top end health service...top end health service 2019-20 service delivery agreement department of...

DEPARTMENT OF HEALTH

Top End Health Service Service Delivery Agreement

2019-20

Top End Health Service 2019-20 Service Delivery Agreement

DEPARTMENT OF HEALTH

of 34

© Department of Health, Northern Territory 2019

This publication is copyright. The information in this publication may be freely copied and distributed for non-profit purposes such as study, research, health service management and public information subject to the inclusion of an acknowledgment of the source. Reproduction for other purposes requires the written permission of the Chief Executive Officer of the Department of Health, Northern Territory.

An electronic version is available at: www.health.nt.gov.au

General enquiries about this publication should be directed to:

System Performance Department of Health PO Box 40596 Casuarina NT 0811 Email: [email protected] Telephone: (08) 8999 2938


DEPARTMENT OF HEALTH of 34

Contents

Introduction ........................................................................................................................................................................................... 4 Objectives .............................................................................................................................................................................................. 4 Strategic context .................................................................................................................................................................................. 4 Principles ................................................................................................................................................................................................ 6 Legislative context ............................................................................................................................................................................... 6 Responsibilities and accountabilities .............................................................................................................................................. 6

Top End Health Service .............................................................................................................................................................................. 6 Department of Health ................................................................................................................................................................................. 7

Management of the Service Delivery Agreement ...................................................................................................................... 7 Term of the Service Delivery Agreement ..................................................................................................................................... 7 Performance measurement .............................................................................................................................................................. 7 Data provision and management .................................................................................................................................................... 7 Research and training ......................................................................................................................................................................... 8 Public health responsibilities ............................................................................................................................................................ 8 Variation to this Agreement ............................................................................................................................................................. 8 Dispute resolution ............................................................................................................................................................................... 8 Execution................................................................................................................................................................................................ 9 Schedule 1: Interpretations and Abbreviations ........................................................................................................................ 10

1.1 Interpretations ............................................................................................................................................................................. 10 1.2 Abbreviations ............................................................................................................................................................................. 11

Schedule 2: Activity and funding .................................................................................................................................................. 13 2.1 Activity and finance .................................................................................................................................................................... 13 2.2 Funding Sources .......................................................................................................................................................................... 14 2.3 National Weighted Activity Unit ............................................................................................................................................. 14 2.4 Specific funded items ................................................................................................................................................................. 15 2.5 Tied funding ................................................................................................................................................................................. 16

Schedule 3: Cultural security, safety, quality and risk ............................................................................................................. 17 3.1 Cultural security .......................................................................................................................................................................... 17 3.2 Safety and Quality ...................................................................................................................................................................... 18 3.3 Risk management and audit...................................................................................................................................................... 18

Schedule 4: Key performance indicators .................................................................................................................................... 20 Schedule 5: Northern Territory and Department strategic directions ............................................................................... 22

5.1 Strategic directions within which services are to be delivered ......................................................................................... 22 5.2 Corporate policies and standards ............................................................................................................................................ 23

Schedule 6: Support to Health Services ...................................................................................................................................... 24 Schedule 7: Data reporting requirements .................................................................................................................................. 26

7.1 Purpose ......................................................................................................................................................................................... 26 7.2 Principles ...................................................................................................................................................................................... 26 7.3 Roles and responsibilities .......................................................................................................................................................... 26

Schedule 8: TEHS service descriptions ....................................................................................................................................... 28 8.1 Hospital and non-hospital services ......................................................................................................................................... 28 8.2 Hosted services ........................................................................................................................................................................... 28 8.3 Co-located services .................................................................................................................................................................... 30

Schedule 9: Remote and Community Services ......................................................................................................................... 31 9.1 TEHS remote primary healthcare service ............................................................................................................................... 31 9.2 Community Health Services Provided in Urban and Regional Centres ........................................................................... 33 9.3 Prison Primary Health Care Services ...................................................................................................................................... 34



Introduction

This Service Delivery Agreement (SDA) is a formal agreement between the Department of Health (the Department) and the Top End Health Service (TEHS) consistent with the requirements of the Health Services Act 2014 (the Act) and the National Health Reform Agreement. The SDA supports improved service integration, local control and decision making and more efficient and effective public hospital and community health services. It outlines the responsibilities and accountabilities of the Department and TEHS in the delivery of the services to be purchased under this agreement.

Key elements of this agreement are:

• The specification of services and activity targets to be delivered by TEHS • The funding to be provided for the delivery of these services, including national partnership

agreements, Commonwealth own purpose expenditure payments and other agreements • The key performance indicators against which performance will be assessed

The success of this agreement depends on a strong commitment by TEHS and the Department as System Manager of the Northern Territory public health system to work together to achieve the best health outcomes from available resources.

The Service Delivery Agreement is supported by the NT Department of Health Service Delivery Agreement Performance Framework. The Framework provides the performance structure and outlines the processes for the development, monitoring and management of the SDAs.

Objectives

The objectives of this agreement are to:

• Specify the healthcare service outcomes and outputs to be provided by TEHS • Specify the funding to be provided to TEHS for the provision of these services • Clearly outline the service delivery and performance expectations for TEHS, including provision

of performance and other data • Ensure Northern Territory and Australian Government health priorities and strategies are

implemented and intended outcomes are achieved • Articulate a performance management and accountability system for monitoring and assuring the

achievement of effective and efficient service provision • Address the requirements of the National Health Reform Agreement and the Act • Promote accountability to the Northern Territory Government and the community

Strategic context

Since 1 July 2014 the public health system in the Northern Territory, operating under the Act, has comprised three entities: the Department of Health, the Top End Health Service (TEHS) and the Central Australia Health Service (CAHS). As these entities and the public health system matured, the governance structure was streamlined. From 1 July 2019, the Chief Operating Officer of each Health Service reports directly to the Chief Executive Officer and is accountable to the Chief Executive Officer through the SDA.

The Northern Territory’s public health system is guided by the Department’s Strategic Plan 2018-2022, which sets out strategic directions and objectives to improve the health and wellbeing of Territorians.

