mid north coast local health district clinical services...

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Mid North Coast Local Health District

Clinical Services Plan 2013-2017

March 2013

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Table of Contents

Executive Summary ................................................................................................... 3

Strategic Initiatives ..................................................................................................... 4

Introduction .............................................................................................................. 14

Policy and Planning Context .................................................................................... 14

Overview of the planning process ............................................................................ 16

Overview of the stakeholder consultations ............................................................... 18

Introducing Mid North Coast Local Health District .................................................... 19

Health Snapshot of Mid North Coast Local Health District Residents ...................... 25

Introducing Services in MNCLHD ............................................................................. 31

Coffs Clinical Network .............................................................................................. 32

Hastings Macleay Clinical Network .......................................................................... 41

Mid North Coast Local Health District Activity .......................................................... 49

District Wide Services .............................................................................................. 58

Partnerships ............................................................................................................. 63

Priority Service Issues, Gaps and Opportunities ...................................................... 65

Aboriginal Health Impact Statement Checklist ......................................................... 71

Appendices .............................................................................................................. 73

Glossary ................................................................................................................... 78

Acronyms and Abbreviations .................................................................................... 81

References ............................................................................................................... 82

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Executive Summary

The Mid North Coast Local Health District Clinical Services Plan 2013-2017 outlines the directions for the development and delivery of all clinical services across the Mid North Coast Local Health District (MNCLHD) over the next 5 - 10 years.

The Plan identifies directions for the development and delivery of:

Clinical services delivered by inpatient facilities or across Networks

Ambulatory, community health and community based services

District-wide clinical services

Corporate support services.

The development of the Plan was informed by consultations with key internal and external stakeholders. Consultations involved discussions with a wide range of people including clinicians, managers, support staff, General Practitioners/Visiting Medical Officers, Aboriginal Medical Services, North Coast Medicare Local and mayors and key local government staff, as well as General Managers of the major private facilities in the District.

The outcomes of consultations have been considered in the development of this Plan, along with assessment and evaluation of population demographics and projections, and service activity and utilisation data (both current and projected); and reviews of National and State policies and plans, and of the literature relating to trends and innovations in health service delivery and models of care.

For the delivery of safe, accessible and high quality services into the future, consideration of the three planning inputs i.e., consultation outcomes, current and projected population and service activity/utilisation data, and trends in healthcare, identified the need to:

enhance collaboration with external partners

focus on the needs of particular groups including those with chronic and complex care needs and Aboriginal people

define the role of all the facilities in the District and devolve services to the smaller facilities to support the major hospitals, including the review of health related transport options

positioning services for the future by investing in research, education and multidisciplinary innovation that will lead to greater sustainability of services

standardise policies, procedures and services throughout the District

review the current models of care and redesign services to integrate acute, community and primary health services

review and develop the workforce to support the proposed models of care, which may include redesigning roles

support preventative models of care.

As demand for health services rapidly increases, the NSW public health system, including MNCLHD, faces a number of pressures and challenges, which will impact on how services are provided into the future. To ensure that health services can be maintained and sustained, there is a need to review and change the nature of health services provided in some areas, increase health services in growth areas, and at the same time maintain core services across all communities.

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Across the Mid North Coast, the ageing population is a significant contributor to the increasing demand for health services (particularly for chronic disease services), with well above average proportions of retirees in several local government areas. The Mid North Coast also has significant groups of disadvantaged people, including Aboriginal people and refugees, people on low incomes, and people living in small, isolated communities, all of whom are at risk of poorer health outcomes than the rest of the population. As well, there are some alarming trends in lifestyle behaviours and risk factors such as increasing overweight and obesity, low levels of physical activity, poor diet, and the number of people who continue to smoke.

Community expectations of health services are growing, and as well as managing high demand for services, the maintenance of our facilities and equipment to support health service delivery is another ongoing challenge. Lack of mental health services in the District, especially adolescent, psychogeriatric and community based services, was one of the biggest concerns for internal and external stakeholders and community groups. The continuing emergence of new technologies, such as new medications and surgical and medical procedures, offers new opportunities, but also puts cost pressures on health services to meet the expense of these new treatments. Making careful planning decisions, therefore, is critical to meeting the health needs of the communities we serve. Our health service will continue to use resources wisely and work with diligence and transparency to further improve clinical service delivery and health outcomes for our communities.

The most significant challenge facing the MNCLHD is ensuring we have an appropriately skilled and experienced workforce into the future. The District is committed to continually reviewing our workforce recruitment and retention strategies and developing innovative models of service delivery and care to address this challenge. That commitment is further evidenced by the development of a Mid North Coast Local Health District Workforce Plan which has been occurring concurrently with the development of this Plan.

The strategic initiatives included in this Plan have been developed to address the priority service issues and gaps identified in the planning process, and the major challenges facing this District discussed above.

Strategic Initiatives As per the planning process, the Strategic Initiatives in this Plan were developed to address priority service opportunities, issues and gaps. The initiatives will:

Improve the health of the population

Improve the patient experience

Represent good value for the health dollar. The Strategic Initiatives align with several of the priority areas identified in the Mid North Coast Local Health District Strategic Plan 2012-2016 – Community, Population Health, Service Access and Patient Flow, Safety and Quality. Initiatives identified through this planning process relating to the priority area of „People and Culture‟, and which addresses workforce issues, are included in the Mid North Coast Local Health District Workforce Plan 2013-2018.

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Mid North Coast Local Health District STRATEGIC DIRECTIONS 2012-2016 V

isio

n

Quality and Excellence in Regional Healthcare

Pri

ori

ty

Are

as

Community

Population Health

Service Access and

Patient Flow

Safety and Quality

Finance and

Management

People and Culture

St

rate

gic

Pri

ori

ties

Empower communities to engage as partners in health

Cooperate, collaborate and communicate with our partners

Improve health literacy in the community

Develop policies and programs to promote health across the lifespan

Close the gap

Provide comprehensive and coordinated care across all settings

Ensure current and future services best meet needs

Ensure our focus is always on the patient

Provide effective, efficient, contemporary and acceptable services

Promote strategies to improve the patient experience

Focus on patient outcomes

Ensure clinical service provision is evidenced based and consistent with best practice

Improve access to quality healthcare

Manage organisational risk

Use resources wisely

Promote and advocate for equity in funding

Work towards an effective transition to ABF

Ensure robust governance mechanisms are in place

Maximise our capital share

Promote an environment of mutual respect

Foster a culture of research and innovation

Increase clinician engagement

Support the well-being and development of our staff

Recruit and retain the staff we need

Collaboration Openness Respect Empowerment

CO

RE

Va

lues

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COMMUNITY

What we will do…

District Wide Initiatives Completion Date

Monitor the impact of population growth and changing demographics on services and ensure any future planning for services aligns with population changes/increases.

Review existing partnerships with external services providing:

retrieval and tertiary services to the District

private hospitals

Aboriginal Medical Services

Medicare Locals

Non-government organisations

pathology, imaging, pharmacy and other health providers

ambulance service and, create a register of Memorandum s of Understanding (MoU) and Service Level Agreements (SLA) with these partners to:

increase care coordination

eliminate duplication of services

improve care and support for people with chronic disease and their carers

facilitate more efficient patient throughput.

Work with non-government organisations to increase availability of appropriate accommodation for people with mental health issues to assist their timely discharge from inpatient services.

Develop an electronic medical record for all care settings, to improve coordination of care across the District.

Investigate an enhanced role for Medicare Locals and other partners to support service delivery (including contracting out services and shared models of service provision), in the first instance, for HIV/HCV, tuberculosis and multicultural health services.

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POPULATION HEALTH

What we will do…


Close the Gap Strengthen performance monitoring, management and accountability (including sharing data and strategies between the Districts two Clinical Networks) for „Close the Gap‟.

Ensure the health of Aboriginal people is considered in the development of models of care.

Develop a governance model for Closing the Gap, which flows to service level departments.

In consultation with appropriate stakeholders:

Identify specific health needs of Aboriginal communities

Develop strategies to improve access for Aboriginal communities to health services

Ensure there is health equity and a culturally respectful and safe environment for Aboriginal patients, carers and staff

Improve partnerships with Aboriginal Medical Services and agencies to:

proactively address health issues such as chronic disease, tuberculosis, mental health, domestic violence and family and maternal health

prevent duplication of services

increase options for care

reduce the number of Aboriginal people who „did not wait‟ for treatment in ED facilities

prevent increased hospitalisations and readmissions to hospital by Aboriginal people

provide follow-up chest x-rays for contacts of tuberculosis infected Aboriginal people

Review the delivery of Cultural Respect Training for staff and include in orientation.

Review how the District provides Aboriginal liaison services in a model that provides linkages with clinical services.

Consider providing appropriate space in health facilities to meet Aboriginal family needs.

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HIV, Sexual Health, Viral Hepatitis and Harm Reduction Services Increase access to testing for priority populations.

Develop and implement initiatives to Reduce the transmission of Human Immunodeficiency Virus (HIV) among gay and other homosexually active men.

Implement rural pilot for HIV Point of Care Testing.

Redesign clinical services to meet NSW HIV, Sexually Transmitted Infections and Viral Hepatitis Strategy targets.

Increase Needle and Syringe Program distribution and access for Intravenous Drug Users.

Develop Rural Tripartite S100 Training Model between North Coast Medicare Local, Australasian Society for HIV Medicine and the District.

Refugee Health Develop a District Refugee Health Plan which aligns with the NSW Refugee Health Plan 2011-2016.

Chronic Disease Maintain and further develop integrated chronic disease services in partnership with Medicare Locals, Aboriginal Medical Services and other relevant community programs/organisations.

Develop a systematic approach to the delivery of chronic disease management services/programs in which referral pathways are defined, and case coordination, transfer of care and follow-up occurs in a timely manner.

Ensure self-management principles are embedded in all programs, referral pathways and approaches to chronic disease management.

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SERVICE ACCESS AND PATIENT FLOW

What we will do…


Define the role of each hospital in the District, and consider having district hospitals as 'centres of excellence' for designated services and seamless networking of services between hospitals. This will include:

Defining the roles of all hospitals in MNCLHD as part of a broader patient health journey

Developing a network of services between district and referral hospitals within each Clinical Network and developing robust procedures to support networked services, e.g. surgery, rehabilitation, palliative care, mental health services

Reviewing systems of referrals between facilities

Reviewing resource allocation/sharing

Maximising the use of telehealth initiatives to enhance services and reduce inpatient admissions or transfers to a referral hospital.

Ambulatory care Review the location and models of service delivery for ambulatory care across the District to:

Identify services that can potentially be relocated or delivered differently

Develop alternative models of service delivery

Provide easily accessible, timely and appropriate ambulatory care (including which is the most efficient model of care delivery and accessibility to public transport).

In collaboration with service partners, describe clear referral pathways into and out of specialist ambulatory care services.

Explore the development of a centralised e-booking system that could potentially be accessed by patients.

Models of Care Engage clinicians and front line managers in developing models of care that are relevant, innovative and efficient with desirable outcomes.

Develop a systematic approach to reviewing, assessing and evaluating current and future models of care and adapting/changing these to achieve optimal health outcomes.

Develop standardised clinical pathways across all care settings.

Review the role of specialist services provided at Coffs Harbour Health Campus and Port Macquarie Base Hospital to identify service gaps and opportunities for stream lining services across the District.

Develop a model of care for case managing patients with chronic and complex needs in the inpatient setting.

Develop Network and District wide strategies to improve discharge planning and includes inpatient and community services.

Develop telehealth strategies for treating patients in the community or at district hospitals to reduce inpatient admissions or transfers to a referral tertiary hospital.

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Support Services Review pathology, medical imaging and pharmacy services across the District, and develop standardised policies and procedures for each service.

Review outpatient services and develop strategies to devolve these services from the major hospitals to other sites in the District.

Review medical imaging services at smaller facilities.

Review medical imaging capacity and capability to support interventional services, particularly gastroenterology and vascular services.

Renal Dialysis Services Assess current renal dialysis services across the District and develop proposals to meet future requirements for acute, chronic, home and private renal dialysis, including exploring different models of providing dialysis services in the community.

Emergency and Critical Care Services Develop processes to ensure the smooth and timely transitioning of patients between the Emergency Department (ED), operating theatres, critical care units and general wards to meet national standards.

Undertake a review of Intensive Care Services with a view to streamlining services across the District, including:

Admission criteria

Policies and processes

Relationships with other clinical areas within facilities, with other hospitals within the District and with other LHDs

Retrieval services

Support services.

Review clinical emergency response services at Coffs Harbour Health Campus and Port Macquarie Base Hospital, and make recommendations on how to improve/streamline these services.

Infection Control Services Develop a District model for Infection Control services that includes community health and Medicare Locals, and is in line with National Standards.

Maternity Services Implement the recommendations of the Mid North Coast Local Health District Review of Maternity Services 2012.

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Paediatric and Children’s Services Identify paediatric and children‟s services that can be:

delivered as a general service

partnered with a specialist service

managed appropriately at the district hospitals, community hospitals/MPS.

Map responsibilities of partners delivering paediatric and child health services in the District.

Undertake further planning and develop strategies and business cases to address identified gaps and issues in paediatric and children‟s services relating to:

Networking of clinical services

Standardisation of policies and procedures

Services provided by other partners, e.g. tertiary services provided by other Districts, Non-Government Organisations, Aboriginal Medical Services and Medicare Locals

Workforce limitations

Child and adolescent mental health services

Access to paediatric and child health services, including improved outreach services and sexual assault services.

Redesign EDs to ensure that children are treated in an appropriate area.

Align ED paediatric services and inpatient paediatric services to maximise staff potential and provide efficiencies in staffing between units.

Community Health Define and describe referral pathways to community health services, and, between GPs/Medicare Locals and acute services, to ensure an integrated approach to support people to remain at home.

Review and plan for future requirements for community resources (services, staff and infrastructure) and align services with future demand, including addressing:

Current and projected demand

Access to services

Population growth

Ageing population

Increasing incidence of chronic disease.

Allied Health Identify existing acute, subacute and community allied health services, and develop an approach to the delivery of allied health services across the District.

Stroke and Rehabilitation Services Review the availability and effectiveness of stroke and rehabilitation programs and models of care in acute and community settings.

Incorporate rehabilitation services planning in all aspects of health care delivery, including acute inpatient care.

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Cardiac Services Explore the opportunity for the development of a District Cardiac Service, including:

The adequacy of current cardiac stress test services

Flexible models for the delivery for rehabilitation programs, medication and disease education, post discharge follow up

Options for delivering speciality cardiac services such as pacemaker and defibrillator checks and echocardiographs for patients in the wards smaller facilities

Defining specialised cardiac services which should be delivered in either Coffs Harbour Health Campus and Port Macquarie Base Hospital, in order to improve efficiency in terms of staffing, resources and equipment, clinician time, staff education initiatives

Reviewing allied health staffing for cardiac services.

Mental Health Services Implement the recommendations of the Mid North Coast Mental Health Clinical Services Plan 2012-2016.

Review mental health models of care and service delivery to ensure linkages with all service partners.

Drug and Alcohol Services Review drug and alcohol services and develop innovative models of care to enhance service delivery. Work with relevant partners (such as GPs/Medicare Locals) to improve access to drug and alcohol services. Review the need for an inpatient detoxification unit in the District.

Palliative Care Services Map palliative care services across the District and develop a framework for the delivery of these services.

Infrastructure Review parking facilities for staff and patients and develop strategies to address gaps/issues.

Consider a plan for a regular transport shuttle between facilities for staff, patients, carers and visitors.

Aged Care Services Review and map aged care services across the District.

Develop models of mental health care for older people in acute and community settings, including dementia programs.

Develop a business case to expand specialist geriatric inpatient services at Coffs Harbour Health Campus and Port Macquarie Base Hospital.

Surgery Develop a Network model for surgery that uses smaller hospitals to maximise self-sufficiency in the context of a best practice model.

Develop business cases to address existing gaps in current surgical models, including:

Endoscopic retrograde cholangiopancreatography (ERCP) procedures at Coffs Harbour Health Campus

Vascular Services at Coffs Harbour Health Campus and Port Macquarie Base Hospital.

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SAFETY AND QUALITY

What we will do…


Ensure there is a formal approach to clinical supervision and training for all professions.

Review the Quality structure across the two Clinical Networks.

Implement the recommendations of the Districts Mid North Coast Information Communication Technology Strategic Plan 2013-2015.

Explore the feasibility of establishing an integrated health information system (hub) for gathering, interpreting and disseminating meaningful data to all staff and services on a regular basis or in response to requests.

Develop a web resource to make available the most up to date activity data - e.g. clinical, casemix, HIE, planning resources.

