Statement of Priorities

2017–18 Agreement between the Minister for Health and Health Services

To receive this publication in an accessible format phone 9096 1309, using the National Relay Service 13 36 77 if required, or email [email protected].

Authorised and published by the Victorian Government, 1 Treasury Place, . © State of , Department of Health and Human Services, November 2017. ISSN 2206-6675 Available at https://www2.health.vic.gov.au/hospitals-and-health-services/funding-performance- accountability/statement-of-priorities

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Contents

Background ...... 4

Strategic priorities ...... 5 Government commitments ...... 5

Part A: Strategic overview ...... 6 Mission statement ...... 6 Service profile ...... 6 Strategic planning ...... 7 Strategic priorities ...... 8

Part B: Performance priorities ...... 11

Part C: Activity and funding ...... 16

Part D: Commonwealth funding contribution ...... 18

Accountability and funding requirements ...... 19

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Background

Statements of Priorities are key accountability agreements between Government and Victorian publicly funded health, mental health and ambulance services. The content and process for preparation and agreement of the annual Statement of Priorities is consistent with sections 65ZFA, 65ZFB and section 26 of the Health Services Act 1988. Statements of Priorities are consistent with the health services’ strategic plans and aligned to government policy directions and priorities. The annual agreements support the delivery of, or substantial progress towards the key shared objectives of quality and safety, good governance and leadership, access and timeliness, and financial sustainability. A Statement of Priorities consists of four parts:

• Part A provides an overview of the service profile, strategic priorities and deliverables the health service will achieve in the year ahead.

• Part B lists the performance priorities and agreed targets. • Part C lists funding and associated activity. • Part D forms the service agreement between each health service and the state of Victoria for the purposes of the National Health Reform Agreement. Performance expectations and mechanisms used by the Department of Health and Human Services to monitor and manage performance are described in the Victorian Health Service Performance Monitoring Framework 2017-18. High standards of governance, transparency and accountability are essential. In this context, the Victorian Government commits to publish Statements of Priorities by 1 November each year and place more data about the performance of our health system into the public domain.

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Strategic priorities

The Victorian Government is responsible for ensuring that a wide range of health services are delivered to the Victorian community. The Department of Health and Human Services (the department) develops policy, funds and regulates health services and activities that promote and protect the health of Victorians. Through the department, the government funds more than 500 organisations to provide various health services to Victorians. Government commitments The Victorian Budget 2017–18 provides an extra $1.67 billion over four years for health, mental health and aged care services across Victoria, including: • $1.3 billion over four years from 2017-18 to respond to growing patient demand across Victoria. • $325.7 million over four years for mental health and investment in forensic mental health services. • $319.8 million over four years from 2017-18 to provide additional elective surgery funding. • $215.1 million over five years from 2016–17 to implement the recommendations of Targeting zero to put patient safety first. • Building on the investment of $526 million in November 2016, a further $26.5 million will help ambulances respond to every emergency even sooner. To support this investment, the Andrews Labor Government is funding capital projects worth $428.5 million across Victoria. This investment will support the implementation of Health 2040: advancing health, access and care - which presents a clear vision for the health and wellbeing of Victorians and for the Victorian healthcare system.

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Part A: Strategic overview

Mission statement The Vision of Ballarat Health Services is: Excellence in Health Care: Our Patients, Our Staff, Our Community

The Mission of Ballarat Health Services is: To deliver quality care to the communities we service by providing safe, accessible and integrated health services resulting in positive experiences and outcomes.

The Values of Ballarat Health Services are: Teamwork – We commit to common goals based on open and honest communication while showing concern and support for all. We are dedicated to working together for common interests and responsibilities. Respect – We acknowledge everyone’s unique strengths and value diversity. We operate in a spirit of co- operation and honour human dignity. Accountability – We personally commit to delivering our best, taking responsibility for all of our decisions and actions. Compassion – We treat people with kindness and empathy. We care about our patients, our people and our community. Service profile Ballarat Health Services is the main public referral health service to a catchment population of around 250,000 people across the Grampians region and has been providing quality care for more than 160 years. Ballarat Health Services delivers care across all settings: in hospital and increasingly in the community and people’s homes. It is the largest public provider of residential aged care in . Additionally, Ballarat Health Services is the main teaching, training and research provider in the region and does this through affiliations with several universities and teaching institutions. Ballarat Health Services is one of the largest employers in Ballarat, which has a population of over 100,000 people. Our workforce is a key strength of our organisation and the broader community. Emergency Department Annually Ballarat Health Services treats more than 53,300 emergency patients and supports more than 50 patient transfers by air ambulance. Since 2012, there has been a significant increase in the proportion of emergency and urgent cases, and a corresponding decrease in semi-urgent and non-urgent cases. This is consistent with the opening of out-of-hours corporate GP services in Ballarat, and has translated into higher rates of presentations being admitted to hospital, including to theatre. With Ballarat’s growing population it is expected that presentations to the emergency department will continue to grow.

