Service Plan 2018-2023

Investing in our health – what matters

Alpine Health Service Plan 2018-2023

Disclaimer

Whilst every reasonable effort has been made to ensure the accuracy of the information presented, the Alpine Health Service and its employees to the extent permitted by law, disclaim any liabilities to any person in respect to errors and omissions. We recognize that policies, programs and statistics may have changed since the printing of this document.

Identification and Acknowledgments

Organisation: Alpine Health

Timeframe of Service Plan: This is Alpine Health’s 7th Service Plan – 1 July 2018 - 30 June 2023

Key Linkages and Alliances: Local Government Areas Alpine Shire, Indigo Shire State Electorates Ovens Valley, Benambra Federal Electorate Indi Department of Health and Human Services East Division Department of Health Commonwealth of Australia Primary Care Network Murray Primary Care Partnership Central Hume PCP

Principal Contact: Lyndon Seys Mail: 30 O’Donnell Avenue Chief Executive Officer Myrtleford VICTORIA 3737 Alpine Health Telephone: +61 3 5751 9344 30 O’Donnell Avenue Myrtleford VICTORIA 3737 E-mail: [email protected]

Consultants: Alpine Health acknowledges the following staff members and Consultants who have helped develop this Plan:

Project Coordination Group: o Convener, Lyndon Seys, Alpine Health o David Whitrow, Murray Primary Health Network o Neville Page, Department of Health and Human Services o Trevor Marshall, Kate Duff and Patricia Brogan, Alpine Health o Deanne Drage, Inspiring Health Solutions o Susan Benedyka, The Regional Development Company

Additional project consultants:

o Gabrielle Prior, Wype Consulting Services o Cath Botta, PCB Consulting o Bill Godfrey, Bill Godfrey and Associates

iii

Message from the Chair, Alpine Health Board of Directors I am pleased to present the Alpine Health Service Plan – Investing in Our Health: What Matters. This is our seventh Service Plan and it covers the period July 2018 – June 2023. This document, when read together with the detailed supporting papers, provides a comprehensive picture of how Alpine Health will operate as an effective and viable Multi-Purpose Service into the future.

I would like to acknowledge and thank all those who have contributed to, and assisted with the development of the Service Plan 2018-2023:  The members of the Alpine Health Community and Health Advisory Groups, who actively led, shaped, participated in, and assisted with the consultations, community survey distribution, planning workshops, and who have given sound feedback and advice  The residents of the Alpine Shire who responded to the community survey and participated in the workshops  All of the Alpine Health staff members who took part in the internal consultation processes,  Neighbouring health, hospital community and community health, education and research, voluntary and representative organisations and services, and officers from the Department of Health and Human Services who participated in key interviews, shared their existing plans, and participated in the service planning workshop  The Murray Primary Health Network for the compilation of the data report, advice and participation in key interviews

I commend this document to you and ask that you consider its opportunities for improving health service delivery to the communities of the Alpine Shire.

All feedback is welcomed and I invite you to contact Mr Lyndon Seys, Chief Executive Officer, Alpine Health, 30 O’Donnell Avenue, Myrtleford (03) 5751 9344 with your comments.

Ms Christine Walker Chair Alpine Health Board of Directors

Contents

Identification and Acknowledgments ...... iii Message from the Chair, Alpine Health Board of Directors ...... iv Executive Summary ...... 1 Vision, and Mission ...... 3 Purpose, Philosophy and Principles ...... 3 Alignment with State and Commonwealth Policy Directions ...... 4 Introduction ...... 8 Purpose of the Service Plan ...... 8 Service Planning Framework...... 8 Methodology ...... 9 Community Consultation ...... 10 Scenario Planning ...... 11 Context ...... 12 Alpine Health – A Multi-Purpose Service ...... 12 Current Situation ...... 12 Service Plan Implications ...... 13 Community Profile ...... 14 Alpine Shire ...... 14 Population and the Demographic Changes...... 15 Community Health Indicators ...... 17 Our Health Indicators ...... 19 Service Plan Implications ...... 22 Services ...... 23 Structure of Alpine Health ...... 23 Current services ...... 23 Service Activity and Trends ...... 25 Service Plan Implications ...... 25 Service Directions...... 26 Service Direction One ...... 26 Service Direction Two ...... 27 Service Direction Three ...... 28 Service Direction Four...... 29

Tables

Table 1: Alpine Shire Townships and Localities ...... 14 Table 2: Services Provided by Alpine Health Identified by Location ...... 23 Table 3: Services provided by other Health and Community Services to the Alpine Shire community ...... 24

Figures

Figure 1: Alpine Health Service Plans ...... 8 Figure 2: Determining service needs – Alpine Health Service Plan ...... 9 Figure 3: Alpine Shire and Victorian Population Projections: Over 65 years 2011-2031 ...... 16 Figure 4: Change in age structure, 2011 - 2016 ...... 16 Figure 5: Alpine Shire population projections 2016 – 2026 (Department of Environment, 2016) ...... 16

Executive Summary

This Service Plan – Investing in Our Health: What Matters provides the course for Alpine Health to follow as a Multi- Purpose Service for the period July 2018– June 2023. It has its basis in a set of principles and directions.

Health is not just the The Service Plan is founded on a broad definition of health and the view absence of disease held by our communities that they are responsible for their health and well- being.

Health improvement and It is predicated on the belief that health and well-being are also outcomes well-being is both an of how people live and that health improvement will come from individual, individual, community environmental, organisational, and social and community action. We and service responsibility believe that individuals, groups, health agencies, Alpine Health staff members and the wider community working together to plan, manage and deliver services that are focussed on health improvement is the most effective way to improved health outcomes.

Service planning is based The Plan is based on population health planning principles, the on evidence, community measurement of the health status of the community and the measurement need and emerging of expressed, felt and relative need for services that the community believes trends are important to health and well-being. It is a comprehensive framework agreed by the community and it provides the basis for more detailed planning by Alpine Health and other agencies working together.

The next 5 years will This Service Plan builds on Alpine Health’s growth and the improvements build on achievements in organisational and financial stability achieved over recent years. It from previous plans and leverages the strong relationships between the organisation and the the evolving maturity of community it serves, the relationships forged through previous service the organisation plans with health service agencies locally and regionally, and a strong set of principles and values. Alpine Health has reached a stage of organisational maturity that enables:

 consolidation, strengthening and growth of services;  continued improvement in the quality of care and services provided;  development and/or early adoption of innovative approaches to service delivery;  a focus on longer term cost-effectiveness, sustainability, integration and flexibility of service provision;  a strong and responsive focus on the health and needs of the population and communities it serves

A key feature of Alpine Health is its commitment to place based planning Alpine Health will build on key strengths as a and service delivery. We believe that the maintenance and development of local service provider local service delivery, placing services as close as possible to where people live, work and play is an important key to health improvement.

The Service Plan Key challenges for Alpine Health to deliver on its commitment as a Multi- addresses key challenges Purpose Service are the increasing number of sites for service delivery over for Alpine Health our communities, further development of flexibility in both human resources and facilities to support sustainability and responsiveness to health needs, and the strengthening of its role in supporting the disadvantaged and those at risk.

