northern nsw local health district strategic plan...

NORTHERN NSW

LOCAL HEALTH DISTRICT

STRATEGIC PLAN

2012 – 2017

This work is copyright. It may be reproduced in whole or part for study training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health 2011 For further information please contact: Planning and Performance Northern NSW Local Health District 31 Uralba Street Lismore NSW 2480 Correspondence P.O. Box 498 LISMORE NSW 2480 Phone: (02) 6620 2949 Fax: (02) 6622 2151

March 2012

NNSW LHD Strategic Plan 2012‐2017

CONTENTS Message from the Chair of the Board ..................................................................................................... 1

Northern NSW Local Health District Vision, Purpose and Strategic Objectives ..................................... 2

Northern NSW Local Health District ....................................................................................................... 3

NNSW LHD Board ................................................................................................................................ 3

Clinical Councils ....................................................................................................................................... 4

NNSW LHD Clinical Council ................................................................................................................. 4

Hospital Clinical Councils .................................................................................................................... 4

Community Engagement ........................................................................................................................ 5

Community Engagement Advisory Council (CEAC) ............................................................................. 5

Ngayundi Aboriginal Health Council ................................................................................................... 5

NNSW LHD at a Glance ........................................................................................................................... 5

Clinical Streams ................................................................................................................................... 7

Other Programs ................................................................................................................................... 7

Current Pressures and Future Challenges ............................................................................................... 8

Where We Want to Be in 2017 ............................................................................................................. 10

NSW State Plan Goals and NNSW LHD Strategic Objectives ................................................................ 12

State Plan Goal 11: ................................................................................................................................ 15

NNSW LHD Strategic Objective 1: ..................................................................................................... 15

State Plan Goal 12: ................................................................................................................................ 17





State Plan Goal 13: ................................................................................................................................ 22


State Plan Goal 26: ................................................................................................................................ 23


State Plan Goal 28: ................................................................................................................................ 24


NNSW LHD Strategic Plan 2012‐2017

State Plan Goal 32: ................................................................................................................................ 25


Appendix 1: Strategic Planning Framework .......................................................................................... 26

Commonwealth Government ........................................................................................................... 26

State Government ............................................................................................................................. 27

NSW State Plan ................................................................................................................................. 28

Planning Process ................................................................................................................................... 28

NNSW LHD Strategic Plan 2012‐2017 Page 1

MESSAGE FROM THE CHAIR OF THE BOARD The District Board has been tasked by Government with the exciting and challenging opportunity to govern and develop a high quality health service for the NSW North Coast community and implement the health reform agenda. This Strategic Plan, prepared in consultation with staff will form the basis of the District’s Business Plans over the next 5 years. A Business Plan is a much larger document which details the actions required by health services staff to achieve the purpose of the Strategic Plan. The objectives of the Strategic Plan will be achieved by working with many partners; these include the District’s Clinical Council, the Community Engagement Advisory Council, the Ngayundi Health Council, non‐government organisations, local government, the University Centre for Rural Health, Southern Cross University, aged care providers and the North Coast NSW Medicare Local. Amongst our priorities are strategies which seek to optimise health and wellbeing across the age continuum and to provide efficient, effective and safe hospital and community based care. Our services will also remain committed to teaching and research and building on our achievements. A particular challenge for the Health Service involves building on the achievements of our staff working in partnership with Aboriginal Medical Services and General Practice Networks, to ‘Close the Gap’. Also we are committed to continuing our effort in mental health service provision and to providing care and support to people of all ages living with mental illness, keeping our older population well and active and maintaining a skilled, motivated and sustainable workforce. Implementation of activity based funding and the reduction in Emergency Department waiting times required by the health reform agenda are in the planning phase and will require a system wide effort. The NSW Government’s ‘ CORE ‘ values of collaboration, openness, respect and empowerment and its intention of “Keeping people healthy and out of unnecessary hospitalisation, fixing public hospitals to improve patient access to timely, quality healthcare and returning quality services to mental health, dental health and Indigenous health”, are shared by the Board and reflected in this Plan. My thanks to my colleagues and to the staff who have contributed to the preparation of this Plan. I look forward to working on the achievement of its objectives.

Hazel Bridgett

Chair NNSW LHD Board


NORTHERN NSW LOCAL HEALTH DISTRICT VISION, PURPOSE AND STRATEGIC OBJECTIVES

Vision

Better Health and Excellence in Health Care

Purpose

To work together to promote better health across our diverse community and provide person centred, integrated care through a valued, skilled, motivated and sustainable workforce.

Strategic Objectives

• Protect the health of our community and make promoting better health a part of everything we do

• Continually improve the quality of and access to a comprehensive range of integrated health services in partnership with key external partners

• Develop a skilled and motivated workforce in a culture based on our core values

• Ensure good stewardship and leadership through strong corporate and clinical governance

• Embed research and education as an integral element of clinical services

• Work in partnership to improve Child Wellbeing Health and Safety

• Work with the Aboriginal community and partners to improve the health of Indigenous Australians

• Maintain the LHDs counter‐disaster and bio‐preparedness system

• Involve the community in decision making.

Values

• Collaboration – Improving and sustaining performance depends on everyone in the system working as a team

• Openness – Transparent performance improvement processes are essential to make sure the facts are known and acknowledged, even if at times this may be uncomfortable

• Respect – The role of everyone engaged in improving performance is valued

• Empowerment – There must be trust on all sides and at all levels with responsible delegation of authority and accountability.


NORTHERN NSW LOCAL HEALTH DISTRICT

NNSW LHD aims to deliver a coordinated, high quality health service to the communities serviced by the District and to provide teaching, training and research. The NNSW LHD also aims to ensure NSW Government and national health priorities, services, outputs and outcomes are achieved and to address the requirements of the National Health Reform Agreement.