Acute Inpatient Services Acute care is the provision of medical treatments and procedures for a short term illness or health problem. Ballarat Health Services provides a comprehensive range of acute services including general medicine, surgery, cardiovascular, emergency care, speciality services, intensive care, oncology, maternity, radiology and pathology services. As demand for services continues to grow Ballarat Health Services has broadened its range of models of care to include community and home-based care such as Hospital in the Home, Residential In Reach, and home-based rehabilitation. Oncology Clinics and chemotherapy sites have been established across the region so that patients can access those services closer to their home towns. Growing demand for elective surgery has seen partnerships develop with other health services across the region to support patients to access care in a timely manner. Sub-Acute Services The Inpatient Rehabilitation Program consists of a 30 bed purpose built facility and provides amputee, brain injury, stroke, general neurology and orthopaedic rehabilitation. The Inpatient Complex Care Unit is a 24 bed, medical and slow stream rehabilitation unit which provides semi acute assessment and care to patients who are generally over 70 years of age. Gandarra Palliative Care Unit is an eleven bed inpatient facility that provides comprehensive and specialised care for patients and their families, who are suffering from a life threatening illness that cannot be cured.

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Mental Health Services Mental Health Services encompass inpatient care, extended care, community teams, as well as child/adolescent and family services. Specialist Ambulatory Services Ballarat Health Services provides a range of specialist acute medical, allied health, nursing and multi- disciplinary outpatient clinics.

Aged Care Services Ballarat Health Services is the largest public residential aged care provider in Australia with 444 operational beds in ten facilities across five different sites in greater Ballarat. It delivers a comprehensive aged care program and provides nursing home care for permanent and respite residents. Primary Care and Community Health Services Ballarat Health Services provides extensive aged care and health independence programs which are integral to ensuring that people are able to remain living safely at home for as long as possible. Dental Health is provided from a new purpose built facility in Sebastopol at the Phoenix College site.

Ballarat Health Services manages the State-wide Equipment Program, enabling patients to access a range of medical equipment to support their daily living requirements within the community.

Ballarat Health Services works collaboratively with other health providers to integrate services for patients with acute and chronic conditions in a community setting. Ballarat Health Services actively participates in the delivery of health promotion messages and activities to improve the health literacy and wellbeing of the community.

2017–2018 Capital Developments Master Plan With the completion of the 2017–27 Clinical Services Plan, Ballarat Health Services will commence work on developing the Capital Master Plan to ensure that capital development and resources continue to meet the service level needs of the community now and into the future. Documents are currently being finalised for tender. Gardner-Pittard and Henry Bolte Building Level 1, inclusive of medical services building A feasibility study and development of a business case will commence in September 2017 for the Gardner- Pittard and Henry Bolte Building Level 1 fit out, which will include additional theatres, administration offices and the upgrade of the Central Sterilisation Supply Department. State Government funding of $1million has been allocated for this work.

Upgrade of Dialysis Unit The Dialysis Unit has received State Government funding to enable an upgrade of the facility, which will increase capacity through the provision of overnight treatment options. The facility is currently being designed ready for tender and construction work which is expected to commence in October 2017 with an approximate completion date of February 2018.

Prevention and Recovery Centre (PARC) A 12 bed prevention and recovery centre for Ballarat has been announced at a cost of $6 million. The new centre will provide an alternative to hospital admission for patients in need of acute mental health treatment and support. The facility is currently being designed ready for tender and construction work is expected to start in 2018.

Upgrade of P.S. Hobson Nursing Home The $600k upgrade work at P.S. Hobson Nursing Home includes an activities/function room. The project is intended to improve the amenity of the facility for residents by providing much needed communal areas to promote and facilitate communal living. The opportunities afforded by the proposed extension will address the issue of socialisation, a key factor in the provision of quality residential aged care. Work will commence in November 2018 and expected completion date is May 2018.