The strategic directions are to: prevent illness; focus on each person; redesign to improve access; lift performance towards excellence; embed research; and systematise effectiveness and efficiency. In partnership with other government and non-government agencies and the community, the



Department and Health Services will work collaboratively to achieve a shared vision of becoming a world leader in the delivery of remote health through collaboration, excellence and innovation and work together as one system to deliver better health for all Territorians.

The Strategic Plan complements the 2018 National Health Reform Agreement addendum that provides for four strategic priorities for health system reform. These priorities are:

• Improving efficiency and ensuring financial sustainability • Delivering safe, high quality care in the right place at the right time • Prioritising prevention and helping people manage their health across their lifetime • Driving best practice and performance using data and research

Further, in 2018 the Department and the Health Services began implementing the Health Sustainability Reform Program to drive improved service delivery and financial sustainability. There are also Department plans and frameworks that guide how services are to be delivered across the Northern Territory (refer Schedule 6).

Strategic initiatives and plans will be prioritised where they are:

• Election commitments • Whole of Northern Territory Government decisions and policies (including A Plan for Budget

Repair and the Root and Branch Review) • National decisions and policies • Clinical Services Plan 2018-2036 – in particular short-term requirements

In addition to purchased activity and funding in Schedule 2 other issues to impact TEHS 2019-20 are

set out below:

Priority Details Funding

Health Sustainability Reform Program

The Department and Health Services will work collaboratively to implement and drive improved service delivery and financial sustainability.

Funding in Schedule 2.1

Public Health Transition of operational public health functions from the Department to the Health Services

Funding to transfer to Health Service

Grants and grants reform

Contribute to development of agreed principles between the Health Services and the Department in the development of grants funding agreements with service providers.

Work with the Department to progress and implement Grants NT and implementation of 5 year funding agreements.

Funding included in Schedule 2.1

Acacia (Core Clinical Systems Renewal Program)

Participation of Health Services in Acacia development. Funding included in Schedule 2.1

Transition to Community Control

Integration of care/services with non-government organisations and Aboriginal community controlled health organisations.


Health care reform

The Department, Health Services and the NT Primary Health Network will work together to implement the coordinated care bilateral agreement to improve the delivery of care for patients with chronic and complex conditions, and reducing avoidable demand for health services.


Independent Commissioner Against Corruption

Participate in the development and implementation of resources and processes for the Independent Commissioner Against Corruption.


Choosing Wisely Australia

The Health Service will identify and implement improvements under the Choosing Wisely Australia initiative.




Principles

This agreement reflects and enables the principles on which the structure of the Department and the Northern Territory’s Health Services are based, being:

• An integrated Northern Territory-wide health system with regional and local services designed to meet overarching objectives and outcomes

• Community responsiveness • Coordination and integration of services across the care continuum • Focus on prevention and early intervention • Local decision-making • Fair and reasonable accountability requirements • Clarity of roles, responsibilities and accountabilities

Legislative context

This Agreement is created in accordance with the National Health Reform Agreement and the Act. Under the Act, the Chief Operating Officer of a Health Service is responsible for the day-to-day operations and the functions of the Service; the Chief Operating Officer enters into and implements the SDA for the Health Service. A Health Service is accountable for its performance in accordance with the SDA for the Service, any Health Service Directive issued to the Service and any other requirements under the Act.

Responsibilities and accountabilities

Top End Health Service

Without limiting any other obligation, TEHS must meet the following accountabilities and responsibilities:

• The terms of this SDA and its schedules • All Northern Territory and Australian Government legislation applicable to it • Alignment with national and Northern Territory policies, plans, frameworks, and quality and

safety standards • Development of contemporary models of care, including, and not limited to, those outlined in

the Clinical Services Plan 2018-2036 • Professional registration and clinical credentialing standards and practice • Achievement and maintenance of service and/or facility accreditation • Business continuity planning to ensure appropriate measures, risk mitigation and

preparedness plans are in place • Planning at the health service level that is aligned with Northern Territory clinical service

plans, frameworks and strategic policy • Repair and maintenance of remote health centres, subject to the implementation of

recommendations from A Plan for Budget Repair • Implementation of coronial recommendations and internal audit recommendations • Implementation of any new initiatives, as required from time to time • Work with the Department to progress strategies and initiatives for example: Total Asset

Management Plan & NT Health Digital Strategy • Compliance with all program, financial and performance reporting required by funding

agreements



Department of Health

Without limiting any other obligations, the Department must meet the following accountabilities and responsibilities:

• The terms of this SDA and its schedules • All Northern Territory and Australian Government legislation and agreements applicable to it • Dealing, negotiating and entering into agreements with the Australian Government • Contributing to negotiating Northern Territory-wide industrial agreements for the terms and

conditions of employees, as required by the Department of Treasury and Finance • Northern Territory-wide health service, workforce and capital planning • Northern Territory-wide health policy development, including leadership of clinical quality

and safety and review of alternative models of care • Northern Territory-wide system management including health system planning, strategic

service planning, coordination and setting of standards • Managing digital heath investments (estimated value exceeds $100,000), subject to the

implementation of recommendations from A Plan for Budget Repair • Managing major capital works (estimated value exceeds $500,000), subject to the

implementation of recommendations from A Plan for Budget Repair • Delivery of Northern Territory-wide services in ways which enable coordination and

integration of service delivery in the Top End/Central Australia region

It is noted that where costs of meeting infrastructure, equipment and legal responsibilities cannot be managed within the Health Service budget due to their significant or unusual nature (for example, provision of emergency services in the instance of major infrastructure failure), the Department will assist Health Services to identify funding options to address these issues.

Management of the Service Delivery Agreement

This SDA will be managed in accordance with the Northern Territory Service Delivery Agreement Performance Framework.

Term of the Service Delivery Agreement

This SDA will operate from 1 July 2019 to 30 June 2020.

Performance measurement

Performance against key performance indicators in the SDA are compliance measures. Performance levels that are not achieved may trigger responses as outlined in the Service Delivery Agreement Performance Framework. Assessment of TEHS performance against the SDA will be additionally measured using progress reports on the implementation of strategies to improve performance.

The performance measures in the agreement may be varied from time to time in response to developments in standards and indicators. This will be managed by variation to the SDA through agreement between the parties.

Data provision and management

The provision of and access to quality data is integral to the efficient and effective operation of the Health Services and the Department. Data reporting requirements are set out in Schedule 8.



