Millicent 10 Year Local Health Service Plan

2011 – 2020

Millicent Health Advisory Council Millicent and District Hospital and Health Services Country Health SA Local Health Network

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10 Year Local Health Service Plan

Millicent and District Hospital and Health Services

2011 - 2020

Table of Contents

1. Executive Summary ...... 3 2. Catchment summary...... 5 3. Needs Analysis Summary ...... 7 4. Local implications of Statewide Plans...... 9 5. Planning Principles...... 10 6. Service Delivery Plan...... 11 6.1 Core Services to be maintained and enhanced ...... 11 6.2 Strategies for new / expanded services ...... 17 7. Key Requirements for Supporting Services...... 25 7.1 Safety & Quality ...... 25 7.2 Patient Journey ...... 26 7.3 Cultural Respect...... 27 7.4 Engaging with our community ...... 28 7.5 Local Clinical Networks ...... 28 8. Resources Strategy ...... 29 8.1 Workforce...... 29 8.2 Infrastructure...... 30 8.3 Finance ...... 30 8.4 Information Technology...... 31 8.5 Risk Analysis...... 31 9. Appendix ...... 32 9.1 Leadership Structure...... 32 9.2 Methodology...... 32 9.3 Review Process ...... 32 9.4 Glossary...... 32

Date: 20 June 2011

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1. Executive Summary

The Millicent Health Advisory Council and the Millicent and District Hospital and Health Services with the support of the Country Health SA Planning Projects Team, have worked closely in the development of the 10 Year Health Service Plan including implementation of the community consultation and oversight of the planning process.

The Millicent and District Hospital and Health Services is a part of the Lower South East Health Cluster and the District Hospital for the Wattle Range District West Council area. It provides a service to the local government areas of Millicent, Kingston, Beachport, Kingston and Robe and shares the health service responsibilities for the local government areas of Robe with the Kingston Soldiers’ Memorial Hospital.

Millicent is located in the centre of the Lower South East of the state, 50 kilometres north west of Mount Gambier, 109 kilometres from Kingston on the Princess Highway, and 426 kilometres from Adelaide. The service area covers 2,329 square kilometres.

The estimated resident population for the Millicent catchment is 9,206 (DPLG, ERP, 2011). People from Aboriginal and Torres Strait Islander backgrounds comprise 1.3% of the Millicent catchment compared with 3.1% of the total country South Australian population. Approximately 2.4% of the population in the catchment speak a language other than English at home, compared with 3.9% of the total country South Australian population.

The population structure for the Millicent catchment is relatively consistent when compared with the structure for country South Australia, with a slightly lower proportion of the population in the 15-24 year age group in Millicent. The projected population for the broader South East Statistical Division (encompassing Millicent) is estimated to increase by approximately 9% by the year 2021. The broader Limestone Coast region attracts an average of 589,000 overnight visitors and 1,758,000 domestic same day visitors per annum. The catchment reflects a moderate level of socioeconomic disadvantage.

Between July to December 2009 the Millicent Health Advisory Council undertook a community consultation process seeking feedback on the health service needs of the local population. Between February and April 2010, the Millicent Hospital Executive team, in partnership with Health Advisory Council members, undertook a needs analysis process to capture the strengths, weaknesses, opportunities and threats (SWOT) of existing services and future directions. The needs analysis has drawn on information obtained through the consultation process and analysis of the Health Service Profile and other relevant data. The needs analysis process identified the following issues: • To assist in the recruitment and retention of general practitioners in Millicent. • The major role for the Millicent Hospital continues to be in low risk acute care, birthing and aged care. • Stronger partnerships with other health units in the region, including the Mount Gambier Country General Hospital, will be critical for effective delivery of services over the next 10 years. • Ageing population. • Waiting lists for respite care and aged care beds. • Need for greater access to primary health care services. • Young residents travelling to Adelaide for access to medically supported detoxification programs. • Need for some hospital infrastructure upgrades. • Provision for the care of patients with multi-resistant organisms.

The primary focus of the Plan is to sustain and enhance its existing core services. Key directions for future enhancement and development include: • Improved access to resident general practitioners to cover 24 hour/7 day on-call service. • Improved access to emergency services. • Increased day surgery.

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• Introduction of a Lower South East health cluster nurse practitioner aged care consultancy service. • Introduction of ear, nose and throat (ENT) services. • Extended and enhanced general practitioner led palliative care program. • Extended and enhanced general practitioner led mental health observation and detoxification treatment program. • Extended shared maternity care in Millicent. • Extended paediatric clinics and consulting in Millicent. • Extended obstetrics consulting clinics in Millicent. • Improved recruitment and retention of skilled nurses in the hospital.

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2. Catchment summary

Introduction

The township of Millicent is located approximately 400 kilometres south-east of Adelaide and approximately 50 kilometres north of Mount Gambier Country General Hospital.

The Millicent and District Hospital and Health Services is situated within the Wattle Range Council area. The catchment area for the Hospital encompasses the Wattle Range – West Statistical Local Area (SLA) which includes Hatherleigh and Furner to the north, Beachport and Southend to the north- west, Tantanoola to the south, and Glencoe to the south-east (see map below).

Reference: http://www.atlas.sa.gov.au

Population

The estimated resident population for the Millicent catchment is 9,206 (DPLG, ERP 2011). People from Aboriginal and Torres Strait Islander backgrounds comprise 1.3% of the Millicent catchment compared with 3.1% of the total country South Australian population. Approximately 2.4% of the population in the catchment speak a language other than English at home, compared with 3.9% of the total country South Australian population.

