WA Country Health Service 2009 –10 · Intent 2010–2015, the WA Country Health Service has...

WA Country Health Service

2009 –10Annual Report


Annual Report 2009-10

WA Country Health Service 189 Wellington Street, East Perth

Western Australia 6004 Telephone: (08) 9223 8500

Fax: (08) 9223 8599

Website: www.wacountry.health.wa.gov.au

http://www.wacountry.health.wa.gov.au/�

WA Country Health Service Annual Report 2009-10 Page 3

Statement of Compliance HON DR KIM HAMES MLA MINISTER FOR HEALTH In accordance with Section 61 of the Financial Management Act 2006, I hereby submit for your information and presentation to Parliament, the Report of the WA Country Health Service for the year ended 30 June 2010. This report has been prepared in accordance with the provisions of the Financial Management Act 2006.

Kim Snowball DIRECTOR GENERAL OF HEALTH Accountable Authority 15 September 2010

WA Country Health Service Annual Report 2009-10

Contents Overview of Agency ..................................................................................... 7 Executive Summary.......................................................................................................................................9 Address and Location..................................................................................................................................12 Service Framework......................................................................................................................................13 Service Framework......................................................................................................................................14 Revitalising WA Country Health Services....................................................................................................15 Our Purpose ...........................................................................................................................................15 What we stand for:.......................................................................................................................................15 Our Values ...........................................................................................................................................15 Services Provided........................................................................................................................................16 Enabling Legislation.....................................................................................................................................17 Statement of Compliance with Public Sector Standards .............................................................................18 Pecuniary Interests ......................................................................................................................................19 Accountable Authority..................................................................................................................................19 Senior Officers ...........................................................................................................................................19 Management Structure ................................................................................................................................20 Key Performance Indicators....................................................................... 21 Certification Statement ................................................................................................................................22 Audit Opinion ...........................................................................................................................................23 Introduction ...........................................................................................................................................25 Comparative Results ...................................................................................................................................26 Performance Targets ...................................................................................................................................26 Consumer Price Index Deflator Series ........................................................................................................26 Efficiency Indicators.....................................................................................................................................26 Mental Health ...........................................................................................................................................26 Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients

and families during terminal illness ...................................................................................27 1-00: Proportion of patients discharged to home after admitted hospital treatment...................28 1-01: Elective surgery waiting times ...........................................................................................29 1-02: Rate of unplanned hospital readmissions within 28 days to the same hospital for a

related condition ................................................................................................................30 MHC07: Rate of unplanned hospital readmissions within 28 days to the same hospital for a

mental health condition......................................................................................................31 1-05: Survival rates for sentinel conditions.................................................................................32 1-06: Percentage of live births with an APGAR score of three or less five minutes post

delivery ..............................................................................................................................36 1-07: Proportion of emergency service patients seen within recommended times (major

rural hospitals) ...................................................................................................................37 1-20: Rate of emergency presentations with a triage score of four and five not admitted .........38 S1-01: Average cost per casemix adjusted separation for non-teaching hospitals ......................39 S1-20: Average cost per bed-day for admitted patients (selected small rural hospitals)..............40 MHC08: Average cost per bed-day in specialised mental health units ...........................................41 S5-20: Average cost per non-admitted hospital based occasion of service for rural hospitals ....42 S5-21: Average cost per non-admitted occasion of service in a nursing post ..............................43 S6-20: Average cost per trip of Patient Assisted Travel Scheme .................................................44

Outcome 2: Improved health of the people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death..............................45

2-01: Rate of hospitalisation for gastroenteritis in children.........................................................46 2-02: Rate of hospitalisation for respiratory conditions...............................................................47 2-10: Rate of hospitalisation for falls in older persons................................................................49 R2-51: Percentage of fully immunised children.............................................................................50 R2-52: Rate of hospitalisations for selected potentially preventable diseases .............................51 S7-00: Cost per capita of Population Health units ........................................................................52

Outcome 3: Enhanced wellbeing and environment of those with chronic illness or disability ..............53 MHC09: Percent of contacts with community-based public mental health non-admitted

services within seven days post discharge from public mental health inpatient units.......54 MHC10: Percent of contacts with community-based public mental health non-admitted

services within seven days prior to admission to a public mental health inpatient unit.....55 MHC11: Average cost per three month period of community care provided by public

community mental health services ....................................................................................56


S9-20: Average cost per bed-day for specified residential care facilities, flexible care (hostels) and nursing home type residents .......................................................................57

Significant Issues impacting the WA Country Health Service .................... 59 Significant Issues and Achievements 2009-10............................................................................................60 Overview ...........................................................................................................................................68 Priorities for 2010-11 ...................................................................................................................................69 Operations .................................................................................................73 Advertising ...........................................................................................................................................74 Disability Access and Inclusion Plan ...........................................................................................................77 Employee Profile..........................................................................................................................................79 Freedom of Information ...............................................................................................................................80 Industrial Relations ......................................................................................................................................80 Internal Audit Controls .................................................................................................................................81 Major Capital Works ....................................................................................................................................83 Pricing Policy ...........................................................................................................................................84 Recordkeeping ...........................................................................................................................................85 Substantive Equality ....................................................................................................................................87 Staff Development .......................................................................................................................................88 Workers’ Compensation and Rehabilitation ................................................................................................89 Occupational Safety & Health and Injury Management Performance.........................................................91 Financial Statements ................................................................................. 93 Certification Statement ................................................................................................................................94 Audit Opinion ...........................................................................................................................................95 Financial Statements ...................................................................................................................................97 Appendices .............................................................................................. 133 Appendix 1: Abbreviations........................................................................................................................ 134

Illustrations Table 1: Number of complaints alleging non-compliance with Codes.......................................................18 Table 2: WACHS Senior Officers as at 30 June 2010 ...............................................................................19 Table 3: Service activities in relation to the health outcomes ....................................................................25 Table 4: Percentage of live births with an APGAR score of 3 or less five minutes post delivery ..............36 Table 5: Proportion of emergency department attendances seen within recommended times.................37 Table 6: Rate of emergency presentation with a triage score of 4 and 5 not admitted..............................38 Table 7: Average cost per casemix adjusted separation for non-teaching hospitals.................................39 Table 8: Average cost per bed day for admitted patients (selected small rural hospitals) ........................40 Table 9: Average cost per bed day in a specialised mental health units ...................................................41 Table 10: Average cost per non-admitted hospital based occasion of service for rural hospitals ...............42 Table 11: Average cost per non-admitted occasion of service in a nursing post.........................................43 Table 12: Average cost per trip of Patient Assisted Travel ..........................................................................44 Table 13: Rate of hospitalisation for gastroenteritis in children (0-4 years).................................................46 Table 14: Rate of hospitalisation per 1,000 for falls in older persons for 2009............................................49 Table 15: Rate of hospitalisation for preventable diseases per 100,000 .....................................................51 Table 16: Cost per capita of population health units ....................................................................................52 Table 17: Percent of contacts with community based public mental health non-admitted services

within seven days post discharge from public mental health inpatient units................................54 Table 18: Percent of contacts with community-based public mental health non-admitted services

within seven days prior to admission to a metropolitan public mental health inpatient unit.........55 Table 19: Average cost per three month period of community mental health care .....................................56 Table 20: Average cost per bed day for specified residential care facilities, flexible care (hostels) and

nursing home type residents ........................................................................................................57 Table 21: 2009-10 WACHS Advertising expenditure...................................................................................74 Table 22: WACHS Total FTE by Category...................................................................................................79 Table 23: Freedom of information applications 2009-10..............................................................................80 Table 24: Completed Audits .........................................................................................................................81 Table 25: Major Capital Works in WACHS...................................................................................................83 Table 26: Workers’ compensation claims ....................................................................................................90


Table 27: Use and Assessment of Worksafe plan .......................................................................................92 Table 28: Occupational safety and health and injury management performance........................................92 Figure 1: Department of Health outcome structure ...................................................................................14 Figure 2: Proportion of patients discharged to home after admitted hospital treatment ...........................28 Figure 3: Survival rate for stroke ...............................................................................................................34 Figure 4: Survival rate for fractured neck of femur (FNOF).......................................................................35 Figure 5: Rate of hospitalisation per 1,000 persons for acute asthma (all ages)......................................47 Figure 6: Rate of hospitalisation per 1,000 children (0-4 years) for acute bronchitis................................48 Figure 7: Rate of hospitalisation per 1,000 children (0-4 years) for bronchiolitis ......................................48 Figure 8: Rate of hospitalisation per 1,000 children (0-4 years) for croup ................................................48 Figure 9: Percentage of fully immunised children at 12 months, 2 years and 5 years..............................50 Figure 10: Residential and Acute Care bed-days........................................................................................68 Figure 11: Non-admitted occasions (hospital and nursing post) .................................................................68 Figure 12: Total trips for the WACHS Patient Assisted Transport Scheme ................................................68 Figure 13: Elective Surgery Cases ..............................................................................................................68 Figure 14: Emergency service attendances ................................................................................................68

This Report is available in alternative formats upon request from a person with a disability.


Overview of Agency Error! No table of contents entries found.


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Our Vision Healthier, longer and better quality lives for all Western Australians

Our Mission

To improve, promote and protect the health of Western Australians by:

Caring for individuals and the community Caring for those who need it most Making best use of funds and resources Supporting our team

Our Values

Care - Respect - Excellence - Integrity - Teamwork - Leadership WA Health’s Code of Conduct identifies the values that we hold as fundamental in our work and describes how these values translate into action. Our clients, their families, carers and other users of the health system are foremost in our decisions and actions.


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Executive Summary In 2009-10, WA Health has continued to provide a first–class public health service for the Western Australian community; driving reform and service improvement and preparing for the challenges of the future

Delivering a Healthy WA Key indicators and patient ratings point to the good health of our community and the strong performance of our health system. Western Australians enjoy a life expectancy among the world’s best, our hospitals perform well on key measures of safety and quality and patient ratings indicate strong satisfaction with the quality of hospital care. Increasing demand for health services and the need to improve healthcare safety and quality present ongoing challenges. WA Health has responded well, matching increased activity levels with safety and quality improvement. However, activity demand increases will continue; safety and quality will remain a priority and we must maintain diligence about addressing gaps in performance. Strong future planning and preparation and vigorous pursuit of our ambitious reform program are absolutely vital. During 2009-10, WA Health has finalised the WA Health Strategic Intent 2010–2015. This sets out our vision, mission and values and outlines the scope of our work in delivering health services to nearly 2.3 million Western Australians. The Strategic Intent’s four pillars will focus and guide and efforts over the next five years: • Caring for individuals and the community; • Caring for those who need it most; • Making best use of funds and resources;

and • Supporting our team. As part of the broader WA Health system, the WA Country Health Service (WACHS) is the largest country health system in Australia and one of the largest in the world. WACHS

delivers comprehensive health services to half a million people, 10 per cent of whom are Aboriginal Australians. Across its 70 regional and remote hospitals WACHS handles as many emergencies as all the metropolitan hospitals combined and almost as many births as the State’s major maternity hospital. Consistent with the WA Health Strategic Intent 2010–2015, the WA Country Health Service has launched Revitalising 2009-2012, a new strategic direction for regional health service delivery. It focuses on overcoming the challenges in providing improved health services to regional WA and the most remote corners of the State. Revitalising 2009 - 2012 defines the four pillars of the WA Country Health Service: • A fair share for country health; • Service delivery according to need; • Closing the gap to improve Aboriginal

health; and • Workforce stability and excellence. Royalties for Regions’ Program — A Fair Share For Country Health Substantial State and Federal Government investment and funding through the ‘Royalties for Regions’ program has secured a fair share of resources for country health. This investment will result in the WA Country Health Service undertaking one of the largest country public hospital building programs, bringing care closer to home and assisting in attracting a skilled workforce to work in country WA. New hospitals and redevelopments are underway at Albany, Kalgoorlie, Busselton, Broome, and Esperance. A major redevelopment at Bunbury Hospital will create a new four bed intensive care unit and


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an expanded emergency department. The $15.2 million State and Federal funded South West Radiotherapy Centre to be built in Bunbury is the first of its kind in regional WA. The centre, scheduled for completion in 2011, will provide radiation oncology services for the majority of the region’s cancer patients. Under a $22 million Federal Government funded program, facilities will be developed at Geraldton, Albany, Kalgoorlie, Northam and Narrogin over the next three years to improve cancer services and provide patient care closer to home for more people. A new $150 million Karratha Health Campus is being planned in consultation with the community and the new $136.7 millon 68 bed Hedland Health Campus is on schedule for completion in October 2010. The $38.2 million partnership between the State Government and the resource industry under the ‘Royalties for Regions’ program will further enhance health services in the Pilbara region. Through the $50 million East Kimberley Development Package, the WA Country Health Service will implement upgrades to health facilities at Wyndham, Kununurra and at the remote Aboriginal communities of Warmun and Kalumburu. Across the WA Country Health Service, the ‘Royalties for Regions’ program has funded $1.2 million of new medical and imaging equipment as well as six new CT scanners installed at Karratha, Esperance, Carnarvon, Geraldton, Kalgoorlie and Narrogin hospitals. Service Delivery According To Need There have been improvements in access to health services in regional WA with telehealth complementing service delivery. Virtual outpatient clinics and services are provided across a range of clinical specialties. Upgrades to bandwidth and technology have seen videoconference facilities expanded to more than 350 sites across WA in the past twelve months. The Royal Flying Doctor Service has increased its fleet from 11 to 13 aircraft, resulting in improved response times for inter-hospital patient transfers. Additional aircraft are planned for 2010-2011 and a new medical jet service is being established with the support of Rio Tinto Iron Ore, as part of a three year pilot program underwritten by the State Government.

The ‘Royalties for Regions’ program will provide $26.1 million over four years to fund seven new ambulances to service remote towns in the Kimberley and the Pilbara, improve support for community paramedics and volunteers and provide subsidies to remote Aboriginal communities requiring emergency health care. Closing The Gap To Improve Aboriginal Health New initiatives funded through National Partnership Agreements (NPA) aim to improve the health and lifestyles of Aboriginal people living in rural and remote areas. WA Health has committed $117.4 million for the Closing the Gap in Indigenous Health Outcomes NPA. The Commonwealth has contributed $17.12 million and WA Health $11.25 million for the Indigenous early Childhood Development NPA initiatives. This represents the single biggest investment into Aboriginal health reform in the State’s history. For the first time, Aboriginal people have been involved in both the planning and development process to improve the delivery of Aboriginal health services across WA. Workforce Stability and Excellence Workforce shortages continue to be a major challenge in providing health services to rural and remote WA. However, there has been an increase in the number of medical graduates choosing to take up internships in regional centres. The Rural Generalist Pathway, which focuses on developing medical graduates to work in country WA through the internship year and beyond, will produce forty rural generalist doctors with skills in general practice, obstetrics, anaesthetics and other areas. 2010-11 and Beyond These achievements over the past financial year have delivered better community access to health services, and improved the health of country Western Australians. I would like to acknowledge the contribution of Mr Jeff Moffet who held the position of Acting Chief Executive Officer, WA Country Health Service during the second half of this financial year and congratulate him on his recent appointment to Director-General, Department of Health and Families, Northern Territory. As former Chief Executive Officer of the WA Country Health Service, I have experienced


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first hand the dedication and commitment displayed by WACHS staff, our District Health Advisory Councils, and our volunteers and I congratulate and applaud each of you for your continuing efforts. Thanks to the contribution of all team members, the WA Country Health Service Health is well –positioned to meet the challenges of 2010-11 and beyond.

Mr Kim Snowball DIRECTOR GENERAL OF HEALTH 15 September 2010


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Address and LocationWACHS – Area Office 189 Wellington Street, EAST PERTH WA 6004 Postal Address PO Box 6680 EAST PERTH BUSINESS CENTRE, WA 6892 Phone: (08) 9223 8500 Fax: (08) 9223 8599 Internet: www.wacountry.health.wa.gov.au WACHS – Kimberley Yamamoto House Unit 4, 9 Dampier Terrace, BROOME WA 6725 Postal Address Locked Bag 4011, BROOME WA 6725 Phone: (08) 9194 1600 Fax: (08) 9194 1666 WACHS – Pilbara Morgans Street, PORT HEDLAND WA 6721 Postal Address PO Box 63, PORT HEDLAND WA 6721 Phone: (08) 9158 1795 Fax: (08) 9158 1472 WACHS – Midwest Shenton Street, GERALDTON WA 6530 Postal Address PO Box 22, GERALDTON WA 6531 Phone: (08) 9956 2209 Fax: (08) 9956 2421

WACHS – Wheatbelt Shop 2, Northam Boulevard 178 Fitzgerald Street, NORTHAM WA 6401 Postal Address PO Box 690, NORTHAM WA 6401 Phone: (08) 9621 0700 Fax: (08) 9621 0701 WACHS - Goldfields The Palms 68 Piccadilly Street, KALGOORLIE WA 6430 Postal Address PO Box 716, KALGOORLIE WA 6433 Phone: (08) 9080 5710 Fax: (08) 9080 5724 WACHS – Great Southern Callistemon House Warden Avenue, ALBANY WA 6331 Postal Address PO Box 165, ALBANY WA 6331 Phone: (08) 9892 2662 Fax: (08) 9842 1095 WACHS – South West Fourth floor, Bunbury Tower 61 Victoria Street, BUNBURY WA 6230 Postal Address Phone: (08) 9781 2350 Fax: (08) 9781 2381

http://www.wacountry.health.wa.gov.au/�


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Service Framework The State Government of Western Australia uses an outcome-based management framework to illustrate the contribution by agencies to achievement of Whole of Government goals. New goals for were developed during the 2009-10 financial year.

There are five strategic goals of the Western Australian Government. These broad, high-level government goals are supported at agency level by more specific desired outcomes. These outcomes contribute to the achievement of the high-level government goals. The current Whole of Government goals are: • State Building – Major Projects.

Building strategic infrastructure that will create jobs and underpin Western Australia’s long-term economic development;

• Financial and Economic Responsibility. Responsibly managing the State’s finances through the efficient and effective delivery of services, encouraging economic activity and reducing regulatory burdens on the private sector;

• Outcomes Based Service Delivery. Greater focus on achieving results in key service delivery areas for the benefit of all Western Australians;

• Stronger Focus on the Regions. Greater focus on service delivery, infrastructure investment and economic development to improve the overall quality of life in remote and regional areas; and

• Social and Environmental Responsibility. Ensuring that economic activity is managed in a socially and environmentally responsible manner for the long-term benefit of the State.

