Annual Report 2006 - 2007 Map of Greater Southern Area Health Service
Hillston
Ungarie
Weethalle West Wyalong MURRUMBIDGEE Barmedman
Barellan Griffith Young Ardlethan Boorowa Temora Crookwell Hay Darlington Harden Point Leeton GOLDEN Murrumburrah SOUTHERN Cootamundra TABLELANDS Narrandera Goulburn Coleambally Coolamon Gunning Junee Yass WAGGA Tooleybuc Gundagai Moulamein WAGGA Wagga Lockhart Wagga SOUTHERN The Rock New South W LOWER WESTERN Tarcutta Tumut Urana CANBERRA Jerilderie Adelong Queanbeyan Vi SLOPES ct Braidwood oria ales Deniliquin Henty Batlow A.C.T. Barham Finley Culcairn Berrigan Holbrook GREATER ALBURY Tumbarumba Batemans Mathoura Tocumwal Bay Corowa Moruya Albury Moama MONARO EUROBODALLA Cooma Narooma
Key Jindabyne BEGA Health Services VALLEY (Hospital, Inpatient Mental Health and Community Health) Bega New South Bombala Health Service Vict Wa Pambula oria les (Hospital and Community Health) Delegate Eden
Multi Purpose Service
Community Health Service only
Acknowledgments Chief Executive, Executive team and staff of Greater Southern Area Health Service who made contributions to this Annual Report
Annual Report Reproduction 800 copies of this report were produced on recycled paper at a cost of $10.52 per copy (equals approximately 8 cents per page). March 2008 Further copies of this report can be downloaded from: www.gsahs.nsw.gov.au Incorporating
Health Services Adelong Albury Ardlethan Barellan Barham The Hon. Reba Meagher MP Barmedman Minister for Health Batlow Parliament House Batemans Bay Macquarie Street Bega SYDNEY NSW 2000 Berrigan Bombala Boorowa Braidwood Coolamon- Dear Minister, Ganmain I have pleasure in submitting the Greater Southern Area Health Service 2006/07 Annual Report. Coleambally Cooma The Report complies with the requirements for annual reporting under the Accounts and Audit Cootamundra determination for public health organisations and the 2006/07 Directions for Health Service Corowa Annual Reporting. Crookwell Culcairn Darlington Point Delegate Deniliquin Yours sincerely Eden Finley Goulburn Griffith Gundagai Gunning Hay Henty Heather Gray Hillston Chief Executive Holbrook Greater Southern Area Health Service Jerilderie Jindabyne Junee Leeton Lockhart Mathoura Moama Moruya Moulamein Murrumburrah- Harden Narooma Narrandera Pambula Queanbeyan Tarcutta Temora The Rock Tocumwal Tooleybuc Tumbarumba Tumut Ungarie Urana Wagga Wagga Weethalle West Wyalong Greater Southern Area Health Service Yass PO Box 1845 (34 Lowe Street) Queanbeyan NSW 2620 Young Tel (02) 6128 9777 Fax (02) 6299 6363 Email [email protected] Better Health for Website www.gsahs.health.nsw.gov.au Rural Australia ABN 17 196 442 397 BETTER HEALTH FOR RURAL AUSTRALIA Greater Southern Area Health Service: The Year in Review
It is with pleasure that I present the Greater Southern Area theatre and pharmacy management systems, emergency Health Service Annual Report for 2006/07 to our communities, department data collection and patient administration staff and partners. systems. Nine new videoconference units were established to enhance clinical consultation, training and meeting The 2006/07 year saw Greater Southern Area Health Service opportunities. (GSAHS) consolidate planning to pave the way for cohesive and coordinated care delivery for our communities. Our We were particularly pleased to have won a number of Strategic Plan ‘A New Direction’ was endorsed by NSW key awards during the year which included a 2006 Baxter Health and aims to ensure all residents have access to the Award for a speech pathology project: ‘Group Phonological health services they need, when they need them, regardless Awareness Intervention: It Works!’. We were also recognised of where they live. by the University of NSW Centre for Health Equity Training Research and Evaluation for contributions to Health Impact In line with this direction, we were pleased to attract two Assessment progression across NSW. This is fabulous HealthOne NSW Services to the region. These innovative recognition of the valuable achievements and successes of models of primary health care bring a multidisciplinary GSAHS staff. team approach to client care under one roof, increasing accessibility for rural health consumers. The Services are We achieved certification with the Australian Council of being established at Cootamundra and Corowa. Healthcare Standards (ACHS) across 10 clusters, mental health and the corporate sector. This gives us the foundations In addition to this, the Border Cancer Collaboration launched for further assessment for accreditation in 2008. a successful multidisciplinary approach to cancer treatment and support for patients, families and carers for the Albury Capital works and redevelopments have been high on our Wodonga region. GSAHS was also successful in obtaining agenda for the past year. Construction of new buildings a grant to implement a shared care model in Cooma, which commenced at Batlow, Berrigan and Junee, with planning well means many residents will receive their cancer treatments underway for Wagga Wagga Base Hospital and Bega Valley locally. Health Service. Redevelopment of Kenmore at Goulburn was completed, and Albury and Wagga BreastScreen services Mental health services made significant gains in recruiting a were relocated. diverse multidisciplinary team to provide care across acute, rehabilitation, perinatal and family and carer dimensions The achievements, successes and progression of GSAHS of mental health. This has included strong involvement reflect the contributions of staff, volunteers, partners and of consumers and employment of consumer advocates. communities. I would like to recognise and thank all of you The mental health team also played a key role in drought for your continued support. support initiatives in partnership with multiple government Heather Gray and non-government agencies. There was significant Chief Executive sustained improvement in mental health access block with targets exceeded and achievement of general long wait and emergency access targets. GSAHS performed well across a number of target areas this year. Otitis media screening for Aboriginal children exceeded NSW Health targets and we achieved amongst the highest childhood immunisation rates in NSW. Our Statewide Infant Screening Hearing (SWISH) Program achieved a 98% screening capture rate across GSAHS with many sites screening 100% of all births. Workforce in rural Australia continues to be a challenge across a number of industry sectors including health. GSAHS saw commencement of 31 Enrolled Nurses (ENs) in the second Bachelor of Nursing cohort in an agreement with Charles Sturt University. Ten ENs graduated from the first cohort in 2007 and are now working as Registered Nurses within GSAHS. We also increased the number of Indigenous nursing staff with six Trainee Enrolled Nurses, and two cadets commencing a Bachelor of Nursing. GSAHS also reviewed roles and training opportunities for allied health assistants across the area in partnership with the Department of Education, Science and Training. The assistants will provide valuable support to our allied health care staff. The geographic area of GSAHS tests us in terms of resource utilisation and infrastructure. Our increased use of technology however, reduces the distance for our clinical and corporate services. This includes implementation of two electronic rostering environments for nursing and midwifery, along with
GSAHS ANNUAL REPORT 2006 - 2007 Highlights of 2006-2007
• Australian Council of Healthcare Standards (ACHS) • Implementation of the GSAHS Nursing and Midwifery certification achieved in mental health, the corporate Knowledge Management model, improving sharing of sector and within all 10 GSAHS Clusters clinical knowledge within GSAHS • Recognised as leaders in NSW for working with local • Significant sustained improvement in mental health government and Health Impact Assessment (HIA); access block with targets exceeded received an award from Centre for Health Equity • Successful Hand Hygiene campaign with 30% Training Research and Evaluation, University of NSW for improvement of hand hygiene compliance and the contribution to HIA progression across the State highest level of doctor participation in NSW • GSAHS awarded 2006 Baxter Award for project ‘Group • Achievement of long wait and emergency access Phonological Awareness Intervention: It works!’ targets • Commendation awarded to the Clinical Documentation • Progression of the Medical Imaging project to tender project at the Treasury Managed Fund Management Award • Accreditation of South West Pathology Service and South West Breastscreen • Mental Health workforce increased from 383 FTE at end June 2006 to 452 FTE at end June 2007 (14 % increase). • Otitis media screening for Aboriginal children exceeded Vacancy rates reduced from 13% to 7.3% as a result of NSW Health target sustained recruitment efforts • GSAHS consistently exceeded the childhood • Commencement of 31 Enrolled Nurses (EN’s) in the immunisation targets set by NSW Health and has second Bachelor of Nursing cohort in a specific agreement amongst the highest immunisation rates in NSW with Charles Sturt University. Ten EN’s graduated from • Department of Education Science and Training Project the first cohort in 2007 and have commenced working as completed to review roles and training opportunities Registered Nurses within GSAHS for allied health assistants in a newly endorsed • Increased number of Indigenous nursing staff in GSAHS National Qualification (Certificate III and IV) in our rural - two Indigenous nursing cadets commenced in 2007 environment and the number of Indigenous Trainee Enrolled Nurses • Development of HealthOne NSW service models of increased to six in 2007 integrated and co-located primary health services in • Implementation of the Mental Health Family and Carer Corowa and Cootamundra. Steering committees have Support program to provide services to people who engaged consumer representatives as active partners in care for, or support a person with mental illness. This service planning and development for the sites represents a strong working relationship with Non • Statewide Infant Screening Hearing (SWISH) Program Government Organisations achieved a 98% screening capture rate across GSAHS • Significant contributions to drought support initiatives with many sites capturing 100% of all births in GSAHS communities in partnership with multiple • Completion of the upgrade and consolidation of the government and non-government agencies Kenmore Hospital complex • Establishment of ‘Greater Southern Health Data Online’ • Commencement of 20 clinician managers in the GSAHS/ which is a comprehensive database of health statistics Statewide Clinical Excellence Commission Leadership for GSAHS and is available to staff and health partners Development Program through the GSAHS web site • Development and implementation of a new Performance • Completion of a Corporate Risk Assessment as the Development System for staff foundation for a three year risk-based Internal Audit Program. The assessment clarified risk management responsibilities, acceptable risk levels and risk mitigation strategies • Deployment of two electronic rostering environments across all GSAHS Nursing and Midwifery sites
BETTER HEALTH FOR RURAL AUSTRALIA GSAHS ANNUAL REPORT 2006 - 2007 Table of Contents
Greater Southern Area Health Service: The Year in Review 2 Highlights of 2006-2007 3 Table of Contents 5 Greater Southern Area Health Service Profile 7 GSAHS Executive Management Structure 8 GSAHS Vision and Goals 8 GSAHS Strategic Plan: A New Direction 9 Strategic Direction 1 10 Make Prevention Everybody’s Business 10 Strategic Direction 2 14 Create Better Experiences for People Using Health Services 14 Strategic Direction 3 20 Strengthen Primary Health and Continuing Care in the Community 20 Strategic Direction 4 23 Build Regional and Other Partnerships for Health 23 Strategic Direction 5 24 Make Smart Choices About the Costs and Benefits of Health Services 24 Strategic Direction 6 26 Build a Sustainable Health Workforce 26 Equal Employment Opportunity 27 Learning and Development 27 On-line recruitment - Ezisuite Goes Live 27 Other Activities 27 Research 28 Overseas Travel 28 Occupational Health, Safety and Wellbeing 28 Corporate Governance Statement 29 Privacy 29 Clinical Governance Statement 30 Introduction 30 Investigation of Serious Adverse Events 30 Complaints Investigation 30 ACHS Certification 30 Complaints or Concerns Against a Clinician 30 Credentialing 30 Infection Control 30 Continuous Process Improvement 30 Quality Awards 31 Policy Development 31 Hand Hygiene 31 Incident Management 31 GSAHS Clusters and Other Health Services 32 Bega Valley Cluster 32 Eurobodalla Cluster 32 Golden Cluster 33 Greater Albury Cluster 33 Lower Western Cluster 34 Monaro Cluster 34 Murrumbidgee Cluster 35 Southern Slopes Cluster 35 BETTER HEALTH FOR RURAL AUSTRALIA Southern Tablelands Cluster 36 Wagga Wagga Cluster 36 Aged and Extended Care 37 Allied Health Services 37 Cancer Services 37 Child Youth and Family Services 37 Clinical Redesign Unit 38 Counselling and Violence Prevention 38 Critical Care Services 38 Drug and Alcohol Services 39 Medical, Chronic and Palliative Care 39 Nursing and Midwifery 40 Oral Health Services 40 Primary and Community Health Integration 41 Renal Services 41 Health Support Services 41 Hotel Services 41 Patient Transport/IPTAAS (Isolated Patient Transport and Accommodation Scheme) 41 Fleet Management 42 Area Travel Office 42 Asset Management 42 Information Services Unit 42 Health Service Community 44 Community Participation within GSAHS 44 Area Health Advisory Council 44 Message from Chair 44 Greater Southern Area Health Service Advisory Council Members 45 Report on Achievements 47 Attendance of AHAC Chair and Members in 2006/2007 51 Health Service Cluster Advisory Councils 52 Local Health Service Advisory Committees 52 Public Hospital Activity Levels 56 Volunteers and Sponsorship 59 Ethnic Affairs Priority Statement (EAPS) 60 Hospital Auxiliaries 61 Freedom of Information 1 July 2006 to 30 June 2007 63 Financial Overview 64 Executive Summary 64 Program Reporting 65 Directions in Funding 65 Financial Statements 70 Appendices 115 Health Services 115 Community Health 116 Other Services 118 1800 Numbers 118 Glossary 119
GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Profile
The Greater Southern Area Health Service (GSAHS) There are 37 hospitals and two affiliated public hospitals encompasses 39 local government areas, including: Albury, within GSAHS providing a range of services and varying Bega Valley, Berrigan, Bland, Bombala, Boorowa, Carrathool, levels of care. Conargo, Coolamon, Cooma, Monaro, Cootamundra, Corowa, There are also eight fully established Multi Purpose Services Deniliquin, Eurobodalla, Goulburn-Mulwaree, Greater Hume, and 62 Community Health Centres predominantly co-located Griffith, Gundagai, Harden, Hay, Jerilderie, Junee, Leeton, with hospitals across the area. These major centres provide Lockhart, Murray, Murrumbidgee, Narrandera, Palerang, outreach services to another 40 smaller towns and villages. Queanbeyan, Snowy River, Temora, Tumbarumba, Tumut, All hospitals are open 24 hours per day; seven days per week Upper Lachlan, Urana, Yass Valley, Young, Wagga Wagga and and community health facilities are open from 8.30am to Wakool. 5.00pm Monday to Friday. Much of the industry of the Greater Southern Area is related GSAHS has a population of approximately 468,000 people. to agriculture. There is also a variety of business and industrial The population is expected to grow to approximately 476,000 enterprises outside of agriculture including government by 2011. In 2001 half of all GSAHS residents were aged 35-39 departments, Defence Forces, tertiary institutions, forestry years and older, and this applied to both women and men. and tourism. GSAHS contributes significantly to communities Over 14% of the population were aged 65 years and over. as one of the region’s major employers, employing just over Projections to 2016 indicate an increase across all age groups 5000 (Full Time Equivalent) staff in a range of clinical and over 50 in the coming years (see figure 1). non-clinical roles.
Males Females
85+ 2006 80-84 2016 75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44 Age group 35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
25000 20000 15000 10000 5000 0 5000 10000 15000 20000 25000 Population
Figure 1 - Population projections by age group and sex GSAHS 2006 to 2016 Source: Transport and Population Data Centre (TPDC), NSW Department of Planning, NSW SLA Population Projections, 2001 to 2031, 2005 Release. GSAHS Population Health 2007.
BETTER HEALTH FOR RURAL AUSTRALIA GSAHS Executive Management Structure
Internal Audit Communication Clinical Executive and Corporate Chief Executive and Community Governance Support Governance Development
Director Population Director Clinical Health, Planning, Director Workforce Director Nursing and Director Corporate Operations Research and Development Midwifery Services Services Performance
Operations- Service Planning Organisation Policy and Practice Finance and Assets Acute Development Corporate Professional Shared Corporate Operations- Planning Learning and Development Services Primary and Professional Performance Human Resources Human Resources Community Health Development Management Recruitment and Chief Information Operations- Human Resources Population Retention Officer Mental Health Health Recruitment and Retention Aboriginal Health Workforce Planning Research Knowledge Management
GSAHS Vision and Goals The values identified by the organisation are: • Patients first Vision: • Best value Better health for rural people. • Results matter Mission: • Improvements through knowledge To promote and deliver accessible quality health services • [Being] open to innovation and research for all people living in the Greater Southern area through an integrated health system. The concepts underpinning and activating these values are:
GSAHS goals: • Accountability • Integrity • To keep people healthy • Respect • To provide the health care that people need • Competence • To deliver high quality services • Leadership • To manage health services well • Quality The Seven Strategic Directions: • Equity 1. Make prevention everybody’s business • Respect, caring and trust will characterise all our 2. Create better experiences for people using health relationships services GSAHS will: 3. Strengthen primary health and continuing care in the community • Ensure the delivery of quality specialty and area-wide services 4. Build regional and other partnerships for health • Set directions and develop area-wide standards 5. Make smart choices about the costs and benefits of health services • Allocate resources to support optimal health outcomes 6. Build a sustainable health workforce • Measure, monitor and report on performance 7. Be ready for new risks and opportunities • Foster the creation of knowledge and innovation through research and learning
GSAHS ANNUAL REPORT 2006 - 2007 GSAHS Strategic Plan: A New Direction
The Greater Southern Area Health Service Strategic Plan Community consultation played an important role in the “A New Direction” was endorsed by the NSW Department development of the Strategic Plan, and GSAHS residents of Health in June 2007. The GSAHS Strategic Plan to 2010 had the opportunity to give views and provide feedback at aims to ensure all residents have access to the kind of health the Annual Community Participation Forum in Queanbeyan services they need, when they need them, regardless of in March 2007. where they live. The plan will be reviewed annually to monitor our progress The Plan encapsulates the GSAHS Vision of Better Health for and the community will have further opportunities to provide Rural People. input. The GSAHS Strategic Plan links in with the seven Strategic Directions for NSW Health. These capture NSW Health priorities and guide the longer-term development of the NSW public health system. They in turn form the basis of the State Health Plan ‘A New Direction for NSW - Towards 2010’ and the ‘Future Directions for Health in NSW – Towards 2025’. The GSAHS Strategic Plan 2010 may be viewed at the website www.gsahs.nsw.gov.au Within GSAHS the Strategic Plan links to the Health Service plan, site service plans and individual performance plans of people working in GSAHS. In this way all staff are striving towards a common set of goals. The Plan contains annual targets which will be reviewed and reported upon annually.
The Strategic Plan responds to our knowledge of the pressures we will face in the future and our understanding of opportunities and priorities. To achieve its vision GSAHS will focus on seven strategic directions: • Health prevention • Creating better experiences for people using health services • Strengthening primary health and continuing care in the community • Building regional and other partnerships for health • Making smart choices about the costs and benefits of health services • Building a sustainable health workforce, and • Being ready for new risks and opportunities
BETTER HEALTH FOR RURAL AUSTRALIA Strategic Direction 1
Make Prevention Everybody’s Business During 2007/08 an increased emphasis will be placed on educational strategies as follows: Performance Indicator: Chronic disease risk factors • Coordinate activities and media coverage during Drug The NSW Health Survey includes a set of standardised Action week questions to measure health behaviours. • Develop and pilot a parenting drug education program Desired Outcome targeting parents of primary school children with the aim of rolling the program across GSAHS Reduced prevalence of chronic diseases in adults. • Conduct the Alcohol Education Program in other GSAHS Alcohol sites as required Alcohol has both acute (rapid and short but severe) and • Continue to provide training and education to health, chronic (long lasting and recurrent) effects on health. Too welfare and community professionals in drug and alcohol much alcohol consumption is harmful, affecting the health use, identification, assessment and treatment and wellbeing of others through alcohol-related violence and road trauma, increased crime and social problems. Smoking Smoking is responsible for many diseases including cancers, Chronic Disease Risk Factors: GSAHS Alcohol - risk drinking respiratory and cardio-vascular diseases, making it the behaviour (%) leading cause of death and illness in NSW. The burden of Source: NSW Health Survey. Centre for Epidemiology and Research illness resulting from smoking is greater for Aboriginal adults than the general population. 1997 1998 2002 2003 2004 2005 2006 GSAHS (%) 48 47 43 42 41 40 39 Chronic Disease Risk Factors: GSAHS Smoking - daily or occasionally (%) NSW (%) 42.3 43.2 34.7 35.6 35.3 32.1 32.8 Source: NSW Health Survey. Centre for Epidemiology and Research
GSAHS 1997 1998 2002 2003 2004 2005 2006 GSAHS (%) 25 25 23 22 22 21 21 100 NSW (%) 24 23.7 21.5 22.3 20.9 20.1 17.7
80
60 GSAHS % 40 100 20 80 0 1997 1998 2002 2003 2004 2005 2006 60 % 40
Comment 20
There is a slow but progressive downwards trend in the levels 0 of risk drinking in GSAHS which is positive. Continued efforts 1997 1998 2002 2003 2004 2005 2006 are required to bring about sustainable cultural changes. In 2006/07 GSAHS implemented strategies targeting all levels of risky drinking including: Comment • Coordination of late night bus services at the snow fields The ongoing reduction in rates of tobacco smoking is a during winter and coast in the summer months positive trend for the health of GSAHS residents. However, • Provision of alcohol education programs to drink driving as with all health risk factors, it is important to maintain the offenders momentum, particularly as rates for these risk factors in GSAHS are still higher than the NSW average. • Training of nursing staff representatives at all GSAHS public facilities in assessment and treatment of patients Throughout 2006/07, GSAHS sites were working towards full who are intoxicated, overdosing or in withdrawal implementation of the NSW Health Smoke Free Workplace Policy by 1 July 2007. More than just a complete ban on • Continued provision of one to one interventions for smoking on GSAHS premises, implementation of this policy clients with drug and alcohol issues has also stimulated a new approach for clinicians to work with patients in managing their nicotine dependence and working towards quitting. During 2007/08, GSAHS will turn its focus to the high rates of smoking amongst pregnant women to develop a comprehensive intervention to reduce smoking rates amongst this group.
10 GSAHS ANNUAL REPORT 2006 - 2007 Overweight and Obese Performance Indicator: Potentially avoidable deaths Being overweight or obese increases the risk of a wide range Potentially avoidable deaths are those attributed to conditions of health problems, including cardio-vascular disease, high that are considered preventable through health promotion, blood pressure, type 2 diabetes, breast cancer, gallstones, health screening and early intervention, as well as medical degenerative joint disease, obstructive sleep apnoea and treatment. Potentially avoidable deaths data (before age 75 impaired psychosocial functioning. years) provides a measure that is more sensitive to the direct impacts of health system interventions than all premature Chronic Disease Risk Factors: GSAHS Overweight or obese deaths. (%) Source: NSW Health Survey. Centre for Epidemiology and Research Desired Outcome
1997 1998 2002 2003 2004 2005 2006 Increased life expectancy. GSAHS (%) 48 49 52 53 54 54 56 Potentially avoidable deaths - persons aged 75 and under NSW (%) 41.8 42 45.9 48.4 48.4 49.9 50.4 (age-adjusted rate per 100,000 population): GSAHS Source: ABS mortality data and population estimates (HOIST).
GSAHS 1995 1996 1997 1998 1999 2000 GSAHS 275.9 265.7 267.3 231.3 251.8 225.6 100 NSW - - - 451.1 436.9 506.6 Aboriginal 80 NSW Non - - - 216.3 217.5 205.1 Aboriginal 60 % NSW - - - 219.5 219.9 208.2 40
20 2001 2002 2003 2004 2005 GSAHS 212.5 220.6 202.9 182.1 174.6 0 NSW 1997 1998 2002 2003 2004 2005 2006 453.8 507.1 435.5 416.7 381.2 Aboriginal NSW Non 192.7 187.7 175.1 169.3 155.8 Aboriginal Comment NSW 195.5 191.1 178 171.8 158.5 The increasing prevalence of overweight and obesity amongst GSAHS residents is consistent with trends across GSAHS the developed world.
During 2006/07, GSAHS developed a multi-strategic approach 300 to preventing weight gain. Program Coordinators for Physical 250 Activity and Nutrition were appointed to guide and coordinate 200 prevention programs across the Area. 150 Rate In 2007/08, GSAHS will 100 • Implement the National Heart Foundation’s Eat Smart 50 Play Smart program in Out of School Hours care 0 5 6 7 8 9 0 1 2 3 4 5 settings 9 9 9 9 9 0 0 0 0 0 0 9 9 9 9 9 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 2 • Implement the Munch and Move program in pre-school settings • Support the Australian Better Health Initiative chronic disease prevention campaign by developing localised Comment materials GSAHS health development programs aimed at increasing • Pilot and evaluate Eat Well Move More which is aiming physical activity, reducing falls and reducing tobacco use to identify the healthy choices available in cafes and have contributed to the reduction in figures, along with restaurants immunisation and infectious disease prevention and control. In addition, cancer screening programs and improved • Continue to support the Fresh Tastes healthy school management of chronic and complex diseases contribute to canteen policy this decrease in potentially avoidable mortality. GSAHS rates • Support development and implementation of the Healthy continue to fall in line with NSW trends, although the GSAHS Food in Health Services initiative rate remains higher than NSW as a whole.
BETTER HEALTH FOR RURAL AUSTRALIA 11 Performance Indicator: Adult immunisation These vaccinations are provided in the private market only. As such GSAHS relies heavily on State and Commonwealth Vaccination against influenza and pneumococcal disease is promotional campaigns and General Practitioner (GP) recommended by the National Health and Medical Research diligence to achieve high vaccination rates in this age group. Council (NHMRC) and provided free for people aged 65 years and over, Aboriginal people aged 50 and over, and those aged GSAHS will continue to work with these groups in promoting 15–49 years with chronic ill health. vaccination.
Desired Outcome Performance Indicator: Children fully immunised at Reduced illness and death from vaccine-preventable diseases one year in adults. Although there has been substantial progress in reducing the incidence of vaccine preventable disease in NSW, it is an People aged 65 years and over vaccinated against influenza ongoing challenge to ensure optimal coverage of childhood - in the last 12 months (%) immunisation. Adult Immunisation: GSAHS Desired Outcome Source: NSW Health Survey, Centre for Epidemiology and Research Reduced illness and death from vaccine preventable diseases 1997 1998 2002 2003 2004 2005 2006 in children. GSAHS (%) 55.6 59.2 74.6 74.5 74 72.2 71.9 Children fully immunised at 1 year (%): GSAHS NSW (%) 57.1 63.3 75.2 76 75.8 74.9 75 Source: Australian Childhood Immunisation Register (ACIR) Target - - - 80 80 80 80 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 GSAHS 92 92 92 93 91 93 GSAHS Actual NSW 91 91 91 91 90 91 Actual 100 Target 90 90 90 90 90 90 80 60 % 40 GSAHS 20 100 0 1997 1998 2002 2003 2004 2005 2006 95
Percentage Target % 90
People aged 65 years and over vaccinated against 85 pneumococcal disease - in the last 5 years (%) 80 01/02 02/03 03/04 04/05 05/06 06/07 Adult Immunisation: GSAHS Actual Target Source: NSW Health Survey, Centre for Epidemiology and Research
2002 2003 2004 2005 2006 Comment GSAHS (%) 33.1 42.2 47.4 49.3 58.4 GSAHS continues to have amongst the highest vaccination NSW (%) 38.6 47.1 47.2 54.1 60.9 rates in NSW and is consistently above NSW state targets. The area health service provides public vaccination clinics, Target - - - 60 60 school based vaccinations and supports all immunisation providers through liaison and coordination with Divisions of General Practice, Aboriginal Medical Services and directly GSAHS with GP’s. GSAHS will continue with current initiatives to maintain the 100 above target rates. 80 60 40 20 0 2002 2003 2004 2005 2006
Percentage Target
Comment GSAHS continues to promote influenza and pneumococcal vaccination and provides support to immunisation providers. Vaccination within aged care facilities was targeted in 2006/07 to encourage vaccination.
12 GSAHS ANNUAL REPORT 2006 - 2007 Performance Indicator: Fall injury hospitalisations Comment – people aged 65 years and over GSAHS has recognised the need for varied strategies Falls is one of the most common causes of injury-related to be effective in meeting the needs of the community preventable hospitalisations for people aged 65 years and in identifying, managing and preventing falls risk. Early over in NSW. It is also one of the most expensive. Older intervention programs established in Primary and Community people are more susceptible to falls, for reasons including Health Services manage and refer individuals identified with reduced strength and balance, chronic illness and medication an increased falls risk. This is generally due to lifestyle and/ use. Nearly one in three people aged 65 years and older or broader health issues. These programs will continue to living in the community reports falling at least once in a year. expand in 2007/08 in partnership with Non Government Effective strategies to prevent fall-related injuries include Organisations, Divisions of General Practice, and Home and increased physical activity to improve strength and balance, Community Care (HACC) services. and providing comprehensive assessment and management Participating in physical activity that improves strength and of fall risk factors to people at high risk of falls. balance is one way of reducing risk for a fall-related injury. Throughout 2006/07, volunteers supported by GSAHS led Desired Outcome community-based programs such as Tai Chi for Arthritis to Reduced injuries and hospitalisations from fall-related injury help reduce falls injury rates amongst residents. Over the in people aged 65 years and over. course of 2007/08 GSAHS will offer further training and support for new and existing volunteers to expand the reach Fall injuries - for people aged 65 yrs+ (age standardised of this program. hospital separation rate per 100,000 population) (excludes day-only stays): GSAHS Source: NSW Inpatient Statistics Collection and ABS population estimates (HOIST).
94/95 95/96 96/97 97/98 98/99 99/00 GSAHS Males 1677 1587 1377 1529 1836 1991 GSAHS Females 2390 2250 2398 2596 2674 3136 NSW Males 1382 1452 1505 1586 1743 1849 NSW Females 2236 2352 2425 2478 2668 2725
00/01 01/02 02/03 03/04 04/05 05/06 GSAHS Males 1917 2016 1804 1845 1954 1959 GSAHS Females 3072 2978 2708 2694 2776 2690 NSW Males 1823 1815 1820 1968 2005 2160 NSW Females 2726 2765 2656 2872 2834 2906
GSAHS
4,000
3,000
2,000 Rate
1,000
0 94/95 96/97 98/99 00/01 02/03 04/05
Males Females
Note: This indicator is calculated differently than in previous years. The rate now includes same day hospital stays.
BETTER HEALTH FOR RURAL AUSTRALIA 13 Strategic Direction 2
Create Better Experiences for People Using GSAHS Health Services 100 Performance Indicator: Emergency department triage 80 times - cases treated within benchmark times 60 % Timely treatment is critical to emergency care. Triage aims 40 to ensure that patients are treated in a timeframe appropriate 20 to their clinical urgency, so that patients presenting to the emergency department are seen on the basis of their need 0 for medical and nursing care and classified into one of 03/04 04/05 05/06 06/07 five triage categories. Good management of emergency department resources and workloads, as well as utilisation Actual Target review, delivers timely provision of emergency care.
Desired Outcome Triage 3 (within 30 minutes) Treatment of emergency department patients within 2003/04 2004/05 2005/06 2006/07 timeframes appropriate to their clinical urgency, resulting in GSAHS Actual 80 78 75 82 improved survival, quality of life and patient satisfaction. NSW Actual 59 60 61 71 Emergency department - cases treated within Australian Target 75 75 75 75 College of Emergency Medicine (ACEM) benchmark times (%): GSAHS Source: EDIS GSAHS
Triage 1 (within 2 minutes) 100 2003/04 2004/05 2005/06 2006/07 80 GSAHS Actual 100 100 100 100 60 % NSW Actual 100 100 100 100 40 Target 100 100 100 100 20 0 03/04 04/05 05/06 06/07 GSAHS Actual Target 100 80 Triage 4 (within 60 minutes) 60 % 2003/04 2004/05 2005/06 2006/07 40 GSAHS Actual 84 79 74 76 20 NSW Actual 65 65 66 74 0 03/04 04/05 05/06 06/07 Target 70 70 70 70
Actual Target GSAHS
Triage 2 (within 10 minutes) 100 2003/04 2004/05 2005/06 2006/07 80 GSAHS Actual 78 73 79 89 60 % Target 80 80 80 80 40 NSW Actual 76 75 80 87 20 NSW Target 80 80 80 80 0 03/04 04/05 05/06 06/07
Actual Target
14 GSAHS ANNUAL REPORT 2006 - 2007 Triage 5 (within 120 minutes) Comment
2003/04 2004/05 2005/06 2006/07 GSAHS performance in relation to Off Stretcher Time continued to improve in 2006/07 and performance for the GSAHS Actual 92 91 86 90 final seven months of the year averaged 91%, which was 1% NSW Actual 86 87 86 89 above benchmark. Target 70 70 70 70 Performance Indicator: Emergency admission performance – patients transferred to an inpatient GSAHS bed within 8 hours Patient satisfaction is improved with reduced waiting time 100 for admission from the emergency department to a hospital 80 ward, intensive care unit bed or operating theatre. Also, emergency department services are freed up for other 60 % patients. 40 20 Desired Outcome 0 Timely admission from the emergency department for 03/04 04/05 05/06 06/07 those patients who require inpatient treatment, resulting in improved patient satisfaction and better availability of Actual Target services for other patients. Emergency Admission Performance - Emergency department Comment patients admitted to an inpatient bed within 8 hrs of commencement of active treatment (%): GSAHS GSAHS facilities achieved all triage time benchmarks in 2006/07 with notable improvements in performance in Source: EDIS the Triage 2, Triage 3 and Triage 5 categories compared to GSAHS 02/03 03/04 04/05 05/06 06/07 Target 2005/06. Jul 86 17 84 87 84 80 Performance Indicator: Off stretcher time < 30 Aug 87 85 84 84 86 80 minutes Sep 87 87 84 88 86 80 Timeliness of treatment is a critical dimension of emergency Oct 89 87 88 88 86 80 care. Better coordination between ambulance services and Nov 86 86 85 90 84 80 emergency departments allows patients to receive treatment more quickly. Also, delays in hospitals impact on Ambulance Dec 89 15 89 81 89 80 operational efficiency. Jan 89 16 87 84 89 80 Desired Outcome Feb 88 86 88 83 89 80 Mar 88 86 88 84 89 80 Timely transfers of patients from ambulance to hospital emergency departments, resulting in improved survival, Apr 88 85 88 84 87 80 quality of life and patient satisfaction, as well as improved May 85 85 84 82 92 80 Ambulance operational efficiency. Jun 84 85 83 82 89 80 Off Stretcher Time - Transfer of care to the emergency department < 30 minutes from ambulance arrival (%): NSW 02/03 03/04 04/05 05/06 06/07 Target GSAHS Jul 69 67 65 72 74 80 Source: Ambulance Service of NSW CAD System Aug 70 64 62 69 75 80 2003/04 2004/05 2005/06 2006/07 Sep 72 68 65 72 77 80 GSAHS Actual 94 89 88 89 Oct 74 71 69 76 81 80 NSW Actual 70 68 76 78 Nov 72 71 71 76 78 80 Target 95 90 90 90 Dec 75 71 75 76 82 80 Jan 73 72 74 76 82 80 GSAHS Feb 72 69 71 76 80 80 Mar 71 69 74 77 79 80 100 Apr 72 70 73 79 79 80 May 70 67 72 78 78 80 Jun 68 66 69 76 75 80
80 03/04 04/05 05/06 06/07
Actual Target
BETTER HEALTH FOR RURAL AUSTRALIA 15 GSAHS Comment
100 GSAHS had an average of 81% of mental health patients admitted to an inpatient bed within eight hours for 2006/07. 80 This is favourable to benchmark and represents a 5% 60 improvement on the 2005/06 average of 76%. % 40 Performance Indicator: Booked surgical patients 20
0 Long wait and overdue patients are those who have not 1 2 3 4 5 6 7 8 9 10 11 12 received treatment within the recommended time frame. The 04/05 05/06 06/07 Target numbers and proportions of long wait and overdue patients represent measures of hospital performance in the provision of elective care. Better management of hospital services Comment helps patients avoid the experience of excessive waits for GSAHS has continued to perform above target for emergency booked treatment. Improved quality of life may be achieved admissions. In 2005/06 Emergency Admission Performance more quickly, as well as patient satisfaction and community averaged 83% and in 2006/07 this performance improved by confidence in the health system. a further 6% to an average of 89%. Desired Outcome Emergency Admission Performance - Mental health patients admitted to an inpatient bed within 8 hrs of commencement Timely treatment of booked surgical patients, resulting in of active treatment (%): GSAHS improved clinical outcomes, quality of life and convenience for patients. Source: EDIS Booked surgical patients waiting - Urgency category 1 > 30 GSAHS 05/06 06/07 Target days (Overdues) Jul 84 77 80 Data Source: WLCOS Aug 72 86 80 GSAHS 03/04 04/05 05/06 06/07 Sep 73 79 80 Jul - 77 179 5 Oct 78 75 80 Aug - 72 164 3 Nov 89 71 80 Sep - 100 164 23 Dec 66 88 80 Oct - 93 171 8 Jan 78 82 80 Nov - 81 107 7 Feb 74 75 80 Dec - 81 93 1 Mar 70 86 80 Jan 130 111 157 - Apr 78 91 80 Feb 99 113 79 1 May 72 86 80 Mar 112 113 84 7 Jun 80 79 80 Apr 122 127 57 10 NSW 05/06 06/07 Target May 105 141 16 2 Jul 84 71 80 Jun 92 170 - 9 Aug 68 71 80 Sep 69 72 80 NSW 03/04 04/05 05/06 06/07 Oct 69 73 80 Jul - 4,180 4,260 1,191 Nov 72 70 80 Aug - 4,059 3,644 966 Dec 73 78 80 Sep - 3,983 3,763 957 Jan 71 79 80 Oct - 4,500 3,970 767 Feb 67 75 80 Nov - 4,018 3,343 490 Mar 73 75 80 Dec - 4,402 3,963 483 Apr 73 77 80 Jan 4,149 5,308 4,632 505 May 75 77 80 Jun 74 76 80 Feb 3,367 4,375 3,390 277 Mar 3,437 4,354 3,351 293 Apr 4,352 4,404 3,087 243 GSAHS May 4,139 4,097 1,836 154 100 Jun 3,916 4,093 824 117 80
60 % 40
20
0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 05/06 06/07 Target
16 GSAHS ANNUAL REPORT 2006 - 2007 GSAHS GSAHS
200 500 400 150 300 100 200 50 100 - - Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
04/05 05/06 06/07 04/05 05/06 06/07
Comment Comment During 2006/07, GSAHS made significant improvements in GSAHS has continued to plan and manage elective services ensuring patients classified as ‘urgent’ receive their surgery to ensure all routine patients classified as ‘ready for care’ are in an appropriate time frame. In 2005/06 there was a monthly treated within a 12 month period. There were no patients average of 106 Category 1 patients waiting > 30 days. In waiting longer than 12 months for elective surgery at June 2006/07 this figure was reduced to a monthly average of six. 2007. This was achieved in an environment of increasing GSAHS continues to work on strategies to further reduce this demand for elective procedures and represents a committed figure. effort by staff to achieve these results. Overall there was approximately a 5% increase in elective bookings in 2006/07 The nine patients waiting > 30 days at the end of June was compared to 2005/06. due to a one-off issue at a GSAHS facility and is not expected to occur again. The patients underwent their procedures in Performance Indicator: Planned surgery – July and since then the site has not had any patients waiting cancellations on the day of surgery > 30 days. The effective management of elective surgical lists minimises Booked surgical patients waiting - All urgency category > 12 cancellations on a day of surgery and ensures patient flow months (long waits) and predictable access. However, some cancellations are Data Source: WLCOS appropriate, being due to acute changes in patients’ medical conditions. GSAHS 03/04 04/05 05/06 06/07 Jul - 337 446 28 Desired Outcome Aug - 339 445 50 Minimised numbers of cancellations of patients from the Sep - 365 381 36 surgical waiting list on the day of planned surgery, resulting Oct - 375 352 24 in improved clinical outcomes, greater certainty of care and convenience for patients. Nov - 373 259 13 Planned surgery - cancellations on the date of surgery (%): Dec - 420 205 2 GSAHS Jan 360 456 182 0 Source: Health service Feb 321 476 150 2 Actual Target Mar 300 458 126 1 Jul-06 3.0 5 Apr 297 451 110 1 Aug-06 3.2 5 May 287 467 41 1 Sep-06 3.4 5 Jun 303 450 - 0 Oct-06 3.4 5 NSW 03/04 04/05 05/06 06/07 Nov-06 3.4 5 Jul - 9,636 5,187 340 Dec-06 2.4 5 Aug - 9,590 4,958 488 Jan-07 3.9 5 Sep - 9,701 4,904 449 Feb-07 3.8 5 Oct - 9,802 4,757 202 Mar-07 2.8 5 Nov - 9,657 4,108 99 Apr-07 3.2 5 Dec - 10,241 3,889 75 May-07 3.1 5 Jan 7,661 10,551 3,724 46 Jun-07 2.7 5 Feb 7,916 10,586 3,405 55 Mar 8,197 10,364 2,525 72 Apr 8,911 9,397 2,157 107 May 9,465 7,285 1,181 115 Jun 9,541 5,076 50 79
BETTER HEALTH FOR RURAL AUSTRALIA 17 GSAHS Performance Indicator: Incorrect procedures Incorrect procedures, though low in frequency, provide 6 5 insight into system failures that allow them to happen. Health 4 studies have indicated that, with implementation of correct 3 2 patient/site/procedure policies, these incidents can be 1 eliminated. 0 Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- 06 06 06 06 06 06 07 07 07 07 07 07 Desired Outcome Elimination of incorrect procedures, resulting in improved Actual Target clinical outcomes, quality of life and patient satisfaction. Incorrect procedures: GSAHS Comment Source: TRIM/Quality and Safety Branch RIB/RCA Database GSAHS continues to perform favourably to this benchmark. Incorrect procedures – all (number)
Performance Indicator: Unplanned/unexpected 2005/06 2006/07 readmissions within 28 days of separation – all admissions GSAHS 1 3 NSW 36 72 Unplanned and unexpected re-admissions to a hospital may reflect less than optimal patient management. Patients might be re-admitted unexpectedly if the initial care or treatment GSAHS was ineffective or unsatisfactory, or if post-discharge planning was inadequate. However, other factors occurring after discharge may contribute to readmission, for example 4 poor post-discharge care. Whilst improvements can be made to reduce readmission rates, unplanned readmissions cannot 3 be fully eliminated. Improved quality and safety of treatment reduces unplanned events. 2
Desired Outcome 1
Minimal unplanned/unexpected readmissions, resulting in 0 improved clinical outcomes, quality of life, convenience and 05/06 0607 patient satisfaction. Unplanned/unexpected readmissions within 28 days of Incorrect procedures - Operating theatre suite separation – all admissions (%) (number) Source: HIE 2005/06 2006/07 04/05 05/06 06/07 GSAHS 0 0 GSAHS 8.4 8.6 8.4 NSW 18 11
Incorrect procedures - Radiology, radiation oncology,
10 nuclear medicine (number) 8 2005/06 2006/07 6 GSAHS 1 2 4 NSW 17 54
2 Comment 0 04/05 05/06 06/07 GSAHS implemented an education program targeted at operating theatre and radiology environments. This is in line with the NSW Health Policy Directive Patient Identification Comment - Correct Patient, Correct Procedure and Correct Site Model Policy. This is stable rate for GSAHS. During 2006/07, there has not been a serious incident involving the wrong procedure performed on a patient in GSAHS operating theatres. However, a small number of incidents in radiology have been fully investigated and action undertaken.