The NNSW LHD Strategic Plan and Healthcare Services Plan are linked in a strategic planning framework from the State Plan down to the LHD Plans as illustrated in Figure 1 Below.

Figure 1: NSW Strategic Planning Framework (see Appendix 1)

The actions and strategies required to achieve the priorities outlined in the State Plan cascade down through the NNSW LHD Strategic and Healthcare Services Plans to Clinical Stream service plans. Workforce, Quality and Patient Safety, Information Management & Technology (IM&T) and Research and Risk Management planning occurs in parallel, to build the LHDs capacity to deliver its strategic priorities.

NNSW LHD Board National Health Reforms have provided an opportunity to further strengthen the LHDs strong management structure and community engagement processes through establishment of the LHD Board. Establishment of the Board has ensured local decision making about the way LHD services are managed and resourced. NNSW LHD is administered by the Chief Executive and the Board. The Board appoints the Chief Executive Officer of the LHD. The Board membership includes clinicians, healthcare management experts and community representatives. The Chairperson of the Board reports directly to the NSW Minister for Health. This position provides leadership to the Board, communicates with government and the community served by the LHD and also has direct involvement in appointing Board members.

LHD Strategic Plan

Annual Service and Performance Agreement

LHD Healthcare Services Plan

NSW State Plan

Clinical Service Plans

LHD Business Plan


Responsibilities of the LHD Board include: • Establishing and overseeing an effective governance and risk management framework • Setting the LHD strategic directions • Ensuring high standards of professional and ethical conduct are maintained • Ensuring that providers and the community are involved in decisions that affect them • Monitoring the service delivery and financial performance of the LHD against its targets • Recruiting and overseeing the performance of the Chief Executive of the LHD.

The NNSW LHD Board has established a number of Clinical and Community Engagement Structures.

CLINICAL COUNCILS

NNSW LHD Clinical Council The District Clinical Council provides the LHD Board and the Chief Executive advice on clinical matters affecting the NNSW LHD including:

• Improving quality and safety in the hospitals within the District

• Planning on the most efficient allocation of clinical services within the District • Translating national best practice into local delivery of services • Developing innovative solutions that best address the needs of the local communities • Other related issues that the Board or Chief Executive may seek advice on from time to time.

Hospital Clinical Councils Hospital Clinical Councils provide an opportunity for clinical staff to have input into hospital management. Membership includes Medical, Nursing and Allied Health representation. These Councils bring together these representatives and managers with the aim of improving patient care and the environment in which care is provided. Members of these Councils provide leadership to the hospital or hospitals involved; provide advice and recommendations and participate in management decisions. Four Clinical Councils have been established across the NNSW LHD as outlined below:

• Clarence Valley Hospitals Clinical Council • Lismore, Ballina and Casino Hospitals Clinical Council • Richmond Smaller Hospitals Clinical Council • Tweed Byron Hospitals Clinical Council.


COMMUNITY ENGAGEMENT

Community Engagement Advisory Council (CEAC) This Council has been established to provide input and advice on community engagement across the NNSW LHD. The Council advises the NNSW LHD regarding community communication strategies and support required for community representatives to more effectively engage with the LHD. The NNSW LHD Board has endorsed this model for community engagement with the aim of seeking broader and targeted community input through a range of consultation and communication strategies. Membership of CEAC includes local government, the education sector, key stakeholders, carers and consumer and community representation.

Ngayundi Aboriginal Health Council This Council provides a forum for members of the Bundjalung and Yaegl Nations in the NNSW LHD, and for Aboriginal people from other Nations who reside in the district, to participate in and provide advice on health service planning, development, delivery, evaluation and prioritisation with a view to attaining equality of health status and life expectancy for Aboriginal communities.

NNSW LHD AT A GLANCE NNSW LHD:

• Covers a geographic region of 21,470 square kilometres • Extends from the Tweed Local Government Area (LGA ) in the north to Clarence Valley LGA

in the south • Shares its northern border with Queensland, its southern border with Mid North Coast

(MNC) LHD and its western border with Hunter New England LHD1 • Comprises a total of 13 Statistical Local Areas (SLAs) and within those, seven LGAs and the

Urbenville part of Tenterfield LGA • Is divided into two planning Health Service Groups, Richmond Clarence and Tweed Byron.

NNSW LHD services are provided by:

• 3,637 FTE staff • 11 Hospitals including, Major Non‐Metropolitan/Rural Referral, District and Community

Acute Hospitals • Three Multipurpose Services • Purpose built Drug and Alcohol Detoxification Unit • Purpose built Adult and Adolescent Inpatient Mental Health Units

1 NSW Local Health Networks Planning Information kit 3 December 2010


• Population health services, including oral health, health promotion, public health and Aboriginal health services

• 17 Community Health Centres. NNSW LHD facilities provide around:

• 1,018,000 Non‐Admitted Patient Occasions of Service • 189,000 Emergency Department attendance services • 90,000 acute admissions • 2,300 sub‐acute admissions • 1,750 Mental Health inpatient admissions • 79,370 Mental Health Ambulatory contacts • 9,800 admissions for Queensland residents • 3,500 admissions for residents of other LHDs excluding Queensland • 3,500 births • 20,000 renal dialysis treatments.

Of the NNSW LHD acute hospitalisations annually, approximately:

• 41,000 are unplanned • 49,000 are planned.

Recent trends and projections show significant increases among NNSW LHD residents and patient populations in terms of:

• 840 people with chronic conditions registered with the Connecting Care Program • 11,700 admissions for residents’ ≥ 65 years.

NNSW LHD has:

• 280,708 residents in 2006 (not including the residents of Queensland who access services in the Tweed Byron Health Service Group)1

• Approximately 5.7 million visitors in 2010/11. The season pattern for visitors surges in January each year. Visitors spend approximately 6.5 million nights in the region each year

• 11,000 (3.7% ) Aboriginal residents in 2006 (2.6% nationally) • 28,400 residents born overseas with 7,733 of these speaking a language other than English.

