Background The development of ACP in New Zealand was driven by the ACP Cooperative, a grass roots organisation of clinicians. The Cooperative’s aim was to drive consistency and address the barriers to ACP implementation. Over time, the lack of an official mandate and funding threatened the sustainability of the work of the Cooperative.

Method In 2017 the Cooperative partnered with the Health Quality & Safety Commission – a crown agency tasked with supporting the public health sector to improve the quality and safety of services. Together they presented a business case to the district health boards (DHBs) to agree to a national programme with a clear mandate and funding. The DHBs agreed to a five-year strategy and roadmap of national and local actions aimed at increasing ACP activity and addressing sustainability. The key strategy workstreams and their aims are:

• promotion: that future health care planning and end of life discussions are normalised in society

• resources: ACP is accessible to all regardless of language, literacy level or cultural beliefs

• education and training: we have workforce and community prepared to have conversations and use ACPs

• monitoring and evaluation: we know care is based on what matters to consumers

• implementation: we are maximising value for DHBs

Result a national mandate, strategy and specified actions have resulted in an increase in ACP activity; increased governance with decision-making being supported by a representative Steering Group; wider national stakeholder engagement and buy in from agencies in and outside of the health sector.