The population structure for the Millicent catchment is relatively consistent when compared with the structure for country South Australia, with a slightly lower proportion of the population in the 15-24 year age group in Millicent. The projected population for the broader South East Statistical Division (encompassing Millicent) is estimated to increase by approximately 9% by the year 2021. The fertility rate for the Wattle Range - West SLA is approximately 2.32. This is above replacement level and higher than the South Australian rate (1.82). The indirect standardised death rate for the area is 7.1, higher than the South Australian rate (6.1).

The broader Limestone Coast region (which includes Millicent, Penola, Bordertown, Kingston, Naracoorte and Mount Gambier) had an estimated 589,000 overnight visitors and 1,758,000 day visitors in 2007. Millicent and surrounding districts host a range of tourist events which bring significant numbers of visitors to the area. 5

Table 1: Millicent catchment population

Country LSE Cluster SA total No. % SA Cluster % % % Total Population 9,206 47,042 490,635 1,667,444

Males 4,653 50.5% 23,659 50.3% 50.5% 49.4% Females 4,553 49.5% 23,383 49.7% 49.5% 50.6%

0-14 years 1,899 20.6% 9,401 20.0% 20.4% 18.5% 15-24 years 1,023 11.1% 5,761 12.2% 11.4% 13.3% 25-44 years 2,165 23.5% 12,138 25.8% 25.1% 26.7% 45-64 years 2,581 28.0% 12,557 26.7% 27.3% 26.1% 65-84 years 1,312 14.3% 6,221 13.2% 13.9% 13.4% 85 years and over 226 2.5% 964 2.0% 1.8% 2.0%

ATSI* 117 1.3% 592 1.3% 3.1% 1.7% CALD (Speaks a language 207 2.4% 1,422 3.2% 3.9% 12.2% other than English at home)* Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government *Source: 2006 ABS Census

Socioeconomic factors

The catchment region has been identified as outer regional indicating a moderate level of remoteness when compared with other South Australian locations. The catchment reflects a moderate to high degree of socioeconomic disadvantage.

Based on data which monitors the trends of diseases, health related problems, risk factors and other issues across major regional areas, the South East region demonstrates higher levels of risk factors for overweight, obesity, physical inactivity, and smoking when compared with total South Australia. The prevalence of chronic disease for persons aged 16 years and over in the South East region demonstrates a higher prevalence of diabetes when compared with total South Australia.

The Limestone Coast is one of South Australia's highly productive and diverse agricultural regions with a range of products including vegetables, wine grapes, cereal grain, softwood timber, pastures and livestock. Fishing is also a major contributor to the regional economy and aquaculture an emerging industry. Unique natural attractions such as the World Heritage listed Naracoorte Caves and the Blue Lake at Mount Gambier contribute to an active tourism industry. Manufacturing make up 21% of total employment across the Millicent catchment, followed by agriculture, forestry and fishing (19%) and retail trade (10%). The Lower South East region has not been identified for exceptional circumstances due to the prevailing drought. However the Upper South East has been identified for exceptional circumstances.

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3. Needs Analysis Summary

The Millicent and District Hospital and Health Services in partnership with the local Health Advisory Council, undertook the needs analysis drawing on information from a range of sources including community and stakeholder consultations including sessions with Millicent and District Hospital and Health Services staff, Health Service Profile data and other data sources.

Currently, the major role for the Millicent and District Hospital and Health Services is the delivery of low risk acute care and aged care services. Information gathered through the needs analysis process supports the continuation of these roles. Activity projections to 2016-17 indicates that there will be a slight increase in demand for acute care services at the Hospital, especially in the area of same-day patients. Millicent and District Hospital and Health Services has 35 public acute multi-use beds and 57 Commonwealth funded aged care beds (covering 34 high care and 23 low care beds).

The needs analysis process confirmed that stronger partnerships with other health units, in particular the Mount Gambier Health Service and South East Regional Community Health Services (SERCHS) will be critical to support effective and efficient delivery of services over the next ten years.

Millicent and District Hospital and Health Services is ideally situated to provide support to patients requiring mental health, ENT, public dental, palliative care, respite and dementia specific assessment unit services.

The outcomes of the needs analysis process supports the provision of services by the Millicent and District Hospital and Health Services in the following key areas:

• Elective Surgery (extended program) Millicent Hospital has the capacity to conduct more day surgery, interconnected with planning for the Country General Hospital in Mount Gambier.

• Ear, Nose and Throat (ENT) (new service) There is an opportunity to provide an ENT consulting and surgical service.

• Aged Care (extended program) There is an opportunity to establish a nurse practitioner position providing a consultancy aged care service across the Lower South East health cluster.

• Maternity Care (extended program) There is an opportunity to form a partnership with Millicent general practitioners, specialist obstetricians and hospital staff to provide midwifery shared care in Millicent. There is an opportunity to continue to strengthen access to an obstetrician and to extend Mount Gambier paediatric clinics and consulting to cover Millicent on a regular basis.

• Paediatric Services (extended service) There is an opportunity to extend Mount Gambier paediatric unit consulting clinics to cover Millicent.

• Palliative Care (extended and enhanced program) The Millicent and District Hospital and Health Services currently supports patients with palliative care needs. There is an opportunity to become a part of the Lower South East palliative care team network and to provide low risk (level 2) care and treatment, inpatient, community based day program and respite for residents living in the Wattle Range West Council service areas. This would involve a general practitioner and registered nurse model with the Lower South East palliative care coordinator advising and supporting the program.

• Mental Health and Detoxification Observation Unit (enhanced and extended program) There is an opportunity to extend and enhance the current general practitioner led Mental Health Observation and Detoxification Program at Millicent and District Hospital and Health Services. 7

The Millicent and District Hospital and Health Services will need to recruit medical and nursing staff with the clinical skills, knowledge and ability to assist in all of the proposed models of care.