Our Strategic Service Directions at a Glance

•We will... •Develop new services to better support our growing aged population •Do more to understand and address the needs of people who are Strategy 1 disadvantaged •Develop new services to adapt to the introduction of the National Disability Insurance Scheme Creating new services •Establish Alpine Health as the local experts in health services access and to meet changing navigation •Establish new partnerships to better address complex care needs especially for community needs the disadvantaged •Establish additional local access to specialist services including dental •Work with our service partners to fill gaps in service provision for mental health and alcohol and other drug prevention and treatment

•We will... •Expand the Alpine Health Home Care Package Program for it to become the service of choice for our local communities • Improve our Urgent Care service by working with general practitioners for after hours and on weekends service Strategy 2 •Work with our service partners to review mental health services and make necessary improvements Improving service •Trial, invest in and make the most of telemedicine technologies to support service improvements and expansion delivery through •Strengthen partnerships and establish systems to support Alpine Health become a centre of excellence in recuperation and recovery person-centred •Improve care coordination and discharge planning practice and safety •Strengthen our relationship with Ambulance Victoria and transport providers to improve servcies for clients and quality led •Participate in the national trial for the new aged care standards and the state systems and national reviews of MPS model and NDIS implementation •Work with Aboriginal and Torres Strait Islander people to ensure their needs are met in a culturally safe and engaging manner •Improve our mechanisms for measuring and responding to patient experience •Continue to build our services through improved staff and community participation

•We will... •Continue to expand the Alpine Institute to provide training that supports and builds our workforce to address changing community needs •Support our staff to maintain and extend their skills to better meet the Strategy 3 changing needs of our community •Explore nursing supporting models of urgent care service delivery with RIPERN Developing and and nurse practitoners improving the •Encourage and support our staff to maintain a healthy lifestyle •Continue to build the volunteer workforce through our model of volunteering workforce •Invest in the necessary administration systems related to workforce management to provide the tools for efficiencies •Investigate the needs of shared workforces working across different organisations and communities in the provision of health services

•We will... • Build formal partnerships with other local and regioanl health services for service improvements and efficiencies •Enable flexibility in our acute services to adjust to fluctuations in patients flow and needs •Boost our health promotion, prevention, palliative care and early intervention services •Prepare for the implementation of the Voluntary Assisted Dying legislation Strategy 4 •Help people to better manage their health •Modernise our interface with consumers to improve access to information Investing in the future and services •Improve our antenatal, post-natal and child and maternal health services •Continue to expand the Alpine Institute to serve the needs of Alpine Health, the health sector and our community •Improve our infrastructure to ensure it is fit for purpose, safe and sustanable •Invest in current health information and communications technology such as My Health Record and electronic medication management systems in partnership other health services

Vision, and Mission

Alpine Health Vision Improved health and well-being of our communities

Alpine Health Mission Provide and improve sustainable health and education services for our communities in partnership with them

Purpose, Philosophy and Principles Alpine Health is driven to improve the health and well-being of the community, by working with individuals, communities, and partner organisations. Our purpose is to work with our communities to improve the overall health and well-being of people within our communities. We provide, and continually improve integrated, sustainable local health services.

This purpose is underpinned by a strong commitment to local service delivery. We agree that community health is best served through local, decentralised service models. ‘Local Services for Local People’ enables better experiences for patients and consumers and better health outcomes for the community. We also believe an educated, informed and engaged community is a healthy community. If we can educate and inform the community about health issues, we effectively empower people to take ownership of, and improve their health.

Service development, governance, delivery and management is guided by the following principles. These have been derived from extensive community consultation with the community, service users and staff members and tested through the planning process. 1. INNOVATION – We are innovative in our approach to improving health.

2. PARTNERSHIP – We work in partnership to ensure seamless health care.

3. CHOICE - We offer people service options and choices.

4. LOCAL - Local service delivery is preferred over distant service delivery and home-based service delivery options are preferred over institutional delivery options.

5. RESPONSIVE – We are flexible and responsive to the needs of individuals.

6. RESPONSIBILITY - We recognise that individuals are primarily responsible for improving their own health and well-being.

7. RESPECT - We respect the rights, dignity, independence and privacy of our clients and we will provide services directed to their needs.

8. SAFETY AND QUALITY - We provide evidence-based health services that deliver safe and high-quality health care.

9. PARTICIPATION AND CONSULTATION – We engage with and listen to our communities, those who use our service, our staff members and our service partners

Alignment with State and Commonwealth Policy Directions The development of the Service Plan has taken into account the following policy contexts.

Victorian Policy Directions At the state level, the Victorian government has established a 20-year plan for design, service and infrastructure for Victoria’s health system (2017-2037) that envisages the characteristics of the future health system. Alpine Health has been working towards these goals through its past two Service Plans, and this current Service Plan is also intentionally shaped towards the following outcomes:

 Strong focus on prevention and early response, with a balanced approach to care delivered in hospital and community settings  Funding flexibility to encourage innovation  Predictive and proactive health system, bringing together patient experience and outcomes, safety and quality data, new technology and research  Empowered patients who direct how care is designed  A system where home health and community health are central, with acute hospitals being designed and used for emergency and acute care only  Place-based approaches to planning, ensuring services are responsive to local need  Closely integrated health and social care systems, with a focus on prevention

Health 2040: Advancing health, access and care1 This Victorian State Government plan provides an overarching strategy for Victoria’s health. The vision is for all Victorians to have:

• Better Health – skills and support to be healthy and well • Better Access – fair, timely and easier access to care • Better Care – world-class healthcare every time.

Relevant to Alpine Health directions, the key actions are:

1. A stronger focus on prevention and early intervention 2. Need to redouble our efforts to provide integrated, holistic care that recognises physical, mental and other health issues are integrally linked. 3. Need to build services around multiple needs by working in partnership with services, communities, families and carers 4. Need to do more to support people who are disadvantaged 5. Need to leverage technology to innovate our service models, treatment and communication 6. Need to be better at working together with people, supporting them to make decisions about what is right for them.

Victorian Health Priorities Framework 2012-2022 Alpine Health has been working towards the Victorian Health Priorities Framework 2012-2022: Rural and Regional Health Plan since its release in May 2011. It includes addressing long term challenges such as the disparity in health behaviours and health outcomes in rural communities, disadvantage, health literacy, access, and being flexible to respond to changing community needs.

The priorities are:

1 Victorian Government, 2016

 A system that is responsive to people’s needs  Improving health status and health experience  Expanding service, workforce and system capacity  Increasing financial sustainability and productivity  Implementing continuous improvements in innovation  Increasing accountability and transparency  Utilising e-health and communications technology

Department of Health and Human Services Strategic Plan 2017 The Department of Health and Human Services Strategic Plan sets out 4 underlying principles, 27 departmental priorities and 8 enabling actions to be delivered by December 2018.

The principles include;  Person-centred services and care – the whole person: physical, cultural and social context  Local solutions – one size does not fit all  Earlier and more connected support  Advancing quality, safety and innovation

Targeting Zero (Duckett Review) 2016 The review was a detailed and extensive analysis into how the Department of Health and Human Services oversees and supports quality and safety of care across the Victorian hospital system.

The resulting report ‘Better, Safer Care – Delivering a world-leading healthcare system’ established recommendations under four areas of emphasis:

 Setting the goal that no one is harmed in our hospitals  Supporting strong leadership in hospital governance – with good clinical leaders, effective boards and rigorous oversight  Sharing excellence across our health system – so that where one hospital does something well, others can follow suit; and  Collecting great data about patients’ experiences and feeding that back across the system to improve patient care

The Travis Review 2015 The Travis Review: Increasing the capacity of the Victorian public hospital system for better patient outcomes, offered 32 recommendations to improve the capacity of Victoria’s public hospital system. These included the need for a state-wide design, service and infrastructure plan (completed) that addresses the “mismatch between facilities, funding and demand” to ensure services are “fit-for-purpose” and the need for new ways to measure activity given the change in service delivery (away from inpatient beds) and that answer the publics questions of “will I get treatment and how long will it take?”.

State-wide Design, Service and Infrastructure Plan 2017-2037 The State-wide Design, Service and Infrastructure Plan for Victoria’s Rural and Regional Health System 2017- 2037 provides a strategic 20-year plan for Victoria’s public hospitals. It aims to align health service demand with recurrent and infrastructure funding and propose reforms to the planning and funding of Victoria’s health and community services.

This Victorian State Government plan was developed from a recommendation of the Travis Review and provides a strategic 20-year plan for Victoria’s public hospitals.

The five priority areas are:

1. Building a proactive system that promotes health and anticipates demand

2. Creating a safety and quality led system 3. Integrating care across the health and social service system 4. Strengthening regional and rural health services 5. Investing in the future

Regional partnerships looks to redefine the role of rural hospitals and their relationships with larger regional centres with an overall goal of improving regional self-sufficiency (everything you need closer to home). It includes improved access to specialists, improved patient flows, and improved clinical governance. Actions include agreed referral and transfer pathways, workforce training and development, and telehealth initiatives.

The Health and Well-being Hubs extend the Multi-Purpose Service concept of integrated and coordinated services, putting the person at the centre and acknowledges the broader context of their circumstances. The hubs are where a range of health and social services can be coordinated from and/or delivered from a single location. This aims to support people accessing and navigating the complex health service system. It is particularly designed to assist the most vulnerable and disadvantaged who are at greatest risk of being admitted to hospital for avoidable reasons.