NNSW LHD population:

• Is expected to number 314,957 by 2016 and 331,839 by 20212 • Has a large percentage of people aged 65 and over (18% in 2006) compared to NSW (14%).

This age group is expected to grow to 19.% (56,904) in 2011; 21.5% (67,860) by 2016; and 24.1% (79,940) of the LHD population by 20212

• Unequally shares the burden of death and disease, with Indigenous, rural and socio‐economically disadvantaged residents the most severely affected

• Most commonly die from malignant neoplasms (cancers) and cardiovascular disease3 • Has significantly higher cancer rates than NSW particularly for melanoma, colon, prostate,

breast and pancreatic cancer

2 NSW Health Population Projection Series 1.2009. Department of Planning & Statewide Services Development Branch, NSW Health March 2009 3 ABS mortality data and population estimates (HOIST). Centre for Epidemiology and Research, NSW Department of Health.


• Most commonly are hospitalised for dialysis (renal failure), glaucoma and lens procedures, other gastroenterology and surgical orthopaedics

• Has a high rate of hospitalisation for ambulatory sensitive conditions, particularly diabetes complications and chronic obstructive pulmonary disease.4

Clinical Streams Clinical Streams have been established as the foundation for ensuring well‐coordinated and integrated multi‐campus health services are delivered to patients to maximise patient outcomes and service efficiency. Current Streams include: Oral Health, Renal, Cancer, Palliative Care and Breast Screen. The Clinical Streams have primary responsibility for clinical performance indicator monitoring and benchmarking across facilities. They are the foundation on which networked health services are delivered and will continue to play an important role in the provision of multi‐campus services to residents of NNSW LHD.

Other Programs There are a number of programs that are managed across population groups, across the LHD and, in some cases, are shared across NNSW LHD and MNC LHD. These programs include Public Health, Health Promotion, Oral Health, Carer Support and Aboriginal Health. Other Aboriginal Health Services Aboriginal Health Posts are located at Muli Muli, Jali (Cabbage Tree Island) and Tabulam. There are also Aboriginal health services provided through Box Ridge Community Centre at Coraki. NNSW LHD Health Funded Non‐Government Organisation (NGO) Grants A broad range of non‐government services are funded through the NSW Health NGO Grants Program to work in partnership with the State funded Health Services of NNSW LHD. Some services work seamlessly with LHD based services and others work to capacity to build the community services networks to meet community needs. The funding for these services are generally Ministerially approved and are generally applied in specific funding streams through a Funding Program. NSW Health NGO Grants in the NNSW LHD are provided through the following programs:

• Drug and Alcohol • Women’s Health • Family Planning • Mental Health • Aboriginal Health • Community Transport • Victims of Crime • Palliative Care • Health Promotion.

4 NSW Department of Health, Health Statistics NSW, http://www.healthstats.doh.health.nsw.gov.au/


CURRENT PRESSURES AND FUTURE CHALLENGES NSW has a strong healthcare system with the majority of the population having access to high quality health services and living long and healthy lives. There are a number of challenges and changes that the healthcare system will face over the next 10 years. These challenges are also faced by the NNSW LHD and include:

A growing and ageing population NNSW LHD is one of the fastest growing and ageing rural and remote LHDs in NSW. The coastal corridor of the LHD has rapid population growth with the greatest population growth to 2021 being expected in the Tweed LGA followed by Byron and Ballina LGAs. The inland areas are either stable or declining in population. Changing population patterns necessitate changes in service delivery and organisation. While the services on the coastal strip have to be increased, core services in other communities have to be maintained. This places ongoing pressure on services and resources. An ageing population necessitates changing models of care, especially as they relate to chronic disease management. This involves a move to more primary health care delivery and stronger partnerships with other providers.

The changing nature of illness and the burden of chronic disease Due to lifestyle choices and behaviours among the population on the North Coast there is an increase in disease risk factors such as diminishing levels of immunisation, overweight and obesity, low levels of physical activity, poor nutrition and high smoking rates. Associated with the above are growing rates of chronic diseases such as diabetes, heart disease and poor mental health. In addition, with close proximity and access to the beach, the population has a higher than average rate of Melanoma cancers.

Increasing community expectations NNSW LHD faces significant community expectations for access to quality and safe health services. The LHD responds to these expectations by continually enhancing the range and quality of services. The continuing need for increased service provision places pressure on health services. A move to alternative and contemporary models of care is a strategy to respond to the increasing and ongoing demands on the health workforce and infrastructure.

Health policy and funding The demand for health services continues to exceed available resources. This demand is continually increasing. As a result, NNSW LHD will need to make careful planning decisions and develop strategies to optimise resource outcomes and use its assets effectively. The Board will continue to work to ensure that the LHD receives its fair share of funding and is prepared for the introduction of Activity Based Funding.

Workforce supply and sustainability NNSW LHD faces staffing shortages and these are expected to be ongoing into the future. Recruitment is easier in the coastal strip of the LHD as it offers popular lifestyle choices. Inland


services face considerable challenges in attracting and retaining clinicians, especially medical professionals and specialist service providers.

Workforce supply is affected by the ageing population which is also reflected in the workforce of the LHD. There is a need for ongoing succession planning to ensure the continuation of a valued, skilled, motivated and sustainable workforce.

Cultural and technological advances and change Many technological advances have been made within NNSW LHD over the last 10 years. While the continual emergence of new medical technologies (e.g. diagnostic, surgical, treatments and communication) offer new opportunities for patient care, these also place significant cost pressures on health services. The vast geography of NNSW LHD requires innovative solutions to service delivery challenges. These include effective use of information and communication technologies. Communication technology has the potential to reduce costs by reducing duplication of some services and improving sharing of information between various providers resulting in improved patient care. Communication technology has continued to advance across the LHD over the last number of years. This technology will need to be continually strengthened throughout the lifespan of this Strategic Plan.