Research and training

The parties to this agreement will continue current arrangements for research and training. Researchers given approval by the Human Research Ethics Committee will be allowed access to available relevant data and to staff and patients as is practicable. The Department will also provide data and access to staff as possible within service constraints. Student and intern training arrangements involving hospitals within the Health Service will continue under current contracts between training institutions and the Department. Any (re)negotiation of related contracts occurring during the year will involve both parties. The Health Service will continue to provide adequate professional development opportunities for all staff in accordance with national standards.

Public health responsibilities

The Department will work collaboratively with TEHS to manage public health issues such as the detention of infected patients (not necessarily requiring health care) under the Notifiable Diseases Act, as well as preparation for and response to disasters and clinical and laboratory services. The public health responsibilities and accountabilities of the Department and TEHS will be reviewed as part of the transition of public health services to the Health Services in 2019.

Variation to this Agreement

Consistent with the Act, the SDA may be varied by written agreement between the Health Service and the Department. In reviewing any proposed variation, the parties will take into account the costs and benefits of the change on service users, providers and the general community as well as considering the key deliverables, budget, staffing and performances measures.

A proposed variation will be in written form. Agreed variations will also be formally documented and only take effect once signed by the Chief Executive Officer and the Chief Operating Officer.

Dispute resolution

In the event of a dispute arising under this agreement, the parties must make reasonable endeavours to attempt to resolve the dispute in good faith and in the public interest.

This begins with an informal process to be conducted at two levels: between the Chief Operating Officer (COO) and Department (or their delegates – officer to officer) and if the matter is not resolved within 30 days, between the Chief Operating Officer and the Chief Executive Officer.

If the parties are still unable to resolve the dispute within 14 days, the parties must refer the matter to alternative dispute resolution conducted by an external party identified by the Australasian College of Health Service Management.



Execution

In accordance with the Act, before 30 June in a year, a SDA between the Department and a Health Service will be signed for the following financial year unless the existing SDA is for a longer period (up to three years).

Northern Territory Department of Health

Signed by the Chief Executive Officer, Department of Health for and on behalf of the Department of Health

Professor Catherine Stoddart PSM

Chief Executive Officer

Signature: signed by Professor Catherine Stoddart PSM

Date: 12 August 2019

Top End Health Service

Signed by the Chief Operating Officer, for and on behalf of the Top End Health Service

Michelle McKay

Chief Operating Officer

Signature: signed by Michelle McKay

Date: 14 August 2019



Schedule 1: Interpretations and Abbreviations

1.1 Interpretations

Aboriginal, the term Aboriginal should be taken to include Torres Strait Islander people.

Chief Executive Officer, within the meaning of the Public Sector Employment and Management Act, of the Department.

COO, of a Service, means the Chief Operating Officer appointed for that Service under section 34 of the Health Services Act 2014.

Department means the Agency principally responsible for health policy in the Northern Territory.

Framework means the Northern Territory Service Delivery Agreement Performance Framework.

Health Service means an entity established under section 17(1) of the Health Services Act 2014

Health Service Directive means a written directive by the Department to a Service or the COO of a Service, directing the Service or COO to do, or not do, certain things or take certain actions.

Hospital services means services provided by or on behalf of a public hospital.

Performance, of a function, includes the purported performance of the function.

PSEMA means the Public Sector Employment and Management Act.

Public health service means a health service provided by:

(a) a Service; or

(b) the Department; or

(c) an affiliated health organisation.

Service Delivery Agreement, see section 45 of the Health Services Act 2014.

System Manager, see section 11(2) of the Health Services Act 2014.



1.2 Abbreviations

ABF Activity based funding

AHP Aboriginal Health Practitioner

AOD Alcohol and other drugs

ASH Alice Springs Hospital

ACAP Aged Care Assessment Program

ACAT Aged care assessment team

ASCC Alice Springs Correctional Centre

BCP Business continuity plans

CAHS Central Australia Health Service

CEO Chief Executive Officer

CHSP Community Home Support Program

COO Chief Operating Officer

COPE Commonwealth Own Purpose Expenditure

DCC Darwin Correctional Centre

D&FV Domestic and family violence

ED Emergency department

ENT Ear, nose and throat

FTE Full time equivalent

FMHS Forensic Mental Health Services

HSD Health Service Directive

HU5K-PF Healthy Under 5 Kids – Partnering with Families program

ICT Information and communications technology

KPI Key performance indicator

LGBTQI Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Intersex

NDIS National Disability Insurance Scheme

NGO Non-government organisation

NHA National Healthcare Agreement

NHRA National Health Reform Agreement

NTG Northern Territory Government

NTPHN Northern Territory Primary Health Network

OHS Oral Health Service

OOS Occasions of service

PHC Primary health care



PRH Palmerston Regional Hospital

RDH Royal Darwin Hospital

SAB Staphylococcus aureus bacteraemia

SDA Service Delivery Agreement

TCH Tennant Creek Hospital

TEHS Top End Health Service

TEMHS Top End Mental Health Services

WAU Weighted activity units

WHS Work Health and Safety



Schedule 2: Activity and funding

2.1 Activity and finance

Funding Type Unit Activity Purchased ($)

($5,134 / WAU)

Activity Funded Services

Admitted Acute WAU 68,575 352,064,050

Admitted Acute – Dialysis WAU 4,890 25,105,260

Admitted Sub Acute WAU 6,916 35,506,744

Admitted Mental Health WAU 3,635 18,662,090

Emergency Department /Emergency Services WAU 14,700 75,469,800

Non-admitted WAU 20,815 106,864,210

Activity Funded Services 119,531 613,672,154

Block Funded Services

Teaching, Training & Research 21,683,000

Non Admitted Home Ventilation 80,000

Aged Care Services OOS 14,140 5,854,980

Community & Residential Mental Health 17,683,000

Child & Adolescent Mental

Health 2,800,000

Primary Health Care Services 193,812,603

Alcohol & Other

Drugs 15,007,960

Breast Screening OOS 4,907

Oral Health OOS 36,990

Hearing Health OOS 6,992

Other Block Funded Services 130,475,303

Interim Budget support 35,000,000

Total Block Funded 422,396,846

Operating Expense Budget (excluding Depreciation, Amortisation and Lease Interest Expense) 1,036,069,000