The Whole of Government goal to which the Department of Health contributes is “Outcomes Based Service Delivery”. WA Health delivers three ‘Outcomes’ to meet this goal. They are: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness; Improved health of the people of WA by reducing the incidence of preventable disease, specified injury, disability and death; and Enhanced wellbeing and environment of those with chronic illness or disability. A range of Key Effectiveness Indicators measure progress achieved toward meeting these ‘Outcomes’. Reporting of these is found in the Key Performance Indicators section of this annual report. Eleven services support the delivery of these outcomes. A significant number of Key Efficiency Indicators are used to measure the cost effectiveness of delivery of these services over time. The Key Performance Indicators section of this annual report provides current year and prior year results for these indicators. A diagrammatic representation of the WA Health outcome structure follows in Figure 1 on the next page


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Service Framework Figure 1: Department of Health outcome structure

Government Goal Outcomes-Based Service Delivery: Greater focus on achieving results in

key service delivery areas for the benefit of all Western Australians.

Current Department of Health Outcomes and Services linked to WA Government Services Goals

Outcome 1 Restoration of patients’ health, safe delivery of

newborns and support for patients and families during terminal illness

Outcome 2 Improved health of the

people of WA by reducing the incidence of

preventable disease, specified injury, disability

and premature death

Outcome 3 Enhanced wellbeing and environment of those with chronic illness or disability

1. Admitted patient 2. Home based hospital

programs 3. Palliative care 4. Emergency

department 5. Non-admitted patients 6. Patient transport

8. Prevention, promotion and protection

9. Dental health

10. Aged and continuing care

11. Drug and alcohol 12. Contracted Mental

health

SERVICES


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Revitalising WA Country Health Services During 2009-10 the WA Country Health Service launched a new strategic direction, Revitalising WA Country Health Services 2009 – 2012. The Revitalising WA Country Health Services 2009 – 2012 outlines the way forward for health service delivery in regional WA over three years. It follows on from the WA Country Health Service Strategic Plan 2007-2010 titled Foundations for Country Health Services. The purpose, values and actions outlined evolved through consultation with WA Country Health Service staff and community members throughout regional WA.

Our Purpose Working together for a healthier Country WA

What we stand for:

• A fair share for country health Securing a fair share of resources and being accountable for their use.

• Service delivery according to need Improving service access based on need and improving health outcomes

• Closing the gap to improve Aboriginal Health Improving the health of Aboriginal people

• Workforce stability and excellence Building a skilled workforce and a supportive workplace

Our Values

Community Country hospitality, where there is openness, generosity and cooperation. Building healthy and empowered communities and teams, being inclusive, working together, valuing each other and the difference we can all make. A ‘can-do’ attitude.

Compassion Commitment to caring for others with consideration, appreciation, understanding, empathy, kindness and respect. Listening and being heard.

Quality Always striving to provide the best possible care and service through questioning and review, high standards, innovation, creativity, learning and improving, All of us being part of the solution.

Integrity Building trust based on openness, honesty, accountability and valuing and respecting others’ opinions and points of view. Demonstrating the values. Respectful communication and relationship building. Being mindful of the legacy we hand on to future staff and communities.

Justice Achieving equity and fairness, showing cultural respect, valuing and embracing diversity and respecting confidentiality. Treating everyone equally. Speaking up when there is injustice. Transparency.


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Services Provided Direct patient services • accident and emergency medicine • acute medical • acute mental health • acute surgical • anaesthetics • antenatal classes • cardiology • dermatology • dental services • ear, nose and throat • endocrinology • extended care • gastroenterology • general practice • genetics • gynaecology • hospital in the home • nephrology • obstetrics • occupational medicine • oncology • ophthalmology • orthopaedics • pain management • pacemaker clinic • paediatrics • plastic surgery • primary health care • podiatry • psychiatry and psychology • renal dialysis • residential aged care • respite care • rheumatology • same day surgery • urology

Medical support services • ambulance and patient transport • audiology • dietetics • medical imaging • occupational therapy • pathology • pharmacy • physiotherapy • podiatry • respiratory medicine • social work • speech pathology • sexual health Community and support services • aged care • child and maternal health • community aged care packages • community health • community mental health • disease control • health promotion • health screening • home and community care • home based hospital programs • immunisation • meals on wheels • medi hotel services • public health • palliative care • residential care Other services • administration and corporate • engineering / supply / maintenance • hotel and catering • medical records


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Enabling LegislationThe Department of Health is established by the Governor under section 35 of the Public Sector Management Act 1994. At the beginning of March 2010 the Mental Health Commission was established by the Governor under section 35 of the Public Sector Management Act 1994. The Director General of Health is responsible to the Minister for Health and the Commissioner for Mental Health is responsible to the Minister for Mental Health for the efficient and effective management of WA Health and the Mental Health Commission. The Department of Health supports the Ministers in the administration of 40 Acts and 102 sets of subsidiary legislation. Acts administered • Alcohol and Drug Authority Act 1974 • Anatomy Act 1930 • Animal Resources Authority Act 1981 • Blood Donation (Limitation of Liability)

Act 1985 • Cannabis Control Act 2003 • Chiropractors Act 2005 • Cremation Act 1929 • Dental Act 1939 • Dental Prosthetists Act 1985 • Fluoridation of Public Water Supplies

Act 1966 • Food Act 2008 • Health Act 1911 • Health Legislation Administration Act 1984 • Health Professionals (Special Events

Exemption) Act 2000 • Health Services (Conciliation and Review)

Act 1995 • Health Services (Quality Improvement)

Act 1994 • Hospital Fund Act 1930 • Hospitals and Health Services Act 1927 • Human Reproductive Technology Act

1991 • Human Tissue and Transplant Act 1982 • Medical Practitioners Act 2008 • Medical Radiation Technologists Act 2006 • Mental Health Act 1996 • Nuclear Waste Storage and

Transportation (Prohibition) Act 1999 • Nurses and Midwives Act 2006 • Occupational Therapists Act 2005 • Optometrists Act 2005

• Osteopaths Act 2005 • Pharmacy Act 1964 • Physiotherapists Act 2005 • Podiatrists Act 2005 • Poisons Act 1964 • Prostitution Act 2000 (Act other than s.62

and Part 5) • Psychologists Act 2005 • Queen Elizabeth II Medical Centre Act

1966 • Radiation Safety Act 1975 • Surrogacy Act 2008 • Tobacco Products Control Act 2006 • University Medical School Teaching

Hospitals Act 1955 • White Phosphorous Matches Prohibition

Act 1912 Acts passed during 2009-10 Nil Bills in Parliament as at 30 June 2010 Cannabis Law Reform Bill 2009 Health Practitioner Regulation National Law (WA) Bill 2010 Health, Safety and Civil Liability (Children in Schools and Child Care Services) Bill 2010 Pharmacy Bill 2010 Royal Perth Hospital Protection Bill 2008 Amalgamation and establishment of Boards There were no Boards amalgamated or established during 2009-10.


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nStatement of Compliance with Public Sector Standards As the accountable authority for the WA Country Health Service (WACHS), I am satisfied that WACHS has implemented procedures and processes to comply with the Public Sector Standards in Human Resource Management (PSS), the WA Public Sector Code of Ethics and the WA Health Code of Conduct. The following information details significant actions undertaken or continued by WACHS in 2009-10 to prevent non-compliance and keep staff informed about the Standards and the Codes. WACHS provides education and awareness training for staff regarding the PSS, Public Interest Disclosure (PID), the WA Health Code of Conduct and the Public Sector Code of Ethics. Training includes increasing workplace behaviour awareness, provides information about legislation changes, and ensures WACHS managerial staff have the required skills to manage and deal with issues pertaining to the Codes. WACHS’ Job Description documentation and employment processes emphasise compliance with the Public Sector Standards, the Codes and Equal Employment Opportunity legislation and policies. The Corporate Governance Directorate of the Department of Health as well as DOH and WACHS human resource branches support the Area Health Service in programs to present information and awareness sessions to health service staff on compliance with PSS and identifying and investigating matters that may constitute misconduct. Mechanisms to promote the compliance with the PSS and the Codes included: employees participating in the WA Health employee satisfaction survey as well as surveys regarding their participation in recruitment processes as selection panel members and position applicants. Specific training programs for managers were provided during 2009-10. Maintaining and reviewing complaints and grievances statistics and records.

Conducting internal and external compliance audits across WACHS; and Performance Development Assessments which include staff knowledge and understanding of the Codes and the expected workplace behaviour. During 2009-10 the level of claims lodged for PSS non-compliance or a breach is low across WACHS where WACHS dealt with twelve claims for non-compliance (plus one carried forward from 2008-09). These were predominantly for recruitment, selection and appointment (6) or grievance resolution (3) with remaining claims for performance management, redeployment or temporary deployment issues. Five claims were referred to the Office of Public Sector Standards Commissioner (OPSSC) with the balance withdrawn, resolved or pending in the agency. WACHS communicates information regarding the Codes to its employees via its intranet site, through staff development and induction training. Formal acceptance of the Codes is required from all staff. Substantiated non-compliance with the Codes is referred to internal or external agencies including the OPSSC for further investigation and action recommendations. Table 1: Number of complaints alleging non-

compliance with Codes

Number Number investigated internally in the agency 160

Number investigated by an external consultant 20

Total number lodged in 2009-10 180

Kim Snowball DIRECTOR GENERAL OF HEALTH 15 September 2010


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Pecuniary Interests Accountable Authority

Senior officers of the WA Country Health Service have declared no pecuniary interests in 2009-10.

The Acting Director General of Health, Kim Snowball, is the accountable authority for the WA Country Health Service for 2009-10.

Senior Officers The senior officers, as at 30 June 2010, for the WA Country Health Service (WACHS) and their areas of responsibility are listed below: Table 2: WACHS Senior Officers as at 30 June 2010

Area of responsibility Title Name

WA Country Health Service A/Chief Executive Officer Jeff Moffet

WACHS Area Operations A/Chief Operating Officer Karen Bradley

WACHS Corporate Services Executive Director Graeme Jones

WACHS Nursing A/Executive Director Coral Harkins

WACHS Medical Services A/Executive Director Dr Felicity Jefferies

Regional Operations Regional Director Kimberley Kerry Winsor

Regional Operations Regional Director Pilbara Tina Chinery

Regional Operations Regional Director Mid West Shane Matthews

Regional Operations Regional Director Goldfields Geraldine Ennis

Regional Operations Regional Director Wheatbelt Tim Free

Regional Operations Regional Director Great Southern Ian Smith

Regional Operations A/Regional Director South West Grace Ley

Regional Operations A/Area Director Primary Health and Engagement Melissa Vernon


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Management Structure WA Country Health Service structure (June 2010)

CHIEF EXECUTIVE

OFFICER

EXECUTIVE DIRECTOR

Clinical Workforce and

Reform

EXECUTIVE DIRECTOR

Corporate Services

CHIEF OPERATING

OFFICER

EXECUTIVE DIRECTOR

Nursing

MANAGER

Medical Services

REGIONAL DIRECTORS

X 7

AREA DIRECTOR

Primary Health &

Engagement


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Key Performance Indicators


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Certification Statement WA COUNTRY HEALTH SERVICE CERTIFICATION OF PERFORMANCE INDICATORS FOR THE YEAR ENDED 30 JUNE 2010 I hereby certify the performance indicators are based on proper records, are relevant and appropriate for assisting users to assess the performance of the WA Country Health Service and fairly represent the performance of the health service for the financial year ended 30 June 2010.

Kim Snowball Director General of Health ACCOUNTABLE AUTHORITY 15 September 2010


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Audit Opinion


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IntroductionThe health of the Western Australian community has many determinants, including the provision of health services, access to and use of other government services and numerous environmental and social factors. The Key Performance Indicators (KPI) reported address the extent to which the strategies and activities of the health services contribute to the improvement of the health of the Western Australian community. This overarching goal is divided into three health outcomes: Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness. Outcome 2: Improved health of the people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death. Outcome 3: Enhanced wellbeing and environment of those with chronic disease or disability.

All health entities contribute to the achievement of these outcomes, with the health service divisions and Area Health Services taking responsibility for specific areas. While the largest proportion of health service activity is directed to Outcome 1 (particularly within the Metropolitan Health Service (MHS), some health services within the WA Country Health Service (WACHS) have proportionally more activity directed to delivering Outcome 3. Therefore, to ascertain the overall performance of the health system the following annual reports must be read in conjunction: Department of Health Metropolitan Health Service WA Country Health Service Drug and Alcohol Office

Table 3: Service activities in relation to the health outcomes

Outcome 1 Service 1 * Public hospital admitted patients Service 2 Home-based hospital programs Service 3 Palliative care Service 4 Emergency department Service 5 * Public hospital non-admitted patients Service 6 * Patient transport

Outcome 2

Service 7 * Prevention, promotion and protection Service 8 Dental health

Outcome 3

Service 9 * Aged and continuing care Service 10 Drug and alcohol Service 11 * Contracted mental health

* These services are reported by WACHS.


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Comparative Results Performance Targets

Where possible comparative results of prior years are provided.

Performance targets have been developed for the Effectiveness and Efficiency Key Performance Indicators wherever possible. Effectiveness indicator targets have been based on published national averages for the indicators, where available, or from the analysis of previous performance results. Efficiency indicator targets are those contributing to the State-wide targets published in the 2009-10 Government Budget Statements (GBS) for estimated expenditure in 2009-10.

Consumer Price Index Deflator Series The Consumer Price Index (CPI) Deflator Series is calculated on a five year cycle. As 2008-09 was the base year for the current five year cycle, the deflator information is required to calculate the CPI-adjusted results for 2009-10.

Efficiency Indicators The efficient use of resources can help minimise the overall costs of providing health care. The efficiency indicators included in the Annual Report describe the health service’s expenditure against a selected number of activity outputs representative of the health service’s provision of health care.

Mental Health The Mental Health Commission commenced on March 8, 2010. The Commission has assumed the operational control and management of the provision of mental health services in Western Australia. The mental health indicators reported in the WA Country Health Service report represent services provided under contract to the MHC and will in future years be reported in the MHC Annual Report.


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Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness The achievement of this outcome of the health objective involves activities which: • ensure that people have appropriate and

timely access to acute care services when they are in need of them so that intervention occurs as early as possible. Timely and appropriate access ensures that the acute illness does not progress or the effects of injury do not progress, increasing the chance of complete recovery from the illness or injury (for example access to elective surgery).

• provide quality diagnostic and treatment services that ensure the maximum restoration to health after an acute illness or injury.

• provide appropriate after-care and rehabilitation to ensure that people’s physical and social functioning is restored as far as possible.

• provide appropriate obstetric care during pregnancy and the birth episode to both mother and child.

• provide appropriate care and support for patients and their families during terminal illness.


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1-00: Proportion of patients discharged to home after admitted hospital treatment

Rationale A direct measure of the extent to which people have been restored to health after an acute illness is that they are well enough to be discharged home after an acute illness that required hospitalisation. The percentage of people discharged home over time provides an indication of how effective the public health system is in restoring people to health. The performance indicator shows the percentage of all separations for patients admitted to WA Country Health Service public hospitals (excluding inter-hospital transfers) that are discharged home after hospital treatment. This indicator should be examined in conjunction with KPI 1-02 and KPI MHC07.

As the normal ageing process tends to decrease a patient’s chances of returning home, the figures are presented in ten-year age groups. Data includes those patients separated after episodes of acute illness, rehabilitation, psycho-geriatric care and geriatric evaluation and management, but excludes other care types. Results The overall proportion for all ages of public patients discharged home from country hospitals was 97.2 per cent, above target of 97.1%. The result is consistent with prior years. The results for the age cohorts demonstrate that the probability of being restored to health (discharged home after hospitalisation) is generally reduced with age.

Figure 2: Proportion of patients discharged to home after admitted hospital treatment

75%

80%

85%

90%

95%

100%

2006 96.7% 96.1% 97.7% 98.2% 97.8% 95.6% 96.9%

2007 96.9% 96.0% 97.9% 98.2% 97.9% 95.1% 97.0%

2008 97.3% 96.3% 97.9% 98.7% 98.2% 95.9% 97.4%

2009 97.2% 96.0% 97.8% 98.2% 98.1% 96.1% 97.2%

<40 40-49 50-59 60-69 70-79 80+ All Ages

Note The target for the years 2006 and 2007 was 96.8% with the 2008 target set at 97.0%. Data source Hospital Morbidity Data System


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1-01: Elective surgery waiting times Rationale In delivering services to achieve Outcome 1, the public health system provides elective surgery capacity in WACHS hospitals. Elective surgery is all non-emergency surgery for which admission to hospital can be delayed for at least 24 hours. Timely access to the required surgical procedures is a measure of the public health system’s capacity to perform elective surgery. After surgery, some types of patients will be restored to health, while for others, surgery will improve the quality of life. Patients who are referred for elective surgery are classified by senior medical staff by clinical need into urgency categories based on the likelihood of the condition becoming an emergency if not seen within the recommended time frame, known as the boundary. Performance targets Category 1: Admission desirable within

30 days Category 2: Admission desirable within

90 days Category 3: Admission desirable within

365 days

Results Cases remaining For the WA Country health Service, as at June 30, 2010, except for over-boundary category one cases, generally there has been increases in the number of cases within and over boundary compared to last year. Elective surgery admissions during the year During 2009-10 WACHS public hospitals maintained the increased activity levels achieved in 2008-09 with the number of cases admitted for surgery rising to 15,696 from 15,423. State and Commonwealth Government initiatives to support and enhance elective surgery capacity in WA have contributed to increased elective surgery activity. A number of these initiatives will continue in 2009-10. WACHS continues a strong focus on managing a growing elective surgery waitlist with increased surgery throughput and particular strategies to address over boundary cases. This will enable more people to receive surgical treatment in country locations. WACHS proposes to target 1,600 additional cases in 2010-11 in order to maintain reasonable waiting times with growing demand for surgery.