Equity and social inclusion Factors such as where we live, what we do, how much money we earn and how long we stayed at school influence our health. Groups with the poorest health have fewer opportunities to achieve and maintain good health. Groups with lower socio‐economic status have more diseases over their lifetimes and die younger. They visit doctors, Emergency Departments and hospital outpatients more, but use preventative services less. The population of the NNSW LHD is one of the most disadvantaged in NSW with all LGAs scoring lower than the NSW average on most measures of socio‐economic status. This population has lower than average weekly earnings, lower levels of education and high rates of unemployment. The overall level of socio‐economic disadvantage in the Northern NSW region contributes to higher than average levels of health problems and demand for services. Aboriginal people are the most disadvantaged group. 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.5 Aboriginal people suffer much higher morbidity across a range of conditions, including: diabetes, renal, cardiovascular and respiratory diseases. People with mental illness, particularly those with chronic conditions and comorbid drug and alcohol issues require high quality, integrated service provision with collaboration between government and non‐government services. Other groups with relatively poor health status include people subject to homelessness, people living in public housing, unemployed people and people with disabilities.6 An equity approach to health recognises that not everyone has the same level of health and people’s health choices are limited by the choices they have available to them. It is important to respond to people differently in order to work towards equal outcomes. By targeting vulnerable communities

5 Department of Health Chronic Disease Management Project Plan 6 South East Sydney Local Health District Strategic Plan 2011‐2015


and working in partnership with other organisations, the LHD can aim to ensure that all people have access to resources which will support them to improve their health. Cross Border Issues The Tweed Byron Network of NNSW LHD faces a number of cross border administrative and planning issues with Queensland Health. In early 2007 a joint planning process was established by the NSW and Queensland Governments to promote an integrated approach to services planning and delivery for the residents of the far north coast of NSW and the southern region of the Gold Coast.

Residents from the Southern Gold Coast region use The Tweed Hospital as their major public facility. Almost all patient movements from the Southern Gold Coast region to The Tweed Hospital and Murwillumbah District Hospital are natural flows. In 2010/11 approximately 5,400 residents of NNSW LHD accessed inpatient care in Queensland resulting in 11,400 cost weighted undiscounted separations. In the same year 9,883 residents of Queensland accessed inpatient care in NNSW LHD resulting in 8,444 cost weighted undiscounted separations. 87% (8,566) of the care provided to residents of Queensland occurred at The Tweed Hospital. In addition, 53% of births at The Tweed Hospital in 2010/11 and 29% of Emergency Department presentations were for residents of Queensland.

Some of the challenges faced due to cross border issues include, interstate differences in admission criteria, discharge planning difficulties, Community Health cross border services and difficulties in arranging ambulance and non‐ambulance transport across State borders. There are also issues around coordination of disaster planning, differences in State legislation and differences in time zones during periods of daylight saving in New South Wales.

There are a number of increases to services and infrastructure planned and currently underway in the Gold Coast. Robina Hospital will grow from 210 to 364 beds in 2012 and the Gold Coast University Hospital will open in 2014. These services, once established will reduce some of the current pressure on The Tweed Hospital. However they will also present some new challenges. Key amongst these challenges will be the higher pay rates and better conditions in Queensland, opening of new services and the consequent need for increased workforce will place further pressure on recruitment over all disciplines particularly across the Tweed Byron Network.

WHERE WE WANT TO BE IN 2017 The NNSW LHD Strategic Plan 2012‐2017 is informed by key goals of the NSW public sector health system, which are to help people stay healthy and to provide access to timely, high quality, patient‐centred health care that are underpinned by the core values of Collaboration, Openness, Respect and Empowerment. We will also work towards providing a more equitable access to health services in the region. What we are striving for in 2017 is a health system that:

• Has a greater focus and investment in improving health and preventing illness while continuing to treat illness effectively paying particular attention to reducing the health gap for communities that experience multiple disadvantages


• Is focused on providing patients with ready access to safe and high quality journeys through NSW health services and ensuring patients and their carers are informed and involved in healthcare decisions and treated with respect

• Helps people to access most of the healthcare they need through an integrated network of primary and community health services across the public and private health systems

• Has a greater focus on healthy ageing strategies integrating services across different levels of government and the private sector

• Engages more effectively with other government and non‐government agencies and the broader community, to provide a more integrated approach to planning, funding and delivering health services to local communities and regions

• Makes the most effective use of the finite resources available and manages costs, services and infrastructure effectively to meet the State’s healthcare needs while maintaining financial sustainability

• Has a valued, skilled and motivated workforce that is well planned, trained, organised and deployed creatively to focus on the changing needs of health consumers, carers and the wider population

• Is alert and capable of readily adapting to the changing needs of the community and is quick to anticipate and respond to new issues as they emerge

• Has a well‐developed strategic relationship with the Gold Coast Health Service District. By 2017 the health services of NNSW LHD will have the following features:

• Residents’ access to health services is effective and timely, based on patients’ needs • Patients will access a more integrated service and journey through the health system in a

seamless manner • Residents will have an overall improved wellness and individuals will be encouraged to take

ownership of their health and lead a healthy lifestyle • Health Services will be coordinated. Coordination and sharing of health information will

result in improved quality of care • There will be greater emphasis on, and access to, health services in the community and the

primary health care sector • A valued and motivated health workforce with improved skills, capacity and models of

practice • An organisational culture that embraces learning and is committed to research, evidence

based practice and teaching • Community and Clinician input into service planning and decision making at all levels of

operation • There will be increased capacity and monitoring of the effectiveness of the delivery of health

care and research into improving models of care • Improved infrastructure to meet the challenges of health service delivery.