Depreciation 46,460,000

Other Balance Sheet items 501,000

TOTAL BUDGET (including Depreciation, Amortisation and Lease Interest Expense) 1,083,030,000

WAU = Weighted Activity Unit (19)

OOS = Occasion of Service

Note: Block funded services - purchased values to be refined in 2019-20



2.2 Funding Sources

Funding Source Value ($)

Commonwealth NHFB Hospital Funding 173,544,000

Capital and other Balance Sheet items Budget 5,986,000

Commonwealth NHFB Hospital Block Funding 18,681,000

Commonwealth NHFB Public Health Funding 1,905,000

NT Hospital & Block Funding 698,406,000

Health Service Generated Revenue 58,969,000

Commonwealth and other Tied Funding 74,156,000

Block Funding Total 1,031,647,000

Pathology funding source

Capital and other Balance Sheet items Budget 94,000

NT Hospital & Block Funding 2,830,000

Health Service Generated Revenue 7,796,000

Commonwealth and other Tied Funding 119,000

Pathology Funding Total 10,839,000

Funding Grand Total 1,042,486,000

2.3 National Weighted Activity Unit

Funding Type Activity

Activity Funded Services

Admitted Acute 68,673

Admitted Mental Health 3,494

Sub-acute 6,271

Emergency Department 14,435

Non-admitted 19,381

Activity Funded Services 112,254

Activity and funding

The National Health Reform Agreement’s arrangements for the funding of public hospitals’ efficient growth were amended in 2017-18 to include an annual cap for funding growth of 6.5%. Management of the cap is the responsibility of National Health Funding Body on behalf of the Administrator, the National Health Funding Pool. Any activity above the funding cap may not be funded and is subject to the national reconciliation process. In recognition of historical funding structures, the Northern Territory also has access to up to $15 million per annum, if and when the national funding cap is exceeded. In addition to the National Health Reform Agreement arrangements the NT Performance Framework states that activity exceeding the purchased values may not receive NTG funding for the additional activity. The Department and Top End Health Service will work closely to monitor and manage activity volume. This will occur in monthly performance meetings.



2.4 Specific funded items

Specific funded item Description Value ($)

Alcohol and drug treatment services

To provide assessment, withdrawal and specialised alcohol treatment services to assist people with alcohol misuse and dependence, as part of the operation of the Banned Drinker Register.

$3,984,000

Road ambulance Emergency road ambulance and medical transportation services $2,044,000

Cardiff model To enable collection and analysis of data from Royal Darwin Hospital alcohol-related emergency department patients in a collaborative project with NT Police Fire and Emergency Services.

$150,000

Berrimah Sobering Up Shelter – clinical assessment position/s

To provide clinical assessment and interventions with clients to prevent unnecessary hospitalisations. Operational costs such as clinical consumables are excluded as these costs are to be paid for by (recovered from) Mission Australia.

Up to $250,000

Pathways to Community Control

To create a framework that supports Aboriginal community control in the planning, development and management of primary health care and community care services.

$278,000

Early Childhood Development Plan

Hearing Health Partnerships - Funding allocated to establish four Hearing Health Partnerships within new Families as First Teachers (FaFT) sites over four years (began in 2018-19). Funding for this program in 2019-20 is $360,000.

Healthy Under 5 Kids– Partnering with Families (HU5K-PF) - NT-wide roll out of the HU5K-PF program across the NT Health Primary Health Care centres in remote and urban locations over four years (began in 2018-19). Funding for this program in 2019-20 is $1,390,883.

$1,750,883



2.5 Tied funding

Agreement name Expiry Total 19-20 funding

Aged Care (TCP) - Flexible Care Subsidy for Transition Care* $ 1,791,000

Aged Care Assessment Program 30/06/2022 $ 1,168,000

Aged Care Short Term Restorative Care* 30/06/2022 $ 870,000

Diesel Fuel Rebate $ 549,000

Flinders University - NT Medical Program* 30/06/2020 $ 1,075,000

NT Pathology Network - Clinical Teaching Services Agreement (Flinders University)* 30/06/2019 $ 68,000

Gove Multi-purpose Service* 30/06/2019 $ 354,000

Community and Home Support 30/06/2022 $ 1,127,000

Encouraging More Clinical Trials in Australia 30/06/2021 $ 145,000

NTGPE - NT General Practice Education* 31/12/2019 $ 1,180,000

Highly Specialised Drugs $ 11,000,000

Indigenous Australians' Health Programme (IAHP) Multiple Schedule Funding - Schedule 2* 30/06/2020 $ 24,091,000

Indigenous Australians' Health Programme Primary Health Care (ANFPP) Schedule 4* 30/06/2022 $ 1,719,000

Indigenous Australians' Health Programme Primary Health Care (Connected Beginnings) Schedule 6*

30/06/2022 $ 250,000

Indigenous Cord Blood Program* 30/06/2019 $ 330,000

McGrath Foundation BreastScreen Nurses 30/06/2021 $ 256,000

National Critical Care and Trauma Response Centre 30/06/2021 $ 5,245,000

National Reform Programme - Organ and Tissue Donation 30/06/2022 $ 1,232,000

Oral, Hearing Health and Cancer Services 30/06/2022 $ 6,734,000

Oral Health - NT Remote Aboriginal Investment 30/06/2022 $ 1,860,000

Public Dental Services for Adults - National Partnership Agreement 30/06/2020 $ 744,000

Hearing Health - NT Remote Aboriginal Investment 30/06/2022 $ 2,759,000

Healthy Ears-Better Hearing, Better Listening – IAHP Multiple Schedule Funding 30/06/2020 $ 1,082,000

National Bowel Cancer Screening Programme – National Partnership Agreement 30/06/2021 $ 134,000

Expansion of the BreastScreen Australia Programme – National Partnership Agreement 30/06/2021 $ 155,000

Primary Health Network NT * 30/06/2019 $ 2,096,000

Primary Health Network NT – Schedule 21 Outreach Health Service Darwin Remote 30/06/2020 $ 411,000

Program of Experience in the Palliative Approach (PEPA) 30/06/2020 $ 214,000

Remote Aboriginal Investment - Schedule 1: Alcohol 30/06/2022 $ 1,010,000

Remote Aboriginal Investment - Schedule 1: Alcohol (Relates to budget transfer from CAHS to TEHS)*