Australian Government Policy Directions The Australian government is also a key partner in the Multi-Purpose Services Program and provides funding to Multi-Purpose Services for integrated health and aged care and community services in small regional and remote communities. Multi-Purpose Services are administered under the flexible provisions of the Aged Care Act 1997 and their associated Aged Care Principles. This includes principles for service delivery and management that are based on person directed care in residential and community settings.

The objectives for Multi-Purpose Services are to provide rural and remote communities with:

 improved access to a mix of health and aged care services that meet community needs  more innovative, flexible and integrated service delivery  flexible use of funding and/or resource infrastructure within integrated service planning  improved quality of care for clients  improved cost-effectiveness and long-term viability of services

These are primary objectives of Alpine Health and are fully supported and integrated into this Service Plan.

Primary Health Networks Primary Health Networks (PHNs) have been established to increase the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care, in the right place, at the right time.

PHNs undertake population health planning in conjunction with local health organisations, and identify key PHN priorities to improve health outcomes and reduce hospital pressure. The Federal Government has set six key priority areas for PHNs targeted work in mental health, Aboriginal and Torres Strait Islander health, population health, health workforce, eHealth and aged care.

The Murray Primary Health Network sets strategic health priorities for the catchment including Alpine Health. The current Murray PHN priorities are:  a strong focus on General Practice, which is at the heart of primary health care  potentially avoidable hospitalisations  chronic diseases: diabetes, heart disease, COPD, and cancer

Aged Care Reforms The Commonwealth Government’s vision is to ensure Australia’s aged care system is sustainable and affordable, offers greater choice and flexibility and supports people to stay at home and part of their communities as long as possible.

Reforms have included the introduction of new Home Care Packages and a fee framework for the Commonwealth Home Support Program, the establishment of My Aged Care, the Aged Care Quality Agency and Aged Care Pricing Commission, and the introduction of the voluntary quality indicators for aged care.

Changes to be implemented in the next 5 years include the development of a single quality framework that will increase the focus on quality outcomes for consumers. Additionally, a review will be undertaken to assess the impact of the reforms to date and determine the next steps to take the system into the future. (Australian Government, 2018).

Rural and Remote Health The National Strategic Framework for Rural and Remote Health (2016) promotes a national approach to policy, planning, design and delivery of health services in rural and remote communities. The Vision is: People in rural and remote Australia are as healthy as other Australians.

The strategy aims for rural and remote communities to have:

1. Improved access to appropriate and comprehensive health care 2. Effective, appropriate and sustainable health care service delivery 3. An appropriate, skilled and well-supported health workforce 4. Collaborative health service planning and policy development 5. Strong leadership, governance, transparency and accountability.

Introduction

Purpose of the Service Plan The Service Plan sets out Alpine Health’s strategic directions and priorities for the next 5 years from 1 July 2018 – 30 June 2023. It details the level and type of services provided for, and used by the community. It describes the community’s demonstrated health and aged care needs, and how Alpine Health will work (as an organisation and in collaboration with other services) to develop effective integrated health and aged care that will best meet the community’s needs.

This is the seventh Service Plan for Alpine Health. Each Service Plan has been themed.

Service Plan 4 (2005-2008) Improving Our Health Service Plan 5 (2008-2013) Building for the Future Service Plan 6 (2013-2018) Keeping Local Services Local

The theme for this Service Plan (2018-2023) is: Investing in Our Health – What Matters.

The Service Plan provides the overarching directions and evidence for service development and delivery over the next five years. It will guide the successive development of more detailed annual Corporate Plans and a number of internal plans (workforce, asset management, community development, marketing and information and communications technology for example) for its implementation.

Service Planning Framework The service planning framework used for the development of this Service Plan is based on a model of community needs assessment, organisational capacity assessment and trend analysis to identify service

• Population Health Status Analysis • Community Perceptions Of Health Status And Service Needs • Perception And Expectations Of External Service Providers Community Health Needs Analysis • Analysis Of Current/Projected Workloads And Capacity • Review Of Mission, Vision, Goals, and Values • Assessment Of Current Capital Stock Organisational Capacity • Workforce Analysis (Skills, Education And Distribution) Assessment

• Social Health Trends • New Emerging Health Issues Future Trend Analysis • New Clinical Technology& Treatment • Environment • Information and Communication Technology

Strategy Formulation • Review Service Profiles • Workforce Development Plan • Capital Development Plan Implementation Planning • Develop New Service Profiles • Communications and Marketing Plan

• Measuring Health and Health Gains Evaluation • Annual Capital Plans

opportunities, and enable the formulation of formulate strategies, for implementation planning and the determination of future resource and capital requirements.

The Service Plan comprises strategies to increase the capability and capacity of Alpine Health to provide sustainable health services to our communities in the future. There were several different quantitative and qualitative approaches used to collect data to identify health needs, support the development of the Service Plan, and inform strategic decision-making.

The strategies have been formulated following:  extensive consultation with the community, service partners, staff and other key stakeholders  analysis of population health profiles and projections  identification of future trends likely to impact on our communities through trend analysis scenario planning  analysis of current service provision and service networks and partnerships  identification of service opportunities  analysis of workforce capacity and capability  analysis of current infrastructure capacity Methodology A Project Control Group was established to oversee the development of the Service Plan, and provide advice, data sources, and feedback.

Community needs assessment was determined through three lenses:

 Statistical and data analysis: service use, community health indicators, population characteristics and changes (needs and gaps)  Market analysis: government policies and directions; local, sub-regional and regional health system; other service providers (how needs are currently met, priorities, collaborations, service gaps and opportunities)  Community voice: service use and experience, projected service use, testing the reliability of data with community feedback and system information

Determining service needs – Alpine Health Service Plan

 Data  Australian Bureau of Statistics (ABS)  Australian Institute of Health and Welfare (AIHW)  Victorian Population Health Survey  Health Service use data  (Data sources and references are provided in Appendix)  (a full data set has been provided separately for staff and service use)  Market  State and Federal Policies and Strategic Plans  Quality Standards  Staff consultation (n=62)  Key stakeholder interviews (n=65)  Key stakeholder Strategic Plan review  Community Voice  Community and Health Advisory Groups (3 groups x 4 meetings)  Community Survey (n=1,547)  Community and Key Stakeholder Workshop (n=60)

Reference: Diagram reproduced in this document courtesy of Murray PHN

The consultation approach was led by and developed with the Community and Health Advisory Groups of Bright, Mount Beauty and Myrtleford. They identified target groups and preferred methods for participation, promoted the community survey, spoke to and engaged with a wide range of community groups and organisations, encouraged respondents to the community survey to ensure a demographic ‘fit’ between respondents and community profile. This consultation was conducted from November 2017 to August 2018.

Stakeholder interviews were conducted by phone and face to face including meetings with the Board Chair and CEO of Alpine Health and Chairs and Senior Executives of Albury Wodonga Health, Beechworth Health, Gateway Health, Murray PHN, and Northeast Health Wangaratta. Interviews were conducted with 65 individuals from service providers, stakeholders and key user groups.

Staff were engaged through an internal survey and workshop. Staff members were actively involved in a scenario planning workshop and future directions forum. Most staff members of Alpine Health are also community members and have valuable professional as well as community/user views and experiences.

Service plan directions were determined through a Future Directions forum conducted in May 2018. Directions were tested against the Scenarios, and then presented to and workshopped with the Alpine Health Board, and three Community and Health Advisory Groups. Community Consultation The consultation process was designed to follow the core values for public participation2 as developed by the International Association for Public Participation:

 Public participation is based on the belief that those who are affected by a decision have a right to be involved in the decision-making process.

 Public participation includes the promise that the public's contribution will influence the decision.  Public participation promotes sustainable decisions by recognising and communicating the needs and interests of all participants, including decision makers.  Public participation seeks out and facilitates the involvement of those potentially affected by or interested in a decision.

 Public participation seeks input from participants in designing how they participate.

 Public participation provides participants with the information they need to participate in a meaningful way.  Public participation communicates to participants how their input affected the decision.

The primary community survey tool was distributed to all households, and available on-line with 1,547 surveys returned. Survey findings were tested at a Future Directions Forum held in May 2017, and through the Community and Health Advisory Groups.

