table 32: health qualifications: highest completed Table 33: health qualifications: currently studying Table 34: health qualifications: intend beginning in next 3 years Table 35: Highest qualification completed by discipline working in Table 36: health qualifications by regulated versus unregulated professions Table 37: Highest qualification completed by ethnicity Table 38: Proportion with degrees Table 39: Proportion with degrees, by discipline working in Table 40: Proportion with degrees, by ethnicity Table 41: Key to successful programme for organisation Table 42: Key to successful programme for staff Table 43: Anything else want staff to learn on course Table 44: Barriers/risks that need to be addressed Table 45: Barriers/risks that need to be addressed Table 46: How feel about strong Māori focus and some Pacific focus Table 47: What they can do to integrate course learnings into workplace Table 48: How well having all staff with public health qualifications fits with workforce development planning Table 49: What support would require to meet Ministry's aspirational targets

4 ACKNOWLEDGEMENTS We wish to thank all those who participated in this research, particularly the person in each organisation who was responsible for organising the collection and collating of data from each public health staff member in their organisation. 4

5 1 SUMMARY INTRODUCTION The research objectives were: To provide an update on the qualifications currently held by the public health workforce To provide information to inform on-going workforce planning To obtain feedback on the planned Certificate in Health course and how it can best meet organisational and staff needs To identify enablers and barriers to uptake of the new course To assess the near future demand for public health qualifications, including the Certificate in Health To assist the Ministry to estimate in provider contracts the numbers of staff that must hold public health qualifications within specified time frames To provide an update on the main workforce issues facing public health organisations and strategies for dealing with these The planned New Zealand Certificate in Health fulfils the Ministry of Health's aim to make a generic, undergraduate level 5 public health qualification widely available for the public health and primary health workforces. Thirty-two organisations were invited to complete a self-completion survey and a phone interview. There were 27 organisations that completed the self-completion and 28 that completed the phone interview. The included all 12 PHUs ( Health Units). The s were selected by Head Strategic with the aim of providing a representative mix in terms of Māori (5 participated), Pacific (5) and other public health providers (6). Given only 16 of the 203 s were included, their data needs to be interpreted with some caution. Within the self-completion survey, some key information was collected about each public health staff member within the organisation, providing a of 883 individuals. The data collection took place between 8 February and 29 March, This report was originally published in June 2012, but has now had data relating to the Certificate in Health corrected with revisions to the data regarding public health qualifications. WHAT IS THE RESPONSE TO THE PLANNED CERTIFICATE IN PUBLIC HEALTH? 1 63% of the managers knew either only a little (52%) or nothing (11%) about the planned course. A third knew a moderate amount and 4% a lot. The concept of block courses had a good level of appeal, but there was some concern that the proposed four day duration of the block courses was too long. Some noted a preference for four block courses of two days. However, there was also some concern with the cost of travel, which the organisations would mostly have to cover (see page 18). The key ingredient to making it a successful programme was that it needed to be relevant to the work the organisation and staff are undertaking (see page 19). The different components of the proposed content of the course generally all received high levels of support from managers (see page 21). Table 1 below shows that, of the organisations which provided data, the mean (average) number of staff who they thought were in the target audience for this course was 14.9 among PHUs and 9.6 among the s. 1 For a full description of the course see the Introduction chapter. 5

6 The same table also shows the estimated number they would support to attend over the first three years in total. The mean for PHUs was 7.6 and for s it was 8.1. s would expect to have 58% of their workforce attend the course in the first three years, while for PHUs it would be just 9%. However, because of the much greater size of the PHUs, the actual numbers attending per organisation would be reasonably similar for PHUs and s. Despite this level of similarity, the s would account for the vast majority of those attending the course, because of the much greater number of s in the country. These findings are at least in part a reflection of the level of qualifications currently held by staff in PHUs versus s. Using relatively conservative assumptions, it has been estimated that there might be approximately 200 per year attending in the first three years, assuming demand could be met. The biggest group likely to attend the course would be health promoters/ educators (accounting for 48% of the PHU staff attending and 58% for the s). Table 1: Number in target audience and number attending NUMBER IN TARGET AUDIENCE Health Unit Mean ATTENDING OVER 3 YEARS Mean Monetary restraints were seen as the biggest potential barrier to supporting staff to attend (see page 25). The responses were generally positive to the concept of having a strong Māori focus and to a lesser degree a Pacific focus in the course material. However, some PHUs in particular noted they had few Pacific peoples in their region. Some also noted the need for the course to adapt to the changing population, which included Asian and refugees (see page 26). The main suggestion for ways in which managers could ensure that what staff learn on the course is successfully integrated into their workplace, was having the staff share their knowledge with other staff, followed by ensuring there are opportunities provided for the staff to put into practice what they have learnt on the course (see page 27). There was a mixed response to the concept of the Ministry preferring everyone employed in public health to hold a public health qualification. Some were totally in agreement, while others felt the important thing was that staff had qualifications which were relevant to their area of work and there should be flexibility around qualifications (see page 28). WHO ARE WE? The 12 PHUs had an average of 81 staff positions, which was an increase from 68 in The 15 s which provided data had an average of 16 staff postions, but the larger s were included in the survey (the average size in 2004 among 171 s was 10). The following profile data was based on 879 staff who answered this section, of whom 672 (76%) were from PHUs and 207 from s. 20% of those who specified their ethnicity were Māori (n=167), 9% Pacific (n=73) and 7% Asian (n=55) 2. 76% were female. 2 There were only 829 who provided ethnicity data. 6

7 Staff in s were predominantly health promotion/education (56%) and management/advisory (20%), while PHUs had a much greater spread of disciplines, reflecting the broader focus of their work (see page 30). Forty percent were aged 50 years and over and a total of 69% were aged 40 years and over. Just 10% were aged under 30 years. Compared with a previous 2004 survey, the proportion aged 50 years and over had increased from 29% to 39%. WHAT ARE THE MOST IMPORTANT WORKFORCE ISSUES? This section was based on the responses of 27 managers. Table 2 below shows funding was the most mentioned issue, both currently (93%) and over the next five years (92%). Staff performance was seen to be more of an issue now (30% mentioned it in their top 3), than in the next five years (15%). Conversely, staff recruitment and retention were expected to be more important issues in the next five years than they are now. More workforce training was a much greater issue for s (47% vs 8% for PHUs). Workloads/burnout were also more of an issue for s (53% vs 33% for PHUs for current issues), as was staff performance (40% vs 17%). Meeting Ministry requirements was more of an issue for PHUs (42% vs 27%). Table 2: Workforce issues TOP 3 WORKFORCE ISSUES Currently TOTAL SAMPLE (27) Next 5 years % % Level of funding/ funding cuts/ obtaining more funding Workloads/ burn out Meeting Ministry requirements/ relationship with Ministry Need for more training for the workforce Staff performance Staff retention Lack of skilled staff available/ recruitment problems When asked to discuss any issues managers had with regard to meeting Ministry requirements and the relationship with the Ministry, the most common responses related to financial issues. A number of managers also talked about the reduced level of contact and reduced quality of relationships with the Ministry (see page 35). The concerns with staff workload and burnout related in large part to the cost-cutting. Some felt they were still trying to deliver the same level of service, but with fewer staff, as they were aware of the amount of work that needed to be done (see page 36). The main staff training issue again related to the lack of funding, and its impact on the ability to fund staff training (see page 36). Almost half the PHUs mentioned issues relating to recruitment for Maori specific roles, while none of the s did. This was linked to there being a limited pool of Maori in the workforce (see page 36). In terms of staff retention, some found it difficult competing with the salaries offered by other agencies (see page 37). 7

