Annual Public Meeting Chief Executives Report 2012/2013 Population - - PDF document

Annual Public Meeting

Chief Executive’s Report 2012/2013

Population

• 261,734 people
• 24,800 Aboriginal – 9.5%
• 1.3% population growth to 2031

Services

• 37 Hospitals
• 60+ service locations

Budget

• $750M Expenditure

Staff

• 7,200 Employees
• 4,900 Full Time Equivalent
• 38% >50 years

Activity

• 172,331 ED presentations – 66%
• 82,449 Admissions ‐ 31%
• 800 Patients in beds daily
• 1,058,823 non admitted occasions of service

Western NSW Local Health District

Challenges

• Are more likely to be
• verweight and obese
• Can expect to live fewer

years

• Are more likely to die from

potentially avoidable causes

• Report more difficulty

getting healthcare where they need it

• Are more likely to go to

hospital with preventable conditions

• Leading causes of death are

– cardiovascular disease – chronic obstructive – pulmonary disease – Cancer – injuries from falls or poisoning – diabetes‐related conditions

Key achievements

• $7.2 M Dubbo Mental Health Rehabilitation and Recovery Centre
• Health Council Summit with representatives from 37 communities
• $3M for new Endoscopes across the District
• Health Needs Assessment published in partnership with Western

Medicare Local

• Partnering with Western Medicare Local to roll out the NSW Ministry of

Health Chronic Disease Management Program

• The new Aged Care Access Centre provides a hub for the District for

referrals and information resulting in equity of access to services and more appropriate pathways for patients to meet their needs.

Capital Investment

Dubbo Hospital Redevelopment ‐ $79.8M

Early works is nearing completion. The project is jointly funded with the NSW Government providing $72.7 million and the Australian Government contributing $7.1 million from the Commonwealth’s Health and Hospitals Fund.

Lachlan Health Service project ‐ $67.5M

The project is now in the Design Development stage. In 2011, the NSW Government committed $42.5m towards the Parkes Hospital redevelopment and $25m for the refurbishment of the Forbes Hospital. As part of this funding commitment, $2.3M was allocated for planning in the 12‐13 Budget and a further $12.5M was allocated in the 2013‐14 Budget.

Capital Investment

Gulgong MPS ‐ $7M

Construction is nearing completion. The NSW Government has committed $7 million to complete the project.

Peak Hill MPS ‐ $12M

Early works construction has begun. The project is jointly funded with the Australian Government committing $6 million through the Health & Hospitals Fund (HHF) and $6 million from the NSW Government.

Encouraging Excellence

There were 10 finalists from 42 entries in the 2013 Western NSW Local Health District Quality Awards

 In Safe Hands: Structured Interdiscplinary Bedside Rounds (SIBR)  Marang Dhali – Eating Well: An Aboriginal food cooking program  Aged Care Access  Improving Dental Services through Collaboration  Participation in Early Access to Stroke Thrombolysis  It pays to be well connected  Up and at ‘em – A trial of early mobilisation in elective orthopaedics in the rural context  Establishment of Specialist Geriatric Medicine Service  Preventing Falls in an older persons acute mental health award  The Fruits of our Labour

NSW Health Award Winner!

“In Safe Hands” – Structured interdisciplinary Bedside Rounds (SIBR) Minister for Health’s Award for Innovation

SIBR project created transformational change to care delivery in the Orange Medical Unit. Other hospitals throughout NSW are now adopting this model

Strategic Health Services Planning Process

• Health Needs Assessment Jan – March 2013
• Board Workshop 6 March ‐ strategic priorities were agreed
• Meetings with Clinician Groups 7 March ‐ over 120 attendees
• 3 leaders workshops held in March, April and June – 30+ participants
• Many consultations with:

– Aboriginal Community Controlled Health Services – Western & Far West Medicare Locals – 37 Local Health Councils – Clinical Councils – Groups of GPs – Other Government Agencies

• Open opportunity for emails with staff giving suggestions and ideas

Western NSW Health Analysis Areas

North West Dubbo Bathur st Orange Remote

Life expectancy at birth 2005‐07 Socio‐economic status

lower is more disadvantaged

Premature mortality (ages 0‐74) 2003‐07 High rates of hospitalisation

High ED utilisation

Informed by the Health Needs Assessment

Interventions likely to provide the greatest population health outcome gains:

• 1. Smoking prevention and cessation
• 2. Nutrition and physical activity interventions
• 3. Diabetes prevention and management
• 4. Well child care during the first 1,000 days of life
• 5. Mental health ‐ strengthening community care and support

The case for change

• Pressures on organisation and services are intensifying

as a result of:

– Difficulties in sustaining services in rural and remote communities – Persisting poor health outcomes of our Aboriginal population – Issues in the configuration and ways of working of our hospital and community services – The need to strengthen performance against key clinical and financial measures

• This is also a time of opportunity

– Commonwealth and State reforms ‐ higher levels of local decision making, new funding, and policy intent to develop integrated services that improve access and outcomes

Strategic priorities

• 1. Develop a coherent Western NSW system of care
• 2. Support high performing primary care
• 3. Close the Aboriginal health gap
• 4. Improve the patient experience
• 5. Live within our means

Develop a coherent Western NSW system of care

• Focus on providing care as close to home as possible with a well
• rganised system of accessing specialised care when needed
• Strengthen the role of the Patient Flow Unit to improve support for

patients needing transfer to other services

• Develop district‐wide clinical streams, with membership from

primary care

• Provide increased and well coordinated specialist outpatient services,
• utreach clinics and support for primary care with Medicare Locals
• Implement a world class telehealth network to decrease travel for

rural patients and improve support for rural clinicians

• Decrease the number of patients needing to go to Sydney for care

through improving the capability of services

Support high performing primary care

• Develop strong partnerships with Medicare Locals and

Aboriginal community controlled health services

• Lead an increased focus on equity of access throughout the

region

• Deliver increased specialist support for primary care
• Shift to planned and structured preventive care
• Expand HealthOne and Connecting Care initiatives
• Transform service and business models in rural and remote

communities

Close the gap in Aboriginal health

• utcomes
• Strengthen strategic partnerships with Aboriginal community

controlled health services, and agree an agenda for change

• Strengthen existing action to boost Aboriginal employment
• Strengthen existing action to develop LHD staff cultural

awareness, and build towards responsiveness and competence

• Implement the Aboriginal Health Service Plan when finalised

in coming months

Improve patient experience

• Implement a patient centred care framework to improve

– Communication – Patient safety – Quality – Cultural responsiveness

• Engage patients, families and carers in planning and review of

services

• Design, implement and monitor patient‐centred care pathways,

with a focus on improving care quality, efficiency and equity of access

• Improve transport and accommodation support for patients and

families accessing services a significant distance from their home community

Live within our means

• Balance all future decisions with considerations of quality of care, health of

the population and affordability – the Triple Aim framework

• Ensure clinical decision making is supported with best practice evidence and

takes consideration of affordability

• Deliver transparent, timely and accurate reporting of performance

information to accountable clinical and managerial leaders

• Establish a ‘whole of system’ district‐wide Efficiency Improvement Program

within a clinical governance framework

• Undertake value for money reviews of outsourced services
• Develop a Strategic Investment Fund to shift resources to prioritised services

and models of care, with an emphasis on supporting cost‐effective ambulatory, and primary and community based delivery

Financial Challenges

• $45 M deficit projected – Dec 2012
• $19.5M deficit recorded 2012/13

– Major savings achieved and some one‐off additional revenue received

• $30M underlying problem 2013‐14

– $15M Savings will be realised this year

• Additional revenue
• Medical locum and agency nurse decreases
• Improved Procurement
• Pathology contract renegotiated

FTE Increase last 3 yrs

500 FTE increase = $47M 13% increase

Activity Based Funding

• Nation wide payment system for patient care
• Well developed national documentation system for each patient’s care
• Mental Health and 3 Referral Hospitals – Bathurst, Dubbo & Orange
• Payment for each patient seen through:

– Inpatient Services – Emergency Department – Outpatient Services – Community Services – Mental Health

• Each payment is weighted for:

– Patient complexity – Remoteness – Aboriginality

Bathurst Orange Dubbo

Acute Hospital Services

Bathurst Bathurst Orange

Emergency Department

Bathurst Lourdes ‐ Dubbo Orange

Sub Acute Services ie Rehabilitation

‘Future‐proofing’ of the Western NSW health system requires adoption of new ways of working that make access and outcomes more equitable, and make better use of the available workforce and funding

Questions ?