NSW STATE PLAN GOALS AND NNSW LHD STRATEGIC OBJECTIVES In September 2011 the NSW Government released a new State Plan, “NSW 2021”. NSW 2021 is a 10 year plan to guide policy and budget decision making. The Plan sets long term goals and outlines immediate actions that will help the Government to achieve these goals. The Plan provides direction for the Public sector for the next 10 years. The overall goal of the NSW Government is to restore confidence in the public health system by rebuilding hospitals and health infrastructure, re‐engaging medical practitioners and giving communities and health care providers a strong direct voice in improved patient care. The NSW Government is committed to health policy that keeps people out of hospital, focusing on illness prevention and reducing the burden of chronic disease and keeping our community healthy and active. The State Plan also highlights the NSW Government’s commitment to providing world class clinical services with timely access and effective infrastructure. There are a number of State Plan goals for which the NSW Health system has primary responsibility and others to which we will need to make a contribution. These goals are detailed throughout the next section of the document and in Appendix 1. They form the basis on which NNSW LHD Strategic Objectives have been developed. The State Plan also sets targets and details high level priority actions for the Ministry of Health. The NNSW LHDs Strategic Objectives build on the work undertaken for the development of the NSW State Plan and are framed to meet the health needs of our communities and to contribute to the achievement of the relevant Goals contained in the NSW State Plan‐NSW‐2021. The next section “What we will do” to achieve these strategic objectives, details actions which NNSW LHD will undertake over the next 5 years to meet these strategic objectives and NSW State Plan Goals and Targets. NNSW LHD will build on this work with the development of an annual Business Plan which will guide the organisation and reflect the more detailed service arrangements and responsibilities detailed in the NNSW LHD Service Agreement with the NSW Ministry of Health.


STATE PLAN GOAL 11: Keep people healthy and out of hospital

State Plan Targets:

• Reduce smoking rates

• Reduce overweight and obesity rates

• Reduce risk drinking

• Close the gap in Aboriginal infant mortality

• Improve outcomes in mental health

• Reduce potentially preventable hospitalisations

NNSW LHD STRATEGIC OBJECTIVE 1: Protect the health of our community and make promoting better health a part of everything we do

What we will do:

• Provide targeted preventive care programs with a focus on smoking, overweight/obesity, risk drinking, fall injuries vaccine preventable diseases, potentially avoidable deaths, blood borne virus infections, sexually transmissible infections, tuberculosis and coordination of immunisation services to population groups

• Develop targeted Aboriginal Health strategies with a focus on smoking, overweight/obesity, Aboriginal infant mortality, physical inactivity, risk drinking, injury and other key contributors to the health disparity between Aboriginal and non‐Aboriginal people, including those outlined in the Close the Gap on Indigenous Health Outcomes National Partnership Agreement, the Aboriginal and Torres Strait Islander Health Performance Framework and Two Ways Together

• Enrol patients onto the Connecting Care Program and implement integrated Connected Care Plans to reduce potentially preventable hospitalisations

• Strengthen a coordinated and integrated primary healthcare services • Provide care targeting potentially preventable hospitalisations in partnership with

HealthOnes and other Primary Healthcare Providers including Medicare Locals and Aboriginal Community Controlled Health Services

• Continue to work in partnership with locally based research into avoidable hospital admission of older people with chronic and complex conditions.


Measuring Success: Our measures of success are matched to the State Plan priorities and targets and NNSW LHD measures.

• Smoking rates for non‐Aboriginal people reduced by 3% by 2015 and by 4% for Aboriginal people

• Rate of smoking by‐non‐Aboriginal pregnant women reduced by 0.5% per year and 2% per year for pregnant Aboriginal women

• Overweight and obesity rates of children and young people (5‐16 years) reduced to 21% by 2015

• Overweight and obesity rates in adults stabilised by 2015, and then reduced by 5% by 2020 • The gap between Aboriginal and non‐Aboriginal infant mortality rates halved by 2018 • Age standardised rate of potentially preventable hospitalisations reduced by 1% overall and

by 2.5% for Aboriginal people by 2014‐15 • Service Agreement target for enrolled Aboriginal and non‐Aboriginal patients in Connecting

Care Program met • Service Agreement target for Aboriginal; non‐Aboriginal babies weighing less than 2,500g

(%) met • Service Agreement target for Aboriginal; non‐Aboriginal children fully immunised at 1 year

of age met


STATE PLAN GOAL 12: Provide world class clinical services with timely access and effective infrastructure

State Plan Targets:

• Reduce hospital waiting times Planned surgery Emergency Department treatments

• Improve transfer of patients from Emergency Department to wards

• Reduce unplanned readmissions

• Decrease healthcare associated bloodstream infections

• Ensure publically provided health services meet national patient safety and quality standards

• Increase patient satisfaction

NNSW LHD STRATEGIC OBJECTIVE 2: Continually improve the quality of and access to a comprehensive range of integrated health services including in partnership with key external partners

What we will do:

• Participate in a recognised accreditation process by 2014 • Develop and implement a LHD Clinical Governance Framework, including clinical governance

structures to oversee the safety and quality of health services • Develop and implement a clinical governance information strategy • Increase patient satisfaction through strategies aimed at improving the patient experience

and the overall care received within the LHD • Continue the implementation of Between the Flags (BTF) Program • Implement Sepsis Pathway and the Chest Pain Pathway • Decrease healthcare associated Infections • Develop a mechanism to facilitate feedback to clinicians from clinical audits and death

reviews • Develop a mechanism to monitor compliance with best practice in clinical service provision


• Continue to implement quality use of medications in hospitals and improve medication management particularly in older people