8 When asked to suggest their top five strategies for managing the current workforce issues, most PHUs and some of the s mentioned workforce development planning. This included looking at both internal needs, including staff needs and external needs (see page 37). There were 83% of the PHUs and 75% of the s who said their organisations had had reductions in public health services contracted for by the Ministry in the previous three years. Effect of these reductions are noted on page 38. HOW ARE WE DOING? EXPERIENCE, RECRUITMENT AND RETENTION There were two thirds of the staff who had worked in public health for less than ten years, with 38% having worked less than five years. Just under two thirds (65%) were working full-time. Managers rated the difficulty of recruiting and retaining staff in a range of positions. With almost all the dedicated Māori and Pacific roles, higher proportions of managers reported recruiting difficulties compared with those reporting no difficulties. The exceptions were Maori and Pacific community workers, where recruitment was more likely to be never difficult (see page 40). The following positions are rated from highest down, in terms of reported levels of recruitment difficulty compared with there never being difficulties. 3 Portfolio managers health dieticians/nutritionists Health protection officers health registrars Researchers/ evaluators/ analysts Medical officers of health health programme co-ordinators Health promotion workers/ advisors Managers Epidemiologists Policy analysts health physicians health nurses Compared with 2004, in 2012 it had got less difficult to recruit for 4 : Māori health promotion workers/ advisors Medical officers of health health physicians Policy analysts health nurses In 2012 it had got more difficult to recruit for: Māori advisors health registrars health dieticians The non-dedicated positions for which there were more difficulties with retention compared with no difficulties are listed below, with the highest difficulty first: 3 4 The percentage reporting that there were at least sometimes difficulties was divided by the percentage saying there were never difficulties, to give a ratio. These are not in any order of level of improvement. 8

9 health dieticians/ nutritionists health programme co-ordinators Health promotion workers/ advisors health nurses Health protection officers Researchers/ evaluators/ analysts The fact that the above list is much shorter than that for recruitment, shows that there were fewer issues with retention than there were with recruitment (see page 43). Compared with 2004, in 2012 there were no positions where it had got less difficult to retain staff. It had got more difficult to retain: Managers Researchers/evaluators/analysts Health promotion workers/advisors health nurses HOW ARE WE DOING? QUALIFICATIONS AND TRAINING Almost all the organisations reported using a workforce development plan to direct internal workforce development activities. There were 83% of the PHUs, but just 31% of the s, that made any use of Te Uru Kahikatea, the Ministry of Health Health Workforce Development Plan, to structure their workforce. As shown in Table 3 below, there were 29% who reported currently having a public health qualification, but there were another 9% who did not answer, which might mean they did not have any public health qualifications, or they may not have answered for some other reason (some of this information may have been supplied by other staff members who may not have known the person s qualifications). There were 22% who held a graduate or higher public health qualification, while 9% held a nongraduate qualification as their highest public health qualification. There were 8% with a Diploma in Health and another 6% with a Master of Health. Comparisons of the PHU with 2004 showed that the proportion of staff holding a Master of Health had increased from 3% to 8%, a Diploma in Health from 4% to 10% and a Certificate in Health Promotion from 10% to 14%. Staff in PHUs were more likely to currently hold a public health degree (28% vs 5% for s). health degrees were more prevalent among those in: medicine (61%), health protection (52%), and analysis/ policy analysis (46%). Asian people were the most likely to currently have a public health degree (47%), Pacific peoples were notably low (8%), while Māori (16%) did not differ significantly from the total (22%). There were 10% who were currently studying for a public health qualification, although another 14% did not answer. There were 16% who intended to begin studying for a public health qualification in the next three years, with another 14% not answering. There were 37% of the public health workforce who had a degree but did not have a public health degree 5, giving a total of 59% with a degree. There were another 3% who currently had no degree but were studying for one (either public health or non-public health). 5 If they had both a public health degree and a non-public health degree, they were not included in this category. 9

10 Table 3: health qualifications: Overview PUBLIC HEALTH QUALIFICATIONS: OVERVIEW TOTAL SAMPLE (883) % Intend beginning next 3 years Highest completed Currently studying for Any Health Qualification Any Graduate/Post-grad Health Qualification Master of Health (MPH) Diploma in Health (DPH) Post graduate Certificate in Health Graduate Diploma Environmental Health 3 * 0 BHS (Health Promotion) BHS/ BSc (Environmental or Health Protection) 1 * * Other Graduate/ Post-grad Health Qualification 1 * * Any Other Health Qualification Diploma in Health Promotion Certificate in Health Promotion Certificate in Health (undergrad) NA NA 3 Other Health Qualification None Not answered NA = Not available; * denotes less than 1%, but not zero 10

11 2 DISCUSSION HIGH LEVEL OF DEMAND FOR CERTIFICATE IN PUBLIC HEALTH The planned Certificate in Health is clearly meeting a need within the s, with them typically expecting to 58% of their workforce to the course in the first three years. While PHUs only intend to send nine percent of their workforce, this is a similar number of staff per organisation as for the s. To estimate the number of staff likely to attend there was a need to estimate the average size of the s, as only 16 were included in the survey. The Ministry have estimated this at 9.7, which is similar to the 9.6 reported in the 2004 survey. In the research the s were planning to send 58% of their public health staff to the course over the first three years. Based on an average size of 9.7 this equates with 5.6 staff attending over the first 3 years. There are currently 203 s contracted to provide public health services, so the 5.6 staff per represents 1137 staff. With the average of 7.6 from the 12 PHUs, this represents 91 staff from them, giving a total of With these types of measures, persons always overstate what eventuates as actual behaviour. This is compounded in this survey, because the managers were encouraged to specify aspirational targets. Also the managers reported the numbers they would support to attend, and it might be that some of their staff might not want to attend or might be unable to attend. Obviously the economic climate and funding available for training within the organisations will have some impact on final numbers. There is also a need to take into account that the data was based on only 13 organisations who provided data for this set of questions. Therefore it is appropriate to take a conservative stance when estimating the numbers who are likely to attend in reality. If half of the intended numbers were achieved, this would equate with just over 600 persons over the three year period, averaging 200 per year. This would seem to be a reasonable number to aim for in terms of contracting for the service delivery. Having a spread of locations for the course will assist in participation rates. Obviously having a course in Auckland would be advantageous, assuming a good proportion of the providers will be closer to Auckland than either Wellington or Christchurch. There will obviously have to be a lot more awareness built up prior to the course being introduced. Any increases in awareness may contribute to an increased demand for the course, beyond that stated in the survey. The four day block courses were thought to be a barrier for some, so perhaps the course could be offered in two configurations, one with fewer longer block courses (e.g. four days) and one with a greater number of shorter block courses (e.g. two days). MIXED RESPONSE TO ALL STAFF HAVING PUBLIC HEALTH QUALIFICATION The concept of having all public staff with a public health qualification met with a mixed response, so the Ministry will have to consider how to more effectively communicate the benefits, if this concept is to be implemented. 11

12 IMPACT OF ECONOMIC CLIMATE Clearly the economic climate and the need for cost-cutting is having a marked impact on the public health workforce, with most of the organisations having had reductions in their contracted services. As well as funding issues being clearly the number one workforce issue, monetary concerns were to the fore for several other workforce issues as well. 12