Cardiac Catheter Laboratory With the $10m allocated by the State Government in 2016–17, the second Cardiac Catheter Laboratory works are moving into the final phase of practical completion with equipment fit out about to occur. Expected completion date is October 2017. Strategic planning Ballarat Health Services’ Strategic Plan 2017–2022 is available online at https://www.bhs.org.au

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Strategic priorities In 2017-–18 Ballarat Health Services will contribute to the achievement of the Victorian Government’s commitments by: Goals Strategies Health Service Deliverables Better Health Better Health Develop an Equity and Diversity Plan that includes strategies to improve A system geared to Reduce state-wide risks patient centred care and access to prevention as much as health services for Aboriginal and Torres treatment Build healthy Strait Islander people; culturally and

neighbourhoods linguistically diverse people; those who Everyone understands are socioeconomically disadvantaged;

their own health and risks individuals with a disability; and people Help people to stay healthy who identify as either lesbian, gay, bisexual, transgender, inter-sex, or

Illness is detected and questioning. Target health gaps managed early Using the Healthy Choices Policy, identify and deliver health promotion activities that assist people to make an Healthy neighbourhoods informed choice on healthy food and and communities drink options, including a review of the encourage healthy lifestyles organisation’s food outlets, vending machines and catering for meetings and events.

Increase health literacy amongst patients, staff and the broader community by conducting health literacy workshops and forums for our workforce and consumers; delivering person centred care education and providing access to tools for our workforce; and involving consumers in the development of easy to access and read healthcare documentation.

Implement the Strengthening Hospital Response to Family Violence model with an initial focus on the emergency department, maternity and children’s services; and provide a regional response to family violence by supporting Beaufort & Skipton Health Service, East Grampians Health Service, Hepburn Health Services, Maryborough District Health Service and Stawell Regional Health Service to implement the same model.

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Goals Strategies Health Service Deliverables Better Access Better Access Participate in the Better Care Victoria Specialist Clinic Collaborative with the Care is always there when Plan and invest aim to enhance the management of people need it patients in the primary care setting; Unlock innovation enhance referral and triage processes; More access to care in the and reduce the number of people not home and community attending scheduled specialist clinic Provide easier access appointments.

Endorse and implement the Older People are connected to Ensure fair access Persons Nurse Practitioner Residential the full range of care and In Reach Model of Care to manage support they need geriatric syndromes across our residential aged care services, thus There is equal access to reducing the need for transfers to the care emergency department and enabling care within the home setting. Develop innovative mental health models of care that meet the requirements of the catchment, including supporting residential rehabilitation for alcohol, drugs and dual diagnosis clients. In partnership with other regional health services, establish a Regional Surgery Initiative which ensures all patients have access to timely and safe surgical options. Outcomes to be measured through the number of additional surgeries across the region and reduction in Ballarat Health Services waitlist. Better Care Better Care Develop a Workforce Plan that is responsive to the Clinical Services Plan, Target zero avoidable harm Put quality first thus ensuring it identifies the current and

future needs and priorities of the health Join up care Healthcare that focusses service and the organisation’s strategic on outcomes goals. Partner with patients Implement a Leadership and

Management Program to equip current Patients and carers are and emerging leaders throughout the Strengthen the workforce active partners in care organisation, with specific skills and

tools necessary to effectively complete

Embed evidence their roles as leaders. Care fits together around people’s needs Improve staff engagement and the Ensure equal care culture of the organisation through

delivering the BHS Together Program, which is designed to create and develop great leaders; enhance staff satisfaction

by recognising and rewarding success; build individual accountability; align behaviours with goals and values; and

improve communication at all levels.

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Goals Strategies Health Service Deliverables Develop a Research and Innovation Framework to underpin the development

and implementation of inclusive and sustainable research and innovation; promote and support collaboration; and test innovative approaches to health service challenges.

Mandatory actions against the ‘Target zero avoidable harm’ goal:

Develop and implement a Develop and implement a Speaking Up plan to educate staff about for Safety Plan to strengthen the obligations to report patient organisation’s patient safety culture and safety concerns. to educate staff about obligations to report patient safety concerns.

Establish agreements to Develop a Rural and Regional involve with external Partnerships Plan that includes specialists in clinical establishing a regional clinical governance processes for governance model; identifying and each major area of activity documenting current regional (including mortality and collaborations; and formalisation of morbidity review). agreements to support clinical governance with the smaller rural health services in the catchment.

In partnership with Use patient feedback to drive improved consumers, identify three health outcomes and experiences priority improvement areas through a strong focus on person and using Victorian Healthcare family centred care in the planning, Experience Survey data and delivery and evaluation of food services, establish an improvement cleanliness and discharge planning and plan for each. These should the development of plans to improve be reviewed every six these areas. months to reflect new areas for improvement in patient experience.