18 GSAHS ANNUAL REPORT 2006 - 2007 Performance Indicator: Deaths as a result of a fall in hospital Falls are a leading cause of injury in hospital. The implementation of the NSW Fall Prevention Program will improve the identification and management of risk factors for fall injury in hospital thereby reducing fall rates. Factors associated with the risk of a fall in the hospital setting may differ from those in the community.
Desired Outcome Reduce deaths as a direct result of fall in hospital, thereby maintaining quality of life and improving patient satisfaction. Deaths as a result of falls in hospitals (number): GSAHS Source: TRIM/Quality and Safety Branch ROB/RCA Database
2005/06 2006/07 GSAHS 6 2 NSW 30 26
GSAHS
8
6
4
2
0 05/06 06/07
Comment All patient falls resulting in death are subject to a thorough and extensive Root Cause Analysis investigation. GSAHS monitors all inpatient falls and introduced a targeted and evidence based fall reduction initiative for inpatients. This initiative focuses on systems to ensure that patients and residents with a risk of falling are appropriately identified and managed for optimal safety. Strategies ensure patients, residents and staff are empowered to manage falls risk with appropriate skills for the delivery of falls prevention programs.
BETTER HEALTH FOR RURAL AUSTRALIA 19 Strategic Direction 3
Strengthen Primary Health and Continuing Performance Indicator: Suspected suicides of Care in the Community patients in hospital, on leave, or within 7 days of contact with a mental health service Performance Indicator: Mental Health acute adult Suicide is an infrequent and complex event, which is readmission influenced by a wide variety of factors. The existence of a Mental Health problems are increasing in complexity and mental illness can increase the risk of such an event. A range co-morbidity with a growing level of acuity in child and of appropriate mental health services across the spectrum adolescent presentation. Despite improvement in access to of treatment settings, as outlined in the Government’s mental health services, demand continues to rise for a wide commitment, NSW: A New Direction for Mental Health, range of care and support services for people with mental are being implemented between now and 2011 to increase illness. A readmission to acute mental health admitted the level of support to clients, their families and carers, to care within a month of a previous admission may indicate help reduce the risk of suicide for people who have been in a problem with patient management or care processes. contact with mental health services. Prior discharge may have been premature or services in the community may not have adequately supported continuity of Desired Outcome care for the client. Minimal number of suicides of patients following contact Desired Outcome with a mental health service. Suspected suicides of patients in hospital, on leave, or within Rates of mental health readmission minimised, resulting 7 days of contact with a mental health service (number): in improved clinical outcomes, quality of life and patient GSAHS satisfaction, as well as reduced unplanned demand on services. Data source: Reportable Incident Briefs and Mental Health Client Death Report Form Mental Health acute adult readmission - within 28 days to same mental health facility (%): GSAHS 2004/05 2005/06 Source: Admitted Patient Collection on HOIST and HIE Datamart GSAHS 5 8 NSW 97 80 2000/01 2001/02 2002/03 2003/04 GSAHS 14.4 14.1 10.3 9.1 NSW 11.3 10.9 10.1 10.1 GSAHS Target 10 10 10 10 10
2004/05 2005/06 2006/07 8 GSAHS 18.0 13.0 14.0 6 NSW 12.0 11.2 10.9 4 Target 10 10 10 2 0 04/05 05/06 GSAHS
20 Comment 15 In addition to significant improvements being made to the mental health emergency care capacity across the area, % 10 GSAHS has commenced a number of early intervention 5 and mental health promotion initiatives aimed at reducing depression and suicide (some in collaboration with other 0 agencies). 00/01 01/02 02/03 03/04 04/05 05/06 06/07 These have included Mental Health First Aid Programs (14), Target Actual implementing the Drought Mental Health Assistance Package which includes mental health workshops, rural service Comment network meetings and extensive media promotion. The These figures remain improved from the 2004/05 peak and School Link partnership with schools also aims to develop should further improve with implementation of new acute resilience in young people along with development of the bed management policies and procedures. Current planning ‘Make-A-Noise’ website to improve access to mental health for increased acute bed numbers will result in ongoing services. Establishment of Older Men Networks and work improvements in the years ahead. with Aboriginal communities thought the ‘Yarn-Up’ program are designed to improve the mental health and wellbeing of The Mental Health Family and Carer Support Service was priority groups (some in collaboration with other agencies). rolled out across all GSAHS clusters. A strong working relationship has been developed through the Mental Health Service Family Sensitive strategy with Non Government Organisations (Carer Assist) to provide services to people who care for, or support a person with a mental illness.
20 GSAHS ANNUAL REPORT 2006 - 2007 Performance Indicator: Mental Health: Mental Health Acute Overnight Inpatient Separations: a) Ambulatory contacts GSAHS b) Acute overnight inpatient separations Data source: HIE and VAX DOHRS Mental Health problems are increasing in complexity and 00/01 01/02 02/03 03/04 co-morbidity with a growing level of acuity in child and Result 1,369 1,373 1,318 1,342 adolescent presentations. Despite improvements in access to mental health services, demand continues to rise for Target - - - - a wide range of care and support services for people with mental illness. Under ‘New Directions’, a range of community 04/05 05/06 06/07 based services are being implemented between now and Result 1,348 1,290 1,221 2011; they span the spectrum of care types from acute care to Target - - 1,400 supported accommodation. There is an ongoing commitment to increase inpatient bed numbers. Numbers of ambulatory contacts, inpatient separations and numbers of individuals GSAHS would be expected to rise.
Desired Outcome 1,600 1,200 Improved mental health and well-being. An increase in the number of new presentations to mental health services that 800 Number is reflective of a greater proportion of the population in need 400 of these services gaining access to them. - Mental Health Ambulatory Contacts: GSAHS 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 Source: 00/01 to 04/05: State HIE (MHAMB collection) plus manual Result Target submissions 05/06 and 06/07: State IQ Server 1 Aug 2007 Comment
2005/06 2006/07 Renovations and structural improvements to mental health units within the area necessitated a reduced number of GSAHS Actual 155,701 beds for a short period of time. This was compounded by GSAHS Target - 159,878 length of stay figures and increased occupancy rates. Two NSW Actual 1,567000 1,669000 positive initiatives that impacted on admission numbers included a major focus on emergency department access NSW Target - 2,115000 block and increased staffing and focus on managing clients in community settings. GSAHS Further work will be undertaken around access at Kenmore Hospital and implementation of Housing packages. New 200,000 procedures and policies relating to bed management and flow through should also start to take effect in 2007/08. 150,000 Performance Indicator: Antenatal visits -confinements 100,000 where first visit was before 20 weeks gestation Number 50,000 Antenatal visits are valuable in monitoring the health of mothers and babies throughout pregnancy. Early - commencement of antenatal care allows problems to be 05/06 06/07 better detected and managed, and engages mothers with health and related services. Actual Target Desired Outcome Comment Improved health of mothers and babies. These figures are believed to reflect a reduction in compliance First antenatal visit - before 20 weeks gestation (%): GSAHS with activity reporting procedures rather than a real drop in the number of ambulatory contacts. Work is underway to Source: NSW Midwives Data Collection (HOIST). improve reporting procedures and compliance monitoring, 1995 1996 1997 1998 1999 2000 which should lead to results more indicative of the actual clinical activity. GSAHS Aboriginal 71.3 60.4 66.9 65.2 70.7 73.3 NSW Aboriginal 66.8 61.0 62.2 66.3 65.5 67.6 Transporting mental health patients safely and appropriately is important to GSAHS. A successful trial was conducted GSAHS Non-Aboriginal 86.8 86 87.5 87.9 89.9 89.8 in the South Coast Cluster where a Mental Health Patient NSW Non-Aboriginal 85.4 85.8 85.2 85.4 86.7 87.0 Transport vehicle was purchased and local security staff engaged to assist with patient transport. This initiative 2001 2002 2003 2004 2005 provides a safe and effective alternative to the use of GSAHS Aboriginal 71.6 71.5 71.2 74.6 77.5 Ambulance and Police resources. NSW Aboriginal 64.7 67.2 70.6 70.1 74.9 GSAHS Non-Aboriginal 90.4 90.5 92.3 90.3 90.8 NSW Non-Aboriginal 86.7 86.9 87.0 88.0 88.4
BETTER HEALTH FOR RURAL AUSTRALIA 21 GSAHS The ‘Babies Like Books Too’ project promotes sharing 100 books with babies from birth, which has a lasting influence on reading and language development. It is funded by the 80 Riverina-Murray Families First project and coordinated 60 by GSAHS. Book packs, pamphlets and a DVD/ video % 40 were developed to support the promotion. It was filmed and produced in Wagga Wagga, using local parents and 20 professionals talking about the benefits of reading books
0 with children. 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Aboriginal Non-Aboriginal Performance Indicator: Postnatal home visits - families receiving a ‘Families NSW’ visit within 2 weeks of the birth Comment The Families NSW program aims to give children the best GSAHS is achieving a rate that is higher than the NSW possible start in life. The purpose is to enhance access to average, which indicates better outcomes for mothers and postnatal child and family services by providing all families babies. The particular change in the Aboriginal figures may with the opportunity to receive their first postnatal health be attributable to the Aboriginal Mothers and Babies program service within their home environment, thus providing staff which encourages earlier access and utilisation of antenatal with the opportunity to engage more effectively with families care by this group. who may not have otherwise accessed services. ‘Families Performance Indicator: Low birth weight babies NSW’ provides an opportunity to identify needs with families in their own homes, and facilitate early access to local – weighing less than 2,500g support services, including the broader range of child and Low birth weight is associated with a variety of subsequent family health services. health problems. A baby’s birth weight is also a measure of the health of the mother and the care that was received Desired Outcome during pregnancy. To solve problems in raising children early, before they become entrenched, resulting in the best possible start in Desired Outcome life. Reduced rates of low weight births and subsequent health Families NSW postnatal universal health home visits (UHHV) problems. (%): GSAHS Low birthweight babies - births with birthweight less than Source: Families NSW Area Health Service Annual Reports 2003/04; 2,500g (%): GSAHS 2004/05; 2005/06 HOIST for birth data. Source: NSW Midwives Data Collection (HOIST). 2004/05 2005/06 2000 2001 2002 2003 2004 2005 GSAHS Actual 46 60 GSAHS Aboriginal 10.6 7.3 10 12.1 13.7 9 NSW Actual 45 44 GSAGS Non Aboriginal 4.6 5.3 5.2 5 4.9 4.4 Target 65 65 GSAHS Total 4.9 5.4 5.4 5.3 5.3 4.6 NSW Indigenous 11.9 13.5 12.8 12.4 12.9 12.5 NSW Non-indigenous 6.3 6.2 6.2 6.1 6.2 6.1 GSAHS NSW Total 6.4 6.4 6.4 6.2 6.4 6.3 100
80
GSAHS 60 % 15 40 20 10 % 0 5 04/05 05/06
0 Actual Target 2000 2001 2002 2003 2004 2005 Note: These percentages are based on Southern AHS figures Aboriginal Non-Aboriginal only.
Comment Comment GSAHS has achieved visiting rates above the NSW state GSAHS has a lower rate than the NSW average. The average and will continue to work to meet state targets. Aboriginal data is perhaps reflective of the Aboriginal Mother Systems for reporting data have been implemented to and Babies programs running across GSAGS, which aim to capture accurate information about the numbers of postnatal reduce low birthweight babies in that target group. Low birth visits. Strategies have also been put in place to increase the weight has a direct correlation with poor perinatal outcomes level of support to midwifery staff which will, in turn, increase and a reduction in the numbers is a very positive outcome for the access of mothers and babies to these services. It is our maternity population. anticipated that GSAHS will exceed state figures in 2006/07.
22 GSAHS ANNUAL REPORT 2006 - 2007 Strategic Direction 4
Build Regional and Other Partnerships for Health Performance Indicator: Otitis media screening - Aboriginal children (0 – 6 year) screened The incidence and consequence of Otitis Media and associated hearing loss in Aboriginal communities has been identified and recognised. The World Health Organisation has noted that prevalence of Otitis Media greater than 4% in a population indicates a massive public health problem. Otitis Media affects up to ten times this proportion of children in many Indigenous communities in Australia.
Desired Outcome Minimal rates of conductive hearing loss, and other educational and social consequence associated with otitis media, in young Aboriginal children. Otitis media screening - Aboriginal children aged 0 - 6 years screened (%): GSAHS Data: Centre for Aboriginal Health
2004/05 2005/06 2006/07 GSAHS 100 93 100 NSW 41 57 85 Target 50 70 85
GSAHS
100 80 60 40 20 0 04/05 05/06 06/07 Actual Target
Comment These figures clearly show that Otitis Media Screening has increased state wide and that GSAHS exceeded the set targets for the number of children to be screened.
The ‘Aboriginal Can’t Hear? Hard to Learn’ program was designed and implemented by GSAHS Aboriginal Health staff and the Katungul Aboriginal Medical service to address Otitis Media in Aboriginal children in the Eurobodalla, Bega Valley, Monaro and Southern Tablelands Clusters. It encompasses regular ear health screening for Aboriginal children, education for parents and caregivers and hearing health training for Aboriginal Health Workers.
BETTER HEALTH FOR RURAL AUSTRALIA 23 Strategic Direction 5
Make Smart Choices About the Costs and Performance Indicator: Creditors > Benchmark as at Benefits of Health Services the end of the year Creditor management affects the standing of NSW Health Performance Indicator: Net cost of service – General in the general community, and is of continuing interest to Fund (General) variance against budget central agencies. Creditor management is an indicator of a Net Cost of Services (NCOS) is the difference between total Health Service’s performance in managing its liquidity. expenses and retained revenues and is a measure commonly While health services are expected to pay creditors within used across government to denote financial performance. In terms, individual payment benchmarks have been established NSW Health, the General Fund (General) measure is refined for each health service. to exclude the: • effect of Special Purpose and Trust Fund monies Desired Outcome which are variable in nature dependent on the level of Payment of creditors within agreed terms. community support Number of Creditors exceeding target days as at the end of • operating result of business units (eg linen and pathology year - Creditors exceeding 45 days $(‘000): GSAHS services) which service a number of health services and Source: Financial Management and Planning Branch, Finance & Business which would otherwise distort the host health service’s Management Division financial performance 2004/05 2005/06 2006/07 • effect of Special Projects which are only available for the specific purpose (eg Oral Health, Drug and Alcohol) GSAHS Actual 7,488 0 0 NSW Actual 13,234 1335 0 Desired Outcome Target 0 0 0 Optimal use of resources to deliver health care. Net cost of services General Fund (General) - variance against GSAHS budget (%): GSAHS Data provided by: Financial Management and Planning Branch, Finance and 9,000 Business Management Division
6,000 2004/05 2005/06 2006/07 GSAHS (%) 1.55 2.41 0 3,000
NSW (%) 1.05 0.38 0.28 - Target 0 0 0 04/05 05/06 06/07
Actual Target GSAHS Comment 2.8 2.4 GSAHS had zero creditors exceeding the benchmark at 30 2 June 2007. This demonstrates consistency with meeting this 1.6 % target. 1.2 0.8 0.4 0 04/05 05/06 06/07
Percentage Target
Comment GSAHS achieved a balanced General Fund – General NCOS result. This is an improved position relative to prior years.
24 GSAHS ANNUAL REPORT 2006 - 2007 Performance Indicator: Major and minor works - Variance against Budget Paper 4 (BP4) total capital allocation Variance against total BP4 capital allocation and actual expenditure achieved in the financial year is used to measure performance in delivering capital assets.
Desired Outcome Optimal use of resources for asset management. The desired outcome is 0 per cent variance, that is, full expenditure of the NSW Health Capital Allocation for major and minor works. Major and Minor Works - variance against BP4 capital allocation (%): GSAHS Source: Asset Management Services
02/03 03/04 04/05 05/06 06/07 GSAHS Actual - - - -10.0 28.9 NSW Actual 12.5 15.7 -3.4 7.2 7.8 Target 0 0 0 0 0
GSAHS
40.0 30.0
20.0
% 10.0 0.0 05/06 06/07 -10.0
-20.0
Actual Target
Comment The GSAHS 2006/07 Capital Works variation was due to commencement of the Queanbeyan project and contract prepayment incentives on this project, which brought cash flow forward. The figure also reflects the ‘catching up’ of projects in the Rural Hospitals Program (Junee, Batlow, Berrigan and Bombala) which were slowed during 2005/06 due to design and scope issues.
Asset Management staff developed a new database to manage assets and related information across GSAHS. The new centralised database replaced existing DOS based systems, access databases and manual systems and is providing a consistent, consolidated approach for users in collecting, analysing and storing asset information.
BETTER HEALTH FOR RURAL AUSTRALIA 25 Strategic Direction 6
Build a Sustainable Health Workforce These groups are primarily the front line staff employed in the health system. In response to increasing demand for The organisation and delivery of health care is complex services, it is essential that the numbers of front line staff and involves a wide range of health professionals, service are maintained in the line with that demand and that service providers and support staff. Clinical staff comprises medical, providers continually examine how services are organised to nursing, allied health and oral health professionals, ambulance direct more resources to frontline care. Note that the category clinicians and other health professionals such as counsellors of a small proportion of this group may be management or and Aboriginal Health Workers. administration (such as ward clerks), where the primary function is supporting direct care provision and providing support for frontline staff.
Staff Profile
June -03 June -04 June -05 June -06 June -07 Medical 122 127 119 133 138 Nursing 2,276 2,384 2,506 2,471 2,510 Allied Health 295 298 319 328 351 Other Prof. and Para professionals 245 247 197 204 217 Oral Health Practitioners & Therapists 55 56 63 58 57 Ambulance Clinicians - - - - 1 Corporate Services 288 304 277 257 234 Scientific and technical clinical support staff 198 200 259 264 286 Hotel Services 641 647 660 626 576 Maintenance and Trades 91 92 86 80 77 Hospital Support Workers 542 541 615 493 555 Other 5 5 4 3 3 Total 4,758 4,902 5,105 4,916 5,003 Medical, nursing, allied health, other health professionals 62.9 63.5 62.8 65.0 65.4 and oral health practitioners as a proportion of all staff
Source: Health Information Exchange and Health Service local data Notes: 1. FTE calculated as the average for the month of June, paid productive and paid unproductive hours. 2. As at March 2006, the employment entity of NSW Health Service staff transferred from the respective Health Service to the State of NSW (the Crown). Third Schedule Facilities have not transferred to the Crown and as such are not reported in the Annual Report as employees. 3. Includes salaried (FTEs) staff employed with ‘Health Services, Ambulance Service of NSW and the NSW Department of Health’. All non-salaried staff such as contracted Visiting Medical Officers (VMO) are excluded. 4. ‘Medical’ is inclusive of Staff Specialists and Junior Medical Officers. ‘Nursing’ is inclusive of Registered Nurses, Enrolled Nurses and Midwives. ‘Allied Health’ includes the following: audiologist, pharmacist, social worker, radiographer and podiatrist. ‘Oral Health Practitioners and Therapists’ includes Dental Assistants/Officers/Therapists/Hygienists. ‘Other Professionals and Para-professionals’, which includes health education officers, interpreters etc. ‘Ambulance Clinicians’ include ambulance on road staff and ambulance support staff. ‘Corporate Services’ includes Hospital Executive, IT, Human Resource and Finance staff etc. ‘Scientific and technical support workers’ includes hospital scientists and cardiac technicians. ‘Hotel Services’ are inclusive of food services, cleaning and security etc. ‘Maintenance & trades’ is inclusive of Trade Workers, Gardeners and grounds Management etc. ‘Hospital Support Workers’ includes ward clerks, public health officers, patient enquiries and other clinical support staff etc. ‘Other’ is employees not grouped elsewhere,
26 GSAHS ANNUAL REPORT 2006 - 2007 Equal Employment Opportunity On-line recruitment - Ezisuite Goes Live GSAHS is committed to Equal Employment Opportunities The introduction of a new on-line recruitment system (EEO) with the following key programs continuing to be (Ezisuite) contributed to improvements in the time taken to progressed: recruit new staff. Training was conducted across the area and the system is now fully operational. • The Area continues to provide training programs for select groups of our area Other Activities • GSAHS continues to develop a ‘People with Disability’ framework and policy • Education was provided by NSW Health Nursing Workloads Unit for community health nurses on • GSAHS Carer Support Program continues to provide reasonable workloads for nurses, with Inpatient information for employees who are carers regarding Monitoring for the Mercy Hospitals and Mental Health entitlements to carer’s leave, relevant carer legislation and other aspects of employment that may impact on • Development and implementation of an electronic caring rostering system (ProAct) including user training, help desk, payroll translation application and ‘Go Live’ support • The GSAHS Code of Conduct continues to be reinforced across all GSAHS Nursing and Midwifery sites in ensuring staff are aware and responsive to EEO principles • Provision of a core education component of the Clinical Excellence Commission Clinical Leadership Program • As part of the ongoing process of Position Description reviews and performance appraisals, specific statements • Delivered an increased range of clinical, management on EEO are included and leadership training in 2007 eg Management Essentials, Leadership for Nurse Unit Managers, First • GSAHS is investigating carrying out an EEO review in Line Emergency Care, Enrolled Nurse Emergency Care the coming year to develop a new base line for various and Mental Health Emergencies groups • Education sessions and workshops conducted across GSAHS regarding the Nursing and Midwifery Policy and Learning and Development Practice System Area Orientation for staff using new technology • The Nurse and Midwives Strategy Funding Steering New technology has advanced our capacity to provide Committee produced the Strategic Plan for Nursing and orientation and training for staff. A successful trial of Area Midwifery Education Orientation utilising video-conference technology was • Dissemination of relevant Knowledge Management and well received by staff with feedback indicating participants CIAP information to GSAHS staff appreciated not having to travel as far. The new format links six sites and new staff can access Area Orientation in a GSAHS Mental Health Service has initiated a program to shorter time-frame. increase the Aboriginal Mental Health Workforce through ten new traineeships. The trainees are undertaking the New leadership development program for GSAHS Charles Sturt University Bachelor in health Sciences degree clinician managers to become fully qualified Mental Health clinicians. The In partnership with the Clinical Excellence Commission, trainees commenced in 2007. GSAHS commenced a new initiative to enhance the skills of clinician managers. Four senior clinician managers joined a State-wide cohort in a 12 month Modular and Residential Program commencing in January 2007. As well as a residential education session held in Sydney, participants must identify two safety or quality challenges from their own Health Service Clinical Services Plan to resolve and work on throughout the program. An additional 20 GSAHS clinician managers from all disciplines and two peers from NSW Ambulance were selected for the local version of the 12 month program. GSAHS appointed two facilitators to lead the local program, and coach and mentor participants. The program provides a structured experiential development process which explores clinical leadership and change management concepts through professional development plans, workshops, coaching, and action learning sets and mentoring.
BETTER HEALTH FOR RURAL AUSTRALIA 27 Research Managers and staff attend mandatory training days where Security, Fire Safety, Manual Handling, Managing Aggressive Summary of applications reviewed by GSAHS Human Behaviour and other relevant topics are covered. GSAHS Research Ethics Committee July 2006 – June 2007 Managers also received training in their OHS and Injury The GSAHS Human Research Ethics Committee (HREC) Management Roles and Responsibilities and have been received a total of 31 applications for the period 2006-07. actively supported in managing issues by the OHSW Unit.
Applications Reviewed 31 Staff are consulted regularly on OHS issues through their local Occupational Health and Safety Committee and are Approved 22 encouraged to raise any issues in team meetings and with Rejected 5 the dedicated OHS officers for their Cluster or Business Unit. Referred to another HREC 1 In 2006/07 new claims for workers compensation injuries Other 3 reduced by 27% against 2005/06 as a result of improved OHS activity across the Area. GSAHS developed positive working The research protocols involved both clinical and general relationships with the Insurer, Employers Mutual Limited and research and included studies involving: mental health the panel of Rehabilitation Providers to ensure a consistent issues; brain injury factors; heart disease; medical devices; approach to Early Intervention and Return to Work for all sexual health; allied health recruitment; workplace practices; injured workers. This has resulted in a 28% decrease in open improving health services; perinatal screening; services for claims during 2006/07. specific groups such as refugees or carers; health awareness campaigns; and data analysis. During 2006/07 GSAHS implemented the following: The following academic institutions were either responsible • Smoke Free Workplace NSW Department of Health for the research being undertaken or was the institution in Policy Directive which a student was completing post-graduate study: All GSAHS sites and facilities are now smoke free and staff • Charles Sturt University (7) were supported through the transition with working parties, information and training, as well as support for smokers to • La Trobe University (1) quit smoking. • Murdoch Children’s Research Institute (1) • Occupational Assessment, Screening and Vaccination • University of NSW (3) NSW Department of Health Policy Directive • University of Technology Sydney (1) Implementation of this program has commenced with all staff required to be screened and assessed by February 2008. In • University of Western Sydney (2) line with the policy directive new staff, who meet specific • Queensland University of Technology (1) criteria, are required to demonstrate immunity against specified diseases to ensure they are not exposed to health Other organisations undertaking research: risks when managing patients. This takes effect from July 1, • Alpine Prosthetics Pty Ltd (1) 2007. This policy is also being actively implemented amongst existing staff to ensure their welfare whilst at work. • Centre for Rural and Remote Mental Health (1) • Return to Work (RTW) Co-ordinator Network Forum • GSAHS (10) This regular forum provides an opportunity for site RTW • National Centre in HIV Social Research (1) Co-ordinators to develop their knowledge and skills in all • NSW Rural Institute for Clinical Services and Training (1) areas relating to RTW, including appropriate referral to • Riverina Division of General Practice (1) rehabilitation, early intervention, provision of suitable duties and appropriate communication with the injured worker. Overseas Travel • Manual Handling Continuous Improvement Working Party There was no overseas travel recorded for GSAHS in the 2006/07 reporting year for training, education or research Manual Handling injuries are still a large proportion of all purposes. claims for GSAHS and the Manual Handling Working Party has been established to identify best practice strategies Occupational Health, Safety and Wellbeing for prevention of related injuries across all work practices in GSAHS. This includes nursing, hotel services, security GSAHS is committed to providing a safe and healthy and administration. Pilot programs are being developed and working environment for all staff, visitors and contractors. evaluated for implementation across the Area. The new Occupational Health, Safety and Wellbeing Unit (OHSWU) structure has enabled a focus on developing Work is continuing on refining operational reports to allow Prevention and Injury Management systems and programs sites and facilities to identify problem areas or trends and the for implementation across the Area. OHSW Unit is working in partnership with sites to improve overall OHS and Injury Management performance. Each Cluster, site and facility uses a risk management framework for identification and management of hazards. This framework is supported by an electronic Incident Information Management System (IIMS) that encourages early reporting of any hazards or injuries and prompt investigation of issues and implementation of appropriate follow up actions to mitigate any risks.
28 GSAHS ANNUAL REPORT 2006 - 2007 Corporate Governance Statement
The Chief Executive carries out the functions, responsibilities A Risk Management Framework has been established and and obligations of that office in accordance with the Health is being enhanced in accordance with Risk Management Services Act, 1997. policies and guidelines published by NSW Health. The Risk Management Framework is in accordance with the Suncorp / GSAHS is committed to good corporate governance practices Treasury Managed Fund model described in Chapter 9 of the as outlined in the Corporate Governance and Accountability Governance Compendium. Compendium (‘the Governance Compendium’) issued by NSW Health. The Chief Executive has established internal management processes and controls that support and give Privacy effect to the following core principles set out in Chapter 1 of The privacy of personal information held by GSAHS is the Governance Compendium: governed by the Privacy and Personal Information Protection 1. To promote and protect the health of the people of NSW Act 1998 and the Health Records and Information Privacy and to ensure they have access to basic health services Act 2002. Patient records generally are covered by the Health Records and Information Privacy Act while all other 2. To perform effectively and efficiently in clearly defined personal information held by the Health Service is governed roles and functions by the Privacy and Personal Information Protection Act. Both 3. To promote and demonstrate our values through Acts establish privacy principles that must be observed by leadership and behaviour all public sector agencies, in the case of the Privacy and Personal Information Protection Act, and by all holders of 4. To take informed transparent decisions and manage risks personal health information, in the case of the Health Records effectively and Information Privacy Act. 5. To develop the capacity and capability to provide Both Acts provide for an internal review where an individual effective and safe health services believes that an agency has breached the terms of the Act. 6. To engage stakeholders and make accountability a During the year GSAHS received three applications for reality internal review. The Chief Executive has systems in place to ensure the Case 1 – a client claimed that Health Service staff had primary governing responsibilities of GSAHS are fulfilled with used and disclosed personal health information contrary respect to: to legislation provisions and Health Privacy Principles. The internal review determined that, while there had been use and • Setting the Health Service’s strategic direction disclosure of the client’s personal health information, such • Ensuring compliance with statutory requirements use and disclosure was in accordance with legislation and Health Privacy Principles. The client subsequently referred • Monitoring the performance of the Health Service the matter to the Administrative Decisions Tribunal. Following • Monitoring the quality of health services provided an initial compulsory conference the client withdrew the application to the Tribunal. • Industrial relations / workforce development Case 2 – a client claimed a staff member disclosed personal • Monitoring clinical, consumer and community health information contrary to legislation provisions and participation and Health Privacy Principles. The internal review determined that • Ensuring ethical practice such a disclosure had occurred. The Health Service issued the client an apology, which was accepted. The Chief Executive has established the following committees as required by the Standard By-Laws issued by the Director- Case 3 - a client claimed that a staff member disclosed General of NSW Health to assist in effectively discharging personal health information contrary to legislation provisions and overseeing the above functions: and Health Privacy Principles. The internal review for this matter is ongoing. • Audit and Risk Management Committee GSAHS has produced a pamphlet informing clients and the • Finance and Performance Committee public generally of its privacy policy and their rights under • Health Care Quality Committee that policy. A copy of the pamphlet is given to all clients on admission and is widely available in emergency departments • Medical and Dental Appointments Advisory Committee and reception and waiting areas. These committees function in accordance with Chapter 12 of The Health Service has also implemented a comprehensive the Governance Compendium. privacy training program. This training program has been An Area Health Advisory Council facilitates involvement of designed to educate staff about the Health Service’s and providers and consumers of health services and members of their own obligations under both Acts. the community in the governance of the Area Health Service. The Area Health Advisory Council functions in accordance with Chapter 10 of the Governance Compendium. An Instrument of Delegations, approved by the Chief Executive, details the functions, authorities and expenditure approvals delegated to officers of the Health Service. The delegations of authority in the Instrument of Delegations are consistent with Chapter 3 of the Governance Compendium.
BETTER HEALTH FOR RURAL AUSTRALIA 29 Clinical Governance Statement
Introduction number of Clusters there were a number of high priority recommendations made by the survey teams. GSAHS has Clinical governance is “the system by which the governing successfully addressed these recommendations. body, managers and clinicians share responsibility and are held accountable for patient care, minimising risks to consumers and for continuously monitoring and improving Complaints or Concerns Against a Clinician the quality of clinical care”. The NSW Health policies Complaint or Concern About a In order to achieve this, the NSW Department of Health Clinician - Principles for Action and Complaint or Concern established the Patient Safety and Clinical Quality Program About a Clinician - Management Guidelines were released by (PS and QCP) in 2004 with the aim of having “all significant NSW Health on January 30, 2006. adverse incidents…reported and reviewed so that education The GSAHS Professional Practice Unit investigates and remedial action can be applied across the whole health complaints or concerns against a clinician. An improved, system”. As part of this program Clinical Governance Units positive reporting culture is responsible for the increasing (CGU) were established in each Area Health Service in 2005. numbers of professional practice referrals. 273 complaints or The CGU has staff located across the Health Service to assist concerns about clinicians (doctors, nurses and allied health Clusters in achieving the goals of PS&QCP. practitioners) have been received and investigated. The The Clinical Governance Unit has maintained close working severity of the issues fall into the following categories: relationships with the Quality and Safety Branch in NSW Level 1 (Serious complaints or concerns) 33 Health, the Clinical Excellence Commission, the GSAHS Level 2 (Significant complaints or concerns) 187 Clinical Operations Directorate and the Director of Corporate Governance. These relationships have enabled the CGU to Level 3 (Performance of an individual varies from peers or drive some of the changes required to improve patient safety expectations) 33 and quality. Level 4 (Frivolous, vexatious or malicious) 20 Investigation of Serious Adverse Events A small number of complaints or concerns about clinicians result in notification to the appropriate Health Professional All reported adverse events are entered into the Incident Board. Others are managed through the GSAHS performance Information Management System (IIMS), which is monitored management system. Identified systems issues are managed daily. Serious adverse events are reported to the NSW at a local level via specific action planning, or at an Area level Department of Health and investigated according to the when appropriate in order to achieve widespread system Root Cause Analysis (RCA) methodology. GSAHS has been change. successful in reporting these events to the NSW Department of Health within the 24 hour timeframe required and Recommendations are followed up at regular intervals. completing the RCA investigation within the 70 days allowed. 80% of recommended actions should be completed within Credentialing the timeframe specified in the RCA recommendation. GSAHS GSAHS meets the mandatory requirements of the National achieved a compliance rate of 72% with efforts continuing Standard for Credentialing and Defining the Scope of Clinical to improve this measure. Overdue recommendations are Practice through the Medical and Dental Appointments tracked weekly with action taken to ensure implementation. Advisory Committee and Credentials Committee. This Committee reviews all applications from all medical and Complaints Investigation dental officers for permanent appointments and for locums In 2006/07 GSAHS received 957 complaints out of 104,328 working for more than three months duration. An audit to test admissions and 1,402,820.7 outpatient contacts. The NSW compliance with the standard is expected to be completed Department of Health requires that 80% of complaints are by the end of August 2007. investigated and resolved with the complainant within 35 days. GSAHS achieved this target during the year and has Infection Control achieved a year to date result of 82%. This is a significant GSAHS actively works to reduce health care facility acquired improvement on last year (57%). infections by ensuring there are adequate policies, resources and training for staff. ACHS Certification During the year, 48 GSAHS facilities collected and reported Throughout 2006/07 GSAHS has been preparing for Australian data on Hospital Acquired Infections to the ACHS at six Council on Healthcare Standards (ACHS) Certification. This is monthly intervals. A small number of hospitals fell outside the the first stage of a two part process for GSAHS to achieve normal range for their rate. Action plans to address possible ACHS Accreditation in 2007/08. sources of infection have been developed and implemented The Accreditation process will provide GSAHS with evidence in these hospitals. of a strong quality organisation dedicated to continuing to improve outcomes of patient care. In July 2006 the Corporate Continuous Process Improvement Certification survey resulted in GSAHS achieving certification. A Continuous Process Improvement (CPI) workshop was held The Health Service is now working towards full corporate in conjunction with the Clinical Excellence Commission with accreditation with the survey due in March 2008. some 40 staff attending. The workshop aimed to skill staff in Ten Cluster surveys and one mental health survey was the process of CPI to assist in improving internal processes conducted between February and May 2007 with largely and systems. positive results. Some Clusters have achieved certification whilst others are waiting on final ACHS results. In a small 30 GSAHS ANNUAL REPORT 2006 - 2007 Quality Awards Incident Management In June 2006, GSAHS held the ‘Better Health for Rural A total of 10644 incidents (adverse events) and near misses / Australia’ Quality Awards as a forerunner to the NSW Health potential hazards were reported and managed within GSAHS State Baxter Awards. A total of 53 entries were submitted for via the Incident Information Management System (IIMS). local awards. IIMS is a statewide incident notification and monitoring GSAHS had three finalists at the 2006 NSW Health Baxter system to support the NSW Safety Improvement Program Awards. The projects selected as finalists were: and assist all clinicians, managers and health care workers to identify, manage and learn from incidents and near misses of • Group Phonological Awareness Intervention: It works! all types to reduce the risk of incident recurrence. • The Antenatal Clinic and The most common incident types reported were falls (2311), • Burns Management. accidents / occupational health and safety (1510), medications (1334) and behaviour / human performance (918). At the awards ceremony, held in Sydney, it was announced that the project ‘Group Phonological Awareness Intervention: Incidents are rated according to the severity of the actual It Works!’ won the ‘Appropriateness Category’. This saw outcome and assigned a Severity Assessment Code (SAC) GSAHS receive its first Baxter Award. ranging from 1 to 4 with SAC 1 being the most severe. In early 2007 GSAHS began the awards process for the Of the incidents reported, SAC ratings were second year running. GSAHS received a total of 46 entries SAC 1 43 for the 2007 GSAHS Excellence Awards and has nominated entries in six of the seven NSW Health Awards categories. SAC 2 289 SAC 3 3415 Policy Development SAC 4 5408 The policy and procedure development system underwent further evaluation and improvement in 2007. Education No SAC assigned 1489 sessions were held including the use of a user friendly Toolkit to assist staff in all areas of Policy and Procedure development, access, version control, storage, indexing and archiving. The system has been developed to streamline and standardise GSAHS Policy and Procedure development. The Toolkit has a multidisciplinary approach incorporating all portfolios from Corporate/Operations to Clinical and Nursing. The system will be changed to reflect the new ACHS accreditation system.