13 3 INTRODUCTION This project was commissioned by Head Strategic, on behalf of the Ministry of Health. Head Strategic and the Ministry have been engaged in public health workforce development for a number of years. The earlier work was informed by research undertaken by Phoenix Research in 2003/04. The Ministry and Head Strategic have also undertaken a lot of consultation with the public health sector. To meet an identified need, it is proposed to introduce a Certificate in Health course. This research was undertaken in part to inform the planning for that course, but also to meet a number of other objectives, as outlined below. RESEARCH OBJECTIVES The objectives were: To provide an update on the qualifications currently held by the public health workforce To provide information to inform on-going workforce planning To obtain feedback on the planned Certificate in Health course and how it can best meet organisational and staff needs To identify enablers and barriers to uptake of the new course To assess the near future demand for public health qualifications, including the Certificate in Health To assist the Ministry to estimate in provider contracts the numbers of staff that must hold public health qualifications within specified time frames To provide an update on the main workforce issues facing public health organisations and strategies for dealing with these THE CERTIFICATE IN PUBLIC HEALTH The following information was provided to research participants, as part of the self-completion questionnaire: What is it? The New Zealand Certificate in Health (the Certificate) fulfils the Ministry of Health's aim to make a generic, undergraduate level 5 public health qualification widely available for the public health and primary health workforces. The Certificate is currently being registered on the New Zealand Qualifications Framework with the aim that it will be offered in Why is it needed? The public health workforce draws from a rich and diverse pool of different disciplines. Many working in public health have come from grassroots community leadership roles while others have come from clinical health and other careers. As a result many in the public health workforce do not hold qualifications in public health. Te Uru Kahikatea the Health Workforce Strategy (Ministry of Health 2007) identified the need to build a stair-cased training and qualification framework for public health. The vision is for 13

14 everybody in the public health workforce to hold public health qualifications, and in the medium term this is likely to be reflected in contractual obligations for Ministry funded public health providers. The Certificate in Health (Level 5) is designed to be the first step on the qualification staircase; providing an accessible qualification that can be achieved through part-time study over one year. The only pre-requisite is an adequate level of English language skills. Over time it is envisaged that the Certificate will become the baseline qualification held by the non-regulated public health workforce, provide a recruitment pool for the regulated workforce, and increase the sector's effectiveness in improving the health of communities. Who is it for? The Certificate is intended for anyone who has a need for baseline knowledge and skills in public health : People working in public health who hold tertiary qualifications in fields other than public health, as a briefer alternative to postgraduate public health qualifications People working in public health who do not hold tertiary qualifications People from the primary health sector who need or want public health skills and knowledge It may also offer an appropriate educational entry point for immigrants to New Zealand whose jobs require competencies that relate to the New Zealand public health sector. What value will it deliver? Graduates will demonstrate the baseline knowledge, skills and attributes required of a public health practitioner, capable of working both independently and in a collaborative manner to analyse, communicate, plan, and implement public health initiatives to improve population health outcomes and address health inequalities for Māori, Pasifika and other specific population groups. If you have staff whom lack some of these baseline knowledge and skills, they should be considered for the course. For more information see Health-Practice-_196.aspx. How has it come about? The Certificate is based on the generic public health competencies (GPHCs) which were developed by the Health Association and sector stakeholders in The Ministry of Health has been working with Careerforce (an Industry Training Organisation) to turn the GPHCs into an undergraduate qualification. A multi-disciplinary panel of public health practitioners have guided the qualification development to ensure relevance and practicality of learning outcomes. A sector consultation provided important advice on the use, access and delivery of the Certificate. What will it entail for participants and employers? It is anticipated that the Certificate will be a 60 credit part-time one-year course delivered mainly through distance learning with up to 8 days of face to face block courses. 14

15 15 Fees grants will be available for those working in public health roles. health providers need to cover travel and accommodation costs to attend block courses. Limited travel and accommodation scholarships will be available for circumstances of hardship.

16 4 RESEARCH METHODS Thirty-two organisations were invited to complete a self-completion survey and a phone interview. There were 27 organisations that completed the self-completion and 28 that completed the phone interview. The included all twelve PHUs (public health units). The other organisations (all referred to as s for the purposes of reporting) were selected by Head Strategic with the aim of providing a representative mix in terms of Māori, Pacific and other public health providers. Table 4 shows the numbers contacted and the numbers completing each part. Within the self-completion survey, some key information was collected about each public health staff member within the organisation, providing a of 883 individuals. This required someone in the organisation managing the collection and collation of this data. In addition to the main selfcompletion survey, on which all the collated data from individuals was recorded (one line per person), Phoenix Research supplied a self-completion survey which could be sent to each staff member to complete and send back to the person in their organisation who was collating the data. This was a large task to request of each organisation and in acknowledgement of this a koha was offered, which not all chose to accept. From the researcher s perspective, this process worked very well, with a high level of completion within a limited time frame. Of the 27 organisations that did the rest of the selfcompletion questionnaire, only one did not complete the section on the individuals. Of the others, one or two organisations had a small proportion of staff not recorded, but most provided data for all of them. Table 4: Type of organisation TYPE OF ORGANISATION Invited to participate Completed organisation part of self-completion survey Completed individual part of self-completion survey Completed phone interview (n= (n= (n= (n= PHU Māori Provider Pacific provider In most cases the main part of the self-completion survey and the phone interview were completed by the manager of the public health team in the organisation. The self-completion and phone interviews were piloted with three organisations (PHU, Māori and ), to check they were working as intended. Two Pacific providers were invited to be part of the pilot but one declined to do the survey and the other was not able to complete it in time for the pilot. Following this piloting, more detail was provided in the self-completion questionnaire about the Certificate in Health course. The pilot interviews were included in the final data set. The phone interviews were undertaken by Phoenix researchers, with all but one being undertaken by Māori researcher Jo Howearth. The average interview duration was approximately one hour. The data collection took place between 8 February and 29 March, 2012.

17 NOTES ON ANALYSIS AND REPORTING The phone interview was mostly open-ended questions. The comments made were noted down by the researcher and these were then coded into categories for the analysis. For most of the data, there is reporting for the PHUs, with the s grouped together. The numbers of Māori and Pacific organisations was not sufficient to report on these separately and are included as part of the grouping. As all PHUs were included, this data should be near to 100% accurate. However for the other 16 organisations, they were a small sub- of the 203 public health organisations. With the size of 16, their data needs to be interpreted with some caution. The data on individual public health staff was based on all staff for which organisations supplied data, so the size was sufficient to readily allow comparisons between sub-groups. For this reason significance testing was undertaken. In the tables denotes a figure for a sub-group which was significantly higher than the total, and denotes a significantly lower figure. For the tables based on the phone survey, the main mentions are often included in the main part of the report, but the fuller list of mentions are also included in Appendix A. The Tables in Appendix A do not include the many responses mentioned by just one person. 17

18 5 WHAT IS THE RESPONSE TO THE PROPOSED CERTIFICATE IN PUBLIC HEALTH? KNOWLEDGE OF THE COURSE In the self-completion survey there was a full page description of the Certificate in Health, using the wording provided in the Introduction section of this report. The managers were asked to rate how much they knew about the Certificate in Health prior to receiving the questionnaire. As shown in Table 5, 63% knew either only a little (52%) or nothing (11%). Levels of knowledge were similar in both PHUs and s. The figures in this and the following tables are percentages, so that comparisons can be made between PHUs and s. However, it should be noted that one person represents 8% for the PHUs and for the s they represent 6%, so differences need to be large to be worthy of note. Because the numbers interviewed were so small, no significance testing has been undertaken on these tables based on the organisations. Table 5: Knowledge of Certificate in Health KNOWLEDGE OF CERTIFICATE IN PUBLIC HEALTH Health Unit (27) (12) (15) % % % A lot (4) A moderate amount (3) A little (2) Nothing (1) Don't know Average HOW WELL PROPOSED DELIVERY MEETS NEEDS In the telephone interviews, managers were asked a series of questions relating to the planned Certificate in Health. The first question asked, As noted in the information supplied about the Certificate in Health, it is proposed that the course operate as distance learning with up to 8 days of block courses. While the location and number of block courses will be determined in consultation with selected providers, for the purposes of this discussion assume there are two block courses each of four days and they are available in Auckland, Wellington and Christchurch. How well will this method of delivery meet the needs of your organisation and its staff? They had previously been told in the self-completion questionnaire that, Fees grants will be available for those working in public health roles. health providers need to cover travel and accommodation costs to attend block courses. Limited travel and accommodation scholarships will be available for circumstances of hardship. The most frequently mentioned responses are showing in Table 6. The concept of block courses had a good level of appeal, but there was some concern that the proposed four day duration of the block courses was too long. Some noted a preference for four block courses of two days. However, there 18