Promote and invest in IT infrastructure to support more efficient models of care e.g. pilot projects, information dissemination for patients/carers/referral services using internet based tools (Facebook, Apps).

Develop and implement a District wide system of evidence based policies and procedures for all services.

Develop a plan for equipment replacement and standardisation of equipment across the District.

Explore the feasibility of clinical rotations between sites and between acute and community services across the District.

Review security provision for high risk areas across the District, e.g. ED and maternity services at Kempsey District Hospital.

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Introduction

In late September 2010, the NSW Government announced that 18 Local Health Networks (later to become Local Health Districts) would be created to replace the existing eight Area Health Services. This change would strengthen local decision-making and community involvement in health service delivery.

As a result, the former North Coast Area Health Service was split into the Northern NSW Local Health District (NNSW LHD) and Mid North Coast Local Health District (MNCLHD). Prior to this, a draft North Coast Area Healthcare Services Plan 2010-2015 had been developed. The development of that Plan had involved extensive consultations with internal and external stakeholders. To develop the Mid North Coast Local Health District Clinical Services Plan 2013-2017, it was decided to review and update the information, data and recommendations in the earlier Plan.

Purpose and scope of the Mid North Coast Clinical Services Plan 2013-2017

The Mid North Coast Clinical Services Plan 2013-2017 outlines the directions for the development and delivery of all clinical services across the MNCLHD over the next 5-10 years. The Plan identifies the directions for the development and delivery of:

Clinical services delivered by inpatient facilities or across Networks

Ambulatory, community health and community based services

District-wide clinical services

Corporate support services.

Policy and Planning Context

The following documents outline key directions for health services across NSW and have been considered in the development of this Plan.

State Directions

NSW 2021: A Plan to Make NSW Number One (2011) This is the State Government‟s 10 year Plan to guide policy and budget decision making. In the Plan, the goals for health services are to keep people healthy and out of hospitals, and provide world class clinical services with timely access and effective infrastructure.

Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals (2008) The Report (commonly known as the Garling Report) was the result of a formal review of acute services in NSW public hospitals. The review was prompted by a series of incidents which raised concerns about the quality and safety of care provided.

Keep Them Safe: A shared approach to child wellbeing This the NSW Government's five year action plan to re-shape the way family and community services are delivered in NSW to improve the safety, welfare, and wellbeing of children and young people. The goal of Keep Them Safe is that "all children in NSW are healthy, happy and safe, and grow up belonging in families and communities where they have opportunities to reach their full potential".

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The protection and wellbeing of children and young people is core business for NSW Ministry of Health (MoH), as health workers are uniquely placed to support families and communities and promote the development of a safe and healthy environment for all children and young people.

Commonwealth Directions

National Health and Hospitals Network (2010) This document outlines the Agreement between the Commonwealth, States and territories, to improve health outcomes for all Australians and the sustainability of the Australian health system. The Agreement sets out the architecture and foundations of the National Health and Hospitals Network, to deliver major structural reforms to access the health system.

Heads of Agreement-National Health Reform (2011) This document further clarifies Commonwealth/State roles and responsibilities, and outlines the role of “Medicare Locals” as primary health care organisation responsible for delivering coordinated and integrated primary health care.

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (Closing the Gap) This document is a Council of Australian Governments (COAG) agreement between all levels of government and with Aboriginal and Torres Strait Islander communities to close the gap on Indigenous disadvantage. Of the six targets set by COAG, two are relevant to health services:

Closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation

Halving the mortality gap for children under five within a decade

Subsequent to this Agreement, the Prime Minister and other key Indigenous and non-Indigenous stakeholders jointly signed a Statement of Intent to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians by the year 2030.

The National Maternity Plan 2010-2015 The Plan recognises the importance of maternity services within the health system and provides a strategic national framework. The Plan focuses on maintaining Australia‟s high standard of safety and quality in maternity care, while seeking to improve access to services and choice in models of care. Key considerations also include increasing and supporting the maternity workforce, strengthening infrastructure, as well as building the evidence-base on what works well in Australia.

Mid North Coast Local Health District Directions

Mid North Coast Local Health District Service Agreement with NSW Ministry of Health This Agreement supports the devolution of decision making, responsibility and accountability for the provision of safe, high quality, patient centred care to the District, by setting out the service and performance expectations and funding for the MNCLHD.

Mid North Coast Local Health District Strategic Plan 2012-2016 This Strategic Plan identifies the District,s vision, priority areas, and strategic priorities to 2016. This is underpinned by the District,s core values of collaboration, openness, respect and empowerment. The development of the MNCLHD Strategic Plan was informed by consultations with the Governing Board, the MNCLHD Community Reference Group, Senior Executive Team, clinicians, managers and staff from across the District.

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Overview of the planning process

Planning for the MCLHD Clinical Services Plan commenced in August 2012. A Steering Group was established in November 2012 to guide the development of the Plan. The Steering Group comprised members of the MNCLHD Executive Team and other relevant stakeholders nominated by the Chief Executive (see Appendix 1 for a list of Steering Group members).

A Clinical Reference Group, with members nominated by the Steering Group, was also formed to:

Provide advice on future models of service delivery and care

Identify challenges and possible solutions to successfully implement the preferred models of service delivery and care

Provide specific activity data/evidence to support proposed recommendations, and/or clarification as required, on clinical matters.

Major steps in identifying the issues and gaps of health service delivery in the MNCLHD included:

Collation and analysis of a range of health services and activity data

Literature reviews of healthcare trends, future challenges and developing models of service delivery and care

A review of local and state planning documents

Identification of current capital works

Identification of private hospital services in the District

Discussions with stakeholders to gain feedback on health service delivery issues and gaps.

The review and updating of relevant facts, data and policy context for the Plan was the first stage of the planning process. The second stage, which commenced in early October 2012, involved a review of the activity and performance of inpatient and community based services, District-wide clinical services (including oral health and mental health), and other clinical and corporate support services. Stage three involved stakeholder consultations to guide and confirm the service issues and gaps, and propose recommendations to be included in the Plan. Figure 1 outlines the planning process.

After consultations were completed and issues confirmed by MNCLHD senior managers at a forum in November 2012, a small working party was formed to further refine priority service gaps, issues and opportunities, and draft strategic initiatives to address the identified issues.

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Figure 1: The Planning Process

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Overview of the stakeholder consultations

Stakeholder consultations were a critical component of the development of the Mid North Coast Clinical Services Plan 2013-2017. Stakeholders were identified by the Steering Group, and invited to participate in face to face meetings with the Planners. Since the MNCLHD Workforce Plan was being developed concurrently with the Clinical Services Plan, the Workforce Planner was involved in all consultations with the Health Services Planners (from here on collectively referred to as the planning team).

The purpose of the consultations was to identify opportunities, issues and gaps relating to the provision and delivery of health services across the MNCLHD. These consultations provided an opportunity for facility managers and senior medical staff (including GP/VMOs), nursing and allied health staff and other support staff to highlight issues and concerns in relation to patient safety, workforce, service gaps and future challenges. External stakeholders, including mayors and other senior council staff, Non-Government Organisations and management of private health facilities provided information on issues related to their organisations.

Feedback from consultations undertaken to inform the development of the Mid North Coast Mental Health Clinical Services Plan, was also used to inform this Plan.

Further information was provided following a Paediatric and Child Health Planning Forum held in August 2012, which identified gaps in paediatric services across the District, and the Clinical Governance and Information Services Unit provided reports on issues relating to service delivery.

The first phase of consultation (August–December 2012) involved the planning team members meeting face to face with identified key stakeholders. Stakeholders who were unable to attend a scheduled session either had a one-on-one interview or were invited to provide feedback by email using a feedback template (Appendix 2). As well, all stakeholders were provided with contact details of the planning team and encouraged to provide any additional comments by email, mail, telephone, facsimile or in person.

Feedback from consultations was collated and grouped into themes. At a forum held in November 2012, senior managers added to and confirmed the service issues identified in consultations, and suggested ways of addressing these issues.

Feedback received from consultations with internal and external stakeholders informed the priority issues, gaps and opportunities.

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Introducing Mid North Coast Local Health District

MNCLHD covers an area of 11,335 square kilometres, extending from the Port Macquarie Hastings Local Government Area (LGA) in the south to Coffs Harbour LGA in the north. The western and southern borders of the MNCLHD join the Hunter New England Local Health District.

At the 2011 census, it was estimated that in the MNCLHD:

There were 200,404 persons

5 per cent of persons identified as being of Aboriginal and/or Torres Strait Islander descent

40,000, or 20 per cent of the total MNCLHD population, were under the age of 16 years, with 10.3 per cent of those under 16 years of Aboriginal and/or Torres Strait Islander descent

As well, Kempsey and Nambucca Local Government Areas (LGA) ranked seven and eight in NSW in terms of disadvantage at the 2006 census

Population changes

The population of the MNCLHD has increased by 8.5 per cent (15,936 people) between 2006 and 2011. The largest increases have been in the 0-14 years (15 per cent), the 65-84 years (17 per cent) and over 85 years (31 per cent) age groups. Bellingen, Coffs Harbour and Kempsey LGAs have seen a decrease in the population group 0-14 years, and are also the LGAs with the largest increases in those aged 65 years and over.

Population under 15 years

Population projections released in 2009 by the Department of Planning have been recalculated using the latest reported fertility rates. For MNCLHD, the 0-14 year group is expected to increase from 38,672 in 2006 to 42,716 in 2026 (an increase of 10.5 per cent). Only Port Macquarie Hastings and Coffs Harbour LGAs are projected to see increases in this age group.

Population 65 – 84 years

Across MNCLHD, the 65-84 years age group is expected to increase by 93 per cent to 2006 from 33,902 in 2006 to 65,420 in 2026. Although all LGAs are projected to see increases in

this age group, the largest increases will be in the Coffs Harbour LGA ( 117 per cent),

followed by Port Macquarie Hastings LGA ( 90 per cent).

Population over 85 years

For most LGAs significant increases are projected in the over 85 years age group. Table 1 shows that the greatest increases will occur in the Coffs Harbour, Port Macquarie Hastings and Kempsey LGAs, with projected increases in those aged 85 years and older of 152 per cent, 144 per cent and 19 per cent, respectively.

The current numbers and projected increases in the numbers of older people have significant service implications for the District, as older people are the greatest consumers of health services. Many older people have complex and chronic health conditions which place demands on all parts of the health system, from primary to tertiary level services.

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Table 1: Mid North Coast Population Projections by Local Government Area and Age to 2026

LGA Age 2011

(census) 2016 2021 2026

Bellingen

0-14 2,446 2,453 2,537 2,558

15-24 2,073 1,188 1,082 1,092

25-44 3,534 2,545 2,548 2,572

45-64 4,028 4,304 4,145 3,922

65-84 4,147 2,576 2,980 3,349

85+ 317 353 385 439

Coffs Harbour

0-14 13,112 14,706 15,770 16,368

15-24 8,206 9,180 9,019 9,497

25-44 14,993 16,935 17,544 18,056

45-64 19,759 22,872 23,711 24,006

65-84 10,638 14,329 17,715 21,136

85+ 1,706 2,292 2,698 3,299

Kempsey

0-14 5,476 5,273 5,272 5,239

15-24 3,038 2,953 2,691 2,614

25-44 5,483 5,992 5,961 5,876

45-64 8,559 9,155 8,986 8,637

65-84 4,862 6,019 7,114 8,106

85+ 716 759 841 1,004

Nambucca

0-14 3,320 3,238 3,232 3,214

15-24 1,760 1,667 1,578 1,559

25-44 3,159 3,284 3,243 3,215

45-64 5,849 5,992 5,784 5,434

65-84 3,928 4,712 5,471 6,180

85+ 627 716 749 861

Port Macquarie Hastings

0-14 12,947 14,012 14,833 15,337

15-24 7,248 7,916 7,859 8,211

25-44 14,183 16,315 16,806 17,250

45-64 20,380 23,781 25,013 25,347

65-84 15,485 19,310 22,795 26,648

85+ 2,454 3,465 4,035 4,794

MNCLHD

0-14 37,301 39,681 41,644 42,716

15-24 22,325 22,904 22,229 22,971

25-44 41,352 45,071 46,102 46,970

45-64 58,575 66,105 67,639 67,345

65-84 39,060 46,946 56,075 65,420

85+ 5,820 7,584 8,708 10,397

Total MNCLHD 204,433 228,291 242,397 255,820 Source: Department of Planning and State-wide Services Development Branch, NSW Ministry of Health, March 2009 N.B. The 2011 population numbers are based on the 2011 census.

The population projections for 2016, 2021 and 2026 are projections from NSW Ministry of Health, based on an estimated resident

population figure from 2006

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Aboriginal population

The traditional custodians of the land covered by the MNCLHD are the Gumbainggir (from south of Grafton to just south of Macksville), Dunghutti (from south of Macksville to half way between Kempsey and Port Macquarie), Birpai (Port Macquarie area), and Nganyaywana (south-east region of the New England Tablelands) Nations (Figure 2).

Figure 2: The Traditional Custodians of Lands in the MNCLHD

Disclaimer: This map indicates only the general location of larger groupings of people, which may include smaller groups such as clans, dialects or individual languages in a group. The boundaries are not intended to be exact. This map is not suitable for use in native title or other land claims.

Table 2 presents the population of the MNCLHD by Aboriginality and LGA. In the 2011 census, the Aboriginal population in the MNCLHD was estimated to be 10,085 people. This represents 5 per cent of the total population, compared to of 2.5 per cent for the whole of NSW. Kempsey LGA has the largest proportion of Aboriginal people in the District (11.1 per cent), followed by Nambucca LGA (7.3 per cent).

Table 2: Aboriginal Population of MNCLHD by LGAs, 2011

LGA Aboriginal Non Aboriginal

Not stated Total

% Aboriginal

Bellingen 378 11,784 355 12,517 3.0%

Coffs Harbour 2,817 62,699 2,898 68,414 4.1%

Nambucca 1,358 16,567 717 18,642 7.3%

Kempsey 3,115 23,751 1,267 28,133 11.1%

Port Macquarie Hastings 2,417 67,402 2,879 72,698 3.3%

MNCLHD Total 10,085 182,203 8,116 200,404 5% Source: Australian Bureau of Statistics, 2011 census.

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In the 2011 census:

The Aboriginal population of MNCLHD had increased from 4.5 per cent in 2006, to 5 per cent in 2011

The largest number of Aboriginal people were in the 0-15 years age group

Half of those aged under 16 years were of Aboriginal descent

Only 0.2 per cent of people aged over 65 years were of Aboriginal descent, compared to 20 per cent in the non-Aboriginal population (Table 3).

Table 3: MNCLHD Population by Age and Aboriginality, 2011

Source: Australian Bureau of Statistics 2011 Census of Population and Housing, Aboriginal and Torres Strait Islander Peoples (Indigenous) Profile (Catalogue number 2002.0)

Health of Aboriginal people in MNCLHD

While many non-Aboriginal people in NSW have experienced significant health gains in recent years, these improvements have not been equally shared by Aboriginal people who continue to experience greater health risks, poorer health and shorter life expectancies than non-Aboriginal people. Aboriginal people aged 45 years and older are considered to be at greater risk of developing a chronic disease. The disproportionally high burden of chronic diseases such as diabetes, heart, kidney and lung disease, contributes to the increased morbidity in Aboriginal populations.

The MNCLHD acute and primary and community health services deliver a wide range of health services to Aboriginal people from preventative, early detection and diagnostic services to acute treatment, rehabilitation and palliative care services. GPs, Medicare Locals, non-government organisations and Aboriginal Community Controlled Health Services play a pivotal role in providing primary health services to Aboriginal people.

A review of service utilisation data for the MNCLHD for 2010/11 indicates that 28 per cent of total Aboriginal separations in the MNCLHD were for renal dialysis. A further 6.5 per cent of Aboriginal separations were for respiratory medicine and 5 per cent for cardiology.

0-15 years 16-24 years 25-39 years 40-64 years 65+ years

Aboriginal 4,127 1,598 1,634 2,312 414

Not stated 1,650 775 996 2,669 2,026

Non Aboriginal 34,248 16,372 25,060 66,048 40,475

5,000

15,000

25,000

35,000

45,000

55,000

65,000

75,000

Nu

mb

er

Mid North Coast LHD 2011 Population by Age and Aboriginality

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Immunisation coverage for Aboriginal children aged 12-<15months is currently 85.5 per cent, which is lower than the state average of 87 per cent, but equal to the Australian average of 85 per cent, and below the NSW MoH‟s target of 90 per cent. Kempsey and Nambucca LGAs have the lowest rates of 78 per cent and 62 per cent respectively.