• Implement Emergency Surgery guidelines and ensure effective implementation of the Predictable Surgery Program to decrease waiting times for all surgical procedures

• Improve access to Emergency Department care and reduce Emergency Department Access Block through effective implementation, monitoring and maintenance of patient flow systems and predictive capacity planning

• Ensure effective and integrated networks of care for the local population that also support cross District and State‐wide networks

• Ensure appropriate utilisation of hospitals through improved bed availability by: o Reducing inappropriate admissions o Expanding community health, ambulatory and hospital in the home support services o Addressing delays in transfer to rehabilitation and other sub‐acute services o Reducing rates of unplanned and unexpected hospital readmissions o Working with carers as partners in care

• Facilitate improved access to specialist Mental Health Services providing solutions to access issues experienced in rural areas

• Implement actions under New Direction in Mental Health: o Reduce Mental Health readmissions within 28 days o Increase the rate of community follow up within 7 days upon discharge

• Develop and implement an integrated response to mental health, alcohol and drug issues, including targeted community campaigns, programs for young people and skills training for Aboriginal communities

• Implement evidence based Models of Care to contribute to a reduction of inappropriate clinical variation, better utilisation of hospitals and improved patient journeys.


• COAG agreed National Emergency Department access target of 90% of persons attending the Emergency Department staying less than 4 hours achieved

• Current rates of unplanned and unexpected readmissions as a percentage of total hospital admissions reduced (5% over 4 years)

• Improved performance and remaining below COAG benchmark for staphylococcus aureus (staph) bloodstream infection rate per 10,000 patients

• Improved performance and remaining below Service Agreement target for incorrect procedures in Operating Theatre

• Improved Mental Health Emergency Admission Performance and Service Agreement targets for patients transferred to an inpatient bed within 8 hours of arrival in the Emergency Department met

• Targets for New Directions in Mental Health met • Mental Health readmissions to any facility within 28 days reduced. • All NNSW LHD health facilities meet national patient safety and quality standards • Level of satisfaction on the previous year’s Patient Experience Survey following treatment

increased.


NNSW LHD STRATEGIC OBJECTIVE 3: Develop a skilled and motivated workforce in a culture based on our core values

What we will do:

• Improve supervision and continuing education of Junior Medical Officers (JMOs) including oversight of clinical notes

• Expand locally based Registrar training posts • Investigate best fit staffing models for medical cover and quality control in smaller rural

hospitals, including clinical redesign options • Increase the role of Nurse Practitioners in Mental Health Services • Increase the role of Nurse Practitioners in Emergency Care in our smaller hospitals and

community • Work in collaboration with Educational Institutions to develop and implement strategies to

build a sustainable health workforce • Put systems and processes in place to ensure that staff and contractors are aware of and

abide by the NSW Health code of conduct and relevant professional registration requirements

• Ensure that policies, procedures and systems are in place to enable the efficient and appropriate management of any breaches of recognised standards of conduct

• Implement strategies to build a sustainable health workforce and promote Aboriginal employment

• Increase the number of Medical Students participating in training at NNSW LHD Referral Hospitals

• Develop and implement local strategy to support the Aboriginal and Torres Strait Islander workforce in relation to recruitment processes, retention and career development opportunities and non‐Aboriginal stakeholder capabilities

• Develop and implement local Cultural Awareness training programs that include: eLearning components and face to face components to support delivery and sustainability.


• Supervision and continuing education of JMOs improved • Locally based registrar training posts increased • 100% staff and contractors sign off on code of conduct • Sick leave reduced • Workplace injuries performance improved • Increased number of Nurse Practitioners • Increased numbers of Medical Students • Aboriginal employment rate increased to ≥2.67% • Staff are offered cultural awareness training through eLearning and face to face.

7 NSW Health benchmark as indicated in the Aboriginal Workforce Strategic Framework 2011-2015


NNSW LHD STRATEGIC OBJECTIVE 4: Ensure good stewardship and leadership through strong corporate and clinical governance

What we will do:

• Implement the National Health Reform Agreement as it applies to the LHD • Embed the Performance Management Framework processes within the LHDs hospitals,

clinical streams and networks • Develop and implement an LHD Clinical Governance Framework, including clinical

governance structures to oversee the safety and quality of health services • Effectively implement the State e‐Health Information and Communication Technology

Strategy (including a seamless State‐wide network) and prepare for the implementation of the national personally controlled Electronic Health Record

• Continue to implement the NSW Health Financial Management Framework • Develop the LHDs capability to implement Activity Based Funding (ABF) including:

o Management capability o Achievement of clinical coding targets o Contribution to State‐wide Casemix costing

• Improve the quality of coding and data collection including ensuring patient type‐change to reflect acute, sub‐acute and other episodes of care. The District Executive anticipates that it will need to train additional Coders

• Increasing awareness of ABF and its implications by conducting education and information sessions and a District wide ‘Roadshow’

• Provide appropriate information technology systems for timely capture and reporting • Ensure that the authority, roles and responsibilities of the LHDs governing, management and

operating structures are clearly understood through the establishment of robust governance and oversight frameworks

• Ensure that clinical management and consultative structures within the LHD are appropriate to the needs of the LHD and those of its clients

• Ensure appropriate arrangements are in place to secure the efficiency and effectiveness of resource utilisation by the LHD and for regularly reviewing the financial and service delivery performance of the organisation.


• Service Agreement target for coding timeliness – records with valid DRGs (%) met • Service Agreement target for cost weighted acute separations met.


NNSW LHD STRATEGIC OBJECTIVE 5: Embed research and education as an integral element of clinical services

What we will do:

• Further develop supportive systems for student placements

• Further develop skills in the provision of supervision and management of student performance

• Develop alternative and innovative models of student supervision suitable for regional and rural areas

• Further develop skills in clinical teaching ‘at the bedside’ • Further develop the supervision and management of junior medical staff • Provide continuing education and clinical skill training opportunities for staff • Work in partnership with education providers to influence the supply of qualified health

professionals and provide further education and teaching opportunities for current staff • Provide specific training programs for the whole of the workforce which support the

implementation of legislation, policy and the desired workplace culture • Develop a system that coordinates the student placements, and affiliation agreements.