Hand Hygiene
The “Clean Hands Save Lives” campaign sponsored by the Clinical Excellence Commission addresses systemic and behavioural factors contributing to low compliance with hand hygiene. The campaign aimed to reduce the incidence of multi-resistant organism infections in acute and residential care facilities through raising awareness of hand hygiene compliance. The program improved hand hygiene compliance by 30% across all categories of staff, with the improvement of doctors’ hand hygiene the highest in NSW. Current rates of hand hygiene compliance are approximately 62%, which is similar to other parts of NSW and is close to rates reported internationally. There is still a need to improve hand hygiene compliance to 100%. An action plan has been developed.
BETTER HEALTH FOR RURAL AUSTRALIA 31 GSAHS Clusters and Other Health Services
Bega Valley Cluster • Increase consumer representation in health service planning The Bega Valley Cluster includes Bega, Merimbula, Pambula, Eden and Bermagui, and smaller villages in the shire. • Ensure patient safety through the continual improvement process Services Delivered • Opening of the new second operating theatre at Bega A wide range of primary and community services including Hospital oncology, mental health, drug and alcohol, Aboriginal health, • Continued partnerships with the University of dental care, palliative care, post acute care, dementia Wollongong and Australian National University and aged care, sexual health, health promotion, child and family care, diabetes care and community nursing. Medical • Opening of a new renal dialysis unit and surgical services delivered include: orthopaedics, • Support a safe and sustainable maternity service for the gynaecology, urology, obstetrics, emergency and day Cluster surgery, Transitional Restorative Aged Care Services (TRACS) and Community Acute / Post Acute Care (CAPAC). Eurobodalla Cluster Major Goals and Outcomes The Eurobodalla Cluster includes Batemans Bay, Moruya, • Achieved ACHS Certification Tuross Head, Eurobodalla and Dalmeny. • Established the TRACS Program Services Delivered • Commenced planning for a new health facility within the A wide range of primary and community services including Shire oncology, renal dialysis, mental health, drug and alcohol, • Commenced planning and construction for a second Aboriginal health, dental care, palliative care, post acute care, operating theatre at Bega Hospital dementia and aged care, sexual health, health promotion, child and family care, diabetes care and community • Increased the High Dependency Unit (HDU) capacity nursing. Medical and surgical services delivered include from four beds to six ophthalmology, orthopaedics, gynaecology, urology, • Commenced planning for upgrading of the HDU include obstetrics, emergency and day surgery. two intensive care unit beds Major Goals and Outcomes • Established the Community Acute / Post Acute Care program • Achieved ACHS Certification • Commenced planning for a renal dialysis unit at Bega • Planning commenced for a ‘Pathways Home’ Ambulatory Hospital Unit at Moruya • All facilities are smoke free • Enhanced the Transitional Care Program with a further four places • Worked with an extremely active and productive Local Health Service Advisory Committee • Increased number of patients for cataract surgery • Recruitment of permanent Dental Officer • All facilities are smoke free • Development and implementation of the Aunty Jean’s • Worked in partnership with the South Eastern NSW Good Health Team programs; a chronic and complex Division of GPs regarding Palliative Care services care program for the Indigenous community • Participation in Acute Post Operative Pain (APOP) • Working in partnership with the South East Division of Collaborative General Practice and Aboriginal Medical Services to • Established the Eurobodalla Health Service Advisory commence the Healthy for Life Program Committee
Key Issues and Events • Participated in the Eurobodalla Health Service patient satisfaction survey • Completion of the Clinical Services Plan for the proposed new Bega Valley Health Facility • Achieved zero patients waiting longer than 12 months for surgery • Met all surgical long wait targets – including all orthopaedic joint replacement surgery • Increased consumer representative on health service committees • Successfully applied for grant funding for Palliative Care Education Program and Palliative Care Suite • Recruitment of permanent Dental Officer
Future Directions Key Issues and Events • Achieve ACHS Accreditation through continuous • Recruit two general surgeons improvement programs • Recruit Director of Critical Care • Continuing and further integration of primary health and • Succession planning for medical and nursing community care services • Development of the Eurobodalla Operational Plan • Continue planning progress for new health facility 2007/08 • Develop partnerships with other health service providers 32 GSAHS ANNUAL REPORT 2006 - 2007 Future Directions • Further integrate and share services and resources within the Cluster • Achieve ACHS accreditation • Develop and implement a recruitment program for • External Numerical Profile specialist nursing and allied health staff with other local • Complete the construction of the ‘Pathways Home’ organisations Ambulatory Unit at Moruya • Increase the provision of Aboriginal services • Further integration of primary health and community • Improve access to services through use of transport and care services technology • Develop partnerships with other health service providers Greater Albury Cluster • Increase consumer representation in health service The Greater Albury Health Service Cluster has staffing FTE of planning over 500 between all sites. Greater Albury covers the towns • Ensure patient safety through the continual improvement of Albury, Corowa, Urana, Lockhart, Henty, Holbrook and process Culcairn. Services Delivered Golden Cluster A broad range of acute medical and surgical services, day The Golden Cluster includes the towns of Coolamon, Junee, surgery, emergency, rehabilitation, aged care, radiology, Narrandera, Leeton, Temora and West Wyalong, along with a pathology and other allied health services including number of other smaller communities. physiotherapy, occupational therapy, dietetic, speech pathology, social work and provision of aids for disabled Services Delivered people (PAPD). A comprehensive out patient service is There are four district hospitals, a community hospital and available including tertiary community health services at a MultiPurpose Services (MPS) delivering a wide range of Albury Community Health and local services in each town. services. These include general medical and surgical services, Greater Albury also has a prosthetics and orthotic service accident and emergency, obstetric services, palliative care, located at the Diggers Road Campus. The South West Brian radiology and allied health services, residential aged care Injury Rehabilitation Service is located in Albury and forms with dementia care. Community health services are provided part of the Greater Albury Cluster. in six local shires/towns. This incudes community nursing, drug and alcohol services, Aboriginal health education, Major Goals and Outcomes immunisation, diabetes and asthma education, child and • Successfully achieved ACHS Certification family services, health promotion, counselling, speech pathology, women’s health, sexual assault services, aged • Achievement of major benchmarks for emergency day care, aged care assessment and social worker services. department and operating theatre waiting list targets • Holbrook achieved three year Aged Care Accreditation Major Goals and Outcomes with success in all 44 standards • Formal links have been established with local councils • Director General’s Nomination for 2006 Baxter Health • There is now sharing of a weekend on-call radiology Awards for Burns Management Project - Henty service between Leeton and Narrandera to support • Service Plan developed for Lockhart workforce retention • Culcairn Health Service Plan 2007-2012 has been • Commenced review and redesign of maternity care accepted in draft and the Implementation Plan is being models to ensure continuation of high quality care progressed • Junee MPS construction commenced and the expected • Introduction of five Transitional Aged Care Community completion date April 2008. Packages in Corowa • Commencement of West Wyalong Service Plan with an • Pilot site for Integrated Primary and Community Health emphasis on primary and community health services Care Centre-HealthOne Corowa and health prevention • Completed review of Albury Community Health Child • Achieved ACHS Certification in May 2007 and Family service with new models of care and service benchmarks to be introduced • All sites went smoke free Key Issues and Events Key Issues and Events • Negotiations continue with Department of Human • Recruitment of specialist nursing staff to support and Services Victoria to progress an integrated health service maintain existing services, in particular maternity and for the Albury and Wodonga communities aged care • Assisting staff to provide best care of older people in our Future Directions residential aged facilities and MPS • Successfully complete ACHS Accreditation in 2008 • Recruitment of additional GPs to support medical • Complete Albury Community Health Service plan services in the community • Introduction of call centre for Albury Oral Health service • Ongoing transport costs to access higher level acute planned for August 2007 to streamline access to dental services services Future Directions • Introduction of Integrated Perinatal Care program to support families to provide the best possible start for • Further integration of hospital and community health services their children BETTER HEALTH FOR RURAL AUSTRALIA 33 • Introduction of a Drug and Alcohol liaison program to Monaro Cluster support clients with complex drug and alcohol, and The Monaro Health Service Cluster includes the city of mental health needs Queanbeyan and the townships of Cooma, Braidwood, • Opportunities to increase post acute care services Bombala, Delegate, Bungendore, Jindabyne and Thredbo. in partnership with Albury Community Health Centre and Albury Base Hospital and thereby reduce hospital Services Delivered admissions Services delivered include medical and surgical services, obstetrics, day surgery, emergency, radiology, pathology, Lower Western Cluster aged care and a broad range of community health services. The Lower Western Cluster includes Barham, Berrigan, Deniliquin, Finley, Jerilderie, Tocumwal, Mathoura, Major Goals and Outcomes Moulamein, Tooleybuc and Moama. • Monaro Cluster was granted certification by ACHS Services Delivered • Queanbeyan achieved re-accreditation as a ‘Baby Friendly’ hospital A wide range of primary and community services including drug and alcohol, Aboriginal health, dental care, palliative • Cooma and Queanbeyan achieved operating theatre care, community nursing, aged care, sexual health, health waiting list benchmarks promotion, child and family care, occupational therapy and • Following a successful pilot, the Sub-Acute Fast-Track diabetes care. Lower Western has a range of health services Elderly (SAFTE) Care project has been funded for the next including a District Hospital, Community Hospitals and an four years under the new name of ‘Healthy at Home’ MPS providing a range of medical and surgical services including obstetrics, emergency care, day surgery, radiology, • Work commenced on Bombala redevelopment in ultrasound, pathology, physiotherapy and aged care. February 2007 due for completion at end of December 2007 Major Goals and Outcomes • Established Podiatry (private) service in Braidwood • Achieved ACHS Certification • Braidwood MPS commenced a structured community • All facilities are smoke free consultation process, identifying future service needs for the service • Achieved zero patients waiting longer than 12 months for surgery • A three year service agreement was completed for Braidwood MPS • Lower Western Service Plan adopted and implementation of recommendations commenced in four identified • Agreement established for mental health outreach clinic priority areas – workforce, cross border, dental services in Braidwood and transport Key Issues and Events • Formation of Lower Western Cluster Advisory Council • Cooma undertook planning and commenced • Development and construction of Berrigan MPS, development of a new shared-care model for the delivery expected completion February 2008 of oncology services in the region Keys Issues and Events • Planning underway for the Jindabyne HealthOne Model of Integrated Primary and Community Health • Recruitment of specialist nursing, dental and allied health staff to maintain and support services. • Construction of the new Queanbeyan health facility is well underway, due for completion in mid 2008 Future Directions • Queanbeyan Hospital implemented a new emergency • Maintain and improve focus on continuos quality department medical model and employed a new improvement to achieve ACHS Accreditation emergency department director • External Numerical Profile • Further implementation of CHIME occurred at Queanbeyan Community Health • Move towards integrated service provision with enhanced primary care services Future Directions • Implementation of ante-natal and shared care maternity • Delegate MPS is working to increase aged care services model • Working towards Cluster Accreditation in 2008 • Further integration of primary health and community care services, multi campus rostering and bed management • Planning for service delivery in the new Bombala and Queanbeyan Health Facilities • Develop partnerships with other health service providers to improve access for border communities, including • Ensuring integrated patient care and service provision development of integrated models of care • Transitional Restorative Aged Care Services (TRACS • Plan for renal services and support chronic and complex Home) program will commence in Queanbeyan following care including care to Aboriginal communities development of a service agreement with a community provider • Workforce planning that explores alternative recruitment methods, achieves flexible work practices, on-the-job • Implementation of the new oncology service delivery training of staff and maximises the use of staff resources model in Cooma to focus on clinical care • Continued development of the Jindabyne Health One Service Model
34 GSAHS ANNUAL REPORT 2006 - 2007 Murrumbidgee Cluster include ophthalmology, orthopaedics, gynaecology, obstetrics, emergency and day surgery. Allied health The Murrumbidgee Health Service Cluster includes the city services include physiotherapy, occupational therapy, of Griffith and townships of Hay, Hillston, Darlington Point, dietetics and speech therapy. Yenda, Hanwood, Yoogali, Beelbangera, Lake Wyangan, Tharbogang, Binya, Barellan and Coleambally. Major Goals and Outcomes Services Delivered: • Achieved ACHS Certification Acute medical/surgical, chronic and complex, rehabilitation, • Completed planning for Boorowa to be formally obstetric services, day surgery, emergency department, recognised as an MPS radiology, pathology, aged care, physiotherapy, Aboriginal • Service Planning completed for all eight communities liaison, oncology unit, renal dialysis unit, intensive/coronary and high dependency unit, large range of visiting services • All facilities are smoke free and a broad range of community health services. • Established the Southern Slopes Health Service Advisory Committee Major Goals and Outcomes: • Southern Slopes Health Service patient satisfaction • Progression of emergency department refurbishment, survey completed which is due for completion in late December 2007. All other department relocation has been completed • Achieved zero patients waiting longer than 12 months for surgery • Clinical Services Plan completed • Eight Local Health Service Advisory Committees • Approval to recruit a Nurse Practitioner to emergency functioning department and a Clinical Nurse Educator to the coronary care unit • Development of Cluster Quality Council – including consumer representation • Basic surgical training and GP procedural training commenced in January 2007 • Recruitment of permanent Dental Officer at Young • Ambulance Integration project moving forward in Hillston • Increased general surgery at Young and Hay with a draft Memorandum of Understanding • Commencement of capital works for Adelong-Batlow circulated for comment MPS • 18 Murrumbidgee staff members completed Frontline • Commenced planning for Cootamundra Community Management training Health to relocate to new HealthOne campus adjacent to • 10 Griffith Base Hospital staff now involved in LEAD the Hospital program • Murrumburrah-Harden Hospital achieved Aged Care • Reconfiguration of two units at Griffith Base to enhance Accreditation until 2010 delivery of care • Completion of minor capital works at Tumut Health Service – improved security and disabled access, Key Issues and Events renovations to both Hospital and Community Health • Hay Expo planned for 19th October 2007 to showcase buildings GSAHS and local services • Integrated Perinatal Care – Families NSW implementation • ACHS Certification obtained by Murrumbidgee Cluster at Tumut and Cootamundra for 12 months • Aboriginal Otitis Media Screening commenced Tumut • NSW Institute of Medical Education and Training region accreditation gained at Griffith Base Hospital • Strengthened links with Mercy Health and Aged Care • Increase in service delivery for renal patients with the unit dialysing six days per week and three afternoons Keys Issues and Events per week • Collaborative recruitment with key stakeholders for • Donation of electric beds for Griffith Base from the local medical and nursing workforce in smaller communities community and surrounding districts through 2007/08. • Griffith Base Recovery Unit received eight new trolleys, • Increased general surgery at Young also from public donations • Recruitment of two GP anaesthetists to Young, improving emergency department and anaesthetic services Southern Slopes Cluster • Development of integrated model of surgical services The Southern Slopes Cluster includes the acute and between Young and Cootamundra primary care and community health facilities at Batlow, Boorowa, Cootamundra, Gundagai, Murrumburrah-Harden, Future Directions Tumbarumba, Tumut and Young. In addition Mercy Health and Aged Care, a third schedule hospital is located at Young. • Achieve ACHS accreditation • External Numerical Profile Services Delivered • Completion of Adelong-Batlow MPS A wide range of primary and community services including oncology, women’s health, mental health, drug and alcohol, • Completion of Gundagai MPS planning Aboriginal health, dental care, palliative care, post acute • Completion of Cootamundra HealthOne facility seeing care, dementia and residential aged care, sexual health, an integration of Community Health, VMO’s and private health promotion, child and family care, diabetes care and providers community nursing. Medical and surgical services delivered BETTER HEALTH FOR RURAL AUSTRALIA 35 • Further integration of primary health and community • Refurbishment of emergency department completed to care services increase clinical area • Develop partnerships with other health service • Approval to recruit two Nurse Practitioners to emergency providers department • Continue to strengthen links with all communities within • Anaesthetic Department accredited by the College of the Cluster Anaesthetics • Ensure patient safety through the continual improvement • NSW Institute of Medical Education and Training re- process accreditation for junior medical staff training • Increase orthopaedic surgery at Young • Approval to restructure Medical Administration and recruit additional support staff • Development of renal planning processes for Cluster • Increased recruitment of senior clinicians for Mental • Expansions of oncology services at Young Health Services • Implementation of Model of Maternity Care at • Mental Health access block continues to improve Young - development of similar models at Tumut and Cootamundra • Commenced Intern Psychologist Program within Drug and Alcohol Services • Increased focus on primary and preventative care within Cluster • Implemented Tolland Community Development Project • Dieticians in the process of developing a Family Healthy Southern Tablelands Cluster weight management program The Southern Tablelands Health Cluster is made up of the • Wagga Wagga Community Health has commenced major towns of Goulburn, Crookwell, Yass and Gunning. implementation of CHIME Services Delivered • Child and Family Health nurses implemented the Human Papillovirus (HPV) immunisation program in all Wagga General medical, surgical: orthopaedic, urology, Wagga high schools with an 80% uptake rate ophthalmology, gynaecology, endoscopy, obstetrics, paediatrics, emergency, intensive care, renal dialysis, acute • Recruitment of two Dentists under the International mental health and rehabilitation. Community health services Recruitment Program such as community and child and family nursing, allied health • Commenced Call Centre for dental appointments services, Aboriginal liaison, a range of clinics, palliative care and health development. Key Issues and Events Major Goals and Outcomes • Introduction of middle management training through the Leadership, Effectiveness, Analysis and Development • Achievement of NSW Health benchmarks for emergency (LEAD) project to increase skills and knowledge in both department and operating theatre waiting lists. leadership and financial management Key Issues and Events • Increased community engagement through fundraising activities to purchase new electric beds with over • Underwent ACHS certification process $50,000 raised to date Future Directions • All workplaces Smoke Free Workplace as of July 2007 • Successfully complete ACHS Accreditation in 2008 • Introduced an iPM record system • Acquisition of a Drago Neonatal Ventilator Wagga Wagga Cluster • Introduction of the Transitional Care Program in Aged The Wagga Wagga Health Service Cluster incorporates Care Wagga Wagga Base Hospital, Wagga Wagga Community Health and Tarcutta Community Centre. Future Directions Services Delivered • Successfully complete ACHS Accreditation in 2008 Services provided include a comprehensive range of medical • Recruit permanent medical staff to obstetrics, and surgical services including all major sub-specialties anesthetics, emergency department, pediatrics and excluding neurosurgery, cardio-thoracic surgery and burns. respiratory medicine A broad range of community health services are provided. • Coordinate oral health school survey Major Goals and Outcomes • Restructure of governance committees to support improved and sustainable patient outcomes • Significant improvement in, and achievement of, major benchmarks for emergency department and operating theatre waiting list targets • Successfully achieved ACHS certification • Introduction of a new CT service in the radiology department • Clinical Services Plan published
36 GSAHS ANNUAL REPORT 2006 - 2007 Aged and Extended Care • Development of Cancer Care Coordinators and Social Worker positions Major Goals and Outcomes • Further improvements in delivery of cancer services to • Transitional rehabilitation care program underway with GSAHS residents 57 clients engaged in service and 52 in progress • Continued development of the partnership with the • Remodelling of dementia services at Goulburn and Cancer Institute to ensure the most appropriate cancer Wagga Wagga services can be provided to GSAHS communities • Falls Management program • A number of successful applications for additional resources for improved cancer services were received in • Healthy Ageing Program commenced at Wagga Wagga 2006/07 Aged Care Service
Key Issues and Events Key Issues and Events • Partnership with Riverina TAFE to support up skilling of • The successful application for funding from the Cancer Assistants in Nursing and Personal Care Assistants in Institute to trial a new model of care for oncology aged care settings in small rural sites services for the Cooma area • Riverina GP Division partnership programs established • Accreditation of the South West Breastscreen service in Wagga Wagga • Participation in significant quality review activities • Falls risk assessment Future Directions • Dementia project • Continued development of cancer services across the GSAHS including exploration of new partnership Allied Health Services opportunities. Major Goals and Outcomes • A grant from the NSW Health Rural Clinical Locum Child Youth and Family Services Program facilitated employment of a clinical support Major Goals and Outcomes physiotherapist, occupational therapist and speech pathologist for three years. This clinical support team • Statewide Infant Screening Hearing (SWISH) Program will provide locum relief as a retention strategy for allied achieved a 98% screening capture rate across GSAHS, health. The three positions are based at Charles Sturt with many sites capturing 100% of all births University (Albury) to enable greater collaboration and • Rates of Families First Universal Home Visiting within sharing of expertise between the academic sector and two and four weeks of birth have improved clinicians • Completion of a five year strategic plan for Women’s • Completion of a Department of Education Science and Health Training Project to review allied health assistants roles in the rural environment. The assistant role will enhance • Continued implementation of the Practical Paediatrics allied health service provision in rural areas. A two year Program grant was received from the NSW Institute of Rural • Development and implementation of the ‘Essential Clinical Services and Teaching to pilot rurally appropriate Paediatrics’ course designed to improve the skills of training in Allied Health Assistance qualification. The nurses providing paediatric care model will be rolled out to rural NSW Area Health Services and is a partnership with Riverina Institute of • Implementation of the ‘Grace Project’ to increase the TAFE in collaboration with Charles Sturt University capacity of services to provide a gendered approach to service provision for women Future Directions • Implementation of the Paediatric E-Learning Package on • Continued involvement in the health assistants role in the GSAHS Intranet rural environment project • Development of a Termination of Pregnancy and Emergency Contraception Strategy Cancer Services Cancer Services includes three Cancer Networks which Key Issues and Events reflect GSAHS patient flows and networking of GSAHS • The Integrated Infant Perinatal Care Program commenced Cancer services: in the western region of GSAHS • Border Cancer Network • Standardisation of GSAHS Genetic Counselling Services • Southern Cancer Network including recruitment to a position in Wagga Wagga. Two papers presented at the National Rural Health • Riverina Cancer Network Conference with one winning the National Institute of Public Oncology Units, Radiation Oncology outreach clinics Clinical Studies prize for Evidence into Practice and Haematology outreach clinics are provided throughout GSAHS. The Cancer Institute NSW has funded GSAHS to Future Directions appoint a range of directors, nurses, social workers and • Finalisation of the Integrated Perinatal Infant Care support staff. Program implementation Major Goals and Outcomes • Development of an education and mentoring strategy for all Child and Family Health Nurses • Continued development of the GSAHS Cancer Services Executive Committee to set the direction for cancer • Implementation of the Statewide Eyesight Preschooler services in GSAHS Screening Program BETTER HEALTH FOR RURAL AUSTRALIA 37 • Implementation of the GSAHS Women’s Health Strategic Counselling and Violence Prevention Plan Counselling and Violence Prevention incorporates Sexual Assault Services (SAS), Physical Abuse and Neglect of Clinical Redesign Unit Children (PANOC), generalist counselling, community health Major Goals and Outcomes social work and psychology and domestic violence.
• Establishment of governance structures for Redesign Major Goals and Outcomes Unit • Ensured the service needs of rural SAS and PANOC were • Completion of projects identified in the CSRP1c Report identified in the Department of Health’s review of sexual in conjunction with a project team from KPMG. This assault and medical forensic service provision was completed as per Work Order CSRP-GSAHS-005, Implementation Project Under the Clinical Services • Highlighted the rural needs of SAS and PANOC Joint Redesign Program (CSRP) Investigation Review Team (JIRT) responses through GSAHS participation in the NSW JIRT Initial Response • Development of Redesign team members through Focus Group project management training provided by KPMG • Improved access to education for paediatricians providing • Creation of project management system, templates and medical and sexual assault forensics examination user guides to be used as shared knowledge throughout through enhancement funding GSAHS • Patient and Carer Interviews and Reports completed Keys Issues and Events as a component of projects in Wagga, Griffith, Albury, • Interim appointment of a senior SAS and senior PANOC Goulburn and Finley clinician Key Issues and Events • Re-negotiated a Memorandum of Understanding with ACT Health’s Forensic and Medical Sexual Assault Care • Development and implementation of a sustainable organisation for the provision of forensic services communications process with Visiting Medical Officers (VMOs) including maintained database • Interim appointment of child protection educators • Waitlist Policy review and site-specific performance • Inaugural service development meeting for generalist report against policy requirements with implementation counsellors, community health social worker and action plan psychologists • Reduction of late operating theatre start times by the Future Directions implementation of an agreed start time definition and recording of data used to drive behaviour • Completion of the policy and procedure manual for generalist counsellors, community health social workers • Patient flow protocol established at Albury Base and and psychologists Wagga Base Hospitals including prioritisation schedule and implementation of the Bed Manager position • Lead the development of an area wide clinical supervision policy • Operating theatre scheduling model created and supplied to Wagga Wagga Base Hospital with training • Establish steering committee with PANOC and Child and for appropriate staff Adolescent Mental Health to develop a GSAHS protocol for working with children under 10 years with sexualised • Training of Redesign team in NSW DoH initiated behaviours methodology including Accelerated Implementation Methodology (AIM) and Patient and Carer Project. These methods to be rolled out across GSAHS to assist in Critical Care Services successful project outcomes Critical Care Service provides a consultancy, planning, educational and advisory role for GSAHS emergency care • Assistance in the implementation of 3:2:1 model of care services and intensive care. These services also liaise in the emergency department at Albury Base Hospital with hospitals, GSAHS groups, and Victorian and ACT stakeholders to ensure seamless transfer of the critically Future Directions ill. Critical care staff have an advocacy role with the NSW • Appointment of GSAHS Redesign Engineer to further Department of Health regarding resources, policy and establish the Redesign Unit’s protocol and procedures protocol development to support clinicians working in the 43 emergency departments, five intensive care units and • Goulburn Redesign Avoidable Admissions Project multiple high dependency units throughout GSAHS. implemented according to the project plan and training plan Major Goals and Outcomes: • Assistance in project methodology including data • Policy development and planning to provide the best collection, status reports and training to projects possible patient safety and levels of care in partnership • Rollout of AIM across GSAHS by Redesign members with clinical governance, mental health, paediatrics, accredited by NSW Health Pastoral Care and NSW Ambulance • Development of program to establish successful Patient • Funding and recruitment for Intensive Care Nurse First Initiatives and Leadership Enhancement and Educator positions in Wagga, Albury, Goulburn, Griffith, Development (LEAD) across area and Bega • The Redesign Unit will continue to provide GSAHS with • Funding granted and planning progressing for the ongoing project management training and support development of two intensive care beds at Bega Hospital
38 GSAHS ANNUAL REPORT 2006 - 2007 • Clinical education programs skilling health professionals basis in Queanbeyan and on request in Cooma. This in First Line Emergency Care, Enrolled Nurse Emergency program addresses risky drinking issues and focuses on Care, Emergency Paediatrics, Advanced Life Support, minimising the harm to other drug users intravenous cannulation, defibrillation, ventilated patient • GSAHS co-ordinates the Brain Bus, an alternate care and Critical Care Postgraduate Education transport service in Jindabyne every snow season. This • Assistance in training for Pastoral Care staff to support service provides transport to patrons of local hotels and acutely distressed patients and their relatives in crisis minimises the risk of drink driving and injury. Patronage situations of the bus service has increased by approximately 20% this year • Multidisciplinary Critical Care seminars with heavy practical scenario-skills base were held in Batemans • Alcometers have been given to 20 GSAHS emergency Bay; an Institute of Trauma Management Trauma day departments (EDs) to provide a quick, cost effective was held in Wagga, attended by a total of 220 doctors, means for breath analysis to assist in management of nurses and ambulance officers patients presenting with alcohol related conditions
Key Issues and Events • A partnership between the Drug and Alcohol Service, Wagga Wagga Community Health Service, the police • Major Emergotrain Disaster Exercise held at Wagga Base (PCYC), the Smith Family and the Department of Sport Hospital and Recreation has led to the establishment of the Tolland • Influenza Pandemic Planning and Exercising for Project. A weekly BBQ is held in Tolland Community to emergency departments and intensive care units and engage the Indigenous Community in health care liaison with significant outside bodies • The Drug and Alcohol Service provides regular education • Medical Emergency Team Response planning and sessions on safe custody of prisoners affected by development at Albury, Wagga, Griffith, Goulburn and substance use at the Goulburn Police College Eurobodalla Future Directions • Continuing clinical service re-design involving introduction • Plans are underway to develop and implement drug and of new models of care to enhance patient flow through alcohol education sessions for parents of primary school Wagga and Albury emergency departments. children Future Directions • Drug and Alcohol training will be offered to Mental • Trial of ‘Medical Assessment for Mental Health Patients’ Health staff and the Aboriginal Medical Services across booklet to be conducted in some GSAHS emergency GSAHS departments Medical, Chronic and Palliative Care • Introduction of a procedure for managing behaviourally disturbed individuals presenting to emergency Major Goals and Outcomes departments • Supported work undertaken on the Auntie Jean’s Good • Introduction of procedures and protocols to ensure Health Team Program by GSAHS Aboriginal Health seamless transfer of critically ill patients from NSW to Services, which aims to promote better health outcomes ACT for Indigenous groups • Emergotrain Exercise conducted at Albury Base Hospital • Contributed to the GSAHS Health Development Plan in relation to smoking prevention and cessation, and Drug and Alcohol Services obesity • Undertook Eurobodalla palliative care service redesign Major Goals and Outcomes in partnership with the South Eastern NSW (SENSW) • Implementation of the GSAHS Drug and Alcohol Nursing Division of General Practice Practice and Patient Safety Policy resulted in 66 nursing • Chronic Obstructive Pulmonary Disease and Chronic staff members being trained as resource people in Heart Failure admissions have reduced and length of nursing management of patients with drug and alcohol stay remains under the NSW average related problems. This represents a significant increase in the capacity of GSAHS to provide high quality care for • GSAHS is partnering with the University of NSW and this group of patients NSW Arthritis Foundation to pilot a self-management program for arthritis. This is in the pre-implementation • GSAHS obtained funding from the Medical Specialist phase Outreach Assistance Program to support monthly education sessions and client review by Professor Bob • Partnerships with Divisions of General Practice for Batey, Professor of Medicine at UNSW. This aims to diabetes management include: improve outcomes for patients with alcohol and drug - A consortium for diabetes management involving related conditions and to improve the skills of staff. The GSAHS staff, Riverina Division of GP’s, local GPs, and project will commence in the new financial year the Riverina Medical and Dental Centre (Aboriginal • Appointment of three drug and alcohol Consultation and Health) Liaison Nurses to Goulburn, Wagga Wagga and Albury - Informal cooperation with the Murrumbidgee Division Base Hospitals. Their role is to work with hospital staff, and SENSW Division of General Practice Mental Health Services and the community to ensure clients receive appropriate and timely intervention - Provision of education to practice nurses by the GSAHS Clinical Nurse Consultant for Diabetes. • The Drug and Alcohol Education Program for people charged with driving with levels above the prescribed • Approximately 5% reduction of admissions was achieved content of alcohol continues to be run on a monthly across eight Diagnostic Related Groups for 2005/06 to 2006/07
BETTER HEALTH FOR RURAL AUSTRALIA 39 • Carer support action plan reviewed in line with the NSW • Increased number of Indigenous nursing staff in GSAHS Carer Action Plan 2007-2012 and Homeless and Parenting - two Indigenous nursing cadets commenced in 2007 Program Initiative (HAPPI) strategy and the number of Indigenous Trainee Enrolled Nurses in 2007 increased to six • Established a partnership with Commonwealth Carelink Centre to pilot the employed carer’s respite program for Key Issues and Events GSAHS employees • Nursing Reasonable Workloads - responsibility • Palliative care education program implemented in various transferred to GSAHS from NSW Health July 2007 sites: to be progressed in 2007/08 • Migration from Staffing Plus Monitoring and Multifunction • Preparation of the corporate certification continuum of system to ProAct and Proactive monitoring system for care component for ACHS certification nursing reasonable workloads Future Directions • Evaluation and implementation of nursing and midwifery staff profiles and continued implementation of Nursing • Develop an implementation plan for medical, chronic and Reasonable Workloads systems across the area with a palliative care clinical service plan focus on Community Health Nursing • Recruit to palliative care service development coordinator and clinical leader for cardiovascular disease position Future Directions • Increase consumer access to chronic care rehabilitation • Collaboration with NSW TAFE and Latrobe University to services commence a Vocational Education Training Certificate III in Acute Care Nursing in 2009 • Contribute to implementation of the HAPPI strategy • Commencement of a research interest group for Nursing Nursing and Midwifery and Midwifery with Charles Sturt University The Nursing and Midwifery directorate continues to work towards setting the strategic direction for nurses and Oral Health Services midwives across GSAHS. Professional development, Oral health services are provided by registered dentists leadership and support, education, clinical practice, policy and registered dental therapists. Over 43,400 occasions of and research, recruitment and retention, and training are all service were provided to children, and dentists provided important in ensuring patients are receiving high levels of over 44,750 occasions of service to adults. At the moment care. demand for services for adults outstrips the capacity for the service to provide clinical care. This is due to a number of Major Goals and Outcomes factors including: • Deployment of two electronic rostering environments, - Australia wide workforce shortages of dentists and including user training, help desk, payroll translation dental therapists application and Go Live's across all GSAHS Nursing and - an ageing population Midwifery sites - increased retention of natural teeth. • Reasonable Workloads for nurses – the ‘General Workload Calculation Tool for Medical and Surgical Ward Recruitment is ongoing through local, national and international continues to be applied across relevant GSAHS sites. agencies. GSAHS works under the guidelines from NSW This includes implementation of an inpatient monitoring Health Priority Oral Health Program which determines the system across a number of sites with work continuing way dental clients are assessed and prioritised for care. into the new financial year The Oral Health Services aim to prevent oral health disease; • Staffing Profiles: all hospital facilities have been reviewed restore good oral health; provide equitable access to high and Nursing and Midwifery Profiles developed quality, appropriate oral healthcare for eligible clients; ensure sufficient skilled staff are recruited and retained; ensure that • NSW Health Overseas Recruitment Campaign: a total good oral health is seen as an integral part of good general of nine nurses and midwives commenced employment health and to work with service, community and government across the area with a further 11 nurses and midwives in partners to provide oral health care. various stages of the recruitment process • Implementation of the GSAHS Nursing and Midwifery Major Goals and Outcomes Knowledge Management model including dissemination • GSAHS oral health development plan developed and of relevant knowledge management and Clinical implemented; new programs implemented including Information Access Project information to the area health “Start School Smiling” for 0-5 year olds service • Successfully applied for two demonstration grants for • The Nursing and Midwifery Policy and Practice Steering health promotion projects. These projects are: Group worked throughout the year to address policy and procedures development. This includes development of - working with Koori children in the Eurobodalla Shire a Policy and Practice Toolkit to produce healthy mouth messages and • A robust ‘Safety Alerts’ process has been developed and - working with Wagga Wagga TAFE to develop an implemented within GSAHS oral health program for the early childhood training program curriculum • Increased collaboration with tertiary institutions - commencement of 31 (2007) and 20 (2008) Enrolled • Successful amalgamation of two databases and two Nurses in a second Bachelor of Nursing cohort in dental services collaboration with Charles Sturt University. Ten staff • Successful rollout of oral health intake service to Wagga graduated from the original Cohort initiated in 2007 and Wagga. Clients are able to access the service using a have commenced working as Registered Nurses within central call number: 1800 450 046 GSAHS 40 GSAHS ANNUAL REPORT 2006 - 2007 • Participation in Internationally Qualified Dentist - introduce Aboriginal Health Education officers in key Programme run through Sydney Dental Hospital and locations Westmead Centre for Oral Health with two overseas - introduce point of care equipment that will assist in qualified dentists undertaking six-month rotations at the screening for people with renal insufficiency Albury and Wagga Wagga dental clinics • Successful recruitment of three additional dental officers Key Issues and Events to the health service • The service contributed to the statewide Rural Renal • Commencement of the volunteer dentist program at Education and Training Working Group. Outcomes Queanbeyan in September 2006 included the development of a skills development tool and resource package for nursing staff and an orientation Future Directions package and associated resources for allied health staff • Service reorientation to include oral health promotion • Six Registered Nurses from Griffith and Wagga Wagga and population health initiatives that have the capacity were funded to complete a post graduate renal nursing to reduce the burden of oral health disease in the certificate community • Wagga Wagga renal nurses commenced the statewide Haemodialysis Models of Care Project. This is a two year Primary and Community Health Integration project facilitated by Professor Mary Chiarella, Professor of Clinical Practice Development and Policy Research, Major Goals and Outcomes University of Technology, Sydney • The successful partnership with the five Divisions of General Practice operating within GSAHS has enabled Future Directions progression of shared planning in the areas of mental • Review of the Renal Services plan for GSAHS health and workforce, along with shared service delivery as exemplified by the Palliative Care service in Eurobodalla Health Support Services • Development of HealthOne NSW service models of Hotel Services integrated and co-located primary health services within GSAHS. Corowa and Cootamundra capital Major Goals and Outcomes works planning was completed for the new HealthOne • Review and reworking of hotel services processes buildings and service delivery is being enhanced through underway at a number of sites which is ongoing improved clinical integration and shared educational opportunities. Jindabyne will also receive a HealthOne • During redevelopment of Queanbeyan Hospital, pre- NSW service. Steering committees that include packed frozen patient meals were provided by the consumer representatives have been established at all Illawarra Cental Production Kitchen three sites Key Issues and Events • Implementation of new GSAHS Regional Health Service programs, funded by the Commonwealth Department of • Cost recovery pricing of Meals on Wheels was Health and Ageing, provide improved access to Primary introduced Health services in small GSAHS rural communities. The • The Wagga Wagga Linen Service was formally program provides integrated clinical care, education, transitioned into NSW HealthSupport prevention and early intervention programs and services, including the provision of allied health services in areas of identified need. The Youth Outreach Program has Patient Transport/IPTAAS (Isolated Patient been remodelled to provide consistent accessible Transport and Accommodation Scheme) programs and increased service options for the youth of the Southern Tablelands Major Goals and Outcomes • Continued rollout of the Community Health electronic • GSAHS Patient Transport Policy and Guidelines were clinical record system (CHIME) developed and rolled out • The Patient Transport Unit was consolidated into Bourke Renal Services Street Health Service premises The Renal Services of GSAHS work closely with teams based • Integration of all non-emergency patient transport at The Royal Prince Alfred and Canberra Hospitals. Within the services has resulted in a more streamlined and efficient Area, renal teams operate from the key locations of Wagga service to patients and clients across the Area Wagga, Griffith, Goulburn and Moruya. Teams consist of facility based haemodialysis, allied health, renal outreach • A 1800 telephone number has been introduced for nursing staff and visiting renal physicians from The Royal Isolated Patient Transport and Accommodation Scheme Prince Alfred Hospital. (IPTAAS) clients and return address envelopes are provided to clients whose forms may have to be returned Major Goals and Outcomes for any reason • Granted additional recurrent funding to: Key Issues and Events - expand renal dialysis services in Goulburn and Griffith • The structure was progressed to enable centralisation of and establish a renal dialysis unit in Bega patient transport management and bookings - provide education to hospital nursing staff in the • Work was undertaken to maximise effectiveness of the management of people undergoing peritoneal ‘Transport for Health’ budget allocation dialysis
BETTER HEALTH FOR RURAL AUSTRALIA 41 Future Directions • Commencement of planning for HealthOne projects at Cootamundra and Corowa • A review of reimbursement processes is in progress with a view to reducing the time taken for finalising claims Key issues and Events • Information packages, which include new IPTAAS • Completion of the Wagga BreastScreen relocation Application Forms and Guidelines for Medical Practitioners and Specialists, will be sent to all General • Completion of Kenmore redevelopment at Goulburn Practitioners across the Area to assist in making current • Significant upgrades to all facilities in areas of fire and information more readily available to prospective clients electrical safety • Revised Service Agreements for brokered transport services from community and mainstream transport Future Directions providers is being finalised in consultation with these • Continuation of planning for the new Bega Valley providers. The revised Agreements incorporate NSW Redevelopment commenced Health’s Transport for Health Policy • Continuation of planning for redevelopment of Wagga GSAHS Area Travel Office implemented a number of Wagga Base Hospital changes to their service this year. Careful mapping and analysis of each step of booking and associated processes Information Services Unit enabled improvements and solutions to be identified. The The Information Services Unit (ISU) provides all information changes resulted in a fast, efficient and reliable service for technology (IT) related support to the GSAHS corporate all users, significant increases in savings, improved data Data Network, computing infrastructure and voice telephony collection and monitoring and expeditious management equipment in addition to management of all IT related and processing of accounts. procurement.