19 was also some concern with the cost of travel, which the organisations would mostly have to cover, so having more block courses would add to that barrier. In relation to the travel costs issues, some noted that they worked in one of the areas where it was proposed there be courses. Table 6: How well delivery meets needs HOW WELL DELIVERY MEETS NEEDS Health Unit (28) (12) (16) % % % Block good over and done with/ less time off work in terms of maintaining staff capacity/ staff can organise their families Will work well/ fine/ fantastic Length of block courses too long/ people have family/ community commitments Expensive travel costs for organisation restricts how many can go Live, work in Auckland/ Wellington/ Christchurch will cut down on expenses x 2 days ideal KEYS TO MAKING IT A SUCCESSFUL PROGRAMME Table 7 shows what managers considered to be the key ingredients to making it a successful programme for their organisation. The key thing was that the programme needed to be relevant to the work the organisation and staff undertake. Along a somewhat similar theme, there was some specific mention of the need for it to able to be put into practice back in the workplace. Locality was again mentioned as important. The kaupapa Māori focus that the course intends to have was also noted as a key to the success of the programme by some managers. The health promotion component was also seen as key, which was consistent with the findings of a separate question, that identified health promoters were the largest discipline who were likely to attend the course. There were a wide range of other things noted by just a few managers and these are included in a more detailed table in Appendix A, Table 41. When the managers were asked what would make it a successful programme for their staff, there were similar types of comments as for the organisation. One comment with more focus for the staff was that they would be concerned as to whether it would be enough of a qualification to provide what was needed in their role. In conjunction with this, it was noted that staff are cautious about investing their time. Associated with this was having the qualification recognised as valid and credible in other areas such as local government, and having it NZQA approved. These concerns were only mentioned by PHU managers. The responses to this question are included in Appendix A, Table

20 Table 7: Key to successful programme for organisation KEY TO SUCCESSFUL PROGRAMME FOR ORGANISATION Health Unit (28) (12) (16) % % % Relevance of course to work meets the needs of contract models and approaches we use/ work plans/ objectives of organisation/ course content relevant to their work/ ensure programme is broad enough to what we think our staff will benefit from Locality great to be nearer to home make better use of time lose a day/ local would be good/ accessible location Needs to have strong practical information can apply back to practice Kaupapa Māori focus/ ensuring kaupapa Māori focus in programmes and delivery/ components Te Pae Mahutonga Does it align with health promotion training delivered how does it build on that?/ health promotion component/ all aspects of health promotion

21 Table 8: Key to successful programme for staff KEY TO SUCCESSFUL PROGRAMME FOR STAFF Health Unit (28) (12) (16) % % % Relevance of course to work meets the needs of contract models and approaches we use/ work plans/ objectives of organisation/ course content relevant to their work/ ensure programme is broad enough to what we think our staff will benefit Kaupapa Māori focus/ ensuring kaupapa Māori focus in programmes and delivery/ components Te Pae Mahutonga Needs to have strong practical information can apply back to practice Will this be enough of a qualification for staff to meet what is needed for their role?/ staff cautious in investing time Does it align with health promotion training delivered how does it build on that?/ health promotion component/ all aspects of health promotion Opportunity to learn and network outside of their own team Having it recognised as a valid qualification in other areas e.g. useful to local government/ NZQA approved/ will certificate have standing?/ credibility is key issue Not too high-powered/ technical/ cover basics/ pitched at the right level Need facilitator who makes people want to learn/ really engages people/ create learning environment KNOWLEDGE/SKILLS WANT GRADUATES TO OBTAIN The information in Table 9 was collected from managers as part of the self-completion survey. They were asked to rate how important each knowledge and skill set listed in the table was, in terms of what they wanted the graduates to obtain from the course. The question had a rating scale from 0 Not important to 5 Extremely important. The percentages shown in the table are those who gave a rating of 4 or 5. The items are listed in the order in which they were asked. Most PHU managers gave all the items a high rating. There was more variation among managers from s. They placed somewhat lower emphasis on: Can describe the health and disability sector in New Zealand and explain the public health sector s role in promoting and protecting public health Can assess the impact and influence of the Treaty of Waitangi on Māori and public health; and analyse public health issues from a Treaty of Waitangi perspective Can demonstrate how the range of approaches used by public health disciplines can improve health outcomes When asked in the phone survey if they had anything they wanted to add, in terms of what they wanted staff to know about, there were no dominant issues mentioned. The main ones are listed in Table 43 in Appendix A. 21

22 Table 9: Knowledge/skills want graduates to obtain KNOWLEDGE/ SKILLS WANT GRADUATES TO OBTAIN Health Unit (27) (12) (15) % % % Can describe the health and disability sector in New Zealand and explain the public health sector s role in promoting and protecting public health Can define the social, cultural and economic determinants of health in New Zealand; and analyse health inequalities Can assess the impact and influence of the Treaty of Waitangi on Māori and public health; and analyse public health issues from a Treaty of Waitangi perspective Can demonstrate how the range of approaches used by public health disciplines can improve health outcomes Contributes effectively to community health development in a public health context Uses research and evaluation effectively to improve own public health practice Builds and maintain relationships with Māori, Pacific and/or other peoples in New Zealand, using culturally appropriate processes and protocols Be a creative problem solver, and apply ethics to professional practice DEMAND FOR THE COURSE The first part of Table 10 shows that, of the 24 organisations which answered this question, the mean number of staff who they thought were in the target audience for this course was 14.9 for PHUs and 9.6 for s. Managers were asked to provide numbers that they would aspire to achieving, rather than what would be an easy target. The same table also shows the estimated number they would support to attend in each of the three years and then the three year total. The mean for the three year total was 8.1 for s and 7.6 for PHUs. The answers to this part of the questionnaire often had a number of missing values. For the analysis purposes it has been assumed that if someone gave an answer somewhere in the target audience column, then the blanks were zero values rather than them having chosen not to answer. There were three cases where there were no values in any part of the target audience column, so these organisations were left out of the analyses. A similar approach was used for the columns where they identified the number they would support each year, as reported in the following section. 22

23 Table 10: Number in target audience and numbers attending course NUMBER IN TARGET AUDIENCE Health Unit (n= Mean ATTENDING 2014 (n= Mean ATTENDING 2015 (n= Mean ATTENDING 2016 (n= Mean ATTENDING OVER 3 YEARS (n= Mean The size (n=, is shown for each part of the table because the numbers varied a little depending on the level of data supplied. While the previous table provided the actual numbers, it is also useful to consider these as a percentage of the total public health workforce. Table 11 shows that for PHUs the managers thought that just 19% of their workforce would be in the target audience for the Certificate. However managers in the s thought 62% of their workforce would be in the target audience. The second set of data in Table 11 shows that PHUs would expect to support half (51%) of those in the target audience to attend the course some time in the first three years. In contrast the managers in the s expected to support almost all of their target audience staff to attend over the three years (83%). The final set of data in the table shows that PHUs would expect to have just 9% of their workforce attend the course in the first three years, while for s it would be 58%. These findings are at least in part a reflection of the level of qualifications currently held by staff in PHUs versus s (see Page 46 for more detail). 23