• Systems for student placements reviewed and analysed and Action Plan developed and implemented

• Supervision of junior medical staff reviewed and Action Plan developed and implemented • System that coordinates student placements developed and implemented • Number of employees undertaking education and training increased.


STATE PLAN GOAL 13: Better protect the most vulnerable members of our community and break the cycle of disadvantage (child wellbeing)

State Plan Targets: • Increase the number of NSW children who are developmentally on track in Australian

Early Development Index domains: o Physical health and wellbeing o Social competence o Emotional maturity o Language and cognitive skills o Communication and general knowledge

NNSW LHD STRATEGIC OBJECTIVE 6: Work in partnership to improve child wellbeing health and safety

What we will do:

• Continue to implement “ Keep Them Safe”, the response to the inquiry into Child Protection

• Offer all new parents a home visit by a Child and Family Nurse

• Offer all mothers an assessment to find any risk of mental health issues, including postnatal depression

• Work in partnership to identify and support families where parental drug or alcohol use and or mental health problems may put children at risk

• Provide early intervention programs to pregnant Aboriginal women in relation to risks associated with substance use in pregnancy and when breast feeding.

Measuring Success:

• All new parents offered a home visit by a Child and Family Nurse

• Early intervention programs to pregnant Aboriginal women in relation to risks associated with substance use in pregnancy and when breast feeding developed and implemented

• All mothers offered an assessment to find any risk of mental health issues, including postnatal depression

• “Keep Them Safe”, the response to the inquiry into Child Protection implemented.


STATE PLAN GOAL 26: Fostering opportunity and partnership with aboriginal people

State Plan Targets:

• Close the life expectancy gap within a generation • Increase the number of Aboriginal communities the State Government is partnering

with to improve local outcomes • Support Aboriginal culture, country and identity

NNSW LHD STRATEGIC OBJECTIVE 7: Work with the Aboriginal community and partners to improve the health of Indigenous Australians

What we will do:

• Put systems in place to accurately identify Aboriginal patients • Improve the patient journey for Aboriginal patients and build trust between Aboriginal

people and the LHD, particularly through the Chronic Care for Aboriginal People Program, the Aboriginal Maternal and Infant Health Service and the Family Health Program

• Work collaboratively with other stakeholders in Aboriginal health service provision • Develop a Partnership Agreement with Aboriginal Medical Services (AMSs) • Develop and implement Aboriginal health Impact Statement Policy.


• Systems in place to accurately identify Aboriginal patients • Ngayundi Aboriginal Health Council maintained and developed • Partnership Agreement with AMS established • Aboriginal Health Impact Statement Policy developed and implemented.


STATE PLAN GOAL 28: Ensuring NSW is ready to deal with major emergencies and natural disasters

State Plan Targets: • Maintain preparedness to deal with biosecurity threats

NNSW LHD STRATEGIC OBJECTIVE 8: Maintain the LHDs counter‐disaster and bio‐preparedness system

What we will do:

• Develop Emergency Response Plans and ensure that the LHD is in readiness to collaborate with local public health units; particularly for bio‐preparedness and infectious disease outbreaks

• Maintain current understanding of NSW Health disaster management policy and practice in light of Commonwealth and State development and advances in disaster medicine and technology

• Undertake ongoing assessment of preparedness for disasters • Regularly exercise and review response capacity in concert with other emergency service

agencies. Measuring Success: Our measures of success are matched to the State Plan priorities and targets and NNSW LHD measures.

• Emergency Response Plan developed • Exercise and review of response capacity undertaken in concert with other emergency

service agencies regularly


STATE PLAN GOAL 32: Involve the community in decision making on government policy, services and projects

NNSW LHD STRATEGIC OBJECTIVE 9: Involve the community in decision making

What we will do:

• Ensure that systems and processes are in place to protect the rights and interests of key stakeholders and that they are provided access to balanced and understandable information about the organisation and its proposals

• Ensure consideration of diversity in representation of stakeholders including local government, education, NGO, Clinicians and equal opportunity in engagement structures and processes

• Maintain and improve clinical and community engagement structures, systems and processes for involving both staff and the community in decision making

• Explore issues initiating from the clinician and community engagement structures for future planning and development of services within the NNSW LHD

• Develop communication tools and processes to keep staff and community informed about the activities and services of NNSW LHD and about opportunities for Engagement.


• Communication tools and processes to keep staff and community informed about the activities and services of NNSW LHD and about opportunities for engagement developed

• Clinical and community engagement structures improved and maintained.

State Plan Targets:• Establish Local Hospital Health Districts with local Boards


APPENDIX 1: STRATEGIC PLANNING FRAMEWORK Commonwealth Government In 2009, the Commonwealth Government released a proposal for major structural reform of the Australian health system to establish the financing and governance foundations of a nationally unified and locally controlled system. In March 2010 the Commonwealth Government announced “A National Health and Hospitals Network for Australia’s Future”. This was the Commonwealth Government’s response to the Final Report of the National Health and Hospitals Reform Commission Report of June 2009. In April 2010 the second part of the Reform Plan was released “A National Health and Hospitals Network: Further Investment in Australia’s Future”. The National Reforms have three primary objectives:

1. Reforming the fundamentals of our health and hospital system, including funding and governance, to provide a sustainable foundation for providing better services now and in the future. This involves permanently establishing the Commonwealth Government as the majority funder of hospitals.