Table 3: Cases remaining on the elective surgery waiting list

Category 1 Category 2 Category 3

Wait list No of Cases %

Median wait

time in days

No of Cases %

Median wait

time in days

No of Cases %

Median wait

time in days

as at 30 June 2010 Cases remaining within boundary 139 84 600 83 2491 96 Cases remaining over boundary 27 16

15 125 17

35 113 4

106


15 89 15

29 53 2

83


25 156 27

39 79 3

110

Data source Patient Electronic Analysis Referral Liaison System (HCARe)


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1-02: Rate of unplanned hospital readmissions within 28 days to the same hospital for a related condition

Rationale Good medical and/or surgical intervention together with good discharge planning will decrease the likelihood of unplanned hospital readmissions. An unplanned readmission is an unplanned return to the same hospital as an admitted patient for the same or a related condition as one for which the patient has previously been discharged within 28 days. Unplanned readmissions necessitate patients spending additional periods of time in hospital as well as utilising additional hospital resources. Although there are some conditions that may require numerous admissions to enable the best level of care to be given, in most of these cases readmission to hospital would be planned. A low unplanned readmission rate suggests that good clinical practice is in operation. This indicator should be considered in conjunction with the indicator KPI 1-00.

Results The reported unplanned readmission rate for WACHS for 2009 was 2.2 per cent, better than the national target. WACHS hospitals continue to monitor readmission rates to ensure that the highest standards of clinical practice and discharge planning have been adopted to deliver the best level of care to all patients.

Table 4: Rate of unplanned hospital readmissions within 28 days to the same hospital for a related

condition

2006 2007 2008 2009 Target <2.8% <2.8% <2.3% <2.3%

Unplanned readmission rate 3.0% 2.8% 2.9% 2.2%

Target - Report on Government Services 2009 National average Data source Hospital Morbidity Data System


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MHC07: Rate of unplanned hospital readmissions within 28 days to the same hospital for a mental health condition

Rationale An unplanned readmission is an unplanned return to the same hospital as an admitted patient for the same or a related mental health condition as one for which the patient has previously been discharged within 28 days. While it is inevitable that some patients will need to be readmitted to hospital within 28 days, in an unplanned way, a high percentage of readmissions may indicate that improvements could be made to discharge planning or to aspects of inpatient therapy protocols. Appropriate therapy, together with good discharge planning will decrease the likelihood of unplanned hospital readmissions. Unplanned readmissions necessitate patients spending additional periods of time in hospital as well as utilising additional hospital resources.

Although there are some mental health conditions that may require numerous admissions to enable the best level of care to be given, in most of these cases readmission to hospital would be planned. A low unplanned readmission percentage suggests good clinical practice is in operation. Results The reported readmission rate for mental health conditions for the WA Country Health Service in 2009 was 5.9 per cent, better than the set target and comparable to prior years. The WACHS continues to provide a range of mental health programs and support networks delivering quality mental health services to country communities providing appropriate treatment and support when required, and preventing unplanned readmission to hospital.

Table 5: Rate of unplanned hospital readmissions within 28 days to the same hospital for a

mental health condition

2006 2007 2008 2009 Target <10% <10% <8.3% <6.5%

Unplanned readmission rate 5.2% 6.7% 7.6% 5.9%

Note The Mental Health Commission commenced on March 8, 2010. However, for the full 2009-10 period, the Metropolitan Health Service (MHS) will continue to report this indicator. Commencing in 2010-11 specific indicators for all contracted mental health services provided by the MHS will be reported by the Mental Health Commission. A return to hospital is a readmission only if the reason for this admission is the same or is related to the condition treated in a previous admission within 28 days. For the WA Country Health Service, the numbers of patients who receive inpatient mental health care is low. Hence, small numbers of patients who have unplanned re-admissions can result in large variations to the annual percentage. Previously reported as KPI 1-03. Target – the WACHS performance target for this indicator is the average performance across WACHS for the period 2004-08. Data source Hospital Morbidity Data System


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1-05: Survival rates for sentinel conditions Rationale The survival rate of patients in hospitals can be affected by many factors. These include the diagnosis, the treatment given or procedure performed and the age, sex and condition of each individual patient. Other factors include whether the patient had other (co-morbid) conditions at the time of admission or developed complications while in hospital. The comparison of ‘whole of hospital’ survival rates between hospitals may not be appropriate due to differences in mortality associated with different diagnoses and procedures. Therefore, three ‘sentinel’ procedures have been selected for which the survival rates are to be measured by specified age groups. These are stroke, heart attack (also known as acute myocardial infarction or AMI) and fractured hip (also known as fractured neck of femur or FNOF). For each of these conditions a good recovery is more likely when there is early intervention and appropriate care. Patients with these conditions are also more likely to develop additional co-morbid conditions, and therefore better comparisons can be made if comparing particular age groups, rather than the whole population.

This indicator measures the hospitals’ performance in relation to restoring the health of people who have had a stroke, myocardial infarction or fractured neck of femur by measuring those who survive the illness and are discharged. Following acute admission, some may be transferred to another hospital for specialist rehabilitation or to a hospital closer to home for additional rehabilitation. Targets The targets are set from the average survival rates achieved over the period 2006-08. Results For the WA Country Health Service the survival rates for heart attack in 2009 are all above the targets except for the 50-59 and 60-69 years age cohorts, which are marginally below the targets. Reported survival rates for 70-79 years age group improved compared to prior years. The survival rates for stroke in 2009 are all above the targets except for the 0-49 and 80+ year age cohorts, which are below the targets. The survival rates for FNOF in 2009 are above target for 80 yrs+ but fall below target for 70-79 yrs. Results are comparable to prior years.

Figure 6: Survival rate for acute myocardial infarction (AMI)

0-49 years

70%

75%

80%

85%

90%

95%

100%

0-49 yrs 100.0% 98.0% 100.0% 100.0%

Target 97.0% 97.0% 99.0% 99.3%

2006 2007 2008 2009

50-59 years

70%

75%

80%

85%

90%

95%

100%

50-59 yrs 98.2% 100.0% 99.1% 98.4%

Target 97.0% 97.0% 99.0% 99.1%

2006 2007 2008 2009


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60-69 years

70%

75%

80%

85%

90%

95%

100%

60-69 yrs 96.9% 94.4% 98.0% 96.8%

Target 95.0% 95.0% 97.0% 97.0%

2006 2007 2008 2009

70-79 years

70%

75%

80%

85%

90%

95%

100%

70-79 yrs 93.5% 91.4% 92.1% 95.9%

Target 90.0% 90.0% 93.0% 92.7%

2006 2007 2008 2009

80+ years

70%

75%

80%

85%

90%

95%

100%

80+ yrs 84.3% 82.4% 86.9% 84.7%

Target 80.0% 80.0% 81.0% 84.4%

2006 2007 2008 2009


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Figure 3: Survival rate for stroke 0-49 years

70%

75%

80%

85%

90%

95%

100%

0-49 yrs 100.0% 98.2% 98.1% 94.9%

Target 90.0% 90.0% 98.0% 98.8%

2006 2007 2008 2009

50-59 years

70%

75%

80%

85%

90%

95%

100%

50-59 yrs 98.5% 90.0% 94.7% 95.9%

Target 85.0% 85.0% 97.0% 95.3%

2006 2007 2008 2009

60-69 years

70%

75%

80%

85%

90%

95%

100%

60-69 yrs 90.0% 96.4% 93.7% 95.7%

Target 85.0% 85.0% 94.0% 93.3%

2006 2007 2008 2009

70-79 years

70%

75%

80%

85%

90%

95%

100%

70-79 yrs 88.7% 78.8% 87.1% 88.6%

Target 85.0% 85.0% 87.0% 85.1%

2006 2007 2008 2009

80+ years

70%

75%

80%

85%

90%

95%

100%

80+ yrs 77.8% 76.4% 75.5% 72.8%

Target 75.0% 75.0% 77.0% 76.6%

2006 2007 2008 2009


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Figure 4: Survival rate for fractured neck of femur (FNOF) 70-79 years

70%

75%

80%

85%

90%

95%

100%

70-79 yrs 100.0% 98.5% 96.3% 96.8%

Target 95.0% 95.0% 99.0% 98.3%

2006 2007 2008 2009

80+ years

70%

75%

80%

85%

90%

95%

100%

80+yrs 95.4% 96.9% 95.0% 95.5%

Target 90.0% 90.0% 95.0% 95.7%

2006 2007 2008 2009

Note For the WA Country Health Service patient numbers for these conditions are generally low and therefore any variations in patient outcomes for these conditions can cause large variations to the annual percentage. Data source Hospital Morbidity Data System


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1-06: Percentage of live births with an APGAR score of three or less five minutes post delivery

Rationale A well managed labour will normally result in the birth of a minimally distressed infant. The level of foetal well-being (lack of stress or other complications or conditions) is measured five minutes post delivery by a numerical scoring system (APGAR) through an assessment of heart rate, respiratory effort, muscle tone, reflex irritability and colour. A high average APGAR score in a hospital will generally indicate that appropriate labour management practices are employed and also is an indication of the wellbeing of the baby. This indicator reports on the number and percentage of babies with a low APGAR score at birth (an APGAR score of 3 or less at 5 minutes post delivery). A baby with a low APGAR is more likely to be premature with immature lungs or its mother had a difficult delivery than one with a higher score.

Target The target set for this indicator is taken from the Report on Government Services for a national perspective and may not necessarily be appropriate for country WA. An indicative specific target appropriate to rural and remote WA will be prepared for future reporting periods. Results The recorded proportions for babies born 0-1499 grams and 2000-2499 grams did not meet the national targets. There were 12 babies born in WACHS facilities with an APGAR score of three or less five minutes post delivery with a total of 4,596 babies born for all weights in WACHS hospitals. Factors other than hospital maternity services can influence APGAR scores within birth weight categories – for example antenatal care, multiple births and socioeconomic factors. Small numbers of babies included in this indicator can result in large variations to recorded proportions.

Table 4: Percentage of live births with an APGAR score of 3 or less five minutes post delivery

Proportion of babies % Birthweight (grams) 2006 2007 2008 2009

Target ≤16.60% ≤13.80% ≤14.60% ≤16.50% 0 – 1499 36.4 38.5 37.5 42.9

Target ≤0.70% ≤1.10% ≤1.30% ≤1.0% 1500 – 1999 0.0 0.0 0.0 4.3

Target ≤0.50% ≤0.50% ≤0.60% ≤0.50% 2000 – 2499 1.2 0.6 1.3 0.0

Target ≤0.10% ≤0.10% ≤0.10% ≤0.10% 2500 and over 0.1 0.1 0.0 0.1

Data source Midwives Notification System Report on Government Services 2009


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1-07: Proportion of emergency service patients seen within recommended times (major rural hospitals)

Rationale When patients first enter an Emergency Department or Service, they are assessed by specially trained nursing staff who assess how urgently treatment should be provided. The aim of this process, known as triage, is to ensure treatment is given in the appropriate time and should prevent adverse conditions arising from deterioration in the patient’s condition. Treatment within recommended times should assist in the restoration to health either during the emergency visit or the admission to hospital which may follow emergency department care. A patient is allocated a triage code between 1 and 5 that indicates their urgency (see below). This code provides an indication of how quickly patients should be reviewed by medical staff. The triage process and scores are recognised by the Australian College for Emergency Medicine and recommended for prioritising those who present to an Emergency Department. In a busy Emergency Department or service when several people present at the same time, the process aims for the best outcome for all.

Treatment should be within the recommended time of the triage category allocated. This indicator measures the percentage of patient attendances in each triage category whose treatment commenced within the time periods recommended by the Australasian College for Emergency Medicine (ACEM) for each Triage category. This indicator reports for 21 WACHS Regional Resource Centres or Integrated Health District sites that provide emergency services and measures the time for medical treatment to commence by either a doctor or nurse. Results Results for the times seen for emergency service attendances were within set thresholds and comparable to prior years for all triage categories except Triage category 1. There were 32 Triage 1 attendances across WACHS reporting sites with a recorded time outside the prescribed ‘time to be seen’. It should be noted that in some cases treatment is delayed due to the aggressive or violent behaviour of the patient.

Table 5: Proportion of emergency department attendances seen within recommended times

Target 2008-09 2009-10 Triage category 1 (within 2 mins) 100% 98.7% 96.3% Triage category 2 (within 10 mins) 80% 92.4% 88.9% Triage category 3 (within 30 mins) 75% 88.2% 86.1% Triage category 4 (within 60 mins) 70% 90.0% 88.1% Triage category 5 (within 2 hours) 70% 95.5% 98.1%

Note Twenty one WACHS sites that provide a significant volume of WACHS’ emergency service activity report this indicator. Bunbury and Kalgoorlie report ‘doctor seen’; all others sites report ‘doctor or nurse seen’ results. Data source Emergency Department Data Collection Data Integrity and TOPAS


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1-20: Rate of emergency presentations with a triage score of four and five not admitted

Rationale When patients attend hospitals they are initially received in the emergency service where assessment, treatment and a decision on whether to admit the patient for further care takes place. Triaging is an essential function of the emergency service where people may present simultaneously. The aim of triage is to ensure that patients are treated in order of their clinical urgency and that patients receive timely care. While urgency refers principally to time-critical intervention and is not synonymous with severity, more patients triaged 1 and 2 are admitted to hospital than those with a score of 4 and 5. Without care provided by staff in the emergency service, the restoration to health of people with an injury or a sudden illness may take longer, or the outcome for the patient may be death. This indicator reports the rate of people presenting to an emergency service given a triage score of 4

or 5 who were assessed and treated, but did not need admitted hospital care That is, they were restored to health. It does not include patients whose sickness or injury requires admitted hospital care. This indicator reports the number of emergency service presentations to a WACHS hospital where the patient is not subsequently admitted. The numbers of presentations include doctor attended assessments and treatment as well as nursing assessment and treatment. Performance target A target has not been set as emergency attendances will be admitted or not admitted in accordance with clinical need. Results The percentages of Triage 4 and 5 emergency service attendances not admitted to WACHS hospitals were 93.1 per cent and 97.8 per cent respectively and are comparable to prior years.

Table 6: Rate of emergency presentation with a triage score of 4 and 5 not admitted

2006-07 2007-08 2008-09 2009-10 Triage 4 not admitted 90.1% 92.0% 92.3% 93.1%

Triage 5 not admitted 97.0% 97.7% 97.7% 97.8%

Data source Emergency Department Data Collection Information Collection and Management


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S1-01: Average cost per casemix adjusted separation for non-teaching hospitals

Rationale The use of casemix for reporting hospital activity is a recognised methodology for adjusting actual activity data to reflect the complexity of health care provided against the resources allocated. Hence, the number of separations in a hospital may be adjusted from the actual raw number by a casemix index to reflect the complexity of the care provided. WA hospitals utilise the Australian Refined National Diagnostic Related Groups (AR-DRGs) to which cost weights are allocated. This indicator measures the average cost of a casemix-adjusted separation in non-teaching hospitals. Separate results are reported for

teaching and non-teaching sites as it is expected that the level of case acuity will be higher at teaching sites than that at non-teaching sites.

Results

The WACHS recorded a cost per casemix adjusted separation of $5,657, exceeding the target. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management.

Table 7: Average cost per casemix adjusted separation for non-teaching hospitals

2006-07 2007-08 2008-09 2009-10 Target $4,349 $4,421 $4,421 $5,102

Actual cost $4,240 $4,302 $5,006 $5,657

CPI adjusted cost $3,910 $3,829 $5,006 $5,519

Note Statewide corporate costs have been apportioned to this key performance indicator. Commencing in 2009-10 Statewide corporate overheads includes all allocation of non direct AHS PathWest expenditure following the removal of a specific KPI reporting this expenditure component. Data source Hospital Morbidity Data System (HMDS) WACHS Financial Systems


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S1-20: Average cost per bed-day for admitted patients (selected small rural hospitals)

Rationale While the use of casemix is a recognised methodology for measuring the cost and complexity of admitted patients in hospitals where there is a wide range of different medical and surgical patients, it is not the accepted method of costing admitted activity in small rural hospitals. Most small hospitals do not have the advantage of economies of scale. Minimum nursing services may have to be rostered for very few patients. Accordingly these hospitals report patient costs by bed-days. This indicator measures

the cost per bed-day for admitted patients. Results The WACHS recorded a cost per small hospital bed-day of $1,486 slightly above the target. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management.

Table 8: Average cost per bed day for admitted patients (selected small rural hospitals)

2006-07 2007-08 2008-09 2009-10 Target $900 $883 $1,301 $1,428 Actual cost $1,275 $1,297 $1,189 $1,486 CPI adjusted cost $1,176 $1,155 $1,189 $1,450

Note Statewide corporate costs have been apportioned to this key performance indicator. Data source HCARe activity data systems WACHS Financial Systems


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MHC08: Average cost per bed-day in specialised mental health units

Rationale The variations in care and episode characteristics for patients receiving mental health care in specialised mental health units compared to other types of admitted care can result in differences in service costs. It has therefore been recognised that for the purpose of quality and cost effectiveness, mental health activity is better reported separately to other admitted activity, by bed-days provided rather than by weighted separations. Specialised mental health units are hospitals or hospital wards for the treatment and care of patients with mental or behavioural disorders. This indicator measures the average cost per bed day in specialised mental health units in Albany, Kalgoorlie and Bunbury Hospitals.

Results

In 2009-10 the average cost per bed-day in WA Country Health Service specialised mental health units was $1,383 including an apportionment of Statewide corporate overheads. The result is above the prescribed target. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management. In addition subsequent to reporting in 2008-09 an error has been identified which produced inflated bed-day activity at one WACHS site, and under-stating the 2008-09 result.

Table 9: Average cost per bed day in a specialised mental health units

2006-07 2007-08 2008-09 2009-10 Target $1,143 $1,017 $1,081 $1,015

Actual cost $982 $1,113 $1,125 $1,383

CPI adjusted cost $906 $991 $1,125 $1,349

Note The WA Country Health Service has three authorised mental Health units situated in the Bunbury, Albany and Kalgoorlie Regional Resource Centres. The Mental Health Commission commenced on March 8, 2010. However, for the full 2009-10 period, the WA Country Health Service (WACHS) will continue to report this indicator. Commencing in 2010-11 specific indicators for all contracted mental health services provided by WACHS will be reported by the Mental Health Commission. The 2009-10 mental health efficiency indicator target has been recast to exclude Statewide corporate overheads although these remain WA Health expenditure items and have been included in the reported result contributing to the actual cost. Previously reported as KPI S2-00. Data source Mental Health Information System WACHS Financial Systems


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S5-20: Average cost per non-admitted hospital based occasion of service for rural hospitals

Rationale Variations in patient characteristics and clinic service types between sites and across time, can result in differences in service delivery costs. It is important to monitor the unit cost of this non-admitted component of hospital care in order to ensure overall quality and cost effectiveness. This indicator measures the average cost per hospital based non-admitted occasion of service.

Results

In 2009-10 WACHS recorded a cost per non-admitted hospital based occasion of service of $206. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management.