The District continues to focus on programs aimed at reducing the health gap between Aboriginal and non-Aboriginal people, including those relating to mothers and babies, chronic disease, drug and alcohol use and preventative health initiatives.

An Aboriginal Health Impact Statement Checklist is included in this Plan.

People from diverse backgrounds

Table 4 shows the number of people born overseas by Mid North Coast LGAs as recorded at the 2006 and 2011 censuses. Port Macquarie Hastings and Coffs Harbour have the largest numbers of people born overseas. People born overseas comprised 12 per cent of the total population in 2006 and 13 per cent in 2011. The majority of the population speak English at home, with only small numbers speaking another language. The top five languages (apart from English) spoken in MNCLHD are Punjabi, German, Italian, French and Cantonese.

Coffs Harbour is one of several designated resettlement locations for refugees, and has a growing number of humanitarian refugees settling in the area. This is mainly due to the employment prospects (service industry, biggest blueberry farm, seasonal work) and the large Sikh community around Woolgoolga. The main refugee communities are:

Afghani

Sudanese

Burmese

Congolese

Togolese

Sierra Leone

Ethiopian

Eritrean

Somali

There are smaller numbers of Asian migrants in Laurieton, Wauchope and Port Macquarie.

Hunter New England Local Health District provides interpreter services to MNCLHD.

Table 4: MNCLHD People Born Overseas by LGA, 2006 and 2011

Year Bellingen Coffs Harbour Nambucca

Port Macquarie Hastings Kempsey Total

2006 1,404 7,503 1,649 7,984 1,897 20,437

2011 1,530 8,831 1,779 8,049 1,972 22,161 Source: Australian Bureau of Statistics, 2006 and 2011 censuses.

Ethnic Affairs Priorities Statement

In the development of the Mid North Coast Clinical Services Plan 2013-2017, the health needs and interests of people from diverse groups have been considered.

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Equity

Equity in health is usually understood to be about ensuring equity of access to health services for people with equal need, regardless of gender, cultural background or place of residence. While equity of health does include consideration of equity of access it is ultimately about improving equity of health outcomes for those people with the poorest health in our society.

The following discussion addresses health equity issues in MNCLHD relevant to the development of this Plan.

Socioeconomic Disadvantage

Socio-Economic Indices for Areas (SEIFA) comprise a range of indicators of relative socio-economic advantage developed by the Australian Bureau of Statistics using census data. The most relevant indicator for the purposes of strategic and health service planning is the Index of Relative Socio-Economic Disadvantage (IRSD). This index is derived from income levels, education attainment and unemployment rates. The index provides a population weighted score for each LGA across Australia, with a low score (<1000) reflecting relative disadvantage and a high score (>1000) indicating relative advantage.

Evidence shows that people from lower socio-economic groups have reduced life expectancy, premature mortality, are more likely to be smokers, have higher rates of overweight and obesity, and higher rates of chronic diseases such as diabetes.

Table 5 presents the IRSD scores for the LGAs of the MNCLHD. It can be seen that all LGAs have a degree of disadvantage, with Kempsey and Nambucca having the lowest IRSD scores. It is also important to note, however, that even within less disadvantaged LGAs there can be pockets of significant disadvantage.

Table 5: MNCLHD LGAs Index of Relative Socio-economic Disadvantage, 2006

LGA Score

Ranking within Australia

Ranking within NSW

Ranking within MNCLHD

Bellingen 954.7 235 47 3

Coffs Harbour 963.79 283 62 4

Hastings 975.51 335 78 5

Kempsey 900.64 102 7 1

Nambucca 902.79 105 8 2 Source: Australian Bureau of Statistics, 2033.0.55.001 - Socio-economic Indexes for Areas (SEIFA), Data Cube only, 2006 NB: 2011 census SEIFA scores not yet available

Rurality

Remoteness and rurality in Australia is generally defined in terms of the size of a community, distance from population centres, and access to services. Clear differences exist in health service usage between areas, such as lower rates of some hospital surgical procedures, lower rates of GP consultation and generally higher rates of hospital admission in regional and remote areas than in major cities. There are also inter-regional differences in relation to health risk factors e.g. people from regional and remote areas tend to be more likely than their major cities counterparts to smoke and drink alcohol in harmful or hazardous quantities. It is also likely that environmental issues such as more physically dangerous occupations and factors associated with driving (e.g. long distances, greater speed, isolation, animals on roads and so on) play a part in elevating accident rates and related injury death in country areas1.

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Other issues relating to rurality that influence the District‟s ability to better address these issues relate to the difficulties of recruiting and retaining skilled health professionals in rural and remote areas and providing those staff with adequate and appropriate clinical support, education and supervision.

MNCLHD recognises the impact of rurality on the health of the population and are working to enhance health education opportunities and access to health services for rural communities.

Service provision

Health status is determined by individual circumstances (including socio-economic and biological circumstances) and by how and where we deliver health services. Health inequalities between some population groups are inevitable. However, when these inequalities are judged to be unfair and/or unjust but amenable to change, they are considered to be inequities. MNCLHD is committed to proactively addressing inequities wherever possible.

Health Snapshot of Mid North Coast Local Health District Residents

This section provides a broad overview of the health status of the people of MNCLHD.

Health Statistics NSW is a new website launched by NSW MoH in 2011 that provides an overview of key population health indicators and topics, including information on the health status and demography of NSW communities, health inequalities and determinants of health, burden of disease and current health challenges, and trends in health and comparisons between age groups and geographic locations. The following information has been sourced from this site. (N.B. Source years vary).

Table 6 shows how MNCLHD compares in certain health indicators compared to the rest of NSW.

Table 6: Comparison of Health Indicators for MNCLHD to the Rest of NSW Health Indicator

Favourable compared to State average

The % of women undertaking cervical cancer screening is higher than the NSW average (in 2009/10, 57.4% compared / 56.4% for the rest of NSW)

The % of women undertaking breast cancer screening is higher than the NSW average (in 2009/10, 56.7% compared / 52.7% for the rest of NSW)

In 2010, 85% of pregnant women had their first antenatal visit before 14 weeks, compared to the rest of NSW at 79%

The rates of hospitalisations related to diabetes in decreasing, and is less than the rate for the rest of NSW (583.2/752.6)

Unfavourable compared to State average

Higher rates of deaths from COPD compared to the rest of NSW (2006/07)

In 2010, smoking during pregnancy was 19.5% of pregnancies. Though this is a decrease from 33.2% in 1996, it is above the NSW average of 11%.

In 2009/10, 8.5% of all births were preterm, compared to the NSW average of 7.3%, Since 2000/01, MNCLHD has consistently been above the NSW average for preterm births. This is the trend for both Aboriginal and non-Aboriginal births.

In 2010, MNCLHD had a perinatal mortality rate of 14.2/1000 births compared to the rest of NSW with 8.1/1000 births. The perinatal mortality rate/1000 birth has been consistently higher than the rest of NSW.

In 2009/10, MNCLHD had a higher percentage of low birth weight babies compared to the rest of NSW (7.4% compared to 6%)

Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au

Table 7 shows the LGAs in MNCLHD which had unfavourable health outcomes.

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Table 7: Unfavourable Health Outcomes for MNCLHD Local Government Areas Health Outcome LGAs with unfavourable outcomes

Potentially preventable hospitalisations (2009/10-2010/11)

Bellingen, Coffs Harbour and Kempsey

Smoking related hospitalisations (2008/09-2009/10)


Chronic obstructive pulmonary disease hospitalisations (2008/09-2009/10)


Coronary heart disease hospitalisations (2008/09-2009/10)

Coffs Harbour, Kempsey, Nambucca and Port Macquarie

Diabetes hospitalisations (2008/09-2009/10) Coffs Harbour and Kempsey

Alcohol related hospitalisations (2008/09-2009/10)

Kempsey

High body mass index related deaths and hospitalisations (2008/09-2009/10)

Coffs Harbour and Kempsey

First antenatal visit before 20 weeks gestation (2007-2009)

Nambucca (numbers were lower than the rest of the state)

Source: NSW Admitted Patient Data Collection and ABS population estimates (HOIST). Centre for Epidemiology and Research, NSW Ministry of Health.

Major causes of death

Between 1999/2000 and 2006/2007, the major causes of deaths in MNCLHD were cardiovascular diseases and major neoplasms (cancers), followed by respiratory diseases and injury and poisoning (Table 8).

Table 8: Cause of Death 1999/2000 – 2006/2007

Cause of death Number per year Rate per 100,000 population

Cardiovascular diseases 5,083 1847.8

Malignant neoplasms= cancers 4,271 1596.9

Respiratory diseases 1,252 450.4

Injury and poisoning 704 356.6

Nervous system and sense organ disorders 583 214.8

Digestive system diseases 465 177.6

Mental and behavioural disorders 407 150.1

Endocrine diseases 378 141.1

Genitourinary diseases 329 116.8

Certain infectious and parasitic diseases 188 70.8

Musculoskeletal and connective tissue diseases 101 36.1

Maternal, neonatal & congenital causes 96 54.2

Other neoplasms 83 29

Ill-defined and unknown causes 66 30.6

Blood and immune system diseases 51 19.4

Skin and subcutaneous tissue diseases 33 11.4

Total 14,090 5307 Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (3 Oct 2012).

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Major reasons for hospitalisations

Between 1998/99 and 2010/11, the major causes of hospitalisation to MNCLHD hospitals were injury and poisoning and digestive system diseases (Table 9). Table 9: MNCLHD Hospitalisations by Cause, 1998/99 to 2010/11

Cause of hospitalisation Number

Injury and poisoning 111,409

Digestive system diseases 107,867

Maternal, neonatal and congenital causes 58,137

Factors influencing health: other 74,305

Factors influencing health: dialysis 86,890

Cardiovascular diseases 75,489

Nervous system and sense organ disorders 67,921

Symptoms, signs and abnormal findings 56,807

Respiratory diseases 50,317

Genitourinary diseases 47,935

Musculoskeletal and connective tissue diseases 49,177

Malignant neoplasms (cancers) 43,486

Mental and behavioural disorders 28,436

Other neoplasms 21,939

Certain infectious and parasitic diseases 14,834

Skin and subcutaneous tissue diseases 14,026

Endocrine diseases 14,551

Blood and immune system diseases 8,984

Other (incomplete records) 81 Source: Health Statistics NSW, http://www.healthstats.nsw.gov.au/

Preventable hospitalisations are admissions to hospital that could potentially have been prevented through the provision of appropriate non-hospital health services (such as access to general practitioners or community health centres). In 2010/11, dehydration and gastroenteritis had the highest rate of hospitalisations, followed by cellulitis and chronic obstructive airways disease (Table 10), accounting for a total of 57,550 bed-days.

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Table 10: Potentially Preventable Hospitalisations by Condition Type, MNCLHD, 2010/11

Sources: NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

Table 11 shows the potentially preventable hospitalisations by Local Health District and Aboriginality for 2010/11. MNCLHD has the highest rate/100,000 population for preventable hospitalisations for Aboriginal people.

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Table 11: Potentially Preventable Hospitalisations by Local Health District and Aboriginality, 2010/11

Sources: NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

Disease Risk Factors

Organisational, economic, and environmental factors are major influences on the health of individuals. Health-related behaviours also contribute significantly to the burden of disease especially chronic diseases.

In the MNCLHD:

Between 1987 – 2008, the number of new cases of prostate cancer increased by 232, and the number of deaths from prostate cancer increased by 32

Chronic Obstructive Pulmonary Disease hospitalisations increased by 139 per cent (982 cases) between 1991 and 2011

Between 1998/99 and 2010/11, injury and poisoning was the top cause of hospitalisations in the District, followed by digestive system diseases

Between 1991/92 and 2010/11, the condition type with the largest number of avoidable admissions was Chronic Obstructive Pulmonary Disease, followed by angina and complications of diabetes

Total fertility rate is higher than the NSW average at 2.3 compared to 1.9.

The proportion of people over the age of 16 who are smokers has dropped (15.9 per cent in 2011, compared to 23.5 per cent in 1997), the number of smoking related hospitalisations has increased

The proportion of overweight and obese people is increasing (55 per cent in 2011 compared to 41.5 per cent in 1997)

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The proportion of people experiencing high or very high psychological distress fluctuates from year to year. Currently, approximately 9.5 per cent of the population over 16 have reported experiencing high or very high psychological distress

The rate of alcohol attributable hospitalisations is increasing from 527.7/100,000 population in 1998/99, to 743.6 in 2010/11

The rate of coronary heart disease hospitalisations is decreasing, while the rate of procedures related to coronary heart disease is increasing.

Health prevention and protection

The early detection of cancers is important for the effective management of the diseases. In 2009/10 the number of women in MNCLHD undertaking:

Cervical cancer screening was higher than the NSW average (57.4 per cent compared to 56.4 per cent for the rest of NSW)

Breast cancer screening is higher than the NSW average (56.7 per cent compared / 52.7 per cent for the rest of NSW).

People aged 65 years and older are considered to be at an increased risk of influenza and invasive pneumococcal disease, with the risk of adverse outcomes likely to be even greater among the hospitalised elderly2. Table 12 shows that the immunisation rates for those aged over 65 years is increasing for both influenza and pneumococcal diseases. Table 12: Estimated Number and Percent of Influenza and Pneumococcal disease Immunisation in >65 Years, 2002-2011

Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (3 Oct 2012).

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Influenza (%) 71.8 71 75.6 73.6 75.1 67.9 72.5 68.9 71.2 76.3

Pneumococcal (%) 38.1 44.3 37.8 57 61.9 58.9 65.9 58.7 56.5 63.2

0

10

20

30

40

50

60

70

80

Pe

rce

nt

Influenza and pneumococcal disease immunisation, persons, > 65 years, MNCLHD, 2002 - 2011

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Introducing Services in MNCLHD

Current health services

The MNCLHD is divided into two geographical Networks:

Coffs Clinical Network

Hastings Macleay Clinical Network

Table 13 shows the two geographical Networks and the LGAs they cover.

Table 13: MNCLHD Networks and Local Government Areas Network Local Government Areas (LGAs)

Coffs Clinical Network Bellingen, Coffs Harbour, Nambucca

Hastings Macleay Clinical Network Kempsey, Port Macquarie Hastings

The Networks were formed based on population numbers. Each Network has a target of 85 per cent self-sufficiency to ensure the threshold volume and throughput of patients required to maintain workforce skills for service efficiency, safety and sustainability, and ongoing access to services for residents.

Role delineation is a process which determines what staffing profile, safety standards and support services are required to ensure that clinical services are safely provided and appropriately supported. The role delineation level of a service describes the complexity of the clinical activity undertaken by that service, and is chiefly determined by the availability of appropriately qualified medical, nursing and other health care personnel to provide the service. Services in the District‟s hospitals range from Level 1 in the smaller hospitals, to Levels 4 and 5 in the major hospitals (see Appendix 3 for role delineations of services provided in the District‟s facilities).

Figure 3 presents a map of MNCLHD facilities and the District‟s relationship to other Local Health Districts in NSW.

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Figure 3: Map of MNCLHD facilities and the District’s relationship to other Local Health Districts in NSW

The following section provides an overview of the geographical Networks of MNCLHD and the hospitals in each Network.

N.B. Public hospitals are grouped by their peer group which is based on the number of patients discharged each year (size), the primary role of the hospital (such as specialist paediatric or principal referral) and whether it is in a metropolitan or rural area. The hospitals peer group is included in the overview of each hospital. Appendix 4 provides a description of MNCLHD hospitals and their peer groups.

Coffs Clinical Network

The Coffs Clinical Network covers an area of 4,261 square kilometres and consists of three LGAs - Bellingen, Coffs Harbour, and Nambucca. It shares its northern border with NNSW LHD, its southern border with the Hastings Macleay Clinical Network, and its western border joins the Hunter New England Local Health District.

Coffs Clinical Network services include:

Hospitals

Coffs Harbour Health Campus Macksville District Hospital Bellinger River District Hospital Dorrigo Plateau Multi-Purpose Service

Community Health Services

Coffs Harbour Macksville Bellingen Dorrigo Woolgoolga

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Coffs Harbour Health Campus

Coffs Harbour Health Campus is B Major Hospital and the major referral hospital in the Coffs Clinical Network, providing the majority of specialist medical and surgical services for the Network.

Services include general medicine, surgery, day surgery, planned and emergency theatre service, coronary care (including a coronary angiography unit), intensive care, obstetrics, paediatrics, 24 hour ED, oncology, palliative care, rehabilitation, stroke, acute renal dialysis, high dependency and mental health, plus an extensive range of outpatient clinics.

Allied health services, including occupational therapy, speech pathology, social work, physiotherapy, dietetics, radiology, pathology, and pharmacy, are an integral part of the organisation and contribute to the high level of patient care provided at Coffs Harbour Health Campus.