Major Goals and Outcomes Fleet Management • Implementation of 38 ADSL (Asymmetric Digital Major Goals and Outcomes Subscriber Line) services further enhancing the Broad • The Webfleet electronic vehicle booking system was Band infrastructure upgrade partially implemented • Completed the rationalisation of legacy telecommunication services Key Issues and Events • Managed procurement of 278 desktops computers, 134 • A fleet reduction and optimisation program was notebook computers and 65 printers commenced involving replacement of six cylinder vehicles with four cylinder vehicles • ISU Technical Support Staff completed 13,618 support calls during the financial year Future Directions • Commenced planning works for deployment of a • Continued implementation of the vehicle booking system Microsoft based standard software environment for and the fleet optimisation program GSAHS. This included procurement of 100 servers and installation of significant telecommunication Area Travel Office infrastructure representing an investment of over $1M • Completed the lease replacement strategy which Major Goals and Outcomes included procurement and replacement of 535 desktop • The Area Travel Office was relocated from Kenmore computers, 65 laptop computers, 35 multi function Hospital to Bourke Street Health Service devices and 132 printers. This project represents an investment in excess of $1.1M Key Issues and Events • Commenced preliminary work in preparation for the • The Unit provided efficient service and achieved best Electronic Medical Records (EMR) project performance in NSW Health in percentage of Lowest • Completed Implementation of the following systems: Cost Logical Airfares - OTIS - Theatre Management System Future Directions - i.Pharmacy - Pharmacy Management System • Review of accommodation processes and procedures - Proactive - Web based rostering system across GSAHS to identify efficiencies - EDISSON - Emergency department Data Collection • Implementing NSW Health guidelines on air travel Key Issues and Events Asset Management • Completed Stage 1 of the Mental Health Emergency Care Major Goals and Outcomes Services project involving videoconference outreach • Commencement of project construction at Junee, Batlow • Nine videoconference units established across GSAHS and Berrigan • Completed implementation of the new Patient • Continuation of construction at Queanbeyan and Administration System: i.PM (i.Soft Patient Manager) in Bombala, Moruya Pathways Home and Griffith Base December 2006 Hospital emergency department • Continued to progress the new ISU structure • Construction of a new operating theatre at Bega Hospital was commenced
42 GSAHS ANNUAL REPORT 2006 - 2007 • GSAHS went ‘Live’ with CHIME (Community Health Information Management Enterprise) at Queanbeyan Community Health centre in October 2006, with planning commencing for introduction of the program at Wagga Wagga Community Health • Completed works associated with the ACHS Corporate Accreditation process
Future Directions • ISU will be progressing strategies detailed in the Information Communication and Technology Strategic Plan, specifically initiatives that support remote working, collaboration and virtual services such as network based videoconferencing and teleconferencing • Commence implementation of the EMR with introduction of the following modules: - Firstnet - ED Management System - Surginet - Theatre Management System - Results Reporting - radiology and pathology results requests and reporting - Scheduling - EMR Scheduling - EDRS - Electronic Discharge Reporting • The total number of CHIME users will be expanded by 180 across the Area Health Service • Migration of the Area Corporate Network to a common Microsoft platform incorporating the deployment of standard computing infrastructure • Recruit to ISU structure • Transition current GSAHS Helpdesk and Service desk facilities to Health Technology (NSW Health IT Organisation) State Wide Service desk facility • Complete stage 2 and progress stages 3 and 4 of the MHECS Videoconference project which includes the installation of the remaining 36 units. Commence Stage 5 of this project which includes an extra 20 units in Community Health Services • Implement quality of service to the data network • Upscale broadband bandwidth to prepare for electronic radiology services across the area
BETTER HEALTH FOR RURAL AUSTRALIA 43 Health Service Community
Community Participation within GSAHS • Provide advice to the Health Care Advisory Council about GSAHS activities that may have state-wide implications GSAHS demonstrates its commitment to community for the delivery of accessible, quality and safe health participation by: care services • selecting the most appropriate method to consult with • Monitor GSAHS’s performance in promoting and the community establishing clinical networks • being open and frank in consultations • Monitor GSAHS’s performance in relation to major health • providing avenues for the community to provide initiatives and annual clinical and consumer performance both positive and negative feedback on community targets based on key performance indicators (the participation ‘dashboard’ indicators) • identifying community members who will be able to • Develop a two year work plan for the approval of the provide relevant input Chief Executive • recognising and acknowledging the value of the input The Greater Southern Area Health Advisory Council does not from the community. have a role in the operations or management of the health service. The GSAHS Community Engagement framework aims to: • promote patient engagement in their own health Message from Chair maintenance and care, as active partners with professionals, including their carers In June 2006 Dr Robert Byrne resigned from his position of Greater Southern Area Health Advisory Council (GS AHAC) • enable patients and the public as a whole to become Chair. As the successful candidate of the recruitment better informed about their treatment and care and to process, I was officially appointed on 27 November 2006 and make informed decisions and choices commenced my direct involvement with the Advisory Council • ensure that patients, the public and staff have the in February 2007. knowledge, skills and support to enable them to influence At the outset I would like to express my gratitude and that of planning, delivery and monitoring of health services the Council to AHAC members Professor Amanda Barnard, • actively involve patients and the public in planning, Ms Jane Ayers and Mr Ray Gamble for their able chairing of delivering and monitoring our services meetings between the time of Dr Byrne’s resignation and my appointment. • acknowledge and act on information we receive from patients and the public AHAC business for 2007 began with revision of the Work Plan. While the original AHAC Work Plan had been developed • provide feedback to patients and the public about how in January 2006, the appointment of new Chief Executive their engagement has influenced the operation of health Heather Gray and the new Chair resulted in an updated Work services. Plan being finalised during February 2007. Greater Southern AHAC meetings have continued to be Area Health Advisory Council held across the region. Meetings were held at Narrandera, Area Health Advisory Councils (AHACs) were established Queanbeyan, Cooma and Yass in March, April, May and in each Area Health Service to enable clinicians (including June. The meeting held on the 19th April coincided with doctors, nurses and allied health professionals), health a successful Community Participation Forum. This was consumers and local communities to have a stronger voice attended by ninety participants who heard from the Chief in health decision-making. In GSAHS, the AHAC has 12 Executive and other executive members about progress members in addition to the Chair, and can co-opt people with being made by the Area in terms of financial improvement, specialist knowledge or skills if needed. The AHAC has a clinical workforce recruitment and advances in programs balance of clinicians and community members with at least related to mental health and illness prevention, among other one community member being an Aboriginal person. things. The AHAC in GSAHS has the following broad functions: I had two opportunities to attend meetings in Sydney with • Obtain the views of clinicians, patients and community senior health officials during 2007. On 20 April the biannual about the accessibility, quality, and safety of health meeting of AHAC Chairs and Area Chief Executives was services provided by GSAHS, ensuring that appropriate held at NSW Health headquarters in North Sydney. Still local consultation mechanisms are in place in my discovery phase, I did more listening than talking. I learned much that day. The second meeting was the regular • Incorporate the views of clinicians, patients and the NSW Health Care Advisory Council meeting on 13 June community in planning, delivering, monitoring and at which the Chair of the Sydney South East-Illawarra Area evaluating health services provided by GSAHS including Health Service (SSEIAHS) AHAC and I were asked to make the Area Health Services Plan presentations about our work and the challenges we faced. It • Work with the Clinical Excellence Commission to was interesting to hear Professor Bob Farnsworth of SSEIAHS promote delivery of safe and quality clinical services express many of the same challenges as did I, the two most based on best available evidence and the most clinically prominent being the great demographic diversity across our and financially effective models areas and the difficulty of interesting younger community members in getting involved with Area or even Local Health • Report to the community and clinicians about Council Councils. and GSAHS activities to improve health services accessibility, quality and patient safety 44 GSAHS ANNUAL REPORT 2006 - 2007 Priorities Greater Southern Area Health Service 1. Site Visits: We regard the face-to-visit as being vital Advisory Council Members to both the communities visited, who are uniformly The NSW Minister for Health appointed Dr Ian Stewart as appreciative of the personal opportunity, and ourselves Chair of the GS AHAC in November 2006. because of the chance to “get the feel” of the local health scene. We are working on ways of overcoming difficulties Dr Stewart graduated from the University of Sydney and that some members have of travelling long distances to has specialised in obstetrics and gynaecology. Practicing in meetings. Advances in video conferencing technology Sydney and the United Kingdom before moving to Wagga may present an alternative for some members and some Wagga, Dr Stewart has been instrumental in establishing a of the meetings. teaching program for obstetrics and gynaecology within the Clinical School at Wagga Wagga Base Hospital. Dr Stewart is 2. Portfolio Allocations: our AHAC has distilled nine areas highly regarded in rural NSW for his work over three decades of high priority from the NSW State Health Plan to focus in medical practice and community involvement. on. Each of the nine represents a ‘portfolio group’ and is allocated to two or three of the AHAC members. To The GS AHAC has a broad professional base of membership. involve clinicians and consumers in planning and delivery Members of the GS AHAC include: of health services, the Chief Executive requests advice • Ms Jane Ayers from relevant portfolio groups. Members of AHAC and the Chief Executive found this process to be useful in • Associate Professor Amanda Barnard both directions i.e. the provision of community input on • Mr John (Jack) Barron a particular topic can be provided to the Chief Executive and provision of opportunities to appraise community • Ms Fay Campbell issues which are being actively pursued by the Area. • Mr Ray Gamble 3. Communication Link Improvement: with the increasingly • Ms Robyn Haberecht smooth running of the Cluster and Local Health Committees and Councils and the regular involvement of • Mr Robert McCully AHAC members in these forums, we are pleased with • Ms Anne Napoli the progress of development of communication links. • Ms Karen Pollard The challenge is to maintain them and the enthusiasm which each level of committee has thus far developed. • Dr Trish Saccasan-Whelan 4. Capital Works: a number of important capital works • Dr Paul Sevier are either planned or are in the process of construction • Rev Tom Slockee across the area. Griffith Base Hospital emergency department is undergoing extensive refurbishment. Wagga Wagga Base Hospital and the Bega Valley Hospital are in the planning stage for major redevelopment. Numerous other ventures are under construction. The AHAC is maintaining an interest in these projects with the intention of conveying, through its communication network, regular progress reports to the communities involved. At the same time, AHAC is gathering feedback from the communities to pass on to the Area’s Executive and beyond. The GS AHAC has seen two far-reaching issues raised by local communities in 2007 which were referred to the relevant investigative bodies for assessment and decision- making. The first was the range of inequity in the Isolated Patient Transport and Accommodation Scheme (IPTAAS) and aspects in consent for medical treatment in the ACT. A Senate Inquiry was set up to examine the first. To this the GS AHAC made a comprehensive submission incorporating advice from local committees. The inquiry is complete. In its report it has made 16 recommendations for improvements to the scheme. With regard to the complex matter of ‘consent-for-treatment’ in the ACT, relating to patients who are not legally capable of consenting for procedures and treatment, ACT Health’s Legal Department has called for submissions regarding improvement in this area. We have made our submission and await the outcome with interest. The GS AHAC looks forward to the challenges of 2007-2008 and will continue our work with clinicians and communities to deliver high quality rural healthcare to the people we serve. Dr Ian Stewart Greater Southern Area Health Service
BETTER HEALTH FOR RURAL AUSTRALIA 45 Dr Stewart, Chair of the AHAC, is Ms Robin Haberecht is the Health a specialist doctor in Obstetrics and Service Manager in Jerilderie. She has Gynaecology and resides in Wagga 10 years experience in management, Wagga. Practicing in Sydney and health services planning, consumer the United Kingdom before moving consultation and management. Ms to Wagga Wagga, Dr Stewart has Haberecht is a former registered been instrumental in establishing a nurse. teaching programme for obstetrics and gynaecology within the Clinical School at Wagga Wagga Base Hospital. Dr Stewart is highly regarded in rural Mr Robert McCully is from Hay NSW for his work over three decades and is managing director and major in medical practice and community shareholder in The Riverine Grazier involvement. newspaper in Hay. He is Chair of the Hay Multi Purpose Service Committee Ms Jane Ayers is a registered nurse and was previously Chair of Hay with extensive experience in palliative Hospital Advisory Committee. care. She is the General Manager of Mercy Health Service Albury. She was awarded the Albury Electorate Woman of the Year in 2005. Ms Ayers resides Mrs Anne Napoli is an Italian born in Albury. Australian citizen from Griffith who is a councillor on Griffith City Council. Mrs Napoli is a strong advocate for improved services for people living Associate Professor Amanda with a disability and is a member of Barnard is Associate Professor of the Multicultural Disability Advocacy Rural Medicine and Director of the Association of NSW. Rural Health Unit at the Australian National University. She has worked as a General Practitioner in urban and rural areas in Western Australia and at the Sexual Assault Referral Centre in Ms Karen Pollard has a background Western Australia. Her clinical interests as clinician and consumer. She is a include women’s health and asthma. lecturer in Medical Imaging at Charles Sturt University, Wagga Wagga. Ms Mr John (Jack) Barron is a farmer Pollard was previously a radiographer and student from Ungarie where he at the Hunter Breast Cancer Screening has been involved in health services Program and Royal Newcastle Hospital. as an active community member in Ms Pollard resides in Wagga Wagga. Ungarie for over 20 years through work on health committees and most recently with the Ungarie Medical Dr Trish Saccasan-Whelan is Director of Goulburn Centre Committee. He is a former Base Hospital emergency department. She was also the member of the Greater Murray Area Area Disaster Coordinator (HSFAC) for the former area health Health Service Network Three Health service. Dr Saccasan-Whelan played a significant role in the Council. Thredbo disaster when Goulburn was used as a Regional Ms Fay Campbell is a former Mayor Disaster Coordination Centre. She lives in Goulburn. of Bombala. She operates a grazing Dr Paul Sevier is a General property and was Chair of Bombala Practitioner and resides in Young. Hospital Board from 1983 to 1994. He is an active health provider in the Ms Campbell has a long history of region and is aware of the challenges involvement in improving mental involved in providing health services health services in rural NSW, serving particularly in the rural areas. on many boards and committees. Ms Campbell resides in Bombala.
Mr Ray Gamble is from Griffith and is Managing Director of Associated Rev Tom Slockee is an Anglican Media Investments Pty Ltd which Church priest. He is a former Chair operates radio stations throughout of the Southern Area Health Service Australia. He is Chairman of the Griffith Board. He has a particular interest in Health Services Committee and Vice Aboriginal Health and has extensive President of the Griffith Palliative Care involvement in many Aboriginal Group. corporations. Mr Slockee resides in Mogo.
46 GSAHS ANNUAL REPORT 2006 - 2007 Report on Achievements government representatives. AHAC members became familiar with the issues and concerns of each site Section A – Advise providers and consumers of health they visited and had an opportunity to respond. The services and other members of the local community, as to effectiveness of rotational cluster visits was reviewed the Area Health Service’s policies, plans and initiatives for in June 2006 with a determination to continue holding the provision of health services. meetings across the health region during the last twelve Indicators 1 and 2 months. • Engagement structures were reviewed with consumers Review and document the existing consultation and and staff at the annual community participation forum engagement structures with consumers, the Area Health in April 2007. Interactive workshops with documented Service, community and health service providers. outcomes formed a framework to which the Chief In GSAHS, three levels of consumer and clinician participation Executive reports progress to the AHAC quarterly. have been established: Indicator 3 • Area Health Advisory Council (AHAC) Advise on the development, implementation and monitoring • Health Service Cluster Advisory Councils (HSCAC) of recommended consultation / communication pathways. • Local Health Service Advisory Committees (LHSAC) The AHAC has supported the Area Health Service Their inter-relationship is best categorised in the diagram in development, implementation and monitoring of below: recommended consultation/communication pathways in the following ways: Carers Area Health • Circulate a monthly summary of AHAC priorities and NSW Health Advisory Council activity to LHSACs and Cluster Councils within a week of monthly AHAC meetings. The summary provided Voluntary LHSACs with timely information to ensure important Organisations Health Service issues were promptly and effectively communicated to GSAHS Cluster Advisory local clinicians and communities. Councils Patients • AHAC members monitored the delivery of accessible health care services in the 10 individual GSAHS Clusters Local Health regularly consulting with these communities. Council Service Advisory Consumers members attended Cluster Council meetings where Committees participants from LHSACs discussed local health care issues and common themes. In addition, AHAC members Community used this forum to provide clusters with information COMMUNITY Organisations about health care developments and AHAC activities and priorities. Community • Endorsed copies of AHAC meeting minutes were Members disseminated to LHSACs, Cluster General Managers Forty six LHSACs have been established across the and GSAHS executive members for circulation to other health region, with a membership of over 230 community members of committees, managers and staff. The AHAC representatives and clinicians. The establishment of 10 Health minutes have also been made available on the GSAHS Service Cluster Advisory Councils was finalised in December website. 2006. The three-tiered structure established an effective • The AHAC Charter and Work Plan have been made communication mechanism between the community, the accessible to the general community by dissemination AHAC and the Area Health Service. to LHSACs and are posted on the GSAHS website. The GS AHAC has reviewed and documented the existing Area • Regular public relations opportunities have been provided Health Service’s consultation and engagement structures in to all forms of media and have highlighted AHAC activities the following ways: to communities and staff. Media releases were issued inviting media to a brief press conference with the Chair • LHSACs and HSCACs are a key mechanism for on the day of each AHAC meeting. Results of monthly engagement of communities. AHAC members sought meetings were issued as media releases and published and obtained the views of consumers and clinicians in the GSAHS Staff Newsletter. All media releases were in regards to their experience and satisfaction with posted on the GSAHS web site. the health service. A nominated member of the AHAC attended each Health Service Cluster Advisory • AHAC has supported the Area Health Service in the Committee meeting, strengthening communication consultation process of policy development. The AHAC between the two groups. was asked to provide advice to the Chief Executive on behalf of clinicians and consumers on new and revised • Discussion of existing consultation and engagement policies. structures with local government shire councils occurred during the 10 monthly meetings. To review the Indicator 4 consultation process, each AHAC meeting was held at a different site across the Greater Southern Area. AHAC Ensure there are mechanisms to test and advise that the members experienced different health service models Area Health Service is documenting and communicating and community settings. The visits proved an effective how to access information in relation to policies, plans and mechanism for communication and provided clinicians initiatives. and communities with opportunities to participate in The AHAC has ensured that the Area Health Service is local health issues. AHAC members heard first hand documenting and communicating avenues of access to about health related issues from regional communities, information on policies, plans and initiatives in the following health care providers, Medical Staff Councils and local ways: BETTER HEALTH FOR RURAL AUSTRALIA 47 • GS AHAC members are provided with a comprehensive • LHSACs met monthly and information/issues from monthly written report from the GSAHS Chief Executive these meetings were relayed to HSCAC meetings. An and executive members which incorporates: a financial AHAC member attended these meetings and provided a report; health service performance targets and state summary to the next meeting of the AHAC. The Cluster plan targets; planning and initiatives; safety and quality; Councils form a link between the LHSACs and the policy development; education and research; key issues; AHAC. community involvement; corporate operations; and • The monthly meetings of the AHAC were held in different communications. locations around the Area. This afforded the AHAC an • Relevant policies, protocols, guidelines, and planning opportunity to meet with representatives of the local and initiative documents are disseminated to AHAC community and local government. Additionally, separate members to enable provision of advice to the Chief time is set aside for meeting with health workers at each Executive. The GS AHAC prioritised 10 areas from the site. NSW State Health Plan and the GSAHS Strategic Plan • In their roles as community members and fellow health on which to focus. Each of the 10 represents a ‘portfolio workers, AHAC members come into conversation with group’ and is allocated to two or three AHAC members. community members in both groups on a regular basis. The Chief Executive formally requests written advice in relation to policies and plans from the relevant portfolio The AHAC has informed the Area Health Service Chief group. Advice provided to the Chief Executive from the Executive of the views of consumers, providers and the portfolio group may be directed to NSW Health, relevant community in the following ways: Area Executives, clinicians and local communities. • The agenda for each AHAC meeting included discussion • The AHAC reviewed the GSAHS website and monitored of reports from HSCACs. This allowed AHAC members to the posting of health service plans, policies and advise the Chief Executive and other AHAC members of initiatives. These included Local Health Service Plans for issues within their area and the views of the community, individual facilities and clusters and monitoring capital clinicians and service providers. works projects. AHAC members actively sought to • AHAC meetings include discussion about consultation ensure that information about the capital works projects with community groups, enabling AHAC members to at Griffith Base Hospital, the Multi-Purpose Service ensure the Chief Executive is informed about relevant developments and Queanbeyan Health Facility were health issues. accessible via regular media updates. • The AHAC Chair and Chairs of the HSCACs met with the • The AHAC reviewed LHSAC access to local policies GSAHS Chief Executive bi-annually. and plans and requested that local managers provide committees with written reports documenting • Presenting advice to the Chief Executive when asked information on policies, plans and initiatives. via the 'Portfolio Groups' method was utilised by the GS AHAC. Each group was given a task to comment • The AHAC Chair and Chief Executive have conducted on particular issues that affect communities within the biannual video-conferences with Greater Southern Area. The contact that AHAC members have with their Cluster Chairs to further ensure and test that relevant constituents allows for information from these sources information is flowing to local communities. to be included in the comments. - Seek views of providers and consumers of health Section B • Portfolio groups provide information to the Chief services and the community on Area Health Service policies, Executive on the following areas: plans and initiatives for the provision of health services and advise the Area Health Service Chief Executive (CE) of those 1. Make prevention everybody’s business views. 2. Create better experiences for people using health services Indicator 1 3. Strengthen primary health and continuing care in the Define the structure and processes for consultation community with consumers, providers and the community. Outline communication mechanisms to inform the Area Health 4. Build regional and other partnerships for health Service Chief Executive of these views 5. Make smart choices about the costs and benefits of Consultation is the process used for capturing the views of a health services diverse range of people. Consultation builds on information 6. Build a sustainable health workforce gained through communication with consumers, communities and health service providers. The AHAC determined a range 7. Be ready for new risks and opportunities of methods that would be used to ensure flexibility and 8. Delivering accessible Aboriginal Health services in sensitivity in consultation processes. The AHAC consulted GSAHS with consumers, health care providers and communities in the following ways: 9. Building Mental Health Services • The community engagement structure was finalised 10. Creating opportunities for community interface to facilitate the two-way flow of information from the Section C – Confer with the Chief Executive of the Area Health community to and from the AHAC to the community. Service in connection with the operational performance Forty six (46) LHSACs were established across GSAHS. targets set by any performance agreement to which the Area LHSACs act as a conduit between the community and Health Service is a party under section 126. local health services. A full listing of LHSACs is included in the Community Engagement Report. Each LHSAC Indicator 1 committee comprises of community representatives, health service providers and clinicians and local health Establish a process for reviewing and providing advice to service management. the Chief Executive in relation to the Area Health Service Performance Agreements.
48 GSAHS ANNUAL REPORT 2006 - 2007 The AHAC has established a process to review and provide council members contributed to capital works steering advice to the Chief Executive on Area Health Service committees and were included in value management Performance agreements during the year: studies. • Quarterly presentations by the Chief Executive to the • Requests for advice from the Chief Executive to the AHAC outlined GSAHS performance as per the Health Portfolio Groups have on occasions had bearing on the Service Performance Agreement (HSPA). The quarterly planning of health services. Among these have been the presentations and reports included dashboard indicators differentiation of services to Aboriginal groups depending and data outlining the health service performance. The on their locality and specific needs, the problem of written monthly reports outlined GSAHS Directorate’s patient transport cost support and devolvement of performance and achievements to HSPA targets. The medical oncology treatment to local sites. process allowed for the provision of data and information on performance relating to targets, significant Indicator 2 achievements, past performance and emerging trends. Work with the Area Health Service and the community • AHAC meetings have a quarterly agenda item for to confirm that consumer, community and health service conferring with the Chief Executive on agreed identified provider engagement plan is appropriate and how the Council priorities relating to the Area Health Service Performance is testing this. Agreements • AHAC members met with other community • Members of the GSAHS Executive Team were invited on representatives including Local Government occasions to meetings to provide updates on activity and representatives, Volunteers and Hospital Auxiliaries to key performance targets. This provided an opportunity facilitate discussion about health services, issues and the to discuss the progress of operational targets with the effectiveness of participation structures implemented by senior executive staff. GSAHS. • In particular the AHAC advised the Chief Executive • Implementation of the Community Participation that GSAHS improvements with performance targets, Framework was completed by 30 July 2006. Following including the reduction of waiting lists for surgery and establishment, AHAC worked towards developing access to emergency care, were assisting in building evaluation tools to review the effectiveness of local community confidence. committees and the satisfaction of members. Evaluation of the community engagement framework will be Section D – Advise the Chief Executive on how best to undertaken after twelve months of operation at the end support, encourage and facilitate community, consumer and of 2007. The results of the review will be reported back health service provider involvement in the planning of health to the communities, and will identify recommendations services by the Area Health Service. for improvement. Indicator 1 • Evaluation measures included the progress of LHSAC establishment and development of the HSCACs. To Review the current Area Health Service approach to health date 46 LHSACs have been established, with 10 Health service provider and community consultation in the planning Service Cluster Advisory Councils in operation. of health services. • A number of communities have demonstrated the value The AHAC has reviewed the Area Health Service approach to and quality of the consultation process by working in consultation in the planning of health services in the following partnership with the Area Health Service to implement ways: new models of care. LHSACs in partnership with AHAC • The GSAHS Director Population Health, Planning, members, have advised the health service on how Research and Performance provided the AHAC with best to support communities and clinicians during regular reports on planning processes within GSAHS. the introduction of an Integrated Ambulance Service, The updates reported progress on development of Integrated Primary and Community Health Models, Health Service Plans for all sites and Health Clusters Oncology Shared Care Service and new Aged Care and by September 2006 and completion of asset plans in Mental Health services. partnership with NSW Health by the same date. This Section E – Liaison with other AHACs in relation to both local process includes extensive community consultation, a and State-wide initiatives for the provision of health services. series of community information sessions and formation of Health Service Planning Steering Committees. There Indicator 1 is LHSAC representation on these local committees, along with community members, local Health Service Indicate level of participation in twice yearly meetings of Managers and GSAHS planning and Asset Management AHAC Chairs and Chief Executives. AHACs may also wish to staff. AHAC members actively participated in planning include any other activities which provided an opportunity to processes for health services in their local area. liaise with other AHACs. • AHAC members were briefed on the progress of The AHAC Chair and GSAHS Chief Executive participated in planning for health services in GSAHS. In particular, a meetings held in 2005/06 and 2007. The first workshop on comprehensive briefing was provided at the sites visited 22/23 August 2005 focused on community engagement by the AHAC. training and development. The second workshop on 2 March 2006 focused on developing a series of Performance • AHAC members also received advice from community Indicators for Health Advisory Councils. Meetings held on 8 members at the bi-monthly Health Service Cluster September 2006 and 20 April 2007 focused on reporting and Advisory Committee meetings. communication, including common issues and challenges • The AHAC maintained an interest in planning for facing all AHACs. redevelopment and capital works projects and reported The AHAC also liaised with other Area Health Advisory progress to the communities involved. At the same Councils in the following ways: time, AHAC gathered feedback from communities to relay to the Area Executive and beyond. On occasion,
BETTER HEALTH FOR RURAL AUSTRALIA 49 • The GS AHAC participated in a presentation to the NSW Indicator 2 Health Care Advisory Council in conjunction with the Area Chief Executives to report on the effectiveness of AHAC Chair of the Greater Western AHAC. advice. Section F – To publish reports (annually or more frequently) Promoting positive participation in healthcare is a crucial as to its work and activities. component of delivering the right care to the right people in Indicator 1 the right place. The GS AHAC, a team of respected clinicians and committed community representatives, provides the AHACs report annually to the public on progress against AHAC health service with a conduit to local communities and brings key performance indicators (both state and local), according the voice of clinicians and consumers to the executive team. to standardised headings developed by NSW Health. Our goal is to ensure that everyone in the Greater Southern Note: AHACs may wish to report more frequently at the local region has access to the kind of health services they need, level via means such as website, newsletters, etc. when they need them, regardless of where they live. The The Greater Southern Area Health Advisory Council Annual people we serve remain at the centre of what we do and it is Report 2005-2006 was submitted to the Minister for Health their needs that drive the solutions we create. by 31 December 2006. The Annual Report was published and Communicating with communities and clinicians requires made available on the Area Health Service website on 30 a robust system that enables the AHAC to effectively listen December 2006. and respond to local communities and provide advice to the Information on AHAC progress was also provided to the Chief Executive. It is in this area that the Council has gained public in the following ways: the most momentum in the last twelve months. • The AHAC 2005-2006 Annual Report was incorporated in Using the AHAC Charter for guidance, the Council has the GSAHS 2005-2006 Annual Report and launched at the developed mechanisms to enable the functions and roles of Annual Forum held on 19 April 2007. It was disseminated the Council. The 2006-2008 Work Plan reflects the uniqueness widely to community groups, GSAHS facilities, tertiary of our rural organisation and is aligned with the strategic providers, Divisions of General Practice and local Shire directions of the Health Service, the local health facilities/ Councils. programs and the key directions of NSW Health. The Work Plan maximised opportunities for AHAC members to provide • Minutes of AHAC meetings and a monthly one page a community and clinician perspective in the planning and activity summary were distributed widely within the provision of health services. Area Health Service, to community representatives and NSW Health for inclusion on the NSW Health internet AHAC members have actively sought the views of providers site. Minutes and media releases relating to AHAC are and consumers of health services. Through participation in posted on the GSAHS website, and a summary of each HSCAC, members have brought feedback on Area policies, AHAC meeting is distributed to all staff and LHSACs via plans and initiatives to the Chief Executive. Further work this the GSAHS Weekly News Bulletin. year was undertaken to ensure community concerns were formally addressed with appropriate feedback. Section G – Other functions as are conferred or imposed on it by the regulations. The most significant advance in the provision of advice to the executive team has been the introduction of the AHAC Indicator 1 portfolio groups. Portfolio groups provide advice in a formal report to the Chief Executive following the review of AHACs are implementing two-year work plans which policy and guidelines, strategic planning and health service include an agreed AHAC budget and AHAC key performance performance. indicators. The AHAC conferred with the Chief Executive on performance The GS AHAC implemented a two-year Work Plan 2006-2008 targets and important issues challenging the Health Service. in September 2006. In particular, the AHAC identified clinical workforce issues A draft work plan was developed in February 2006. The work as a major factor impacting on the efficient and effective plan undertook to ensure the Council was working towards delivery of services in the Greater Southern Area. a confident position understanding and fulfilling its given GSAHS values the commitment rural community’s display role, making best use of members’ skills and experience, and towards their local health services. The Area Health Service available resources. This plan was reviewed in September is committed to assisting communities to convert this 2006 and the two year Greater Southern Work Plan was commitment into understanding and knowledge about the finalised. planning and provision of health services The AHAC has developed a 2006-2008 work plan that I would like to acknowledge the work and achievements includes the following key areas for action: of the Council members. Their positive engagement with • Strengthening current communication pathways to communities and health service providers is ensuring ensure the views of the community are acknowledged constructive input into the planning and development of and feedback is provided. integrated rural health services. • Monitoring the effectiveness of the community Heather Gray engagement framework including an evaluation of the Chief Executive framework after 12 months in operation. This is due to Dr Ian Stewart take place in June 2007. Chair GSAHS Area Health Advisory Council • A renewed emphasis on listening to communities and clinicians and providing the mechanisms for response.