30/06/2022 $ 2,338,000

Rural Health Outreach Fund 30/06/2020 $ 3,000,000

STP - Specialist Training Programs* 31/12/2020 $ 2,541,000

Integrated Rural Training Program $ 690,000

Rural Junior Doctors Training Innovation 30/04/2021 $ 337,000

Eye and Ear Surgical Support 30/06/2020 $ 340,000

Eye Health Coordination* 30/06/2022 $ 200,000

Visiting Optometrists Scheme 30/06/2020 $ 1,414,000

Darwin Private Hospital Medical Cover (Previously OSR) $ 500,000

TOTAL $ 74,275,000

*- In principle agreement, agreement yet to be signed



Schedule 3: Cultural security, safety, quality and risk

3.1 Cultural security

Cultural security is fundamental to enhancing service access, equity and effectiveness and leads to improved health outcomes for Aboriginal Territorians. The Northern Territory Health Aboriginal Cultural Security Policy, Aboriginal Cultural Security Framework 2016-2026 and supporting resources aim to support and increase NT Health’s capacity to provide culturally secure services. NT Health’s commitment to the development and provision of culturally secure and safe health services will focus on key priorities across six domains:

• Whole of organisation approach • Workforce • Communication • Consumer and community participation • Leadership • Quality improvement, planning and evaluation

TEHS commits to working collaboratively with the Department of Health to support cultural security across its services focusing on the following key domains. The Health Services will provide a report at mid-year and year end of activities undertaken to progress the priorities across the domains.

Whole of organisation approach

Governance and accountability

• Evidence of actions to prioritise cultural security in health service planning, delivery and evaluation. i.e. provide examples of strategies/programs/initiatives developed that relate to any of the six domains within the NT Aboriginal Cultural Security Framework

• Number of services that have commenced implementing cultural security within their services i.e. developed a work plan and incorporated cultural security within their operational/business plans � Number of staff who have undertaken a cultural security self-assessment � Number of service who have undertaken a cultural security organisation

assessment

Workforce

Training and professional development:

• Staff at all levels are supported to participate in training and development opportunities to enhance cultural knowledge

• Support staff at all levels to attend training to strengthen skills in working with language assistance services

• All new staff attend mandatory Aboriginal Cultural Awareness training with in three months of commencement

Aboriginal Workforce: Aboriginal workforce initiatives are actioned to:

• Increase the number of Aboriginal employees to a goal of 10% by 2020 including increased representation of Aboriginal staff at senior and executive levels

• Increase the number of Aboriginal nurses (including midwives); Aboriginal health practitioners; doctors; allied health professionals as a proportion of overall FTE; and;

• Implement the Special Measures initiative to all recruitment processes.



Communication Language Assistance Services (Aboriginal Interpreter Services)

• Undertake research to assess the language services need in Health Services with a particular focus on service areas of high demand

Consumer and community participation

• Consumers Engagement and Feedback: A patient experience survey that is culturally appropriate and suitable for the NT context will be implemented in 2019-20.

• Consumer Participation and Control: Ongoing commitment to the principles of Pathways to Community Control demonstrated through collaboratively with the Department of Health and the Aboriginal Community Controlled Health Sector in the transition of programs and or remote primary health care centres and projects to increase Aboriginal participation in NTG operated clinics.

3.2 Safety and Quality

3.2.1 Statutory oversight

TEHS is responsible for responding to recommendations and directions from statutory oversight bodies, including the Coroner, the Health and Community Services Complaints Commission, the Anti-Discrimination Commission and the Children’s Commission, or any other statutory authority.

TEHS is responsible for maintaining a register in conjunction with the Department (NT Health Clinical Governance Committee). The register is to monitor the status of recommendation and direction responses.

3.2.2 Consumer feedback

TEHS will ensure there are culturally appropriate mechanisms in place to capture, monitor and evaluate consumer and community feedback and ensure where there is any feedback of concern that may attract significant media attention or substantial liability it is escalated to the Chief Executive Officer.

TEHS will provide the Department with a report at mid-year and year-end review meetings that includes:

• A trend analysis outlining the overall number of complaints and compliments (formal and point of service) received for the six month period by severity rating

• An overview of key themes identified from complaints reporting and what actions the Health Service is taking to address these themes.

• Developing and promoting opportunities for the voices and experiences of consumers including consumers of diverse cultures, abilities, ages, sexual orientation and genders to be reflected in quality and safety improvements within health care environments.

3.3 Risk management and audit

The Strategic Internal Audit Plan is oversighted by the agency Risk and Audit Committee on behalf of the Chief Executive Officer, supported by Risk and Audit Services.

3.3.1 Audit

The Health Service is responsible for implementation of external and internal audit recommendations in the Health Service and may make recommendations to the system level Risk and Audit Committee regarding priorities for strategic internal audits and scope of audits. Health Service staff with appropriate and relevant knowledge will be included in meetings with auditors relating to audits and in response to draft audit findings.



3.3.2 Risk

The Health Service is responsible for identifying, managing and mitigating risk; maintaining a risk register; and adhering to the Department’s Risk Management Framework and Policy. Risk and Audit Services will provide strategic advice to the Health Service in risk management.

In line with the ad hoc reporting requirements of the Risk Management Framework, the Health Service will notify the Chief Executive Officer, immediately or as soon as practicable, of any new extreme emerging risks.

The Health Service is responsible for developing, maintaining and testing business continuity plans for essential services, and will provide the Department with a mid-year and year-end report detailing the plan coverage and the progress of annual testing of business continuity plans.