Table 14(a) presents the beds/bed equivalents at Coffs Harbour Health Campus.

Table 14(a): Coffs Harbour Health Campus, Beds/Bed Equivalents

Beds/Bed Equivalents Current Bed/Bed Equivalent numbers

ICU 6

Coronary Care (overnight) 4

Coronary Care (same day) 10

Coronary Angiograms 8

Medicine 38

Medical Assessment and Planning Unit 10

Stroke 4

Emergency Medical Unit 10

Surgical 42

Same Day Surgery 19

Extended Short Stay surgical 6

Paediatrics 18

Maternity 20

Special care cots 5

Mental Health Acute 30

Mental Health Rehabilitation 20

Rehabilitation 20

Subtotal beds 270

Emergency Trolleys 18

Renal chairs 10

Subtotal chairs and trolleys 28

Operating Theatre Recovery Places 10

Delivery suite 4

Bassinettes 28

Transit Lounge 6

Subtotal Other Treatment Areas 48

Grand Total 346

Source: NSW Ministry of Health Bed Audit Sign Off Report, 30 June 2012

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Activity

Table 14(b) provides an overview of inpatient activity for Coffs Harbour Health Campus from 2008/09 to 2011/12.

Between 2008/09 and 2011/12, there has been:

An 11 per cent increase in all separations (excluding mental health), with bed occupancy remaining at or over 97 per cent

The number of surgical operations has increased by 17 per cent

The number of live births have increased by 2 per cent, but decreased between 2010/11 and 2011/12 (by 39 births or 4 per cent)

ED attendances overall have decreased by 2 per cent, but presentations by Aboriginal people as increased by 39 per cent.

Table 14(b): Coffs Harbour Health Campus Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations (excluding mental health) 25,092 25,275 26,968 27,857

Acute separations 19,721 20,307 21,303

ALOS (days: acute episodes) 4 3 3

Day only admissions 7,971 8,118 8,430

% Day only admissions 40% 40% 40%

Sub-acute separations 106 279 371

Live births 1,056 1,114 1,111 1072

Occupied bed-days 73,011 73,877 76,470 77,766

Available bed-days 75,189 75,515 75,967 80,005

% bed occupancy 97% 98% 101% 97%

Surgical operations 7,944 8,405 9,075 9,314

Acute Overnight Separations

Medical 7,915 8,210 8,462

Procedural 619 615 670

Surgical 3,216 3,364 3,741

Neonates (qualified) 117 275 312

Day Only Separations

Medical 3,736 3,588 3,526

Procedural 2,556 2,573 2,838

Surgical 1,679 1,957 2,066

Sub-acute/Non acute Separations/Activity

Total bed-days 2,419 6,529 9,372

Rehabilitation Separations 99 262 265

Rehabilitation ALOS (days) 23.8 24.5 33.4

Acute Mental Health Separations/Activity (Designated Mental Health Beds)

ALOS 19 21 18 18

Total separations 567 518 577 553



% bed occupancy 97% 98% 97% 92%

Rehab Mental Health Separations/Activity (Designated Mental Health Beds)

ALOS (days) _ 145 107 116

Total separations _ 12 40 43

Available bed-days _ 2,637 6,684 7,320

Occupied bed-days _ 1,736 4,270 4,989

% bed occupancy _ 66% 64% 68%

Separations/Activity - Aboriginal People

Acute - total 827 924 996

Sub-acute - total 1 7 11

ED attendances 1,475 1,730 1,767 2,046

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Activity 2008/09 2009/10 2010/11 2011/12

Births 91 69 95 84

Emergency Department Activity

ED presentations 34,377 35,300 32,871 33,796

ED T1 % total 0.60% 0.70% 0.80% 0.8%

ED T2 % total 9.00% 9.60% 9.70% 11.0%

ED T3 % total 35.30% 37.10% 39.70% 42.0%

ED T4 % total 41.80% 38.30% 36.20% 35.0%

ED T5 % total 13.20% 14.00% 13.50% 11.3%

No. admissions and discharges from ED 3,282 3,103 3,209 2,769 Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.

Capital Developments

There are several projects either currently being undertaken or recently completed at Coffs

Harbour Health Campus that will impact on clinical services and models of care for the

facility and the District. These are:

1. A Commonwealth Government grant of $5.802M under the Health and Hospital Fund -

Regional Cancer Centres (HFF-RCC) program funded for a MRI machine at Coffs

Harbour Health Campus

2. The Simulation Learning Centre was established in 2011. This centre provides

simulation education for healthcare professionals

3. A 10 bed Emergency Medical Unit (EMU) opened in June 2012. This unit, predominantly

for older people presenting to ED, provides timely access to senior physicians and a

multidisciplinary team for assessment. This model aims to decrease pressure currently

placed on the ED

4. A 10 bed Coronary Care Unit was opened in November 2011, providing four acute beds

and six monitored beds

Implications for Planning

There was an increase of 265 separations in subacute activity on the Coffs Harbour Health

Campus between 2008/09 and 2010/11

There was a 20 per cent increase in presentations of Aboriginal people to the ED

In 2011/12, ED presentations are up by 925, with the majority of increases in the over 65

year age group

Large numbers of patients admitted and discharged from ED

The bed occupancy of the campus has consistently been at or above 97 per cent

Surgical operations have increased by over 400/year since 2008/09

Inpatient separations continue to increase

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Macksville District Hospital

Macksville District Hospital is a community hospital providing services for residents of Nambucca LGA. The hospital provides 24 hour inpatient and ED services, low complexity low risk birthing and Day Only surgical services. There is a limited range of community and allied health services based at the hospital.

Table 15(a) presents the beds/bed equivalents at Macksville District Hospital.

Table 15(a): Macksville District Hospital, Beds/Bed Equivalents


General 42

Surgical - Same Day 10

Maternity 8

Subtotal beds 60


Subtotal trolleys 6

Bassinettes 6


Grand Total 72 Source: NSW Ministry of Health Bed Audit Sign Off Report, 30 June 2012

Activity

Table 15(b) provides an overview of inpatient activity for Macksville District Hospital from 2008/09 to 2011/12. The data shows:

Inpatient separations, surgical operations and ED attendances have been decreasing

Triage 4 presentations account for the majority of ED presentations

The number of Aboriginal people attending the ED is increasing.

Table 15(b): Macksville District Hospital Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations 2,928 2,897 2,864 2,664






Live births 48 56 35 52

Occupied bed-days 13,817 13,008 12,557 11,130 Available bed-days 17,510 17,917 17,553 13,780 % bed occupancy 79% 73% 72% 80%



Medical 1,585 1,538 1,486

Procedural 22 26 30

Surgical 45 38 23



Medical 315 281 169


Surgical 353 445 390


Total bed-days 732 781 1,614

Rehabilitation Separations 2 35

Rehabilitation ALOS (days) 31.5 17.6

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Activity 2008/09 2009/10 2010/11 2011/12



Sub-acute - total 5

ED attendances 0 1,139 1,234 1,294

Births 12 12 5 9


ED presentations 2 12,903 13,025 12,377

ED T1 % total 8.7% 9.4% 10.3%

ED T2 % total 0% 0% 0.1%

ED T3 % total 100% 0.1% 0.1% 0.1%

ED T4 % total 85.8% 87.4% 86.3%

ED T5 % total 0% 0% 0.0%

No. admissions and discharges from ED 0 129 69 29 Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.


Decreasing births

86 per cent of ED presentations are Triage 4

Bellinger River District Hospital

Bellinger River District Hospital is an acute facility (D1 Community Acute with Surgery) providing medical services for the residents of Bellingen LGA. Bellingen Hospital works closely with Coffs Harbour Health Campus.

Services provided include emergency medicine, general medicine, aged care and day surgery. Medical services are provided by GP/VMOs. Surgical Services are predominantly day only and provided by specialist surgeons and anaesthetists.

A limited range of community and allied health services are based at the hospital. These include community nursing and outpatient clinics for physiotherapy, podiatry and speech pathology.

Table 16(a) presents the beds/bed equivalents at Bellinger River District Hospital.

Table 16(a): Bellinger River District Hospital, Beds/Bed Equivalents


Medical 18

Surgical 15

Maternity 1

Subtotal beds 34


Subtotal trolleys 3

Delivery suite 1



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Activity

Table 16(b) provides an overview of inpatient activity for Bellinger River District Hospital from 2008/09 to 2011/12. There is a decrease in all inpatient separations between 2008/09 and 2011/12, and a continuing decrease in the bed occupancy, which was 69 per cent in 2011/12 from 80 per cent in 2008/09. Table 16(b): Bellinger River District Hospital Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations 1,698 1,495 1,470 1,427



Day only admissions 806 694 620



Live births 11 3 3 0

Occupied bed-days 10,131 9,643 9,479 9,263 Available bed-days 12,591 12,775 12,775 12,915 % bed occupancy 80% 75% 74% 69%

Surgical operations 223 Not recorded

231 234


Medical 836 757 735

Surgical 39 35 52



Medical 647 526 453

Procedural 2 1 4



Total bed-days 1,791 1,080 2,814

Rehabilitation Separations 11 57

Rehabilitation ALOS (days) 19.5 15.9



Sub-acute - total 1

ED attendances 3 54 2 244

Births 0 0 0 0


ED presentations 121 2,033 170 6,145

ED T1 % total 2.50% 0.05% 0 Not

recorded

ED T2 % total 0 4% 0 Not

recorded

ED T3 % total 0 18.35 0.6% Not

recorded

ED T4 % total 96% 54% 0 Not

recorded

ED T5 % total 0 22% 0.6% Not

recorded


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1. Work has commenced on a 14 bed sub-acute unit comprising eight rehabilitation beds

and six palliative care beds. This is due for completion in October 2013

2. Work has commenced on an expansion and refurbishment of the ED to address space

and functionality issues. This is due for completion in August 2013.


Decreasing bed occupancy

Increasing numbers of patients admitted and discharged from ED

Majority of ED presentations are Triage 4 and 5

Data too inconsistent to base planning decisions on

Dorrigo Plateau Multipurpose Service (MPS)

Dorrigo Plateau MPS is a peer group F3 Multipurpose Service providing services for the residents of Bellingen LGA. Services provided include emergency, general medicine, aged and nursing home care.

The MPS has inpatient beds for acute care (including two respite beds), a role delineation level 2 ED, and flexible aged care places.

A limited range of community and allied health services are available.

Local GP/VMOs provide medical cover for the ED and inpatient beds. There are some low risk minor general surgical procedures undertaken under local anaesthetic.

Table 17(a) presents the beds/bed equivalents at Dorrigo Plateau MPS.

Table 17(a): Dorrigo Plateau MPS, Beds/Bed Equivalents


General 6

Subtotal beds 6


Subtotal trolleys 3

Residential Aged Care - High 14

Residential Aged Care - Low 7

Subtotal Residential Aged Care 21


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Activity

Table 17(b) provides an overview of inpatient activity for Dorrigo Plateau Multipurpose Service from 2008/09 to 2011/12.

Table 17(b): Dorrigo Plateau Multipurpose Service Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations 515 435 448 436

Acute separations 499 418 423


Day only admissions 224 176 181


Sub-acute separations 1 7



% bed occupancy 89% 88% 93% 86%


Medical 275 242 242


Medical 224 176 181


Total bed-days 9 43

Rehabilitation Separations 1

Rehabilitation ALOS (days) 11


Acute - total 9 3 7




ED T1 % total 1.6% 1.8% 2.4% 2.3%

ED T2 % total 0.0% 0.0% 0.0% 0.0%

ED T3 % total 0.0% 0.1% 0.0% 0.1%

ED T4 % total 96.8% 91.0% 93.1% 94.7%

ED T5 % total 0.0% 0.0%

Not recorded

0.0%



In November 2012, an extension of the Community Health building was completed.


Decreasing inpatient separations

High bed occupancy levels

Increasing ED presentations

95 per cent of ED presentations are Triage 4

Increasing numbers of patients are admitted and discharged from ED

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Hastings Macleay Clinical Network

The Hastings Macleay Clinical Network covers an area of 7,074 square kilometres and is the southern Network of MNCLHD. This Network consists of two LGAs - Kempsey and Port Macquarie Hastings, and shares its northern border with the Coffs Clinical Network, and its western and southern borders with Hunter New England LHD.

Hastings Macleay Clinical Network services include:

Hospitals

Port Macquarie Base Hospital

Wauchope District Memorial Hospital

Kempsey District Hospital

Community Health Services

Port Macquarie

Wauchope

Kempsey

Camden Haven

South West Rocks


Port Macquarie Base Hospital is the major referral hospital for the Hastings Macleay Clinical Network. The hospital provides high level services for the population of Port Macquarie Hastings and Kempsey LGAs, as well as for residents of the Greater Taree and Great Lakes LGAs in Hunter New England LHD.

Services include planned/unplanned surgery, intensive care, coronary care and a range of diagnostic services. Port Macquarie Base Hospital also has an important role in providing regional services in maxillofacial, vascular, urology and upper gastrointestinal surgery. A full range of community and allied health services are also based at the hospital.

Table 18(a) presents the beds/bed equivalents at Port Macquarie Base Hospital.

Table 18(a): Port Macquarie Base Hospital, Beds/Bed Equivalents


Intensive Care 10

Medical overnight 47 Medical same day 1 Medical assessment unit 8

Obstetrics 19


Paediatrics 15

Special Care Nursery 8

Surgical same day 8 Surgical overnight 45

Mental Health - Acute 12

Subtotal beds 176

Emergency Department 12

Renal dialysis – same day (chairs) 7

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Recovery 8

Bassinets 16

Delivery suite 3



Activity

Table 18(b) provides an overview of activity for Port Macquarie Base Hospital from 2008/09 to 2011/12.

Table 18(b): Port Macquarie Base Hospital Activity, 2008/09 – 2011/12

Activity 2008/09 2009/10 2010/11 2011/12

All separations (excluding mental health) 19,033 18,549 18,747 19,670





Sub-acute separations 52 213

Live births 816 815 793 839


Available bed-days 66,788 66,320 67,193 66,746 % bed occupancy 89% 90% 90% 90%

Surgical operations 6,045 6,048 6,036 6,270 Acute Overnight Separations

Medical 7,993 7,503 7,757


Surgical 2,941 2,958 2,832



Medical 1,371 1,493 1,557


Surgical 1,082 1,106 1,121


Total bed-days - 335 1702

Rehabilitation Separations - 3 36

Rehabilitation ALOS (days) - 3.7 8.5

Mental Health Separations/Activity (Designated Mental Health Beds)

ALOS (days) 22 20 20 23




% bed occupancy 96% 96% 96% 96%



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Activity 2008/09 2009/10 2010/11 2011/12

Sub-acute - total 1 5

ED attendances 1,172 1,376 1,756 1,937

Births 51 63 70 66



ED T1 % total 0.50% 0.50% 1% 0.5%

ED T2 % total 9% 10% 11% 13.1%

ED T3 % total 37% 38% 40% 38.2%

ED T4 % total 47% 45% 44% 40.8%

ED T5 % total 7% 5% 4% 6.7%

No. admissions and discharges from ED 255 125 415 1,208

Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.


A major capital project is currently underway at Port Macquarie Base Hospital, and is due for completion in 2014. The new build will provide increased physical capacity, a greater range of services and improved facilities for patients, including:

A 13 bed Geriatric Evaluation and Management Unit (GEM)

A 13 bed medical inpatient unit

12 additional surgical beds

16 bed Intensive Care Unit/High Dependency Unit (extra 10 beds)

New 27 bed ED which includes an Emergency Medical Unit and three resuscitation bays

with telehealth capacity

A new Cardiac Centre consisting of:

o An 8 bed Coronary Care Unit

o A cardiac catheterization laboratory

o Trans-oesophageal echo and stress testing laboratories

A new nine room operating theatre block

A new and expanded perioperative unit (32 beds)

A relocated and expanded central sterilizing and supply department

Space for the relocation and expansion of the pre-admissions clinic and clinical support

services

Paediatric ward relocation

New stores and linen services

Significant increase in available car parking at the hospital and improved vehicle access

to the ED

Capacity for:

o Renal dialysis department

o Ambulatory care services

o Pathology, imaging and pharmacy services

o Roof-top helipad

o Additional inpatient beds

o Expanded paediatric services

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Increases in inpatient separations, surgical operations, births and ED presentations

Increasing numbers of Aboriginal people attending the ED

Bed occupancy rate consistently at 90 per cent

In 2011/12, 1208 patients were admitted and discharged from the ED

Major capital works currently underway


Kempsey District Hospital is located in the Kempsey LGA, and provides medical and surgical services, which include general surgery, gynaecology, ophthalmology, orthopaedics, dental procedures and endoscopies. There is also a 24 hour ED staffed by local GP/VMOs, ED consultants and career medical officers. GP and specialist VMOs and staff specialists provide medical cover for inpatients beds and the ED.