Survey respondents were asked to answer:  Demographic questions (Age, location, household size)  Self-assessment of current physical and mental health  Knowledge about health services, and accessing services  “Healthy” behaviours  Connection with community

2 www.iap2.org International Association of Public Participation

 Use of Alpine Health Services, and how well they met needs  Suggested improvements to current services  Health information  Importance of specific health services to meeting current personal and family needs  Importance of future health services (projected needs)

Scenario Planning Scenario planning was undertaken in April 2017 with government agencies, regional and community health services, board, staff and community input. Three scenarios were developed to test the robustness of strategies resulting from this service plan.

For purposes of the Service plan, three scenarios were developed in 2017:

Scenario 1: Working Together for Health and Wealth

A relatively benign scenario in which there is a sound socioeconomic environment, but the need for care is high and both professional and voluntary support are reasonably available

Scenario 2: Struggling to Meet Needs

A much more difficult scenario in which the socioeconomic position is difficult, the need for care is high and voluntary support is available but professional care is scarce.

Scenario 3: Maintaining Good Health

A world of relatively slow economic growth but reasonably low care needs, but one in which both voluntary and professional care are difficult.

Context

Alpine Health – A Multi-Purpose Service Alpine Health is a Multi-Purpose Service funded by both the Commonwealth government and the Victorian state government. It is the largest health service organisation servicing the communities of the Alpine Shire, employing almost 200 staff (full time equivalent) and with over 350 volunteers. Alpine Health is also the provider of Commonwealth Home Support Program services to the communities of the Indigo Shire in partnership with Beechworth Health Service, Indigo North Health and Yackandandah Health (from July 2018).

Alpine Health provides integrated acute health, community health, community and aged care, and education services for residents and visitors of the Alpine Shire. There are three sites - Bright, Mount Beauty and Myrtleford - in addition to home based and community services, support services and flexible residential aged care across the whole of Alpine Shire.

This Service Plans sets out the strategic directions for Alpine Health to respond to the health and well-being needs of the Alpine Valleys communities. It builds on the overall health and service improvements that have been made over the last decade, with a focus on service delivery. The Service Plan is based on an understanding of what matters to consumers now and in the future, and where and how to invest and shape the best possible services and infrastructure to meet community needs.

Current Situation Alpine Health has worked continuously to build a strong organisation and is now in a position that enables innovation, flexibility and responsiveness:

 The organisation provides a desirable range of quality services, valued by the community and meeting internal and external quality and safety assurances  There are strong partnerships with key stakeholders and the community  It is financially strong, with income from multiple sources, and successful sustainability strategies are well established  It has demonstrated innovation and ‘outside the square’ thinking to meet challenges in attracting and retaining skilled workforce, developing flexible services tailored to individual needs, and working through health service reforms at both state and federal level

Alpine Health’s financial position is the strongest achieved since amalgamation and continues to improve. This has enabled the organisation to invest in new and upgraded equipment, grow its expenditure on asset maintenance and improvements, and extend its workforce development and training, and service development for the future.

Community participation in the governance, management, leadership and delivery of services has continued to grow. Three dedicated Community and Health Advisory groups provide immediate feedback on service quality and delivery, and community needs. They are involved in all aspects of planning including scenario planning, service planning, corporate planning and specific program plans. More than 350 volunteers are involved directly in committees, Boards (Alpine Health and Communities that Care), and service delivery through Op Shops, Men’s Sheds, support groups for arthritis, dementia, diabetes, cancer, anxiety, autism spectrum disorders, aged care, aged care advocacy, visiting services, women’s health, mental health and patient transport. Members of the Alpine community also serve on advisory committees to Murray PHN. Volunteers complement the paid workforce of Alpine Health, and through a single registration system, they are valued as part of the workforce, and provided corporate support, workforce training and development.

Alpine Health has been able to maintain service levels and accommodate changing levels of demand whilst working through the significant reforms in acute hospital funding, aged care, and primary care funding and services.

Since the last Service Plan, service changes have been made in response to changing community needs, and policy and funding reforms:

 Introduction of a national pricing system for hospital services and reduced private health insurance support for private inpatients has been managed through changing patterns of demand for acute hospital services  Cessation of birthing services in 2016 in response to declining demand. However, this has been replaced with very strong sub-regional approach to obstetric services and partnerships with Northeast Health Wangaratta and Albury Wodonga Health to deliver quality, safe, tailored, specialised services and increase options for women and families  Significant declines in demand for low level residential aged care services at Hawthorn Village, and rapidly increased demand for community aged care services have led to changes in residential aged care use of beds for respite care, adoption of Montessori Model of Care, and employment of a Nurse Practitioner at Hawthorn Village.  Primary Health Care reforms and the establishment of Murray PHN have enabled expansion of Health Promotion and Primary Intervention services  Commonwealth Home Support Programs (previously Home and Community Care) services hosted by Alpine Shire have been integrated into Alpine Health from Alpine Shire and expanded to include the Indigo Shire  Establishment of the Alpine Institute, Registered Training Organisation  Expansion of Commonwealth Home Support Program  Community aged services provision in conjunction with Beechworth Health, Indigo North Health and Yackandandah Health

Service Plan Implications

Future service planning will need to consider the following:

 The MPS sector in Victoria is small and at risk of being disadvantaged by broad based national and state-wide reforms. As a result, Alpine Health needs to have a voice in the national review of the MPS program in 2018/19 and continue to build its financial sustainability.  Alpine Health will be involved in the national review of the Multi-Purpose Service Program and participate in the Royal Commission into Aged Care Quality and Safety to the extent required  We will work to align our aged care services with the national aged care quality framework and prepare for revised standards and reporting requirements  We must shift gears to new levels of working with our communities on prevention and early intervention and working holistically to support people in their context with joined up service support.  We need to continue our commitment to local service provision and explore opportunities for new models of care by working with our regional service partners for improved clinical governance, patient outcomes and patient experiences.  Alpine Health taking a leadership role in designing and trialling innovative solutions to improved health and community services proposed by State Government.  The exploration of new technology tools that Alpine Health will need for it to be a modern, fit for purpose, connected health service with strong clinical governance and impeccable safety and quality.  The shift to person-centred care will need a change in our thinking of the ways that services are provided, and place more emphasis on communication and participation with service users and their carers

 Increased service delivery in the home, and new technology will be key drivers of change, with resulting shifts needed in workforce distribution, training, and access, and consideration of socialisation/potential for isolation

 Consumers want health systems and information to adapt to their needs, and are increasing comfortable with wearable technology, on-screen direct communication with remote specialists, digital services, E-health and shared records are still controversial, but with longer-term likelihood of adoption

 Safety, quality and evidence-based practice is imperative and there is the need to develop this across the ‘system’ of multiple agencies, to flow with the consumer all the way through their health interactions

Community Profile

Alpine Shire Alpine Health provides a range of services across the Alpine Shire which is in the North East of rural Victoria, approximately 270 kilometres from Melbourne.

The Alpine Shire covers 4,787 square kilometres with a significant portion being forest and national parks (Mount Buffalo and Alpine National Parks).

The population of 12,515 people is spread over 40 localities within the Shire and the major towns of Myrtleford, Bright and Mount Beauty.

The mountainous topography of the Alpine Shire has influenced transport routes, population movement and town development. Myrtleford and Bright are in the Ovens River Valley in the western sector of the Shire and relate naturally to Wangaratta as the regional support centre, while Mount Beauty is in the Kiewa River Valley in the eastern sectors and relates to Wodonga and Albury.

Table 1: Alpine Shire Townships and Localities

Postcode Township / Locality Postcode Township / Locality 3691 Coral Bank, Dederang, Glen Creek, Kancoona, 3738 Ovens Mongans Bridge, Running Creek, Upper 3739 Eurobin Gundowring 3740 Brookside, Buckland, Mount Buffalo, Porepunkah 3697 Tawonga 3741 Bright, Freeburgh, Germantown, Harrietville, 3698 Tawonga South Hotham Heights, Mount Hotham, Smoko 3699 Bogong, Falls Creek, Mount Beauty 3744 Wandiligong 3737 Abbeyard, Barwidgee, Buffalo Creek, Buffalo 3898 Cobungra, Dinner Plain River, Dandongadale, Gapsted, Havilah, Merriang, Mudgeegonga, Myrtleford, Nug Nug Rosewhite

Population and the Demographic Changes Three elements of population influence service planning3:

1. Population size – determining the scale of demand 2. Population distribution – determines the location of demand and; 3. Population composition e.g. age, gender, occupation – determines the dimensions of demand

Alpine Shire population characteristics

12,515 population 75% Live in the west 7,188 households 2.2 people per household We are older and ageing faster We mostly speak English Small growth rate (0.73% P.A) High visitor numbers (737,200 in 2017)

The Alpine Shire has a population of 12,515 people (idProfile, 2018) with a relatively even number of males and females (49% and 51%). The population in the Alpine Shire is older and growing older faster than regional Victoria with a median age of 49 years (compared with 37 years) and 23.7% being over 65 years (compared with 19.6%). Those aged over 65 years in Alpine Shire is projected to increase to 27.3% by 2021 (see figure 1 and 2).