It is anticipated that these initiatives will provide Millicent and District Hospital and Health Services with the focus and activity required to address staff recruitment and retention issues, as well as increase activity and services to the local and wider community specifically in the areas of ENT, day surgery, aged care, detoxification program, dementia and palliative care.

Millicent and District Hospital and Health Services has the infrastructure for most of the proposed models but will require some funding to remodel the acute care wards, to provide a Mental Health Observation and detoxification program and dementia care.

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4. Local implications of Statewide Plans

The Strategy for Planning Country Health Services in South Australia, endorsed in December 2008, builds on the vision in South Australia’s Health Care Plan 2007-2016, South Australia’s Strategic Plan, and the SA Health Aboriginal Cultural Respect Framework and sets out how to achieve an integrated country health care system so that a greater range of services are available in the country, meaning fewer country residents will need to travel to Adelaide for health care.

The Strategy identifies the need for significant changes to achieve a sustainable health system that addresses the contemporary challenges facing the health system. The main factors contributing to an increasingly unsustainable health system include the ageing population, increasing prevalence of chronic diseases, disability and injury, poorer health of Aboriginal people and people of lower socioeconomic status, and increasing risks to society from communicable diseases, biological threats, natural disasters and climate change.

A number of Statewide Clinical Service Plans have been developed, or are currently under development, providing specific clinical direction in the planning of services. Interpreting these plans for country South Australia and specific health units is an important element of the planning process for Country Health SA. The enabling factors which are demonstrated across the statewide clinical plans include:

• Multi-disciplinary teams across and external to the public health system.

• Patient focused care.

• Care as close to home as possible.

• Teaching and research integrated in service models.

• Integrated service model across the continuum of care.

• Streamlining access to specialist consultations.

• Increasing use of tele-medicine.

• Improving Aboriginal health services.

• Focus on safety and quality.

• Recruiting and developing a workforce to meet future service models.

• Engaging closely with consumers and community.

• Developing the infrastructure to meet future service models.

• Clinical networking and leadership.

• Connecting local patients with pathways to higher level care needs.

• Reducing progression to chronic disease for at risk populations.

Strategies within the Statewide Clinical Service Plans which support the achievement of local needs have been integrated through the 10 year health service plans.

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5. Planning Principles

The Strategy for Planning Country Health Services in South Australia set out important principles which have been used to guide the local planning which include:

1. Focusing on the needs of patients, carers and their families utilising a holistic care approach.

2. Ensuring sustainability of country health service provision.

3. Ensuring effective engagement with local communities and service providers.

4. Improving Aboriginal health status.

5. Contributing to equity in health outcomes.

6. Strengthening the IT infrastructure.

7. Providing a focus on safety and quality.

8. Recognising that each health service is part of a total health care system.

9. Maximising the best use of resources.

10. Adapting to changing needs.

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6. Service Delivery Plan

6.1 Core Services to be maintained and enhanced Note: The 10 Year Millicent Health Service Plan acknowledges that it will continue to maintain a district and local level of services as defined in the Country Health Care Plan Taskforce Service Delineation Framework for Country Health Services Service Category Service Description Target Group Directions over next 10 years Community Health • Chronic disease self management All age groups • Maintain and extend current services Promotion and Prevention programs, domiciliary care, Aboriginal living in the Wattle Range • Strong partnership between Millicent Hospital and South East Programs health, community nursing and West and Kingston, Regional Community Health Service (SERCHS) midwifery services, children and youth Robe Councils, tourists, • Extend community health programs including allied, child and services, drug and alcohol services, and seasonal workers youth, drug and alcohol, generic counselling, community community mental health (adult and mental health services and diabetes education 1 children), counselling and allied health services. Specialised chronic disease practitioners such as diabetes educators and chemotherapy Community Health & GP • Community Health Services in the All age groups • Maintain and extend the current service Plus strategy services South East are delivered through living in the Wattle Range • Increase Hospital in the Home services 2 SERCHS West and Kingston, • Strong partnership with SERCHS and the Hospital Robe Councils, tourists, • See section 6.2 and seasonal workers Allied Health • Public physiotherapist works 0.2FTE at All age groups • Maintain and extend current services Millicent Hospital living in the Wattle Range • Increase access to allied health staff in Millicent for all age • Other allied health staff are a part of West and Kingston, groups the SERCHS structure such as Robe Councils, tourists, • Introduce adolescent health clinics and sexual health occupational therapy, speech therapy, and seasonal workers programs dietician, diabetes educator and • Increased services for children podiatry • Increased public appointments for children in allied health services, especially speech pathology and dietetics • Introduce a men’s health service • Increased use of video conferencing • Partnerships with outside agencies • See section 6.2

1 Strategy for Planning Country Health Services in South Australia 2 Chronic Disease Action Plan for South Australia 2009-2018 11