Schedule 4: Key performance indicators

Key performance indicator Target

Strategic Priorities

• Number and proportion of Aboriginal clients with type II diabetes and whose HbA1c measurements are within certain levels

41.5%

• Percentage of measured Aboriginal children less than 5 years of age who are anaemic

10%

Tier 1

Safety and Quality

• Potentially preventable hospitalisations (excluding dialysis) 11%

• Mental health 28-day readmissions 10%

• Hospital acquired complications (count) Decrease prior year by HAC

• Aboriginal inpatients who discharged from a hospital or left against medical advice

7%

Access and effectiveness

• Elective surgery long waits (category 1) • Elective surgery long waits (category 2) • Elective surgery long waits (category 3)

0%

2.4%

2.4%

• Emergency department presentations departing within four hours 78%

Finance and efficiency

• Full year budgeted operating position Deficit of $40,544,000

• Weighted activity units 119,531

Tier 2

Safety and Quality

• Staphylococcus Aureus Bacteraemia infections (per 10,000 occupied bed days)

≤ 0.5

• Hand hygiene compliance 85%

• Mental health community follow up within seven days of inpatient discharge

80%



Key performance indicator Target

• Mental health rate of acute seclusion (per 1,000 bed days) 10

• Sentinel events (IHPA definition) 0


• Adult health checks – proportion of resident remote Aboriginal population

70%

• ACAP clients receiving timely intervention 95%

• Timing of first antenatal visit within three months for resident Aboriginal clients

75%

• Proportion of resident clients aged 15 years and over with type II diabetes who have had an HbA1c test in the last six months

80%

• Telehealth occasions of service 5500

Workforce

• Paid full time equivalent, FTE-equivalent agency staff and FTE-equivalent overtime

N/A

• Aboriginal health workforce as a proportion of overall FTE 10%

Tier 3


• Proportion of clients aged 15 years and over with type II diabetes and/or coronary heart disease and with a chronic disease management plan

90%

• Children between 6 months and 5 years of age who have been tested for anaemia

85%

• Early intervention for conductive hearing loss in remote Aboriginal children

42%

Workforce

• Expired visa or not recorded visa expiry date 0%



Schedule 5: Northern Territory and Department strategic directions

5.1 Strategic directions within which services are to be delivered

The following strategies, policies and frameworks inform the development of actions, initiatives and work programs to underpin the achievement of the six strategic directions of the Northern Territory Strategic Plan 2018-2022.

• Addressing Fetal Alcohol Spectrum Disorder (FASD) in the Northern Territory 2018-2024 • Appropriate Workplace Behaviour Strategy • Best Opportunities in Life - Northern Territory Child and Adolescent Health and Wellbeing Strategic

Plan 2018-2028 • Clinical Safety and Quality Governance NT Health Framework • Conflict of Interest NT Health Policy • Data Governance NT Health Framework • Domestic and Family Violence Policy NT Health Policy • Fifth National Mental Health and Suicide Prevention Plan • Fraud and Corruption Control Policy and Plan • Gifts and Benefits Framework - NT Ombudsman • Indigenous Employment and Career Development Strategy 2015-2020 • Internal Audit Policy • Intersex, Differences of Sex Development and Transgender NT Health Policy • Mandatory Reporting: Reporting Child Abuse and Neglect and Domestic and Family Violence NT

Health Policy • Musculoskeletal Injury Reduction Work Health and Safety Strategy • National Disability Insurance Scheme Quality and Safeguarding Framework • National Disability Strategy • National Oral Health Plan 2015-2024 • Northern Territory Aboriginal Health Forum - Pathways to Community Control • Northern Territory Cancer Care Strategy 2018-2022 • Northern Territory Cardiac Services Framework • Northern Territory Chronic Conditions Prevention and Management Strategy 2010-2020 • Northern Territory Health Aboriginal Cultural Security Policy • Northern Territory Health Governance and Accountability Framework • Northern Territory Health Hospital Services Capability Framework • Northern Territory Health Promotion Framework • Northern Territory Medicines Management Framework • Northern Territory Mental Health Services Strategic Plan 2015-2021 • Northern Territory Public Sector Capability and Leadership Framework • Northern Territory Public Sector Employability Strategy • Northern Territory Rehabilitation Strategy 2017-2021 • Northern Territory Renal Services Strategy 2017-2022 • Northern Territory Sexually Transmissible Infections and Blood Borne Viruses Strategic and

Operational Plan 2019 - 2023 • Northern Territory Suicide Prevention Strategic Framework 2018-2023 • Northern Territory Tobacco Action Plan 2019-2023 • NT Health Healthy Food and Drink Options for Staff, Volunteers and Visitors in NT Health Facilities

Policy • NT Health Infrastructure Governance Framework and Model • NT Health Nutrition and Physical Activity Strategy 2015-2020 • NT Health Work Health and Safety Strategy 2019-2022



• Professional Practice Supervision Framework • Project Management CSB Framework • Risk Management Policy and Framework • Stakeholder Engagement Framework • Starting Early for a Better Future – Early Childhood Development in the Northern Territory 2018-

2028 • Strategic Infrastructure Plan • Strategic Plan for Nursing and Midwifery in the Northern Territory 2019-2022 • Tackling Ice in the Northern Territory • The Northern Territory Chronic Conditions Self-Management Framework 2012-2020 • WHS Consultation and Communication Strategy • Workplace Health and Safety Management System

5.2 Corporate policies and standards

All Northern Territory Government and Department corporate policies and standards in relation to finance, human resource management, procurement and contract management, grant management, digital technology and related matters are to be adopted and implemented by TEHS, as required under the Act.



Schedule 6: Support to Health Services

Note: The support services provided to Health Services are subject to machinery of government changes arising from A Plan for Budget Repair

The Chief Executive Officer of the Department will be responsible for providing specific areas of support to the Health Services. This will principally be through the following divisions: Governance and Business Services, Health Policy and Strategy, Finance, People and Organisational Capability, Public Health and the Office of the Chief Executive Officer.

Services to be provided by the Governance and Business Services will include:

• Infrastructure Services, providing strategic advice and program oversight of the capital works program, infrastructure investment, capital equipment program, strategic asset management, and lease management

• Corporate Services providing travel, transport and general services to staff • Digital health, developing policy, strategies, services and standards for the use of digital

information and communications technology (ICT) through: o Acute Care Information Services o Community Care Information Services o Health Interoperability Services o Health Services Information Systems o ICT Infrastructure o Strategic eHealth Services

• Enterprise Portfolio Management Office supports NT Health in the management of its portfolio of projects, through provision of project and change management support and the effective delivery of projects, programs and the ICT portfolio

• Data Management and System Reporting providing corporate information services (including records management), health information to support evidence-based decision making, performance monitoring, service planning and policy development, including the provision of validation reports to enable the Health Service to confirm the data is in accordance with national standards on a monthly basis.