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Part B: Performance priorities

The Victorian Health Services Performance monitoring framework outlines the Government’s approach to overseeing the performance of Victorian health services.

Changes to the key performance measures in 2017-18 strengthen the focus on high quality and safe care, organisational culture, patient experience and access and timeliness in line with Ministerial and departmental priorities.

Further information is available at https://www2.health.vic.gov.au/hospitals-and-health-services/funding- performance-accountability/performance-monitoring High quality and safe care

Key performance indicator Target

Accreditation

Accreditation against the National Safety and Quality Health Service Full compliance Standards

Compliance with the Commonwealth’s Aged Care Accreditation Standards Full compliance

Infection prevention and control

Compliance with the Hand Hygiene Australia program 80%

Percentage of healthcare workers immunised for influenza 75%

Patient experience

Victorian Healthcare Experience Survey – percentage of positive patient 95% positive experience responses experience

Victorian Healthcare Experience Survey – percentage of very positive 75% very positive responses to questions on discharge care experience

Victorian Healthcare Experience Survey – patients perception of cleanliness 70%

Healthcare associated infections (HAI’s)

Number of patients with surgical site infection No outliers

Number of patients with ICU central-line-associated bloodstream infection Nil (CLABSI)

Rate of patients with SAB1 per occupied bed day ≤ 1/10,000

1 SAB is Staphylococcus Aureus Bacteraemia

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Key performance indicator Target

Adverse events

Number of sentinel events Nil

Mortality – number of deaths in low mortality DRGs2 Nil

Mental Health

Percentage of adult acute mental health inpatients who are readmitted within 14% 28 days of discharge

Rate of seclusion events relating to a mental health acute admission – all age ≤ 15/1,000 groups

Rate of seclusion events relating to a child and adolescent acute mental health ≤ 15/1,000 admission

Rate of seclusion events relating to an adult acute mental health admission ≤ 15/1,000

Rate of seclusion events relating to an aged acute mental health admission ≤ 15/1,000

Percentage of child and adolescent acute mental health inpatients who have a 75% post-discharge follow-up within seven days

Percentage of adult acute mental health inpatients who have a 75% post-discharge follow-up within seven days

Percentage of aged acute mental health inpatients who have a 75% post-discharge follow-up within seven days

Maternity and Newborn

Rate of singleton term infants without birth anomalies with Apgar score ≤ 1.6% <7 at 5 minutes

Rate of severe foetal growth restriction (FGR) in singleton pregnancy ≤ 28.6% undelivered by 40 weeks

Continuing Care

Functional independence gain from an episode of GEM3 admission to ≥ 0.39 discharge relative to length of stay

Functional independence gain from an episode of rehabilitation admission to ≥ 0.645 discharge relative to length of stay

2 DRG is Diagnosis Related Group 3 GEM is Geriatric Evaluation and Management

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Strong governance, leadership and culture

Key performance indicator Target

Organisational culture

People matter survey - percentage of staff with an overall positive response to 80% safety and culture questions

People matter survey – percentage of staff with a positive response to the 80% question, “I am encouraged by my colleagues to report any patient safety concerns I may have”

People matter survey – percentage of staff with a positive response to the 80% question, “Patient care errors are handled appropriately in my work area”

People matter survey – percentage of staff with a positive response to the 80% question, “My suggestions about patient safety would be acted upon if I expressed them to my manager”

People matter survey – percentage of staff with a positive response to the 80% question, “The culture in my work area makes it easy to learn from the errors of others”

People matter survey – percentage of staff with a positive response to the 80% question, “Management is driving us to be a safety-centred organisation”

People matter survey – percentage of staff with a positive response to the 80% question, “This health service does a good job of training new and existing staff”

People matter survey – percentage of staff with a positive response to the 80% question, “Trainees in my discipline are adequately supervised”

People matter survey – percentage of staff with a positive response to the 80% question, “I would recommend a friend or relative to be treated as a patient here”

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Timely access to care

Key performance indicator Target

Emergency care

Percentage of patients transferred from ambulance to emergency department 90% within 40 minutes

Percentage of Triage Category 1 emergency patients seen immediately 100%

Percentage of Triage Category 1 to 5 emergency patients seen within clinically 80% recommended time

Percentage of emergency patients with a length of stay in the emergency 81% department of less than four hours

Number of patients with a length of stay in the emergency department greater 0 than 24 hours