50 GSAHS ANNUAL REPORT 2006 - 2007 Attendance of AHAC Chair and Members in 2006/2007
AHAC July 06 Aug 06 Sept 06 Oct 06 Feb 07 Mar 07 Apr 07 May 07 June 07 Dr Ian Stewart HSP - Chair Dr Nigel Lyons A/ Chief Executive Ms Heather Gray Chief Executive Ms Jane Ayers A/Chair A Chair HSP Prof Amanda Barnard A/Chair HSP Mr John Barron CR Ms Fay Campbell CR Mr Ray Gamble A/Chair Sick leave Sick leave Sick leave Sick leave Sick leave CR Ms Robin Haberecht Resigned HSP Mr Rod McCully A/Chair CR Mrs Anne Napoli CR Ms Karen Pollard CR Dr Paul Sevier HSP Rev Tom Slockee CR AR Dr Trish Saccasan Whelan HSP
Deniliquin Queanbeyan Queanbeyan Wagga Wagga Batemans Bay Narrandera Queanbeyan Cooma Yass Meeting Location 4-5 July 9 August 20 Sept. 24-25 Oct. 6-7 February 6-7 March 19 April 1-2 May 5-6 June
Key: HSP - Health Service Provider CR - Community Representative AR - Aboriginal Representative
BETTER HEALTH FOR RURAL AUSTRALIA 51 Health Service Cluster Advisory Councils Batlow Health Service Cluster Advisory Councils have been formed Name Position in each Cluster in GSAHS. The Councils meet between Jan Knott three and five times per year and meetings are attended by Scott Baron nominated members of the AHAC. This structure ensures the Christine Menon two-way flow of information from the community and GSAHS Diana Droscher Communication Officer to the AHAC and back again. Isobel Crain Deputy Chair Membership of Health Service Cluster Advisory Councils Janice Vanzella Chair comprises: Heather Jamieson
• Chairs of each Local Health Service Advisory Committee Bega Valley within the Cluster • A further representative from each Local Health Service Name Position Advisory Committee Lynne Teale Jan Aveyard Chair • The Cluster General Manager (who also provides Judith Reid Communication Officer secretarial support) Ian Jessop The role of Health Service Cluster Advisory Councils is to: Allen Collins Pat Luker • work in partnership with GSAHS to ensure that decisions about public health services in the Greater Southern Val Malcolm Area reflect community needs Berrigan • progress community involvement in the planning, development and evaluation of health services, policies Name Position and programs Rowan Perkins Elaine Hawkins • form the link between the Local Health Service Advisory Susanne Chisholm Committees, the Area Health Advisory Council and the Marion Dickins GSAHS Executive John McGrath • ensure a direct line of communication to the AHAC, as Bill Petzke Cluster Chairs will meet with the Chief Executive and Barbara Fox the Chair of the AHAC bi-annually and more frequently if Inara Fox required Bernard Curtin Chair
• work to ensure the views of their communities are Bombala represented in planning health service delivery, priority setting and evaluation at the Area level. Name Position Local Health Service Advisory Committees in the Bega Valley, Fay Campbell the Eurobodalla and Wagga Wagga also act as the Cluster Ruth Allan Chair Advisory Council for their Cluster. A member of the AHAC Bronwen Longden attends every second meeting of these Committees. Colin Pate Medical Representative Jenni Platts Staff Representative Local Health Service Advisory Committees Leslie Smith Communication Officer Norman Vincent Local Health Service Advisory Committees (LHSACs) provide Anna Vincent a community perspective for the provision of services and Margaret Knight information. Community participation is critical to the future of health services. Proper community involvement results in Boorowa more transparent, accountable and reliable services. A total of 46 local Committees represent 55 different Name Position communities in GSAHS. Each Committee is made up of Peter Sykes Chair between five and seven community members, a staff Hugh Darling representative and a clinical representative. They meet 10 times per year and support is provided by the local health Pat Webster service. Don Webster The commitment of the LHSAC members to the improvement Jayne Apps of our health services and facilities is considerable, as is their David Philpott commitment to the communities they represent. Geoff Mackey Local Health Service Advisory Committees and MPS Liz Webster Committees - Members as at 30 June 2007 Julie Styles Staff Representative
Barham
Name Position Sally McConnell Staff Representative Joy Eagle Communication Officer Ruth Morpeth Chair Ciaran Keogh Rebecca Lodge
52 GSAHS ANNUAL REPORT 2006 - 2007 Braidwood Crookwell
Name Position Name Position Jeremy Campbell-Davys Chair David Rees David Cargill Doreen Wheelwright Peter Camiller Johanna Kovats Medical Representative Jo Wilson John Bell Anthony Cairns Serina Kynch Margaret Jones Geoffrey Bunn Culcairn Kirsten Sturgiss Name Position Mary Mathias Deputy Chair David Gilmour Chair Carrathool Nigel Preston Deputy Chair Janet Drummond Name Position Barry Gibbons Ellen McMaster Jenny Lodge Jenny Rose Janice Scheuner Clifford Rose Communication Officer Ian Bahr Vincent Cashmere Chair Mark Leov Janette Anthony Staff Representative Arik Bronstein Medical Representative Darlington Point/Coleambally
Coolamon Name Position James Tongue Chair Name Position Gail Hibbert Dianne Suidgeest Monika Whelan Cheryl O’Brien Deputy Chair Helen Mason Staff Representative William Levy Chair Ruth Holden Delegate Jacqueline Gattenhoff Name Position Peter Mangan Jan Ingram Chair Betty Menzies Sue Guthrie Cooma Pat Ventry Natalie Armstrong Name Position Gloria Cotterill Anthony Mackenzie Chair Jayne Sellers Patricia Scheele Rhonda Linehan Staff Representative Christyopher Reeks Anne Goggin Deniliquin Judith Gibson Staff Representative Name Position John Neilson Sue Taylor Chair Lee Evans Sylvia Baker Cootamundra Bobby Murphy Naomi Willis Name Position Edgar Day Carmel Herald Chair Elsa Bolton Jeff Sowiak Communication Officer Ruth O’Dwyer Eurobodalla Margery Taprell Name Position Fiona Grogan Staff Representative David McCann Jacques Scholtz Medical Representative Ursula Bennett John Dietsch Rosemary Testaz Corowa Edith Sorum Elizabeth Cook Name Position Norman Parker Ida Mensforth Raja Ratnam Elizabeth Tidd Angela Nye Staff Representative Peter Wortmann Keith Barber Chair Finley Barbara Robinson Communication Officer Name Position Bruce Slonim Medical Representative Sydney Dudley Chair Gillian Kingston Staff Representative Bradley Carlon Rosemary Brooks
BETTER HEALTH FOR RURAL AUSTRALIA 53 Goulburn Holbrook
Name Position Name Position Marie Heath Chair Graeme Joyce Chair Julien Vanslambrouck John McInerney Ian Cameron Desmond Lum Lynne Lace Staff Representative Jane Bunyan Gabriel Kolos Medical Representative Jody Whitely Simone Goppert Kevin Farrelly Judy Wettenhall Griffith Jerilderie Name Position Andrew Crakanthorp Chair Name Position Simon Croce Ruth McRae Chair Deanna Marriott Ian Snedden Albert Ravanello Dawn Taylor Yvonne Turnell Brian Nethery Ann-Maree Barbaro Denise Buckley Julie Vardanega Staff Representative Jaime McEncroe Medical Representative Jindabyne
Gundagai Name Position Bruce Hodges Chair Name Position Lee Taylor-Friend Communication Officer Keith Turner Chair John McLoughlin Des Manton Verity Jackson Rebecca Smart Cath Newman Jennifer McDonnell Shari Luckhurst Staff Representative
Gunning Junee
The Gunning District Community and Health Service Inc acts Name Position as a Health Service Advisory Committee for the Gunning James Davis Chair community. Darren Corbett Leslie Eisenhauer Harden-Murrumburrah Bronwyn Lemmich Staff Representative Name Position Gary Dyson Brian Dunn Chair Robert Smith Paul Atherton Elizabeth Lewis Robert Bradly Phil Wood Yusuf Khalfan Medical Rpresentative Peter Logan Carmel Brown Leeton Zonia Argue Staff Representative Name Position Hay Pat Bowles Chair Name Position Kate Alexander Communication Officer Robert McCully Chair Julie Ramponi John Treloar Robyn Whittaker Kellie Rutledge-Robinson Paul Maytom Jennifer Grimm Daniel Pettersson Medical Representative Wayne Mitchell Lockhart Michael Beckwith Patricia Ray Name Position Deborah Payne Staff Representative Larraine Hoffman Chair Donna Jones Henty Ian McLeod Name Position Colleen Healy Michael Broughan Chair Myra Jenkyn Roslyn Kilo Moama/Mathoura Joan Uebergang Jean Bennett Name Position Mark White Betty Murphy Emma Scholz Teresa Kerr Julie Meyer Richard Kerr
54 GSAHS ANNUAL REPORT 2006 - 2007 Moulamein /Tooleybuc Ungarie
Name Position Name Position Peg Watts Robert Rattey Chair Margaret Morton John Barron Barbara Culross Elaine Clemson Beverly McKindlay Judy Rogan Judith Gatacre Staff Representative Emma McRae Georgina Douglas Staff Representative Mark Bryant Roslyn Alcorn Patricia Daly Secretary
Narrandera Urana
Name Position Name Position Gayle Murphy Chair Marea Urquhart Chair Joyce Spencer Denis Smith Wade Mitchell Medical Representative Janette Dodds Pauline Hatherly Staff Representative Janina Korycki Shirley Walsh Harry Couzin Sonya Hammer John Hunt
Queanbeyan Wagga Wagga
Name Position Name Position Kevin Grainger Chair Anna Nightingale Chair Nerida Dean Alan Puckett Tom Mavec Ruth Lennon Wayne Brown Sonia Marshall Pamela Orr Representing Bungendore Trish Carlson Brigid Bol Margaret Goodman
Temora West Wyalong
Name Position Name Position Rick Firman Chair Carolyn Stephenson Chair Wendy Skidmore Staff Representative Deirdre Haub Staff Representative Gail Lynch Frances Mitchell Elisabeth Kirkby Mal Croucher Rex Bryant Patricia Daly Representing Ungarie Gary Lavelle Robert Rattey Brian Monaghan Tocumwal Simone Maloney Representing Weethalle Name Position Louise Butler Esther Bryan Yass John Gradie Pauline Gilbee Name Position Val Cole Eric Bell Chair Ross Shaw Tumbarumba Terence Legge Name Position Kelvin Lees Ronald Costello Chair Cathy Campbell Ken Campbell Deputy Chair Jennifer Wilson Owen Graham Sue Powell Medical Representative Bruce Wright David Harrison Alison Bradley Staff Representative Tumut Young Name Position Alan Tonkin Chair Name Position Isobel Crain Helen Waugh Chair Daphne Clarke Nola Noakes Geoffrey Pritchard Russell Price Janette Wilson Stephen Ross Medical Representative Eric Smith John Walker Cliff Sheridan
BETTER HEALTH FOR RURAL AUSTRALIA 55 Public Hospital Activity Levels
Beds and Bed Equivalents, June 2007 (Beds in Emergency Departments, Delivery Suites, Operating Theatres and Recovery Rooms are excluded ) Selected Data for Year Ended June 2007 Part 1 Hospital / Area Health Service General Nursing Home Community Other Units Bed Total Hospital Units Units Residential Equivalents Wyalong Health Service 22 22 Albury Base Hospital 145 145 Barham Health Service 18 18 Berrigan Health Service 14 14 Culcairn Multi-Purpose Service 5 5 Corowa Health Service 23 23 Deniliquin Health Service 58 58 Finley Health Service 14 14 Henty Health Service 3 3 Holbrook Health Service 10 10 Jerilderie Multi-Purpose Service 3 3 Mercy Health Service - Albury 30 30 Urana Multi-Purpose Service 3 3 Tocumwal Health Service 16 16 Tumbarumba Multi-Purpose Service 10 10 Wagga Wagga Community Health Service 8 8 Culcairn Residential Aged Care 22 22 Corowa Residential Aged Care 31 31 Henty Residential Aged Care 12 12 Holbrook Residential Aged Care 16 16 Jerilderie Residential Aged Care 12 12 Mercy Health Service Albury RACC 10 10 Urana Residential Aged Care 19 19 Tumbarumba Residential Aged Care 27 27 South Western Brain Injury Service 3 3 Kenmore Hospital 32 22 54 Bateman’s Bay District Hospital 34 34 Bega District Hospital 71 4 75 Bombala Health Service 18 18 Boorowa Health Service 18 18 Braidwood Multi-Purpose Service 5 5 Cooma Health Service 46 46 Crookwell Health Service 18 18 Delegate Multi-Purpose Service 4 4 Goulburn Base Hospital 108 108 Mercy Care Centre, Young 26 26 Moruya District Hospital 72 6 78 Murrumburrah-Harden Health Service 13 13 Pambula District Hospital 34 34 Queanbeyan Health Service 39 39 Bourke Street Health Service 35 35 Yass Health Service 10 10 Young Health Service 33 33 Goulburn Community Health Service 19 19 Braidwood Residential Aged Care 27 27 Delegate Residential Aged Care 9 9 Bourke St Health Service - CADE unit 16 16 Mount St. Joseph’s Nursing Home, Young 65 65
56 GSAHS ANNUAL REPORT 2006 - 2007 Murrumburah-Harden Residential Aged Care 20 20 Southern Brain Injury Service 2 2 Batlow Health Service 12 12 Griffith Base Hospital 99 99 Gundagai Health Service 26 26 Hay Health Service 28 28 Hillston Health Service 16 16 Junee Health Service 34 34 Coolamon Multi-Purpose Service 2 2 Leeton Health Service 29 29 Lockhart Health Service 16 16 Narrandera Health Service 29 29 Temora Health Service 34 34 Tumut Health Service 34 34 Wagga Wagga Base Hospital 233 8 8 249 Cootamundra Health Service 30 30 Coolamon Residential Aged Care 12 12 Leeton Residential Age Care 38 38 Yathong Lodge Residential Aged Care 16 16 Greater Southern TOTAL 1,580 344 81 22 18 2,045
Selected Data for Year Ended June 2007 Part 2 Excludes Contracted to Private Hospitals Activity Non Total Bed Acute Acute Separations Planned Same day Daily Occupancy Acute Admitted ED Facility Days (Days Avg Overnight YTD Sep % Sep % Average Rate Bed Days Patient Attendances episode) LOS Bed Days Services Albury Base Hospital 10,305. 36.44% 34.61% 44,725. 3.9 122.5 81.3% 39346 35786 88818.8 29875 Barham Health Service 319. 5.64% 38.56% 3,957. 2.5 10.8 724 601 7448.1 1594 Bateman’s Bay District 3,791. 32.00% 44.29% 11,182. 2.5 30.6 92.5% 9172 7499 16937 15071 Hospital Batlow Health Service 263. 4.94% 20.53% 3,609. 3.0 9.9 615 562 2537.4 443 Bega District Hospital 5,184. 33.35% 35.86% 19,531. 3.1 53.5 75.2% 15259 13400 19392.3 12805 Berrigan Health Service 433. 9.70% 26.10% 4,210. 2.4 11.5 880 770 874.1 419 Bombala Health Service 275. 12.00% 14.55% 4,341. 6.1 11.9 1586 1546 5135.2 1939 Boorowa Health Service 254. 8.27% 20.08% 5,358. 4.2 14.7 1065 1014 8904.1 1057 Bourke Street Health 340. 27.06% 0.59% 10,355. 4.0 28.4 4 4 10723 Service Braidwood Multi-Purpose 173. 21.97% 22.54% 776. 4.0 2.1 644 605 7038.9 1232 Service Contracted to Private 1,453. 100.00% 99.80% 1,453. 1.0 Hospital Coolamon Multi-Purpose 239. 41.42% 68.20% 870. 3.1 2.4 722 560 2644 1099 Service Cooma Health Service 2,972. 30.65% 37.11% 9,954. 3.0 27.3 53.7% 8847 7746 46038.1 9766 Cootamundra Health 1,977. 21.24% 35.51% 5,673. 2.1 15.5 3900 3201 24051.7 4096 Service Corowa Health Service 1,488. 24.46% 44.15% 4,885. 2.7 13.4 3751 3099 18060.9 5059 Crookwell Health Service 701. 3.14% 21.54% 4,795. 5.3 13.1 3278 3128 16571.3 2993 Culcairn Multi-Purpose 278. 6.47% 16.55% 1,123. 2.5 3.1 544 498 8112.3 806 Service Delegate Multi-Purpose 33. 27.27% 6.06% 215. 6.5 0.6 215 213 1784.8 389 Service Deniliquin Health Service 2,961. 25.70% 33.81% 10,471. 2.7 28.7 54.6% 7287 6294 45742.9 7210 Finley Health Service 689. 6.53% 25.25% 2,514. 3.2 6.9 2076 1902 7292.8 1074 Goulburn Base Hospital 7,822. 42.69% 40.82% 29,202. 3.7 80.0 78.6% 28419 25237 29126.1 17490 Griffith Base Hospital 9,919. 33.30% 53.67% 23,526. 2.2 64.5 55.9% 21317 16006 47853.2 22563 Gundagai Health Service 856. 4.32% 24.30% 7,400. 2.9 20.3 2343 2135 5410.9 1538 Hay Health Service 577. 5.72% 45.06% 6,481. 2.0 17.8 993 739 8019.6 2178 Henty Health Service 226. 5.31% 25.22% 721. 2.8 2.0 564 507 1604 564 Hillston Health Service 549. 16.03% 52.46% 3,340. 2.4 9.2 1227 939 3176 1072 Holbrook Health Service 589. 1.36% 47.71% 2,611. 3.3 7.2 1903 1623 4227.3 1561 BETTER HEALTH FOR RURAL AUSTRALIA 57 Jerilderie Multi-Purpose 246. 19.11% 43.50% 772. 2.5 2.1 586 480 3311 418 Service Junee Health Service 692. 5.35% 31.21% 11,220. 2.3 30.7 1169 964 12825.3 1611 Kenmore Hospital 131. 35.88% 17,033. 4.0 46.7 8 8 Leeton Health Service 1,665. 12.43% 33.33% 6,434. 3.3 17.6 5242 4688 18160.3 5655 Lockhart Health Service 288. 4.51% 29.86% 4,489. 2.7 12.3 672 586 10827.4 601 Mercy Care Centre, 387. 37.21% 0.26% 6,527. 14.8 17.9 1232 1232 41086.5 Young Mercy Health Service 529. 47.07% 0.95% 9,502. 26.0 33026.9 - Albury Moruya District Hospital 6,607. 40.79% 42.92% 18,282. 2.3 50.1 78.0% 14597 11788 20143 12844 Murrumburrah-Harden 623. 9.79% 27.13% 2,269. 3.4 6.2 2044 1876 13508.6 2191 Health Service Narrandera Health 1,786. 12.09% 26.71% 6,660. 3.3 18.2 5680 5204 15166.1 3350 Service Pambula District Hospital 2,228. 18.63% 39.50% 8,651. 3.1 23.7 6742 5862 9217.3 7538 Queanbeyan Health 4,384. 32.89% 51.39% 10,982. 2.4 30.1 71.8% 10531 8284 82293.900 17100 Service Temora Health Service 1,736. 11.87% 22.41% 5,561. 2.6 15.2 4271 3885 17944.8 2326 Tocumwal Health Service 354. 14.97% 31.64% 3,875. 3.2 10.6 971 860 3992.6 697 Tumbarumba Multi- 498. 2.41% 31.93% 1,746. 3.2 4.8 1507 1350 1886 995 Purpose Service Tumut Health Service 2,240. 13.17% 35.27% 6,407. 2.6 17.6 5601 4812 20702 3589 Urana Multi-Purpose 69. 5.80% 42.03% 232. 2.8 0.6 172 143 2828.5 186 Service Wagga Wagga Base 22,353. 38.33% 46.79% 66,790. 2.7 180.7 71.6% 59624 49179 149454.5 31819 Hospital Wyalong Health Service 1,303. 5.60% 38.76% 3,513. 2.3 9.6 2956 2453 12288 2923 Yass Health Service 748. 0.67% 31.42% 2,875. 3.5 7.9 2548 2313 22926.4 4767 Young Health Service 2,248. 19.04% 34.21% 6,076. 2.6 16.6 5866 5099 29682.9 8195
Community Health Services Albury Community Health 58182.6 Amputee Services 3027 Bega Valley Community 48183.4 Health Service BreastScreen NSW South 16012 West Eurobodalla Community 54849.7 Health Service Goulburn Community 57744.3 Health Service Griffith Community 30210.4 Health Mental Health Access 21186 Line Mental Health Intake 6985 Rural and Community 47690.2 Services South Western Brain 7436.2 Injury Service Southern Brain Injury 7115.9 Service Wagga Wagga Community Health 85401.200 Service TOTAL 105,781. 31.35% 41.91% 423,174. 2.9 1,153. 71.8% 288,700. 246,680. 1,402,821. 250,698.
58 GSAHS ANNUAL REPORT 2006 - 2007 Volunteers and Sponsorship
Volunteers contribute to all aspects of GSAHS work from • Nell Verbunt (39 years), Nancy Larcombe (32 years), Elsie assisting in our hospitals, community health services, acting Crawford (27 years) and May Houlihan (27 years) have as drivers, undertaking special training to provide a visiting been long standing volunteers at the Corowa Health service to home based clients and simply providing a listening Service ear to community members who are using our facilities. The • Rhonda Miller, Judy Hill, Aliceson Scifleet, Lorna work of volunteers in GSAHS is invaluable. Volunteers give McGlynn and Robyn Absalom who have all contributed many thousands of hours, sharing their time and skills to to the Cootamundra Health Service for many years make a significant contribution to the services provided to the community. • Adrienne Greenwood who acts as a coordinator for the provision of direct palliative care services to clients and In addition to Hospital Auxiliaries there are a great number of is a link between volunteers and clients volunteers that support GSAHS activities. These include: • Pat Ventry who was President of the Delegate Branch of • Cancer Patients Assistance Society the United Hospital Auxiliaries of NSW for 9 years and a • Pastoral carers member for 30 years. Pat was also a member of the MPS Committee at Delegate • Palliative Care and Oncology Support Groups • Mary Demery who has been the Day care Coordinator at • Community transport providers Delegate Health Service for many years • Day care volunteers • All the other unnamed volunteers who are committed • Diversional Therapy Volunteers to their local facility and community and who give their time so generously. • Meals on Wheels volunteers All are special in their own right and deserve our thanks. • Palliative care volunteers • Pink Ladies • Red Cross Cosmetic Care volunteers • Legacy, Lions, Rotary and Soroptimist Clubs • Friends of Hospitals • Volunteer coordinators • Individuals who undertake tasks such as attending to patients’ flowers, assisting patients with writing of letters, providing cheerful company and conversation for patients, assisting with gardens and grounds, supplying fresh flowers to facilities, conducting music groups and those who visit patients to give them company and attention • Local staff members who fundraise in their own time Many thanks go to these volunteers for their assistance, hard work and dedication. A special mention should be made of: • Karen Price, Barbara Fisher, Isobel Heaton and Shirley Riches who volunteer at Goulburn Base Hospital and between them have over 50 years of volunteering • Helen Martin who has been a member of the Albury Base Hospital Pink Ladies for many valuable years and was President of the Pink Ladies for 30 years. Helen is passionate about her job and has no intention of giving it up • Enid Antone who has been the President of the Albury Hospital Pink Ladies for the last six years and is dedicated to her job • Mrs Kath Dore who has been Secretary of the Urana Branch of the United Hospital Auxiliaries for many valuable years • The Urana Central School students who have commenced weekly visits to residents and bring much pleasure to the facility • Gill Bahr and Noel Wood who have been long term volunteers at the Culcairn Health Service
BETTER HEALTH FOR RURAL AUSTRALIA 59 Ethnic Affairs Priority Statement (EAPS)
The Culturally and Linguistically Diverse Background (CALD) population within GSAHS has been determined from the 2006 Census. This data indicates that the GSAHS Non English Speaking Background (NESB) population is 14,402, approximately 3.2% of the total population. Languages other than English are spoken at home by 4.5% of the population, however, only 0.5% of GSAHS total population speaks poor English, or none at all. With the great diversity of people from a range of social, economic and cultural backgrounds, GSAHS needs to be well informed about these diversities in order to adequately meet the needs of the community. Knowing about and recognising diversity allows us to identify groups who may be at risk of various health problems and enables us to address these needs through the diverse resources that we have within the organisation. In the Health Service Strategic Plan, GSAHS has identified areas to enhance health services for people from a CALD background. This includes: • increased participation in cultural activity • creating better experiences for people using health services, and • strengthening primary health and continuing care in the community by building and developing links and partnerships with multicultural services Staff education is a priority for GSAHS and diversity and cultural respect in health is addressed at orientation. GSAHS provides many services to many patients from NESB and we aim to ensure the right of equality of access to health care services regardless of a person’s cultural origin and language background. Staff are encouraged to treat patients in a way that demonstrates respect for them as individuals and to utilise the following services: • NSW Refugee Health Service – provides education support • NSW Health Multicultural Communication Service – provides services, including information and advice on appropriate ways to communicate with CALD people • Health Care Interpreter Service – facilitates communication between people who are not fluent in English The majority of interpreter service usage within GSAHS occurs in Community Health Centres, approximately 29.2%, and Hospital Outpatients, approximately 28.7%. The interpreter service usage includes approximately 48.9% over the telephone and approximately 47.5% on a face-to- face basis. The majority of services were provided to Arabic, Iranian, Italian, Macedonian and Mandarin language groups.
60 GSAHS ANNUAL REPORT 2006 - 2007 Hospital Auxiliaries
Barellan Hospital Auxiliary Corowa District Hospital Auxiliary President: Jean Inglis President: Dorothy Long Vice President: Margaret West Secretary: Margaret Lingham Treasurer: Val Hawker Treasurer: Dawn Williams
Barham-Koondrook Soldiers Crookwell Auxiliary Memorial Hospital Auxiliary President: June Dennis Secretary: Jo Star President: Betty Hodgkinson Treasurer: Aimee Hallam Secretary: Joy Eagle Treasurer: Ethelwyn Hahn Delegate Auxiliary Batemans Bay Hospital Auxiliary President: Pat Ventry Secretary/Treasurer: Gail Smallman President: Noeline McNeish Secretary: Cherie Clarke Deniliquin Hospital Auxiliaries: Treasurer: Jacqui Mudge Mayrung Auxiliary Batlow Hospital Auxiliary President: Jess Beer President: Janice Vanzella Secretary: Barbara Ryan Secretary: Christine Menon Treasurer: Hilda Jones Treasurer: Margaret Sedgwick Naponda Auxiliary Bega Hospital Auxiliary President: Maureen Strutt President: Dorothy Mullaney Secretary: Pam Ellerman Secretary: Helen Robbie Treasurer: Joan Finucane Mathoura Auxiliary President: Jean Osborne Berrigan Hospital Auxiliary Secretary: Denise Hanson President: Jill Edwards Treasurer: Leanne Vesty Secretary: Aileen Bradley Treasurer: Dawn Lane Moulamein Auxiliary President: Cheryl Garrett Bombala Hospital Auxiliary Secretary: Margaret Morton President: Betty Cowell Secretary: Jenny Brownlie The Pink Ladies Auxiliary Treasurer: Brenda Kelly Secretary: Norma Drenkhahn Bookham Auxiliary Finley Hospital Auxiliary President: Noeleen Hazell President: Marjorie Kable Secretary: Mavis Armour Secretary: Madeleine Wark Treasurer: Wilma Bingley Treasurer: Margaret Ryan Boorowa Hospital Auxiliary Griffith Base Hospital Auxiliary President: Mary Corcoran President: Irene Pettiford Secretary: Judy McGuiness Secretary: Heather Eagleton Treasurer: Phoebe Stewart Treasurer: Lavelle Wallace Braidwood Hospital Auxiliary Gundagai Hospital Auxiliary President: Ken Thomas President: Helen Turner Secretary: Clare Sutherland Secretary: Josephine Bryan Treasurer: Jill Judge Treasurer: Maureen Barrington Coolamon Auxiliary Hay Hospital United Hospital Auxiliary President: Betty Menzies President: Norma Milliken Secretary: Nolene Black Secretary: Nerida Reid Treasurer: Jenny Kerr Treasurer: Wendy Heery Ganmain Auxiliary Henty Hospital Auxiliary President: Faye Jones President: Pam Green Secretary: Heather Kember Secretary: Marilyn Broughan Treasurer: Nita Hare Treasurer: Betty Willis Cooma Hospital Auxiliary Henty Community Centre Auxiliary President: Janette Langwill President: Pam Green Secretary: Jan Carpenter Secretary: Marilyn Broughan Treasurer: Mary McKee Treasurer: Betty Willis Cootamundra District Hospital Auxiliary Hillston Hospital Auxiliary President: Margaret Young President: Margaret Warren Secretary: Yvonne Smith Secretary: Pat Johnson Treasurer: Don Elliot Treasurer: Eileen Whelan
BETTER HEALTH FOR RURAL AUSTRALIA 61 Holbrook Hospital Auxiliary Tumut District Hospital Auxiliary President: Trish Bull President: Trish Clee Secretary: Kym Hulme Secretary: Rhonda Blunt Treasurer: Nanno MacKinlay Treasurer: Marlene McLennan Jerilderie Health Service Auxiliary Urana Health Service Auxiliary President: Nancy Locke President: Ann Bourke Secretary: Judy Ryan Secretary: Kath Dore Treasurer: Pam Collier Treasurer: Pauline Smith Junee District Hospital Auxiliary West Queanbeyan Hospital Auxiliary President: Iris Gamble President: Tui Dawes Secretary: Peter Logan Secretary: Nancy Monk Treasurer: Dennis Sullivan Treasurer: Marion Coffey Leeton Hospital Auxiliary West Wyalong Hospital Auxiliary President: Des Driscoll President: Betty Seberry Secretary: Leanne Kidd Secretary: Mavis Smith Treasurer: Kath Lamont Treasurer: Helen Murdoch Lockhart Hospital Auxiliary Yass Hospital Auxiliary President: Larraine Hoffmann President: Wendy Findlay Secretary: Jeanette Baker Secretary: Lorraine Legge Treasurer: Sylvia Creighton Treasurer: Shirley Williamson Mercy Care Young Auxiliary Young Hospital Auxiliary President: Joyce Cavanagh President: Chris Page Secretary: Marie Cass Secretary: Prue Lindsay Treasurer: Janice O’Reilly Treasurer: Nola Noakes Moruya District Hospital Auxiliary President: Marion Marsden Secretary: Kathleen Smith Treasurer: Christine Smith Murrumburrah-Harden Hospital Auxiliary President: Carmel Brown Secretary: Jackie Berrell Treasurer: Rose Adler Narooma Community Health Auxiliary President: Raja Ratnam Secretary: Lizabeth Fell Treasurer: Anne Hunter Narrandera District Hospital Auxiliary President: Pauline Hatherly Secretary: Helen Langley Treasurer: Dianne McVicker Pambula Merimbula District Hospital Auxiliary President: Val Fryers Secretary: Gail McCombie Treasurer: J Bennett Tarcutta Auxiliary President: Joy Granger Secretary: Fay Belling Treasurer: Sue Hardwick Tathra Auxiliary President: Margaret McFadden Secretary: Ben Boller Treasurer: Ellen Harris Temora District Hospital Auxiliary President: Myre Bruest Secretary: Marie Wallace Treasurer: Mavis Bean Tocumwal Hospital Auxiliary President: Valda Cole Secretary: Mrs Kaye Couch Treasurer: Pauline Gilbee
62 GSAHS ANNUAL REPORT 2006 - 2007 Freedom of Information 1 July 2006 to 30 June 2007
The Freedom of Information Act (1989) gives the public Discounts allowed a legally enforceable right to information held by public Nil discounts were requested or approved. agencies, subject to exemptions. The Health Service has a policy of open access for clients Time to Process to their personal health records. Applications for access to personal health records are therefore not included in Personal Other applications received under of the Freedom of Information 0 – 21 days 4 8 Act. 22 – 35 days - 3 Number of new FOI Requests from 1 July 2006 to 30 Over 35 days - - June 2007 TOTALS 4 11
Personal Other TOTAL Processing Time New (inc transferred in) 6 12 18 Personal Other Brought forward - - - 0 – 10 hours 4 - 11 - Total to be processed 6 12 18 11 – 20 hours - - - - Completed 6 12 18 21 – 40 hours - - - - Transferred out - - - Over 40 hours - - - - Withdrawn 3 - 3 TOTALS 4 - 11 - Total processed 3 12 15 Unfinished (carried forward) - - - Reviews and Appeals
Completed Requests Number of Internal Reviews finalised 1 Number of Ombudsman Reviews finalised 0 Personal Other Number of District Court/ADT appeals lodged 0 Granted in full 2 6 Number of District Court/ADT appeals finalised 0 Granted in part - - Refused 2 5 Deferred - - Completed 4 11
There were no Ministerial Certificates issued. One request required formal third party consultation. There were no requests for amendments or notation of records.
FOI Applications Granted in Part or Refused
Personal Other S19 (incomplete, wrongly addressed) - - S22 (deposit not paid) 2 - S25(1)(a1) (diversion of resources) - - S25(1)(a) (exempt) 1 2 S25(1)(b), (c), (d) (info otherwise available) - 1 S28(1)(b) (documents not held) 1 2 S24(2) (exceed 21 day limit, deemed refusal) - 2 S31(4) (released to Medical Practitioner) - - TOTAL 4 7 Note: the total need not reconcile with the refused requests total as there may be more than one reason cited for refusing an individual request.
Costs and Fees of Requests Processed
All Completed Assessed FOI Fees Requests Costs Received GSAHS 11 $1961 $1961
BETTER HEALTH FOR RURAL AUSTRALIA 63 Financial Overview
Executive Summary In achieving the above result GSAHS is satisfied that it has operated within the level of government cash payments and The audited financial statements presented for the GSAHS restricted operating costs to the budget available. It has are for the period 1 July 2006 to 30 June 2007. The Net Cost also ensured that no general creditors exist at the end of the of Services budget was $653.8 million, against which the month in excess of levels agreed with the NSW Department audited actuals of $656.5 million represents a variation of of Health and further, has effected all loan repayments within $2.7 million or 0.4%. the time frames agreed. The reported variation can be attributed to continued high This information is detailed below: demand for services across GSAHS.
2005/06 Actuals 2006/07 Budget 2006/07 Actuals $000 $000 $000 Employee Related Expenses 386,683 389,058 391,060 Visiting Medical Officers 52,909 53,894 54,445 Goods and Services 304,528 274,318 281,058 Maintenance 10,513 16,621 19,160 Depreciation and Amortisation 16,551 15,727 15,727 Grants and Subsidies 3,811 4,785 5,119 Borrowing Costs 926 1,776 1,930 Payments to Affiliated Health Organisation 12,321 13,252 14,040 Other Expenses 635 1,100 1,100 Total Expenses 788,877 770,531 783,639
Sale of Goods and Services 95,366 96,888 107,617 Investment Income 1,360 1,221 1,671 Grants and Contributions 9,853 9,031 9,305 Other Revenue 6,282 9,624 8,594 Total Revenues 112,861 116,764 127,187 Gain/Loss on Disposal of Non Current Assets 467 0 (63) Net Cost of Services 675,549 653,767 656,515
The variations in the two years reported stem from budget adjustments and other movements as follows:
Budget Increases 2006/07 $M Salary Award Entitlements 13.6 Medical Officer Supplementations 2.6 Mental Health Enhancements 1.6 17.8
Other Adjustments $M Reduced Interstate Patient Flow Expenses (36.1)
64 GSAHS ANNUAL REPORT 2006 - 2007 Program Reporting $19M compared to the prior year. $10M of this reduction occurred in Overnight Acute and relates to the reduction in The Health Service reporting of programs is consistent with Interstate Patient Flows. the ten programs of health care delivery utilised across NSW Health and satisfies the methodology for apportionment The remaining variances are primarily related to the advised by the NSW Department of Health. realignment of cost centres to the patient service models following the amalgamation and major workforce review Net Cost of Service for the GSAHS decreased approximately program.
2005/06 2006/07 Program Exp Rev NCOS Exp Rev NCOS $000 $000 $000 $000 $000 $000 Primary and Community 52,955 4,293 48,662 60,906 18,276 42,630 Aboriginal Health 4,045 39 4,006 3,788 0 3,788 Outpatient Services 27,940 1,994 25,946 35,313 1,854 33,459 Emergency Care Services 93,733 5,871 87,862 77,867 2,331 75,536 Overnight Acute 393,939 61,542 332,397 382,056 60,375 321,681 Same Day Acute 61,854 9,424 52,430 64,412 14,585 49,827 Mental Health Services 45,253 549 44,704 52,715 547 52,168 Rehab and Extended Care 100,735 27,448 73,287 95,954 29,030 66,924 Population Health 4,901 1,701 3,200 8,173 189 7,984 Teaching and Research 3,055 0 3,055 2,518 0 2,518 Total 788,410 112,861 675,549 783,702 127,187 656,515
Directions in Funding each patient has the best possible journey through the health system. This will ensure that patient care is better As a result of the establishment of the new Area Health coordinated, leading to improved patient outcomes and more Services on 1 January 2005, it has become necessary for efficient use of resources. each Area Health Service to prepare its financial statements utilising the Australian Equivalents to International Financial The Area Health Service amalgamation which took effect Reporting Standards (AEIFRS). on 1 January 2005 seeks to better align population growth centres with existing centres of excellence and specialist In addition to the need to adopt AEIFRS, the Area Health medical expertise and also link areas of traditional clinical Service has needed to respond to several other significant resource strength to areas of traditional shortage. In addition, challenges: the new Areas will integrate a range of administrative and • the amalgamation of accounting and financial systems; clinical systems, removing duplication and overlap, with the savings being progressively invested in clinical services. • the restructuring of corporate and business support services designed to generate funds to source further A major internal reform program has also been initiated to front line services consolidate and share corporate and business support services across the NSW public health system. These reforms • increasing service capacity across a number of state- are aimed at redirecting resources to frontline health care, wide and specialty services while also improving the cost effectiveness, consistency and The 2007/08 budget - about the forthcoming year accessibility of support services across NSW. The initial focus of these reforms is linen, food and IT systems and overall GSAHS received its 2007/08 allocation on 29 June 2007. The procurement practices, this approach being consistent with allocation is earmarked by the provision of additional funding the NSW Government’s Shared Corporate Services Reform to address: Strategy. • the provision of increased bed capacity to improve The Minister for Health has announced the following new access block performance and provide sustainable capital works: management of elective surgery - it is expected that the funding provided will facilitate the establishment and • Moruya Hospital Minor Works opening of an additional 58 bed equivalents • Non Acute Mental Health Planning • the provision of more elective surgery to address existing • Bombala Staff Accommodation waiting lists • Integrated Primary Health Care Planning • the need to increase the number of intensive care beds In addition, the 2007/08 capital program provides for the and cots for adults, children and infants with two beds continuation of 2006/07 projects including: expected to open and operate in 2007/08 • Queanbeyan Hospital Redevelopment • mental health service improvements, including Housing and Accommodation Support as well as Child and • Batlow Hospital Redevelopment Adolescent Services • Junee Hospital Redevelopment • the continued enhancement of the delivery of cancer • Bombala Hospital Redevelopment research and direct patient services • Berrigan Hospital Redevelopment GSAHS will work with the NSW Department of Health in a major reform program that will focus on ensuring that • Griffith Hospital emergency department BETTER HEALTH FOR RURAL AUSTRALIA 65 Certification of Parent/Consolidated Financial Statements for period Ended 30 June 2007
The attached financial statements of the Greater Southern Area Health Service for the year ended 30 June 2007: i. Have been prepared in accordance with the requirements of applicable Australian Accounting Standards which include Australian equivalents to International Financial Reporting Standards (AEIFRS), the requirements of the Public Finance and Audit Act 1983 and its regulations, the Accounts and Audit Determination and the Accounting Manual for the Area Health Services and Public Hospitals; ii. Present fairly the financial position and transactions of the Greater Southern Area Health Service; iii Have no circumstances which would render any particulars in the financial statements to be misleading or inaccurate; iv. The provision of the Charitable Fundraising Act 1991, regulations under the Act and the conditions attached to the fundraising authority have been compiled with by the Greater Southern Area Health Service; and v. The internal controls exercised by the Greater Southern Area Health Service are appropriate and effective in accounting for all income received and applied by the Greater Southern Area Health Service from any of its fundraising appeals.