Emergency Service • 24 hour, 7 day/week emergency All age groups • Maintain and extend current service to enhance capacity to service triage and assessment living in the Wattle Range respond to accident and emergencies and disaster • 24 hour, 7 day/week emergency West and Kingston, management trauma and resuscitation, initial Robe Councils, tourists, • Advocate and support for Millicent Medical Clinic to recruit management eg. strokes, car accidents and seasonal workers and retain more general practitioners to cover the 24/7 on- • Appropriately staffed and supported by call roster medical and nursing staff • Strengthen access to support and guidance from medical • Treatment for/management of specialists in Mount Gambier appropriate (non-life threatening) • Recruit and retain skilled triage nurses conditions eg. skin disorders, asthma, • Access to statewide clinical networks, SA Ambulance, Royal gastroenteritis, pneumonia, Flying Doctor Service and SA Retrieval Services musculoskeletal injuries • Safe transfer of patients requiring mental health services • Inpatient diagnosis, monitoring and • Development of culturally respectful practice treatment of appropriate conditions • IT infrastructure to support consultations and procedures • 24 hour, 7 day/week emergency • See section 6.2 surgical procedures eg. appendicectomies, caesarean sections, fractures, emergency mental health service • Telehealth facilities in the Emergency Department (ED) • Medical services provided by resident general practitioners • Resident medical practitioners cover Millicent ED Acute Inpatient Care • Admission of patients for low risk All age groups • Maintain and extend current services medical, surgical, birthing, living in the Wattle Range • Maintain workforce and infrastructure to maintain low risk chemotherapy and maintenance of West and Kingston, acute care chronic diseases Robe Councils, tourists, • Increased use of information technology and video • Access to statewide clinical networks and seasonal workers conferencing to support consultations and procedures and Rural and Remote Mental Health • Stronger partnerships with clinical networks and statewide Services services • Access to a General Practitioner • Development of culturally respectful practice Service to provide both acute illness • See section 6.2 management and general practitioner consulting for less serve illnesses. • Resident general practitioners and visiting medical specialists provide acute care services. There are limited anaesthetists to cover the workloads

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Elective Surgical • Operating theatre staff equipped to All age groups living in • Maintain and extend the current staffing and resources to support a range of lower risk the Lower South East cover low risk elective surgery appropriate surgeries such as • Improved information technology and video conferencing to tonsillectomies, lower segment support consultations and procedures caesarean sections, carpal tunnel • Easy access to statewide clinical networks and statewide releases, arthroscopies, plastics, services urology, gynaecology, ENT • Strengthen partnerships with South East health units to • General practitioner and visiting improve discharge planning and continuity of care specialist services • See section 6.2 • Residential obstetrics, general surgery or anaesthetic specialist services • Resident general practitioners and visiting medical specialists provide acute care services Maternal and Birthing • Deliver low risk, single births, theatre Women, and • Maintain and extend the current staffing and resources to Services and staffing for emergency and elective children aged 0-18 years cover low risk maternity and birthing caesarean sections 24 hour, 7 living in the Wattle Range • Meet requirements set out in Standards for Maternal and day/week West Kingston and Robe Neonatal Services in SA 3 • Resident general practitioners and Council areas • Strengthen Midwifery Shared Care program in Millicent visiting medical specialists provide • Improved information technology and video conferencing to maternal and birthing services support consultations and procedures • Strengthen partnerships with Child and Family Health Service and Aboriginal Health Birthing Project • Integrated system with statewide services • Introduce a South East maternity network to improve discharge planning and continuity of care • See section 6.2 Medical Specialist • Visiting medical specialists provide All age groups • Maintain and extend staffing and resources to support the Services treatment and procedures in Millicent covering the Lower South current medical specialist treatment and procedures in including: East Millicent o Paediatrics • Strengthen and increase access to support and guidance o General surgery from medical specialists in Mount Gambier o Gynaecology • Explore opportunities for increasing access to timely o Oral surgery specialists appointments in Mount Gambier and Adelaide o Breast surgery • Strong partnerships with South East health units to improve continuity of care for all patients • See section 6.2

3 Standards for Maternal and Neonatal Services in South Australia 2009 13

Mental Health • Specialised assessment for low 18 years and onwards • Maintain and extend the current low risk mental health complex, voluntary admission to living in the Wattle Range services for adults and especially youth and children general wards West Kingston and Robe • Increase mental health service and support for children and • Respite admissions to a local hospital Council areas, tourists, youth eg. exploring services to be provided 24/7 days/week, • Access to specialist clinical support seasonal workers psychological counselling, access to psycho-geriatrician, safe • Shared care management in transfer to metropolitan health units, increased youth partnership with general practitioner counsellors, community information • 24/7 day/week emergency mental • Continue local voluntary admissions for mental health care health service, individual psychosocial • Establish local mental health network rehabilitation • Implement the provisions of the new Mental Health Act • Community counselling services and (2009) from 1st July 2010 local admission for mental health • Strengthen primary mental health care services through improved partnerships with general practice and other primary care providers 4 • Improved access to specialist mental health services through increased visiting services and utilisation of telehealth network for video conferencing consultations and assessments • Continued consumer consultations to ensure their participation and involvement in designing and implementing the local mental health network • Development of culturally respectful practice • Strengthen partnerships with school counsellors, youth workers, drug and alcohol services, CAMHS, Department of Education and Children’s Services to provide easier access to advice, support and services for adults and youth • Collaborate with other agencies to contribute to reducing the suicide rate in the South East • Strengthen worker relationship between Country Health SA Mental Health team and the other South East health workers • See section 6.2 Respite Services • Respite for higher level acuity/disability All age groups in the • Maintain and extend current services care, domiciliary care and transitional Lower South East • Explore any opportunities for increasing access to respite care care beds in the South East when required

Aged Care • Inpatient admission admissions for All age groups in the • Maintain and enhance current aged care services elderly, including respite care, Lower South East • Develop a dementia specific assessment unit in Millicent • Residential aged care Hospital 5