The population is spread across 40 communities, each with a slightly different age distribution. Most of the residents live in the west (75%) of the Shire with Myrtleford having the largest population (25%).

From 2011 to 2016 the population increased by 441 people (3.7%). This represents an average annual population change of 0.73% per year. The largest changes were:

 Empty nesters and retirees (60 to 69 years), an increase of 267 people  Seniors (70 to 84 years), an increase of 180 people  Parents and home builders (35 to 49 years), a decrease of 127 people  Babies and pre-schoolers (0 to 4 years), a decrease of 105 people

Whilst there will be minimal total population growth predicted, there is a marked change in the structure of the population, with a reduction in those aged under 19 years and aged between 40 and 59 years, and a significant increase in those aged over 65 years. This pattern of change in population structure is predicted to continue (see Figure 1).

3 Detailed data tables are in the accompanying Alpine Health Data Report.

Figure 1: Alpine Shire and Victorian Population Projections: Over 65 years 2011-2031

Population Projections - Over 65 years - Alpine Shire and Victoria 40.00

30.00

20.00

10.00

0.00 2011 2016 2021 2026 2031

Alpine Shire % over 65 years Regional Victoria - % over 65 years

Figure 2: Change in age structure, 2011 - 2016

Figure 3: Alpine Shire population projections 2016 – 2026 (Department of Environment, 2016)

Alpine Shire Population Projections 2016 - 2026 1,200

1,000

800

600

400

200

2016 2026

Cultural diversity is comparatively low. Aboriginal and Torres Strait Islander people represent 0.8% of the population, lower than the regional average of 1.6%. Whilst 23.6% were born overseas only 7.3% were born in non-English speaking countries, the highest being Italy (278) and only 0.7% have difficulty speaking English.

Employment is slightly higher than the regional average at 96.2% compared to 94.0%.

Tourism is the largest industry in Alpine Shire and represents a higher industry percentage than Regional Victoria (13.7% compared with 7.0%). Consequently, there is a large temporary population in the Alpine Shire at any one time. This industry is growing with over 432,000 domestic overnight visitors and 10,200 international overnight visitors during January-Dec 2017 (up by 16.3% and 29.7% respectively from 2016). There were also 295,000 domestic day trip visitors (up by 50.7% from 2016). (Alpine Shire Council, 2018).

Community Health Indicators

The following summary highlights where Alpine residents rate better or worse in comparison to other regional Victorian local government areas (LGAs). Whilst a summary has been included in this section, detailed data tables have been provided in a separate report.

The Strengths… Improvements Needed…

 Life Expectancy – especially  Respiratory disease, cancer, Alzheimer’s/dementia rates females  Avoidable deaths from cardiovascular disease  General health and mental  Mental health conditions well-being  Excessive alcohol use  Feeling safe  Acute conditions  Obesity rates – especially  Influenza Rates males  Child emotional / behavioural problems at school entry  Low intentional injury rates  Child protection  High cancer screening  People reporting poor to fair health participation rates  Some pockets of highly disadvantaged people  Low rates of asthma and  Physical inactivity – especially females high blood pressure  Not meeting dietary guidelines - especially males  Birth weights, Breastfeeding at 3 months and Immunisation

Standout features of the available data:

 Well-being - Whilst Alpine Shire has a relatively good level of self-reported general health there is a higher than average number of people reporting poor to fair health, especially males (19%).

 Pockets of disadvantage - Alpine Shire overall scores mid-range better than the rest of Victoria on the Social Economic Index scale, however there are specific communities with higher levels of disadvantage. These include Mount Beauty/Bogong and Myrtleford (and neighbouring villages).

This level of disadvantage affects people’s health in many ways including delaying medical consultations (16.9%), delaying purchasing medications (11.3%), food insecurity (5.1%) and mortgage stress rental stress (14.9%) and rental stress (25.6%). It may also influence the low number of houses with internet connections (55.23%). Typically, single parent families are at risk of financial disadvantage. In Alpine Shire 11.9% of families are single parent families (like Vic) with a higher than average proportion of male head single parent families (21.6%).

 Safety – The residents of Alpine Shire feel safe walking on the streets alone (96%) and there were less family violence incidents, less crime incidences and slightly less drug offenses than the state average. However, there were a higher number of substantiated child protection investigations than the state average (Alpine 12.2 per 1,000 population, compared to 11.4 per 1000 population for Vic).

 Mental Health – Whilst Alpine Shire has a very small proportion of residents reporting a high degree of psychological distress and intentional injury, there are a higher than average number of registered mental health clients than the state average (19.1 per 1,000 compared with 11.9 Vic) and a higher number of people with chronic mental health conditions (19 per 1,000 population compared with 13.5 Vic).

 Chronic Disease – Alpine Shire residents report much less than average rates of asthma and high blood pressure rates, and slightly less than average rates of arthritis, heart disease/stroke/vascular disease, osteoporosis and poor oral health. However, residents report a much higher rate of respiratory disease (Chronic Obstructive Pulmonary Disease 3.69 compared to Vic 2.54 per 1,000 population) and cancer incidents in males (8 per 1,000 population compared to 5.6). Residents also report slightly higher than average rates of cancer in females (9 per 1,000 population compared to 4.8) and Alzheimer’s/Dementia (22.5 per 1,000 population compared to 16.8). Admissions to all health services for patients from Alpine Shire show a higher rate of admissions than state rates for Chronic Obstructive Pulmonary Disease (COPD) and Congestive Cardiac Failure (CCF)

 Chronic Disease Risk Factors – The biggest chronic disease risk factor concern for Alpine Shire is the higher than average number of people at risk of harm from alcohol consumption, both on single occasions (56.1% compared to Vic 42.5%) and over a lifetime (71.5% compared to Vic 59.2%). Other areas of concern include physical inactivity and diet. Physical activity guidelines are not being met, especially females (66.9%). Dietary guidelines are not being met by more than half of males (50.1%) and over one third of females (34.7%). Smoking rates are slightly lower than the Victorian rates (12.7% compared with 13.1%).

 Acute Conditions – Alpine Shire residents have a higher than average rate of acute conditions than the Victorian average (9.7 per 1,000 population compared to 11.2).

 Health Screening – Alpine Shire residents have a higher than average rate of participation in cancer screening (breast, bowel and cervical) than the state averages.

 Communicable Disease -Mostly, Alpine Shire residents have much lower than average reportable communicable diseases (Pertussis and Chlamydia) and around state average for Influenza.

 Child Health – Overall the children in Alpine Shire have better than average rates of birth weights, breastfeeding, immunisation, kindergarten participation and speech and language development. Slightly higher than average rates are also present for child first assessments, attending 3 years old maternal and child health checks and multiple child development vulnerability measures. An area for consideration however is the slighter higher rates of children with emotion/behavioural problems at school entry. Additionally, there has been a decline in physical health and well-being and social competence (2009 – 2015).

 Avoidable Morbidity – The median age of death in Alpine Shire is the same as Victoria (82 years). Females in the Shire live longer than males (84.8 years compared to 78.5 years). Alpine Shire has a much higher than average rate of avoidable deaths (under 75 years) from cardiovascular disease (31.3 per 100,000 population, ranked 16 compared to 23.0).