2. Changing the way health services are delivered, through better access to high quality integrated care designed around the needs of patients, and a greater focus on prevention, early intervention and the provision of care outside of hospitals.

3. Providing better care and better access to services for patients, through increased investments to provide better hospitals, better infrastructure, and more doctors and nurses.

The initial focus is on improving public hospital services, building on existing strengths of our current system along with free and ready access to best‐practice healthcare for public patients across Australia, and to ensure that our public health system is sustainable.8 It is expected that priority will be given to national initiatives, such as the Australian Safety and Quality Goals for Health Care. Under the National Health and Hospitals Network Agreement the State Government has established LHDs comprising small groups of public hospitals with a geographic and functional connection, large enough to operate efficiently and to provide a reasonable range of hospital services and small enough to enable the LHDS to be effectively managed to deliver high quality services. The LHDs are the direct managers of public hospital services and have a professional Board and Chief Executive Officer. They are responsible for delivering agreed services and performance standards, within an agreed budget and based on an annual strategic and operating plan, in order to achieve the LHD Service Agreement. The responsibilities of LHDs include:

• Local planning and delivery of clinical services ‐ hospital and community, Aboriginal health services in priority program areas (e.g. Diabetes and Renal), budget management, recruitment, procurement and other expenditure decisions, clinical governance, patient services (including complaints management, social work and support services), infection control, clinical and health service research and governance and medical records

8 Commonwealth Of Australia, 2010, “A National Health and Hospitals Network For Australia’s Future – Delivering The Reforms”


• Workforce management, including training, recruitment, performance management, discipline and grievance management, Employee Assistance Program, Workers Compensation and return to work schemes.

Other functions of the LHD include Occupational Health and Safety, Fire Safety, Asset Management, Biomedical Engineering, Sterilising Services, Local IT system support, Executive Support, community engagement, Interpreter Services and Disaster Plans. Governance arrangements for the LHD are aimed at improving clinical engagement including working with clinicians to incorporate their views, especially on quality and safety into day to day operations. The National Health Reform Agreement requires the NSW Government to establish a Service Agreement with each LHD and to implement a Performance Management and Accountability System including processes for remediation of poor performance. Health Services are required to meet the applicable conditions of the Council of Australian Governments (COAG) National Agreements and National Partnership Agreements between the NSW and the Commonwealth Government and commitments under any related Implementation Plans. The performance of the NNSW LHD is assessed in terms of whether it is meeting the performance targets for individual key performance indicators (KPIs) including Triage and access targets. The performance targets described in the NNSW LHD Service Agreement are in line with this Strategic Plan.

State Government The NSW Government has supported the call for change and is working with the Commonwealth to improve the availability and quality of care for the people of NSW. On 1 January 2011 in response to the National Health Reforms a major restructure of the NSW Health System was implemented. As part of this restructure the former North Coast Area Health Service (NCAHS) was de‐amalgamated and the Northern NSW Local Health Network was established. In April 2011 it was announced that the Local Health Networks would transition to LHDs with a shift to increased local decision making and responsibility for service provision to meet the needs of the local population. The LHD is overseen by a local Board and is responsible for ensuring the delivery of coordinated high quality health services which will address the needs of its community into the future. With the significant increase in localisation and specialisation comes an added responsibility that every public health organisation in NSW meets high standards of patient care. In terms of strategic and service planning, implementation of the recent health reforms will build upon the consistent approach to strategic planning which has been pursued across NSW, since the introduction of the Integrated Strategic Planning Framework in 2005. The planning process at State and Area levels involved extensive consultation with the community, patients and carers, stakeholders, managers and staff. Area Health Advisory Councils (AHAC), Health Priority Taskforces and special working groups have contributed to these activities, resulting in a rigorous and comprehensive framework that will focus NSW Health’s priorities for the future. NNSW LHD will continue to engage with external agencies such as the Clinical Excellence Commission, Agency for Clinical Innovation, Bureau of Health Information, Health Education and Training Institute and the Health Care Complaints Commission to leverage off State‐wide projects and innovations.


NSW State Plan The NSW State Government’s goal for health is to “Restore confidence in the public health system by rebuilding hospitals and health infrastructure, re‐engaging medical practitioners, and giving communities and health care providers a strong and direct voice in improved patient care”.9 There are two goals within the State Plan which the Minister for Health is directly accountable for. These are:

GOAL 11: “Keep people healthy and out of hospital”

GOAL 12: “Provide world class clinical services with timely access and effective infrastructure”

In addition to these two goals there are a number of other goals within the State Plan which the health system will also contribute to. These are:

GOAL 13: “Better protect the most vulnerable members of our community and break the cycle of disadvantage”

GOAL 26: “Fostering opportunity and partnership with Aboriginal people”

GOAL 28: “Ensuring NSW is ready to deal with major emergencies and natural disasters”

GOAL 32: “Involve the community in decision making on Government policy, services and projects”

Achieving these goals requires clear priorities, supportive leadership and staff working together, underpinned by the core values of:

Collaboration – Improving and sustaining performance depends on everyone in the system working as a team.

Openness – Transparent performance improvement processes are essential to make sure the facts are known and acknowledged, even if at times this may be uncomfortable.

Respect – The role of everyone engaged in improving performance is valued. Empowerment – There must be trust on all sides and at all levels with responsible delegation

of authority and accountability.

PLANNING PROCESS As part of the planning process, consultations were held with the following groups to inform the NNSW LHD Strategic Plan:

• NNSW LHD Board

• NNSW LHD Executive

9 NSW Government, NSW 2021, A Plan To Make NSW Number One, October 2011


• NNSW LHD Clinical Council

• NNSW LHD Hospital Clinical Councils

• NNSW LHD Senior Nurses Executive

• NNSW LHD Community Engagement Advisory Council

• Allied Health Consultation

• Senior Management Forum

• Executive Medical Staff Council.

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