Table 10: Average cost per non-admitted hospital based occasion of service for rural hospitals

2006-07 2007-08 2008-09 2009-10 Target $187 $176 $180 $184

Actual cost $174 $160 $182 $206

CPI adjusted cost $160 $142 $182 $201

Note Statewide corporate costs have been apportioned to this key performance indicator. A small volume of radiology activity (1,744 occasions 0.15%) has been excluded from the denominator as the spilt between inpatient and outpatient activity cannot be identified. Data source HCARe and site non-admitted activity data systems WACHS Financial Systems


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S5-21: Average cost per non-admitted occasion of service in a nursing post

Rationale Variations in patient characteristics and clinic service types between sites and across time, can result in differences in service delivery costs. It is important to monitor the unit cost of this non-admitted activity provided at these specialised service units, which often provide the only health service facility in rural or remote localities, in order to ensure overall quality and cost effectiveness. This indicator measures the average cost per non-admitted occasion of service provided in a nursing post.

Results

In 2009-10 WACHS recorded a cost per non-admitted occasion of service in a nursing post of $209, exceeding the target. While nursing post activity has continued a downward trend reported in past few years, nursing posts do not have the advantage of applying economies of scale, where minimum service capacity must be provided for very few patients. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management.

Table 11: Average cost per non-admitted occasion of service in a nursing post

2006-07 2007-08 2008-09 2009-10

Target $146 $143 $133 $161

Actual cost $139 $147 $165 $209


Note Statewide corporate costs have been apportioned to this key performance indicator. Data source HCARe and site non-admitted activity data systems WACHS Financial Systems


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S6-20: Average cost per trip of Patient Assisted Travel Scheme

Rationale The aim of the Patient Assisted Travel Scheme (PATS) is to allow permanent country residents to access the nearest medical specialist and specialist medical services. A subsidy is provided towards the cost of travel and accommodation for patients and, where necessary, an escort for the patient. Without travel assistance many people would be unable to access the services needed to diagnose or treat some conditions.

Results

In 2009-10 WACHS recorded a cost per PATS trip of $488, slightly above the target. Increased actual expenditure as well as that expressed in the target compared to prior years, reflects the State Government initiative to provide additional funding to improve the Scheme. There has also been an increase of 16% in the number of trips provided under the Scheme during 2009-10 compared to 2008-09.

Table 12: Average cost per trip of Patient Assisted Travel

2006-07 2007-08 2008-09 2009-10

Target $317 $304 $319 $478

Actual cost $327 $346 $394 $488


Note Statewide corporate costs have been apportioned to this key performance indicator. Data source PATS activity data systems WACHS Financial Systems


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Outcome 2: Improved health of the people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death The achievement of this outcome of the health objective involves activities which: 1. Increase the likelihood of optimal health

and wellbeing by: − providing programs which support the

optimal physical, social and emotional development of infants and children.

− encouraging healthy lifestyles (e.g. diet and exercise).

2. Reduce the likelihood of onset of disease or injury by: − delivering immunisation programs. − delivering safety programs. − encouraging healthy lifestyles (e.g.

diet and exercise). 3. Reduce the risk of long-term disability or

premature death from injury or illness through prevention, early identification and intervention, such as:

− programs for early detection of developmental issues in children and appropriate referral for intervention.

− early identification and intervention of disease and disabling conditions (breast and cervical cancer screening, screening of newborns) with appropriate referrals.

− programs which support self-management by people with diagnosed conditions and disease (diabetic education).

4. Monitor the incidence of disease in the population to determine the effectiveness of primary health measures.

Note WACHS population health units deliver both illness prevention and health promotion services as well as health protection services. This section contains population-based indicators. The residential postcode of the individual receiving the service allows for epidemiological comparisons and is not the postcode of the location where the service was provided. Performance measurement for these indicators is provided for both Aboriginal and non-Aboriginal populations.


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2-01: Rate of hospitalisation for gastroenteritis in children Rationale Gastroenteritis is a condition for which a high number of patients are treated either in the hospital or in the community. It would be expected that hospital admissions for this condition would decrease as performance and quality of service in many different health areas improves. Reduction in the number of children who are admitted to hospital per 1,000 population for treatment of gastroenteritis may be an indication of improved primary care or community health strategies - for example, health education. It is important to note, however, that other factors such as environmental issues will also have an impact on the prevalence of transmissible diseases like gastroenteritis. Health promotion and illness prevention programs are delivered to ensure there is an understanding of hygiene within homes to assist the prevention of gastroenteritis. WACHS also supports a number of Environmental Health Workers that work in Aboriginal communities and with Aboriginal

Medical Services. The Department of Health is also engaged in the surveillance of enteric diseases. Some forms of gastroenteritis, for example salmonellosis and shigellosis, are notifiable diseases and infection rates are monitored. Results In 2009 the WA Country Health Service reported hospitalisation rates for gastroenteritis in non-Aboriginal children and Aboriginal children which were lower than in 2008 and continued the improving trends shown across prior years. However, while the rate for non-Aboriginal children was below the total population target, the rate for Aboriginal children exceeded this target. A combination of environmental and community health programs implemented by WACHS in conjunction with other agency initiatives such as community infrastructure projects, aim to prevent gastroenteritis and similar conditions in rural and remote locations, especially amongst Aboriginal populations.

Table 13: Rate of hospitalisation for gastroenteritis in children (0-4 years)

0

10

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30

40

50

60

Rat

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00

Non Aboriginal 13.3 10.5 6.9 5.9

Aboriginal 51.3 54.1 43.8 36.8

Target (≤) 21.3 19.9 19.9 17.5

2006 2007 2008 2009

Note This indicator measures hospital separations of children living in a given location who may attend a hospital close to home or in another Health Service area. This indicator is not necessarily a measure of the performance of the Health Service providing the hospitalisation. Data source Hospital Morbidity Data System; Australian Bureau of Statistics


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2-02: Rate of hospitalisation for respiratory conditions Rationale The number of children who are admitted to hospital per 1,000 population for treatment of respiratory conditions such as acute bronchitis, bronchiolitis and croup and the number of all persons admitted for the treatment of acute asthma may be an indication of improved primary care or community health strategies - for example, health education. It is important to note however, that other factors may influence the number of people hospitalised with these conditions. These conditions are ones that have a high number of patients treated either in hospital or in the community. It would be expected that hospital admissions for these conditions would decrease as performance and quality of service increases.

Results The recorded rates for 2009 of hospitalisation for respiratory conditions in non-Aboriginal populations across WACHS met all population targets. The reported results in 2009 for WACHS Aboriginal populations apart from croup, did not meet the targets for the respiratory conditions reported. Specific programs developed and implemented by WACHS target the prevention, management and treatment of respiratory conditions especially in Aboriginal populations. Programs target individuals, families, groups and communities and focus on the determinants of poor health.

Figure 5: Rate of hospitalisation per 1,000 persons for acute asthma (all ages)

Age 2006 2007 2008 2009

Non Aboriginal Aboriginal




Target <11.2 <10.6 <10.4 <9.7 0-4 years Result 8.3 15.7 8.8 14 8.1 16.7 7.6 14.3

Target <3.7 <3.9 <3.4 <3.3 5-12 years Result 3 3.8 2.9 3.3 3.1 3.7 3.2 3.6

Target <1.7 <1.5 <1.5 <1.4 13-18 years Result 0.9 3.1 1.2 1.8 0.9 1.9 0.9 1.4

Target <1.6 <1.5 <1.5 <1.4 19-34 years Result 1.2 3.4 0.9 2.6 1.0 3.2 1.2 3.2

Target <2.0 <1.8 <1.7 <1.6 35+ years Result 1.1 5.5 1.1 8.0 1.0 7.7 1.0 6.3


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Figure 6: Rate of hospitalisation per 1,000 children (0-4 years) for acute bronchitis

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r 1,0

00

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Non-aboriginal 0.7 1.1 0.9 0.5

Aboriginal 2.8 2.5 2.4 1.8

Target 1.3 1.3 1.2 1.2

2006 2007 2008 2009

Figure 7: Rate of hospitalisation per 1,000 children (0-4 years) for bronchiolitis

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00

0

10

20

30

40

50

60

70

Non-aboriginal 9.9 10.2 12.1 10

Aboriginal 54.3 46.7 60.9 57.1

Target 17.1 18.9 16.9 17.4

2006 2007 2008 2009

Figure 8: Rate of hospitalisation per 1,000 children (0-4 years) for croup

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00

0

2

4

6

8

10

Non-aboriginal 5.1 3.8 5.9 3.1

Aboriginal 7.7 4.1 6.4 4.4

Target 6.4 6.7 5.5 5.6

2006 2007 2008 2009

Note This indicator measures hospital separations of individuals living in a given location who may attend a hospital in their own or another Health Service. The performance of the Health Service providing the hospitalisation is not being measured. Data source Hospital Morbidity Data System Australian Bureau of Statistics


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2-10: Rate of hospitalisation for falls in older persons Rationale There are a number of illness prevention, and health promotion and protection initiatives delivered by Area Health Service Population Health Units supported by similar initiatives provided by Department of Health Divisions, aimed at community safety and well being and injury prevention. Some of these, such as the “Stay on Your Feet” program, are designed to reduce the incidence and severity of fall-related injuries and hospitalisations of older persons. The number of older persons admitted to hospital per 1,000 population of a specific age group for treatment as a result of a fall in a domestic or community setting may be an indication of the impact of these strategies. It would be expected that hospital admissions for these conditions would decrease as performance and quality of service increases. The hospitalisations for falls by older persons

demonstrates a relationship between falls events and an older person’s possible diminished mobility. A fall in the home or in a community setting can affect an older person’s quality of life. Targeting older persons with community and public health programs to prevent falls occurring can reduce injury and hospitalisation and support their ability to live safely at home. Results The hospitalisation rates recorded for 2009 continue to demonstrate a higher rate of hospitalisation for a fall for Aboriginal populations than for non-Aboriginal populations and that hospitalisation for a fall as expected, increases with age. Consultation with the Falls Prevention Network and other stakeholders is continuing to develop other performance measures and develop appropriate targets.

Table 14: Rate of hospitalisation per 1,000 for falls in older persons for 2009

2008 2009

Age Cohorts Aboriginal Non-Aboriginal Aboriginal Non-Aboriginal

55-64 years 32.4 4.3 22.0 5.3

65-79 years 45.3 16.5 34.8 17.5

80+ years 81.6 91.6 115.3 85.5

Note This indicator measures hospitalisations of individuals living in a given location who may attend a hospital in their own or another Health Service. The performance of the Health Service providing the hospitalisation is not being measured. Individuals may experience repeat hospitalisations from the same cause. Falls in hospitals and health facilities are not included in this KPI measurement, nor are falls occurring in settings not primarily targeted by the health promotion programs. Data source Hospital Morbidity Data System Australian Bureau of Statistics


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R2-51: Percentage of fully immunised children Rationale The community sets a very high priority on ensuring that the health and well being of children are safeguarded. It is important not only to restore children to good health when they become ill but also to maintain a state of ‘wellness’ that allows them to develop to full potential. One of the key components of this is to attempt to ensure that every child experiences the full benefit provided by appropriate and timely immunisation against disease, by delivering internationally recognised vaccination practices. Without access to immunisation for children the consequences of any illness or disability are likely to be more disabling and more likely to contribute to a premature death. This indicator measures the rate of complete immunisation against particular diseases, by age group, of the resident Health Service child population. The benchmark percentages for immunisations are the agreed targets in the National Childhood Immunisation Program as follows:

At least 90 per cent of children fully immunised at 12 months, 2 years and 5 years. Rates of hospitalisation for infectious diseases or treatment for complications of these diseases are shown in R2-52. Without an immunisation program there is likely to be higher rates of hospitalisation or more disability and death resulting from the diseases. Results For 2009 the percentage of WACHS non-Aboriginal children fully immunised continues to exceed the national targets for the age cohorts except for 5 yrs with results consistent with prior years. The 2009 immunisation percentages for Aboriginal children remain below the national benchmarks. WACHS continues to promote its immunisation programs across rural communities with specific attention given to Aboriginal communities.

Figure 9: Percentage of fully immunised children at 12 months, 2 years and 5 years

0%

20%

40%

60%

80%

100%

5 years 0 0 84.7% 80.4% 83.6% 73.9% 84.2% 78.8%

2 years 93.5% 86.3% 93.7% 89.1% 93.0% 89.4% 90.9% 81.5%

12 months 92.0% 79.1% 91.1% 77.3% 90.5% 82.1% 90.1% 80.4%

Target 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%

Non-AboriginAboriginal Non-AboriginAboriginal Non-AboriginAboriginal Non-AboriginAboriginal

Dec Quarter2006

Dec Quarter2007

Dec Quarter2008

Dec Quarter2009

Note Reporting the five year age group as per the National Childhood Immunisation Program commenced in 2007. Data source Australian Childhood Immunisation Register (ACIR); Australian Bureau of Statistics


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R2-52: Rate of hospitalisations for selected potentially preventable diseases

Rationale Area Health Services supported by Department of Health Divisions provide numerous health promotion, illness prevention and health protection strategies and initiatives aimed at optimising health and well-being, and preventing disease, illness and injury. To provide additional information about the effect of these programs, the rates of hospitalisation for treatment of some of these preventable diseases are monitored. In 2008 this indicator has examined the hospitalisation rates for the infectious diseases measles, mumps, diphtheria, pertussis, poliomyelitis, rubella, hepatitis B and tetanus which are subjected to prevention immunisation programs provided to the community. Commencing in 2009 additional preventable diseases will be added to this indicator. For 2008 hospitalisations were only recorded for pertussis 0-12 years and mumps 0-17 years. Cases are identified by the principal diagnosis recorded for a hospital admission. Performance targets There should be no individuals hospitalised for infectious diseases when an immunisation program is effective.

Results In 2009 WACHS recorded nine hospitalisations for Aboriginal populations and four for non-Aboriginal populations for pertussis for the recorded rates shown below. WACHS also recorded one hospitalisation for mumps for non-Aboriginal populations for a recorded rate per 100,000 of 0.9. The elevated rates of hospitalisation for pertussis are consistent with increased pertussis activity across Australia, from 2008 to present. The recent resurgence in pertussis is thought to result, in part, from waning immunity in older populations that may then acquire the illness and transmit it to younger, more vulnerable cohorts. The episodic re-emergence of pertussis underscores the need to ensure that young infants are vaccinated on time and the importance of promoting pertussis vaccinations among teenagers and carers of newborn children. WA Health continues to work with other jurisdictions and agencies to implement a national immunisation campaign to encourage adults, especially those caring for young children, to maintain their immunisations. WACHS population health units also monitor the occurrence of these diseases to inform any local refinement of immunisation programs.

Table 15: Rate of hospitalisation for preventable diseases per 100,000

2007 2008 2009

Aboriginal Non-Aboriginal Aboriginal Non-

Aboriginal Aboriginal Non-Aboriginal

Pertussis 0-12yrs 0.0 0.0 21.5 3.8 64.6 5.0

Mumps 0-17yrs 5.0 0.0 16.0 0.9 0.0 0.9

Note The indicator was originally titled ‘Rate of hospitalisation with an infectious disease for which there is an immunisation program’. The new title reflects a similar indicator under the new National Healthcare Agreement. In future reporting this indicator will include other ‘selected’ potentially preventable conditions. The hospitalisations reported will represent a range of conditions for which hospitalisation could be avoided because the disease or condition has been prevented from occurring or because affected individuals have had access to timely and effective primary care or health protection and illness prevention programmes. Data source Hospital Morbidity Data System; Australian Bureau of Statistics


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S7-00: Cost per capita of Population Health units Rationale Population health considers the health of individuals, groups, families and communities by adopting an approach that addresses the determinants of health. With the aim of improving health, population health works to integrate all activities of the health sector and link them with broader social and economic services and resources. This is based on the growing understanding of the social, cultural and economic factors that contribute to a person’s health status. Population health units support individuals, families and communities to increase control over and improve their health. In rural locations Population Health units provide both illness prevention and health promotion, and health protection services and programs including:

Supporting growth and development, particularly in young children (community health activities); Promoting healthy environments Prevention and control of communicable diseases Injury prevention Immunisation Promotion of a healthy lifestyle to prevent illness and disability Support for self-management of chronic disease Prevention and early detection of cancer Results In 2009-10 WACHS recorded a cost per capita for the Area Health Service’s Population Health Units of $189 slightly above target.

Table 16: Cost per capita of population health units

2006-07 2007-08 2008-09 2009-10 Target $168 $157 $174 $184

Actual cost $161 $164 $174 $189


Note Statewide corporate costs have been apportioned to this key performance indicator. Data source Australian Bureau of Statistics WACHS Finance Systems


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Outcome 3: Enhanced wellbeing and environment of those with chronic illness or disability The achievement of this outcome of the health objective involves provision of services and programs that improve and enhance the wellbeing and the environment of people with chronic illness or disability. To enable people with chronic illness or disability to maintain as much independence in their everyday life as their illness permits, services are provided to enable normal patterns of living. Support is provided to people in their own homes for as long as possible but when extra care is required long term placement is found in residential institutions. This involves the provision of clinical and other services which: • Ensure that people experience the

minimum of pain and discomfort from their chronic illness or disability.

• Maintain the optimal level of physical and social functioning.

• Prevent or slow down the progression of the illness or disability.

• Make available aids and appliances that maintain, as far as possible, independent living (for example, wheelchairs).

• Enable people to live, as long as possible, in the place of their choice supported by, for example, home care services or home delivery of meals.

• Support families and carers in their roles. • Provide access to recreation, education

and employment opportunities. Significant services are provided for people with a chronic illness or disability by the Area Health Services principally in the areas of contracted Mental Health, Community Care and Aged Care. Services and programs provide people with chronic illness and disability choices regarding their lifestyle and accommodation. A person with a disability, including a younger person, can also receive support through a number of other agencies including the Disability Services Commission and the Quadriplegic Centre. The DOH and Area Health Services also provide assistance to those with disabilities through the provision of Home and Community Care (HACC) services. This program is administered through the DOH and the effectiveness and efficiency indicators for HACC are reported by DOH.

Note Area Health Services will also provide acute services to those with disabilities under Outcome 1.