Our Health Indicators

Key

Rankings represent the 79 Victorian LGAs and are Much better than all Victorian LGA’s based on who has the most of something e.g. Mid-range better than all Victorian LGA’s  Family Violence - 1 is Worst and 79 is Best Mid-range worse than all Victorian LGA’s  Immunisations – 1 is Best and 79 is Worst Much worse than all Victorian LGA’s

Alpine Shire INDICATOR Alpine Shire Victoria Comparison Rank POPULATION CHARACTERISTICS Self-reported general well-being 8.1 7.8 Self-report fair or poor health status – NB males 19.3% 10 15.9% 20.8% Percentage highly disadvantaged 23.8% 33 20.0% Socio Economic Status - SIEFA Index 994 4th quintile 1010 SIEFA Index – Mount Beauty/Bogong, 945 / 958 2nd quintile Myrtleford People with less than $400 per week 44.8% 21 39.9% People who delayed medical consultation 16.9% 19 14.4% because they could not afford People who delayed purchasing prescribed 11.3% 54 11.1% medication because unable to afford Non-indigenous total household median weekly $1,000 - $1,422 income Indigenous total household median weekly $1,104 - $1,422 income Food Insecurity (2011 data) 5.1% 30 4.6% Unemployment (Sept 2015) 4.4% 59 6.3% Social housing as a percentage of total 1.5% 62 3.9% dwellings Households with mortgage stress (2011) 14.9% 12 11.4% Households with rental stress (2011) 25.6% 35 25.1% Low income families with children 7.1% 57 8.7% Single parent families 11.9% 68 15.5%  Male head – single parent families 21.6% 9 17.2%  Female head – single parent families 78.4% 71 82.8% Population completed higher education 39.7% 43 45.7% qualifications Computer/internet access (Hume avg 63.74%) 55.23% - 70.64% Age pension recipients per 1,000 743.4 42 707.4 Aged 75+ who live alone – total population – 36.3% 52 35.9% NB/ mostly females 74.3% Disability support pension recipients per 1,000 64.1 42 51.3 Severe/profound disability in the community – 4.1% 48 4.0% all ages Severe/profound disability in the community – 10.7% 62 13.7% over 65 years SAFETY People who feel safe on the street alone 96.9 3 92.5 Family violence incidents per 1,000 population 6.8 67 12.4 Child protection investigations substantiated per 12.2 34 11.4 1,000 population Total number of crime offenses per 1,000 41.8 69 82.6 population Drug possession offences per 1,000 population 3.6 48 5.1

Alpine Shire INDICATOR Alpine Shire Victoria Comparison Rank

MENTAL HEALTH People who have a high degree of psychological 8.2% 68 18.3% distress Registered mental health clients per 1,000 19.1 15 11.9 Chronic Mental Health Conditions per 1,000 19 - 13.5 population People sleeping less than 7 hours per day ? ? ? People with adequate work-life balance 44.6% 65 53.1% Intentional Injury treated in hospital per 1,000 2.3 53 3.0 CHRONIC DISEASE RISK FACTORS Pre-obesity - all 30.2% 47 31.2%  Females 23.9% 43 24.3%  Males 37.4% 45 38.4% Obesity - all 13.5% 71 18.8%  Females 16.4% 58 17.2%  Males 10.8% 75 20.4% Not meeting physical activity guidelines – males 54.6% 37 54.0% females  Females 66.9% 3 56.1%  Males 42.5%, 71 52.0% Not meeting dietary guidelines for either fruit or 41.9% 71 48.6% vegetable consumption  Females 34.7% 68 43.4%  Males 50.1% 63 54.0% People who drink soft drink every day 12.5% 44 11.2% Smoking rates 12.7% 49 13.1% Alcohol – lifetime risk of harm 71.5% 59.2% Alcohol – people at risk of harm on a single 56.1% 6 42.5% occasion People who received alcohol and drug 1.0 78 5.0 treatments per 1,000 population CHRONIC DISEASES Asthma 7.2% 76 10.9% Type 2 diabetes 5.0% 35 5.0% High blood pressure 21.8% 67 25.9% Heart disease, stroke and vascular disease 6.8% 43 6.9% Osteoporosis 5.2% 44 5.3% Arthritis 19.3% 54 19.8% Chronic obstructive Pulmonary Disease (COPD) 3.69 2.54 admissions per 1,000 population Alzheimer’s / Dementia per 1,000 population 22.5 23 16.8 Cancer incidence per 1,000 population 7 21 5.2 Cancer incidence per 1,000 males 8 17 5.6 Cancer incidence per 1,000 females 9 26 4.8 People reporting poor oral health 4.7% 54 5.6% HEALTH SCREENING Breast screening participation, females 50-69 56.3% - 53.6% years Bowel cancer screening participation, persons 45.1% - 41.8% Cervical Screening 66.6% - 57.2% COMMUNICABLE DISEASES Pertussis per 100,000 16.6 77 80.9 Influenza per 100,000 249.4 37 293.8

Alpine Shire INDICATOR Alpine Shire Victoria Comparison Rank Chlamydia per 100,000 166.1 74 330.7 CHILD HEALTH Low birthweight babies 5.6% 62 6.6% Infants fully breastfed at 3 months (2011-12) 61.5% 19 51.7% Child first assessments 2014/2015 16.3% 27 10.1 Children immunised at 60-63 months (2017 100% 1 95% data) Children attending 3-year-old maternal and 70.5% 34 66.1% child health check Kindergarten participation 109.9% 4 98.1% Children with emotional/behavioural problems 5.5% 30 4.6% at school entry Children with speech or language problems at 12.7% 61 14.2% school entry Child development vulnerability – one+ domains 15.7% 54 19.5% Child development vulnerability – two+ domains 7.4% 57 9.5% Adolescents who report being bullied 5.5% UNINTENTIONAL INJURY Unintentional injuries treated in hospital per 52.0 50 61.0 1,000 population Unintentional injuries due to falls 37.1% 47 38.7% MORTALITY Median age of death 82 years - 82 years same Life expectancy – Males 78.5 48 80.3 Life expectancy – Females 84.8 15 84.4 Annual avoidable deaths aged under 75 years – per 100,000  Avoidable deaths - All Causes 95 65 109.0  Indirect standardised death rate 5.6 40 5.3  Avoidable deaths from cancer 20 64 23.8  Avoidable deaths from cardiovascular disease 31.3 16 23.0  Avoidable deaths from respiratory disease na na 8.1 AMBULATORY CARE SENSITIVE CONDITIONS All conditions – per 1,000 population 29.2 32 26.0 Acute conditions per 1,000 population 9.7 14 11.2 Chronic Conditions per 1,000 population 19 64 13.3 Vaccine Preventable conditions per 1,000 0.4 79 1.7 population AVOIDABLE MORTALITY BY CAUSE 2010-2014 data – per 100,000 Cancer - All Causes 26.8 - 31.6 Colorectal cancer 9.6 - 10.1 Breast cancer 5.9 - 17.0 Diabetes 13.0 - 6.2 Circulatory system 33.9 - 39.5 Ischaemic heart disease 25.5 - 25.6 Cerebrovascular disease 6.1 - 9.0 Respiratory system 8.1 - 11.0 COPD 12.4 - 9.9 External causes e.g. falls, burns, suicide na - 14.8 Suicide and self-inflicted injuries na - 12.4 Other External Causes e.g. transport accident, 19.0 - 20.2 drowning Transport accident 8.9 - 9.5

Ref: PHIDU Social Atlas

Service Plan Implications

 There is an increasing need for improved access to Mental Health Services and an imperative for Alpine Health to further develop its existing service capacity to meet the increasing demand for Children, Adolescents, Adults and Aged Care service provision.  There is now greater imperative that strong partnerships are developed with regional and statewide service providers to ensure access to those services that are not available and/or cannot be provided locally. Eg. Pediatric Specialist, Dental Service, Clinical Mental Health Service.  Continue to explore opportunities for using digital technology services to support people in our community.  Continue the development of local services to meet the demand for Cardio and Pulmonary rehabilitation programs and supports.  Explore and develop Alpine Health’s services to meet the changing arrangements for people with a disability that will be accessing service through the NDIS.  Consider options for developing further rehabilitation and convalescent services that can be delivered locally.  Develop services that support the coordination and referral pathways for Alpine Shire residents that improves access to services and support, and their delivery in a timely manner  Further develop our early intervention and health promotion activities that support our community with health literacy and self-management. Encouraging people to take greater responsibility for their own health and well-being.  Consider the opportunities that the Alpine Shire provides, as a local tourist destination for the development of respite, convalescence, and sub-acute care  Support Regional providers to increase their reach into the shire with those services that specialize in Aged Care, Drug and Alcohol and other services as required by our community.  Configure a highly and broadly skilled workforce to meet the breadth of health service needs of Alpine communities  Establish a research capability to best understand community health needs and trends