Ms Heather Gray Mr Darren Atkinson Chief Executive Chief Financial Officer Greater Southern Area Health Service Greater Southern Area Health Service 30 November 2007 30 November 2007
66 GSAHS ANNUAL REPORT 2006 - 2007 GPO BOX 12 Sydney NSW 2001
INDEPENDENT AUDITOR’S REPORT
GREATER SOUTHERN AREA HEALTH SERVICE AND ITS CONTROLLED ENTITY
To Members of the New South Wales Parliament I have audited the accompanying financial report of the Greater Southern Area Service (the Service) and the Service and it’s controlled entity (the consolidated entity), which comprises the balance sheet as at 30 June 2007, and the operating statement, statement of recognised income and expense, cash flow statement, program statement - expenses and revenues for the year then ended, and a summary of significant accounting policies and other explanatory notes. The consolidated entity comprises the Service and the entities it controlled at the year’s end or from time to time during the financial year.
Auditors Opinion In my opinion, the financial report: • presents fairly in all material respects, the financial position of the Service and the consoildated entity as at 30 June 2007, and of their financial performance and their cash flows for the year then ended in accordance with Australian Accounting Standards (including the Australian Accounting Intrepretations) • is in accordance with section 45E of the Public Finance and Audit Act 1983 (the PF&A Act) and the Public Finance and Audit Regulation 2005 • is in accordance with the Charitable Fundraising Act 1991 (the CF Act), including showing a true and fair view of the Service’s financial result of fundraising appeals for the year ended 30 June 2007.
The Chief Executive’s Responsibilty for the Financial Report The Chief Executive is responsible for the preparation and fair presentation of the financial report in accordance with Australian Accounting Standards (including the Australian Accounting Interpretations) and the PF&A Act. This responsibilty includes establishing and maintaining internal control relevant to the preparation and fair presentation of the financial report that is free from material misstatement whether due to fraud or error; selecting and applying appropriate accounting policies; and making accounting estimates that are reasonable in the circumstances.
Auditor’s Responsibilty My responsibilty is to express an opinion on the financial report based on my audit. I conducted my audit in accordance with Australian Auditing Standards. These Auditing Standards require that I comply with relevant ethical requirements relating to audit engagements and plan and perform the audit to obtain reasonable assurance whether the financial report is free from material misstatement.
BETTER HEALTH FOR RURAL AUSTRALIA 67 An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial report. The procedures selected depend on the auditor’s judgement, including the assessment of the risks of material misstatement of the financial report, whether due to fraud or error. in making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial report in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by the Chief Executive, as well as evaluating the overall presentation of the financial report. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my audit opinion. My opinion does not provide assurance: • about the future viability of the Service or consolidated entity, • that they have carried out their activities effectively, efficiently and economically, • about the effectiveness of their internal controls, or on the assumptions used in formulating the budget figures disclosed in the financial report.
Report on Other Aspects of the Charitable Fundraising Act 1991 I have audited the Service’s operations in order to express an opinion on the matters specified at sections 24(2)(b), 24(2)(c) and 24(2)(d) of the CF Act for the year ended 30 June 2007.
Auditor’s Opnion In my opinion: • the Ledgers and associated records of the Service have been properly kept during the year in accordance with the CF Act and the Charitable Fundraising Regulation 2003 (the CF Regulation) (section 24(2)(b)) • money received as a result of fundraising appeals conducted during the year has been properly accounted for and applied in accordance with the CF Act and the CF Regulation (section 24(2)(c)) • there are reasonable grounds to believe that the Service will be able to pay its debts as and when they fall due (section 24(2)(d)).
The Chief Executive’s Responsibility for Compliance The Chief Executive of the Service is responsible for ensuring compliance with the CF Act and the CF Regulation. This responsibility includes: • establishing and maintaining internal control relevant to compliance with the CF Act and CF Regulation • ensuring that all assets obtained during, or as a result of, a fundraising appeal are safeguarded and properly accounted for, and • maintaining proper books of account and records.
68 GSAHS ANNUAL REPORT 2006 - 2007 Auditor’s Responsibility My responsibility is to express an opinion on the matters specified at sections 24 (2)(b), 24 (2)(c), and 24 (2)(d) of the CF Act. I conducted my audit in accordance Australian Auditing Standards applicable to assurance engagements. These Auditing Standards require that I comply with relevant ethical requirements relating to assurance engagements and plan and perform the audit to obtain reasonable assurance whether there were any material breaches of compliance by the Service. An audit involves performing procedures to obtain audit evidence about the entity’s compliance with the CF Act and CF Regulation and about its solvency. The procedures selected depend on the auditor’s judgement, including the assessment of the risks of material breaches of compliance. In making those risk assessments, the auditor considers internal control relevant to the entity’s compliance in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. My procedures included examination, on a test basis, of evidence supporting the Service’s solvency and its compliance with the CF Act and CF Regulation. These tests have not been performed continuously throughout the period, were not designed to detect all instances of non-compliance, and have not covered any other provisions of the CF Act and CF Regulation apart from those specified. I believe that the audit evidence I have obtained i s sufficient and appropriate to provide a basis for my audit opinion.
Independence In conducting this audit, the Audit Office has complied with the independence requirements of the Australian Auditing Standards and other relevant ethical requirements. The PF&A Act further promotes independence by: • providing that only Parliament, and not the executive government, can remove an Auditor- General, and • mandating the Auditor-General as auditor of public sector agencies but precluding the provision of non-audit services, thus ensuring the Auditor-General and the Audit Office are not compromised in their role by the possibility of losing clients or income.
Jack Kheir BEc, FCPA Director, Financial Audit Services 26 November 2007 SYDNEY
BETTER HEALTH FOR RURAL AUSTRALIA 69 Financial Statements
Greater Southern Area Health Service Operating Statement for the year ended 30 June 2007
PARENT CONSOLIDATION Actual Budget Actual Notes Actual Budget Actual 2007 2007 2006 2007 2007 2006 $000 $000 $000 $000 $000 $000
Expenses excluding losses Operating Expenses 0 0 270,993 Employee Related 3 391,060 389,058 386,683 391,060 389,058 115,690 Personnel Services 4 0 0 0 54,445 53,894 52,909 Visiting Medical Officers 54,445 53,894 52,909 300,218 290,939 315,041 Other Operating Expenses 5 300,218 290,939 315,041 15,727 15,727 16,551 Depreciation 2(i), 6 15,727 15,727 16,551 5,119 4,785 3,811 Grants and Subsidies 7 5,119 4,785 3,811 1,930 1,776 926 Finance Costs 8 1,930 1,776 926 Payments to Affiliated Health 14,040 13,252 12,321 9 14,040 13,252 12,321 Organisations
782,539 769,431 788,242 Total Expenses excluding losses 782,539 769,431 788,242
Retained Revenue 107,617 96,888 95,366 Sale of Goods and Services 10 107,617 96,888 95,366 1,671 1,221 1,360 Investment Income 11 1,671 1,221 1,360 19,359 18,643 12,745 Grants and Contributions 12 9,305 9,031 9,853 8,594 9,624 6,282 Other Revenue 13 8,594 9,624 6,282
137,241 126,376 115,753 Total Retained Revenue 127,187 116,764 112,861
(63) 0 467 Gain/(Loss) on Disposal 14 (63) 0 467 (1,100) (1,100) (635) Other gains/(losses) 15 (1,100) (1,100) (635)
646,461 644,155 672,657 Net Cost of Services 32 656,515 653,767 675,549
Government Contributions NSW Health Department 623,576 623,576 638,538 Recurrent Allocations 2(d) 623,576 623,576 638,538 NSW Health Department 38,132 37,554 13,450 Capital Allocations 2(d) 38,132 37,554 13,450 Acceptance by the Crown Entity of 0 0 7,161 employee benefits 2(a)(ii) 10,054 9,612 10,053
661,708 661,130 659,149 Total Government Contributions 671,762 670,742 662,041
15,247 16,975 (13,508) RESULT FOR THE YEAR 15,247 16,975 (13,508)
The accompanying notes form part of these Financial Statements
70 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Statement of Recognised Income and Expense for the year ended 30 June 2007
PARENT CONSOLIDATION Actual Budget Actual Notes Actual Budget Actual 2007 2007 2006 2007 2007 2006 $000 $000 $000 $000 $000 $000
Net increase/(decrease) in Property, 199,485 0 11,687 Plant and Equipment Revaluation 199,485 0 11,687 Reserve
TOTAL INCOME AND EXPENSE RECOGNISED 199,485 0 11,687 DIRECTLY IN EQUITY 199,485 0 11,687
15,247 16,975 (13,508) Result for the Year 15,247 16,975 (13,508)
TOTAL INCOME AND EXPENSE 214,732 16,975 (1,821) RECOGNISED FOR THE YEAR 214,732 16,975 (1,821)
The accompanying notes form part of these Financial Statements
BETTER HEALTH FOR RURAL AUSTRALIA 71 Greater Southern Area Health Service Balance Sheet as at 30 June 2007
PARENT CONSOLIDATION Actual Budget Actual Notes Actual Budget Actual 2007 2007 2006 2007 2007 2006 $000 $000 $000 $000 $000 $000 ASSETS
Current Assets 12,682 10,239 12,804 Cash and Cash Equivalents 18 12,682 10,239 12,804 16,259 18,304 13,857 Receivables 19 16,259 18,304 13,857 3,506 2,773 3,123 Inventories 20 3,506 2,773 3,123 0 0 56 Non Current Assets Held for Sale 22 0 0 56
32,447 31,316 29,840 Total Current Assets 32,447 31,316 29,840
Non-Current Assets 818 871 871 Receivables 19 818 871 871 Property, Plant and Equipment 489,101 268,189 275,153 - Land and Buildings 21 489,101 268,189 275,153 23,139 41,356 22,818 - Plant and Equipment 21 23,139 41,356 22,818 7,403 0 1,156 - Infrastructure Systems 21 7,403 0 1,156 519,643 309,545 299,127 Total Property, Plant and Equipment 519,643 309,545 299,127
520,461 310,416 299,998 Total Non-Current Assets 520,461 310,416 299,998
552,908 341,732 329,838 Total Assets 552,908 341,732 329,838
LIABILITIES
Current Liabilities 46,245 36,555 40,238 Payables 24 46,245 36,555 40,238 7,279 5,695 7,627 Borrowings 25 7,279 5,695 7,627 104,882 105,388 94,361 Provisions 26 104,882 105,388 94,361
158,406 147,638 142,226 Total Current Liabilities 158,406 147,638 142,226
Non-Current Liabilities 16,446 21,024 21,028 Borrowings 25 16,446 21,024 21,028 1,466 3,023 2,577 Provisions 26 1,466 3,023 2,577
17,912 24,047 23,605 Total Non-Current Liabilities 17,912 24,047 23,605
176,318 171,685 165,831 Total Liabilities 176,318 171,685 165,831
376,590 170,047 164,007 Net Assets 376,590 170,047 164,007
EQUITY 211,172 0 11,687 Reserves 27 211,172 0 11,687 165,418 170,047 152,320 Accumulated Funds 27 165,418 170,047 152,320
376,590 170,047 164,007 Total Equity 376,590 170,047 164,007
The accompanying notes form part of these Financial Statements
72 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Cash Flow Statement for the year ended 30 June 2007
PARENT CONSOLIDATION Actual Budget Actual Actual Budget Actual 2007 2007 2006 Notes 2007 2007 2006 $000 $000 $000 $000 $000 $000 CASH FLOWS FROM OPERATING ACTIVITIES Payments 0 0 (258,562) Employee Related (380,199) (376,584) (371,140) (5,119) (4,785) (3,811) Grants and Subsidies (5,119) (4,785) (3,811) (1,930) (1,776) (926) Finance Costs (1,930) (1,776) (926) (745,814) (739,002) (490,117) Other (365,615) (362,418) (377,539)
(752,863) (745,563) (753,416) Total Payments (752,863) (745,563) (753,416)
Receipts 105,254 96,823 92,626 Sale of Goods and Services 105,254 96,823 92,626 1,671 529 696 Interest Received 1,671 529 696 17,899 28,959 16,742 Other 17,899 28,959 16,742
124,824 126,311 110,064 Total Receipts 124,824 126,311 110,064
Cash Flows From Government NSW Health Department Recurrent 633,630 623,576 638,538 Allocations 633,630 623,576 638,538 NSW Health Department Capital 38,132 37,554 13,450 Allocations 38,132 37,554 13,450
671,762 661,130 651,988 Net Cash Flows from Government 671,762 661,130 651,988
NET CASH FLOWS FROM OPERATING 43,723 41,878 8,636 ACTIVITIES 32 43,723 41,878 8,636
CASH FLOWS FROM INVESTING ACTIVITIES Proceeds from Sale of Land and Buildings, Plant and Equipment 182 1,529 and Infrastructure Systems 182 1,529 Purchases of Land and Buildings, Plant and Equipment (39,097) (39,925) (15,761) and Infrastructure Systems (39,097) (39,925) (15,761)
NET CASH FLOWS FROM INVESTING (38,915) (39,925) (14,232) ACTIVITIES (38,915) (39,925) (14,232)
The accompanying notes form part of these Financial Statements
BETTER HEALTH FOR RURAL AUSTRALIA 73 Greater Southern Area Health Service Cash Flow Statement for the year ended 30 June 2007 (cont.)
PARENT CONSOLIDATION Actual Budget Actual Actual Budget Actual 2007 2007 2006 Notes 2007 2007 2006 $000 $000 $000 $000 $000 $000 CASH FLOWS FROM FINANCING ACTIVITIES Proceeds from Borrowings and 1,976 (4,518) 15,106 Advances 1,976 (4,518) 15,106 (6,906) 0 (4,692) Repayment of Borrowings and Advances (6,906) 0 (4,692)
NET CASH FLOWS FROM FINANCING (4,930) (4,518) 10,414 ACTIVITIES (4,930) (4,518) 10,414
(122) (2,565) 4,818 NET INCREASE / (DECREASE) IN CASH (122) (2,565) 4,818 12,804 12,804 7,986 Opening Cash and Cash Equivalents 12,804 12,804 7,986
CLOSING CASH AND CASH 12,682 10,239 12,804 EQUIVALENTS 18 12,682 10,239 12,804
The accompanying notes form part of these Financial Statements
74 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Program Statement of Expenses and Revenues for the year ended 30 June 2007 0 926 467 2006 (635) $000 Total 3,811 1,360 6,282 9,853 12,321 16,551 52,909 95,366 112,861 315,041 (13,508) 662,041 788,242 675,549 386,683 0
(63) 2007 $000 5,119 1,671 1,930 9,305 8,594 (1,100) 15,727 15,247 14,040 54,445 127,187 107,617 671,762 656,515 300,218 391,060 782,539
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Non 2006 $000 662,041 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Attributable 2007 $000 671,762 0 0 0 0 0 0 0 0 0 0 0 0 0 13 2006 $000 3,042 3,055 3,055 Program 0 0 0 0 0 0 0 0 0 0 0 58 54 500 2007 $000 2,518 2,518 1,906 6.1 * 6.1 0 0 0 0 0 0 0 0 0 25 79 2006 $000 1,701 1,701 3,735 1,062 4,901 3,200 Program 0 0 0 0 0 0 0 14 15 174 123 189 244 2007 $000 8,173 5,410 7,984 2,382 5.1 * 5.1 0 67 96 (91) 578 593 2006 $000 2,414 1,888 2,820 4,355 17,190 22,147 11,895 64,183 27,448 73,287 100,711 Program 0 (9) 329 263 290 586 384 (156) 2007 $000 2,149 2,035 4.1 * 4.1 44,718 14,038 95,789 33,624 29,030 66,924 26,403 0 0 0 0 0 0 90 48 920 268 459 549 2006 $000 4,063 29,617 10,337 44,704 45,253 Program 0 0 0 0 0 0 82 60 547 405 2007 $000 1,052 1,934 4,620 3.1 * 3.1 52,715 52,168 11,888 33,221 0 0 80 101 200 238 644 (272) 2006 $000 1,015 1,426 7,664 9,424 4,556 61,782 25,573 52,430 29,909 Program 0 0 177 272 (27) 290 345 484 (472) 2007 $000 1,713 2,108 2.3 * 12,211 63,913 24,073 14,585 49,827 36,825 0 0 478 457 200 (272) 2006 $000 1,610 1,528 7,360 1,243 23,512 57,947 61,542 222,734 138,540 332,397 393,867 Program 2 0 (27) 947 489 (472) 2007 $000 1,713 1,165 1,061 6,452 2.2 * 57,008 60,375 44,903 321,681 181,905 381,557 146,287 0 0 0 0 112 119 149 403 583 2006 $000 5,871 5,200 2,604 20,318 87,862 13,630 93,733 56,486 Program 0 0 0 0 0 0 16 241 234 2007 $000 3,121 1,794 2,315 2,331 2.1 * 2.1 31,106 41,371 77,867 75,536 0 0 0 0 48 44 161 148 875 398 2006 $000 7,413 1,678 1,391 1,994 17,778 27,940 25,946 Program 0 0 0 0 0 0 19 163 337 933 458 2007 $000 1,233 1,854 1.3 * 17,953 16,071 35,313 33,459 0 0 0 0 0 39 39 45 83 426 457 632 2006 $000 2,402 4,045 4,006 Program 2 0 0 0 0 0 0 0 0 34 323 2007 $000 1,921 3,788 3,788 1,508 1.2 * 0 0 0 0 16 64 828 558 645 483 644 2006 $000 3,075 4,293 9,944 1.1 * 1.1 40,991 52,955 48,662 Program 0 0 0 0 0 48 681 431 2007 $000 1,137 8,027 6,650 3,599 18,276 20,027 42,630 38,582 60,906 SERVICE’S EXPENSES AND REVENUES Expenses excluding losses Operating Expenses Employee Related Visiting Medical Officers Other Operating Expenses Depreciation and Amortisation Grants and Subsidies Finance Costs Payments to Affiliated Health Organisations Other Expenses Total Expenses excluding losses Revenue Sale of Goods and Services Investment Income Grants and Contributions Other Revenue Total Revenue Gain / (Loss) on Disposal Other Gains / (Losses) Net Cost of Services Government Contributions RESULT FOR THE YEAR * The name and purpose of each program is summarised The program in Note 17. statement uses statistical dataeach to December 31 program. No 2006 changes to allocate have occurred the current during period’s the period financial between information 1 January to 2007 and 30 June 2007 which would materially impact this allocation.
BETTER HEALTH FOR RURAL AUSTRALIA 75 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
1. The Health Service Reporting Entity The financial statements and notes comply with Australian Accounting Standards which include AEIFRS. The Greater Southern Area Health Service was established Comparative figures are, where appropriate, reclassified to under the provisions of the Health Services Act with effect give a meaningful comparison with the current year. from 1 January 2005. The Health Service, as a reporting entity, comprises all Impacts of Amendments to Accounting Standards the operating activities of the Hospital facilities and the AASB-2007.04, Amendments to Australian Accounting Community Health Centres under its control. It also Standards arising from ED151 and other amendments, has encompasses the Special Purposes and Trust Funds which, application for accounting periods commencing on or after 1 while containing assets which are restricted for specified July 2007. The standard is not being early adopted in 2006/07 uses by the grantor or the donor, are nevertheless controlled and the new options available in the standard will not be by the Health Service. The Health Service is a not for profit applied. entity. AASB123, Borrowing Costs, has application in reporting With effect from 17 March 2006 fundamental changes to the years beginning on or after 1 January 2009. employment arrangements of Health Services were made through amendment to the Public Sector Employment and The Standard, which requires capitalisation of Borrowing Management Act 2002 and other Acts including the Health Costs has not been adopted in 2006/07 nor is adoption Services Act 1997. The status of the previous employees expected prior to 2009/10. of Health Services changed from that date. They are now AASB101, Presentation of Financial Statements, has reduced employees of the Government of New South Wales in the the disclosure requirements for various reporting entities. service of the Crown rather than employees of the Health However, in not for profit entities such as Health Services Service. Employees of the Government are employed in there is no change required. AASB7 Financial Instruments: Divisions of the Government Service. Disclosures, locates all disclosure requirements for financial In accordance with Accounting Standards these Divisions instruments within the one standard. The Standard has are regarded as special purpose entities that must be application for annual reporting periods beginning on or after consolidated with the financial report of the related Health 1 January 2007. The Standard will not be early adopted and Service. This is because the Divisions were established to has no differential impact. provide personnel services to enable a Health Service to Other significant accounting policies used in the preparation exercise its functions. of these financial statements are as follows: As a consequence the values in the annual financial a) Employee Benefits and Other Provisions statements presented herein consist of the Health Service (as the parent entity), the financial report of the special purpose i) Salaries and Wages, Current Annual Leave, Sick entity Division and the consolidated financial report of the Leave and On Costs (including non-monetary economic entity. Notes have been extended to capture both benefits) the parent and consolidated values with notes 3, 4, 12, 24, 26 At the consolidated level of reporting liabilities for and 32 being especially relevant. salaries and wages (including non monetary benefits), In the process of preparing the consolidated financial annual leave and paid sick leave that fall wholly within statements for the economic entity consisting of the 12 months of the reporting date are recognised and controlling and controlled entities, all inter-entity transactions measured in respect of employees’ services up to the and balances have been eliminated. reporting date at undiscounted amounts based on the amounts expected to be paid when the liabilities The reporting entity is consolidated as part of the NSW Total are settled. State Sector Accounts. All Annual Leave employee benefits are reported These financial statements have been authorised for issue by as “Current” as there is an unconditional right to the Chief Executive on 19th November 2007. payment. Current liabilities are then further classified as “Short Term” or “Long Term” based on past trends 2. Summary of Significant Accounting Policies and known resignations and retirements. Anticipated The Health Service’s financial statements are a general payments to be made in the next twelve months are purpose financial report which has been prepared in reported as “Short Term”. On costs of 21.7% are accordance with applicable Australian Accounting Standards applied to the value of leave payable at 30 June 2007 (which include Australian equivalents to International inclusive of the 4% award increase payable from Financial Reporting Standards (AEIFRS)), the requirements 1 July 2007, such on costs being consistent with of the Health Services Act 1997 and its regulations including actuarial assessment. observation of the Accounts and Audit Determination for Unused non-vesting sick leave does not give rise to a Area Health Services and Public Hospitals. liability as it is not considered probable that sick leave Property, plant and equipment, investment property, assets taken in the future will be greater than the benefits held for trading and available for sale are measured at fair accrued in the future. value. Other financial statement items are prepared in The outstanding amounts of workers’ compensation accordance with the historical cost convention. All amounts insurance premiums and fringe benefits which are are rounded to the nearest one thousand dollars and are consequential to employment, are recognised as expressed in Australian currency. liabilities and expenses where the employee benefits Judgements, key assumptions and estimations made by to which they relate have been recognised. management are disclosed in the relevant notes to the financial statements. 76 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
ii) Long Service Leave and Superannuation Benefits c) Finance Costs At the consolidated level of reporting Long Service Finance costs are recognised as expenses in the period Leave employee leave entitlements are dissected as in which they are incurred. “Current” if there is an unconditional right to payment d) Income Recognition and “Non Current” if the entitlements are conditional. Current entitlements are further dissected between Income is measured at the fair value of the consideration “Short Term” and “Long Term” on the basis of or contribution received or receivable. Additional anticipated payments for the next twelve months. comments regarding the accounting policies for the This in turn is based on past trends and known recognition of revenue are discussed below. resignations and retirements. Sale of Goods and Services Long Service Leave provisions are measured on a Revenue from the sale of goods and services comprises short hand basis at an escalated rate of 8.1% inclusive revenue from the provision of products or services, ie of the 4% payable from 1 July 2007 for all employees user charges. User charges are recognised as revenue with five or more years of service. Actuarial when the service is provided or by reference to the stage assessment has found that this measurement of completion. technique produces results not materially different from the estimate determined by using the present Patient Fees value basis of measurement. Patient Fees are derived from chargeable inpatients and non-inpatients on the basis of rates specified by the The Health Service’s liability for the closed NSW Health Department from time to time. superannuation pool schemes (State Authorities Superannuation Scheme and State Superannuation Investment Income Scheme) is assumed by the Crown Entity. The Interest revenue is recognised using the effective interest Health Service accounts for the liability as having method as set out in AASB139, “Financial Instruments: been extinguished resulting in the amount assumed Recognition and Measurement”. Rental revenue is being shown as part of the non-monetary revenue recognised in accordance with AASB117 “Leases” on a item described as “Acceptance by the Crown Entity straight line basis over the lease term. Dividend revenue of Employee Benefits”. Any liability attached to is recognised in accordance with AASB118 when the Superannuation Guarantee Charge cover is reported Health Service’s right to receive payment is established. in Note 24, “Payables”. Debt Forgiveness The superannuation expense for the financial year Debts are accounted for as extinguished when and is determined by using the formulae specified by only when settlement occurs through repayment or the NSW Health Department. The expense for replacement by another liability. certain superannuation schemes (ie Basic Benefit and First State Super) is calculated as a percentage Use of Hospital Facilities of the employees’ salary. For other superannuation Specialist doctors with rights of private practice are schemes (ie State Superannuation Scheme and subject to an infrastructure charge for the use of State Authorities Superannuation Scheme), the hospital facilities at rates determined by the NSW Health expense is calculated as a multiple of the employees’ Department. Charges consist of two components: superannuation contributions. - a monthly charge raised by the Health Service based Consequential to the legislative changes of 17 on a percentage of receipts generated March 2006 no salary costs or provisions have been recognised by the Parent Health Service beyond that - the residue of the Private Practice Trust Fund at the date. end of each financial year, such sum being credited for Health Service use in the advancement of the iii) Other Provisions Health Service or individuals within it. Other provisions exist when: the agency has a present Use of Outside Facilities legal or constructive obligation as a result of a past The Health Service uses a number of facilities owned and event; it is probable that an outflow of resources will maintained by the local authorities in the area to deliver be required to settle the obligation; and a reliable community health services for which no charges are estimate can be made of the amount of the obligation. raised by the authorities. The cost method of accounting
is used for the initial recording of all such services with These provisions are recognised when it is probable cost being determined as the fair value of the services that a future sacrifice of economic benefits will be given which is then duly recognised as both revenue and required and the amount can be measured reliably. matching expense.
Grants and Contributions b) Insurance Grants and Contributions are generally recognised as The Health Service’s insurance activities are conducted revenues when the Health Service obtains control over through the NSW Treasury Managed Fund Scheme of the assets comprising the contributions. Control over self insurance for Government Agencies. The expense contributions is normally obtained upon the receipt of (premium) is determined by the Fund Manager based on cash. past experience.
BETTER HEALTH FOR RURAL AUSTRALIA 77 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
NSW Health Department Allocations The composition of patient flow expense/revenue is Payments are made by the NSW Health Department disclosed in Notes 5 and 10. on the basis of the allocation for the Health Service g) Acquisition of Assets as adjusted for approved supplementations mostly The cost method of accounting is used for the initial for salary agreements, patient flows between Health recording of all acquisitions of assets controlled by Services and approved enhancement projects. This the Health Service. Cost is the amount of cash or allocation is included in the Operating Statement before cash equivalents paid or the fair value of the other arriving at the “Result for the Year” on the basis that consideration given to acquire the asset at the time of the allocation is earned in return for the health services its acquisition or construction or, where applicable, the provided on behalf of the Department. Allocations are amount attributed to that asset when initially recognised normally recognised upon the receipt of Cash. in accordance with the specific requirements of other General operating expenses/revenues of Affiliated Australian Accounting Standards. Health Organisations have only been included in the Assets acquired at no cost, or for nominal consideration, Operating Statement prepared to the extent of the cash are initially recognised as assets and revenues at their payments made to the Health Organisations concerned. fair value at the date of acquisition except for assets The Health Service is not deemed to own or control the transferred as a result of an administrative restructure. various assets/liabilities of the aforementioned Health Fair value means the amount for which an asset could be Organisations and such amounts have been excluded exchanged between knowledgeable, willing parties in an from the Balance Sheet. Any exceptions are specifically arm’s length transaction. listed in the notes that follow. Where settlement of any part of cash consideration is e) Goods and Services Tax (GST) deferred beyond normal credit terms, its cost is the cash Revenues, expenses and assets are recognised net of price equivalent, i.e. the deferred payment amount is the amount of GST, except: effectively discounted at an asset-specific rate. - the amount of GST incurred by the Health Service Land and Buildings which are owned by the Health as a purchaser that is not recoverable from the Administration Corporation or the State and administered Australian Taxation Office is recognised as part of the by the Health Service are deemed to be controlled by the cost of acquisition of an asset or as part of an item of Health Service and are reflected as such in the financial expense; statements. - receivables and payables are stated with the amount h) Plant and Equipment and Infrastructure Systems of GST included. Individual items of property, plant and equipment are f) Inter Area and Interstate Patient Flows capitalised where their cost is $10,000 or above. Prior to 1 July 2006 assets were recognised based on a value of Inter Area Patient Flows $5,000 or above. Health Services recognise patient flows from acute inpatients (other than Mental Health Services), “Infrastructure Systems” means assets that comprise emergency and rehabilitation and extended care. public facilities and which provide essential services and enhance the productive capacity of the economy Patient flows have been calculated using benchmarks for including roads, bridges, water infrastructure and the cost of services for each of the categories identified distribution works, sewerage treatment plants, seawalls and deducting estimated revenue, based on the payment and water reticulation systems. category of the patient. i) Depreciation The adjustments have no effect on equity values as the movement in Net Cost of Services is matched by Depreciation is provided for on a straight line basis for a corresponding adjustment to the value of the NSW all depreciable assets so as to write off the depreciable Health Recurrent Allocation. amount of each asset as it is consumed over its useful life to the Health Service. Land is not a depreciable Inter State Patient Flows asset. Health Services recognise the outflow of acute inpatients Details of depreciation rates initially applied for major from the area in which they are resident to other States asset categories are as follows: and Territories within Australia. The Health Services also recognise the value of inflows for acute inpatient Buildings 2.5% treatment provided to residents from other States and Electro Medical Equipment territories. The expense and revenue values reported - Costing less than $200,000 10.0% within the financial statements have been based on - Costing more than or equal to $200,000 12.5% 2005/06 activity data using standard cost weighted separation values to reflect estimated costs in 2006/07 Computer Equipment 20.0% for acute weighted inpatient separations. Where Infrastructure Systems 2.5% treatment is obtained outside the home health service, the State/Territory providing the service is reimbursed Motor Vehicles 20.0% by the benefiting Area. Office Equipment 10.0% The reporting adopted for both inter area and interstate Plant and Machinery 10.0% patient flows aims to provide a greater accuracy of the cost of service provision to the Area’s resident population Linen 20.0% and disclose the extent to which service is provided to Furniture, Fittings and Furnishings 5.0% non residents.
78 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
Depreciation rates are subsequently varied where k) Impairment of Property, Plant and Equipment changes occur in the assessment of the remaining useful As a not-for-profit entity with no cash generating units, life of the assets reported. the Health Service is effectively exempt from AASB j) Revaluation of Non Current Assets 136 Impairment of Assets and impairment testing. This Physical non-current assets are valued in accordance is because AASB136 modifies the recoverable amount with the NSW Health Department’s “Valuation of Physical test to the higher of fair value less costs to sell and Non-Current Assets at Fair Value”. This policy adopts fair depreciated replacement cost. This means that, for value in accordance with AASB116, “Property, Plant and an asset already measured at fair value, impairment Equipment” and AASB140, “Investment Property”. can only arise if selling costs are regarded as material. Property, plant and equipment is measured on an existing Selling costs are regarded as immaterial. use basis, where there are no feasible alternative uses l) Restoration Costs in the existing natural, legal, financial and socio-political environment. However, in the limited circumstances The estimated cost of dismantling and removing an asset where there are feasible alternative uses, assets are and restoring the site is included in the cost of an asset, valued at their highest and best use. to the extent it is recognised as a liability. Fair value of property, plant and equipment is determined m) Non Current Assets (or disposal groups) Held for Sale based on the best available market evidence, including The Health Service has certain non-current assets (or current market selling prices for the same or similar disposal groups) classified as held for sale, where their assets. Where there is no available market evidence the carrying amount will be recovered principally through asset’s fair value is measured at its market buying price, a sale transaction, not through continuing use. Non- the best indicator of which is depreciated replacement current assets (or disposal groups) held for sale are cost. recognised at the lower of carrying amount and fair value The Health Service revalues Land and Buildings less costs to sell. These assets are not depreciated while and Infrastructure at minimum every three years by they are classified as held for sale. independent valuation and with sufficient regularity to ensure that the carrying amount of each asset does not n) Maintenance differ materially from its fair value at reporting date. The The costs of maintenance are charged as expenses as last revaluation for assets assumed by the Area as at incurred, except where they relate to the replacement 30 June 2007 was completed on 30 June 2007 and was of a component of an asset in which case the costs are based on an independent assessment. capitalised and depreciated. Non-specialised assets with short useful lives are o) Leased Assets measured at depreciated historical cost, as a surrogate for fair value. A distinction is made between finance leases which When revaluing non-current assets by reference to effectively transfer from the lessor to the lessee current prices for assets newer than those being substantially all the risks and benefits incidental to revalued (adjusted to reflect the present condition of the ownership of the leased assets, and operating leases assets), the gross amount and the related accumulated under which the lessor effectively retains all such risks depreciation are separately restated. and benefits. For other assets, any balances of accumulated Where a non-current asset is acquired by means of depreciation existing at the revaluation date in respect of a finance lease, the asset is recognised at its fair those assets are credited to the asset accounts to which value at the commencement of the lease term. The they relate. The net asset accounts are then increased or corresponding liability is established at the same decreased by the revaluation increments or decrements. amount. Lease payments are allocated between the Revaluation increments are credited directly to the asset principal component and the interest expense. revaluation reserve, except that, to the extent that an Operating lease payments are charged to the Operating increment reverses a revaluation decrement in respect of Statement in the periods in which they are incurred. that class of asset previously recognised as an expense p) Inventories in the Result for the Year, the increment is recognised immediately as revenue in the Result for the Year. Inventories are stated at cost. Costs are assigned to Revaluation decrements are recognised immediately as individual items of stock mainly on the basis of weighted expenses in the Result for the Year, except that, to the average costs. extent that a credit balance exists in the asset revaluation Obsolete items are disposed of in accordance with reserve in respect of the same class of assets, they are instructions issued by the NSW Health Department. debited directly to the asset revaluation reserve. q) Other Financial Assets As a not-for-profit entity, revaluation increments and decrements are offset against one another within a class Financial assets are initially recognised at fair value plus, of non-current assets, but not otherwise. in the case of financial assets not at fair value through Where an asset that has previously been revalued profit or loss, transaction costs. is disposed of, any balance remaining in the asset revaluation reserve in respect of that asset is transferred to accumulated funds.
BETTER HEALTH FOR RURAL AUSTRALIA 79 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007 r) Equity Transfers Low or zero interest loans are recorded at fair value on inception and amortised cost thereafter. In 2005/06 this The transfer of net assets between agencies as a result involved the restatement of loan values as at 1 July 2005 of an administrative restructure, transfers of programs/ for all loans negotiated prior to that date. functions and parts thereof between NSW public sector agencies is designated as a contribution by owners and Other Investments is recognised as an adjustment to “Accumulated Funds”. Terms and interest conditions - Short term deposits have an average maturity of 60 to 90 days and effective Transfers arising from an administrative restructure interest rates of 6.3% to 6.5% as compared to 5.4% to between Health Services/government departments 6.0% in the previous year. are recognised at the amount at which the asset was recognised by the transferor Health Service/Government Trade and Other Payables Department immediately prior to the restructure. In Accounting Policies - These amounts represent liabilities most instances this will approximate fair value. All other for goods and services provided to the Health Service equity transfers are recognised at fair value. and other amounts, including interest. Payables are The Statement of Recognised Income and Expense recognised initially at fair value, usually based on the does not reflect the Net Assets or change in equity in transaction cost or face value. Subsequent measurement accordance with AASB 101 Clause 97. is at amortised cost using the effective interest method. Short-term payables with no stated interest rate are s) Financial Instruments measured at the original invoice amount where the effect Financial instruments give rise to positions that are a of discounting is immaterial. Payables are recognised for financial asset of either Greater Southern Area Health amounts to be paid in the future for goods and services Service or its counter party and a financial liability received, whether or not billed to the Health Service. (or equity instrument) of the other party. For Greater Southern Area Health Service these include cash at Terms and Conditions - Trade liabilities are settled within bank, receivables, other financial assets, payables and any terms specified. If no terms are specified, payment borrowings. is made by the end of the month following the month in which the invoice is received. In accordance with Australian Accounting Standard Borrowings AASB139, “Financial Instruments: Recognition and Measurement” disclosure of the carrying amounts for Accounting Policies - Bank Overdrafts are carried at each of the AASB139 categories of financial instruments the principal amount. Other loans are classified as is disclosed in Note 36. The specific accounting policy non trading liabilities and measured at amortised cost. in respect of each class of such financial instrument is Interest is charged as an expense as it accrues. Finance stated hereunder. Lease Liability is accounted for in accordance with AASB117, “Leases”. Classes of instruments recorded and their terms and Terms and Conditions - Bank Overdraft interest is charged conditions measured in accordance with AASB139 are at the bank’s benchmark rate. Non Interest bearing as follows: loans of $21.0 million are repayable in quarterly intervals Cash with the final instalment due on 30 June 2013. Interest Accounting Policies - Cash is carried at nominal values bearing loans are payable at six monthly intervals with reconcilable to monies on hand and independent bank interest charged at 6.97%. statements. t) Borrowings Terms and Conditions - Monies on deposit attract Non interest bearing loans within NSW Health are initially an effective interest rate of approximately 5.5% as measured at fair value and amortised thereafter. All compared to 5.8% in the previous year. other loans are valued at amortised cost. Loans and Receivables u) Trust Funds Loans and receivables are recognised initially at fair The Health Service receives monies in a trustee capacity value, usually based on the transaction cost or face for various trusts as set out in Note 29. As the Health value. Subsequent measurement is at amortised cost Service performs only a custodial role in respect of these using the effective interest method, less an allowance for monies, and because the monies cannot be used for the any impairment of receivables. Short-term receivables achievement of the Health Service’s own objectives, they with no stated interest rate are measured at the original are not brought to account in the financial statements. invoice amount where the effect of discounting is v) Budgeted Amounts immaterial. An allowance for impairment of receivables The budgeted amounts are drawn from the budgets is established when there is objective evidence that the agreed with the NSW Health Department at the beginning entity will not be able to collect all amounts due. The of the financial reporting period and with any adjustments amount of the allowance is the difference between for the effects of additional supplementation provided. the assets carrying amount and the present value of estimated future cash flows, discounted at the effective interest rate. Bad debts are written off as incurred. Terms and Conditions - Accounts are generally issued on 30-day terms.