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MHC09: Percent of contacts with community-based public mental health non-admitted services within seven days post discharge from public mental health inpatient units

Rationale A large proportion of people with a mental illness have a chronic or recurrent type illness that results in only partial recovery between acute episodes, and a deterioration in functioning that can lead to problems in living an independent life. As a result, hospitalisation may be required on one or more occasions a year with the need for ongoing clinical care from community-based non-admitted services following discharge. These community services provide ongoing mental health treatment and access to a range of rehabilitation and recovery programs that aim to reduce hospital readmission and maximise an individual’s independent functioning and quality of life. This type of care for persons who have experienced an acute psychiatric episode requiring hospitalisation is essential after discharge, to maintain or improve clinical and functional stability and to reduce the likelihood of an unplanned readmission.

The time period of seven days has been recommended nationally as an indicative measure of follow up with non-inpatient services for people with a persistent mental illness. Results In 2009, 61 per cent of patients with a mental illness discharged from public mental health inpatient units had contact with a community-based public mental health non-admitted service within seven days of discharge. This result is above the set target and shows an improvement from the previous year. Patients may also be seen by private sector clinicians (e.g. General Practitioners, Private Psychiatrists, Private Psychologists) following discharge, for which data is not available. Mental health services endeavour to ensure that contact occurs as soon as possible following discharge.

Table 17: Percent of contacts with community based public mental health non-admitted services

within seven days post discharge from public mental health inpatient units.

Days to first contact 2007 2008 2009 Target 60% 60% 60%

0-7 days 52.9% 60.5% 61.0%

Note The Mental Health Commission commenced on March 8, 2010. However, for the full 2009-10 period, the WA Country Health Service (WACHS) will continue to report this indicator. Commencing in 2010-11 specific indicators for all contracted mental services provided by the WACHS will be reported by the Mental Health Commission. Previously reported as KPI 3-00. Data source Mental Health Information System, Data Collection and Analysis-Inpatient and Mental Health Information Management and Reporting DOH


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MHC10: Percent of contacts with community-based public mental health non-admitted services within seven days prior to admission to a public mental health inpatient unit

Rationale A large proportion of people with a mental disorder have a chronic or recurrent type illness that results in only partial recovery between acute episodes and deterioration in functioning that can lead to problems in living an independent life. As a result, hospitalisation may be required on one or more occasions a year with the need for ongoing clinical care from community-based non-admitted services. Access to community based mental health services may alleviate the need for, or assist with improving the management of, admissions to inpatient care. Many consumers admitted to public sector mental health acute inpatient units are known to public sector community mental health services and it is reasonable to expect that community services should be involved in pre-admission care. The time period of seven days was recommended nationally as an indicative measure of contact with public community based non-admitted services prior to admission to public mental health inpatient units. There is currently no agreed target

benchmark for the proportion of patients to be seen within seven days prior to admission and the target set is aspiratory and subject to review. Results In 2009, 67.7 per cent of the people who were to be admitted to a country public mental health inpatient unit were in contact with a community-based public mental health non-admitted service within seven days prior to admission. This result is above the target set by the Mental Health Commission. In addition to these clinical services, clients also have access to non-clinical support services reported under key performance indicators covered by the newly formed Mental Health Commission. Patients may also be seen by private sector clinicians (e.g general practitioners, private psychiatrists, private psychologists) prior to admission, for which data is not available Mental health services endeavour to ensure that contact is made with a person within seven days prior to admission.

Table 18: Percent of contacts with community-based public mental health non-admitted

services within seven days prior to admission to a metropolitan public mental health inpatient unit

Days to first contact 2009 Target 65%

0-7 days 67.7%

Note The Mental Health Commission commenced on March 8, 2010. However, for the full 2009-10 period, the WA Country Health Service (WACHS) will continue to report this indicator. Commencing in 2010-11 specific indicators for all contracted mental services provided by the WACHS will be reported by the Mental Health Commission. This is a new KPI. Data source Mental Health Information System Data Collection and Analysis-Inpatient and Mental Health Information Management and Reporting DOH


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MHC11: Average cost per three month period of community care provided by public community mental health services

Rationale Services provided by public community mental health services include assessment, treatment and continuing care. This indicator gives a measure of the cost effectiveness of treatment for patients (non-admitted/ambulatory patients) receiving care from public community based mental health services. The unit of measure for this indicator has been revised for 2009-10 to better reflect the coverage and scope that persons with a mental health condition receive from public community mental health services. Accordingly no comparatives are presented.

Results

In 2009-10 the average cost per three month period of care receiving care from public community mental health services was $1,783, below the target. While the note regarding corporate overheads applies, the result against target has been achieved due to an under-estimation in activity when setting the target.

Table 19: Average cost per three month period of community mental health care

2009-10 Target $1,959

Actual cost $1,783

CPI adjusted $1,740

Note The Mental Health Commission commenced on March 8, 2010. However, for the full 2009-10 period, the WA Country Health Service (WACHS) will continue to report this indicator. Commencing in 2010-11 specific indicators for all contracted mental services provided by WACHS will be reported by the Mental Health Commission. The mental health efficiency indicator target has been recast to exclude Statewide corporate overheads although these remain WA Health expenditure items and have been included in the reported result contributing to the actual cost. This is a new KPI. Data Source Mental Health Information Systems Area Health Service Financial Systems


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S9-20: Average cost per bed-day for specified residential care facilities, flexible care (hostels) and nursing home type residents

Rationale The WA Country Health Service provides residential care for patients who require long term care involving 24 hour nursing and support care. The provision of non-acute permanent residential care is a significant activity provided to rural clients across the WA Country Health Service where access to local alternative private or non-government providers may be limited. WACHS residential care services include permanent high dependency, high dependency respite, permanent low dependency and low dependency respite, nursing home type care in hospital, and hostel and flexible care.

This indicator reports the cost per residential aged care bed-day for residents of the specified residential aged care facilities in the Kimberley at Kununurra, and in the Pilbara at Karlarra and for all other WACHS residential aged care services. Results In 2009-10 WACHS recorded a cost per residential care bed-day of $448. The increased unit cost for WACHS casemix adjusted hospitals is a combination of additional allocations from Statewide corporate overheads for PathWest as well as adjustments adopted by WACHS to more effectively align and integrate cost processes with the introduction of Activity Based Funding and Activity Based Management.

Table 20: Average cost per bed day for specified residential care facilities, flexible care (hostels)

and nursing home type residents

2006-07 2007-08 2008-09 2009-10 Target $386 $396 $369 $447

Actual cost $337 $366 $389 $448


Note Statewide corporate costs have been apportioned to this key performance indicator. Data source WACHS HCARe data warehouse WACHS Financial Systems


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Significant Issues and Achievements 2009-10 The WA Country Health Service adopted a new strategic direction during 2009-2010 with Revitalising WA Country Health Service 2009-2012 outlining the way forward for health service delivery in regional WA. It follows on from the WA Country Health Service Strategic Plan 2007-2010 titled Foundations for Country Health Services.

This vision for revitalising country health services has been backed by significant investment from the State Government through its ‘Royalties for Regions’ program and through the support of industry and our partner health service providers. As a result an enormous amount of service and infrastructure development has occurred during the past financial year and is continuing across the WA Country Health Service (WACHS). These developments are predicated by the four pillars on which WACHS stands: • securing a fair share for country health; • service delivery according to need; • closing the gap to improve Aboriginal

health; and • workforce stability and excellence. Securing a fair share for country health Albany Hospital Redevelopment The State Government has contributed $166 million to the Albany Hospital redevelopment including $31 million from the ‘Royalties for Regions’ Funding Program. John Holland has been announced as the successful contractor to build the new Albany Health Campus with construction due to start in 2011. Agreement is also being negotiated with the Commonwealth Government for the provision of additional facilities to enhance cancer services and patient accommodation to the value of $5.7 million. Negotiations are continuing with private health providers for potential additional private health services to be included on the Albany Health Campus.

Broome Hospital redevelopment Stage two of the Broome Hospital redevelopment comprises the construction of two new facilities for Broome, the Acute Psychiatric Unit and the Paediatric Ward. Both of these buildings will be built simultaneously with a total budget of $17.3 million. Stage 2 went to tender in March 2010; and the successful builder (Norbuild)

was appointed in July 2010. Construction will commence in late July; and on completion of Stage 2, Broome Hospital will be a 65 bed facility (not including emergency treatment bays).

Esperance Hospital Facility and service redevelopment planning has been completed and has included extensive consultation with all key stakeholders. The services plan will inform the design and master planning for the Esperance Hospital redevelopment, which will include improving emergency, maternity, ambulatory care and community based primary health care services. It also supports co-location of general practitioner (GP) services on site at the hospital.

Critical care at Bunbury Hospital WACHS is undertaking a major redevelopment of critical care facilities and services at Bunbury Hospital. The project will provide both a four bed intensive care unit service and an expanded emergency department capacity. Refurbishment and equipping of the current high dependency unit to create the four bed intensive care unit (ICU) will be completed by early 2011. The total project capital funding of $14.9 million is available with $14.1 million from the Commonwealth. The project involves a set of highly interdependent capital and service developments.

Radiation Oncology Service WACHS is undertaking a major project to establish radiation oncology facilities and services at the South West Health Campus in Bunbury. This project has an estimated total capital cost of $15.2 million and is jointly funded by the State and Commonwealth, with the latter providing $6 million. Construction work on the radiotherapy centre commenced in March 2010 and is planned for completion in April 2011. Construction will be followed by installation and commissioning of


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the major items of radiation oncology equipment, including a linear accelerator. The new facility is scheduled to open in June 2011. This project is a first for rural Western Australia. It is planned that the centre will provide local radiation oncology services for approximately 70 per cent of those South West residents who require this type of cancer treatment.

Busselton Health Campus WACHS is currently planning for a major $77.4 million redevelopment of the Busselton Hospital on the current hospital site. Aurora Projects has been engaged to finalise detailed scoping work in order for this project to be progressed. Construction is scheduled to commence in mid 2012 and be completed in mid 2014. A number of options including the co-location of the mental health clinic and the involvement of the private sector in delivering various services are being reviewed by Government. Environmental issues are an important consideration in determining the master plan for the redevelopment.

Port Hedland Hospital The Port Hedland Hospital is being replaced by a new $136.7 million 68 bed hospital in South Hedland. Transition planning to the new Hedland Health Campus is under way. The health campus incorporates acute inpatient services, community mental health, population health, community aged care and support services. Construction is due to be completed in October 2010. The project remains on time and budget at this stage.

Nickol Bay Hospital ‘Royalties for Regions’ has committed $150 million to redevelop the Karratha Health Campus (Nickol Bay). Services planning is currently being finalised which will inform the capital design and master planning of the facility. It is anticipated that the redevelopment will be finalised by the end of 2013.

Kalgoorlie Health Campus WACHS is currently undertaking a major $55.8 million redevelopment of the Kalgoorlie Health Campus. The four stage redevelopment includes new palliative care, medical imaging and emergency department,

together with a significant refurbishment of out-patients and allied health areas. The new palliative care unit has commenced construction and is due for completion in February 2011. A recent Commonwealth initiative announced this year for a new $4.5 million cancer centre will also be incorporated within the current scope of works.

East Kimberley Development Package As part of the National Partnership Agreement, WACHS has been granted $50 million to implement a number of targeted priority infrastructure projects across the East Kimberley. These projects include: • $3.4 million to upgrade Wyndham health

facility and associated staff accommodation;

• $20 million for a new ambulatory care facility and $4 million for short term patient accommodation expansion at Kununurra Hospital;

• $3.2 million for Wyndham residential rehabilitation facilities;

• $4 million for remote aged care facilities and $5.5 million for the remote clinics at the Warmun and Kalumburu communities;

• $4.3 million for environmental health upgrades;

• $0.6 million for sobering up centres at Wyndham and Kununurra; and

• $5 million for health service provider housing in Kununurra.

$1.2 million for medical and imaging equipment The State Government’s ‘Royalties for Regions’ program has provided $1.2 million for the purchase of medical equipment across WACHS. In addition, six 16 slice computed tomography (CT) scanners have been installed or are close to being installed in Karratha, Esperance, Carnarvon, Geraldton, Kalgoorlie and Narrogin hospitals.

Pilbara Revitalising Health Services Initiative The Pilbara Health Partnership is a three-year $38.2 millon partnership between the State Government’s ‘Royalties for Regions’ program and major Pilbara industries (BHP- Billiton Iron Ore, Woodside, Chevron, North West Shelf Venture and Rio Tinto) that aims to boost health services in the region. This partnership funded the installation of a CT


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scanner at Nickol Bay Hospital in Karratha this year, and the installation of new medical equipment at Tom Price, Newman, Port Hedland, Nickol Bay and Onslow hospitals. Other initiatives include boosting emergency response capacity through the strengthening of volunteer ambulance services and emergency management education and training to improve disaster responses in the region. It is also planned to boost the number of emergency, surgical and paediatric medical specialists based in Karratha. These new specialists will reduce the number of emergency evacuations to Port Hedland and Perth and increase the number of more complex surgical interventions carried out in Karratha. The employment of an emergency department nurse practitioner at Newman Hospital will also improve emergency services at the hospital. A helipad will be built at Nickol Bay Hospital. An indigenous employment initiative will provide scholarships, training and employment opportunities to Aboriginal people in the Pilbara to encourage them to take up roles in the health service. Two sexual health nurses will be employed at Port Hedland and Newman, and women’s and children’s health services enhanced at Tom Price. Minor works and health service planning will be undertaken at small hospitals including Tom Price, Newman and Paraburdoo.

Service delivery according to need The State Government’s innovative Four Hour Rule Program (FHR) to improve the way hospital patients receive unplanned and emergency care is now under way State-wide. The FHR is being implemented across Western Australian hospitals to ensure that the majority of patients arriving at emergency departments are admitted, discharged or transferred within a four-hour timeframe, unless required to remain with the emergency department for clinical reasons. Albany, Broome, Geraldton, Kalgoorlie, Port Hedland and Nickol Bay hospitals have joined the King Edward Memorial Hospital and the Peel Health Campus in the third wave of WA hospitals to commence the program. Royal Perth, Sir Charles Gairdner, Princess Margaret and Fremantle hospitals were the

first WA hospitals to start the program in April 2009. Rockingham General, Armadale-Kelmscott Memorial, Swan District and Bunbury hospitals and the Joondalup Health Campus followed, joining the program in October 2009. Each hospital has been given two years to implement the major change.

Elective Surgery WACHS continues to have a strong focus on managing a growing elective surgery waitlist with increased surgical throughput and particular strategies to address over boundary cases. WACHS Kimberley are investing resources to tackle specialist referral and wait list management issues to ensure patients in the Kimberley have timely access to elective care, particularly aboriginal children. WACHS is proposing to target an additional 1,600 cases in 2010-2011 in order to maintain reasonable waiting times with growing demand for elective surgery.

Cancer Centres The Commonwealth has approved $22.291 million for rural cancer services infrastructure funding over the next three years. Improved cancer services facilities will be developed at Geraldton, Albany, Kalgoorlie, Northam and Narrogin. For example, in Geraldton service model planning will inform the design of the new cancer centre services in Geraldton. It is anticipated that capacity for seven chemotherapy chairs will be built along with patient accommodation units for patients travelling from other parts of the region to Geraldton for treatment. This centre will also have capacity for office, group and meeting space for a variety of health professionals involved in supporting people with cancer and their families. The services will provide multi-disciplinary, holistic, patient-centred care closer to home for more people. The facilities will be the base for providing chemotherapy treatments. It is expected that approximately 25 per cent of patients with more complex cancers will always need to travel to Perth for specialist treatment.

Aged Care Several programs are under way across the WACHS to improve access to aged care


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services and services for younger people with disabilities including: • Friend In Need Emergency (FINE) funding

for two positions in the South West and Great Southern in 2009-10, expanding to other regions over 2010-12. The program is attached to larger emergency departments to coordinate care for “at risk” older patients who are admitted to emergency;

• COAG funding over four years for sub-acute care, which includes rehabilitation services;

• visiting geriatrician and psycho geriatrician specialists to all regions;

• part-time clinical support positions in all regions for visiting geriatricians;

• day therapy in Albany, Bunbury, Geraldton, Northam and Kalgoorlie (and community physiotherapy in Northam);

• expansion of inpatient rehabilitation units in Albany and Geraldton, and new units in Bunbury and Kalgoorlie;

• community rehabilitation in Albany, Geraldton and Bunbury;

• appointment of a full time geriatrician to the South West;

• older adult mental health positions in Goldfields, Wheatbelt and South West regions, and

• continued growth in Home and Community Care programs across country regions with growth funding in 2009-10 of $2.3 million.

Mental health services planning WACHS is currently considering and will be responding to the consultation paper ‘WA Mental Health, Towards 2020’. Submissions will be made to the new Mental Health Commission. The new Strategic Directions for mental health services across WA will be informed by this paper and the discussions it generates, and will guide mental health service planning across WACHS to 2020. Community mental health services are provided in all WACHS regions. These are available to all age groups and are delivered in clinics and patients homes, in hospitals, and via outreach services to remote communities. Services provided include assessment and treatment interventions for moderate to severe mental illness. The challenges of providing a range of services across the spectrum of care require that

mental health teams in rural and remote areas work in partnerships with other service providers and agencies. Three WACHS regions (Goldfields, Great Southern and South West) have inpatient mental health facilities at their principal hospital sites. Vital areas of progress in 2009-10 have been: • Older Adult Mental Health: working in

partnership with aged care services, funding has been obtained to improve sub-acute mental health care to older people. This will include visiting psycho-geriatrician services as well as seed funding for community teams.

• Aboriginal Mental Health: WACHS has developed and submitted a position paper and business case to the Mental Health Commission for funding under the COAG National Partnership Agreement to improve the health of Aboriginal people.

• Broome Acute Psychiatric Unit: construction has commenced on a new inpatient mental health facility in Broome. This will service the northwest regions with completion anticipated in late 2011.

Specific mental health initiatives across WACHS include: • The Drumbeat Program - a music-based

therapy program helping at-risk youngsters in Narrogin to develop a greater sense of health and wellbeing. Drumbeat targets 12-24 year olds who are faced with a range of recognised risk factors including mental health disorders, drug and alcohol misuse and criminal activity. The program is delivered by the Rural Community Support Service (RCSS) and is designed to reach those young people for whom traditionally based therapies have failed. RCSS is run by the WACHS Great Southern Mental Health Service and is funded by the Commonwealth Department of Health and Ageing.

• WACHS Great Southern has also been offering adult, youth and Indigenous Mental Health First Aid courses to members of the public, government agencies and private and not-for-profit organisations across the southern Wheatbelt for the past four years. This award winning two-day course, funded by the Commonwealth Department of Health and Ageing, has been designed to provide


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important skills on how to support people in a mental health crisis situation or who are developing a mental health disorder.