4 South Australia’s Mental Health and Wellbeing Policy 5 South Australia’s Dementia Action Plan 2009-2010 14

• Access to aged care assessment, • In partnership with Mount Gambier introduce gerontology transitional and community packages services including psycho-geriatric support and increase mental health services for older people • Form a partnership with Commonwealth Government to meet aged care requirements • See section 6.2 Palliative Care • Palliative care beds All age groups • Maintain and extend current services, including required • In-home-support living in the Wattle Range staffing and resources • Special interest GP palliative care West and Kingston, Robe • Integrate closely with the Lower South East health cluster • Palliative care support teams Councils, tourists, and palliative care team seasonal workers • Extend Mount Gambier oncology services consultation, assessment and treatment needs across the South East considering outreach services and increased use of telemedicine • Development of a culturally respectful practice • Support strengthened palliative care / hospice care in the South East, building on existing planning and development of the Country General Hospital in Mount Gambier • Improved information technology • Partnership with cancer clinical networks • See section 6.2 Clinical Support Services • Access to general x-rays and ultra All age groups • Maintain and improve the current structure and service sound capacity covering the Wattle • Investigate opportunities to provide an IMVS/Gribbles • More advanced point of care testing Range West Council collection centre in Millicent and Gribbles Blood Diagnostic • Access to pathology testing 7 days per areas, tourists, seasonal Centre in Millicent Hospital week workers • Video conferencing link up with pharmacists for staff • Improved blood service information, consultation and education sessions • Access to radiology advice through networked support 24 hour, 7 days week Oral Health • Primary dental care, early intervention, All age groups • Maintain and improve the current structure and service oral health assessments and oral Covering the Wattle • Advocate to provide a public consulting and surgical oral surgery Range West Council service at Millicent Hospital areas, tourists, seasonal • Investigate opportunities for timely access to SA Dental workers Services and providing emergency and after hours services • Advocate for Patient Assistance Transport Scheme coverage for oral health • Advocate for increased Medicare rebates for accident dental work

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Rehabilitation • Admission for recuperative care All age groups living in • Commitment to maintain and enhance current level of • Post surgical rehabilitation the Wattle Range West services especially for aged, patients requiring mental health • Transitional care packages Council areas services and children • Day rehabilitation services • Adequate staffing and resources to cover rehabilitation • In-hospital allied health and programs rehabilitation care • Stronger partnerships with outside providers such as Hampstead Rehabilitation Centre and statewide rehabilitation networks 6

6 Statewide Rehabilitation Service Plan 2009-2017 16

6.2 Strategies for new / expanded services

Service objective: To improve general medical practitioner services in Millicent Target group: All age groups living in the Wattle Range West, Kingston and Robe Council areas, tourists and seasonal workers Critical milestones: 2010

Outcomes Future Strategies Time Frames • Sustainable access to general practitioners 24 hour/7 days • Explore opportunities for increasing and retaining local access to general 2010 per week to cover hospital and clinic workloads practitioners including working in partnership with Millicent general practitioners, • General practitioners are providing private services in Limestone Coast Division of General Practice, and local community • Millicent Hospital To assign a duty doctor at the hospital and an on-call doctor at the clinic • Bulk billing in Millicent Emergency Department (ED) • Review private services in Millicent Hospital • Consider bulk billing patients in Millicent ED • Consider electronic sharing of records between Medical Clinic and Hospital • Produce information to increase community awareness of available services

Service objective: To improve Emergency Services in Millicent and District Hospital and Health Services Target group: All age groups living in the Wattle Range West, Kingston and Robe Council areas, tourists and seasonal workers Critical milestones: 2010

Outcomes Future Strategies Time Frames • Millicent Hospital ED is covered 24 hours seven days per • Establish appropriate and skilled workforce to support the delivery of ED in 2010 week with skilled triage staff Millicent • Improved efficiency and effectiveness in Millicent Hospital • Strengthen partnerships with Millicent general practitioners, Mount Gambier ED specialists and salaried medical officer to provide advice, support and adequate • Reduced waiting time in Millicent Hospital ED service in the Millicent Hospital ED • Acceptable fee rates for all the community in Millicent • Strengthen links with Mount Gambier Health Service ED staff (staff to cover the Hospital ED Millicent ED when required) • Strengthen partnerships with SA Ambulance, Royal Flying Doctor Service, and SA Retrieval Team to initiate an extended care response and smoother patient transfer to urban health and South East health units

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Service objective: To improve and extend acute care in Millicent and District Hospital and Health Services Target group: All age groups living in the Wattle Range West, Kingston and Robe Council areas, tourists and seasonal workers Critical milestones: 2010-2015

Outcomes Future Strategies Time Frames • Acute inpatient care service profile and infrastructure to meet • Modify and upgrade the infra-structure and capacity of Millicent Hospital by 2010-2015 future needs remodelling the current wards • Upgrading all wards to be single rooms with en-suites for all general patients • Recruit and retain skilled nursing staff • Form stronger partnerships with South East health units and metropolitan health units to improve discharge planning and continuity of care for all patients • Improved information technology and video conferencing • Improved South East inter-regional transport

Service objective: To improve and extend aged care in Millicent and District Hospital and Health Services Target group: People aged 55 years and over living in the Lower South East Critical milestones: 2010-2015

Outcomes Future Strategies Time Frames • Sustainable skilled staff covering aged care • Explore the opportunity to establish a nurse practitioner position providing a 2010-2015 • Increased access to respite care and dementia beds in the consultancy aged care service across the Lower South East health units Lower South East • Establish appropriate and skilled workforce to support the delivery of aged care • Increased opportunities for aged people to remain in their services in Millicent homes and early discharge from hospital • Improved communication between Lower South East hospitals and aged care • Form strong partnerships with South East aged care facilities to provide adequate service in the Millicent Hospital • Increase education is required for carers to keep the resident/patients in their own homes, and have early discharge from Millicent Hospital

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Service objective: To enhance the general practitioner led Mental Health and Detoxification Treatment Service Target group: Over 14 years of age living in the South East and seasonal workers Critical milestones: 2010-2011