A full range of community and allied health services are also available at Kempsey Health Campus.

Table 19(a) presents the beds/bed equivalents at Kempsey Health Campus.

Table 19(a): Kempsey Health Campus, Beds/Bed Equivalents


High Dependency Care 6

Medical 28

Medical surge 4

Surgical same day 6

Obstetrics 8

Psychiatric acute (voluntary patients) 10

Rehabilitation 8

Subtotal beds 75

Emergency Department 9

Renal dialysis – same day (chairs) 5


Recovery 6

Nursery bassinets 8

Delivery suite 2



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Activity

Table 19(b) provides an overview of activity for Kempsey District Hospital from 2008/09 to 2011/12.

Table 19(b): Kempsey District Hospital Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations (excluding mental health and renal dialysis separations) 8,370 8,717 9,147 9,177






Live births 317 284 300 277



% bed occupancy 98% 104% 102% 89%



Medical 3,605 3,573 3,521

Procedural 24 24 17




Medical 3,080 3,353 3,701




Total bed-days 2,081 2,537 2,392


Rehabilitation ALOS (days) 14.3 13.6 12.5

Mental Health Separations/Activity (Designated Mental Health Beds)

ALOS (days) 12 15 16 12




% bed occupancy 81% 83% 87% 79%


Acute - total 1,063 1,235 1,365

Sub-acute - total 3 3 18

ED attendances 2,843 3,429 4,588 5,001

Births 59 52 75 56



ED T1 % total 0.40% 0.40% 0.30% 0.4%

ED T2 % total 7% 8% 7.30% 9.1%

ED T3 % total 36% 39% 39% 38.6%

ED T4 % total 49% 46% 44% 41.3%

ED T5 % total 8% 7.50% 5% 10.6%

No. admissions and discharges from ED 2,287 2,703 3,008 2,958 Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.

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Plans for a redevelopment of the entire Kempsey District Hospital are underway. The redevelopment will deliver:

Expanded renal services

Extra ED treatment spaces, especially for children

Extra operating theatres

An increase in the overall bed capacity of the facility


Increasing admissions and discharges from ED

Increasing ED presentations, especially Triage 3s and 4s (though 4s are decreasing)

Increasing ED attendances by Aboriginal people

High bed occupancy

Decreasing births

Capital development works


Wauchope District Memorial Hospital is located in the Port Macquarie Hastings LGA and provides inpatient care for low complexity medical admissions and low level day only elective surgery. It also has a 24 hour ED.

Local GP/VMOs provide medical cover for ED and inpatient care. A nurse led model of service covers the ED after hours with telephone backup provided by Port Macquarie Base Hospital ED medical officers.

Table 20(a) presents the beds/bed equivalents at Wauchope District Memorial Hospital.

Table 20(a): Wauchope District Memorial Hospital, Beds/Bed Equivalents



Medical 16

Palliative Care 6

Rehabilitation 8

Same Day surgical 4

Subtotal beds 37

Recovery 4


Grand Total 41

Source: NSW Ministry of Health Bed Audit Sign Off Report, 30 June 2012

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Activity

Table 20(b) provides an overview of activity for Wauchope District Memorial Hospital from 2008/09 to 2011/12.

Table 20(b): Wauchope District Memorial Hospital Activity, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

All separations 2,117 2,366 2,386 2,447








% bed occupancy 94% 96% 97% 94%



Medical 900 802 597

Procedural 1 1 -

Surgical 6 1 -

Neonates (qualified) 2


Medical 98 369 505




Total bed-days 1,907 2,493 3,210


Rehabilitation ALOS (days) 21.4 20 19.6



Sub-acute - total 6 1




ED T1 % total 8% 8% 8.4%

ED T2 % total 0.1% 0.1% 0.1%

ED T3 % total 0.3% 0.3% 0.1%

ED T4 % total 87% 89% 90.2%

ED T5 % total 0% 0% 0.0%

No. admissions and discharges from ED 62 52 8 Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.

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An eight bed Palliative Care Unit is proposed for Wauchope District Memorial

Hospital. These inpatient services have been relocated from Port Macquarie Base

Hospital, and are currently accommodated in existing ward accommodation that is

not conducive to the model of care. This update should be completed by April 2014

Refurbishment of the existing ED and new construction to provide an Urgent Care

Centre


Increase in sub-acute activity

Increase in ED presentations

Large number of Triage 4 presentations to ED

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Mid North Coast Local Health District Activity

An overview of MNCLHD activity is presented in Table 21. Data shows that there have been increases in day only separations and surgical operations between 2008/09 and 2010/11. Total acute separations have increased by 4 per cent overall, however bed days for acute separations have fallen (-4 per cent). There have also been significant increases in ED attendances (30 per cent) and sub-acute separations (232 per cent).

Table 21: MNCLHD Activity Overview, 2008/09 – 2011/12 Activity 2008/09 2009/10 2010/11 2011/12

ED attendances 84,138 108,796 109,421 116,468


Bed-days for acute separations 180,901 177,888 173,534

ALOS (acute) 4 4 3

Day only (acute) separations 19,075 19,778 20,896

Sub-acute separations 397 791 1,320

Bed-days for sub-acute separations

8,930 13,764 21,147

ALOS (sub-acute) 22 17 16

Live Births 2,248 2,272 2,242 2,240

% total bed occupancy 92% 92% 92% 93%

Surgical operations 17,995 18,333 19,481 19,835 Source: MNCLHD data reported for 2011/12 for the following variables: live births, surgical operations, ED data, occupied and available bed-days, mental health activity, ED activity and Aboriginal births. Mid North Coast data does not have any exclusions. All other data from Flowinfo V11.2 reported to 2010/11. Flowinfo data excludes unallocated, unqualified neonates, renal dialysis and chemotherapy separations.

Non-Admitted Patient Occasions of Service (NAPOOS) generally refers to outpatient or community health activity. Table 22 shows NAPOOS activity by service and setting (community health centres, home or hospital) between 2008/09 and 2011/12. There has been an overall increase of 16 per cent in NAPOOS activity in the District, with the majority of services delivered in Community Health Centres.

NB. In the future, more community health and primary care services will be devolved to Medicare Locals. At this time it is unclear what effect this will have on community health activity, staffing and budget.

Table 22: NAPOOS by MNCLHD Service 2008/09 - 2011/12

Unit Name Setting Type 2008-09 2009-10 2010-11 2011-12

Bellingen Community Health Centre

Community Health Centre

8,740 9,104 8,919 12,436

Home 886 750 673 859

Total 9,626 9,854 9,592 13,295

Camden Haven Community Health


17,400 15,887 14,824 14,890

Home 2,866 2,780 2,582 2,528

Total 20,266 18,667 17,406 17,418

Coffs Harbour Community Health Centre


155,048 166,092 180,825 194,129

Home 7,090 5,990 5,534 4,688

Hospital 245 77 316 260

Total 162,383 172,159 186,675 199,077

Dorrigo Community Health Centre


2,481 3,769 4,289 3,974

Home 369 1,488 720 19

Total 2,850 5,257 5,009 3,993

Hastings District Community Health 100,405 116,644 115,711 112,215

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Unit Name Setting Type 2008-09 2009-10 2010-11 2011-12

Centre

Home 5,938 5,467 4,833 6,416

Hospital 603 478 519 542

Total 106,946 122,589 121,063 119,173

Kempsey Community Health Centre


53,038 55,068 58,322 60,337

Home 4,606 5,058 4,220 3,750

Total 57,644 60,126 62,542 64,087

Macksville Community Health Centre


14,965 23,074 22,720 20,160

Home 5,147 6,213 5,356 4,838

Total 20,112 29,287 28,076 24,998

Wauchope Community Health Centre


6,885 8,012 8,106 7,132

Home 1,723 1,321 1,457 1,607

Total 8,608 9,333 9,563 8,739

MNCLHD Total 388,435 427,271 439,926 450,780

Source: MNCLHD data, accessed November 2012

Patient Flows

Patient flows determine where people are admitted to hospital for treatment and provide information on whether residents of a Local Health District are receiving their treatment from facilities within their Local Health District or from facilities in other Local Health Districts or interstate. Ideally, the majority of people resident in a Local Health District should receive their treatment in that Local Health District.

There are occasions, however, where people are admitted to facilities away from their place of residence, either for planned or unplanned care. These are referred to as outflows. Reasons for outflows include: treatment for injuries and trauma, the need for highly complex care, or where historically referrals have been in a particular direction or to a particular facility.

Inflows occur when the situation is reversed, i.e. when residents of other Local Health Districts or from interstate are admitted to MNCLHD facilities.

Inflows

In 2010/11, there were 65,675 inpatient separations from MNCLHD facilities. Of these, 4361 (7 per cent) were people from other LHDs, with the majority from NNSW LHD, followed by Hunter New England LHD (Table 23). The proportion of inflows has remained constant (at 7 per cent) since 2008/09.

Table 23: Inflows to MNCLHD Facilities by Place of Residence and Urgency of Admission 2010/11 LHD/State of Residence Emergency Planned Other

Northern 739 1088 124

Hunter New England 533 412 60

Queensland 278 30 13

Other 156 14

Victoria 115 11 2

South Eastern Sydney 84 5 2

Northern Sydney 79 4 1

South Western Sydney 76 1 2

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LHD/State of Residence Emergency Planned Other

Central Coast 75 8 3

Illawarra Shoalhaven 60 29 1

Western Sydney 55 7 7

Nepean Blue Mountains 47 2 2

Western 44 17 1

Australia Capital Territory 28 2 4

Sydney 28 3 5

Southern 28 3 4

Murrumbidgee 20 1

South Australia 17 1

Tasmania 10 2

Western Australia 8 2

Northern Territory 5 0 1

Far West 2

Total 2487 1642 232 Source: Flowinfo V11.2. No exclusions 2010/11 data is the most current data reported in Flowinfo. N.B: Emergency: An admission of a patient whose condition requires treatment within 24 hours. This includes patients on a waiting list, whose admission is brought forward. Planned: An admission of a patient who is on the hospitals waiting list, and whose admission is not an emergency. Other: An admission of a patient whose condition does not require treatment within 24 hours, and who is also not on the hospitals waiting list. These patients are considered an emergency

Table 24 presents the top 10 reasons for inflows to MNCLHD facilities between 2008/09 and 2010/11, by enhanced service related groups (ESRGs). Orthopaedic surgery accounts for the largest number of inflows, followed by invasive cardiac investigations. Most separations were urgent, with the exception of separations for invasive cardiac investigative procedures, which were predominantly planned.

Table 24: Top 10 ESRGs for Inflows to MNCLHD Facilities, 2008/09 – 2010/11 Enhanced SRG V40 2008/09 2009/10 2010/11

Other Orthopaedics - Surgical 282 305 341

Invasive Cardiac Investigative Procedure 229 238 270

Injuries to Limbs - Medical 149 167 165

Other Psychiatry 151 192 153

Other Gastroenterology 126 130 131

Injuries 116 107 126

Other Urological Procedures 56 78 122

Chest Pain 101 94 109

Cystourethroscopy 59 71 98

Percutaneous Coronary Angioplasty 64 72 98 Source: Flowinfo V11.2. No exclusions 2010/11 data is the most current data reported in Flowinfo.

Outflows

Table 25 shows that in 2010/11, 31,744 residents of MNCLHD were treated at facilities outside of the District, either in another Local Health District or interstate. The majority of these admissions were planned admissions to private hospitals and day procedure centres, followed by Hunter New England LHD facilities, mainly John Hunter Hospital. Patients treated in non MNCLHD facilities represent approximately 34 per cent of separations for residents of MNCLHD. There has been a 13 per cent increase in the number of residents admitted to public facilities outside MNCLHD or the private facilities either within or outside the District.

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Table 25: Outflows from MNCLHD by Place of Treatment and Urgency of Admission

2010/11

Place of treatment Emergency Planned Other

Other Private 475 15,867 3,151

Private Day Procedure Centres

6,357

Hunter New England LHD 590 577 109

South Eastern Sydney LHD 235 460 129

Sydney Children's Network 91 402 40

Northern 244 335 21

Sydney 65 311 102

Northern Sydney 211 276 150

Queensland 234 170 61

St. Vincent's Network 43 133 68

Western Sydney 66 82 11

Nepean Blue Mountains 50 71 9

Victoria 65 64

South Western Sydney 41 26 23

Central Coast 42 18 3

Tasmania 15 5 2

Western 46 5 9

A.C.T. 17 4 9

North. Territory 29 4 1

Illawarra Shoalhaven 27 2

Murrumbidgee 28 2 2

South Australia 9 2

West. Australia 3 1 4

Justice Health 1 1

Far West 4

Network with Victoria 2

Southern 31 1

Total 2,663 25,175 3,906

Source: Flowinfo V11.2. No exclusions 2010/11 data is the most current data reported in Flowinfo. N.B: Emergency: An admission of a patient whose condition requires treatment within 24 hours. This includes patients on a waiting list, whose admission is brought forward. Planned: An admission of a patient who is on the hospitals waiting list, and whose admission is not an emergency. Other: An admission of a patient whose condition does not require treatment within 24 hours, and who is also not on the hospitals waiting list. These patients are considered an emergency

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Table 26 shows the top 20 separations from non MNCLHD hospitals, by ESRGs, for residents of MNCLHD. Renal dialysis was the top ESRG. It should be noted that renal dialysis patients require treatment at least three times per week, which inflates their total separations. The majority (81 per cent) of these separations occurred at private hospitals and day procedure centres.

Table 26: Top 20 Separations for MNCLHD Residents from Non MNCLHD Facilities, by ESRG, 2008/09 – 2010/11

Enhanced SRG V40 2008/09 2009/10 2010/11

Renal Dialysis 2517 2520 3101

Glaucoma and Lens Procedures 2501 2556 2804

Other Colonoscopy 2374 2326 2485

Gastroscopy 1067 1186 1166

Other Orthopaedics - Surgical 840 902 973

Other Gastroscopy 844 882 832

Skin, Subcutaneous Tissue and Breast Procedures 709 768 810

Other Eye Procedures 801 800 803

Knee Procedures 665 657 699

Other Urological Procedures 512 613 678

Other Gynaecological Surgery 627 669 614

Dental Extractions and Restorations 611 629 588

Other Non-specialty Surgery 487 462 575

Cystourethroscopy 399 517 542

Invasive Cardiac Investigative Procedures 459 567 485

Wrist and Hand Procedures incl Carpal Tunnel 393 437 445

Other Gastroenterology 429 424 440

Rehabilitation Other - Same day 331 203 439

Anal, Stomal and Pilonidal Procedures 302 409 428

Other Neurosurgery 367 425 406

Source: Flowinfo V11.2

Includes all patient types – no exclusions

NB: While private hospital overnight stays and Day Only Centre activity is available, the actual individual private hospital/centre is not identified in Flowinfo data. However, it can be assumed that most people accessing these services will either attend the facility because it is closest to where they live, where their medical officer of choice works or the facility/centre provides the services they need.

Self-sufficiency

Self-sufficiency is a measure of how many residents requiring hospitalisation are able to be treated within their Local Health District. The measure is calculated as a proportion of the number of patients admitted to acute inpatient facilities within the Local Health District (locally), compared to the total number of residents from the District requiring admission, i.e. total demand. Self-sufficiency is best measured at a Clinical Network or whole of District level.

Self-sufficiency for MNCLHD, Coffs and Hastings Macleay Clinical Networks is presented in Table 27. Overall, in 2010/11, there was a self-sufficiency of 91 per cent for MNCLHD, while both Networks had a self-sufficiency of 90 per cent.

Private hospital separations for residents from MNCLHD are not included when calculating self-sufficiency.

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Table 27: Self-Sufficiency for MNCLHD, Coffs Clinical Network and Hastings Macleay Network, 2010/11

Area Treated locally

Total treated (demand) Self-sufficiency

Coffs Clinical Network 27494 30538 90%

Hastings Macleay Clinical Network 28836 32152 90%

Total for MNCLHD Facilities 57282 62690 91% Source: Flowinfo V11.2. *Only acute patient types. **Excludes unqualified neonates and private hospitals/day procedure centre separations


Primary community services may be transferred to Medicare Locals

Most outflows are to private hospitals and day procedure centres

Outflows to public facilities are for tertiary level services

Little opportunity to reverse flows, unless services provided by private facilities are targeted

Large increases in subacute activity

NAPOOS activity has increased in most centres

Activity Projection Data

This section presents information on projected demand for health services in the Mid North Coast using the Acute Inpatient Modelling tool (aiM2012 v2.1). aiM 2012 provides data on current acute inpatient activity and projects levels of acute activity to 2031/32. In this Plan projections to 2026/27 are reported.

