National Service Planners Forum:

Toward sustainable system wide service planning

Sue Brennan

Manager, Strategic Planning & Asset Management

7 April 2011

Context, challenges and initiatives

Context

A lot has happened in Victoria – and elsewhere – since we last met

• Departmental restructure – Health Department• National Health Reform – marks 1 and 2• Federal Election• State Election (Victoria and others)• New Government

Concurrently, our endeavours to plan well have continued

The growth keeps on coming

Victoria’s population projected to 2030

Service Planning is dynamic and multi faceted – a basic representation of Victoria’s approach

DH Policy and Strategy

WOG Planning

Program Planning

Health Service Planning

Service System Planning

Regions

Community

Stakeholders

Inputs

Health service planning is part of whole of government planning

Department of Health engages with state’s population, land use, urban and transport planners and other groups, to inform where services and assets will be required

• challenges include early land purchase/allocation, how to plan for a mixed health model; can integrated infrastructure create value

The Victorian government has committed to a new plan for Metropolitan Melbourne (~ 2 years to prepare) –

• impact of location, nature and balance between in fill and expanded boundaries, on health planning

Victorian health specific initiative – development of transport distribution model

• This uses transport system modelling techniques to distribute health activity across hospitals according to travel time. Can model different hospital size, location and service mix to inform where the services/capacity, should go

Plans and commitments for health

State government commitment to Health Services Plan 2022

• Metropolitan health plan

• Rural and Regional health plan

• Capital works plan

State government commitment to 800 additional beds in first term and further 800 in second term; election commitments; upcoming budget

National health reform

• Many issues still being worked through including performance requirements

• Strong focus on enhanced sub acute and elective and emergency services with related asset development (336 beds)

• System wide approach including redesign projects to improve performance

Commonwealth Health and Hospitals Fund

Forecasts and trends inform service planning – what services are needed into the future?

2011 Inpatient Forecast Model close to finalisation

Continued decline in LOS –

• All (multiday and same day) - 3.19 days (from 3.23)

• Multiday – 6.10 (from 6.23)

Increase in projected beddays (3% per annum to 2009-10 - 2021-22)

Highest areas of forecast % increase in separations:

• Acute multiday: emergency medical and endoscopy

• Acute sameday: renal dialysis, chemotherapy and endoscopy

• Sub acute

In growth areas of Melbourne (north, west and south-east) and major regional centres

Length of stay by age, based on 2010 forecast(08-09 data)

0.001.002.003.004.005.006.007.008.009.00

10.00

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Aver

age

leng

th o

f sta

y

0-14

15-44

45-69

70-84

85+

Capacity planning – what assets are needed to deliver services?

Gap in skills and information base –

• Can forecast and analyse service need, articulate changing models of care and plan for mitigation and management of demand (with limits in terms of quantifying impact)

• Service planning needs to be combined with an understanding of existing assets, their utilisation/occupancy, length of remaining functional life etc, to be effective

Victorian initiatives - examples

Recent bed census of physical capacity

• Will round out information base

Review of service benchmarks related to functional spaces

• No longer aligned with practice (in at least some cases). Project under definition

Service and capacity planning – renal dialysis

How to manage high growth forecast

Models of care (eg)

• increase home based treatment & peritoneal dialysis

• End of life care (conservative pathways)

Capacity planning

• Analyse occupancy/utilisation of existing chairs – variable; not fully occupied

• Calculate throughput according to different shift models eg 2/3 per day

• Able to accommodate significant projected growth through better use of existing capacity; saves capital not recurrent

• Policy issues – eg rural access

Governance & funding models

Mitigating and managing demand – prevention, diversion/substitution, efficiency

Medical patients

• Promotion & prevention of chronic disease – long term impact (note recent suggested obesity decline in young children)

• Better management of chronic disease in the community – unrealised potential (eg re-presentations to emergency departments and readmission to hospital) – timely access to care and advice within integrated system

• Efficient use of hospital care – focus on short stay models, eg up to 72 hours. Gains in reducing length of stay. No system wide picture yet

• Maximising use of our resources - scope for better understanding of interaction between acute and sub acute services (important for jurisdictions growing their sub acute to consider)

• Better measurement and benchmarking of performance and the impact of models of care and new initiatives

Area based planning - Modelled Bed Growth By Planning Area and Hospital Supply/Resident Demand from 2008/09 to 2021/22 (Base Case – No Policy Change)

0

100

200

300

400

500

600

700

Dand

enon

gRa

nges

Inne

r Eas

t

Yarr

a Va

lley

Diam

ond

Valle

y

Inne

r Nor

th

Nor

ther

nG

row

th A

rea

Peni

nsul

a

Inne

r Sou

th

Mid

dle

Sout

h Ea

st

Sout

h Ea

stG

row

th A

rea

Inne

r Wes

t

Wes

tern

Gro

wth

Are

a

Wyn

dham

Eas tern Northern Peninsula Southern Western

Beds

Growth for Hospita l Supply Growth For Res ident Demand

Area and Health Service (entity, campus, clinical stream) planning

All data analysed on area basis, eg flows; projected growth

Need to move increased capacity closer to home

Increased focus on plans for areas/corridors/sub regions and entity wide plans for health services with a large geographic base

Gives the umbrella view into the future which then drops down service planning by campus and service level according to priorities (driven by settlement patterns, service growth, fabric, sequencing), and capital planning

Significant work underway across all major health services, by geographic service and capital planning and capital development teams within DH

Linking service planning to asset and site planning for a system wide plan

Site planning

• analysis of sites to ensure major sites can accommodate projected medium term service growth; longer term – what land/sites do we need?

Scale of asset base

• drivers of replacement/expansion cost are square metreage (itself driven by increasing standards) and escalating construction costs. Are we managing those best for the future?

Improving asset information management to support decision making

• Integrating data about asset condition, obsolescence and remaining functional life to help prioritise and sequence asset replacement

Planning sustainable service growth aligning capital and recurrent funding scenarios

Future opportunities and risks

Key opportunity

• Improve our long term planning, evidence base and scenario development across domains – eg service, asset, capital and recurrent funding projections – to underpin service development and asset investment decisions and maximise their effectiveness

Key risk

• Investment combined with model of care and efficiency innovations will be insufficient to maintain a high performing health system which provides high quality contemporary health care