24 Table 11: Proportions attending TARGET AS A % OF THE WORKFORCE Health Unit (n= Mean ATTENDING OVER 3 YEARS AS % OF TARGET (n= Mean ATTENDING OVER 3 YEARS AS % OF WORKFORCE (n= Mean Table 12 shows that health promotion/education accounted for the largest proportion of the staff that managers thought would be in the target audience for the course (62% for s and 30% for PHUs). Among PHUs, public health nurses were the second largest group (28%), followed by Other, which would be any discipline not included in the categories shown in the table. Table 12: Proportion of target audience in each discipline PROPORTION OF TARGET AUDIENCE IN EACH DISCIPLINE Health Unit (23) (9) (14) % % % health programme co-ordinator Health promotion/education Community health work Health protection health nurse Management/advisory Other Table 13 is based on the data for how many staff the managers would support to attend the Certificate programme over the first three years. There were 19 of the managers who provided some data in answer to this question. This table shows that health promotion/education staff accounted for 48% of the PHU staff likely to be attending and 58% for the s. health nurses accounted for 22% of PHU staff attending. 24

25 Table 13: Proportion of those attending over first 3 years in each discipline PROPORTION OF THOSE ATTENDING OVER FIRST 3 YEARS IN EACH DISCIPLINE Health Unit (19) (8) (11) % % % Health programme co-ordinator Health promotion/ education Community health work Health protection health nurse Management/ advisory Other IMPACT OF HAVING TO TRAVEL FURTHER FOR COURSE The estimates of numbers of staff that they would support to attend the course were based on the block courses being in Auckland, Wellington and Christchurch. In the phone interview they were asked if the course was only available in Auckland/Wellington [they were asked about the option farthest from them], would this make any difference to the numbers they would support to attend. If they said it would, the interviewer sought to obtain an estimate of the likely percentage reduction in numbers attending. There were 11% who said it would make no difference, 43% gave some level of reduction and 48% did not provide any percentage reduction. The percentage reductions mentioned were: 20% (1 person), 25% (2 persons), 50% (5 persons), 80% (1 person), 90% (2 persons) and one person said they would not send anyone if it was out of town (i.e. 100% reduction). In terms of other responses to this question, a quarter mentioned cost issues, particularly in the current environment. There were two who said they would not send staff to Christchurch, and all the other comments were mentioned by just one person. BARRIERS/RISKS THAT NEED TO BE ADDRESSED Managers were asked in the phone interview what possible barriers or risks needed to be addressed before their organisation could feel it was able to fully support this programme. As shown in Table 14, monetary restraints were seen as the biggest potential barrier. Once again, relevance to their work was also mentioned. The time involved was also noted, as was the fact that there are competing priorities for their time. There was also some mention that it was not an appropriate course for some staff, in terms of their existing qualifications already being at a higher level. A fuller set of responses, with the more minor mentions included, is included as Table 44 in Appendix A. When asked what barriers/risks needed to be addressed before there was full support from staff, 25% of managers mentioned the need for staff to see the relevance of it to their roles and being an extension of what they have already learnt. No other risks/barriers were mentioned by more than one person. 25

26 Table 14: Barriers/risks that need to be addressed BARRIERS/RISKS THAT NEED TO BE ADDRESSED Health Unit (28) (12) (16) % % % Monetary restraints/ budget/ funding/ small organisation no funding increase for long time/ stop cutting funding Relevance to their roles extension of what they've learnt/ alignment in terms of content of course/ must be applicable, have cultural content in training/ what we do and not just top-level theory/ of value to staff, practicality issue Time family commitments/ arranging childcare/ working full-time/ managing workload If staff didn t have a set of learning and development linked into their pathway Competing priorities/ prioritise the need for professional development Course is of a quality standard is at a level for someone with few qualifications through to someone who has practical knowledge of public health and health promotion ADDRESSING BARRIERS/RISKS When asked how the barriers/risks for the organisation might be best addressed, two mentioned the need to be notified early, so they can be included in the budget. Nothing else was mentioned by more than one person. There were only single response comments for how these barriers/risks with staff might be addressed. RESPONSE TO STRONG FOCUS ON MAORI AND, TO LESSER EXTENT, PACIFIC Managers were advised that, With the course material for the Certificate in Health, it is proposed that there will be a strong Maori focus, and to a lesser degree a Pacific focus. The responses were generally positive, but some PHUs in particular noted they had few Pacific peoples in their region. Some also noted the need for the course to adapt to the changing population, which included Asian and refugees. 26

27 Table 15: How feel about strong Māori focus and some Pacific focus HOW FEEL ABOUT STRONG MĀORI FOCUS AND SOME PACIFIC FOCUS Supportive comments Health Unit (28) (12) (16) % % % Positive, as there is a strong Māori population in our region/ the main communities we work with and deliver to Pacific needs focus/ needs to be there/ needs to have Pacific content/ understand Pacific world Is good, as have a good number of Māori staff here Hundred percent support Māori/ Māori focus Pacific community growing need to address Neutral comments Not many Pacific in this region/ not an issue for us Courses need to be able to adapt to changing population Asian, refugee More Pacific in Auckland than registered Māori/ larger focus on Pacific in Auckland much lower demographics in health WHAT CAN DO TO INTEGRATE COURSE LEARNINGS INTO WORKPLACE Table 16 shows the main ways which managers felt they could make sure what staff learn on the course is successfully integrated into their workplace. Having the staff share their knowledge with other staff was the most mentioned, followed by ensuring there are opportunities provided for the staff to put into practice what they have learnt on the course. Table 16: What they can do to integrate course learnings into workplace WHAT THEY CAN DO TO INTEGRATE COURSE LEARNINGS INTO WORKPLACE Health Unit (28) (12) (16) % % % Feedback to others what is learnt nice to re-energise team/ everything new you learn integrate back/ share knowledge with other staff Identify where in their roles they can take learnings on board/ embed the knowledge in terms of practice Performance appraisal process identifies whether staff have got value from the course and are using it in their work Having opportunity as manager to sight course content and assessment criteria or obligations will sit down with staff member and chat, agree on some learning objectives topics manager will pick up for staff member/ meaningful for staff member and useful for organisation Mentor informally for staff who want to do training (buddy up)

28 RESPONSE TO CONCEPT OF ALL PUBLIC HEALTH STAFF HOLDING PUBLIC HEALTH QUALIFICATIONS Managers were asked, The Ministry would like everyone employed in public health to hold public health qualifications. How well does this fit with your workforce development planning? As shown in Table 17, there was a mixed response to this concept. Some were totally in agreement, while others felt the important thing was that staff had qualifications which were relevant to their area of work and there should be flexibility around qualifications. Table 17: How well having all staff with public health qualifications fits with workforce development planning HOW WELL HAVING ALL STAFF WITH PUBLIC HEALTH QUALIFICATIONS FITS WITH WORKFORCE DEVELOPMENT PLANNING Health Unit (28) (12) (16) % % % Need to have relevant qualifications for their area of work/ if useful to their work Absolutely agree/ totally support/ good idea Not a focus for our organisation for everyone to have public health qualifications focus on Ministry of Health leadership training course/ health qualifications Fits with some of our workforce planning/ starting to review workforce development now/ going into new planning stage good opportunity moving forward to build that in Barrier money to finance learning Nice goal but doubt could be achieved/ public health so broad Need competent workforce not necessarily qualifications health should allow flexibility around qualifications have an MBA but not a degree in public health/ university degree minimum when employing Don't expect all staff to have public health qualifications admin staff/ public health nurses, advisors, health protection officers, etc Professionalise workforce do need to make sure qualifications are part of this

