Part 1: Introduction

1.1
This report presents the findings from a performance audit we carried out of the leadership of the Accident Compensation Corporation (ACC) in the implementation of the national falls prevention strategy, Preventing Injury from Falls: The National Strategy 2005/2015 (the Strategy).

1.2
In this Part, we discuss the context for our audit, including:

• ACC’s injury prevention function;
• the New Zealand Injury Prevention Strategy (NZIPS);
• the national falls prevention strategy;
• why we carried out the audit;
• our expectations;
• how we carried out the audit; and
• matters outside the scope of the audit.

The Accident Compensation Corporation’s injury prevention function

1.3
Preventing injury is a core function for ACC. The Injury Prevention, Rehabilitation, and Compensation Act 2001 makes ACC responsible for promoting measures to reduce the incidence and severity of personal injury. ACC’s Strategic Plan 2007-2012 lists injury prevention as one of its focus areas, and outlines ACC’s commitment to putting effective programmes into place to reduce the incidence, severity, and cause of injuries.

1.4
For 2007/08, ACC has budgeted to spend about $33 million on injury prevention, about $5.2 million of which is to be spent on falls prevention. ACC has about 130 people working on injury prevention.

1.5
ACC’s injury prevention work is focused on significantly reducing injuries with serious consequences for costs to the ACC scheme, and targets four areas of prevention:

• in the workplace;
• on the roads;
• in the home; and
• through sports and recreation.

The New Zealand Injury Prevention Strategy

1.6
In June 2003, the Government launched the NZIPS.

1.7
The NZIPS was developed in response to the significant costs of injuries and fatalities, the lack of a clear and consistent strategic direction for injury prevention activities, and the need for co-ordination between government agencies working in this area.

1.8
The NZIPS has six priority areas, each with its own lead agency or agencies (see Figure 1). One of these areas is falls prevention.

1.9
A small secretariat within ACC leads the implementation of the NZIPS. The NZIPS Secretariat is responsible for working closely with the lead agencies for the six priority areas to ensure effective implementation, and to co-ordinate monitoring and reporting of progress.

Figure 1
National injury prevention areas and lead agencies

The national falls prevention strategy

1.10
Falls are a leading cause of death from injury in New Zealand, and also the leading cause of injuries requiring admission to hospital. Falls also have wider social and economic effects, such as the injured person’s loss of confidence, long-term impairment to quality of life, and loss of capacity to work. The cost to ACC of falls-related claims in 2006/07 was $693 million.

1.11
The NZIPS gave rise to a national strategy to reduce the incidence, severity, and cost of injuries from falls. The strategy was approved by Cabinet in June 2005, and published in August 2005.

1.12
ACC is responsible for leading the implementation of the Strategy, and published an implementation plan in December 2006. ACC’s leadership in the implementation of the Strategy was the subject of our audit.

1.13
The Strategy is based on the vision "Towards a New Zealand free of injury from falls". This vision is supported by two goals and five objectives (see Figure 2).

Figure 2
Structure of the national falls prevention strategy

1.14
The two goals are:

• to reduce the incidence and severity of injury from falls; and
• to reduce the social, psychological, and economic impact of fall-related injuries on individuals, families/whanau, and the community.

1.15
The five objectives are:

• Objective 1 – Build effective leadership and co-ordination in the prevention of injury from falls.
• Objective 2 – Improve the gathering and dissemination of knowledge about the prevention of injury from falls.
• Objective 3 – Develop and implement programmes and interventions that focus on the prevention of injury from falls, based on best practice.
• Objective 4 – Create safer environments to prevent injury from falls.
• Objective 5 – Ensure appropriate resource levels for the prevention of injury from falls.

We discuss progress in carrying out the actions to meet Objectives 1, 2, and 3 in Part 3.

1.16
The Strategy does not deal with falls that occur in the workplace. These are addressed through the Department of Labour’s Workplace Health and Safety Strategy for New Zealand to 2015. However, ACC has recognised the need for coordinating falls prevention initiatives to support both strategies.

1.17
The Strategy was to be carried out in three phases:

• Phase One (July 2005 to June 2006) – establishing leadership structures and accountability mechanisms, and developing the implementation plan;
• Phase Two (2006 to 2010) – implementing the plan developed during Phase One; and
• Phase Three (2010 to 2015) – consolidation and looking to the future.

1.18
The Strategy has a time frame of 10 years. This reflects the fact that measurable results may take years to become apparent.

Why we carried out the audit

1.19
More efficient and better co-ordinated activities to prevent falls can help reduce the number of falls and their severity, and thereby lower the ongoing costs to ACC and the wider community.

1.20
ACC is New Zealand’s primary injury prevention agency, and has a history of leading programmes in falls prevention. However, it is only one of a large number of government agencies and non-government organisations with an interest in falls, injuries from falls, and falls prevention. Groups with an interest in falls prevention make up what we have termed the falls prevention sector.¹ The many different interests and perspectives of these agencies and organisations create a challenge for ACC in securing wide stakeholder commitment and in leading the implementation of the Strategy.

1.21
We carried out the audit to assess how well ACC was leading the implementation of the Strategy, given the high social and economic costs of injuries from falls, and the importance of the Strategy to the Government.

1.22
Our audit adds to a body of recent audit work carried out by our Office that examines how different government agencies have implemented government initiatives and strategies in collaboration with a range of partners.²

1.23
With the implementation of the Strategy still in its early stages, we did not expect to find evidence of measurable results. Our objective in carrying out the audit at this time was to review ACC’s preparation of the implementation plan and the progress on the implementation of the Strategy to date. It would also allow us to highlight any leadership issues for action by ACC.

Our expectations

1.24
We expected ACC to have:

• prepared a comprehensive implementation plan for the Strategy, with clear objectives, realistic priorities, clear expectations, and defined time frames for action;
• used effective governance and project management to prepare the implementation plan, working in close consultation with the falls prevention sector; and
• promoted the implementation of the Strategy in accordance with the plan, including:
  • establishing effective leadership and direction within ACC and externally;
  • gathering and distributing information about falls prevention;
  • establishing ongoing communication with stakeholders;
  • promoting the delivery of programmes and interventions in alignment with the plan; and
  • establishing systems to monitor progress and evaluate results.

How we carried out the audit

1.25
We reviewed relevant ACC documents and spoke to current and former ACC staff and external contractors about their involvement with the Strategy and its effect on their work.

1.26
We interviewed people from a range of government agencies and non-government organisations about the Strategy and its implementation. We also used a questionnaire to find out their views on consultation, their assessment of ACC’s leadership, and their impressions of progress to date. With the questionnaire we were also seeking evidence of benefits from the Strategy.

Matters outside the scope of our audit

1.27
We did not examine ACC’s implementation of the NZIPS, except where it had an effect on the Strategy’s implementation plan.

1.28
We did not assess whether the Strategy was appropriate. The Strategy was prepared in close consultation with a wide range of interest groups with extensive knowledge and experience in falls prevention. It was also formally endorsed by the Government. The principles underlying the Strategy, the Strategy itself, and the Strategy’s implementation plan were all approved by Cabinet.

1.29
The effectiveness of individual falls prevention programmes was also outside the scope of this audit.

1: The falls prevention sector includes researchers, district health boards, primary health care providers, government agencies, non-government organisations, and community groups. In this report, the groups comprising this sector are also referred to as stakeholders.

2: Key Success Factors for Effective Co-ordination and Collaboration between Public Sector Agencies, October 2003; Implementing the Māori Language Strategy, November 2007; Sustainable development: Implementing the Programme of Action, June 2007; Co-ordination and Collaboration in the Criminal Justice Sector, October 2003.