Renal Dialysis Plan WACHS is finalising a 10 year plan for renal dialysis. The number of people on dialysis in rural and remote WA is projected to increase from 320 in 2010 to over 650 in 2021. The plan aims to keep people closer to home by increasing the number of people on home dialysis, and exploring alternative options such as placing dialysis facilities (chairs) in some small hospitals and remote clinics. An agreement has been reached with the Northern Territory governments to ensure that renal patients from the Central Desert area can access treatment at the closest appropriate service, regardless of what side of the border they live. The Western Australian and the Northern Territory government are also undertaking joint planning for the Central Desert to ensure that future health needs are met through a cooperative relationship between health service providers.

Wheatbelt Health Memorandum of Understanding The Wheatbelt Health Memorandum of Understanding (MOU) signed in 2008, established a framework for communication on health planning issues across the key stakeholders in the region. Signatories are WACHS Wheatbelt, the Wheatbelt Development Commission, three Wheatbelt zones of the Local Government Association and the Wheatbelt General Practice Network. The Wheatbelt Health MOU group initiated the Wheatbelt Planning Initiative to provide a reliable and representative documentation of community perceived health needs and suggestions for meeting them. The review produced a final report which is valued by key stakeholders as a comprehensive account and sound reflection of community views, aspirations and perceived needs regarding health services. This report will inform Wheatbelt services planning.

Eastern and Southern Wheatbelt planning Service planning is currently underway to inform service and capital developments at Merredin, Narrogin and surrounding smaller sites. The intent is to strengthen the services at the larger hubs and provide greater capacity for district community based

services to outreach to the smaller sites, and for the smaller sites to have more capacity to provide local community based health care services.

Services planning for Geraldton and Carnarvon health campuses Services planning for Geraldton Health Campus and Carnarvon Health Campus will inform the future service and facility requirements at these sites, to meet the needs of the growing population.

Telehealth Telehealth is the use of technology to complement service delivery by improving access to safe, high quality health care for regional residents, reducing inequities that arise because of distance, and providing education and training opportunities to local health workers in rural and remote areas. For example, an ophthalmologist in his private rooms is able to examine live eye images ‘streamed’ via specialised equipment to a video unit without the patient having to travel. A recent initiative includes a telehealth Corrective Services program that has led to a reduction in the number of prisoner escorts and prisoner attendances at public hospitals. Regular ‘virtual’ outpatient services are provided across WACHS in the specialities of burns, plastics, neurology, gastroenterology, amputee clinics, gerontology, pain management, infectious diseases, orthopaedic clinics, ophthalmology and otology. Extensive upgrades to technology and bandwith throughout WACHS has improved the quality of service for video connections, and extended the service to 350 sites across the State. About 98% of these are Internet Protocol (IP) enabled, meaning that there are no call costs, making the video connection for health both cost efficient and effective. There has been a steady uptake of telehealth services across rural and remote WA. In the Kimberley the number of video conferencing units has risen from nine in 2008 providing services to 15 patients per month to 27 units in 2010 with the number of patients using the service rising to 80 patients per month. In the Pilbara the use of videoconferencing for clinical services trebled between 2007 and 2009 with close to 450 occasions of service recorded in 2009. In the first half of 2010 this number has already been exceeded with 483


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telehealth consultations occurring between January and June. Under ‘Royalties for Regions’ and the industry supported Pilbara Health Initiative, multi-purpose practitioner carts have been installed in five emergency departments across the region. These carts will support clinical consultation and also enable medical peripheral equipment such as a vital signs monitor and video-scopes to be attached.

Patient Assisted Travel Scheme The Patient Assisted Travel Scheme (PATS) election commitment has been fully implemented. ‘Royalties for Regions’ provided an additional $30.8 million from 2008-09 to 2011-12 to reduce the financial burden on country residents who need to travel more than 100kms one way to access the nearest medical specialist services. Improvements to financial subsidies included increases for kilometre road travel and patient accommodation subsidies, as well as increased support to patients, particularly the aged, disabled and people who require treatment for cancer and a simplified and equitable accessible system to the Scheme including the development of a seamless web based data management system to ensure more timely processing of applications. Trends since January 2009 to date show an increase in demand for PATS with over 59,000 trips provided between April 2009 and March 2010 supported by Scheme expenditure across WACHS of over $25 million. Feedback from country areas indicates the improvements have met with approval of country residents.

Royal Flying Doctor Service In 2008-09 the State Government approved increased funding of $68.5 million over five years to the Royal Flying Doctor Service (RFDS) to build its capacity to achieve clinically appropriate response times. The increase has funded five new aircraft to replace existing ageing aircraft and two additional aircraft, increasing the RFDS fleet from 11 to 13 aircraft. A third additional aircraft is due for purchase in 2010-11. The increased capacity has resulted in improved response times for inter-hospital patient transfers, with further improvements expected in 2010-11, with the third additional aircraft. Funds of up to $3 million over three

years were also approved for the RFDS in 2009-10 to underwrite a new medical jet service. The service is a three year pilot program being established by the RFDS, with the support of Rio Tinto Iron Ore. The service will reduce the flight times for inter-hospital patient transfers for critically ill country patients in the Northwest, being transported to tertiary hospitals in Perth for treatment.

Closing the gap to improve Aboriginal Health Over the next three years, WA Health is investing $117 million in the Closing the Gap in Aboriginal Disadvantage National Partnership Agreement which addresses five priority areas: • tackling smoking; • healthy transition to adulthood; • making Indigenous health everyone’s

business; • primary health care services that can

deliver, and • fixing the gaps and improving the patient

journey. The State will contribute a further $11.25 million over the next four years for Element 3 of the Indigenous Early Childhood Development National Partnership Agreement, while the Commonwealth has contributed $17.12 million for Element 2 to target: • Increased access to antenatal care, pre-

pregnancy and teenage sexual and reproductive health, and

• Increased access to, and use of, maternal and child health services by Aboriginal families.

A critical component of the COAG process entailed provision of support from the nine WA metropolitan and regional Aboriginal Health Planning Forums. These forums were responsible for developing overarching Aboriginal Health Plans and coordinated responses for the submission of health service proposals to meet Closing the Gap and Indigenous Early Childhood Development objectives and outcomes. Over 160 service proposals were developed, of which 120 were endorsed by the Aboriginal Health Planning Forum for implementation on a regional or state-wide basis. Contracts with agencies for the provision of these services were finalised in July 2010.


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Workforce stability and excellence Rural Generalist Pathway The Rural Generalist Pathway focuses on developing medical graduates in country WA through the internship year and beyond to boost the regional medical workforce. The focus is on providing doctors with wide ranging skills in general practice, obstetrics, anaesthetics and other areas. It is anticipated this program will produce 40 rural generalist doctors to work in rural and remote WA per year. The State Government’s ‘Royalties for Regions’ program has provided $8.5 million over three years for travel and accommodation for these doctors.

Staff Accommodation The Area Health Service currently owns 576 staff houses and manages 454 leases for staff. The organisation continues to increase investment in improving both the standard of and access to, suitable accommodation for its staff across regional WA. For instance, lease payments for staff accommodation in 2009-10 were $17 million across WACHS, representing a significant increase in investment from preceding years. The increase in investment in staff accommodation leases has been augmented by a substantial capital investment in staff accommodation via initiatives such as the Capital Expenditure Program. This funding has seen $36.6 million invested in purchasing or constructing new staff accommodation across WACHS. It is expected that total funds will be expended by the end of 2011. In line with State Government policy, WACHS is working with Government Regional Officers Housing Unit (GROH) and the Department of Housing and Works (DHW), to transfer Area Health Service owned housing stock, occupied by permanent or long-term employed staff, to GROH. This initiative will reduce WACHS’s exposure to the current housing challenge. WACHS Mid-West is working closely with Geraldton University Centre, Durack Institute of Technology, St John of God Hospital, the Combined Universities Centre for Rural Health, Rural Clinical School and other adjacent health services to develop a proposal to extend the existing Durack

Accommodation Village to form a more comprehensive village that is capable of housing a wide range of health and education staff and students.

WA Country Health Service Nursing and Midwifery Leadership Forum 2010 The Nursing and Midwifery Leadership Forum was held on 18 and 19 February 2010 in Perth and was sponsored by the WA Health Nursing and Midwifery Office. This was the fourth WACHS Nurses Leadership Forum since the first was held in 2005. The Forum was designed to provide an opportunity for nurses and midwives across WACHS to: • share their innovative ideas; • develop and enhance networks; and • showcase improvements being made in

patient care. The WACHS Nursing and Midwifery Leadership Development Framework was launched at the Forum and was the first in a series of leadership master classes. The Forum was a great success with 105 senior nurses and midwives attending over the two days. It provided opportunities for nurses and midwives to network with their rural and remote peers, and share ideas through the formal array of power point presentations and regional poster displays. Forum features were a Master Class and Open Space plus an opportunity to undertake a site visit to a series of departments at Royal Perth Hospital. A follow up Master Class has been delivered with more classes planned via video conferencing facilities for nurses and midwives across WACHS. The next Forum is planned for February 2011 with a focus on aged care, midwifery and community health.

Cultural Awareness Training WACHS has contracted the Aboriginal Health Council of WA (AHCWA) to develop and deliver cultural awareness training across the state. This work will complement the WACHS Aboriginal Reconciliation Framework which is currently being developed. Funding of $80,000 provided in 2010-11 will train a specific number of WACHS employees in cultural awareness competencies. An independent evaluation will be conducted


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using this grant to provide recommendations for future cultural awareness strategies across the organisation.

Service provision During the period April 2009 to March 2010 WACHS hospitals experienced a 10 per cent increase in total separations. However, the volume of beddays, both acute and residential, only increased by 2.1 per cent from 487,093 beddays in 2008-09 to 497,378 in 2009-10. Attendances across the five Triage categories at WACHS emergency services increased by 2.8 per cent in 2009-10 compared to 2008-09 although the number of emergency attendances with the more serious triage categories of 1, 2 and 3 rose by 6.5 per cent, 46.8 per cent and 6.4 per cent respectively. Non-admitted occasions of service also continued to rise with an increase by 1.7 per cent in 2009-10 following a 1.0 per cent increase in 2008-09. There was a 16.6 per cent increase in the number of PATS trips provided April 2009 to March 2010, a reflection of the increased resources provided to the Scheme. In 2009, 4,390 babies were born in WACHS public hospitals. In 2009 mental health ambulatory service occasions increased 25.6 per cent with the total number of persons receiving these services increasing by 12.6 per cent compared to 2008.


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Overview Activity Figure 10: Residential and Acute Care bed-

days

Note: Bed-day data for all WACHS hospitals excluding Boarders. Figure 11: Non-admitted occasions (hospital

and nursing post)

0

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800,000

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Figure 12: Total trips for the WACHS Patient Assisted Transport Scheme

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Figure 13: Elective Surgery Cases

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,423

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Figure 14: Emergency service attendances

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WACHS

150,000 175,000 200,000 225,000 250,000 275,000 300,000 325,000 350,000

2006-07 2007-08 2008-09 2009-10

Acute Care Beddays Residential Care Beddays


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Priorities for 2010-11 The 2010-11 State Budget provided a major funding boost for WA Health, and country health services in particular stand to benefit from the introduction of important new initiatives.

Health Infrastructure The commencement and accelerating pace of construction on a number of additional major WACHS infrastructure projects means that budgeted expenditure on these capital works during 2010-11 will be $160.5 million, up 40 per cent on planned capital spending in 2009-10. The substantial effort that has gone into the planning and design of these facilities is now coming to fruition in their physical construction. Major project spending in 2010-11 includes: Port Hedland Hospital ($40.2 million of a total budget of $137 million); Albany Hospital ($32 million of a total budget of $166 million); Kalgoorlie Hospital ($10.7 million of a total budget of $55.8 million); and Development of health services in the Kimberley ($70 million) WACHS’s capital works program is further expanded in the 2010-11 State Budget with the allocation of an additional $220 million from the ‘Royalties for Regions’ Fund for new capital works in country Western Australia. The centrepiece of this investment in our regions is $150 million for a new hospital at Nickol Bay (Karratha), recognising the growing demand for health care services in the State’s north-west. Construction of the new hospital is expected to start in 2011-12 and be completed in 2014-15. Additional ‘Royalties for Regions’ funding has also been provided to: Refurbish the Exmouth health clinic ($8.1 million) by 2011-12 to better cater for dental, mental health, pathology, occupational health and community health; Upgrade Carnarvon Hospital ($20.8 million) for mental, allied and community health; a new dental facility, as well as redevelopments to day surgery and pathology renovations; Upgrade Esperance Hospital ($18.8 million contribution to $31.8 million total project cost)

due to start in 2010-11. The hospital will have substantially improved emergency, maternity, obstetrics and medical imaging services. It will also provide a ‘one-stop shop’ for ambulatory care, community and allied health services which will have strong links with local GP services; and Upgrade health infrastructure in remote indigenous communities ($22.2 million). Planning will continue or commence on the: $77 million Busselton Hospital development – construction to start in 2012; $13.9 million redevelopment of Harvey Hospital with construction to start in 2012; $9 million redevelopment of Merredin Hospital; and $9 million redevelopment of Narrogin Hospital.

Emergency Ambulance Services The 2010-11 Budget allocates additional funding of $41.1 million over four years to improve emergency ambulance services across country WA. This includes $26.1 million from the ‘Royalties for Regions’ fund for country ambulance service enhancements. This funding will be used to significantly improve ambulance service capacity and ambulance response times in major regional centres as part of a new performance-based service agreement with St John’s Ambulance commencing in 2010-11. The funding will also provide much needed support for volunteer ambulance crews in country WA by funding the placement of additional community paramedics in specific locations over the four years, and providing additional regionally based support to St John Ambulance staff and volunteers in the country. In the first year of the agreement there will be funding for up to ten community paramedics to be located around WA in priority locations to be agreed between WACHS and St John Ambulance. Funding for these community paramedic positions includes an extra $6.7 million over four years through the Pilbara


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Priorities for 2010-11 (continued) Health Initiative which will provide five paramedic positions in the Pilbara. The Pilbara Health Initiative is a $38.3 million partnership between the State Government and major Pilbara industries to boost health services in the region. Under the partnership agreement, $32.96 million of funding is being provided through the ‘Royalties for Regions’ Pilbara Revitalisation Plan, with the Chamber of Minerals and Energy’s Pilbara Industry’s Community Council (PICC) Health Initiative members (BHP Billiton Iron Ore, Chevron Australia Pty Ltd, North West Shelf Joint Venture, Rio Tinto and Woodside Energy) contributing $5.28 million. ‘Royalties for Regions’ funding will enable enhanced ambulance services to be provided by WACHS in the Kimberley and new services in the Pilbara at Nullagine and Marble Bar. Both the Kimberley and Pilbara will be able to purchase new ambulances over the four years; seven in the Kimberley and two in the Pilbara. Improved clinical coordination for patients needing to be transported for emergency treatment from location to location will also be supported. A subsidy scheme will be introduced for indigenous communities in rural and remote communities currently serviced by their local St John Ambulance sub centre, who will be able to subscribe for an annual St John Ambulance membership.

Child Development Services The 2010-11 Budget allocates additional funding of $1.7 million over four years to support young country Western Australian children in need of speech pathology, occupational therapy, physiotherapy, and other clinical support services. The funding will enable an additional 16 specialist child health professionals to be appointed in 2010-11, targeting reductions in waiting times for all disciplines. The new funding will address key priorities from the report by Parliament’s Education and Health Standing Committee, Invest Now or Pay Later: Securing the Future of Western Australia’s Children.

Four Hour Rule The implementation of the Four Hour Rule Program into WACHS commenced in October 2009 with Bunbury Hospital, followed

by other country hospitals starting the program in May 2010. The focus will be on streamlining and enhancing patient care and will provide an opportunity to review treatment methods currently in place and implement changes, where required, to streamline and improve the patient’s care in hospital. Bunbury hospital has set a target of 85 per cent of patients being seen in the emergency department and admitted, discharged or transferred within four hours to be achieved by October 2010. The other five WACHS hospitals to take on the challenge to implement the Four Hour Rule are, Albany, Broome, Nickol Bay (Karratha), Port Hedland and Geraldton.

Activity Based Funding / Management The introduction of the Activity Based Funding (ABF) and Activity Based Management (ABM) approach to plan, budget, allocate and manage activity and financial resources will be a major initiative in 2010-11. ABF / ABM will be the tool which assists the capturing of consistent information on activity and the costs of delivery of services to enhance public accountability, drive technical efficiency in the delivery of health services and support improved clinical outcomes for patients. It will aid the management of variation in costs and practices to improve efficiency and effectiveness and provide evidence based mechanisms to reward good practice and support quality initiatives. ABF / ABM will provide WA Health with a whole system management framework that integrates clinical services, planning, funding, resource allocation, resource utilisation and quality management. The WACHS Area Office and the regions are working with the Department of Health to implement the principles of ABF / ABM and apply the funding concept to 2010-11 operations particularly for admitted, emergency and non-admitted service provision.

Improving Aboriginal Health Work will continue to support the implementation of service initiatives under the Closing the Gap in Aboriginal Disadvantage and Indigenous Early Childhood Development National Partnership. These


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initiatives are taken to help improve the health and lives of Aboriginal people living in rural and remote Western Australia. The implementation of these initiatives will require an increased Aboriginal workforce across government providers, Aboriginal community controlled services and other private and non government agencies. The recruitment and retention of an Aboriginal workforce has been identified as a critical factor in the delivery of these services and programs. Approximately 75 new positions, to be filled by Aboriginal people, will be created within WACHS as part of these initiatives. A $1.2 million State Government ‘Royalties for Regions’ funded cardiac program called Cardio-vision will provide better care and improve the health of Aboriginal people in the Pilbara who suffer from heart failure and acute coronary syndrome.

Mental health The new Strategic Directions for mental health services across WA will be informed by the consultation paper ‘WA Mental Health, Towards 2020’ being prepared by the newly formed Mental Health Commission. During 2010-11 the WA Country Health Service will continue its work towards developing a plan for mental health including mental health promotion and an integrated service delivery model for drug and alcohol and mental health disorders.

Medical workforce recruitment Through the State Government ‘Royalties for Regions’ program $8.5 million has been provided over three years to support travel and accommodation for doctors taking up the Rural Generalist Pathway program. It is expected that this initiative, which focuses on developing medical graduates in country WA through the internship and beyond, will significantly boost the regional medical workforce, producing 40 rural generalist doctors to work in rural and remote WA each year. These doctors will have wide ranging skills in general practice, obstetrics, anaesthetics and other areas.