• Strategic Procurement and Contracting Services, providing the development, management and governance of NT Health’s procurement policies and procedures, and a range of procurement and contract management services.

• Strategic media and corporate communication • Legal services • Freedom of information and information privacy services • Grants administration services through:

o Management of databases and systems that administer grants and funding arrangements o Processing grant payments, system administration and reporting o Business improvement and quality control to ensure compliance with NT Government

policies relating to grants

Services to be provided by Finance will include:

• Financial Services, providing financial information and forecasts, accounting, revenue, budget and financial policy development on behalf of NT Health.



Services to be provided by People and Organisational Capability will include:

• Human resource management and industrial relations, including policy and system framework advice and quality assurance, strategic work health and safety, and specialised career development

• Learning and development, through traditional and eLearning mechanisms to grow and build corporate capability and skills of employees

• Work health and safety • Library services

Services to be provided by Health Policy and Strategy will include:

• Developing policy, strategies and leadership in: o Activity based funding o Mental health, alcohol and other drugs o Disability o Innovation and research o Intergovernmental relations and aged care o System performance

Services to be provided by Public Health will include:

• Developing policy, strategies and leadership in: o Patient safety and clinical quality o Medicines management o Disease control o Environmental health o Pathology

Services to be provided by the Office of the Chief Executive Officer will include:

• Disaster coordination • Ministerial liaison services • Risk and assurance services

Service Standards between branches of the Department and the Health Services have been put in place to clearly establish the scope and quality of services to be provided. Refinements to the provision of corporate support services may occur as recommendations from the Corporate Services Review are implemented.



Schedule 7: Data reporting requirements

7.1 Purpose

The Health Services Act provides for the Service Delivery Agreement to set out the performance data and matters to be reported to the Department by a Health Service and the frequency of that reporting.

This Schedule specifies the data the Health Service will provide to the Department and the requirements for the provision of the data.

7.2 Principles

The following principles guide the collection, storage, transfer and disposal of data:

(a) Trustworthy: data is accurate, relevant, timely, available and secure;

(b) Private: personal information is protected in accordance with the law;

(c) Valued: data is a core strategic asset;

(d) Managed: collection of data is actively planned, managed and compliant; and

(e) Quality: data provided is complete, consistent, undergoes regular validation and is of sufficient quality to enable the purposes outlined in this schedule.

The parties agree to constructively review the data reporting requirements as set out in this schedule on an ongoing basis to ensure data reporting requirements are able to be fulfilled; and minimise regulatory burden.

7.3 Roles and responsibilities

The Health Service will provide the following data, in accordance with this schedule:

i. Data required to delivery and manage clinical care and services;

ii. Data required to report to national bodies, including but not limited to National Minimum Data Sets, National Best Endeavour Data Sets; and other collections (such as the National Hospital Cost Data Collection)

iii. Data required under relevant legislation, including but not limited to the Freedom of Information Act and the Public Sector Employment and Management Act;

iv. Data required to facilitate reporting against the key performance indicators set out in this Service Delivery Agreement;

v. Data required to determine activity based funding and block funding amounts;

vi. Data required to monitor implementation of NT Health policies and whole of Government plans; and

vii. Data requested in writing by the Chief Executive Officer of the Department, or delegate, from time to time, whether or not specified in this schedule or the Service Delivery Agreement, where the request specifies the form and manner of the data and at the timeframes for provision.

The Health Service will provide data in the form and manner as established in front-line clinical settings and in agreements.



The Health Service will provide data of suitable quality and completeness in accordance with the principles in this schedule and will address, in a timely manner, any issues related to the quality and completeness of data provided.

The Health Service will provide data in accordance with the following timeframes, unless otherwise agreed between parties:

viii. Data required for reporting to national bodies (such as the Independent Hospital Pricing Authority) must be provided in accordance with the national data provision timeframes;

ix. All other data required, including data to facilitate reporting against the key performance indicators set out in this Service Delivery Agreement, must be provided monthly or quarterly, where agreed.

The Department will provide the Health Service with routine access to data for the purposes of benchmarking and performance improvement.

The Department will provide a monthly performance report by the ninth working day of each month. The report will include:

i. actual activity compared with purchased activity levels

ii. performance information to demonstrate the Health Service’s performance against the performance indicator targets specified in this Service Delivery Agreement

The Department will utilise the data sets provided for a range of purposes including:

i. to fulfil legislative requirements (e.g. quarterly report to the Minister)

ii. to deliver accountabilities to state and Commonwealth governments

iii. to monitor and promote improvements in the safety and quality of health services

iv. to support clinical innovation

The Department will advise the Health Service of any updates to data provision requirements as they occur.



Schedule 8: TEHS service descriptions

TEHS provides a range of services, as stated in the TEHS Clinical Services Plan 2018-2036.

Further details of these services are listed below and in schedule 9.

Where a party seeks to alter the scope or nature of any of these services, this information is to be provided to the Department three months prior to the proposed date of the change and requires the CEO’s agreement as the accountable officer under the Act. It may require formal variation consistent with the process set out in this SDA.

TEHS will, as far as possible, ensure that:

• Aboriginal Health Practitioners, Aboriginal Liaison Officers and Aboriginal Community Workers contribute to assessments to determine a suitable service and culturally appropriate response

• Staff ensure the involvement of appropriate cultural brokers to enhance assessment • Accredited interpreters are used where language issues may influence interactions or

assessments.

8.1 Hospital and non-hospital services

TEHS will provide services as articulated in the TEHS Clinical Services Plan 2018-2036, including:

• Royal Darwin Hospital providing Level 5/6 services for a range of secondary and tertiary inpatient and outpatient services for the local Darwin population, and to greater NT, WA and South East Asia.

• Palmerston Regional Hospital providing Level 3 services to the greater Darwin and NT population.

• Katherine Hospital providing Level 2/3 services. • Gove District Hospital providing Level 2/3 services. • Primary Health Care from 24 primary health care centres.

8.1.1 Sexual Assault Referral Centre

The Sexual Assault Referral Centre provides medical access for men, women and children victims of acute, recent and historical sexual assault.

8.2 Hosted services

8.2.1 Mental Health

TEHS mental health services will provide mental health services to the catchment population within

TEHS and deliver some agreed services to CAHS.