29 SUPPORT REQUIRED TO REACH MINISTRY S ASPIRATIONAL GOALS The question asked, In the medium term the Ministry is considering setting aspirational targets for each provider organisation in terms of the numbers of staff required to undertake public health qualifications. What support would your organisation require to achieve this? The main responses all related to funding. This included funding to support the staff getting qualified, and more specific mentions of funding course-related costs and funding back-filling when staff are away at the courses. Other less frequently mentioned comments are in Table 49 in Appendix A. Table 18: What support would require to meet Ministry's aspirational targets WHAT SUPPORT WOULD REQUIRE TO MEET MINISTRY'S ASPIRATIONAL TARGETS Health Unit (28) (12) (16) % % % Financial support give us workforce funding for staff to get qualified Funding for course-related costs travel/accommodation grants Funding for back-filling/ release time/ need to look at this

30 6 WHO ARE WE? SIZE OF WORKFORCE The 12 PHUs reported having 934 current public health staff, an average of They also had 43 vacancies, taking their public health workforce size to 977, an average of The numbers of current public health staff in the PHUs ranged from 23 to 180. The median 6 number was 60. The 15 s which provided data had 230 public health staff, an average of They also had 6 vacancies, taking their public health workforce size to 236, an average of The numbers of current public health staff in the PHUs ranged from 3 to 40. The median number was 10. When compared with 2004, the mean number of PHU staff had increased from 68 to 81. A much higher proportion of s were included in the more extensive study undertaken in 2004 (171 compared with 16 in the current survey). The mean number of staff in the s in 2004 was 9.6. The much higher level of 15.7 for the current survey reflected the being more focussed on the larger organisations. DATA REPORTED The data for the remainder of this chapter comes from the details that each organisation provided for each of their staff. There were 879 staff reported on, with 672 (76%) from PHUs and 207 from s. Within PHUs there were 72% reported on, while among s there were 90% reported on. The data in the tables which follow are based on those who responded, so the base numbers vary, especially for the ethnicity question. Because of the larger numbers, it has been possible to conduct significance testing, for comparisons between the PHU and responses. An upward arrow ( ) denotes a significantly higher value for compared with PHUs, while a downward arrow ( ) denotes a significantly lower value. DISCIPLINE WORKING IN It can be seen in Table 19 that the staff in s were predominantly health promotion/education (56%) and management/advisory (20%), while PHUs had a much greater spread of disciplines, reflecting the broader focus of their work. Where possible, comparisons have been made with the same organisations in 2004, but there the data came from staff self-completion surveys, so there were fewer staff who responded. The Sample results were reasonably similar between the two surveys. 6 The median is the value which the middle person is at, after ranking from lowest to highest values. Medians are often used as a better indicator than means, because means can be affected by a few extreme values. 30

31 Table 19: Discipline working in DISCIPLINE WORKING IN Health Unit (879) (672) (207) % % % health programme coordinator Health promotion/education Community health work Health protection Medicine Analysis/policy analysis Management/Advisory health nurse Support worker denotes is significantly higher than the PHU, and denotes a significantly lower figure DEDICATED MAORI AND PACIFIC ROLES In the s, 17% said they worked in a dedicated Māori role and 18% in a dedicated Pacific role (Table 20). To provide some context to these findings, there were 13% of the s which were Maori and 11% which were Pacific, although obviously dedicated roles can exist in organisations which are not Māori or Pacific providers. There were very few dedicated roles in PHUs. Table 20: Dedicated role DEDICATED ROLE Health Unit (865) (662) (203) % % % Dedicated Maori role Dedicated Pacific role Neither ETHNICITY Persons were asked to code all ethnic groups that applied to them, which is why the columns in Table 21 totals more than 100%. Māori and Pacific persons were both better represented in the s than PHUs, which was consistent with the s including Māori and Pacific providers. The ethnic composition was relatively similar between 2004 and

32 Table 21: Ethnicity ETHNICITY Health Unit (829) (622) (207) % % % Maori Pacific Asian NZ European/Pakeha Other GENDER Just over three quarter of the staff were female (76%) and this level was the same for both PHUs and s. This was similar to AGE Forty percent were aged 50 years and over and a total of 69% were aged 40 years and over (Table 22). Just 10% were aged under 30 years. The age profile was similar in PHUs and s. Compared with 2004, the proportion aged 50 years and over had increased from 29% to 39% 7. Table 22: Age AGE Health Unit (825) (617) (208) % % % Under 30 years to 39 years to 49 years to 59 years years or over Table 23 shows how age varied by discipline. Health promotion/education staff tended to be a little younger (40% aged under 40 years vs 31% for the Sample). Those in management/advisory were more likely than others to be aged 40 to 49 years (39% vs 29%), while public health nurses were more likely to be aged 50 to 59 year (41% vs 28%). In this table, and any others with more than just two groups being compared, the significance testing is for the difference between the group with the upward or downward arrow and the Sample. 7 The 39% differs from the 40% in Table 22 because some organizations in the current survey did have data for 2004 and were excluded from the comparisons. 32

33 Table 23: Age by discipline AGE: 2012 Health Programme coordinator Health Promotion/ education Community health work DISCIPLINE WORKING IN Analysis/ policy analysis Health protection Medicine Management/ advisory health nurse Support worker (823) (66) (307) (30) (126) (39) (39) (108) (73) (120) % % % % % % % % % % Under 30 years to 39 years to 49 years to 59 years years or over

34 7 WHAT ARE THE MOST IMPORTANT WORKFORCE ISSUES? In the self-completion survey managers were presented with the list of workforce issues shown in Table 24 and asked to rate the top five from one to five. This table has PHU and s combined. Level of funding/ funding cuts/ obtaining more funding was the number one issue, both now and in the next five years. 8 Workloads/burnout was the next most mentioned in the top three, for both now and in the next five years. Meeting Ministry requirements/ relationship with the Ministry was one of a group of three items with around a third rating them in their top three for current issues. The other two were the Need for more training for the workforce and Staff performance. Staff performance was seen to be more of an issue now (30% mentioned it in their top 3), than in the next five years (15%). Conversely, Staff recruitment and Staff retention were expected to be more important issues in the next five years than they are now. The questionnaire allowed managers to write down other workforce issues, apart from those listed. Two managers in PHUs (7%) mentioned cultural competency in their top three current issues. Table 24: Workforce issues WORKFORCE ISSUES Most important CURRENTLY Top 2 TOTAL SAMPLE (27) Top 3 NEXT 5 YEARS Most important Top 2 Top 3 % % % % % % Level of funding/ funding cuts/ obtaining more funding Workloads/ burn out Meeting Ministry requirements/ relationship with Ministry Need for more training for the workforce Staff performance Staff retention Lack of skilled staff available/ recruitment problems Table 25 shows the data for PHUs and s. More workforce training was a much greater issue for s (47% vs 8% for PHUs for current issues). Workloads/burnout were also more of an issue for s (53% vs 33% for PHUs), as was Staff performance (40% vs 17%). Meeting Ministry requirements was more of an issue for PHUs (42% vs 27%). 8 Although the items in the list were based on the most mentioned in 2004, this earlier survey asked the question unprompted (i.e. they were not shown the list of items), so it is not valid to make comparisons. 34