Services

Structure of Alpine Health Alpine Health is the major health service organisation in the Alpine Shire, employing almost 200 staff (full time equivalent) and with over 360 volunteers and based across the Alpine Shire. Current services

Table 2: Services Provided by Alpine Health Identified by Location

Mount Services Bright Myrtleford Notes Beauty

Acute Hospital and Clinical Support Services Acute Inpatient Services – Urgent Care 9 beds 15 beds 10 beds Service Available 24/7

General Surgical and Procedural Services    Visiting surgeons Endoscopy Services    Visiting surgeons and physicians

Peri-operative Services (Day Surgery)   

Central Sterilizing Services    Ante and Post-Natal Midwifery Service   

Emergency and Urgent Care Services    . Radiology (Basic X-Rays and limited    Ultrasound) Renal Dialysis   

Bed-based Sub-Acute Services   

Palliative Care Inpatient Service    Respite Residential Aged Care   

Residential Aged Care and Support Services

Hawthorn Village (Bright) 40   Barwidgee Lodge (Myrtleford)  30  High Care/Low Care as required.

Kiewa Valley House (Mount Beauty)   20

Diversional Therapy (Residential Aged Care)    Aged Care Packages (Community based – Catchment wide service Alpine and Indigo Shires high and low care)

Commonwealth Home Support Program Catchment wide service Alpine and Indigo Shires Primary Health Care Services Physiotherapy Catchment wide service Inpatient, Home -Assessments Occupational Therapy Catchment wide service Inpatient, Home Assessments

Diabetes Services Catchment wide service Client Diabetes Management

Dietitian Services Catchment wide service District Nursing Services Catchment wide service Home Visits Disability Services Catchment wide service Alpine and Indigo Shires (National Disability Insurance Service) Midwife and Early Parenting Support Service Catchment wide service

McGrath Breast Care Nurse Catchment wide service Assessment and Community Care Co- Catchment wide service ordination 8 week Program in Bright, Mt Beauty & Myrtleford PACE Program (Cardio & Pulmonary Rehab) Catchment wide service which is supported by local private providers. Early Intervention Mental Health Service Rural Child and Adolescent Program Catchment wide service Health Promotion Officer Rural Primary Health Service Program – Catchment wide service Regional Health Service Health Promotion and Primary Intervention Palliative Care Volunteer Service Catchment wide service Support for Volunteer Services – aged care, cancer, diabetes, dementia, autism, Men’s Catchment wide service Sheds and Community Medical Transport Alpine Leisure Group (Planned Activity    Groups)

Mount Services Bright Myrtleford Notes Beauty Alpine Institute Catchment wide service

Certificates 3 and 4 in health services Catchment wide service

First Aid Level 2 and CPR Catchment wide service Bridging Program International Nurses Catchment wide service

Additional services include the Alpine Institute, essential support services (catering, cleaning, gardening, building and asset management) and corporate and business services.

Alpine Shire is well resourced with over 40 organisations providing a wide range of health and community services. These organisations are publicly funded, not-for-profit and private. They provide services either into the Alpine Shire on an outreach basis, or services that can be accessed at regional centres (primarily Albury- Wodonga and Wangaratta).

Murray PHN research indicates a higher than Victorian average number of general practitioners (1.3 per 1,000 population) and higher than Victorian average number of allied health service sites (also 1.3 per 1,000).

Table 3: Services provided by other Health and Community Services to the Alpine Shire community

Delivery method Service Providers Service Description to Alpine Shire Residents Within Alpine Regional centre Type

General Practitioners Myrtleford (3), Bright (4), Mount Beauty (5) Yes

Visiting Medical Specialists Consultation and procedural services (4) Yes Yes North East Health Wangaratta Regional Hospital - Acute specialist inpatient services Yes Yes and radiology by referral

Health Funds Alpine Health to provide Hospital in the Home, Post-Acute Care Albury Wodonga Health Service Acute specialist inpatient services by referral Yes Yes Rural allied health services Hume Region Palliative Care Funds Alpine Health to provide district nursing service. Yes Consultation support (CNSs, grief & loss counselling) Carer Respite & Information HACC: Hospital to Home Yes Service Dorevitch Pathology Pathology collection, testing and results Yes Border Medical Imaging Medical Imaging diagnostic testing and results Yes Pharmacies Medication, screening, information and advice Yes General Practitioners Mental health treatment plan Yes Albury Wodonga Health Service North East Child & Adolescent Mental Health Service Yes

Mental Community Psychiatric Service Health North East Health Wangaratta Inpatient psychiatry, Community psychiatry Yes Yes Carer Respite & Information Carer support Yes Yes Service MIND Outreach support in home Yes Yes Residential and outreach support Australian Primary Mental Psychological Therapy Services (PTS) Low, moderate Yes Yes Health Alliance (APMHA) needs (Delivered in partnership with Alpine Health) Primary Mental Health Clinical Care Coordination (moderate and high needs) Gateway Health Youth, community health, health promotion, drug & Yes Yes

Community alcohol, psych rehabilitation, parenting, relationship Health education, counselling services Goulburn North East Women's Health promotion, and service development Yes Health Service Upper Murray Centre Against Support and counselling Yes Sexual Assault Alpine Shire Immunizations, Maternal and Child Health Yes North East Support and Action Youth support, accommodation support (foster care), Yes Yes Child and Youth for Youth counselling. (School visits: Myrtleford) Department of Human Services Specialist Children's Services, Juvenile Justice, Child Yes Yes Protection, School Health Nurses (Bright and Myrtleford) Family Upper Murray Family Care Foster care, respite Yes

Delivery method Service Providers Service Description to Alpine Shire Residents Within Alpine Regional centre Type

Department of Human Services Disability Support Services Yes Yes

Vision Australia Service Coordination, information referral, adaptive Yes devices, telelinks, talking book library, orientation & Disability mobility, occupational therapy, education and training Scope Australia Speech pathology to schools Yes Yes Disability Advocacy & Support and advocacy Yes Information Service Regional Convener - Office of Visiting - Supported Residential Services, community Yes Yes the Public Advocate disability and Disability houses Community Interlink Early Choices, ABI assisted community living, early Yes Yes intervention Hume Region Aged Care Assessment Yes Yes

Assessment Service Alpine Shire Senior Citizens Yes LaTrobe Community Health Home Care Packages Yes Yes

Aged Community Interlink Home Care Packages Yes Yes Villa Maria Centre Home Care Packages Yes Yes Uniting Care Wangaratta Home Care Packages, Dementia specific respite, host Yes Yes respite care Dept. of Veterans Affairs Fund Alpine Health to provide district nursing, allied Yes Yes health Community Interlink Commonwealth Respite for Carers Yes Yes Myrtleford Lodge Ageing in Place Residential Aged Care Service (60 Yes Yes beds)

Service Activity and Trends Increasing demand for services for the growing population of older people continues. The services in most demand:

 General practice  Urgent care services  Community based aged care services (including home care packages)  Primary mental health services across all age groups  Health promotion and well-being services (diabetes screening, health screening

Service Plan Implications

 There is a growing imperative for health services to work better together in collaboration for innovative solutions that bring the highest quality service delivery. Collaboration is critical to best meet the health needs of the Alpine Shire community. To support this, Alpine Health leads, participates or actively engages in many partnerships, collaborations and alliances.  There is an opportunity to better define clinical pathways and clinical governance for in-patients moving between hospital services  Improve the partnership with local GP’s and pharmacists in meeting the increasing demand for older people staying at home longer.  Consider the service options to support those in our community who have been diagnosed with cancer.  Continue to develop our expertise in case management and brokerage to support people with complex care needs to remain in their own homes.  Develop agreements to enable better, smoother patient flows to and from regional hospitals (these agreements can include funding moving with the patient, clinical protocols, shared care plans).