Supply and demand projection models are provided in this section. The „supply‟ model presents data on number of admissions to MNCLHD acute facilities from all places of residence - within the Mid North Coast, other Local Health Districts and interstate. The „demand‟ model presents data on admissions of Mid North Coast residents to any hospitals – within Mid North Coast, in other Local Health Districts, interstate and to private facilities.

Supply data on separations, bed-days and average length of stay (ALOS) for the years 2010/11, projections to 2021/22 and 2026/27, and the percentage change between 2010/11 and 2026/27 is presented in Table 28.

Table 28: Current (2010/11) and Projected (2021/22 and 2026/27) Inpatient Acute Activity in MNCLHD Facilities by All Places of Residence

Hospital 2010/11 2021/22 2026/27 % change 2010/11– 2026/27

Coffs Harbour Health Campus

Separations 27,161 34,323 38,251 40.8%

Bed-days 71,529 88,520 98,466 37.7%

ALOS 3 3 3

Bellinger River District Hospital

Separations 1,395 1,673 1,815 30.1%

Bed-days 6,203 8,297 9,368 51.0%

ALOS 4 5 5

Macksville District Hospital

Separations 2,828 3,528 3,817 35.0%

Bed-days 11,121 12,551 13,697 23.2%

ALOS 4 4 4

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Hospital 2010/11 2021/22 2026/27 % change 2010/11– 2026/27

Dorrigo Plateau Multi-Purpose Service

Separations 423 476 498 17.7%

Bed-days 1,270 1,535 1,635 28.8%

ALOS 3 3 3


Separations 18,890 25,421 28,203 49.3%

Bed-days 59,579 83,319 92,661 55.5%

ALOS 3 3 3


Separations 10,770 12,517 13,271 23.2%

Bed-days 21,616 26,069 27,833 28.8%

ALOS 2 2 2

Wauchope Memorial District Hospital

Separations 2,253 3,097 3,408 51.3%

Bed-days 6,664 9,132 10,367 55.6%

ALOS 3 3 3

Source: aiM 2012 (V2.1) No exclusions

Table 29 presents demand data for residents of MNCLHD by Local Government Area for the years 2010/11, 2021/22 and 2026/27. Numbers of admissions to all hospitals (MNCLHD facilities, other NSW facilities, interstate public hospitals and private hospitals and day procedure centres) by place of residence are provided. Currently approximately 34 per cent of all admissions are to facilities outside the District. This is expected to increase to 35 per cent by 2021/22 and 36 per cent by 2026/27.

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Table 29: Current (2010/11) and Projected (2021/22 and 2026/27) Admission for Residents of MNCLHD to Hospitals Anywhere Source: aiM 2012 (V2.1) No exclusions

LGA of residence MNC hospitals Other NSW hospitals Interstate public hospitals

Private hospitals and Day Procedure Centres

2010/11 2021/22 2026/27 2010/11 2021/22 2026/27 2010/11 2021/22 2026/27 2010/11 2021/22 2026/27

Bellingen 4,042 4,474 4,807 288 308 323 75 91 96 1,077 1,246 1,330

Coffs Harbour 18,518 24,823 28,136 1,424 1,864 2,056 258 365 410 7,682 10,413 11,798

Kempsey 12,798 14,622 15,441 734 923 976 63 80 84 2,391 3,103 3,417

Nambucca 6,536 8,021 8,644 459 493 518 73 90 95 1,582 1,936 2,092

Port Macquarie Hastings 17,632 24,388 27,288 1,864 2,418 2,689 200 276 323 11,266 16,237 18,566

Total 59,526 76,327 84,316 4,769 6,005 6,562 669 902 1,008 23,998 32,934 37,204

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Projected Demand by Age Group

Table 30 presents data on total inpatient separations and the percentage increase in separations by age group for 2010/11 (current), 2016/17 and 2026/27 (projected). The biggest increases between 2010/11 and 2026/27 will be in the over 70 years age group, with separations for those aged over 85 years nearly doubling.

Table 30: Separations by Age Group From all MNCLHD Facilities for 2010/11, 2021/22 and 2026/27

Age group 2010/11 2021/22 2026/27 % change 2010/11-2026/27

00-15 years 6,512 7,161 7,302 12.1%

16-44 years 13,239 13,414 13,593 2.7%

45-69 years 22,031 25,541 26,265 19.2%

70-84 years 17,424 28,074 33,788 93.9%

85+ years 4,514 6,846 8,317 84.2%

Grand Total 63,720 81,036 89,264 40.1% Source: aiM 2012 (V2.1) No exclusions. Includes all separations

Projected Demand by Service Related Groups

Demand for a range of specialty services is expected to increase significantly over the next decade. Table 31 presents the top 10 specialty services that are projected to see the greatest increases in separations from 2010/11 (current) to 2021/22 and 2026/27 (projected). These projected increases reflect the likely increasing incidence of end stage kidney disease and an ageing population.

Table 31: Top 10 ESRGs with Greatest Projected Increases in Separations for 2010/11, 2021/22 and 2026/27

ESRG 2010/11 2021/22 2026/27 % change 2010/11-2026/27

Renal Dialysis 10,330 16,166 18,966 83.6%

Other Gastroenterology 2,575 3,590 3,916 52.1%

Other Colonoscopy 2,154 2,539 2,765 28.4%

Glaucoma and Lens Procedures 1,439 2,193 2,496 73.4%

Other Orthopaedics - Surgical 1,631 1,966 2,134 30.8%

Other Respiratory Medicine 1,295 1,681 1,860 43.6%

Gastroscopy 1,151 1,679 1,854 61.1%

Other Non-Subspecialty Medicine 1,163 1,620 1,783 53.3%

Chest Pain 1,316 1,627 1,762 33.9%

Other Neurology 1,226 1,590 1,736 41.6% Source: aiM 2012 (V2.1) Excludes unqualified neonates. Includes separations from all LGAs, interstate and overseas

Implications for Planning Projected increases in procedures for age related diseases

Greatest projected increases in inpatient separations in the over 70 years age group

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District Wide Services

There are some services that are delivered at a Network/facility level, but are a District service due to their super specialty aspect. These include the following services.

Health Promotion and Prevention

Health Promotion seeks to improve the health of the population through the development of public policy and structures that promote health, and through the provision of environmental, social, psycho-social and educational support systems. Using a range of strategies, health promotion services work to create environments that support wellbeing, reduce inequitable differences in health status between groups, and enable individuals and communities to make healthy choices.

Public Health Services

North Coast Public Health services are delivered across both the MNC and NNSW Local Health Districts, from Johns River to Tweed Heads.

The core functions of the Public Health Unit are: Communicable disease surveillance and control Tuberculosis Prevention and Control Immunisation including the school-based immunisation program Environmental Health, including Tobacco control Aboriginal Public/Environmental Health Public Health Disaster Management Public Health aspects of bio-preparedness Epidemiology and Health Informatics.

The Public Health Unit takes a population health approach, designing and implementing strategies to protect and promote the health of the population as a whole or for population sub-groups. These population-level strategies recognise the influence of the broad determinants of health which are also the responsibility of other parts of the District and other agencies (notably local councils, GPs, Medicare Locals, Aboriginal Medical Services, Local Aboriginal Land Councils, schools and child care centres).

The Public Health Unit‟s primary responsibilities are to assess, monitor and communicate health risk, facilitate the development of strategies to address priority issues, provide specialist technical advice and supervision, and to take direct service action as required by public health legislation.

Sexual Health, HIV/AIDS Services

The Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and Related Programs (HARP) Services are a part of the Public Health Unit. These services focus on the prevention, early detection, treatment and management of HIV/AIDS, Hepatitis C Virus (HCV) and Sexually Transmitted Infections (STI). Services are mainly community based and are provided to key target populations.

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Multicultural Health

Refugee health and multicultural health are also the responsibility of the Public Health Unit. There is a Refugee Health Nurse attached to the unit, who assesses refugees on arrival to the area. Issues facing the provision of health services to refugees settling in the area include:

Funding for GPs, who have to spend a longer time with these patients due to language, cultural and other issues

Transport to access health services, as they often have to travel to see specialists Use of interpreters is patchy and is underutilised by GPs and specialists. There are

also problems accessing interpreters for languages that are not commonly spoken There is no outpatient department at Coffs Harbour Health Campus, and the service

does not have the resources to fund public patients to access doctors in their private rooms.

Oral Health Services

Oral Health Services provide general and limited specialist services to the eligible people through public dental clinics and Oral Health Fee for Service Schemes. The objectives of the service are to improve the oral health of the community, reduce inequities for people accessing oral health services and reduce disparities in the oral health status of the community.

Mental Health Services

Good mental health is essential to the wellbeing of the community. A number of community factors in the District are expected to contribute to increasing demands for mental health services. These include:

High population growth A large and growing population of older people A relatively high level of socio-economic disadvantage High levels of drug and alcohol use.

There are also large and growing Aboriginal and Torres Strait Islander communities that require culturally appropriate and accessible services to promote mental health and wellbeing.

Specialist mental health services operate as a “clinical stream” across the District. The Director of Mental Health and Drug and Alcohol is responsible for overall management of mental health services.

Each Clinical Network has a Mental Health Integrated Care Manager, who is responsible for managing mental health services across the Networks and for strengthening partnerships and liaison between mental health services and other services.

There are three mental health inpatient units in the District - Coffs Harbour Health Campus (30 beds), Kempsey District Hospital (10 beds) Port Macquarie Base Hospital (12 beds). Units at Coffs Harbour Health Campus and Port Macquarie Base Hospital have the capacity to accommodate both voluntary and involuntary patients. Kempsey District Hospital only provides for voluntary admissions. There are no designated adolescent or private psychiatric units in the MNCLHD.

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Drug and Alcohol Services

Drug and Alcohol services include ambulatory detoxification, counselling, early intervention, hospital consultation, opioid treatment services, medical support and treatment, community development, education and training and the diversion into treatment of illicit drug offenders (MERIT) program. A centralised intake service ensures timely and appropriate access to services.

The Draft NSW Health Drug and Alcohol Plan 2012‐2017, once finalised, will be a key component of the Government‟s reform of the drug and alcohol service in NSW.

In the MNCLHD, drug and alcohol services are based at Coffs Harbour Health Campus, Port Macquarie and Kempsey Community Health Campus, with outreach to smaller sites as required. The service operates a 1300 (1300 662 263) telephone access during business hours for enquiries, assessments and treatment. There is no inpatient drug and alcohol detoxification unit in the District, with patients having to access units in Hunter New England and NNSW LHDs.

Children’s Services

The MNCLHD is part of the Northern Child Health Network, which is one of three paediatric Networks in NSW. Each Network incorporates metropolitan and rural partners and is based on an assessment of flow patterns for paediatric inpatient care. The Northern Child Health Network is a collaboration between Hunter New England, Mid North Coast and NNSW LHDs, and is linked to the John Hunter Children‟s' Hospital.

Acute paediatric services are primarily provided through an „in-reach‟ model within the two Clinical Networks, with paediatric services provided within each Network at the major hospitals.

There is no paediatric tertiary facility within the District. Through the Northern Child Health Network, outreach services are provided from John Hunter Children‟s Hospital. Services include paediatric surgery, cleft palate, neonatal, trauma and diabetes services. The majority of paediatric outflows from the District are to the John Hunter Children‟s Hospital, with smaller numbers going to the Sydney Children‟s Hospitals.

Maternity Services

Maternity Services are provided by midwives, GPs and specialist obstetricians in inpatient, outpatient and community settings, through a range of service models designed to meet the needs of women and their families. Maternity Services include antenatal, birthing, postnatal care, special care nurseries and neonatal intensive care units.

Across the District access to maternity care varies according to a facility‟s role delineation, and the resources and support services available. The majority of births occur at Coffs Harbour Health Campus and Port Macquarie Base Hospital (including high complex births from the smaller hospitals in each Network), with moderate to low complex births occurring at Kempsey District Hospital, and low complex births at Macksville and Bellinger River District Hospitals. Macksville and Bellinger River District Hospitals have reported declining numbers of births and are expecting difficulties in recruiting and retaining a suitable maternity workforce to provide safe birthing services. There are no level 6 maternity services in the District, with high risk women who develop obstetric and/or foetal complications transferred to Newcastle or Sydney for ongoing management.

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The NSW MoH has released a policy directive, PD 2010_045 - Towards Normal Birth in NSW, which provides direction for NSW maternity services regarding actions to: increase the vaginal birth rate and decrease caesarean sections; develop, implement and evaluate strategies to support women, and to ensure that midwives and doctors have the knowledge and skills necessary to implement this policy.

Women’s Health Services

Gender is recognised as an important determinant of health status and behaviour that influences health. A Women‟s Health Coordinator manages the Districts Women‟s Health Program and works with health services, non-government organisations and external agencies to deliver coordinated health services for women. Women‟s health nurses provide free sexual and reproductive health clinics targeting women most at risk of poor health outcomes. They also provide counselling, health promotion, education, community development and advocacy.

Sexual Assault Services

Sexual Assault Services offer support, advocacy and counselling to victims and their families, and, contribute to forensic processes by providing court reports, expert testimony and court support. Services also provide community education and secondary prevention activities for vulnerable populations such as the disabled, mental health clients and Aboriginal communities.

Aged Care Services

The expected growth in the proportion of people aged 65 years and older in the future will have a significant impact on demand for a range of health services including specialist aged care services. The District provides aged care services across a range of settings including in the older person‟s home, acute facilities, day centres, and a range of primary and community health settings. Services are provided in collaboration with GPs, non-government organisations, Aboriginal controlled health services and other Government organisations.

Cancer Services

Cancer control and care programs involve public and private service providers and aim to help people live longer, healthier lives through prevention of disease and injury. Cancer programs are proactive and community wide, and address lifestyle, cultural, environmental and socio-economic factors which contribute to cancer and other chronic diseases.

The North Coast Cancer Institute is part of the NNSW Local Health District. It provides integrated cancer services at Port Macquarie, Coffs Harbour and Lismore.

Clinical Support Services

Allied Health Services

Allied health services are provided across the District by allied health professionals and technical officers, with occupational therapy, physiotherapy, psychology, radiography and social work comprising the largest professional groups. Other groups include dietetics, pharmacy, speech pathology and welfare, with podiatry, counselling, diversional therapy, sexual assault and orthotists/prosthetists.

Most allied health services are provided on an inpatient basis, with few services provided on an outpatient basis or as outreach to smaller facilities.

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Pharmacy Services

Pharmacy supply systems vary across the two Clinical Networks. Supply is based on a hub and spoke model with the major hospital in the Clinical Network supplying medication to the smaller hospitals in that Network.

Coffs Harbour Health Campus has a Director and Deputy Director of Pharmacy supported by clinical pharmacists, pharmacy technicians and pharmacy assistants. Medications are dispensed at Coffs Harbour Health Campus and sent to Bellinger River District and Macksville District Hospitals as well as the Dorrigo Plateau MPS.

Within the Hastings Macleay Clinical Network, Port Macquarie Base Hospital Pharmacy Services are supplied by private contractors, who provide all inpatient services, Hospital in the Home requirements, and a comprehensive discharge medicine supply and counselling service. Port Macquarie Base Hospital Pharmacy Services also support Kempsey District Hospital and Wauchope District Memorial Hospital.

Medical Imaging Services

Medical Imaging services are provided across the two Networks and includes general radiography, computed tomography, ultrasound, digital subtraction angiogram, magnetic resonance imaging, fluoroscopy, mobile radiography, mobile image intensifier, orthopantomogram and cardiac catheterisation facilities.

Pathology Services

Pathology services, like pharmacy services, vary across the two Clinical Networks. In the Hastings Macleay Clinical Network, Port Macquarie Base Hospital is serviced by a private provider, while Kempsey and Wauchope hospitals are serviced by Pathology North, an arm of NSW Health Pathology. All facilities in the Coffs Clinical Network are serviced by Pathology North.

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Partnerships

MNCLHD recognises that engaging and working with our partners is critical to achieving our strategic objectives. A range of initiatives have been identified to improve health outcomes for communities through better communication, coordination and collaboration between government agencies, general practitioners and general practice organisations, Aboriginal community controlled health services and Non-Government Organisations. It should be noted that service changes of each partner in service provision have significant impact on the environment and demand levels of the other partners. When planning changes for patient care, there is a need to identify cross agency impact encompassing care coordination, referral and funding arrangements. MNCLHD recognises the importance of including partners as stakeholders in detailed planning exercises.