35 Table 25: Top three workforce issues TOP THREE WORKFORCE ISSUES CURRENT ISSUES Health Unit NEXT 5 YEARS Health Unit (12) (15) (12) (14) % % % % Level of funding/ funding cuts/ obtaining more funding Workloads/ burn out Meeting Ministry requirements/ relationship with Ministry Need for more training for the workforce Staff performance Staff retention Lack of skilled staff available/ recruitment problems In the phone interviews the managers were asked for details about most of these workforce issues, which are described in the following sections. There was not a specific question relating to level of funding/funding cuts/obtaining more funding, but some of the comments relating to the other issues, especially the relationship with the Ministry, did relate to funding issues. MEETING MINISTRY REQUIREMENTS AND RELATIONSHIP WITH MINISTRY When asked to discuss any issues managers had with regard to meeting Ministry requirements and the relationship with the Ministry, the most common responses related to financial issues. Many commented on funding cuts, or the lack of any increases in funding to cover increasing costs. The implications of this were having to cut staff, or concerns about having to do so. Once staff were cut, there was still the same amount of work to do, but with less staff. Also associated with funding concerns were questions as to whether their contracts were going to be renewed and, if so, in what form. Looking ahead to the next five years, the s were particularly concerned about funding issues. A number of managers talked about the reduced level of contact and reduced quality of relationships with the Ministry. Comments included: Continuous restructuring of the public health directorate, changed parameters, increased workloads of Ministry staff - our relationship has become non-existent. Want more dialogue with Ministry of Health staff Used to have a great relationship, now none. Would value the opportunity to do so again. Not enough people [at the Ministry] to deal with the easy contracts too busy with the hard ones. Unclear on direction of the Ministry. They have no capacity to interact effectively... We are working in isolation, which is frustrating. Difficult to build relations and work productively with them. Have lost expertise from within the Ministry. 35

36 How can they ask that of the workforce [increased workloads] when they ve [the Ministry] got a whole lot of stuff going on. Monitoring reports sent in in January did not have feedback until July. No relationship, non-existent. Prior to this relationships were very strong, opportunity to talk with contract manager if things weren t working, looking at possible solutions. STAFF WORKLOAD/ BURNOUT ISSUES The concerns with staff workload and burnout related in large part to the cost-cutting. Some felt they were still trying to deliver the same level of service, but with fewer staff, as they were aware of the amount of work that needed to be done. Some noted the need to proactively plan and ensure the work matched the resources they had. This included prioritising and saying no to some things. A few mentioned encouraging staff to take their leave entitlements, to reduce the possibility of burnout. Some managers mentioned the risk of manager burnout over the next five years, as the amount which managers are responsible for keeps growing. STAFF TRAINING ISSUES The main issue again related to the lack of funding and its impact on the ability to fund staff training. This was particularly seen as an issue over the next five years for the s. A few noted that older members of the workforce had limited interest in doing any further training, particularly external training. Two mentioned the Ministry emphasis on outcome evaluation, and that they did not have the skills in their health promotion teams to be able to do that level of evaluation. STAFF RECRUITMENT ISSUES Almost half the PHUs mentioned issues relating to recruitment for Maori specific roles, while none of the s did. This was linked to there being a limited pool of Maori in the workforce. Some PHUs felt they were training Maori, and then they would go off to s. Some used the term poached, and some felt that some s could offer financial incentives which the PHUs could not match. However, some PHU managers felt fine about training Māori staff, who would then go off and work for s in their own communities. There was less mention of issues recruiting for Pacific roles, but there were some issues with finding appropriate people with the right skills, which included the ability to speak the language. A quarter of the PHUs specifically mentioned issues recruiting for health protection officers, due to the lack of people in this field. Medical Officers of Health were also singled out for mention by some PHUs. There was also some comment about the medical staff being an aging population. The aging workforce generally was an issue noted by a few managers for the next five years. Meeting salary expectations was mentioned by a few, as both a current issue and for the next five years, and how difficult it was matching salaries paid elsewhere. 36

37 Some PHUs noted the difficulty of attracting good administration staff and that there was a big turnover. A few felt that recruitment issues will continue improving, due to the impact of the recession. A few PHU managers noted that over the next five years the skill base will be different and will not reflect historical practices. STAFF RETENTION ISSUES Two PHU managers and one manager noted that they found it difficult competing with the salaries offered by other agencies, such as DHBs, PHOs and Auckland City. Some turnover was expected due to aging, particularly for Nurses and Health Protection Officers. A few noted that some staff left seeking better and higher training opportunities. Some noted that with the current economic climate, staff were not moving around as much as they used to. In terms of the next five years, some PHU managers noted the impact of the current changing political environment and expected that, when things were more settled, there would be more people changing jobs. STAFF PERFORMANCE ISSUES There were no dominant issues with regard to staff performance. There was some mention of the problems associated with staff who are new to the sector, the shortage of certain skill sets, and the need to have staff trained appropriately. A few mentioned there being an issue in keeping staff motivated to continue working in the current climate of cost-cutting and the impact on workloads. Some managers mentioned their high expectations of staff and that these will possibly increase. In relation to this they noted the need to manage expectations, to be clear about what they expect from staff and the increasing need for stellar performance. STRATEGIES TO MANAGE WORKFORCE ISSUES When asked to suggest their top five strategies for managing the current workforce issues, most PHUs and some of the s mentioned workforce development planning. This included looking at both internal needs, including staff needs and external needs. Some specifically mentioned having comprehensive training plans. It was noted that these needed to be based on staff needs going forward and include organisational mandatory training. IT training was also noted as being an important part of the mix. Ensuring supervision and/or EAP services were in place was also mentioned by some managers. Some of the PHU managers mentioned staff identifying their performance issues and annual reviews. There were also some of the PHU managers who noted the importance of having a supportive work environment, so that people enjoyed working there. 37

38 There were several managers, particularly in PHUs, who mentioned building stronger relations with other providers in the area. This was seen as advantageous in terms of trying to address poaching, to have more understanding of what was going on around them, and could include sharing some of their plans. It was noted that this could extend beyond workforce issues, and look at other opportunities for partnership, such as in encouraging the public to adopt healthier behaviours. Funding issues again received some mention, although not a lot, in terms of trying to have adequate funding to meet the aspirations of the workforce. In terms of the next five years, it was a case of keeping doing what they were doing now. EFFECTS OF REDUCTION IN PUBLIC HEALTH WORKFORCE There were 83% of the PHUs and 75% of the s who said their organisations had had reductions in public health services contracted for by the Ministry in the previous three years. When asked about the effects of this on their public health workforce, comments included: Workforce reduced increased their workload process could have been better managed wears us down. Lost staff Tends to make others wonder who s next When, where is the next cut? Lost contracts and therefore staff in who we have invested a lot. Way in which changes in [specified contract] occurred took a lot of energy and heart out of the programme people don t work with the same level of passion. 38

39 8 HOW ARE WE DOING? EXPERIENCE, RECRUITMENT AND RETENTION YEARS IN PUBLIC HEALTH There were two thirds of the staff who had worked in public health for less than ten years, with 38% having worked less than five years. As shown in Table 26, those working in Analysis/policy analysis had been there less time than most others (90% less than 10 years). Those working in Health Protection, Medicine and Management/Advisory tended to have been in public health for longer. Table 27 shows that there was little difference between ethnic groups for time in public health. The only significant difference was for Maori to be less likely to have been involved for 20 years or more (4% vs 12% for the Sample). There were no noticeable differences between the 2004 and 2012 data. Table 26: Years in public health, by discipline YEARS IN PUBLIC HEALTH BY DISCIPLINE WORKING IN Health Programme coordinator Health Promotion/ education Community health work DISCIPLINE WORKING IN Analysis/ policy analysis Health protection Medicine Management/ advisory health Support nurse worker (824) (67) (310) (30) (126) (37) (41) (106) (74) (120) % % % % % % % % % % Less than 5 years to 9.9 years to 14.9 years to 19.9 years years or over Table 27: Years in public health, by ethnicity YEARS IN PUBLIC HEALTH BY ETHNICITY NZ European/ Pakeha Māori Pacific Asian (822) (494) (167) (73) (55) (88) % % % % % % Less than 5 years to 9.9 years to 14.9 years to 19.9 years years or over

