Summary

The New Zealand Injury Prevention Strategy (NZIPS) was launched by the Government in June 2003. The NZIPS was designed to focus effort and resources on injury prevention, through setting a strategic direction for government agencies and non-government organisations at a national level.

The NZIPS, as the parent strategy, established six priority areas, and a lead agency was assigned to each area. Falls prevention, led by the Accident Compensation Corporation (ACC), was one of the six priority areas. Work in this area led to the national falls prevention strategy, Preventing Injury from Falls: The National Strategy 2005/2015 (the Strategy), which the Government published in August 2005.

Our performance audit focused on ACC’s leadership in the implementation of this Strategy.

Our findings

ACC published an implementation plan for the Strategy in December 2006, which it developed through a consultative and managed process. The plan contains an appropriate mix of specific and more general objectives and actions and provides a useful basis for implementing the Strategy. The implementation plan defines responsibilities and sets out a progress reporting system, the expected results, and time frames for achieving results.

ACC has carried out useful work to establish the basis for the ongoing implementation of the Strategy. Notably, this has included:

• establishing governance arrangements;
• commissioning new research;
• collating and disseminating information;
• working with government agencies, district health boards, and local government on injury prevention; and
• using ACC’s contracting process to extend the reach of its falls prevention programmes for older adults.

However, progress on the implementation of the Strategy has been uneven. Progress has been limited by changes in project management responsibilities within ACC, restructuring, and the need to align ACC’s injury prevention business to the Strategy. A progress monitoring system is in place, but current reports against the actions in the implementation plan describe activities rather than recording results in terms of preventing falls. We are aware that ACC is considering the need for more meaningful progress reporting and a closer focus on selected priorities.

We identified two matters for ACC’s immediate attention – ACC’s leadership mandate and the evaluation framework.

Leadership mandate

ACC should make full use of the accountability relationships it has established with government agencies to promote co-ordinated injury prevention (including falls). However, the effectiveness of these mechanisms relies on persuasion, and on the willing commitment of ACC’s partners. We found some evidence of variable commitment to implementing the Strategy. In the longer term this is a risk to achieving the Strategy’s goals.

To strengthen ACC’s leadership mandate and to ensure progress in implementing the Strategy, ACC should establish a protocol with its partner agencies. This would refer closely to the implementation plan, be based on a statement of shared outcomes, and require consultation on planning, information sharing, and funding. The Strategy’s protocol would define explicitly the nature and extent of accountabilities, and specify objectives and targets. Ideally, the relevant Ministers, chief executives, and boards should endorse this protocol.

Evaluation framework

ACC also needs to draw up a comprehensive and results-oriented evaluation framework and evaluation methodology. While a broad evaluation framework has been prepared, this did not meet our expectations of a model to assess progress and evaluate results. There is currently no methodology to assess whether expected results have been achieved. ACC and other agencies should prepare and apply this methodology to assess whether intended results, as set out in the implementation plan, have been achieved, and to report on the achievement of the Strategy’s objectives and associated actions.

Other matters

We identified various factors which, in our view, are important to ACC for maintaining momentum with the implementation of the Strategy. These are:

• sustainable resourcing of ACC’s leadership role;
• close alignment (where appropriate) with business planning for ACC’s own injury prevention activities (including design of the research programme); and
• ongoing communication with agencies and organisations with an interest in falls prevention to ensure broad commitment to achieving the Strategy’s objectives.

While these matters are not sufficiently critical to require recommendations, we encourage ACC to take them into account as the implementation of the Strategy progresses.

Our recommendations

We recommend that the Accident Compensation Corporation:

1. draw up a protocol with those agencies responsible for actions in the implementation plan, to guide future work on the national falls prevention strategy; and
2. give priority to finalising a comprehensive and results-oriented evaluation framework and methodology.

Response from the Accident Compensation Corporation

ACC has outlined specific actions to put our two recommendations into practice, and to address the other matters we have noted for its consideration. Actions under way or planned include initiatives to strengthen the accountability framework for implementing the Strategy, and the drafting of a comprehensive evaluation framework. ACC has also advised that internal systems will be set up to support the role of the project manager in implementing the Strategy, and to provide continuity in the event of staffing changes. Work is continuing to ensure alignment between the Strategy and ACC’s own injury prevention activities, and to maintain effective communications with stakeholders. ACC will also be addressing the need for a research action plan.