Outcomes Future Strategies Time Frames • Enhanced mental health service at Millicent and District • Formalise an appropriate environment for care provided to patients requiring 2010-2011 Hospital and Health Services mental health/ detoxification services, including activity/therapy • Work with Drug & Alcohol Services SA to improve access to • Support local service delivery by increasing access to training in detoxification detoxification and treatment programs and methadone programs for the employed workforce and general practitioners • Develop stronger partnerships with providers of drug and alcohol services, the Mental Health Team in the South East • Strengthen pathways for local people with a mental illness to access all levels of care, including intermediate care and limited treatment care from the Country General Hospital in Mount Gambier • Support service provision by the increased use of video conferencing facilities • Promote effective discharge planning and support systems for patients returning to the community following acute episodes of care • Develop strong links with other health units and service providers

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Service objective: To improve child and youth health services in Millicent Target Group: Residents 0-18 years living in the Wattle Range West, Kingston and Robe Council, tourists and seasonal workers Critical milestones: 2010-2015

Outcomes Future Strategies Time Frames • Increased early intervention services for children and youth • Increase services and specialists for children and youth in the South East 2010-2015 in the South East • Paediatric patients to be triaged to Mount Gambier for care and treatment • Mount Gambier paediatric team conducting regular • To extend Mount Gambier paediatric clinics and consulting to cover Millicent on consulting clinics in Millicent a regular basis • Reduced waiting list for allied health programs and services • Improve community information about access to health services for children and youth • Introduce more services in the South East for disabled children and youth • Reduced waiting lists for mental health services for children • Increase the number of mental health services for children and youth and and youth support for parents • Services for children with autism, cystic fibrosis and allergy • Strengthen partnerships with CAMHS to improve mental health services for testing introduced children and youth and reduce waiting times • Improved information about children’s services and contacts • Strengthen partnerships with Child and Family Health Service and Department of Education and Children Services to improve health services for children and youth and to provide support and advice to school youth counsellors • Explore the opportunities with SHINE-SA to improve services and access to information for children and youth living in the South East • Improved speech pathology services in schools

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Service objective: To improve maternal and birthing services in Millicent and District Hospital and Health Services Target group: Women 15-50 years, children 0-18 years living in the Wattle Range West Council areas Critical milestones: 2010-2011

Outcomes Future Strategies Time Frames • Sustainable skilled staff covering Millicent birthing and • Strengthen partnerships with Millicent general practitioners, Mount Gambier 2010-2011 maternity unit to provide all services specialists and salaried medical officer to provide advice, support and adequate • Low risk obstetric maintained in Millicent services in Millicent Hospital maternal and birthing unit 7 • Reduction in the number of women being transferred to • Strengthen links with Mount Gambier Health Service maternity and paediatric Mount Gambier Hospital for services staff (staff to cover the Millicent Maternal and Birthing unit when required) • Explore opportunities with Millicent general practitioners, specialist obstetricians and hospital staff to provide midwifery shared care in Millicent • Explore opportunities for a regular visiting obstetrician to Millicent • Strengthen partnerships with Child and Youth Health Services and South East health units to improve continuity of care and discharge planning and transfers

Service objective: To improve access to elective surgery in Millicent and District Hospital and Health Services Target group: All age groups living in the Wattle Range West, Kingston and Robe Council areas, tourists and seasonal workers Critical milestones: 2010-2011

Outcomes Future Strategies Time Frames • A sustainable elective surgery service is conducted in • Strengthen partnerships with Millicent general practitioners, Mount Gambier 2010-2011 Millicent specialists and salaried medical officer to provide advice, support and adequate services in elective surgery • Strengthen links with Mount Gambier Hospital surgical staff (staff to cover Millicent elective surgery when required). • To recruit and retain anaesthetists and skilled staff in Millicent to support medical specialists and elective surgery • Explore opportunities for Millicent Hospital to provide ENT consulting and day surgery services

7 Standards for Maternal and Neonatal Services in South Australia 2009 21

Service objective: To improve access to medical specialists in the Millicent and District Hospital and Health Services Target group: All age groups living in the Wattle Range West, Kingston and Robe Council areas, tourists and seasonal workers Critical milestones: 2010-2015

Outcomes Future Strategies Time Frames • Regular visiting medical specialist clinics in Millicent meeting • Work closely with Mount Gambier to extend Mount Gambier paediatric clinics to 2010-2015 local needs cover Millicent on a regular basis and moderate to high risk paediatric patients are triaged to Mount Gambier Hospital • Increase telemedicine and video conferencing to access medical specialist advice and consultations • Advocate for improved South East public transport to access Millicent Hospital services

Service objective: To improve and extend mental health service in Millicent Target group: All age groups living in the South East Critical milestones: 2010-2011

Outcomes Future Strategies Time Frames • Well established local mental health service network • Increase emphasis on mental health services for children, youth and the aged 2010-2011 • Improved local access to specialist mental health care and • Improved use of information technology and video conferencing for consulting community based support services for people with serious and treatment mental illness • Improve continuity of care when being admitted to and discharged from • Additional/new psychogeriatric services and better mental metropolitan services and local services health care for older people • Strong partnerships with Rural and Remote Mental Health Services to develop an appropriate mental health service in the South East and reduce the amount of time travelling and living away from home for care • Strong partnership with all government and non government providers to improve mental health service for children and youth and reduce waiting times

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Service objective: To improve and extend South East Regional Community Health Service (SERCHS) in Millicent Target group: All age groups living in the Wattle Range West Council areas and seasonal workers Critical milestones: 2010-2015

Outcomes Future Strategies Time Frames • SERCHS facilities in Millicent are user friendly and provide a • Explore opportunities to extend facilities on the Millicent existing site to 2010-2015 safe working environment for the staff accommodate current and new projects and associated staff increases • Improved community knowledge about local community • Increase allied health services especially for children, youth and aged health services • Form strong partnerships with all South East health units to improve continuity of care and discharge planning • Explore provision of a seven day a week service • Podiatry staffing levels have been increased to match the expected growth in ageing population • Establish South East men’s health service • Public physiotherapists practicing in Millicent • Increased appointments and clinics for patients requiring diabetes services • Increased dietetics services