40 EMPLOYMENT STATUS Just under two thirds (65%) were working full-time. Most of the rest (32%) were part-time and 2% were contractors. No one classified themselves as a consultant and no one was in a voluntary role. health nurses were more likely than others to be part-time (55%), while Health protection and Management/advisory were more likely to be full-time (both 81%). Pacific persons were more likely than others to work full-time (81%) or contractors (5% vs 2% for Sample). Comparisons with 2004 for the same organisations show a higher proportion working part-time in 2012 (30% 9 vs 18% in 2004). In 2004 there were fewer employees in the organizations who completed questionnaires, so it is possible that the difference was due to part-time staff being less likely to complete the survey in 2004 compared with the full-time staff. Table 28: Employment status EMPLOYMENT STATUS Health Programme coordinator Health Promotion/ education Community health work Analysis/ policy analysis Health protection Medicine Management/ advisory health Support nurse worker (868) (67) (311) (30) (132) (44) (41) (112) (84) (138) % % % % % % % % % % Full-time in Health Part-time Contractor RECRUITMENT The self-completion survey included a list of all the positions listed in Graph 1 and Graph 2 and managers rated how difficult it was to recruit staff for each position in the last two years, using the scale shown at the top of the graphs. This included options for Not recruited in last 2 years and Wanted to but can t afford. In the graphs, the bars to the left of the vertical axis represent the reported level of difficulty, red being Always difficult and orange being Sometimes difficult. The green bar to the right is for those who reported that it was Never difficult. The numbers inside the bars are the percentages who gave that response (the percentages total across to 100%). Graph 1 shows the dedicated Maori and Pacific positions. For all but the Maori and Pacific community workers, there were higher proportions of managers reporting sometimes / always difficult than were reporting never having difficulties. Those who were trying to recruit Maori or Pacific health protection officers usually reported that it was always difficult. All those recruiting for Maori policy analysts, Maori advisors, Pacific managers, Pacific policy analysts and Pacific public health programme co-ordinators always reported some level of difficulty. As health promotion workers/advisors were the largest part of the workforce, they had 9 This figure is different to the 32% reported elsewhere for 2012, because not all of the current organizations were in the 2004 data base, and therefore included in the comparison between 2012 and

41 the highest levels for difficulties, but the Maori health promotion workers/advisors also had the highest levels for no difficulties. Graph 1: Recruitment difficulty Māori and Pacific dedicated positions Recruitment Difficulty - Maori and Pacific Dedicated Positions Always difficult Sometimes difficult Never difficult Not recruited in last 2 years Want to but can t afford Don't know Māori Managers Māori Policy Analysts Māori Advisors Māori Health Protection Officers Māori Health Programme Co-ordinators Māori Health Promotion Workers/ Advisors Māori Community Health Workers Pacific Managers Pacific Policy Analysts Pacific Advisors Pacific Health Protection Officers Pacific Health Programme Co-ordinators Pacific Health Promotion Workers/ Advisors Pacific Community Health Workers Graph 2 shows the recruitment difficulty for non-dedicated positions. The few managers who had recruited portfolio managers all reported some level of difficulty. For all the other positions there were some managers who reported that it was never difficult. On most of these there were more than twice the number reporting at least some difficulties (the red and orange bars) compared with no difficulties (the green bars). From highest to lowest rates of difficulties to non-difficulties, they were: health dieticians/nutritionists (27% vs 4%, ratio of 6.75) Health protection officers (34% vs 8%, ratio of 4.3) health registrars (16% vs 4%, ratio of 4.0) Researchers/ evaluators/ analysts (46% vs 15%, ratio of 3.1) Medical officers of health (19% vs 8%, ratio of 2.4) health programme co-ordinators (19% vs 8%, ratio of 2.4 ) Health promotion workers/advisors (58% vs 27%, ratio of 2.1) Managers (54% vs 27%, ratio of 2.0) Epidemiologists (8% vs 4%, ratio of 2.0) Policy analysts (19% vs 12%, ratio of 1.6) health physicians (12% vs 8%, ratio of 1.5) health nurses (15% vs 12%, ratio of 1.25) 41

42 Graph 2: Recruitment difficulty non-dedicated positions Recruitment Difficulty Non-dedicated positions Always difficult Sometimes difficult Never difficult Not recruited in last 2 years Want to but can t afford Don't know Portfolio Managers Managers Medical Officers of Health Health Physicians Health Registrars Health Protection Officers Policy Analysts Epidemiologists Researchers/ Evaluators/ Analysts Health Education Specialists Health Programme Co-ordinators Health Promotion Workers/ Advisors Health Dieticians/ Nutritionists Health Nurses Community Health Workers Administrators Receptionists Other support workers It was possible to compare 2004 and 2012 data for 19 organisations, of which 12 were PHUs. Change was analysed using the ratio of difficulty to no difficulty. In 2012 it had got easier to recruit for 10 : Māori health promotion workers/ advisors Medical officers of health health physicians Policy analysts health nurses In 2012 it had got more difficult to recruit for: Māori advisors health registrars health dieticians 10 These are not in any order of level of improvement. 42

43 RETENTION Of the Maori and Pacific dedicated positions, the only one where any managers reported it always being difficult retaining staff was for Maori health protection officers. However, overall there were more who reported that it was never difficult (15%) than reported at least some level of difficulty (12%). There were several positions where those who did have staff in these roles always reported they sometimes had difficulties, these being: Maori policy analysts, Pacific policy analysts, Pacific advisors, and Pacific health protection officers. Other positions where the proportion reporting some level of difficulty exceeded the proportion where it was never difficult were for: Maori public health programme co-ordinators (12% some difficulty vs 8% never difficult), Pacific managers (11% vs 7%), and Pacific public health programme co-ordinators (8% vs 4%). Graph 3: Retention difficulty Māori and Pacific dedicated positions Retention Difficulty - Maori and Pacific Dedicated Positions Always difficult Sometimes difficult Never difficult Not employed in last 2 years Don't know Māori Managers Māori Policy Analysts Māori Advisors Māori Health Protection Officers Māori Health Programme Co-ordinators Māori Health Promotion Workers/ Advisors Māori Community Health Workers Pacific Managers Pacific Policy Analysts Pacific Advisors Pacific Health Protection Officers Pacific Health Programme Co-ordinators Pacific Health Promotion Workers/ Advisors Pacific Community Health Workers In terms of retention for non-dedicated positions (Graph 4), epidemiologists were the only position for which no difficulty was reported, but there were only 4% who reported having employed any in the last two years. health dieticians/ nutritionists were the only group where there was always some level of difficulty retaining them (i.e. none saying never difficult ). The proportion reporting more difficulties with retention (the red and orange bars) compared with no difficulties (the green bars) are listed below. From highest to lowest rates of difficulties to non-difficulties, they were: health programme co-ordinators (16% vs 4%, ratio of 4.0) Health promotion workers/advisors (54% vs 27%, ratio of 2.0) health nurses (23% vs 12%, ratio of 1.9) Health protection officers (27% vs 15%, ratio of 1.8) Researchers/ evaluators/ analysts (35% vs 23%, ratio of 1.5) 43

44 The fact that this list is much shorter than that for recruitment and the ratios much lower, shows that there are fewer issues with retention than there are with recruitment. Graph 4: Retention difficulty non-dedicated positions Retention Difficulty Non-dedicated positions Always difficult Sometimes difficult Never difficult Not employed in last 2 years Don't know Portfolio Managers Managers Medical Officers of Health Health Physicians Health Registrars Health Protection Officers Policy Analysts Epidemiologists Researchers/ Evaluators/ Analysts Health Education Specialists Health Programme Co-ordinators Health Promotion Workers/ Advisors Health Dieticians/ Nutritionists Health Nurses Community Health Workers Administrators Receptionists Other support workers Compared with 2004, in 2012 there were no positions where it had got less difficult to retain staff. It had got more difficult to retain: Managers Researchers/evaluators/analysts Health promotion workers/advisors health nurses 44