E-Health WACHS will develop and implement a strategy for e-health records and health communication that will enable the secure electronic exchange of clinical information, and strengthen links to regional and metropolitan hospitals and private providers through the use of telehealth and other e-health services.

Aged Care Work will continue to improve access to aged care services and services for younger people with disabilities during 2010-11. This will include improving access to residential aged care through initiatives such as the COAG Long Stay Older Persons Initiative. The ‘Friend in Need Emergency’ program will be expanded to cover six regions during 2010-11 and the Wheatbelt in 2011-12 to better coordinate care for ‘at risk’ older patients who are admitted to hospital emergency departments in country WA.


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Advertising The following table lists expenditure on advertising, market research, polling, direct mail and media advertising made by the WA Country Health Service and published in accordance with the requirements of Section 175ZE of the Electoral Act 1907. The total expenditure for Advertising for the WACHS in 2009-10 was $367,314. Table 21: 2009-10 WACHS Advertising expenditure

Summary of Advertising Amount ($)

Advertising Agencies 302,889

Market Research Organisations 119

Polling Nil

Direct Mail Organisations Nil

Media Advertising Organisations 64,306

Total 367,314 Recipient / Organisation Amount ($)

Advertising Agencies Adcorp Australia Ltd 292,042

Albany Advertiser 787

Albany Chamber of Commerce 576

Britel Enterprises Pty Ltd 495

Co-ordinates Therapy Services 379

Coral Coast Print and Design 788

Countrywide Media Pty Ltd 583

Market Creations Pty Ltd 4,928

Marketforce Productions 1,033

Marketforce Express 93

M2 Technology Pty Ltd 165

Newman Mainstreet Project Inc. 182

Nursing Review 787

Sensis Pty Ltd 51

Total 302,889 Market Research Media Monitors 119

Total 119 Polling Organisations Total Nil Direct Mail Organisations Total Nil


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Recipient / Organisation Amount ($) Media Advertising Adcorp Australia Ltd 448 Adepto Publications Pty Ltd 438 Albany Advertiser 6,140 APN Educational Media 715 Australian College of Health Service Executives 1,000

Boddington Community Newsletter 43

Collie Mail 116

Chittering Times 616

CMPMedica Australia Pty Ltd 1,774

Daylabels Advertising Services 573

Denmark Bulletin 111

Geraldton Newspapers Ltd 1,109

Great Southern Herald 142

Hits Radio Pty Ltd 639

Infection Control Association of WA Inc. 330

Jokers on Ryrie Advertising Services 77

Jurien Bay Telecentre 50

Kununoppin Agencies 46

Magpie Squawk 20

Marketforce Productions 218

Midwest Aboriginal Media Association 9,520

Medical Life Publishing Pty Ltd 4,500

Nursing Review 11,025

Rural Press Regional Media (WA) Pty Ltd 421

Sensis Pty Ltd 264

Smith and Brown Design 1,000

South West Printing and Publishing 292

Telecentre Network 61

Telecentre Network (Dalwallinu) 720

Telecentre Network (Lakes Link) 10

Telecentre Network (York) 220

Telecentre Network (Wongan Hills) 176

Telstra Corporation Ltd 34

The Australasian College for Emergency Medicine 3,953

The Fence Post 124

The Gimlet Newspaper 14

The Kimberley Echo 300

The Muddy Waters 260

The Nursing Post Pty Ltd 11,858

The West Australian 120


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Recipient / Organisation Amount ($) WA News 72

Weekender 1,177

Wheatbelt Chamber of Commerce 100

Whistling Moose Graphics 3,480

Total 64,306


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Disability Access and Inclusion Plan The Disabilities Services Act 1993 requires public authorities to develop and implement a Disability Access and Inclusion Plan and undertake a continuous process of review to ensure the organisation meets the outcomes outlined in the Act. Disability Access and Inclusion Plans (DAIP) has been implemented in each region in accordance with the WA Country Health Service (WACHS) DAIP and the WA Health DAIP. DAIP committees in each WACHS region work to ensure that the Outcomes detailed in the legislation are addressed in the activities undertaken by WACHS’ hospitals, health care facilities and within the various health programs implemented by the Area Health Service. The following is a selection of the specific actions undertaken during 2009-10 across WACHS in relation to the outcomes of the WA Health DAIP. Outcome 1

People with disabilities have the same opportunities as other people to access the services of, and events organised by, the relevant public authority: • The WACHS regional DAIPs have been

reviewed to ensure all appropriate standards and design codes have been applied to infrastructure developments including projects at the South West radiation oncology service, and at Augusta, Busselton and Margaret River hospitals, in the East Kimberley and Broome, at Onslow resulting in improvements to access ramps, pathways, road surfaces and signage.

Outcome 2

People with disabilities have the same opportunities as other people to access the buildings and other facilities of a public authority: • DAIP is a standing agenda item for all

WACHS capital works projects across all regions.

• WACHS regions regularly audit and assess their facilities to ensure they comply with current disability access criteria and allocate resources appropriately to maintain and improve disability access.

Outcome 3

People with disabilities receive information from a public authority in a format that will enable them to access the information as readily as other people are able to access it: • In accordance with the regional DAIPs,

WACHS regions conduct periodic audits of public information provided to ensure they are kept up-to-date, especially to meet local needs and current advice from clinical specialists such as speech therapists, and are produced in accordance with the DOH Communications Style Guide and available in alternative formats.

• In particular, Aboriginal Health Workers at all sites are able to provide information in an appropriate manner including translation services to assist aboriginal people with a disability to access services.

Outcome 4

People with disabilities receive the same level and quality of service from the staff of a public authority as other people receive from the staff of that authority: • Regional accessibility audits involve the

participation and feedback of people with a disability to identify areas where there is a breakdown in the provision and/or quality of services and facilities for those with a disability.

• WACHS regions provide all staff with education and training including on-line options, on the regional DAIPs and disability access in general, especially providing disability awareness training in employee induction sessions, self-directed learning packages and in WACHS global communications.

Outcome 5

People with disabilities have the same opportunities as other people to make complaints to a public authority: • The South West complaints management

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Disability Access and Inclusion Plan patients and customer liaison officers have been appointed. • Across WACHS the number and subject of

all complaints is monitored and provides information to management regarding common and repetitive items which need to be reviewed and actioned. Regions maintain complaints registers recording the complaint and action taken.

• WACHS regions provide all staff with specific education and training on the processes for dealing with complaints and enquiries from clients, patients and the public.

• Complaints can be received in a number of different ways: in person; by telephone; by email or letter. Regions conduct regular reviews and audits on the complaints process and on the complaints received, to ensure relevance to people with a disability, including complaint documentation and the availability of alternative methods to progress a complaint. All complaints are treated equally irrespective of the complaint’s background or personal circumstances.

• Complaints brochures especially designed for Aboriginal people are provided.

• Contact information for other agencies that assist people with disabilities is also provided to patients and clients where these agencies may be able to progress and resolve a complaint or issue, for example the Disability Services Commission (DSC) Local Area Coordinators.

• All sites provide information regarding Advocare, an agency that provides regular visits to regional areas to advise people with disabilities about their services.

Outcome 6

People with disabilities have the same opportunities as other people to participate in any public consultation by a public authority: • People with a disability are encouraged to

participate in the work of the various District Health Advisory Committees (DHACs), particularly in relation to services to those with a disability. Where community consultation is used or required, a venue is chosen that enables people with disability to take part.

• People with disabilities are sought to participate in regional DAIP assessments and facility audits to ensure services and facilities are accessible to those with a disability.

An initiative introduced by WACHS Midwest has been the Annual Mystery Observer Exercise. The Mystery Observer when used in conjunction with other processes, can provide useful feedback to a health service about courtesy of staff and the ease with which necessary information, services and care is provided. Mystery Observer Tools are used in many service industries. This is useful information gathering tool for regional DHACs where, following discussion with the Regional Director or District Manager to inform the health service that the concept will be used, the process is applied without prior knowledge of the time frame. While forewarning may alert the health facility and some bias may occur through awareness, the variations in the time frame allow for more insightful observation. There are varying perceptions of the benefits and concerns about the Mystery Observer Tools and planning for its use and applying the principles and practice in the guidelines is required to achieve useful feedback.


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Employee Profile Agencies are required to report a summary of the number of employees by category, in comparison with the preceding financial year. The table below shows the average number of full-time equivalent staff employed by WACHS for 2009-10 by category. Table 22: WACHS Total FTE by Category

Category Definition 2008-09 2009-10 Administration and clerical

Includes all clerical-based occupations – ward and clerical support staff, finance managers and officers. 1,181 1,177

Agency Includes contract staff in occupational categories: administration and clerical, medical support, hotel and site services, medical.

34 34

Agency nursing Includes nurses engaged on a “contract for service” basis. 131 71

Assistants in nursing

Support registered nurses and enrolled nurses in delivery of general patient care. 1 5

Dental nursing Includes dental clinic assistants. 0 0

Hotel services Includes catering, cleaning, stores/supply laundry and transport occupations. 1,265 1242

Medical salaried Includes all salary-based medical occupations including interns, registrars and specialist medical practitioners.

216 226

Medical sessional Includes sessional based medical occupations. 8 7

Medical support Includes all Allied Health and scientific/technical related occupations. 601 636

Nursing Includes all nursing occupations. Does not include agency nurses. 2,444 2,518

Site services Includes engineering, garden and security-based occupations. 165 164

Other categories Includes Aboriginal and ethnic health worker related occupations. 83 90

Total 6,128 6,171 Totals may not add due to rounding. Notes FTE is calculated as the monthly Average FTE and is the average hours worked during a period of time divided by the Award Full Time Hours for the same period. Hours include ordinary time; overtime; all leave categories; public holidays, Time Off in Lieu, Workers Compensation. FTE figures provided are based on Actual (Paid) month to date FTE. The 2008-09 reported data has been realigned to reflect the 2009-10 FTE WACHS grouping. Data Source HR Data Warehouse, extracted August 2010.


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Freedom of Information For the year ending 30 June 2010, the WA Country Health Service considered 1,812 applications for access to information in accordance with the Freedom of Information Act 1992. Table 23: Freedom of information applications 2009-10

Applications Number

Carried over from 2008-09 70

Received in 2009-10 1,742

Total applications received in 2009-10 1,812

Granted full access 1,316

Granted partial or edited access 326

Withdrawn 35

Refused 43

In progress 63

Transferred and other 29

The types of documents held by WACHS include: administrative documents, including: • minutes of meetings and committee proceedings; • policy and procedure manuals; • finance, accounting and statistical documents; • equipment and supplies documentation; • works and buildings documentation; • staff and human resource records; • health and hospital service related material; • accreditation and quality assurance documents; • medical and allied health records; • information technology documentation; and • health information and pamphlets.

Industrial Relations Please see the Department of Health Annual Report 2009-10.


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Internal Audit ControlsThe Corporate Governance Directorate has the role of accountability adviser and independent appraiser, reporting directly to the Director General of Health. The Directorate provides internal audit, accountability and risk services to the Director General, Senior Management and WA Health, in support of the common objective of achieving and maintaining sound managerial control over all aspects of operations.

Completed audits are considered by the relevant executive (generally through the local audit liaison meetings), and are also considered at the WA Health Audit Committee. The Audit Committee has external and internal representation, and has an external Chair and Deputy Chair. The Audit Committee, which also has oversight over the Strategic Audit Plan, meets on at least a quarterly basis. Audits undertaken were generally planned audits; however, on occasion, management

initiated audits or special audits were also carried out. Audits target numerous subject areas including financial and operational compliance, service performance or information system efficiency or integrity. In addition, external consultants were utilised to complete some audits either independently or in a co-sourced arrangement. The audit process assists senior management to achieve sound managerial control. Thirty five internal audits were completed during the reporting period:

Table 24: Completed Audits

Audit Area audited Review of Aboriginal Healing Project Contract North Metropolitan Area Health Service

Alesco Web Self Service Security Health Corporate Network Review of AMA Industrial Agreement (Private Practice Arrangement A) Metropolitan Area Health Services

Ambulatory Surgery Initiative WA Health Capital Project Health Check Fiona Stanley Hospital South Metropolitan Area Health Service

Review of Coffee Shop Cash Handling Controls – Princess Margaret Hospital Child and Adolescent Health Service

Compliance With E-Health 2007 OAG ICT Project Management Issues Health Information Network

Corporate Governance Review Health Corporate Network

Corporate Governance Review PathWest Review of Documentation Compliance – Royal Perth Hospital Ventricular Assist Device (VAD) Program

South Metropolitan Area Health Service

Review of Financial Statement Close Process 2009

Metropolitan Area Health Services and Department of Health

Review of HCN Feeder Process Fremantle Hospital and Health Service, South Metropolitan Area Health Service

Review of HCN Feeder Process Health Corporate Network

Review of HCN Feeder Process Princess Margaret Hospital North Metropolitan Area Health Service

Review of HCN Feeder Process Sir Charles Gairdner Hospital North Metropolitan Area Health Service

Review of Internal Audit Report on compliance with supply policies Health Corporate Network

Review of iPharmacy Project Health Information Network IS Governance E-health Program Patient Administration System Health Information Network

Mental Health Unit, Sir Charles Gairdner Hospital, Capital Project Health Check North Metropolitan Area Health Service


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Audit Area audited Review of Oracle Security and separation of duties Health Corporate Network

PathWest Billing System – ULTRA PathWest

Review of PathWest Capital Expenditure PathWest Patient Billing in Radiation Oncology (Sir Charles Gairdner Hospital) North Metropolitan Area Health Service

Review of Patients’ Private Property Murchison Ward - Graylands Hospital

Office of the Chief Psychiatrist Department of Health

Review of Payroll Services Health Corporate Network

Review of Purchasing Cards Health Information Network

Review of Purchasing Cards Director General’s Division

Review of Purchasing Cards Health Finance

Review of Purchasing Cards Innovation And Health System Reform

Review of Purchasing Cards Office Of Aboriginal Health

Review of Purchasing Cards Public Health Division

Review of SPAs – Royal Perth Hospital South Metropolitan Area Health Service

The Privately Referred Non-Inpatient Model WA Health Review of the Use Of Policy Within The WA Health System WA Health

WA Country Health Services Financial Management Act Compliance Review WA Country Health Service


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Major Capital WorksPlease refer to the 2009-10 Department of Health Annual Report for financial details of capital works in the WA Country Health Service. Table 25: Major Capital Works in WACHS

Capital works projects completed in the WACHS during 2009-10

Capital works projects in progress in the WACHS during 2009-10

Broome Regional Resource Centre Redevelopment stage 1

Kalgoorlie Redevelopment Stage 1 Albany Health Campus Stage 1

Broome Paediatrics and Mental Health Units

Wyndham MPC

Port Hedland Regional Resource Centre Stage 2 Country staff accommodation Stage 4 – South Hedland CT projects at Esperance, Carnarvon and Narrogin Karratha Staff Accommodation South West New Radiotherapy Facility South West Critical; Care Unit Bunbury $50m East Kimberley Development Package

WACHS Staff Accommodation Stage 3 – Staff Housing Port Hedland

CT Installation Nickol Bay Hospital


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Pricing PolicyThe National Healthcare Agreement (NHA) sets the pricing framework for the charging of public hospital fees and charges.

Under the National Healthcare Agreement, where a Medicare eligible patient elects to receive medical treatment as a public patient in a public hospital, or publicly contracted bed in a private hospital, they will be treated ‘free of charge’. Patients in a public hospital for more than 35 continuous days, who no longer require acute care and are deemed to be Nursing Home Type Patients, may be charged a patient contribution as determined by the Commonwealth Minister for Health and Ageing. Private patients, compensable patients and ineligible persons may be charged an amount for public hospital services as determined by the State of Western Australia. This can be on a full cost recovery basis. The Commonwealth Department of Health and Ageing sets the minimum default benefit payable by private health funds to privately insured patients. The State sets its fees for these patients to equate with the minimum default benefit. Pharmaceutical items supplied to admitted private patients will be provided ‘free of charge’ and cannot be claimed under the Pharmaceutical Benefits Scheme. The pricing policy for the setting of public hospital accommodation charges to private patients aims to pass on health indexation costs to health funds. Under the National Healthcare Agreement, eligible patients who have entered into ‘third party’ arrangements with compensable insurers are known as compensable patients. This cohort of compensable patients may include among other groups, the Australian Defence Force, the Insurance Commission of

Western Australia covering motor vehicle accident patients, and WorkCover for workers’ compensation patients. The charging of eligible war service veterans is determined under a separate agreement with the Department of Veterans’ Affairs. Under this agreement the Department of Health does not charge medical treatment costs to eligible war service veteran patients, instead medical charges are to be recouped from the Department of Veterans’ Affairs. In summary, the majority of hospital fees and charges for public hospitals are set out in the Hospitals (Services Charges) Regulations 1984 and the Hospitals (Services Charges for Compensable Patients) Determination 2005. These public hospital fees and charges are reviewed annually and increased each financial year in accordance with Ministerial and other approval processes. The exceptions to this general rule are pharmaceuticals and nursing home type patients, which are increased on advice from the Commonwealth Department of Health and Ageing. The Dental Health Service charges eligible patients for dental treatment based on the Department of Veterans’ Affairs Local Dental Officers fee schedule, with eligible patients charged either of the following co-payment rates: • 50 per cent of the treatment fee if the

patient is the holder of a Health Care Card or Pensioner Concession Card; or

• 25 per cent of the treatment fee if the patient is the holder of one of the above cards and in receipt of a near full pension or an allowance from Centrelink or the Department of Veterans’ Affairs.


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RecordkeepingThe State Records Act 2000 was established to mandate standardized statutory record keeping practices for every Government agency including records creation policy, record security and the responsibilities of all staff. Government agency practice is subject to the provisions of the Act and the standards and policies, and Government agencies are subject to scrutiny by the State Records Commission.

The Department of Health’s Recordkeeping Plan applies to the WA Country Health Service, and under which WACHS ensures that all health service clinical and administrative records comply with the DOH recordkeeping plan and comply with records management policies and procedures set down under State legislation. During 2009-10 WACHS undertook a review of its Area Office corporate records management practises and has put into place a number of initiatives addressing records management processing which comply with State Records Office (SRO) and Record Keeping Plan (RKP) requirements. Using the framework developed for Area Office, it is planned to review regional records management processes and practises and recommend changes where necessary. The RKP addresses the key components of the records management framework through six key principles: 1) Proper and Adequate Records A complete framework of records management is being established by training in general records management principles via presentations, “one on one” and via the intranet. The latest version of the records management system in use, Trim Context, has been rolled out, and staff have been provided with training in that system, enabling records to be organised with correct retention and disposal and appropriate file titles. 2) Policy and Procedures WACHS has created and ratified a comprehensive “Guideline” dealing with all aspects of Records Management and published this on the internal WACHS Policies Online system. As part of a records management suite, a further seven guidelines are at various stages of development.