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Service objective : To expand and enhance Millicent general practitioner led Palliative Care Service Target Group: People living in the Wattle Range West, Kingston and Robe District Councils areas. Older people and those in residential care and community aged care settings Critical milestones: 2010-2011

Outcomes Future Strategies Time Frames • Part of the Lower South East health cluster palliative care • Increased capacity to provide an enhanced and extended level 2 (low risk) 2010-2011 team, providing level 2 (low risk patients) spectrum of palliative care service 8 services, intervention and programs within the Wattle Range • Part of the Lower South East health cluster interdisciplinary palliative care team; West Council area providing short episodes of inpatient care for symptom control, rehabilitation, • Equity of access for people living in the Wattle Range West terminal care, respite and continuity of care, instruction where care at home Council area. Older people and residents of residential and cannot be sustained and community care for (level 2) low risk palliative care community aged care settings patients in Millicent • General practitioner and registered nurse led program, supported by the Lower South East health cluster palliative care coordinator • Explore and use general practitioners with a specialised interest in palliative care • Explore opportunities for a day hospice in the South East covering therapeutic procedures and intervention, assessment and rehabilitation activities, carer education, carer respite and support to mitigate against social isolation • Explore options for modifying buildings to provide a dedicated two bed capacity palliative care area • Establish appropriate and skilled workforce to support the extended palliative care program in Millicent • Build strong partnerships with Mount Gambier Health Service, Penola Hospital and Adelaide health units • Provide access to specialised equipment and necessary treatments • Increase use of video conferencing facilities

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7. Key Requirements for Supporting Services

7.1 Safety & Quality

Objective: Improve the safety and quality of care for service providers in the Millicent catchment Critical milestones: 2010

Outcomes Existing Strategies Sustained Strategies for the Future • To provide a safe environment for staff and • Hospital buildings have been adequately maintained • Increased skilled staffing levels to cover aged care, patients at Millicent and District Hospital and and new standards are being met emergency department, maternal and birthing, Health Services • High risk and complex patients transferred to Mount elective surgery and acute care in Millicent Gambier • Establish a mental health service meeting all the • Staffing levels to adequately cover all areas of standards outlined in the new Mental Health Act service delivery 24 hours/7 days per week (2009) • Up-grade and modify wards in Millicent Hospital • High risk and complex paediatric patients are triaged to Mount Gambier Hospital • SERCHS Millicent facilities to be upgraded or rebuilt • Contribute to coordinating access to medical specialists in Adelaide or Mount Gambier to improve patient journeys • Provision has been made for the care of patients with multi-resistant organisms • Safer transfer and transition of patients to other health units as required

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7.2 Patient Journey

Objective: To improve Lower South East transport options for accessing health services Critical milestones: 2010

Outcomes Existing Strategies Sustained Strategies for the Future • Improved patients journey conditions and • Patient Journey Project • Improve and assist with transport for Millicent experiences for Millicent residents • Red Cross transport residents to other health facilities • Access to the South Australian Patient Assistance • To improve liaison, coordination and communication Transport Scheme (PATS) between doctors, staff and patients in Adelaide and Mount Gambier to improve patient journey • Review PATS coverage within and outside the South East • Investigate an intra South East patient transport system • Facilitate scheduling of appointments with specialists or metropolitan hospitals during the middle of the day so patients can travel to Adelaide and back on the same day • Form strong partnerships with SA Ambulance Service (Royal Flying Doctor Service, SA Retrieval Team) to provide a smoother patient transfer to urban health units • Advocate for medical specialist telephone consultations be recognised and reimbursed through Medicare

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7.3 Cultural Respect

Objective: To recognise and understand the needs of people from culturally and linguistically diverse (CALD) populations using Millicent and District Hospital and Health Services Critical milestones: 2010

Outcomes Existing Strategies Sustained Strategies for the Future • Increased cultural awareness and sensitivity by • Facilitation of workshops on the needs and culture of • Conduct cultural respect education and training hospital staff a diverse range of multicultural people living in the programs for all Millicent and District Hospital and service areas Health Services staff • Aboriginal health promotion and prevention project • Strengthen relationships between Millicent and officer District Hospital and Health Services and Aboriginal • Strong working relationships with Pangula people and other cultures Mannarmurna staff and sharing programs • Establish stronger representation of cultural groups on Millicent advisory committees • Provide suitable counselling, culturally appropriate programs for culturally diverse groups • Deliver culturally appropriate women’s health clinics • Facilitate improved coordination of services • Provide improved consultation mechanisms for Aboriginal and Torres Strait Islander people • Satisfaction with hospital services by patients • Use of interpreter services • Conduct cultural respect education and training from culturally diverse backgrounds • Partnership with Limestone Coast Migrant Centre programs for all Millicent and District Hospital and • Accessible health promotion and prevention • Partnership with Skilled Migrant Centre Health Services staff programs for all populations groups • Advocate to review Visa holders’ access to medical care • Advocate on behalf of skilled migrants for access to health care services • Form stronger partnerships with the South East Migrant Resource Centre and Skilled Migrant Programs • Strengthen relationships between hospital and patients from a range of culturally diverse backgrounds

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7.4 Engaging with our community

Objective: Improved communication and partnership between health workers and communities in the South East Critical milestones: 2010

Outcomes Existing Strategies Sustained Strategies for the Future • Stronger partnerships and liaison links have • Support the Millicent Health Advisory Council to • A South East health information directory has been been developed and maintained with the implement their ongoing role of engaging with their developed and updated on a regular basis community community and local stakeholders representatives on • Acknowledgement that local community support will advisory groups be vital to the success to new and changed services • Improve communication and marketing of the health system throughout the South East community

