MEDICAL SERVICES Tel: (03) 5320 4278 Fax: (03) 5320 4554

OVERVIEW

FROM EXECUTIVE DIRECTOR, MEDICAL SERVICES FOR THE MEDICAL STAFF GROUP CLINICAL DIVISIONS AND HMOs APRIL 2011

1. BUDGET AND WORKLOAD

The table below shows activity to the end of March 2011. WIES activity at the end of February was 101.67%, just below the upper limit for funding. This increase of just over 2% since the end of February 2011 is partly a result of coding corrections, and aligns with our objective of attaining an activity level as close as possible to 102% at the end of the financial year to support out requests to the Department of Health for additional WIES next year.

Ballarat Health Services Summary of Activity March 2010/11 YTD 2010/11 YTD 2009/10 Change % Change WIES 18,027 17,520 507 2.90% Acute Separations 25,556 24,725 831 3.36% Acute Discharged Bed 59,384 58,782 602 1.02% days 948 973 -25 -2.57% Discharged Births 7,930 8,301 -371 -4.47% Theatre Cases 39,622 37,433 2,189 5.85% Emergency Attendances 32,754 31,564 1,190 3.77% Outpatient VACS 1.158 1,437 -279 -19.42% Waiting List

The YTD figures show an increase of 2.90% in WIES, 3.36% in acute separations, 5% in emergency attendances, and a decrease of 19.42% in the total number of patients on the elective surgery waiting list despite a decrease of 4.47% in operating theatre activity by number of cases since last year. Outpatient VACS activity has increased by 3.7% YTD since last year.

The financial operating result for March is a deficit of $19,000, which is $270,000 ahead of budget expectations; this continues our trend of improvement against our YTD budget, which is a reflection of gains starting to be seen as a result of our cost saving and revenue generating initiatives. The YTD result shows a surplus of $160,000 which is $386,000 worse than budget. Significant deficits continue in Residential Services ($1.7M over budget), Medical Services, ($859,000 over budget), Nursing Services ($671,000 over budget) YTD. The Medical Services budget deficit YTD has declined by $38,000 in the last month. Current indications are that the organisation will achieve a break even result by the end of the 2010/2011 financial year, which will be an outstanding achievement given the funding reductions we experienced in that period.

The Medical Services overspend continues to be largely in the areas of Pathology and Radiology. Medical staff salaries are $1.07M over budget, an increase of $200,000 in the last month. This is entirely due to an increase in base salaries reflecting new staff appointments (a total of just over 13EFT YTD) not included in the budget. Overtime costs have declined from $63,000 over budget YTD last month to $1000 over budget YTD at the end of March.

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A submission for additional funding for 2011/2012 has been sent to the Department of Health, focusing on areas where we have seen significant growth in activity – Cardiology, Oncology, the Short Stay Unit and patients admitted from regional centres such as Maryborough. While it is unlikely that any formal advice on WIES funding for the next financial year will be received before May or June, early signs are that the health budget for next year will be the toughest we have seen in a very long time, and that growth funding will be at best minimal. The cost saving and revenue generating initiatives currently being undertaken will therefore need to continue and it is therefore likely that further similar initiatives will need to be identified and implemented.

2. MEDICAL STAFF

JUNIOR MEDICAL STAFF:

There were no changes in the BHS junior medical staff compliment during March 2011.

SENIOR MEDICAL STAFF:

The following senior medical staff took up new appointments at Ballarat Health Services in March: . Dr Genevieve Flannery, Specialist Physician in Nuclear Medicine . Dr Adam Scheinberg, Specialist Physician in Paediatric Rehabilitation . Dr Michael McDonough, Specialist Physician in Addiction Medicine & Toxicology . Dr Rachel Chang, Dental Practitioner.

On behalf of Ballarat Health Services I would like to offer a warm welcome to these new arrivals.

In addition Dr John Yamba has been recruited as a Specialist General Physician with an interest in Endoscopy and it is hoped that he will join us in June or July. Dr Yamba has spent several years as Head of Internal Medicine at Mt Gambier and his endoscopic skills will be a welcome addition to our repertoire.

3. CLINICAL ISSUES

(i) Performance Monitoring Framework

Ballarat Health Services performance against Department of Health performance monitoring framework in the quarter ending 31st March 2011 was 75 out of 100 points, a 5% increase since the last quarter and comfortably above the 70% benchmark below which performance watch is invoked by the Department of Health. Initiatives to minimize hospital initiated postponements and staphylococcus aureus bacteraemia rates appear to be bearing fruit and have contributed to this improvement. I would like to take this opportunity to thank all staff for their contributions in this area.

(ii) Review of Mental Health Services

Informal feedback from the reviewers indicates that the report of this review is likely to be favourable; we await the formal report.

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(iii) Wound Management

The ongoing wound management program conducted in conjunction with Smith & Nephew is achieving positive outcomes, with any reduction in the prevalence of pressure ulcers at Ballarat Health Services declining from 11% in August 2009 to 6% in March 2011; this improvement has been seen in all directorates with reductions from 26% to 11% in Subacute Services and from 9% to 5% in Residential Services being particularly prominent.

(iv) Short Stay Unit

Following its opening in February, the Short Stay Unit now accounts for 20% of admissions through the Emergency Department, despite being open for only five days out of seven. In March there were a median of 6.5 inpatient episodes per day and 94% of these were discharged home.

(v) Rights of Private Practice

Discussions are in progress with senior medical staff who receive payments in lieu of the Right of Private Practice (with the corrollary that they will donate fees arising from episodes of private care to BHS) to optimize the organization’s income from this source by ensuring that BHS bills appropriate patients on behalf of the practitioner and receives the relevant revenue. This is an important initiative which has the potential to make a major contribution to our ongoing financial viability and I would urge all senior medical staff involved in this process to offer their full cooperation.

4. FACILITIES AND EQUIPMENT

(i) Cardiac Catheterization laboratory

Construction of this facility continues with no further revisions of the schedule. Completion of construction is anticipated in October 2011 although it may be possible to advance this date to September. Thereafter commissioning will take approximately two weeks before operations commence. Operational and financial planning is well underway although operational funding from the Department of Health – as yet an unknown quantity – will be an important consideration. In addition to cardiac services including pacemaker insertion and transosophageal echocardiography, the Cardiovascular Suite will provide additional facilities for interventional radiology and endovascular surgery.

(ii) Ballarat Regional Integrated Cancer Centre

Piling operations for construction of the BRICC foundations commenced on 18th March 2011. To facilitate the construction work the relocation of Dental Services has now been completed, with services on the new site having commenced on 27th April, and the relocation of Pathology has been commenced at an estimated cost of $280,000. Pathology relocation is estimated to be complete on 20th May 2011.

Because of a lack of funding support from the Department of Health, plans to provide 16 inpatient/accommodation beds for cancer services in the BRICC at a

3 cost of approximately $4M have been suspended and it is now anticipated that this accommodation will be provided off site.

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Governance and operational planning for the centre has commenced in conjunction with Austin Health, who will provide staff for the Radiation Oncology component of the BRICC.

The funding received will support an integrated service including 4 radiotherapy bunkers (two fitted with linear accelerators and two spare to allow future expansion), simulation and transit holding areas, 16 day oncology chairs, offices, reception areas, waiting areas and stores facilities.

PHILIP REASBECK BChir MA MBA MD MRCP FRCS FRACS Executive Director of Medical Services

3 May 2011

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