3) Language Control Teaching and training in the Business Classification Scheme (thesaurus) via presentations, the WACHS intranet and personal training are helping staff develop competency in language control enabling correct file creation for documentation. 4) Preservation Compliant facilities are being used to store records, i.e. concrete floor, metal shelving, standard archive boxing and files, and rooms with regulated temperature to ensure records are being preserved. Personnel are being trained in records Retention and Disposal and correct file naming conventions to ensure that permanent archive records are identified and preserved. As part of the preservation of Electronic Records, a guideline based on the Source Record General Disposal Authority (GDA) is being developed to ensure that all scanned records preserve the original source information. 5) Retention & Disposal The WACHS authorised guideline has helped establish clear boundaries of compliance and delegation in the area of retention and disposal. Through presentations and via the intranet personnel are able to access and utilise the General Disposal Authorities with greater efficiency. 6) Compliance Training and information sessions have enabled personnel to be compliant in areas of records management. The Department of Health has released an Online Records Awareness Training programme which many staff have completed, giving them an awareness of necessary compliance in records management.


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Recruitment The WA Country Health Service recruitment processes are undertaken in accordance with the “Public Sector Standards in Human Resource Management” policies and aim to recruit suitably skilled persons to positions promptly to ensure continuation of service.

The priority for recruitment across the WA Country Health Service remains focused on the allied health, medical and nursing workforce, recruiting locally where possible, and increasing the level of employment of aboriginal people. Medical Recruitment

The Clinical Workforce and Reform Unit (CW&RU) assists regions to recruit ‘hard to fill’ places, providing a centralised unit for coordination of employment of international medical graduates. At 30 November 2009, 52 per cent of the rural and remote medical workforce in WA had obtained their basic medical qualifications overseas. The Unit is the liaison point for recruitment to permanent medical positions and provides employment contracts for hospital salaried medical practitioners employed under the DOH Medical Practitioners (WACHS) AMA Industrial Agreement 2008. Recruitment for locum positions is the responsibility of the individual regions as is the management of the Medical Practitioners employed on Medical Services Agreements. Regional vacancies are advertised on the WACHS website which is used by recruitment agencies, and provides the focal point for Medical Practitioners in considering a role within WACHS. Applications are also received directly to the regions and the CW&RU team. Regions are also encouraged to add their vacancies to the jobs vacancies site managed by HCN. A generic media advertising campaign for medical practitioners commenced in June 2010 and is currently in process with positions placed on the WACHS Internet site. The Nationally Consistent Assessment Process for International Medical Graduates, an initiative of the Council of Australian Governments, has had significant impact on the recruitment processes for medical practitioners, reducing the number of experienced applicants seeking work in Australia. Medical Board of Western

Australia (MBWA) data indicates an 80% reduction in applicants for rural and remote WA throughout 2009. The Rural Generalist Pathway continues to develop with additional posts created for junior doctors in Broome, Albany and Geraldton. WACHS has worked closely with its partners Rural Health West, WA General Practice Education and Training (WAGPET) and the Postgraduate Medical Council of WA (PMCWA) to ensure appropriate education and support systems are developed at all rural hospitals providing training for junior doctors. ‘Royalties for Region’ funding will assist with accommodation and training of junior doctors. However, the business case for additional junior doctors salaries remains unfunded. WACHS successfully negotiated with the PMCWA and the metropolitan Primary Allocation Centres (PACs) to include applications for training in rural hospitals through the Rural Generalist Pathway as part of the annual intern application process managed by PMCWA. WACHS has this year interviewed Interns who are interested in working in rural positions in 2011 and will assist in ensuring appropriate placements for these doctors. WACHS is also progressing towards applying to be a Primary Allocation Centre in 2012. Graduate Nurse and Nurse Rotational Programs

WACHS provides graduate nurse and rotational programs which aim to expose nurses to rural and remote health care and provide them with a diversity of experience from a rural and remote setting. These programs which facilitate local recruitment to permanent positions have been implemented in all WACHS regions, and continued to attract interest from nurses.

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Recruitment provide graduates to local nursing staff programs, which can also provide nurses with a variety of workplace experiences unique to rural and remote locations. Regional GradNurse Connect recruitment and selection processes for registered and enrolled nurses commenced during 2009-10. This process provides a central point for advertising for registered nurse (RN) and EN graduate positions, and means that applicants only have to apply once for a number of different positions in a particular WACHS region. Aboriginal employment

The implementation of ‘Revitalising WA Country Health Service 2009-2012’ identified the significant contribution of Aboriginal employment and recruitment to closing the gap. WACHS has continued to expand its Aboriginal employment opportunities. WACHS has developed culturally secure recruitment and selection strategies and processes for the implementation of the new COAG National Partnerships agreement positions within WACHS. These strategies involved a state-wide advertising campaign and innovative selection processes which are currently being implemented. WACHS has established a WACHS Aboriginal Workforce Taskforce reporting to WACHS via an executive subcommittee.

This taskforce is working towards the development of further Aboriginal employment strategies relating to recruitment, retention, culturally secure training and resources. WACHS also recruited two Aboriginal Business Trainees following the development of an Aboriginal Business Trainee framework and a newly established industrial instrument. Recruitment initiatives

WACHS area office is also coordinating recruitment from overseas via the London based recruitment office. 2009-10 nursing recruitment has focused on the recruitment of specialist skills such as midwifery, per-operative nurses, emergency and critical care and nurse practitioners. WACHS proactively markets rural and remote careers to university students through a variety of strategies such as career expos, lectures and support for rural health student clubs and via the website. All the WACHS regions have a dedicated nursing resource to help coordinate nursing and midwifery recruitment processes and provide a single point of contact for new staff.

Substantive Equality The WA Health Substantive Equality Implementation Committee is guiding the development and implementation of substantive equality within WA Health 2008-2013. Members of the Implementation Committee represent all areas of WA Health and are senior officers from a clinical or operational area who are in a position to be able to influence how services are delivered. Please see the Department of Health Annual Report 2009-10


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Staff Development Specific initiatives have been implemented across WACHS in its commitment to maintaining an environment that encourages personal and professional development of staff.

Local and regional professional and personal development strategies adopted by WACHS in 2009-10 include: • developing strong partnerships with the

Metropolitan Health Service and continued the education across the state in Paediatric Life Support Training;

• continuing to provide workforce training programs such as Induction, Manual Handling, Fire Training, Aggression Management, and Infection Control to the workforce in planned study days across WACHS, along with other development workshop programs such as computer skills training and management / coaching development;

• improving regional educational resources such as additional mannequins, laptops, and software for eLearning development;

• developing web portals for Learning and Development programs to store eLearning resources provided by both internal and external educational providers. This initiative is a continuation of the work that was commenced in 2008-09, with further development and enhancement to meet the needs for regional WA health professionals;

• developing workplace programs such as the OSH for Managers program, which has been converted to eLearning which enables the workforce improved access to this important and valued program;

• Professional Development program – Diploma of Management has been undertaken in the Kimberley region during

2010 and will continue for a further 12 to 18 months. This qualification provides an opportunity for Managers to develop and enhance their leadership and management skills and styles;

• enhancing the reporting infrastructure across WACHS to maintain records of the workforce skills that have been acquired; and

• continuing to provide professional development opportunities across WACHS: − cultural awareness; − ethical Decision Making Training; − safety and quality training; − risk management training; − computer training; − coaching for Managers; − safe driver training; − basic food safety ; − Infection control – hand hygiene; − senior first aid; − disease control; − obstetric emergencies; − dementia care; − quality improvement; − basic life support; − neonatal resuscitation; − pain management and wound care; − burns management; − triage; and − occupational safety and health.


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Workers’ Compensation and RehabilitationThe WA Country Health Service is committed to providing its staff with a safe and healthy work environment and recognizes this as pivotal in attracting and maintaining the workforce necessary to deliver effective and efficient health care services.

Occupational safety and health initiatives The WA Country Health Service developed a safety management system (SMS) in 2007 using the WorkSafe Plan elements and the SMS has been reviewed to align it with the requirements of the WA Code of Practice for Occupational Safety and Health (OSH) in the Public Sector. The SMS as been restructured with all policy and procedural guidance arranged under the headings to ensure that performance data can be collected to allow for an evaluation of the system’s effectiveness: • Management commitment – the Whole of

Health OSH Policy 2007 has been adopted;

• Planning – addresses the eventual collection of a range of performance data. A draft WACHS safety improvement action plan 2010-11 has been developed to address program initiatives and strategic risk. A comprehensive safety review was completed in June 2009;

• Hazard Management - All safety and risk identification and risk control procedures are arranged under this heading and the WA Health risk management system is incorporated into injury prevention procedures to assist regions to identify and control safety risks using the hierarchy of control with corrective actions applied through risk analysis and control measures based on priority of risk.

• It is proposed to progressively collect

performance data during 2010-11 to ensure all WACHS sites conduct regular site safety inspections. All procedures have been reviewed to provide clearer guidance and templates to regions;

• Consultation - Consultative mechanisms are described in the system under this heading. A revised draft safety issue resolution procedure has been developed to provide clear guidance to regions on how to escalate unresolved

safety risks through the tiers of the organization; and

• Training – A draft procedure identifies safety training needs for WACHS and a draft safety training matrix is attached to the draft WACHS safety improvement action plan 2010-2011. Training codes have been allocated to safety training and data is reported monthly to leaders.

In 2008, WACHS concluded a two year project which identified security and aggression risks across all regions, and provided each region with a risk-based plan to mitigate safety risks. In conjunction with this project, the WACHS Learning and Development Unit sponsored a trainer to deliver prevention of aggression training in all regions. Additionally and again based on risk assessment, regions received a funding allocation to improve aspects of physical security including: • physical barriers; • safe rooms; • improved duress systems; • improved closed circuit television; and • improved communications in remote

areas. As a further outcome of this project, WACHS has developed and implemented an annual workplace violence risk assessment process for each site. Regions, subject to resource capacity, are currently undertaking a preliminary assessment of the implementation of the WACHS SMS using the WorkSafe Plan self-assessment tool, as required by the Public Sector Commission Circular 12/2009. The results, in concert with the Australian Council on Healthcare Standards EQuIP quality improvement program, will be used to further improve WACHS safety programs. Employee rehabilitation WACHS has a workers compensation and injury management system as required by the


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Workers Compensation and Injury Management Act 1981. The system adopts a case management approach to ensure that ‘return to work’ outcomes are optimised for injured workers: • Regional workers compensation staff

ensure that injured employees receive their entitlements and refer injured workers for injury management intervention; and

• Three WACHS injury management coordinators, using a referral system, coordinate ‘return to work’ programs for injured employees in consultation with line managers for regional staff with workplace and non-work related injuries.

The results of a survey of injured workers conducted during 2008 continue to inform injury management processes adopted by WACHS with a general simplification of the workers compensation claim lodgement process as well as a number of other improvements including: • simplier and less claim lodgement forms; • increasing the rate of referral of injured

workers with lost time injuries for injury management;

• ensuring all lost time claims are appropriately investigated and corrective action taken to mitigate any safety risks identified; and

• improving data collection in consultation with the insurer to improve performance monitoring through 2010-11.

It is envisaged that the revision of the injury management system will be approved for implementation during 2010-2011. Table 26: Workers’ compensation claims

Employee category Claims

Nursing Services/Dental Care Assistants 110

Administration and Clerical 32

Medical Support 11

Hotel Services 120

Maintenance 19

Medical (salaried) 4

Total 296

Notes “Administration and clerical” includes administration staff and executives, ward clerks, receptionists and clerical staff. “Medical support” includes physiotherapists, speech pathologists, medical imaging technologists, pharmacists, occupational therapists, dieticians and social workers. “Hotel services” includes cleaners, caterers and patient service assistants.


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Occupational Safety & Health and Injury Management Performance The WA Country Health Service is committed to providing a safe workplace to achieve high standards in safety and health for its employees, contractors and visitors.

‘All areas of WA Health will comply with or exceed OSH legal requirements, and continuously develop and implement safe systems and work practices that reflect its commitment to safety and health’. (Source: WA Health OSH Policy 2007) WA Country Health Service is committed to assisting injured workers to return to work as soon as medically appropriate and adheres to the requirements of the Workers Compensation and Injury Management Act 1981 in the event of a work related injury or illness. The establishment of WACHS’ regional Occupational Safety and Health Committees are a formal part of the consultative process with employees on OSH matters. Committee membership is stipulated in an agreed terms of reference and is consistent with the OSH Act 1984. WACHS has an established Safety Management System, including a formal OSH issue resolution procedure, as well as an Injury Management System which meets the requirements of the Worker’s Compensation and Injury Management Act 1981. In 2009, as part of a quality improvement initiative, WACHS reviewed its safety management system (SMS). Safety and injury management policies and procedures are available to all employees on-line or from their line manager and details are provided to employees during the WACHS induction and orientation days.

Programs for injury management are implemented through: • regional workers compensation staff

ensuring that injured employees receive their entitlements and are referred for injury management intervention; and

• injury management coordinators who coordinate the return to work programs for those employees with workplace and non-work related injuries.

Where appropriate, WACHS engages appropriately qualified and WorkCover accredited rehabilitation providers to assist in the process of facilitating employees who are injured at work to return to gainful employment. These providers liaise with all involved parties to establish and monitor an injury management program as soon as practicable in consultation with the treating doctor, supervisory staff and the injured employee to match capabilities with available duties. To maintain ongoing quality improvement and support their accreditation, Safe Practice and Environment (SPE) standard of the Australian Council on Healthcare Standards (ACHS) EQuIP, WACHS regions participate in regular external reviews of their safety systems Regions also conduct annual self-assessments of their safety management system using the ACHS SPE criteria: • safety management systems ensure

safety and wellbeing for consumers/ patients, staff, visitors and contractors; and

• regions are required to submit a documented self-assessment of findings and improvement actions, and are subject to periodic review and formal audit by accredited ACHS surveyors within the accreditation cycle.


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Occupational Safety & Health and Injury Management Performance During 2009-10 WACHS continued to replace regional systems with the new SMS and full implementation across 199 sites is scheduled for completion in 2012. The SMS assists in

validating and supporting the EQuIP assessment process. The implementation process uses the WorkSafe Plan self-assessment framework to maximise improvement opportunities.

Table 27: Use and Assessment of Worksafe plan

Region

Number of regional sites or entities to be assessed using

WorkSafe Plan

Number of documented WorkSafe Plan self-

assessments completed Goldfields 7 7

Great Southern 9 2

Kimberley 43 0

Midwest 40 0

Pilbara 20 20

South West 45 29

Wheatbelt 35 0

Total 199 58

Table 28: Occupational safety and health and injury management performance

Note *For the period Jan 2009 to December 2009

Fatalities

Lost time injury/disease incidence rate

Lost time injury/disease incidence rate

Percentage of injured workers returned to work within 28 weeks

Percentage of managers trained in OSH and injury management responsibilities

1 2.46 24.34 72.3% 91.7%


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Financial Statements


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Certification Statement WA COUNTRY HEALTH SERVICE CERTIFICATION OF FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 JUNE 2010 The accompanying financial statements of the WA Country Health Service have been prepared in compliance with the provisions of the Financial Management Act 2006 from proper accounts and records to represent fairly the financial transactions for the financial year ending 30 June 2010 and financial position as at 30 June 2010. At the date of signing we are not aware of any circumstances which would render the particulars included in the financial statements misleading or inaccurate. Rob Henry Kim Snowball Acting Chief Finance Officer Accountable Authority Department of Health Department of Health Date: 15 September 2010 Date: 15 September 2010


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Audit Opinion


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Financial Statements


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Appendices


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Appendix 1: Abbreviations A

ABF / ABM Activity Based Funding / Activity Based Management

ACHS Australian Council on Health Care Standards

AHCWA Aboriginal Health Council of WA

APGAR Appearance Pulse Grimace Activity Respiration

AMI Acute myocardial infarction

B

BSWA BreastScreen WA

C

CPI Consumer Price Index

COAG Council of Australian Governments

CT Computed Tomography

CW&RU Clinical Workforce and Reform Unit

D

DAIP Disability Access and Inclusion Plan

DHAC District Health Advisory Councils

DOH Department of Health

DSC Disability Services Commission

E

ED Emergency Department

EN Enrolled Nurse

F

FINE Friend-in-Need Emergency

FHR Four Hour Rule

FMA Financial Management Act 2006

FNOF Fractured Neck of Femur

FTE Full Time Equivalent

G

GBS Government Budget Statement

GP General Practitioner

H

HACC Home and Community Care

HCARe Health Care And Related Information System

HCN Health Corporate Network


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HIN Health Information Network

I

ICT Information Communications Technology

ICU Intensive Care Unit

IMS Injury Management System

K

KPI Key Performance Indicators

M

MeRITS Medical Record Information Tracking System

MHC Mental Health Commission

MHS Metropolitan Health Service

MOU Memorandum of Understanding

MPC Multi-purpose Centre

MPS Multi-purpose Service

N

NPA National Partnership Agreement

O

OAH Office of Aboriginal Health

OPI Older Patient Initiative

OPSSC Office of the Public Sector Standards Commissioner

OSH Occupational Safety and Health

P

PACs Primary Allocation Centres

PATS Patient Assisted Travel Scheme

PID Public Interest Disclosure

PICC Pilbara Industry’s Community Council

PLS Paediatric Life Support

PSS Public Sector Standards in Human Resource Management

PMCWA Post Graduate Medical Council of WA

PYLL Person Years of Life Lost

R

RCSS Rural Community Support Service

RFDSWO Royal Flying Doctors Service (Western Operations)

RKP Record Keeping Plan

RN Registered Nurse

RTO Registered Training Organisation


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SMS Safety Management System

SPE Safe Practice and Environment

SQuIRe Safety and Quality Investment in Reform

StJAA St John Ambulance Association

T

TAFE Technical and Further Education

TI Treasurer’s Instruction

U

UWA University of Western Australia

V

VAD Ventricular Assisted Device

W

WACHS WA Country Health Service

WAGPET WA General Practice Education and Training

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