Key partners include:

Medicare Locals/General Practitioners

In May 2010, as part the National Health Reform Agenda, the Federal Government announced the establishment of a nation-wide network of primary health care organisations. Medicare Locals are being established to coordinate primary health care delivery and address local health care needs and service gaps. Medicare Locals aim to shift the focus of health care away from hospitals by providing better coordinated primary care (out of hospital care) in the community.

North Coast Medicare Local was established through a partnership of Hastings Macleay General Practice Network, Tweed Valley General Practice Network, Mid North Coast Division of General Practice, Northern Rivers General Practice Network, North Coast GP Training and Many Rivers Aboriginal Medical Services Alliance. There are four branches of the North Coast Medicare Local, with the Hastings Macleay and Mid North Coast branches servicing the MNCLHD.

Ambulance Service

As an integral part of the State‟s Health System, the Ambulance Service of NSW provides responsive, quality emergency clinical care, patient transport and retrieval services across the north of the State. It is noted that the Ambulance Service of New South Wales continues to evolve from the traditional ambulance role of 'taking the patient to health care' moving towards the role of 'taking health care to the patient'. This shift is in response to the growth in demand for emergency ambulance care and on the health system generally.

Non-Government Organisations (NGO)

NGOs play a vital role in the ongoing health and support management of patients, especially those with chronic diseases and mental illnesses. Many NGOs provide services that are also provided by the District, which results in duplication. This Clinical Services Plan recommends reviewing services provided by partner organisations (including NGOs) to increase care coordination, eliminate duplication of services, improve care and support for people with chronic disease and their carers, and facilitate more efficient patient access and throughput.

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Aboriginal Community Controlled Health Services (ACCHS)

ACCHS have a central role in improving health outcomes for Aboriginal people. ACCHS are independent organisations, providing primary health care services, and operated by local Aboriginal communities. Aboriginal communities across the MNCLHD have access to the following service:

Durri Aboriginal Corporation Medical Service (Kempsey) Galambila Aboriginal Health Service (Coffs Harbour) Darrimba Maara Aboriginal Health Clinic at Nambucca and Macksville (auspiced by

Durri Aboriginal Medical Service) Werin Aboriginal Medical Centre in Port Macquarie (auspiced by Biripi Aboriginal

Corporation Medical Centre) Bennelong‟s Haven is an Aboriginal Family Alcohol and Drug Rehabilitation Centre

located north of Kempsey. This service has established formal links with Drug and Alcohol services based in Port Macquarie and Kempsey.

Developing innovative models of care that improve the delivery of culturally safe health services, embedding culturally appropriate models of care into mainstream services, providing an integrated and complementary network of Aboriginal health services, and addressing the disconnects in the Aboriginal persons journey, is critical to improving Aboriginal peoples‟ experiences of using health services.

Over the next five years the focus will be on priorities that increase access and improve Aboriginal peoples‟ experiences of health services, by ensuring:

Culturally sensitive health services Appropriate and equitable access to services Greater service integration Alternative treatments for selected conditions Effective partnerships with internal and external partners Community engagement Development of the District‟s Aboriginal workforce.

Private Health Sector

MNCLHD is committed to working with all external partners to improve access to the health services required to meet the needs of our communities. Part of this commitment involves working with the private health sector to increase access to surgery and reduce waiting lists. Private hospitals make a significant contribution to the provision of health services within the District, providing a range of general surgical and medical services, and selected specialist services.

Education Facilities

The MNCLHD recognises the benefits of, and is committed to develop a culture of learning within the organisation through:

Professional development / educational opportunities for staff Teaching of junior staff through structured and “on the run” strategies Clinical placements for tertiary students Vocational education traineeships Processes to facilitate research being undertaken within the District.

As part of its focus on professional development/education, training and research, the District has developed links with a variety of educational institutions including universities and vocational education providers. The relationship with the recently established Clinical Education and Training Institute will continue to be developed.

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Priority Service Issues, Gaps and Opportunities

The Strategic Initiatives identified in this Plan have been developed to address priority Service issues, gaps and opportunities. These priorities are from policy, literature and National/State plans. This section provides an overview of the priority service issues, gaps and opportunities, and was identified through review and consideration of Service issues and gaps raised through the consultation process, analysis of population demographics and service activity/utilisation data.

Issues and gaps impacting on Service delivery

Changing population demographics

Ageing population

Increasing Aboriginal population

Increasing chronic diseases – renal, diabetes, obesity

The District is a tourist area, with seasonal surges in population and the resultant impacts on primary health, emergency and cardiac services

The socio-economic status of the Districts communities is well below NSW and Australian average

Emerging economic developments in the District, such as increased local provision of tertiary education, is likely to sustain population growth in younger age groups with in-migration of students and staff from other areas

The Coffs Harbour area has a significant and growing refugee community which is likely to continue to grow. There is also a significant Punjabi population in the Coffs-Woolgoolga area.

Aboriginal residents represent 5 per cent of the local population. Of these, 38.4 per cent are younger than 15 years and only 4 per cent are aged 65 years or older. On average Aboriginal people have a much higher age-adjusted demand for health services, being admitted to hospital at over double the rate of non-Aboriginal residents for all hospitalisations, and more than three times the non-Aboriginal rate for potentially preventable hospitalisations.

Patient flow through the services

Lack of coordination between services to manage patients with comorbidities, e.g.: o Mental health patients undergoing medical treatments o Medical issues in patients undergoing surgery o Aged care input for older patients undergoing acute treatment

Lack of standardisation of clinical processes across the District leads to inefficiencies in service delivery

No process for the seamless transfer of patients between ED, wards, ICU, operating theatres, mental health and community services

Lack of integration and coordination between all parts of the patient journey. This should involve coordination of care between acute and community services, GPs, transport, discharge planning and bed management

Lack of supports in the community for patients, resulting in potentially avoidable admissions and re-admissions

Limited opportunity for expansion of services on the current site of the Coffs Harbour Health Campus

Underutilisation of smaller facilities.

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Closing the Gap between the health of Aboriginal and non-Aboriginal people

Lack of culturally appropriate facilities and services

Ineffectiveness of the current Aboriginal cultural respect training

“Closing the Gap” strategies are not part of mainstream health services, and are seen as being the responsibility of Aboriginal health services

There is a need to work more closely with Aboriginal Medical Services

Should make up-skilling of Aboriginal people for health related jobs a District priority

Need to identify and implement appropriate programs with meaningful performance measures to help close the gap

Limited preventative and chronic health management for Aboriginal people

There are few Aboriginal people employed by the District, with little support given to those who are in the workforce.

Chronic diseases

Increasing chronic age related illnesses such as mental health illnesses, cardiac, pulmonary, diabetes, renal disease and dementia

Chronic care programs need to be expanded to allow greater volumes of people to access the programs. These include Aboriginal specific and maintenance programs

Cancer services, although enhanced, require further development to allow more specialised services including dedicated oncology surgical services, paediatric oncology and oncology outreach services with appropriately skilled staff and resources

There is a need to develop a health framework along the continuum from prevention, early diagnosis, treatment and end of life care with the focus on prevention and maximising potential

Lack of associated infrastructure/resources for chronic disease programs – e.g. clerical support and fleet services.

Service access and availability

Fragmented service delivery where patients have appointments in the same area on different days/times

There needs to be more emphasis on innovative ways to deliver services, as well as through partnerships and collaboration with other health providers

Lack of coordination of services between different service providers (Multicultural Service providers/community health/Medicare Locals/dental and AMSs).

Surgery o No cardiac surgery in the District o No District vascular surgery/services o Coffs Clinical Network - No Endoscopic retrograde

cholangiopancreatography procedure. Currently all cases are transferred to Port Macquarie Base Hospital or out of the District

Limited Services o chronic pain service o multicultural health services o ICU/HDU resources and availability o drug and alcohol services o inpatient and outreach palliative care services o service provision for infectious diseases/microbiology o equipment and staffing for interventional radiology o dental services

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Cardiology o Hastings Macleay Clinical Network – Long waiting list for interventional

cardiology. Difficulty getting care in a timely manner for patients who are not in the urgent category

o Coffs Clinical Network – Cardiac services scattered across the campus

Mental Health Services o Limited adolescent mental health services and no inpatient unit o Lack of secure transport for transferring mental health patients to higher level

services o Limited psychogeriatric services for the growing ageing population o Treatment of mental health patients in EDs remains problematic

Outpatient Clinics o All outpatient services are located on the major health campuses rather than

closer to where people live o No outpatient departments at Coffs Harbour Health Campus or Port

Macquarie Base Hospital, so patients have to go private providers

Renal Dialysis o Increase in renal dialysis patients o The only outpatient renal dialysis services are in Coffs Harbour or Kempsey

hospitals. 33 per cent of outpatient renal dialysis patients come from the Nambucca area

o Hastings Macleay Clinical Network Outpatient renal dialysis services at capacity No capacity to do inpatient renal dialysis at Kempsey Health Campus

Human immunodeficiency virus/Sexual Health and hepatitis C virus assessment and treatment

o Limited access to specialist infectious diseases/clinical microbiological services

o Changing models of care for HIV and the emergence of new treatments for hepatitis C virus and hepatitis B virus will have implications for clinical services

Health Protection. There is a need to expand: o Childhood immunisation o School-based vaccination o Public health response to communicable diseases control

Maternity o No midwife models of care o Hastings Macleay Clinical Network

Post natal care (which includes maternal and infant care, identification and treatment of post natal depression, lactation consultations) is not provided and has to be sourced elsewhere (GPs)

Referral Services o Issues with provision of retrieval and referral services from John Hunter

Hospital, especially around spinal and neurological services o The placement of the retrieval services teams at Lismore and Newcastle

means that patients are retrieved to hospitals in these areas rather than to the two major hospitals in MNCLHD

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Community Health o Clinical services in the community need to be streamed with acute services

(including staffing) o Coffs Clinical Network

Lack of tracheostomy care and Total Parental Nutrition (TPN) service in the community for long-term patients

Very little community allied health services available No community physiotherapy services

Paediatrics o Lack of a comprehensive child development service o No paediatric inpatient beds in district hospitals o Adult patients sometimes accommodated in paediatric wards o Coffs Clinical Network

Lack of child sexual assault services – family and community services are reducing funding for these services

No outpatient clinics for paediatrics

Transport and Accommodation o Lack of parking on the two major health campuses to access inpatient and

outpatient services o Lack of public transport options for accessing services provided on the major

campuses o General lack of health related transport options o Lack of accommodation for patients who have to travel for services, and their

carers o Housing shortages in the community for mental health patients leads to delay

in inpatient discharges

Oral Health Services o There are limited oral health services in the community o External stakeholders have identified issues with dental services in the public

and private sector

Support Services o Lack of standardisation of policies and procedures for pathology, imaging and

pharmacy services o Two providers of pathology and pharmacy services in the District

(combination of private and public providers)

Communication o Limited engagement between GPs, Medicare Locals and District services

Models of care

There is a need to develop clinical streams across the District to improve efficiencies in service delivery, standardisation of policies and procedures, mentoring, training and rotation opportunities, governance and career pathways

There needs to be more emphasis on keeping patients out of hospital by managing their health in community settings

Services need to be more accessible to the population, especially in view of the growing ageing population

Require more access, improvement and efficient use of information technology (IT) to support continuity of care for patients, patient and staff education, and outreach services (e.g. iPads, single electronic record, telehealth initiatives)

Home based services are not adequately resourced with cars and mobile phones.

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Defining the role of major and district hospitals

Development of subacute facilities at District hospitals without adequate allied health therapies and facilities

Underutilisation of operating theatres in District hospitals

Emergency surgery impacts on elective surgery in the major hospitals

Provision of elective caesarean sections in all hospitals

Duplication of services provided in both major hospitals. Should there be certain specialist services provided in one or other hospital for efficiencies?

Devolvement of some services (e.g. high volume short stay surgery) to district hospitals

Issues with discharging patients to smaller hospitals: o Inadequate supports for patients being discharged to these hospitals o Bariatric patient care – lack of equipment for smaller sites, staffing and

infrastructure gaps o Need networking of patient flows and ongoing allied health and medical care

in the smaller sites and community o Require improved IT services to support transfers o Require more single rooms in smaller sites for infectious/palliative patients

Workforce and governance

Staffing vacancies affect the sustainability of services

There are differing staffing ratios across the District

There is an inability to fill some specialist roles, for example geriatrician.

Lack of medical coverage for District hospitals Too many locums employed across the District

Should make up-skilling of Aboriginal people for health related jobs a District priority

Difficulty in recruiting and retaining staff in regional areas

Difficulty in recruitment, retention and training of all clinical staff

Lack of career pathways for clinical staff – particularly allied health staff

Lack of allied health positions across acute and community settings, as well as current management structures limiting mentoring and career development

There is inadequate number of staff for succession planning

Inability to back fill positions when staff are on leave or attending training/education

Expectations to supervise/train undergraduates within current workload

Inadequate clerical support across all services

Inequities between services across the District – for example the number of allied health professionals located at each facility

Increased workload without increases in staffing, which can impact on patient discharges, length of stay and increase readmission rates

Lengthy recruitment process, which can take up to two months

Barrier of multiple assignments for one staff member A „multiple assignment‟ is where a person has more than one position. This can include a combination of full-time, part-time and casual

Lack of clinical supervision

Lack of standardised policies and procedures and clinical forms across the District

No formalised process to review clinical work such as regular Morbidity and Mortality meetings and clinical audits.

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Opportunities

There are opportunities in the District to address many of the issues identified. These include:

Capital works at most facilities in the District to address ageing infrastructure and provide opportunities to devolve services to smaller inpatient and community facilities

Redesign of models of care to better meet the needs of the population and maximise the available workforce

Increased opportunities to work with Medicare Locals, NGOs and other external providers

Engaging the expertise of the “Four Pillars” of the NSW MoH (Clinical Excellence Commission, Bureau of Health Information, Clinical Innovation and Enhancement Agency, Institute of Clinical Education and Training).

Challenges to Future Service Delivery

The issues that have been identified present significant challenges for the District in relation to maintaining and sustaining service delivery into the future, including:

Maintaining key clinical services

Barriers to provision and access to services, especially transport issues

Sustaining services at district and smaller facilities

Impact of changing demographics and disease burden

Increase in demand for aged care services

Increasing pressure on the health workforce which may require redesigning of some positions and services

The introduction of Activity Based Management (ABM) and its implications for service delivery

Technological advances that will impact on the District‟s budget

Governance pressures to ensure the accountability of all professions to provide safe, quality care.

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Aboriginal Health Impact Statement Checklist

The health* needs and interests of Aboriginal people have been considered and appropriately addressed in the development of this initiative

Appropriate engagement and collaboration with Aboriginal people has occurred the development and implementation of this initiative

Completed checklist attached

*For Aboriginal people, health is defined as not just the physical well-being of the individual but the social, emotional and cultural well-being of the whole community.

Checklist for the Statement Development of the Policy, Program or Strategy

1. Has there been appropriate representation of Aboriginal stakeholders in the development of the policy, program or strategy? Yes No

2. Have Aboriginal stakeholders been involved from the early stages of policy,

program or strategy development? Yes No

The Director of Aboriginal Health and Primary Partnerships is a member of the Steering Committee for the Mid North Coast Local Health District Clinical Services Plan 2013-2017. Consultations for this Plan were undertaken with Aboriginal stakeholders identified by the Director of Aboriginal Health and Primary Partnerships. Stakeholders consisted of representatives from MNCLHD Aboriginal staff, Durri AMS, Galambila AMS, and Werin Medical Clinic.

3. Have consultation/negotiation processes occurred with Aboriginal stakeholders:

Yes No N/A

4. Have these processes been effective? Yes No

Consultation has occurred with staff in both MNCLHD Networks, as well as the Aboriginal Medical Services (mentioned above), and recommendations have been included in the Plan to address issues identified during these consultations.

5. Have links been made with relevant existing mainstream and/or Aboriginal-specific policies, programs and/or strategies? Yes No N/A

The District‟s Strategic Plan is very strong and clear on the direction for services for Aboriginal People, and the recommendations in the Plan are based on the priority areas of the District‟s Strategic Plan.

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Contents of the Policy, Program or Strategy

6. Does the policy, program or strategy clearly identify the effects it will have on Aboriginal health outcomes and health services? Yes No

Improving Aboriginal health is a priority of the Ministry of Health and the MNCLHD. It is clear in the Plan that Aboriginal health should be addressed in all models of care.

7. Have these effects been adequately addressed in the policy, program or strategy? Yes No

Recommendations have been made to address Aboriginal health issues and Aboriginal employment.