80 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 3. Employee Related
Employee related expenses comprise the following:
0 189,302 Salaries and Wages 280,505 265,629 0 11,511 Awards 14,352 16,159 0 7,981 Superannuation [see note 2(a)] - defined benefit plans 10,053 12,823 0 12,044 Superannuation [see note 2(a)] - defined contributions 22,937 19,350 0 8,435 Long Service Leave [see note 2(a)] 11,390 11,842 0 19,032 Annual Leave [see note 2(a)] 27,241 26,720 0 4,907 Sick Leave and Other Leave 6,808 7,010 0 4,225 Redundancies 934 8,140 0 890 Nursing Agency Payments 1,224 1,249 0 3,239 Other Agency Payments 5,051 4,547 0 9,378 Workers Compensation Insurance 10,414 13,165 0 49 Fringe Benefits Tax 151 49
0 270,993 391,060 386,683
Note 1 addresses the changes in employment status effective from 17 March 2006
4. Personnel Services
Personnel Services comprise the purchase of the following:
280,505 76,327 Salaries and Wages 0 0 14,352 4,648 Awards 0 0 10,053 4,842 Superannuation [see note 2(a)] - defined benefit plans 0 0 22,937 7,305 Superannuation [see note 2(a)] - defined contributions 0 0 11,390 3,407 Long Service Leave [see note 2(a)] 0 0 27,241 7,688 Annual Leave [see note 2(a)] 0 0 6,808 2,103 Sick Leave and Other Leave 0 0 934 3,915 Redundancies 0 0 1,224 359 Nursing Agency Payments 0 0 5,051 1,308 Other Agency Payments 0 0 10,414 3,788 Workers Compensation Insurance 0 0 151 0 Fringe Benefits Tax 0 0
391,060 115,690 0 0
Note 1 addresses the changes in employment status effective from 17 March 2006
BETTER HEALTH FOR RURAL AUSTRALIA 81 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000
5. Other Operating Expenses
2,472 2,062 Blood and Blood Products 2,472 2,062 7,633 5,653 Domestic Supplies and Services 7,633 5,653 14,619 14,175 Drug Supplies 14,619 14,175 5,697 5,762 Food Supplies 5,697 5,762 5,977 5,447 Fuel, Light and Power 5,977 5,447 19,867 20,334 General Expenses (See (b) below) 19,867 20,334 7,222 7,363 Hospital Ambulance Transport Costs 7,222 7,363 5,446 5,196 Information Management Expenses 5,446 5,196 92 93 Insurance 92 93 42,785 44,644 Inter Area Patient Outflows, NSW (see (d) below) 42,785 44,644 106,208 134,554 Interstate Patient Outflows (see (e) below) 106,208 134,554 Maintenance (See (c) below) 3,262 2,121 Maintenance Contracts 3,262 2,121 7,256 2,851 New/Replacement Equipment under $10,000 7,256 2,851 5,096 4,220 Repairs 5,096 4,220 3,546 1,321 Other 3,546 1,321 19,387 18,667 Medical and Surgical Supplies 19,387 18,667 2,700 2,981 Postal and Telephone Costs 2,700 2,981 1,584 1,972 Printing and Stationery 1,584 1,972 595 614 Rates and Charges 595 614 3,586 3,389 Rental 3,586 3,389 25,066 22,895 Special Service Departments 25,066 22,895 784 389 Staff Related Costs 784 389 6,261 5,182 Sundry Operating Expenses (See (a) below) 6,261 5,182 3,077 3,156 Travel Related Costs 3,077 3,156
300,218 315,041 300,218 315,041
82 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 (a) Sundry Operating Expenses comprise: 4,188 3,703 Aircraft Expenses (Ambulance) 4,188 3,703 0 1 Contract for Patient Services 0 1 2,073 1,478 Isolated Patient Travel and Accomodation Assistance Scheme 2,073 1,478
6,261 5,182 6,261 5,182
(b) General Expenses include:- 778 499 Advertising 778 499 204 169 Books, Magazines and Journals 204 169 Consultancies 1,801 934 - Operating Activities 1,801 934 1,487 1,517 Courier and Freight 1,487 1,517 274 128 Auditor’s Remuneration - Audit of financial reports 274 128 (241) 536 Data Recording and Storage (241) 536 289 454 Legal Services 289 454 288 285 Membership/Professional Fees 288 285 4,387 3,576 Motor Vehicle Operating Lease Expense - minimum lease payments 4,387 3,576 2,591 3,408 Other Operating Lease Expense - minimum lease payments 2,591 3,408 319 208 Quality Assurance/Accreditation 319 208
(c) Reconciliation Total Maintenance Maintenance expense - contracted labour and other (non employee 19,160 10,513 related), included in Note 5 19,160 10,513 Employee related/Personnel Services maintenance expense included in 7,926 7,754 Notes 3 and 4 7,926 7,754
27,086 18,267 Total maintenance expenses included in Notes 3, 4 and 5 27,086 18,267
(d) Expenses for Inter Area Patient Flows, NSW on an Area basis are as follows:- 9,304 7,695 Sydney South West AHS 9,304 7,695 22,426 18,044 Sydney East Illawarra AHS 22,426 18,044 3,145 10,194 Sydney West AHS 3,145 10,194 1,555 2,292 Northern Sydney/Central Coast AHS 1,555 2,292 412 485 Hunter New England AHS 412 485 340 305 North Coast AHS 340 305 1,537 2,733 Greater Western AHS 1,537 2,733 4,066 2,896 Children’s Hospital 4,066 2,896 42,785 44,644 42,785 44,644
BETTER HEALTH FOR RURAL AUSTRALIA 83 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 (e) Expenses for Interstate Patient Flows are as follows:- 62,248 82,385 ACT 62,248 82,385 1,145 221 Queensland 1,145 221 75 431 South Australia 75 431 41,829 51,425 Victoria 41,829 51,425 145 86 Tasmania 145 86 144 71 Northern Territory 144 71 622 (65) Western Australia 622 (65) 106,208 134,554 106,208 134,554
6. Depreciation
11,261 12,105 Depreciation - Buildings 11,261 12,105 4,466 4,446 Depreciation - Plant and Equipment 4,466 4,446
15,727 16,551 15,727 16,551
7. Grants and Subsidies
1,214 1,731 Non Government Voluntary Organisations 1,214 1,731 3,905 2,080 Other 3,905 2,080
5,119 3,811 5,119 3,811
8. Finance Costs
1,920 900 Interest on Bank Overdrafts and Loans 1,920 900 10 26 Other Interest Charges 10 26
1,930 926 Total Finance Costs 1,930 926
9. Payments to Affiliated Health Organisations
(a) Recurrent Sourced 6,110 4,682 Mercy Care Centre- Young 6,110 4,682 7,930 7,639 Mercy Care Centre- Albury 7,930 7,639
14,040 12,321 14,040 12,321
84 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 10. Sale of Goods and Services
(a) Sale of Goods comprise the following:-
599 389 Sale of Prosthesis 599 389 140 102 Pharmacy Sales 140 102
(b) Rendering of Services comprise the following:-
55,153 51,979 Patient Fees [see note 2(d)] 55,153 51,979 84 80 Staff-Meals and Accommodation 84 80 Infrastructure Fees 3,316 4,666 - Monthly Facility Charge [see note 2(d)] 3,316 4,666 240 364 Cafeteria/Kiosk 240 364 745 673 Commercial Activities 745 673 60 48 Fees for Medical Records 60 48 11,053 9,629 Inter Area Patient Inflows, NSW 11,053 9,629 0 17 Linen Service Revenues - Other Health Services 0 17 65 252 Linen Service Revenues - Non Health Services 65 252 840 803 Meals on Wheels 840 803 22,928 15,235 Patient Inflows from Interstate 22,928 15,235 12,394 11,129 Other 12,394 11,129
107,617 95,366 107,617 95,366
(c) Revenues from Inter Area Patient Flows, NSW on an Area basis are as follows: 809 843 Sydney South West AHS 809 843 1,569 1,594 Sydney East Illawarra AHS 1,569 1,594 477 348 Sydney West AHS 477 348 428 389 Northern Sydney/Central Coast AHS 428 389 355 416 Hunter New England AHS 355 416 280 227 North Coast AHS 280 227 7,135 5,812 Greater Western AHS 7,135 5,812 11,053 9,629 11,053 9,629
(d) Revenues from Patient Inflows from Interstate are as follows:- 3,264 1,237 ACT 3,264 1,237 387 412 Queensland 387 412 290 254 South Australia 290 254 18,646 13,205 Victoria 18,646 13,205 142 (21) Tasmania 142 (21) 44 41 Northern Territory 44 41 155 107 Western Australia 155 107 22,928 15,235 22,928 15,235
BETTER HEALTH FOR RURAL AUSTRALIA 85 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 11. Investment Income
1,055 696 Interest 1,055 696 616 664 Other 616 664
1,671 1,360 1,671 1,360
12. Grants and Contributions
3,343 3,562 Commonwealth Government grants 3,343 3,562 1,527 2,784 Industry Contributions/Donations 1,527 2,784 2,521 1,983 Mammography grants 2,521 1,983 1,044 1,272 NSW Government grants 1,044 1,272 10,054 2,892 Personnel Services - Superannuation Defined Benefits 0 0 870 252 Other grants 870 252
19,359 12,745 9,305 9,853
13. Other Revenue
Other Revenue comprises the following:-
0 22 Bad Debts recovered 0 22 63 52 Commissions 63 52 0 71 Conference and Training Fees 0 71 28 20 Sale of Merchandise, Old Wares and Books 28 20 0 22 Sponsorship Income 0 22 4,683 0 Treasury Managed Fund Hindsight Adjustment 4,683 0 3,820 6,095 Other 3,820 6,095
8,594 6,282 8,594 6,282
86 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 14. Gain/(Loss) on Disposal
286 1,056 Property Plant and Equipment 286 1,056 97 767 Less Accumulated Depreciation 97 767
189 289 Written Down Value 189 289 182 306 Less Proceeds from Disposal 182 306
Gain/(Loss) on Disposal of (7) 17 Property Plant and Equipment (7) 17
56 773 Assets Held for Sale 56 773 ----- 1,223 Less Proceeds from Disposal ----- 1,223 Gain/(Loss) on Disposal of Assets (56) 450 Held for Sale (56) 450
(63) 467 Total Gain/(Loss) on Disposal (63) 467
15. Other Gains/(Losses)
(1,100) (635) Impairment of Receivables (1,100) (635)
(1,100) (635) (1,100) (635)
PARENT AND CONSOLIDATION
16. Conditions on Contributions Purchase of Health Promotion, Other Total Assets Education and Research
$000 $000 $000 $000
Contributions recognised as revenues during the current reporting period for which expenditure in the manner specified had not occurred as at balance date 231 182 4,877 5,290
Contributions recognised in amalgamated balance as at 30 June 2006 which were not expended in the current reporting period 501 263 1,801 2,565
Total amount of unexpended contributions as at balance date 732 445 6,678 7,855
Comment on restricted assets appears in note 23
BETTER HEALTH FOR RURAL AUSTRALIA 87 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
17. Programs/Activities of the Health Service Program 1.1 - Primary and Community Based Services
Objective: To improve, maintain or restore health through health promotion, early intervention, assessment, therapy and treatment services for clients in a home or community setting.
Program 1.2 - Aboriginal Health Services
Objective: To raise the health status of Aborigines and to promote a healthy life style.
Program 1.3 - Outpatient Services
Objective: To improve, maintain or restore health through diagnosis, therapy, education and treatment services for ambulant patients in a hospital setting.
Program 2.1 - Emergency Services
Objective: To reduce the risk of premature death and disability for people suffering injury or acute illness by providing timely emergency diagnostic, treatment and transport services.
Program 2.2 - Overnight Acute Inpatient Services
Objective: To restore or improve health and manage risks of illness, injury and childbirth through diagnosis and treatment for people intended to be admitted to hospital on an overnight basis.
Program 2.3 - Same Day Acute Inpatient Services
Objective: To restore or improve health and manage risks of illness, injury and childbirth through diagnosis and treatment for people intended to be admitted to hospital and discharged on the same day.
Program 3.1 - Mental Health Services
Objective: To improve the health, well being and social functioning of people with disabling mental disorders and to reduce the incidence of suicide, mental health problems and mental disorders in the community.
Program 4.1 - Rehabilitation and Extended Care Services
Objective: To improve or maintain the well being and independent functioning of people with disabilities or chronic conditions, the frail aged and the terminally ill.
Program 5.1 - Population Health Services
Objective: To promote health and reduce the incidence of preventable disease and disability by improving access to opportunities and prerequisites for good health.
Program 6.1 - Teaching and Research
Objective: To develop the skills and knowledge of the health workforce to support patient care and population health. To extend knowledge through scientific enquiry and applied research aimed at improving the health and well being of the people of New South Wales.
88 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 18. Current Assets - Cash and Cash Equivalents
5,458 6,012 Cash at bank and on hand 5,458 6,012 7,224 6,792 Short Term Deposits 7,224 6,792
12,682 12,804 12,682 12,804
Cash assets recognised in the Balance Sheet are reconciled to cash at the end of the financial year as shown in the Cash Flow Statement as follows:
12,682 12,804 Cash and cash equivalents (per Balance Sheet) 12,682 12,804
12,682 12,804 Closing Cash and Cash Equivalents (per Cash Flow Statement) 12,682 12,804
19. Current/Non Current Receivables
Current 12,124 9,808 (a) Sale of Goods and Services 12,124 9,808 0 92 Leave Mobility 0 92 1,699 1,591 NSW Health Department 1,699 1,591 2,756 2,725 Other Debtors 2,756 2,725
16,579 14,216 Sub Total 16,579 14,216
(1,039) (674) Less Allowance for impairment (1,039) (674)
15,540 13,542 Sub Total 15,540 13,542 719 315 Prepayments 719 315
16,259 13,857 16,259 13,857
(b) Impairment of Receivables during the year - Current Receivables 735 751 - Sale of Goods and Services 735 751 - Other
735 751 735 751
BETTER HEALTH FOR RURAL AUSTRALIA 89 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 (c) Sale of Goods and Services Receivables include: 1,223 1,310 Patient Fees - Compensable 1,223 1,310 291 232 Patient Fees - Ineligible 291 232 4,095 3,250 Patient Fees - Other 4,095 3,250
5,609 4,792 5,609 4,792
Non Current 818 871 Prepayments 818 871
818 871 818 871
20. Inventories
Current - at cost 1,075 890 Drugs 1,075 890 2,014 2,022 Medical and Surgical Supplies 2,014 2,022 83 0 Food and Hotel Supplies 83 0 223 211 Engineering Supplies 223 211 111 0 Other including Goods in Transit 111 0
3,506 3,123 3,506 3,123
90 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 21. Property, Plant and Equipment
Land and Buildings 963,956 472,575 At Fair Value 963,956 472,575 Less Accumulated depreciation 474,855 197,422 and impairment 474,855 197,422
489,101 275,153 Net Carrying Amount 489,101 275,153
Plant and Equipment 73,526 71,669 At Cost 73,526 71,669 Less Accumulated depreciation 50,387 48,851 and impairment 50,387 48,851
23,139 22,818 Net Carrying Amount 23,139 22,818
Infrastructure Systems 15,697 1,156 At Fair Value 15,697 1,156 Less Accumulated depreciation 8,294 ----- and impairment 8,294 -----
7,403 1,156 Net Carrying Amount 7,403 1,156
Total Property, Plant and Equipment 519,643 299,127 At Net Carrying Amount 519,643 299,127
BETTER HEALTH FOR RURAL AUSTRALIA 91 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT AND CONSOLIDATION
21. Property, Plant and Equipment - Reconciliations
Land Buildings Work in Plant and Infrastructure Total $000 $000 Progress Equipment Systems $000 $000 $000 $000
2007 Carrying amount at start of year 32,126 225,185 17,911 22,750 1,155 299,127 Additions 6 16,862 16,841 5,388 0 39,097 Recognition of Assets Held for Sale 0 Disposals (154) 0 0 (36) 0 (190) Administrative restructures - transfers in/(out) (150) (347) 0 (1,652) 0 (2,149) Net revaluation increment less revaluation decrements recognised in reserves 12,933 179,149 0 0 7,403 199,485 Impairment losses (recognised in other gains/losses) 0 Depreciation expense 0 (11,261) 0 (4,466) 0 (15,727) Reclassifications 0 0 0 1,155 (1,155) 0 Carrying amount at end of year 44,761 409,588 34,752 23,139 7,403 519,643
Land Buildings Work in Plant and Infrastructure Total $000 $000 Progress Equipment Systems $000 $000 $000 $000
2006 Carrying amount at start of year 20,623 236,779 9,998 21,119 0 288,519 Additions 251 271 8,992 6,171 76 15,761 Recognition of Assets Held for Sale 0 Disposals (195) 0 0 (95) 0 (290) Administrative restructures - transfers in/(out) 0 Net revaluation increment less revaluation decrements recognised in reserves 11,447 240 0 0 0 11,687 Impairment losses (recognised in other gains/losses) 0 Depreciation expense 0 (12,105) 0 (4,445) 0 (16,550) Reclassifications 0 0 (1,079) 0 1,079 0 Carrying amount at end of year 32,126 225,185 17,911 22,750 1,155 299,127
(i) Land and Buildings include land owned by the Health Administration Corporation and administered by the Health Service [see note 2(g)]. (ii) Land and Buildings were valued by AON Valuation Services (Certified Practising Valuers) on 30 June 2007 [see note 2(j)]. AON Valuation Services are not an employee of the Health Service.
92 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 22. Non Current Assets held for sale
Assets held for sale ----- 56 Land and Buildings ----- 56
----- 56 ----- 56
23. Restricted Assets
The Health Service’s financial statements include the following assets which are restricted by externally imposed conditions, eg. donor requirements. The assets are only available for application in accordance with the terms of the donor restrictions.
Category Brief Details of Externally Imposed Conditions including Asset Category affected
4,435 4,348 Specific Purposes Hospital/Ward specific 4,435 4,348
311 293 Private Practice Funds Private Practice Trust 311 293
3,109 3,126 Other Not restricted to specific hospitals 3,109 3,126
7,855 7,767 7,855 7,767
BETTER HEALTH FOR RURAL AUSTRALIA 93 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION
2007 2006 2007 2006
$000 $000 $000 $000 24. Payables Current 0 0 Accrued Salaries and Wages 8,487 7,618 0 0 Payroll Deductions 3,044 2,462 11,531 10,080 Accrued Liability - Purchase of Personnel Services 0 0 28,483 25,021 Creditors 28,483 25,021 Other Creditors 4,562 2,861 - Capital Works 4,562 2,861 1,669 2,276 - Intra Health Liability 1,669 2,276
46,245 40,238 46,245 40,238
25. Current/Non Current Borrowings
Current 7,279 7,627 Other Loans and Deposits 7,279 7,627
7,279 7,627 7,279 7,627
Non Current 16,446 21,028 Other Loans and Deposits 16,446 21,028
16,446 21,028 16,446 21,028
Other loans still to be extinguished represent monies to be repaid to the NSW Health Department. Final Repayment is scheduled for 30 June 2013
Repayment of Borrowings
7,279 7,627 Not later than one year 7,279 7,627 13,953 21,028 Between one and five years 13,953 21,028 2,493 0 Later than five years 2,493 0
23,725 28,655 Total Borrowings at face value 23,725 28,655
94 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 26. Provisions
Current Employee benefits and related on-costs 0 0 Employee Annual Leave - Short Term Benefit 28,507 25,980 0 0 Employee Annual Leave - Long Term Benefit 15,205 13,159 0 0 Employee Long Service Leave - Short Term Benefit 4,699 5,093 0 0 Employee Long Service Leave - Long Term Benefit 56,471 50,129 104,882 94,361 Provision for Personnel Services Liability 0 0
104,882 94,361 Total Current Provisions 104,882 94,361
Non Current Employee benefits and related on-costs 0 0 Employee Long Service Leave - Conditional 1,466 2,577 1,466 2,577 Provision for Personnel Services Liability 0 0
1,466 2,577 Total Non Current Provisions 1,466 2,577
Aggregate Employee Benefits and Related On-costs 104,882 94,361 Provisions - current 104,882 94,361 1,466 2,577 Provisions - non-current 1,466 2,577 0 0 Accrued Salaries and Wages and on costs (Note 24) 11,531 10,080 11,531 10,080 Accrued Liability - Purchase of Personnel Services (Note 24) 0 0
117,879 107,018 117,879 107,018
BETTER HEALTH FOR RURAL AUSTRALIA 95 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
27. Parent and Consolidation
Accumulated Funds Asset Revaluation Available for Sale Total Equity Equity Reserve Reserves 2007 2006 2007 2006 2007 2006 2007 2006 $000 $000 $000 $000 $000 $000 $000 $000
Balance at the beginning of the financial reporting period 152,320 173,658 11,687 0 0 0 164,007 173,658 Correction of errors 0 (4,930) 0 0 0 0 0 (4,930)
Restated Opening Balance 152,320 168,728 11,687 0 0 0 164,007 168,728
Changes in equity - transactions with owners as owners
Increase/(Decrease) in Net Assets from Administrative Restructure (Note 39) (2,149) (2,900) (2,149) (2,900)
Total 150,171 165,828 11,687 0 0 0 161,858 165,828
Changes in equity - other than transactions with owners as owners
Result for the year 15,247 (13,508) 15,247 (13,508)
Correction of errors
Increment/(Decrement) on Revaluation of: Land and Buildings 192,082 11,687 192,082 11,687 Infrastructure Systems 7,403 7,403 0
Total 15,247 (13,508) 199,485 11,687 0 0 214,732 (1,821)
Transfers within equity
Asset revaluation reserve balances transferred to accumulated funds on disposal of asset 0 0
Total 0 0 0 0 0 0 0 0
Balance at the end of the financial reporting period 165,418 152,320 211,172 11,687 0 0 376,590 164,007
The asset revaluation reserve is used to record increments and decrements on the revaluation of non current assets. This accords with the Health Service’s policy on the “Revaluation of Physical Non Current Assets” and “Investments”, as discussed in Note 2(j).
96 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 28. Commitments for Expenditure (a) Capital Commitments Aggregate capital expenditure contracted for at balance date but not provided for in the accounts:
2,516 2,275 Not later than one year 2,516 2,275
2,516 2,275 Total Capital Expenditure Commitments (including GST) 2,516 2,275
(b) Other Expenditure Commitments Aggregate other expenditure contracted for at balance date but not provided for in the accounts:
1,523 1,911 Not later than one year 1,523 1,911 1,362 842 Later than one year and not later than five years 1,362 842 231 0 Later than five years 231 0
3,116 2,753 Total Other Expenditure Commitments (including GST) 3,116 2,753
(c) Operating Lease Commitments Commitments in relation to non-cancellable operating leases are payable as follows:
4,572 4,968 Not later than one year 4,572 4,968 4,205 5,307 Later than one year and not later than five years 4,205 5,307 160 226 Later than five years 160 226
8,937 10,501 Total Operating Lease Commitments (including GST) 8,937 10,501
BETTER HEALTH FOR RURAL AUSTRALIA 97 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT AND CONSOLIDATION 29. Trust Funds
The Health Service holds trust fund moneys of $1.846 million which are used for the safe keeping of patients’ monies, deposits on hired items of equipment and Private Practice Trusts. These monies are excluded from the financial statements as the Health Service cannot use them for the achievement of its objectives. The following is a summary of the transactions in the trust account:
Patient Trust Refundable Private Practice Deposits Trust Funds
2007 2006 2007 2006 2007 2006 $000 $000 $000 $000 $000 $000 Cash Balance at the beginning of the financial reporting period 1,152 535 118 97 507 166
Receipts 490 1,279 80 383 4,362 4,800
Expenditure (462) (662) (61) (362) (4,340) (4,459)
Cash Balance at the end of the financial reporting period 1,180 1,152 137 118 529 507
PARENT AND CONSOLIDATION c) Affiliated Health Organisations 30. Contingent Liabilities Based on the definition of control in Australian Accounting Standard AASB127, Affiliated Health Organisations listed a) Claims on Managed Fund in Schedule 3 of the Health Services Act, 1997 are only Since 1 July 1989, the Health Service has been a member recognised in the Department’s consolidated Financial of the NSW Treasury Managed Fund. The Fund will pay to Statements to the extent of cash payments made. or on behalf of the Health Service all sums which it shall However, it is accepted that a contingent liability exists become legally liable to pay by way of compensation which may be realised in the event of cessation of health or legal liability if sued except for employment related, service activities by any Affiliated Health Organisation. In discrimination and harassment claims that do not have this event the determination of assets and liabilities would statewide implications. The costs relating to such be dependent on any contractual relationship which may exceptions are to be absorbed by the Health Service. As exist or be formulated between the administering bodies such, since 1 July 1989, apart from the exceptions noted of the organisation and the Department. above no contingent liabilities exist in respect of liability claims against the Health Service. A Solvency Fund (now called Pre-Managed Fund Reserve was established to deal with the insurance matters incurred before 1 July 1989 that were above the limit of insurance held or for matters that were incurred prior to 1 July 1989 that would have become verdicts against the State. That Solvency Fund will likewise respond to all claims against the Health Service. b) Workers Compensation Hindsight Adjustment Treasury Managed Fund normally calculates hindsight premiums each year. However, in regard to workers compensation the final hindsight adjustment for the 2000/01 fund year and an interim adjustment for the 2002/03 fund year were not calculated until 2006/07. As a result, the 2001/02 final and 2003/04 interim hindsight calculations will be paid in 2007/08.
98 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT 31. Charitable Fundraising Activities
Fundraising Activities The Greater Southern Area Health Service conducts direct fundraising in all hospitals under its control. All revenue and expenses have been recognised in the financial statements of the Greater Southern Area Health Service. Fundraising activities are dissected as follows:
INCOME DIRECT INDIRECT NET
RAISED EXPENDITURE* EXPENDITURE+ PROCEEDS $000 $000 $000 $000
Appeals (In House) 7 0 0 7
Fetes 4 0 0 4
Raffles 1 0 0 1
Functions 1 0 0 1 13 0 0 13
Percentage of Income 100% % % 100%
* Direct Expenditure includes printing, postage, raffle prizes, consulting fees, etc + Indirect Expenditure includes overheads such as office staff administrative costs, cost apportionment of light, power and other overheads.
The net proceeds were used for the following purposes: $000
Purchase of Equipment 1
Research 1
Held in Special Purpose and Trust Fund Pending Purchase 11 13
The provision of the Charitable Fundraising Act 1991 and the regulations under that Act have been complied with and internal controls exercised by the Greater Southern Area Health Service are considered appropriate and effective in accounting for all the income received in all material respects.
BETTER HEALTH FOR RURAL AUSTRALIA 99 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT CONSOLIDATION 2007 2006 2007 2006 $000 $000 $000 $000 32. Reconciliation Of Net Cash Flows from Operating Activities To Net Cost Of Services
43,723 8,636 Net Cash Flows from Operating Activities 43,723 8,636 (15,727) (16,551) Depreciation (15,727) (16,551) Acceptance by the Crown Entity of Employee Superannuation 0 (7,161) Benefits (10,054) (10,053) (9,410) (6,816) (Increase)/ Decrease in Provisions (9,410) (6,816) 3,096 1,084 Increase / (Decrease) in Prepayments and Other Assets 3,096 1,084 (6,007) (443) (Increase)/ Decrease in Creditors (6,007) (443) (63) 467 Net Gain/ (Loss) on Sale of Property, Plant and Equipment (63) 467 (623,576) (638,538) (NSW Health Department Recurrent Allocations) (623,576) (638,538) (38,132) (13,450) (NSW Health Department Capital Allocations) (38,132) (13,450) (Asset Sale Proceeds transferred to the (365) 115 Allowance for impairment of receivables (365) 115
(646,461) (672,657) Net Cost of Services (656,515) (675,549)
33. 2006/07 Voluntary Services It is considered impracticable to quantify the monetary value of voluntary services provided to the health service. Services provided include: - Chaplaincies and Pastoral Care - Patient and Family Support - Pink Ladies/Hospital Auxiliaries - Patient Services, Fund Raising - Patient Support Groups - Practical Support to Patients and Relative - Community Organisations - Counselling, Health Education, Transport, Home Help and Patient Activities
100 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT AND CONSOLIDATED Cash Flows 34. Unclaimed Moneys Closing Cash and Cash Equivalents decreased $0.1M during the year and were $2.4M favourable to budget. Net Cash Unclaimed salaries and wages are paid to the credit of the Flows from Operating Activities were $1.8m favourable to Department of Industrial Relations and Employment in budget with the sale of goods and services $8.4M higher accordance with the provisions of the Industrial Arbitration than budget and reflects the improved revenue performance Act, 1940, as amended. of the Health Service. All money and personal effects of patients which are left Movements in the level of the NSW Health Department in the custody of Health Services by any patient who is Recurrent Allocation that have occurred since the time of the discharged or dies in the hospital and which are not claimed initial allocation on 30 June 2006 are as follows: by the person lawfully entitled thereto within a period of twelve months are recognised as the property of health $000 services. Initial Allocation, 30 June 2006 558,514 All such money and the proceeds of the realisation of any Interstate Patient Flows 31,732 personal effects are lodged to the credit of the Samaritan Inter Area Patient Flows 11,888 Fund which is used specifically for the benefit of necessitous patients or necessitous outgoing patients. General Assistance 2,582 Medical Officer Supplementations 2,502 35. Budget Review - Parent and Consolidated Risk Shared Procurement 1,831 Mental Health Enhancements 1,576 Net Cost of Services Rural Doctors Grants 1,312 The actual Net Cost of Services was higher than budget by Amalgamation Separation Costs 1,284 $2.7M (0.4%). This was primarily due to the continued high Elective Surgery List Reduction 1,056 costs of providing a diverse range of public hospital services in a rural setting with increasing demands for services. Nurse Education 771 Total expenditure was approx $13.1M (1.7%) unfavourable to Award Costs 694 budget. Major overruns evident in Interstate Patient Outflows Treasury Managed Fund 692 $4.7M, Maintenance costs $2.5M, Employee Related Renal Dialysis Expansion 577 expenses $2.0M and expenditure on Operational Goods & Oral Health Strategy 554 Services $2.0M. Total Revenue was favourable to target by $10.4M (8.9%). Interstate Patient Inflows contributed $7.9M Highly Specialised Drugs 542 of this favourability reflecting the success of flow reversal Rural Stroke Enhancements 531 strategies progressed. Transport for Health 388 Clinical Services Redesign 373 Result for the Year Other Miscellaneous Adjustments 4,177 The Result for the Year was unfavourable to budget by $1.7M. Government contributions totalled $671.8M and were approx $1.0M higher than budgeted for and offset the $2.7M Net Balance as per Operating Statement 623,576 Cost of Service deficit.
Assets and Liabilities
Total Assets exceeded budget by $211.2M with the current year balance representing an increase of $223.1M on last year. This increase is primarily due to the revaluation of Non Current Assets that was undertaken during the year and resulted in an increase in asset values of approx $199.5M. The Area has also commenced a number of capital programs that have added $39.2M to the asset base. Total liabilities exceeded budget by $4.6M, much of this relates to an increase in payable amounts which have increased $6.0M from last year.
BETTER HEALTH FOR RURAL AUSTRALIA 101 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007 % 2006 rate * 6.25% 6.25% 0.00% 0.00% 5.80% 5.80% % 2007 effective interest 6.97% 6.97% 0.00% 0.00% 5.50% 5.50% Weighted average 2006 $000 13,542 12,804 28,655 40,238 26,346 68,893 Total carrying Balance Sheet 2007 $000 23,725 12,682 69,970 15,540 28,222 46,245 amount as per the
0 80 2006 $000 13,622 13,542 40,238 40,238 bearing
0 Non-interest 51 2007 $000 15,591 15,540 46,245 46,245 0 0 0 0 2006 $000 0 0 2007 $000 2,493 2,493 More than 5 years 0 0 2006 $000 21,028 21,028 0 0 2007 $000 Over 1 to 5 years 13,953 13,953 Fixed interest rate maturing in: 2006 $000 7,627 7,627 6,792 6,792 1 year or less 2007 $000 7,224 7,224 7,279 7,279
0 rate 2006 $000 5,932 5,932 0 2007 $000 Floating interest 5,407 5,407 Financial Instruments Interest Rate Risk Interest rate risk, is the risk that the value of the financial instrument will fluctuate due to changes in market interest rates. Greater Southern Area Health Service’s exposure to interest rate risks and the effectiveboth recognised interest rates and unrecognised, of financial assets at the (consolidated)and liabilities, Balance Sheet date are as follows: Financial Instruments Financial Assets Cash Receivables Total Financial Assets Financial Liabilities Borrowings-Other Payables Total Financial Liabilities * Weighted average effective interest rate was computed on a semi-annual basis. It is not applicable for non-interest bearing financial instruments. 6. PARENT AND CONSOLIDATED 3 a) 102 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007 2006 Total $000 13,542 12,803 26,345 2007 $000 12,682 15,540 28,222 80 2006 $000 4,259 4,339 Other 51 2007 $000 8,313 8,364 2006 $000 4,792 4,792 Patients 2007 $000 4,385 4,385 2006 $000 Banks 12,723 12,723 2007 $000 12,631 12,631 2006 $000 4,491 4,491 Governments 2007 $000 2,842 2,842 Financial Instruments Credit Risk Credit risk is the risk of financial loss arising from another party to a contract or financial position failing to discharge a financial obligationThe Greater thereunder. Southern Area Health Service’s maximum exposure to credit risk is represented by the carrying amounts of the financial assets included in the consolidated Balance Sheet. Credit Risk by classification of counterparty. Financial Assets Cash Receivables Total Financial Assets The only significant concentration of credit risk arises in respect of patients ineligible for free treatment under the Medicare provisions.Receivables from these entities totalled $291K at balance date. Derivative Financial Instruments The Greater Southern Area Health Service holds no Derivative Financial Instruments. 6. PARENT AND CONSOLIDATED 3 b) c) BETTER HEALTH FOR RURAL AUSTRALIA 103 Greater Southern Area Health Service Notes to and Forming Part of the Financial Statement for the Year Ended 30 June 2007
PARENT AND CONSOLIDATED 40. After Balance Date Events 37. Cross Border Issues The issue of patient flows between the ACT and NSW was referred to arbitration to establish whether activity target Effective from 1 July 2003, the Area Health Service entered throughput limits and marginal pricing for the years 2005/06, into an agreement with the Wodonga Regional Health Service 2006/07 and 2007/08 for public patients treated in ACT whereby it assumes responsibility for the provision of service hospitals were still appropriate. at Albury Base Hospital. The arbitrators delivered their judgement on 14 September The agreement seeks through improved integration of 2007 ruling in favour of ACT Health and thereby increasing hospital and health services to improve continuity of care and the NSW Health expenses for both 2005/06 and 2006/07. access to services. The component applicable to Greater Southern has not yet The agreement has been extended to 30 June 2008. been determined by NSW Health and will be taken up in the financial statements for 2007/08 once the quantum of the 38. Prior Period Errors adjustment is known. In 2006/07 the Department of Health determined the need to make allowance for on costs which need to be paid on the settlement of annual leave liability. This resulted in the End of Audited Financial Statements application of an on cost of 21.7% as reported in Note 2(a). The provisions of AASB119, Employee Benefits and Treasury’s Financial Reporting Code for Budget Dependant General Government Sector Agencies, as pre existing in prior years, recognised the need to include such on costs and therefore the on costs now recognised have been brought to account as “Prior Period Errors”. . The amount corrected against the Opening Balance at 1 July 2005 was $4.932M, with the 2005/06 Result being increased by $0.760M. In the Parent financial statements the $0.760M has been apportioned between Employee Related Expense ($0.540M) for the period up to 17 March 2006 and Personnel Services ($0.220M) for the period 17 March 2006 to 30 June 2006.
39. Decrease in Net Assets from Administrative Restructure
With effect from 1 October 2006, responsibility for the provision of linen services transferred from the Area to Health Support from which the Area now purchases its linen needs. Details of the equity transfer are as follows: 2007 $000
Assets Property, Plant and Equipment - Land and Buildings 496 - Plant and Equipment 1,653
Liabilities Borrowings (576) Provisions 576 Net Assets/Equity (Refer Note 27) 2,149
104 GSAHS ANNUAL REPORT 2006 - 2007 Certification of Special Purpose Entity for Period Ended 30 June 2007
The attached financial statements of the Greater Southern Area Health Service Special Purpose Entity for the year ended 30 June 2007. i. Have been prepared in accordance with the requirements of applicable Australian Accounting Standards which include Australian equivalents to international Financial Reporting Standards (AEIFRS), the requirements of the Public Finance and Audit Act 1983 and its regulations, the Health Services Act 1997 and its regulations, the Health Services Act 1997 and its regulations, the Accounts and Audit Determination and the Accounting Manual for Area Health Services and Public Hospitals; ii. Present fairly the financial position of the Greater Southern Area Health Service Special Purpose Service Entity; and iii Have no circumstances which would render any particulars in the financial statements to be misleading or inaccurate.
Ms Heather Gray Mr Darren Atkinson Chief Executive Chief Financial Officer Greater Southern Area Health Service Greater Southern Area Health Service 30 November 2007 30 November 2007
BETTER HEALTH FOR RURAL AUSTRALIA 105 GPO BOX 12 Sydney NSW 2001
INDEPENDENT AUDITOR’S REPORT
GREATER SOUTHERN AREA HEALTH SERVICE AND ITS CONTROLLED ENTITY
To Members of the New South Wales Parliament I have audited the accompanying financial report of Greater Southern Area Health Service Special Purpose Service Entity (the Entity), which comprises the balance sheet as at 30 June 2007, and the income statement, statement of recognised income and expense and cash flow statement for the year then ended, and a summary of significant accounting policies and other explanatory notes.
Auditor’s Opinion In my opinion, the financial report: • presents fairly, in all material respects, the financial position of the Entity as of 30 June 2007, and of its financial performance and its cash flows for the year then ended in accordance with Australian Accounting Standards (including the Australian Accounting Interpretations) • is in accordance with section 45E of the Public Finance and Audit Act 1983 (the PF&A Act) and the Public Finance and Audit Regulation 2005.
Chief Executive’s Responsibility for the Financial Report The Chief Executive is responsible for the preparation and fair presentation of the financial report in accordance with Australian Accounting Standards (including the Australian Accounting Interpretations) and the PFEtA Act. This responsibility includes establishing and maintaining internal controls relevant to the preparation and fair presentation of a financial report that is free from material misstatement, whether due to fraud or error; selecting and applying appropriate accounting policies; and making accounting estimates that are reasonable in the circumstances.