• TEHS provides a single point of access mental health service responsive to individual requirements to Top End and Central Australia after-hours.



Forensic Mental Health Services

FMHS is a Territory-wide specialist, tertiary level service within TEHS and CAHS mental health services. Prison Forensic Mental Health Services will be provided by TEHS and will cover TEHS and CAHS. The CAHS Forensic Team (comprising two forensic nurses and an Aboriginal health practitioner) will be professionally supported by the Prison Forensic Mental Health Service.

Assessment and treatment of individuals experiencing moderate to serious mental illness in the Darwin Correctional Centre and Alice Springs Correctional Centre. FMHS also carries out ‘at-risk’ assessments for individuals in custodial settings.

FMHS considers requests from other secondary level services within TEHS and CAHS for specialist opinion or for co-case management of high-risk complex individuals with enduring major mental illness. Consideration is given to individuals who are subject to ongoing criminal justice orders.

8.2.2 Aged Care

Transition Care Program

The Northern Territory Transition Care Program is a TEHS work unit funded by Medicare revenue which delivers 29 transition care packages across the whole of the Northern Territory. The Darwin based work unit consists of a team leader (case coordinators), therapy assistants, patient care assistants and administration support. The unit manages clients in Darwin and case manages packages across other regions in the Northern Territory.

Short Term Restorative Care Program

This is a new Commonwealth aged care program that aims to reverse or slow functional decline in aged persons through time limited, goal oriented, multidisciplinary and coordinated range of services. These services are delivered in the person’s home or a residential care setting if available. The program has five packages coordinated by the Transition Care Unit in Darwin and can be delivered across the NT.

8.2.3 Specialist Outreach Northern Territory (Subject to A Plan for Budget Repair)

SONT coordinates air charter, travel and logistics Northern Territory-wide for specialist teams in Australian Government funded priority areas, including:

• Maternal and child health – including obstetrics and gynaecology, paediatrics, paediatric cardiology and midwifery

• Eye health – ophthalmology • Mental health

TEHS also provides visiting sonography outreach services.

8.2.4 Hearing health services

TEHS provides Northern Territory-wide program direction, quality and professional support for Commonwealth-funded outreach services and coordinates the newborn hearing screening services.

8.2.5 Cancer screening services

The Northern Territory Cancer Screening Service is a TEHS based work unit that delivers BreastScreenNT, CervicalScreenNT and BowelScreenNT services across the whole of the Northern Territory.



8.3 Co-located services

8.3.1 Pathology

Territory Pathology is a network of six public hospital laboratories located at Royal Darwin Hospital, Alice Springs Hospital, Palmerston Regional Hospital, Katherine Hospital, Gove District Hospital and Tennant Creek Hospital. Territory Pathology functionally reports to the Chief Health Officer (CHO) and the CHO is accountable for its budget; TEHS holds a budget for pathology services.

8.3.2 National Critical Care and Trauma Response Centre (NCCTRC)

In collaboration with the Australian Government, the NCCTRC works to enable the reception and management of local, national and international victims of disaster.

The NCCTRC program ensures an enhanced clinical trauma surge capacity for RDH to provide a rapid response in the event of a mass casualty in the region. It prioritises disaster preparedness though training and education including:

• Major incident medical management support • Hospital major incident medical management support • Trauma-related courses for NT health personnel



Schedule 9: Remote and Community Services

9.1 TEHS remote primary healthcare service

Remote Health Centre Location

Number in catchment

Public health nutrition services

A&E response/medevac 24/7

Primary health care

Antenatal care

Healthy School aged kids program

Healthy Under 5 Kids –Partnering with Families program

Childhood & adult Immunisation

Well Women’s & Men’s health screens

Preventable chronic conditions program

Infectious disease prevention and control

Batchelor 536

Adelaide River

223

Pine Creek 473

Wadeye 2800

Daly River 400

Palumpa 340

Pirlamgimpi 370

Milikapiti 900

Julanimawu 1600

Ramingining 1 1175

Gapuwiyak 2 1150

Maningrida 3000



Schedule 9: Remote and Community Services

9.1 TEHS remote primary healthcare service

Remote Health Centre Location

Number in catchment

Public health nutrition services

A&E response/medevac 24/7

Primary health care

Antenatal care

Healthy School aged kids program

Healthy Under 5 Kids –Partnering with Families program

Childhood & adult Immunisation

Well Women’s & Men’s health screens

Preventable chronic conditions program

Infectious disease prevention and control

Alyangula 1100

Angurugu 900

Numbulwar 800

Umbakumba 450

Milyakburra 120

Milingimbi 1350

Borroloola 925

Robinson River

270

Wurruwi 340

Gunbalanya 1300

Jabiru 1135

Minjilang 270

Belyuen 250

Wagait Beach 450

1 & 2 Pending gazetted transfer to Miwatj Health



9.2 Community Health Services Provided in Urban and Regional Centres

Community Care Centre / Service location / coverage

Primary Health Care

PHC Outreach to Darwin region

Healthy Under 5 Kids Partnering -Families Program

Childhood & Adult

Immunisation

Well Women’s & Men’s Health

Screens

Specialist Nursing Service

Casuarina

Stuart Park Infant Health

Karama Infant Health

Palmerston & Rural

Katherine

Nhulunbuy

Service coverage Outreach Child, Youth and Family Services / School based services

Healthy Under 5 Kids – Partnering Families

Program

Home Birth Service School Health Service School Immunisation Program

Darwin City & Suburbs

Palmerston

Rural Area

Katherine

Nhulunbuy



9.3 Prison Primary Health Care Services

Services and Delivery Location Darwin Correctional

Centre Health Centre

Living Skills Unit J Block (Women) Don Dale Juvenile Detention Centre Berrimah

Approximate split of Full Time services (%)

Early Intervention and Reception 8

Treatment and Emergency Care 38

Health Promotion and Health Protection

9

Rehabilitation / Chronic Disease Prevention

14

Specialist Referral 5

Staff Education 5

Prison Health Administration 3

After Hours on-call and Emergency 1

Visiting Services Frequency

Physiotherapy 4hrs/ month

Podiatry 6hrs/ month

Optometry 6hrs/ month

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