Service Directions

Service Direction One Creating new services to meet changing community needs We will...  Develop new services to better support our growing aged population  Develop new services to adapt to the introduction of the National Disability Scheme  Establish Alpine Health as the local experts in health services access and navigation  Establish new partnerships to better address complex care needs especially for the disadvantaged  Establish additional local access to specialist services including dental  Work with our service partners to fill gaps in service provision for mental health and alcohol and other drug prevention and treatment.  Work with private service providers to develop new and innovative service models.  Increasing our organisations response to Family Violence in our community.  Grow health promotion and primary health intervention services  Establish/build on partnerships with other health organisations to meet community-based aged care needs  Explore service development and service models to best meet the needs of those covered by the National Disability Insurance Scheme  Investigate Health Services ‘ShopFront’ in conjunction with Gateway Health and other health service providers – to provide face to face one stop community and primary service delivery, health and community information, and assist service navigation  Investigate Service Brokering – delivering health and well-being services on behalf of other agencies  Explore destination health services for post-operative recovery, respite, recuperation– building on landscape beauty and amenity, tourism and hospitality strengths  Increase communities access to rehabilitation programs that support those with Chronic Health issues eg Cardio and Pulmonary Programs.

SUCCESS STORY: Building Youth Mental Health and Well-being

Alpine Health auspices Alpine Communities That Care, a community coalition with local schools, community members and agencies that promotes healthy youth development, improves youth health and well- being, and reduces problem behaviours. Significant improvements in school student survey results were achieved between 2009 and 2016 (Years 5 6, 7 and 9) with success in reducing targeted risk factors and increasing targeted protective factors.

Alongside this program, Alpine Health has continued its long-term continuous investment in early intervention and prevention services for young people. This includes place-based youth workers, school-based counsellors, and strong partnerships with regional specialist youth services. No youth suicide has occurred in the Alpine Shire for nearly 20 years. Anecdotally, the strength and support of the community and services has influenced this outcome. This presents a unique research opportunity/case study to find and replicate the success factors (which are counter to rural and regional Australian trends).

Service Direction Two Improving service delivery through person-centred practice and safety and quality led systems

We will...  Expand the Alpine Health Home Care Package Program for it to become the service of choice for our local communities  Improve our Urgent Care service and increase access to general practitioners after hours and on weekends  Work with our service partners to review mental health services and make necessary improvements  Continue our investment in addressing family violence  Work with specialised regional agencies to develop access to local alcohol and other drugs services  Trial invest in and make the most of technology to support service improvements and expansion  Strengthen partnerships and establish systems to support Alpine Health become a centre of excellence in recuperation and recovery  Improve care coordination and discharge planning  Improve Ambulance and patient transport service  Participate in the national trial for the new aged care standards and the state and national reviews of MPS model and NDIS implementation  Work with Aboriginal and Torres Strait Islander people to ensure their needs are met in a culturally safe and engaging manner  Improve our mechanisms for measuring and responding to patient experience  Continue to build our service through improved staff and community participation  Focus on person-centred care as the driver of health service delivery, safety, quality and improvement  Sustain basic hospital, residential care, community and primary care services  Build strong clinical governance framework in partnership with eastern Hume regional, sub-regional and small health services to address recommendations of Targeting Zero and changes in the Health Services Act (Vic)  Forge new pathways and agreements with Albury Wodonga Health and Northeast Health Wangaratta to improve patient journey to aid early return to home area; local recovery services; and local palliative care  Improving access to bulk billing medical practices in the community

SUCCESS STORY: Home Care Packages – tailored and successful

The impact of effective, caring, locally based case management and great support services can be life-changing.

Seventy-three-year-old Mr K spiralled downhill after his wife died, and was separated from her grave in Bright whilst he was residing in Myrtleford. With not much to look forward to, his health and wellbeing declined. Every day activities and caring for himself became difficult. His local Alpine Health case manager really took the time to understand what was happening for Mr K. Together they worked out that being close to his wife and living independently would bring some spark back. What seemed out of reach and improbable was supported using resources from Mr K’s home care package, and the skills, care and encouragement of his case manager.

Mr K set his goals with support, and using the care package now:

 Lives independently in a 2 bedroom unit within walking distance of the Bright cemetery and close to support services  Has his new place modified with appropriate fittings  Manages his chronic diabetes and related foot care with the local GP and podiatrist, including correctly fitted shoes, and walking aids  Has immediate access to emergency services with a ‘Find Me’ watch, and medic alert bracelet

Above all, Mr K is happy, active and engaged. He visits the cemetery whenever he needs, takes part in local community events (loves the football) and has regained the confidence to travel independently to Wangaratta occasionally. He continues to be supported in home, and now actively determines and manages his own goals and wellbeing.

Service Direction Three Developing and improving the workforce We will... • Continue to expand the Alpine Institute to provide training that supports and builds our workforce to address changing community needs and supports the implementation of this service plan • Support our staff to maintain and extend their skills to better meet the changing needs of our community and enables them to work at the top of their skill level • Encourage and support our staff to maintain a healthy lifestyle • Build our volunteer workforce through new models of volunteering • Work with Latrobe University, ANMAC, NMBA and other relevant stakeholders to secure the future of the graduate international nursing programs and the establishment of the Diploma of Nursing program • Invest in the necessary administration systems related to workforce management to provide the tools to improve efficiencies • Expand the work of the Alpine Institute to ensure our workforce is able to meet our community needs • Build partnerships to enhance access to increased staff education opportunities • Provide support for our staff to access training that assists with organisational culture and respect • Build multi-disciplinary teams for service development and delivery • Continue investment in service delivery and leadership by volunteers and voluntary organisations • Improve our understanding of the needs of volunteers coming into our workforce. • Investigate the needs of shared workforces working across different organisations and communities in the provision of health services

SUCCESS STORY: Alpine Institute

Alpine Health established Alpine Institute; a Registered Training Organisation that provides Certificate III and IV health training, first aid training and the bridging program for international graduate nurses. The Institute now trains approximately 400 students annually.

The Alpine Institute is a key contributor to workforce sustainability and community strengthening strategy (through education and employment pathways), as well as the financial health and stability of Alpine Health. The Alpine Institute has recently formed a partnership with Latrobe University, extending educational pathway opportunities for students into diploma and degree level education.

Service Direction Four Investing in the future

We will... • Do more to address the needs of people who are disadvantaged • Enable flexibility in our acute hospital services to adjust to fluctuations in patients flow and needs • Alpine Health will be involved in the national review of the Multi-Purpose Service Program and participate in the Royal Commission into Aged Care Quality and Safety to the extent required • We will work to align our aged care services with the national aged care quality framework and prepare for revised standards and reporting requirements • Boost our health promotion, prevention and early intervention services • Expand our palliative care service and address this to take the Voluntary Assisted Dying legislation into account • Help people to better manage their health • Modernise our interface with consumers to improve access to information and services • Improve our antenatal, post-natal and child and maternal health services • Continue to expand the Alpine Institute to serve the needs of Alpine Health, the health sector and our community • Improve our infrastructure to ensure it is fit for purpose, safe and sustainable • Consider opportunities for Digital Storage • Continue focus on strong governance including growth in effectiveness of the Board and clinical leadership, and rigorous oversight in line with evidence based governance frameworks • Invest more in capital planning in light of the new Victorian Health Building Guidelines and investigate developments for Mount Beauty and Myrtleford and expanded and dedicated Alpine Institute facilities • Review and refine Bright Masterplan (in light of private sector investment in residential aged care in Bright) • Establish a population health, health service and health workforce focus for Alpine Health in partnership with Latrobe University

SUCCESS STORY: Community and Health Advisory Groups

Community and Health Advisory Groups (CHAGs) have been established in Bright, Mount Beauty and Myrtleford. Their role has significantly increased, and they are now integral to community and consumer participation with Alpine Health. CHAGs members developed the Service Principles for Alpine Health using community input. They continue to work with the community to help raise awareness that individuals need to be informed and responsible for improving their own health and well-being. They actively advocate for services and community-led responses to building health and well-being eg support groups were initially identified by CHAGs in response to community need. Over 350 volunteers are engaged with Alpine Health.

CHAGs were lead partners in developing and refining this Service Plan and engaging the broader community. The CHAGs co-designed the community engagement approach. They identified target groups and preferred engagement methods. Over 12% of the population responded to the community survey (1,547 people) encouraged by CHAGs members who spread the word about how the community could shape their health directions, presented sessions for community groups, assisted community members to complete surveys, gave considered advice at the Planning Forum, and helped develop future scenarios.