Auditor’s Responsibility My responsibility is to express an opinion on the financial report based on my audit. I conducted my audit in accordance with Australian Auditing Standards. These Auditing Standards require that I comply with relevant ethical requirements relating to audit engagements and plan and perform the audit to obtain reasonable assurance whether the financial report is free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial report. The procedures selected depend on the auditor’s judgement, including the assessment of the risks of material misstatement of the financial report, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial report in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by the Chief Executive, as well as evaluating the overall presentation of the financial report. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my audit opinion.
106 GSAHS ANNUAL REPORT 2006 - 2007 My opinion does not provide assurance: • about the future viability of the Entity, • that they have carried out their activities effectively, efficiently and economically, or • about the effectiveness of their internal controls.
Independence In conducting this audit, the Audit Office has complied with the independence requirements of the Australian Auditing Standards and other relevant ethical requirements. The PF&A Act furtherpromotes independence by: • providing that only Parliament, and not the executive government, can remove an Auditor- General, and • mandating the Auditor-General as auditor of public sector agencies but precluding the provision of non-audit services, thus ensuring the Auditor-General and the Audit Office are not compromised in their role by the possibility of losing clients or income.
Jack Kheir BEc, FCPA Director, Financial Audit Services 26 November 2007 SYDNEY
BETTER HEALTH FOR RURAL AUSTRALIA 107 Operating Statement of the Greater Southern Area Health Service Special Purpose Service Entity for the Year Ended 30 June 2007
2007 2006 $000 $000
Income Personnel Services 396,532 115,690 Acceptance by the Crown Entity of Employee Benefits 10,054 2,892
Total Income 406,586 118,582
Expenses Salaries and Wages 280,505 76,327 Awards 14,352 4,648 Defined Benefit Superannuation 10,053 4,842 Defined Contributions Superannuation 22,937 7,305 Long Service Leave 11,390 3,407 Annual Leave 32,713 7,688 Sick Leave and Other Leave 6,808 2,103 Redundancies 934 3,915 Nursing Agency Payments 1,224 359 Other Agency Payments 5,051 1,308 Workers Compensation Insurance 10,414 3,788 Fringe Benefits Tax 151 0 Grants and Subsidies 10,054 2,892
Total Expenses 406,586 118,582
Result For The Year 0 0
The comparatives for 2006 cover the period 17 March 2006 to 30 June 2006 only. Note 1(c) refers.
The accompanying notes form part of these Financial Statements.
108 GSAHS ANNUAL REPORT 2006 - 2007 Balance Sheet of the Greater Southern Area Health Service Special Purpose Service Entity for the Year Ended 30 June 2007
Notes 2007 2006 $000 $000 ASSETS Current Assets Receivables 2 116,413 104,441 Total Current Assets 116,413 104,441
Non-Current Assets Receivables 2 1,466 2,577 Total Non-Current Assets 1,466 2,577 Total Assets 117,879 107,018
LIABILITIES Current Liabilities Payables 3 11,531 10,080 Provisions 4 104,882 94,361
Total Current Liabilities 116,413 104,441
Non-Current Liabilities Provisions 4 1,466 2,577
Total Non-Current Liabilities 1,466 2,577
Total Liabilities 117,879 107,018
Net Assets 0 0
EQUITY Accumulated funds 0 0
Total Equity 0 0
The accompanying notes form part of these Financial Statements
BETTER HEALTH FOR RURAL AUSTRALIA 109 Statement of Recognised Income and Expense of the Greater Southern Area Health Service Special Purpose Service Entity for the Year Ended 30 June 2007
2007 2006 $000 $000
Opening Equity 0 0
Result for the Year 0 0
Closing Equity 0 0
The accompanying notes form part of these Financial Statements
Cash Flow Statement of the Greater Southen Area Health Service Special Purpose Service Entity for the Year Ended 30 June 2007
2007 2006 $000 $000
Net Cash Flows from Operating Activities 0 0
Net Cash Flows from Investing Activities 0 0
Net Cash Flows from Financing Activities 0 0
Net Increase/(Decrease) in Cash 0 0
Closing Cash and Cash Equivalents 0 0
The Greater Southern Area Health Service Special Purpose Service Entity does not hold any cash or cash equivalent assets and therefore there are nil cash flows.
The accompanying notes form part of these Financial Statements.
110 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Special Purpose Service Entity Notes to and forming part of the Financial Statements for the Year Ended 30 June 2007
1. SUMMARY OF SIGNIFICANT ACCOUNTING A receivable is measured initially at fair value and POLICIES subsequently at amortised cost using the effective interest rate method, less any allowance for impairment. A short- a) The Greater Southern Area Health Service Special term receivable with no stated interest rate is measured at Purpose Entity the original invoice amount where the effect of discounting The Greater Southern Area Health Service Special Purpose is immaterial. An invoiced receivable is due for settlement Entity “the Entity”, is a Division of the Government Service, within thirty days of invoicing. established pursuant to Part 2 of Schedule 1 to the Public If there is objective evidence at year end that a receivable Sector Employment and Management Act 2002 and may not be collectable, its carrying amount is reduced by amendment of the Health Services Act 1997. It is a not- means of an allowance for impairment and the resulting for-profit entity as profit is not its principal objective. It is loss is recognised in the income statement. Receivables consolidated as part of the NSW Total State Sector Accounts. are monitored during the year and bad debts are written It is domiciled in Australia and its principal office is at 34 off against the allowance when they are determined to be Lowe St, Queanbeyan, New South Wales. irrecoverable. Any other loss or gain arising when a receivable The Entity’s objective is to provide personnel services to the is derecognised is also recognised in the income statement. Greater Southern Area Health Service. f) Payables The Entity commenced operations on 17 March 2006 when Payables include accrued wages, salaries, and related on it assumed responsibility for the employees and employee- costs (such as payroll deduction liability, payroll tax, fringe related liabilities of the Greater Southern Area Health Service. benefits tax and workers’ compensation insurance) where The assumed liabilities were recognised on 17 March 2006 there is certainty as to the amount and timing of settlement. with an offsetting receivable representing the related funding A payable is recognised when a present obligation arises due from the former employer. under a contract or otherwise. It is derecognised when the The financial report was authorised for issue by the Chief obligation expires or is discharged, cancelled or substituted. Executive Officer on 19 November 2007. The report will not A short-term payable with no stated interest rate is measured be amended and reissued as it has been audited. at historical cost if the effect of discounting is immaterial. b) Basis of preparation g) Employee benefit provisions and expenses This is a general purpose financial report prepared in i) Salaries and Wages, current Annual Leave, Sick accordance with the requirements of Australian Accounting Leave and On-Costs (including non-monetary Standards, the requirements of the Health Services Act 1997 benefits) and its regulations including observation of the Accounts and Audit Determination for Area Health Services and Public Liabilities for salaries and wages (including non- Hospitals. monetary benefits), annual leave and paid sick leave that fall wholly within 12 months of the reporting Generally, the historical cost basis of accounting has been date are recognised and measured in respect of adopted and the financial report does not take into account employees’ services up to the reporting date at changing money values or current valuations. undiscounted amounts based on the amounts The accrual basis of accounting has been adopted in the expected to be paid when the liabilities are settled. preparation of the financial report, except for cash flow All Annual Leave employee benefits are reported information. as “Current” as there is an unconditional right to Management’s judgements, key assumptions and estimates payment. Current liabilities are then further classified are disclosed in the relevant notes to the financial report. as “Short Term” and “Long Term” based on past trends and known resignations and retirements. All amounts are rounded to the nearest one thousand dollars Anticipated payments to be made in the next 12 and are expressed in Australian currency. months are reported as “Short Term”. c) Comparative Information Unused non-vesting sick leave does not give rise to Comparative information reflects the creation of the Special a liability, as it is not considered probable that sick Purpose Services Entity with effect from 17 March 2006 and leave taken in the future will be greater than the covers the period 17 March 2006 to 30 June 2006. benefits accrued in the future. d) Income The outstanding amounts of payroll tax, workers’ compensation insurance premiums and fringe Income is measured at the fair value of the consideration benefits tax, which are consequential to employment, received or receivable. Revenue from the rendering of are recognised as liabilities and expenses where the personnel services is recognised when the service is provided employee benefits to which they relate have been and only to the extent that the associated recoverable recognised. expenses are recognised. ii) Long Service Leave and Superannuation Benefits e) Receivables Long Service Leave employee leave entitlements are A receivable is recognised when it is probable that the future dissected as “Current” if there is an unconditional cash inflows associated with it will be realised and it has a right to payment and “Non-Current” if the entitlements value that can be measured reliably. It is derecognised when are conditional. Current entitlements are further the contractual or other rights to future cash flows from it dissected between “Short Term” and “Long Term” expire or are transferred. on the basis of anticipated payments for the next 12 months. This in turn is based on past trends and known resignations and retirements. BETTER HEALTH FOR RURAL AUSTRALIA 111 Greater Southern Area Health Service Special Purpose Service Entity Notes to and forming part of the Financial Statements for the Year Ended 30 June 2007
Long Service Leave provisions are measured on a Terms and conditions - Accounts are generally issued on 30 short hand basis at an escalated rate of 8.1% for short day terms. term entitlements and 8.1% for long term entitlements Payables above the salary rates immediately payable at 30 June 2007 for all employees with five or more years Accounting Policies - These amounts represent liabilities of service. Actuarial assessment has found that for goods and services provided to the Health Service and this measurement technique produces results not other amounts, including interest. Payables are recognised materially different from the estimate determined by initially at fair value, usually based on the transaction cost or using the present value basis of measurement. face value. Subsequent meausrement is at amortised cost using the effective interest method. Short term payables The Entity’s liability for the closed superannuation pool with no stated interest rate are measured at the original schemes (State Authorities Superannuation Scheme invoice amount where the effect of discounting is immaterial. and State Superannuation Scheme) is assumed by Payables are recognised for amounts to be paid in the future the Crown Entity. The Entity accounts for the liability for goods and services received, whether or not billed to the as having been extinguished resulting in the amount Health Service. assumed being shown as part of the non-monetary revenue item described as “Acceptance by the Crown Terms and Conditions - Trade liabilities are settled within Entity of Employee benefits”. Any liability attached to terms specified. If no terms are specified, payment is made Superannuation Guarantee Charge cover is reported at the end of the month following the month in which the in Note 3, “Payables”. invoice is received.
The superannuation expense for the financial year is determined by using the formulae specified in the NSW Health Department Directions. The expense for certain superannuation schemes (i.e. Basic Benefit and Superannuation Guarantee Charge) is calculated as a percentage of the employees’ salary. For other superannuation schemes (i.e. State Superannuation Scheme and State Authorities Superannuation Scheme), the expense is calculated as a multiple of the employees’ superannuation contributions. Consequential to the legislative changes of 17 March 2006 no salary costs or provisions are recognised by the Health Service beyond that date. h) Financial Instruments Financial instruments given rise to positions that are a financial asset of either the Entity or its counter party and a financial liability (or equity instrument) of the other party. For the Entity, these include cash at bank, receivables, other financial assets, payables and borrowings. In accordance with Australian Accounting Standard AASB 139, “Financial Instruments: Recognition and Measurements” disclosure of the carrying amounts for each of AASB 139 categories of financial instruments is disclosed in Note 5. The specific accounting policy in respect of each class of such financial instrument is stated hereunder. Classes of instruments recorded and their terms and conditions measured in accordance with AASB 139 are as follows: Receivables Accounting Policies - Receivables are recognised at initially fair value, usually based on the transaction cost or face value. Subsequent measures are at amortised cost using the effective interest method, less an allowance for any impairment of receivables. Short term receivables with no stated interest are measured at the original invoice amount where the effect of discounting is immaterial. An allowance for impairment of receivables is established when there is objective evidence that the entity will not be able to collect all amounts due. The amount of the allowance is the difference between the asset’s carrying amount and the present value of estimated future cash flows, discounted at the effective interest rate. Bad debts are written off as incurred.
112 GSAHS ANNUAL REPORT 2006 - 2007 Greater Southern Area Health Service Special Purpose Service Entity Notes to and forming part of the Financial Statements for the Year Ended 30 June 2007
2007 2006 $000 $000 2. RECEIVABLES Current Accrued Income - Personnel Services Provided 116,413 104,441
Non-Current Accrued Income - Personnel Services Provided 1,466 2,577
Total Receivables 117,879 107,018
3. PAYABLES Current Accrued Salaries and Wages on-costs 11,531 10,080
Total Payables 11,531 10,080
4. PROVISIONS Current Employee benefits and related on-costs Employee Annual Leave - Short Term Benefit 28,507 25,980 Employee Annual Leave - Long Term Benefit 15,205 13,159 Employee Long Service Leave - Short Term Benefit 4,699 5,093 Employee Long Service Leave - Long Term Benefit 56,471 50,129
Total Current Provisions 104,882 94,361
Non-Current Employee benefits and related on-costs Employee Long Service Leave - Conditional 1,466 2,577
Total Non-Current Provisions 1,466 2,577
Aggregate Employee Benefits and Related on-costs Provision - Current 104,882 94,361 Provision - Non-Current 1,466 2,577 Accrued Salaries and Wages on-costs 11,531 10,080
Total 117,879 107,018
BETTER HEALTH FOR RURAL AUSTRALIA 113 Greater Southern Area Health Service Special Purpose Service Entity Notes to and forming part of the Financial Statements for the Year Ended 30 June 2007
5. FINANCIAL INSTRUMENTS a) Interest Rate Risk Interest rate risk is the risk that the value of the financial instrument will fluctuate due to changes in market interest rates. The Entity’s exposure to interest rate risks and the effective interest rates of financial assets and liabilities, both recognised and unrecognised, at the Balance Sheet date are as follows:
Financial Instruments Non-Interest Total carrying Bearing amount as per the Balance Sheet
2007 2006 2007 2006 $000 $000 $000 $000 Financial Assets
Receivables 117,879 101,326 117,879 101,326
Total Financial Assets 117,879 101,326 117,879 101,326
Financial Liabilities
Payables 11,531 10,080 11,531 10,080
Total Financial Liabilities 11,531 10,080 11,531 10,080
b) Credit Risk Credit risk is the risk of financial loss arising from another party to a contract, or financial position, failing to discharge a financial obligation thereunder. The Entity’s maximum exposure to credit risk is represented by the carrying amounts of the financial assets included in the Balance Sheet.
Credit Risk by Governments Other Total classification 2007 2006 2007 2006 2007 2006 of counterparty
Financial Assets
Receivables 117,879 101,326 0 0 117,879 101,326
Total Financial Assets 117,879 101,326 0 0 117,879 101,326
c) Net Fair Value Financial Instruments are carried at cost. The resultant values are reported in the Balance Sheet and are deemed to constitute net fair value.
d) Derivative Financial Instruments The Entity holds no Derivative Financial Instruments.
End of Audited Financial Statements
114 GSAHS ANNUAL REPORT 2006 - 2007 Appendices
Health Services Coolamon Ganmain Health Griffith Base Hospital Noorebar Ave Albury Base Hospital Service Buchanan Dr Griffith Borella Rd Coolamon Telephone: 02 6969 5555 Albury Telephone: 02 6927 3303 Fax: 02 6969 5507 Telephone: 02 6058 4444 Fax: 02 6927 3565 Fax: 02 6058 4504 Gundagai District Hospital O’Hagan St Albury Mercy Hospital Cooma Hospital 2a Bent St Gundagai Poole St Cooma Telephone: 02 6944 1022 Albury Telephone: 02 6455 3222 Fax: 02 6944 1630 Telephone: 02 6042 1400 Fax: 02 6452 2117 Fax: 02 6021 4378 Hay Hospital and Health Service Murray St Barham Koondrook Soldiers Cootamundra Hospital MacKay St Hay Memorial Cootamundra Telephone: 02 6990 8700 Punt Rd Telephone: 02 6942 0444 Fax: 02 6990 8771 Barham Fax: 02 6942 0433 Telephone: 03 5453 2026 Henty District Hospital Fax: 03 5453 2656 Corowa Hospital 7 Keighran St Guy St Henty Batemans Bay District Hospital Corowa Telephone: 02 6929 4999 Pacific St Telephone: 02 6033 1333 Fax: 02 6929 4940 Batemans Bay Fax: 02 6033 3646 Telephone: 02 4472 4504 Hillston District Hospital Fax: 02 4472 0678 Crookwell Hospital Burns St Kialla Rd Hillston Batlow District Hospital Crookwell Telephone: 02 6967 2502 Cnr Park St and Wakehurst Ave Telephone: 02 4832 1300 Fax: 02 6967 2284 Batlow Fax: 02 4832 2099 Telephone: 02 6949 1105 Holbrook District Hospital Fax: 02 6949 1390 Culcairn Health Service Bowler St Balfour St Holbrook Bega District Hospital Culcairn Telephone: 02 6036 2522 McKee Dr Telephone: 02 6029 8203 Fax: 02 6036 2782 Bega Fax: 02 6029 8762 Telephone: 02 6492 9111 Jerilderie Health Service Fax: 02 6492 3274 Delegate Multi Purpose Service Newel Highway Craigie St Jerilderie Berrigan War Memorial Hospital Delegate Telephone: 03 5886 1300 Anzac Pl Telephone: 02 6458 8008 Fax: 03 5886 1277 Berrigan Fax: 02 6458 8156 Telephone: 03 5885 2208 Junee District Hospital Fax: 03 5885 2505 Deniliquin District Hospital Button St 411 Charlotte St Junee Bombala Hospital Deniliquin Telephone: 02 6924 1122 Wellington St Telephone: 03 5882 2800 Fax: 02 6924 2485 Bombala Fax: 03 5882 2815 Telephone: 02 6458 3166 Leeton District Hospital Fax: 02 6458 3759 Finley Hospital Palm and Wade Ave Dawe Ave Leeton Boorowa Hospital Finley Telephone: 02 6953 1111 Dry St Telephone: 03 5883 1133 Fax: 02 6953 1113 Boorowa Fax: 03 5883 1457 Telephone: 02 6385 3004 Lockhart Hospital Fax: 02 6385 3206 Goulburn Hospital Hebden St 130 Goldsmith St Lockhart Bourke Street Health Service Goulburn Telephone: 02 6920 5206 234 Bourke St Telephone: 02 4827 3111 Fax: 02 6920 5483 Goulburn Fax: 02 4827 3248 Telephone: 02 4823 7800 Mercy Care Centre Fax: 02 4821 9659 Kenmore Hospital Campbell St Taralga Rd Young Braidwood Hospital Goulburn Telephone: 02 6382 1111 73 Monkittee St Telephone: 02 4827 3301 Fax: 02 6382 8400 Braidwood Fax: 02 4827 3315 Telephone: 02 4842 2566 Fax: 02 4842 2054
BETTER HEALTH FOR RURAL AUSTRALIA 115 Moruya District Hospital Yass District Hospital Berrigan Community Health River St Meehan St Centre Moruya Yass Memorial Pl Telephone: 02 4474 2666 Telephone: 02 6226 1333 Berrigan Fax: 02 4474 1586 Fax: 02 6226 2944 Telephone: 03 5885 2208 Murrumburrah-Harden Hospital Young District Hospital Fax: 03 5885 2505 Swift St Allanan St Bombala Community Health Murrumburrah-Harden Young Centre Telephone: 02 6386 2200 Telephone: 02 6382 1222 Wellington St Fax: 02 6386 2931 Fax: 02 6382 4398 Bombala Narrandera District Hospital Telephone: 02 6458 3166 Cnr Douglas and Adams Sts Community Health Fax: 02 6458 3759 Narranderra Adelong Community Health Boorowa Community Health Telephone: 02 6959 1166 Centre Centre Fax: 02 6959 1063 Tumut St Dry St Pambula District Hospital Adelong Boorowa Merimbula St Telephone: 02 6946 2055 Telephone: 02 6385 3450 Pambula Fax: 02 6946 2041 Fax: 02 6385 3206 Telephone: 02 6495 6002 Albury Community Health Centre Braidwood Community Health Fax: 02 6495 6570 596 Smollett St Centre Queanbeyan District Hospital Albury 74 Monkittee St Cnr Collette and Erin Sts Telephone: 02 6058 1800 Braidwood Queanbeyan Fax: 02 6058 1801 Telephone: 02 4842 2566 Telephone: 02 6298 9211 Ardlethan Community Health Fax: 02 4842 2054 Fax: 02 6299 1536 Centre Coleambally Community Health Temora and District Hospital Redmond St Centre Loftus St Ardlethan 33 Brolga Pl Temora Telephone: 02 6978 2066 Coleambally Telephone: 02 6977 1066 Fax: 02 6977 1545 Telephone: 02 6954 4297 Fax: 02 6977 1545 Barellan Community Health Fax: 02 6954 4420 Tocumwal Hospital Centre Coolamon Community Health Adams St Bendee St Centre Tocumwal Barellan Buchanan Dr Telephone: 03 5874 2166 Telephone: 02 6963 9266 Coolamon Fax: 03 5874 2321 Fax: 02 6963 9556 Telephone: 02 6927 3303 Fax: 02 6927 3565 Tumbarumba Health Service Barham Community Health Centre Albury St Gonn St Cooma Community Health Centre Tumbarumba Barham Cnr Victoria and Bombala Sts Telephone: 02 6948 9600 Telephone: 03 5453 3299 Cooma Fax: 02 6948 2263 Fax: 03 5453 2656 Telephone: 02 6455 3201 Fax: 02 6455 3360 Tumut District Hospital Barmedman Community Health Simpson St Centre Cootamundra Community Health Tumut Robertson St Centre Telephone: 02 6947 1555 Barmedman 37 Hurley St Fax: 02 6947 3074 Telephone: 02 6976 2183 Cootamundra Fax: 02 6972 2802 Urana Health Service Telephone: 02 6940 1111 Princess St Batemans Bay Community Health Fax: 02 6940 1199 Urana Centre Corowa Community Health Centre Telephone: 02 6920 8106 Pacific Street Guy St Fax: 02 6920 8263 Batemans Bay Corowa Telephone: 02 4472 4544 Wagga Wagga Base Hospital Telephone: 02 6033 1340 Fax: 02 4472 0680 Edward St Fax: 02 6033 4397 Wagga Wagga Batlow Community Health Centre Crookwell Community Health Telephone: 02 6938 6666 Wakehurst Ave Centre Fax: 02 6921 5632 Batlow Kialla Rd Telephone: 02 6949 1105 West Wyalong Hospital Crookwell Fax: 03 6949 1390 Hospital Rd Telephone: 02 4832 1300 West Wyalong Bega Community Health Centre Fax: 02 4832 2099 Telephone: 02 6979 0000 McKee Dr Culcairn Community Health Fax: 02 6979 0006 Bega Centre Telephone: 02 6492 9620 Balfour St Fax: 02 6492 3257 Culcairn Telephone: 02 6029 8917 Fax: 02 6029 7018
116 GSAHS ANNUAL REPORT 2006 - 2007 Darlington Point Community Holbrook Community Health Murrumburrah-Harden Health Centre Centre Community Health Centre Boyd St Bowler St Swift St Darlington Point Holbrook Murrumburrah-Harden Telephone: 02 6968 4131 Telephone: 02 6036 2787 Telephone: 02 6386 2200 Fax: 02 6968 4131 Fax: 02 6036 2782 Fax: 02 6386 2931 Delegate Community Health Jerilderie Community Health Narooma Community Health Centre Centre Centre Craigie St 62 Southey St Marine Drive Delegate Jerilderie Narooma Telephone: 02 6458 8008 Telephone: 03 5886 1300 Telephone: 02 4476 2344 Fax: 02 6458 8156 Fax: 03 5886 1277 Fax: 02 4476 1731 Deniliquin Community Health Jindabyne Community Health Narranderra Community Health Centre Centre Centre 2 Macauley St Bent St Cnr Douglas and Adams Sts Deniliquin Jindabyne Narranderra Telephone: 03 5882 2900 Telephone: 02 6457 2074 Telephone: 02 6959 1166 Fax: 03 5882 2905 Fax: 02 6457 2158 Fax: 02 6959 1063 Eden Community Health Centre Junee Community Health Centre Pambula Community Health 144 Imlay St 77 Lorne St Centre Eden Junee Merimbula St Telephone: 02 6496 1436 Telephone: 02 6924 1791 Pambula Fax: 02 6496 1452 Fax: 02 6924 2839 Telephone: 02 6945 7294 Finley Community Health Centre Karabar Community Health Centre Fax: 02 6495 7448 Dawe Ave 12 Southbar Rd Queanbeyan Community Health Finley Queanbeyan Centre Telephone: 03 5883 3627 Telephone: 02 6299 7299 Antill St Fax: 03 5883 1527 Fax: 02 6299 7601 Queanbeyan Goulburn Community Health Leeton Community Health Centre Telephone: 02 6298 9233 Centre Palm and Wade Ave Fax: 02 6299 6920 Cnr Goldsmith and Faithful Sts Leeton Talbingo Community Health Goulburn Telephone: 02 6953 1205 Centre Telephone: 02 4827 3913 Fax: 02 6953 1214 Talbingo Medical Centre Fax: 02 4827 3943 Lockhart Community Health Talbingo Griffith Community Health Centre Centre Telephone: 02 6949 5467 Yambil St Hebden St Fax: n/a Griffith LockHart Tarcutta Community Health Telephone: 02 6966 9900 Telephone: 02 6920 5206 Centre Fax: 02 6964 1743 Fax: 02 6920 5483 Oberne Rd Gundagai Community Health Mathoura Community Health Tarcutta Centre Centre Telephone: 02 6928 7258 O’Hagan St Livingstone St Fax: 02 6928 7385 Gundagai Mathoura Temora Community Health Centre Telephone: 02 6944 1297 Telephone: 03 5884 3301 294-296 Hoskins St Fax: 02 6944 1878 Fax: 03 5884 3604 Temora Hay Community Health Centre Moama Community Health Centre Telephone: 02 6977 4951 351 Murray St 6 Meninya St Fax: 02 6977 4960 Hay Moama The Rock Community Health Telephone: 02 6990 8732 Telephone: 02 5482 4399 Centre Fax: 02 6990 8767 Fax: 02 5480 2707 King St Henty Community Health Centre Moruya Community Health Centre The Rock Ivor St River St Telephone: 02 6920 2066 Henty Moruya Fax: 02 6920 2502 Telephone: 02 6929 4999 Telephone: 02 4474 1561 Tocumwal Community Health Fax: 02 6929 4940 Fax: 02 4474 1591 Centre Hillston Community Health Centre Moulamein Community Health Adams St 48C Burns St Centre Tocumwal Hillston 54 Barratta St Telephone: 02 5874 2166 Telephone: 02 6967 2201 Moulamein Fax: 03 5874 2321 Fax: 02 69672284 Telephone: 03 5887 5012 Tooleybuc and Early Childhood Fax: 03 5887 5037 Flat 2/34 Murray St Tooleybuc Telephone: 03 5030 5189 Fax: 03 5030 5251
BETTER HEALTH FOR RURAL AUSTRALIA 117 Tumbarumba Community Health Mandala House Domestic Violence Line Centre Bourke Street 1800 656 463 Goulburn NSW 2850 Albury Rd The Domestic Violence Line provides Telephone: 02 4824 1830 Tumbarumba telephone counselling, information Fax: 02 4824 1831 Telephone: 02 6948 2566 and referrals for people who are Fax: 02 6948 2263 375 Townsend Street experiencing or have experienced Tumut Community Health Centre Albury NSW 2640 domestic violence. Telephone: 02 6058 1700 Simpson St NSW Artificial Limb Service Fax: 02 6058 1737 Tumut Accredited Clinic Telephone: 02 6947 1811 Level 2 Fax: 02 6947 2220 75 Johnson Street Rehabilitation Department Wagga Wagga NSW 2650 PO Box 159 Ungarie Community Health Centre Wagga Wagga NSW 2650 Condamine St Telephone: 02 6933 9100 Fax: 02 6933 9188 Telephone: 02 6938 6344 Ungarie Fax: 02 6040 1359 Telephone: 02 6975 9102 Southern Area Brain Injury Fax: 02 6972 0401 Service Urana Community Health Centre ‘Carrawarra’ Princess St 104 Bradley Street Urana GOULBURN NSW 2580 Telephone: 02 6920 8101 Telephone: 02 4823 7911 Fax: 02 6920 8263 Fax: 02 4821 9165 Wagga Wagga Community Health South West Brain Injury Centre Rehabilitation Service Docker St PO Box 326 Wagga Wagga Albury NSW 2640 Telephone: 02 6938 6411 Australia Fax: 02 6938 6410 Telephone: 02 6041 9902 Fax: 02 6041 9928 Weethalle Community Health Email: [email protected] Centre Bulga St 1800 Numbers Weethalle Telephone: 02 6975 6120 Mental Health and Alcohol and Drug Fax: 02 6972 0401 Services GSAHS provides a telephone based West Wyalong Community Health risk assessment, triage, consultation, Centre support and information service. Hospital Rd West Wyalong This service is provided through: Telephone: 02 6972 2122 Accessline Fax: 02 6972 0401 1800 800 944 Yass Community Health Centre Accessline is available 24 hours a day, Meehan St seven days a week, 365 days a year. Yass Telephone: 02 6226 3833 Accessline is the first contact point to Fax: 02 6226 2485 access Mental Health and Drug and Alcohol Services of GSAHS. Young Community Health Centre Accessline is staffed by trained mental Allanan St health professionals. Accessline works Young with ‘on-the-ground’ services and has Telephone: 02 6382 8700 regular contact with case managers to Fax: 02 6382 1047 support clients and contribute to care planning. Other Services Public Oral Health Clinics Public Health 641 Olive Street GSAHS: 1800 450 046 Albury NSW 2640 Griffith: 02 6969 5581 Telephone: 02 6021 4799 (24 hours) Deniliquin: 03 5882 2990 Fax: 02 6021 4899 All clients needing to access Oral Other Offices Health Services in GSAHS should contact the relevant number. 34 Lowe Street Queanbeyan NSW 2620 Telephone: 02 6128 9777 Fax: 02 6299 6363
118 GSAHS ANNUAL REPORT 2006 - 2007 Glossary
A Community Participation: A range of activities and structures providing opportunities for individuals and organisations that ACAT (Aged Care Assessment Team): A range of health are part of a community to identify issues/needs, comment professionals providing assessment, treatment, ongoing on policies and programs (proposed and existing) and management and other services designed to meet the needs participate in the decision making process. of elderly people. They are also responsible for assessing and approving placement into nursing home and hostels. Continuum of care: The relationships between services so that there is an easy transition for patients either moving Australian Council on Healthcare Standards (ACHS): from one service to another or receiving care from a number promotes a series of health care standards that enable of services. hospitals and health care services to measure their performance. D Acute Care: The principal clinical intent is to do one or more Day Care: A service that provides personal care and or the following: manage labour (obstetric), cure illness supervision for a person for all or part of a day. This may or provide definitive treatment of injury; perform surgery; occur on a regular or respite basis. A range of activities with a relieve symptoms or illness or injury (excluding palliative rehabilitation focus, to prevent deterioration and retain social care); reduce severity of an illness or injury: protect against skills, for the frail aged and/or disabled. exacerbation and/or complication of an illness and/or injury which could threaten life or normal function; perform Dementia: An organic mental disorder characterised by a diagnostic or therapeutic procedures. general loss of intellectual abilities involving impairment of memory, judgment and abstract thinking as well as changes Aged: The aged population is defined as the group of people in personality. aged 65 and older. There are also younger groups of people with aged related needs e.g. dementia and disabilities, for Dietetics: The study and regulation of the diet. whom it is appropriate to access age care services. Domiciliary Care: A service dedicated to the provision of Allied Health Staff: Include qualified staff engaged in duties nursing or other professional paramedical care or treatment of a professional nature; audiologist, chiropractor and and also non-qualified domestic assistance to people in their osteopath, dietician, occupational therapist, optometrist, own homes. orthopaedist, orthodontist, podiatrist, psychologies, prosthetist, physiotherapist, radiographer, social worker and E counsellor and speech therapist. ED: Emergency departments are often recognised by the Ambulatory Care: Describes health care services delivered community as the main entry point into the hospital system. to patients on a “day stay” basis, as an alternative to the The emergency department operates as the interface patient being an inpatient. between the hospital and the community. Despite location, size or specialty of the hospital all emergency departments Antenatal: The period between conception and birth. Same provide a minimum standard of care. as ‘prenatal’. EN: Enrolled Nurse Audiology: The study of hearing. Emergency Services: Treatment provided on an un-planned Audiometry: The measurement of hearing. basis or in a designated emergency department within a hospital. It is generally expected that the treatment is of a B surgical or medical nature.
C F Community: The people who live in a defined geographical locality. G Community Based Services: Services provided in the Geriatrician: A specialist in the branch of medicine concerned community. with the physiological and pathological aspects of the aged, including the clinical problems of being old and senility. Community Consultation: Consultation is regarded as a form of community participation where views and opinions are GP: General Practitioner sought on specific issues. Consultation processes are usually one-off or short-term and are organised around a specific H issue or topic. HACC: Home and Community Care Community Development: The process of involving Health: A state of complete physical, mental, spiritual and people in initiatives to improve their health by supporting social well-being, not merely the absence of disease or community actions to identify and overcome a community’s infirmity. health problems e.g. Self help groups, support networks, improvements in transport, access to services. Health promotion: Health promotion is the process of enabling individuals and communities to increase control Community Health: A service that provides coordinated over the determinants of health and thereby improve their community based health services to a defined community. Its health. It covers a number of approaches aimed at changing size and service mix varies. Service components may include living conditions and lifestyles for the purpose of improving physiotherapy, mental health, screening of school children, health, including health education. child health, counselling, drug and alcohol services etc.
BETTER HEALTH FOR RURAL AUSTRALIA 119 Home and Community Care (HACC) program: For the Outpatient Clinic: Medical, surgical, diagnostic, nursing or frail aged, people with disabilities, and their carers. HACC paramedical services are provided to non-residents from a services include community nursing, allied health services, clinic on an appointment basis. personal care, meals on wheels and day-centre meals, home help, home modification and maintenance, transport and P community based respite care. Paediatrician: A medical doctor who treats children and Home Nursing: Defined as any nursing service provided to a infants. client in their own home. Palliative Care: Palliative care is provided when a person’s Hostel Care: Refers to residents in residential accommodation condition has progressed beyond the state where curative who do not require personal care support. treatment is effective and attainable, or where the person chooses not to pursue curative treatment. Palliation provides Hostels: Provide residential care for people requiring some relief of suffering and enhancement of quality of life. An form of assistance with daily living. Most do not provide approach to care which supports the physical, psychological, nursing care. Staff are available on a 24-hour call basis and emotional, cultural and spiritual needs of a dying person and can assist with personal care tasks. Usually Commonwealth their family and friends, and includes grief and bereavement funded for low-level care. support during the life of the patient and continuing after I death. PANOC: Physical (and emotional) Abuse and Neglect Of Integrated Care: Seamless health care, where all aspects Children. PANOC workers provide a service aimed at assisting of care are linked and managed in a coordinated manner, to children to cope with their experiences and the effects of provide more effective and efficient health service provision. abuse and neglect. PANOC workers also assist families Intrapartum: During labour and delivery or childbirth. where abuse of children has occurred to provide a more nurturing environment for children to minimise the chances J of re-abuse. PANOC services take referrals of substantiated child physical and emotional abuse and neglect from the K department of Community Services and the police. The PANOC services see children and young people aged up to L 18 years. LAN: Local Area Network Physiotherapy: A physical therapist is a specialist trained to LGA(s): Local Government Area(s) use exercise and physical activities to condition muscles and improve levels of activity. Physical therapy is helpful in those M with physical debilitating illness (for example stroke). Meals on Wheels: Meals fresh or frozen are delivered to a Podiatrist: A podiatrist is trained to care for feet and person’s residence. recognise mechanical faults. (Podiatrists used to be called chiropodists.) Multi Purpose Service (MPS): Provide integrated acute, nursing home, hostel, community health and aged care Podiatry: The medical study of the diagnosis and treatment services under one organisational structure, as agreed of disorders of the foot. between the Commonwealth and State governments. MPSs Postnatal: Occurring after birth, with reference to the provide a range of services that are negotiated with the newborn. community. Primary Health Care: The components of the health system N which places an emphasis on health promotion and disease prevention as well as addressing illness/disability at an early Neurology: The branch of science that treats disorders of the stage. Also refers to an approach to health care that looks nervous system. at the whole individuals in the whole community to ensure NSW Health: The NSW Health system is made up of Area social justice is achieved. Health Services both rural and metropolitan, the NSW Psychology: The science of the human soul; specifically, Department of Health, Corrections Health Service, the the systematic or scientific knowledge of the powers and Ambulance Service of NSW and the Children’s Hospital. functions of the human soul, so far as they are known by Nursing Care: Type of service provided to a person who consciousness. needs the assistance of qualified personnel with such things as the taking of medication and administration of an Q injection. R Nursing Homes: Provide accommodation for frail, older people who need ongoing nursing and help with personal Radiology: The study of X-rays in the diagnosis of a disease. care. Rehabilitation: Establishments with a primary role in providing services to persons with an impairment, disability O or handicap where the primary goal is improvement in Occupational Therapy: A form of therapy that encourages functional status. and instructs manual activities for therapeutic or remedial Renal Services: Services pertaining to care of patients with purposes in mental and physical disorders. kidney disorders. Oncology: The study of diseases that cause cancer. Respite Care: Provides relief for carers who have the Orthopaedic: Pertaining to the correction of deformities responsibility for ongoing care, attention and support of of the musculoskeletal system; all the muscles, bones, another person. It provides an alternative form of care and and cartilages of the body collectively pertaining to enables the carer to have a break. orthopaedics.
120 GSAHS ANNUAL REPORT 2006 - 2007 Root Cause Analysis: This is an investigative process used to review sentinel or major clinical events to determine the causes. This differs to previous investigative processes in that it seeks to determine system issues that may have led to the problem. Recommendations aim to rectify systemic issues, making the environment safer for patients, visitors and staff and reducing the likelihood of the event occurring again.
S SAFTE: Sub-Acute Fast Track Elderly Care aims to minimise the need for older people to be admitted to hospital. Social Support Services: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. Speech Pathology: The science concerned with functional and organic speech defects and disorders.
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U UPI: Unique Patient Identifier
V VMO: Visiting Medical Officer
W WinPAS: Windows Patient Administration System
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BETTER HEALTH FOR RURAL AUSTRALIA 121 GREATER SOUTHERN AREA HEALTH SERVICE ANNUAL REPORT 2006 - 2007
BETTER HEALTH FOR RURAL AUSTRALIA