8. Are the identified effects on Aboriginal health outcomes and health services sufficiently different for Aboriginal people (compared to the general population) to warrant the development of a separate policy, program or strategy? Yes No N/A

One of the recommendations in the Plan is for the development of a MNC Aboriginal Health (Close the Gap) Plan.

Implementation and Evaluation of the Policy, Program or Strategy

9. Will implementation of the policy, program or strategy be supported by an adequate allocation of resources specifically for its Aboriginal health aspects? Yes No N/A To be advised

10. Will the initiative build the capacity of Aboriginal people/organisations through

participation? Yes No N/A

There are many recommendations in the Plan that involves Aboriginal staff and organisations. These include employment, education and mentoring strategies.

11. Will the policy, program or strategy be implemented in partnership with Aboriginal stakeholders? Yes No N/A

The Plan is strong in recommending that Aboriginal health is everyone's business, and any program or model of care will involve consultation and partnership with Aboriginal people and organisations.

12. Does an evaluation plan exist for this policy, program or strategy? Yes No N/A

13. Has it been developed in conjunction with Aboriginal stakeholders? Yes No N/A

This Plan will have flow on effects to each facility and services operational plan. The Plans‟ progress and effectiveness will be monitored by the MNCLHD Board and Executive.

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Appendices

Appendix 1 Steering Group Members Name Position

Stewart Dowrick Chief Executive

Robyn Martin Director Aboriginal Health and Primary Partnerships

Theresa Beswick Network Co-ordinator, Coffs Clinical Network

Bronwyn Chalker Acting Network Co-ordinator, Hasting Macleay Clinical Network

John Leary Director Mental Health and Drug and Alcohol Services

Bill Lancashire District Director of Clinical Services

Helena Johnson District Director of Clinical Services

Kathleen Ryan Executive Director Clinical Governance and Information Services

Vicki Simpson Nurse Manager, Operational Support and Performance, Nursing and Midwifery

Paul Corben Director Public Health

Deborah Lawson Senior Health Services Planner

Patsy Hetherington Health Services Planner

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Appendix 2

Consultation Feedback Template

Facility/Unit:

Staff present:

Date/Time:

Description of Service:

Questions:

1. What does this facility/service currently do well in terms of service delivery?

2. Taking into account the particular features of the facility/service and the local context

[e.g. population size, vulnerable groups, clinical capability etc], what are the gaps in

service delivery?

3. Are there any “easy to implement” initiatives that can be actioned now to address these

gaps?

4. Thinking about the future, what do you think are the major challenges this facility will face

over the next 5-10 years?

5. Do you have suggestions about how these major challenges can be addressed?

Workforce

6. What type of clinical placements do you take?

7. What are the difficult positions to recruit?

8. What can be done to address these issues and assist with recruitment and retention of

staff?

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Appendix 3

Role Delineation of Hospitals – Mid North Coast Local Health District November 2011 No. Service Coffs Harbour Port Macquarie Kempsey Macksville Bellingen Wauchope Dorrigo

SUPPORT SERVICES

1 Pathology 5 5 3 3 3 3 2

2 Pharmacy 6 5 3 3 3 3 2

3 Diagnostic Image 5 5 3 3 3 3 1

4 Nuclear Medicine 5 5 3 0 0 0 0

5 Anaesthetics 5 5 3 3 2 3 1

6 Intensive Care 5 5 3 3 2 3 0

7 Coronary Care 5 5 3 3 1 3 1

8 Operating Suites 6 6 3 3 3 3 0

CORE SERVICES

9 Emergency Med 5 5 3 3 2 2 2

MEDICINE

10 General Medicine 5 5 3 3 2 3 2

11 Cardiology 5 5 3 3 2 3 2

12 Dermatology 4 4 3 3 2 3 2

13 Endocrinology 5 5 3 3 2 3 2

14 Gastroenterology 5 5 3 3 2 3 2

15 Haematology – Cli. 5 5 3 3 2 3 2

16 HIV/AIDS 4 4 3 2 2 2 2

17 Immunology 4 4 3 3 2 3 2

18 Infectious Disease 5 5 3 3 2 3 2

19 Medical Oncology 5 5 3 3 2 3 2

20 Neurology 4 4 3 3 2 3 2

21 Radiation Oncology 5 5 0 0 0 0 0

22 Renal Medicine 5 5 3 2 2 2 1

23 Respiratory Med. 5 5 3 3 2 3 2

24 Rheumatology 5 5 3 3 2 3 2

SURGERY

25 General Surgery 5 5 3 3 2 3 1

26 Burns 3 3 2 2 2 2 0

27 Thoracic/Car Sur 1 1 0 0 0 0 0

28 Day Surgery 4 4 3 3 3 3 0

29 Ear, Nose & Throat 4 4 1 1 1 1 0

30 Gynaecology 5 5 3 3 2 3 0

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No. Service Coffs Harbour Port Macquarie Kempsey Macksville Bellingen Wauchope Dorrigo

SURGERY Cont.

31 Neurosurgery 4 4 1 1 1 1 0

32 Ophthalmology 3 3 3 3 1 1 0

33 Orthopaedics 5 5 3 2 2 3 0

34 Plastic Surgery 4 1 1 1 1 1 0

35 Urology 5 5 1 1 1 3 0

36 Vascular 4 5 3 1 1 3 0

MATERNAL & CHILD HEALTH

37 Maternity 5 5 3 2 2 0 0

38 Neonatal 4 4 2 2 2 0 1

39 Paediatric Medicine 4 4 2 1 2 1 1

40 Paed Surgery 4 4 1 1 1 1 1

41 Family and Child 4 4 3 2 2 3 3

INTEGRATED COMMUNITY & HOSPITAL

42 Adolescent Health 3 3 3 2 1 1 1

43 Adult Mental Inpa. 5 5 3 1 1 1 1

44 Adult Mental Com. 4 5 3 2 1 1 1

45 Child/Adol. M. In 4 4 3 1 1 1 1

46 Child/Adol. M. C 4 5 3 2 1 1 1

47 Older Adult. M. In 1 3 1 1 1 1 1

48 Older Adult. M. C 3 3 1 2 1 3 1

49 Child Protection 4 4 3 1 3 2 1

50 Drug and Alcohol 5 3 3 2 2 1 1

51 Geriatrics 4 5 3 2 2 3 1

52 Health Promotion 5 5 4 2 2 2 2

53 Palliative Care 4 4 3 3 3 4 2

54 Rehabilitation 5 5 4 3 3 4 1

55 Sexual Assault 4 4 3 3 3 3 3

COMMUNITY BASED SERVICES

56 Aboriginal Health 4 4 5 3 3 1 1

57 Comm. H. Gen. 5 5 4 3 3 2 2

58 Community Nurs. 5 5 5 2 3 2 2

59 Genetics 4 4 1 1 1 1 0

60 Multicultural Hth. 1 1 1 1 1 1 1

61 Oral Health 3 4 5 0 2 1 2

62 Sexual Health 4 4 2 1 3 1 1

63 Women’s Health 3 4 4 3 3 1 3 Source: Mid North Coast Local Health District, November 2011

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Appendix 4 Peer Groups of MNCLHD Facilities

Source: Flowinfo V11

Peer Group Code

Peer Group Name

Description MNCLHD Facility

B Major Acute hospitals treating 10,000 or more acute casemix weighted separations per annum that are located in rural areas providing acute specialist and referral services for a catchment population from a large geographical area.

Coffs Harbour Health Campus, Port Macquarie Base Hospital

C2 District Group 2 hospital

Acute hospitals, treating 2,000 or more, but less than 5,000 acute casemix weighted separations per annum, plus acute hospitals treating less than 2,000 acute casemix weighted separations per annum but with more than 2,000 separations per annum.

Kempsey District Hospital, Bellingen River District Hospital, Macksville District Hospital

D1a Community Acute - Surgery

Acute hospitals, treating less than 2,000 acute casemix weighted separations per annum, and less than 2,000 acute separations per annum, with less than 40% non-acute and outlier bed days of total bed days and greater than 2% of their acute weighted separations being surgical.


F3 Multi‐Purpose Service

Multi-Purpose Services (MPSs) which provide integrated acute health, nursing home, hostel, community health and aged care services under one organisational structure, as agreed between the Commonwealth and State Governments. MPSs provide a range of services which are negotiated with the community, the service providers and the relevant Departments.

Dorrigo Multi-Purpose Service

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Glossary

Term Definition

Access The ability to make use of, without difficulty or delay.

Activity A broad term describing what health services do to treat patients, usually measured by occasions of service.

Acute care The specialist management of patients requiring urgent short-term medical and/or surgical treatment. The clinical intent or treatment goal may be to:

manage labour (obstetric)

treat, relieve symptoms of, and/or protect against exacerbation of

illness or injury

perform surgery

perform diagnostic or therapeutic procedures.

aIM2012 Acute Inpatient Modelling Tool – developed by Statewide Services, NSW MoH. A medium to long term projection tool that allows users to model future demand for acute inpatient care.

Admission The beginning of a period of inpatient service in a hospital.

Allied health In Australia, typically includes all health professions other than medicine, nursing and dentistry that are part of the public health system and require a tertiary degree to practice, including but not limited to physiotherapy, social work, occupational therapy, podiatry, dietetics and speech pathology.

Ambulatory care Care provided to hospital patients who are not admitted to the hospital, such as patients of emergency departments and outpatient clinics. The term is also used to refer to care provided to patients of community-based (non-hospital) health-care services. „Ambulatory‟ in these medical contexts implies that the person is „capable of walking‟ and is not confined to bed (or, more strictly, a hospital bed).

Average Length of Stay (ALOS)

Average length of stay refers to the average number of days that patients spend in hospital. It is generally measured by dividing the total number of days stayed by all inpatients during a year by the number of admissions or discharges. Day cases are excluded. The average length of stay in hospitals is often used as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive outpatient or community settings.

Bed day A day during which a person occupies a hospital bed for all or part of the day.

Bed occupancy The average proportion of beds occupied for a defined period of time.

Catchment A defined geographic area from which a facility/facilities attract patients (in this plan, this term usually refers to the Hunter Valley Cluster).

Chronic disease care Care where the principal intent is to provide support, maintain function and prevent further disability for patients with an illness that is prolonged in duration, does not often resolve spontaneously, and is rarely cured completely.

Clinical support service A set of departments organised around several clinical and support professions, including but not limited to pharmacy, pathology, patient transportation, medical records and medical imaging.

Demand Use of health services by residents of a defined geographical area. It does not include unmet demand which may be expressed through waiting list data.

Discharge The end of a period of inpatient service in a hospital, where the patient is sent home or to another facility.

External stakeholders External stakeholders are not direct employees of MNCLHD, but are members of organisations or groups that have regular interaction with a particular service e.g. non-government organisations, consumer groups, Aboriginal community controlled health services and Medicare Locals.

FlowInfo NSW MoH planning tool containing data on numbers of admitted patients treated in public and private NSW facilities and public interstate facilities.

Incidence The number of newly identified cases of disease for a population for a defined time period.

Inflows Inflows occur when residents of other LHDs or from interstate are admitted to MNCLHD facilities.

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Term Definition

Inpatient A patient admitted to a hospital for treatment either overnight or on a day-only basis.

Internal Stakeholders Internal stakeholders are direct employees of MNCLHD.

Length of stay The number of days a patient spends in hospital for a single admission.

Medicare Local A network of primary health care organisations established to coordinate primary health care delivery and tackle local health care needs and service gaps. They have strong links to local hospital networks, local communities, health professionals and service providers including GPs, allied health professionals and Aboriginal Medical Services.

Morbidity Illness or disease.

Mortality Death rate, measured as the number of deaths in a certain population over a defined time period.

Multidisciplinary care A collaborative approach to treatment planning and ongoing care throughout the treatment pathway.

Non-acute care Care to maintain health but with no or minimal clinical intent. Nursing home, respite care and residential mental health services are considered non-acute services.

Outflows Residents treated in facilities other than the public health facilities of MNCLHD

Outpatient A person who receives health care services without being admitted to a hospital.

Palliative care Care in which the primary clinical purpose is to optimise the quality of life of a patient with an active and advanced life limiting illness.

Planning A plan is defined as a map, as preparation, as an arrangement. Planning defines where one wants to go, how to get there and the timetable for the journey.

Population density The average number of residents per hectare/square kilometre.

Primary care Used to describe the range of services that are normally the first point of contact for patients, predominantly provided by GPs, as well as by practice nurses, community health care nurses, early childhood nurses and community pharmacists.

Prevalence Total number of persons in a given population with a disease or other health-related event during a defined time period. Often expressed as a percentage.

Preventive/public/ population health

The organised response by society to protect and promote health, and to prevent illness, injury and disability. The starting point for identifying public health issues, problems and priorities, and for designing and implementing interventions, in the population as a whole, or population sub-groups.

Proceduralist A physician who performs diagnostic or therapeutic procedures.

Projection Estimate of future health service activity, based on historical trends of hospital utilisation and population growth.

Psychogeriatric care Care in which the clinical intent or treatment goal is improvement in health, modification of symptoms and enhancement in function, behaviour and/or quality of life for a patient with an age-related organic brain impairment with significant behavioural or late onset psychiatric disturbance or a physical condition accompanied by severe psychiatric or behavioural disturbance.

Role delineation A categorisation system which defines the complexity of clinical activity undertaken by a health service to meet the needs of the population. There are six levels. A service‟s category determines the support services, staff profile, safety standards and other requirements to ensure that clinical services are provided safely and with appropriate support.

Same day (day-only) A planned admission for a surgical, diagnostic or treatment procedure where the patient is discharged on the same day.

Satellite sites Services supported and led by a central location but located away from the principal site.

Separation An occasion where a patient completes a period of inpatient or emergency department service for any reason (transferred to another facility, discharged home, left against medical advice, died).

Service related group (SRG)

A classification method for grouping hospital inpatient records into categories corresponding to clinical divisions of hospital activity.

SiAM2012 Subacute Inpatient Activity Modelling – developed by Statewide Services, NSW MoH. A medium to long term projection tool that allows users to model future demand for subacute inpatient care.

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Term Definition

Statistically significant Unlikely to have occurred by chance.

Strategic Planning A strategic planning process assumes a new look at an issue, and an outcome that will take time to put in place but will exist for a period longer than one funding cycle.

Subacute care Specialised, goal oriented (and in many instances time-limited) interventions, generally provided in a multidisciplinary environment to people requiring evaluation, treatment and management for post-acute, chronic or terminal conditions, to optimise functioning and quality of life. Subacute care comprises the defined care types of rehabilitation, palliative care, geriatric evaluation and management and psychogeriatric care.

Tertiary services Advanced medical investigation and treatment requiring highly specialised skills, technology and support. Examples of tertiary care services are cardiac surgery, neurosurgery, transplants and treatment for severe burns.

Transitional care Care in which the goal is to help people improve their independence and confidence after a hospital stay. Allows patients and carers to consider long-term care arrangements where required.

Triage The process of sorting patients according to the urgency of assessment and treatment required.

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Acronyms and Abbreviations ABM Activity Based Management

ABS Australian Bureau of Statistics

ACAT Aged Care Assessment Team

ACE Aged Care Emergency

AHW Aboriginal Health Worker

ALOS Average Length of Stay

AMIHS Aboriginal Maternal and Infant Health Service

CCU Coronary Care Unit

COAG Council of Australian Governments

COPD Chronic Obstructive Pulmonary Disease

CT Computed Tomography (scanner)

DRG Diagnostic-related Group

ED Emergency Department

ENT Ear, Nose and Throat

ESRG Enhanced Service Related Groups

GP General Practitioner

HARP HIV and Related Programs

HDU High Dependency Unit

HITH Hospital in the Home

ICU Intensive Care Unit

IRSD Index of Relative Social Disadvantage

LGA Local Government Area

MAU Medical Assessment Unit

MoH NSW Ministry of Health

MNCLHD Mid North Coast Local Health District

MPS Multi-Purpose Service

NAPOOS Non-admitted Patient Occasions of Service

NEAT National Emergency Access Target

NEST National Elective Surgery Target

NGO Non-Government Organisation

NSW New South Wales

SEIFA Social and Economic Index for Areas

SLA Statistical Local Area

SRG Service Related Group

VMO Visiting Medical Officer

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References 1 Australian Institute of Health and Welfare (2012), Impact of Rurality on Health Status, available at:

http://www.aihw.gov.au/rural-health-impact-of-rurality/ 2 Ross M Andrews, Susan A Skull,3 Graham B Byrnes, Donald A Campbell, Joy L Turner, Peter B McIntyre,

Heath A Kelly (2005), Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria, Communicable Disease Intelligence, Volume 29 No: 3.

http://www.aihw.gov.au/rural-health-impact-of-rurality/

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