7.5 Local Clinical Networks

Objective: To use Statewide Clinical Networks to improve services and access Critical milestones: 2010-2011

Outcomes Existing Strategies Sustained Strategies for the Future • All residents of the South East have access to • SA Health Clinical Networks are in place in some • Increased partnerships with South East communities, Country Health SA Clinical Networks areas within the South East covering: Limestone Coast Division of General Practice, o Cancer general practitioners, SERCHS, aged care facilities o Cardiology and assessment team drug and alcohol services, o Child health Mental Health Team, SA Police, SAAS, SA Dental o Maternal neonatal Services, Bensons Radiology and other agencies to o Mental health improve health services o Older people • Extend clinical networks across the South East o Orthopaedics • Electronic sharing of files between Millicent and o Palliative care District Hospital and Health Services and general o Rehabilitation practitioners o Renal • Strengthen partnerships with Mount Gambier Health o Stroke Service ED, maternal and birthing and surgical staff • Lower South East health cluster meetings • Strengthen working partnerships with CAMHS, Child and Family Health, Department of Education and Children Services to improve health services for children and youth and to provide support and advice to school youth counsellors

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8. Resources Strategy

8.1 Workforce

Service objective: To have a skilled and adequate workforce working in Millicent and District Hospital and Health Services Critical milestones: 2011 Outcomes Existing Strategies Sustained Strategies for the Future • There are sufficient and skilled staff working • Emergency, surgical, maternity and birthing Mount • Nurse practitioner has been trained and/or recruited across the current and future service profile Gambier Lower South East teams are in place to provide a consulting service in Lower South East aged care facilities • Supported accommodation and other support is available for health professionals moving to the South East • Increase and recruit staff in the following departments and new programs: • Aged Care o Increased staff to cover the current workloads, especially at meal times o Lower South East nurse practitioner consultancy aged care service • Theatre o Increased skilled staff to cover current workloads o Anaesthetists • Maternal and Birthing o Increased skilled staff to cover current workloads o Anaesthetists • Emergency Department o Increased skilled triage staff to cover current workloads o Increased access to general practitioners to cover 24/7 on-call service • Palliative Care o Increased skilled staff to cover the current and increased workloads o Local general practitioner with availability to support the program • Partnership with Lower South East health cluster palliative care team staff

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8.2 Infrastructure

Service objective: To expand Millicent and District Hospital and Health Services infrastructure and capacity Critical milestones: 2015

Outcomes Existing Strategies Sustained Strategies for the Future Infrastructure and capacity meets local needs • Modification of acute care wards to be single wards with en-suites • Additional infrastructure development undertaken to support extended and enhanced programs • SERCHS modified or new building • Extra storage throughout facilities • Increased car parking for staff and visitors

8.3 Finance

Objective: To resource Millicent and District Hospital and Health Services to achieve planned service profile Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future • Millicent and District Hospital and Health • State Government funding • Explore opportunities for increasing resources to Services is resourced to deliver a district health • Commonwealth funding support existing and expanded services services • Specific purpose funds • Reduce duplication of services across the South East • Donations and funds stay locally

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8.4 Information Technology

Objective: To improve information technology and video conferencing throughout the South East Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future • Increased use of video conferencing for • Improve access to up-to-date information technology specialists services not available in Millicent and to support services encompassing: a reduction in travelling for patients o Discharge planning information between the hospital staff and outside health providers. o Open Architecture Clinical Information System (OACIS) o Best practice o Nursing clinical system o Electronic files • Improve the use of video conferencing for all services and to reduce patient travelling expenses and time for services.

8.5 Risk Analysis

Objective: To provide good management of all services and continuous improvement in decision making in Millicent and District Hospital and Health Services Critical milestones: 2010-2015

Outcomes Existing Strategies Sustained Strategies for the Future • All staff are aware of the need for risk analysis • Maintain existing mechanisms in place including • Appropriate ongoing risk management staff training and the need to continually monitor and review accreditation; risk register; policies; procedures and and development services standards; physical safeguards to sustain risk • Regular risk management education sessions analysis • Regular review and adjustment of current strategies • Control meetings currently in place are: o Cluster Executive o Health Advisory Council o OHS&W o Safe Practice and Environment o Quality Patient Safety meetings o Morbidity meetings with GP Clinic o Staff meetings

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9. Appendix

9.1 Leadership Structure

The leadership structure for the development of the 10 year Health Service Plan consists of: • Millicent Health Advisory Council • Lower South East Cluster Executive • Millicent and District Hospital and Health Services Executive Team • South East Regional Community Health Executive

9.2 Methodology

Information included in this 10 Year Plan has been collected during consultations conducted in 2009 by the Millicent Health Advisory Council.

Consultations comprised 148 individual and community group sessions including: 1. Millicent community – via a public meeting and face to face interviews. 2. Parents of children aged 0-12 years. 3. Adolescents aged 13-24 years - groups consulted included youth advisory groups, school counsellors and school representative groups. 4. Adults aged 25-55 years including service club members. 5. Retired adults aged 56 years and older including aged care residents, elderly citizens groups, service club members and Masonic Lodge members. 6. Millicent general practitioners.

9.3 Review Process

The monitoring and evaluation strategy for this Plan will be developed for the final version.

9.4 Glossary

24/7 24 hours seven days per week ABS Australian Bureau of Statistics CAMHS Child Adolescent Mental Health Services ED Emergency Department ENT Ear, Nose and Throat FTE Full-time equivalent GP General Practitioner PATS Patient Assistance Transport Service SAAS SA Ambulance Service SERCHS South East Regional Community Health Service SHINE-SA Sexual Health Information Networking Education - SA SLA Statistical Local Area SWOT Strengths, weaknesses, opportunities, threats methodology

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