Elective surgery

Percentage of urgency category 1 elective surgery patients admitted within 30 100% days

Percentage of urgency category 1,2 and 3 elective surgery patients admitted 94% within clinically recommended time

Percentage of patients on the waiting list who have waited longer than clinically 5% or 15% recommended time for their respective triage category proportional improvement from prior year

Number of patients on the elective surgery waiting list4 980

Number of hospital initiated postponements per 100 scheduled elective surgery ≤ 8 /100 admissions

Number of patients admitted from the elective surgery waiting list 5,600

Specialist clinics

Percentage of urgent patients referred by a GP or external specialist who 100% attended a first appointment within 30 days

Percentage of routine patients referred by GP or external specialist who 90% attended a first appointment within 365 days

4 the target shown is the number of patients on the elective surgery waiting list as at 30 June 2018

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Effective financial management

Key performance indicator Target

Finance

Operating result ($m) 0.00

Average number of days to paying trade creditors 60 days

Average number of days to receiving patient fee debtors 60 days

Public and Private WIES5 activity performance to target 100%

Adjusted current asset ratio 0.7 or 3% improvement from health service base target

Number of days of available cash 14 days

5 WIES is a Weighted Inlier Equivalent Separation

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Part C: Activity and funding

The performance and financial framework within which state government-funded organisations operate is described in Volume 2: Health operations 2017–18 of the Department of Health and Human Services Policy and funding guidelines 2017. The Policy and funding guidelines are available at https://www2.health.vic.gov.au/about/policy-and- funding-guidelines Further information about the Department of Health and Human Services' approach to funding and price setting for specific clinical activities, and funding policy changes is also available at https://www2.health.vic.gov.au/hospitals-and-health-services/funding-performance-accountability/pricing- funding-framework/funding-policy

Funding type Activity Budget ($'000)

Acute Admitted WIES Public 26,695 126,323 WIES Private 6,082 21,557

WIES DVA 171 855 WIES TAC 167 701 Other Admitted 1,286

Acute Non-Admitted Emergency Services 19,590 Home Enteral Nutrition 330 69 Specialist Clinics - Public 53,082 13,379 Specialist Clinics - DVA 9 Other non-admitted 1,210 Subacute & Non-Acute Admitted Subacute WIES - Rehabilitation Public 554 5,767 Subacute WIES - Rehabilitation Private 166 1,606 Subacute WIES - GEM Public 556 5,784 Subacute WIES - GEM Private 158 1,532 Subacute WIES - Palliative Care Public 188 1,954 Subacute WIES - Palliative Care Private 58 565 Subacute WIES - DVA 34 422 Transition Care - Bed days 13,870 2,108 Transition Care - Home days 9,125 511 Subacute Non-Admitted Health Independence Program - Public 41,898 8,979 Health Independence Program - DVA 91 Victorian Artificial Limb Program 606 Subacute Non-Admitted Other 781 Aged Care Aged Care Assessment Service 2,045

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Residential Aged Care 153,317 7,389 HACC 24,284 1,547 Aged Care Other 1,251 Mental Health and Drug Services Mental Health Ambulatory 52,322 21,055 Mental Health Inpatient - Available bed days 14,610 10,372 Mental Health Inpatient - Secure Unit 4,383 2,463 Mental Health PDRS 50 Mental Health Residential 7,305 723 Mental Health Service System Capacity 1 429 Mental Health Subacute 7,305 2,834 Mental Health Other 63 Drug Services 135 Primary Health Community Health / Primary Care Programs 8,363 874 Community Health Other 205 Other Health Workforce 138 6,802 Other specified funding 4,419

Total Funding 278,337

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Part D: Commonwealth funding contribution

The Victorian health system has faced a number of changes to Commonwealth funding since 2012–13. The changes to the funding arrangements announced in the 2014–15 Commonwealth Budget will continue to be applicable for the period 1 July 2017 to 30 June 2018 with funding continued to be linked to actual activity levels. The Commonwealth funding contribution outlined in the 2017–18 Commonwealth Budget was based on estimates and has since been updated by the Administrator of the National Health Funding Pool, based on latest activity estimates from States and Territories. However, given that final funding amounts are based on actual activity, there may be adjustments to funding throughout the year as a result of reconciliations and other factors outlined below.

Period: 1 July 2017 – 30 June 2018

Service category Estimated Total funding ($) National Weighted Activity Units (NWAU17) Activity based Acute admitted services 35,688.44 222,154,231 funding Admitted mental health services 2,983.29 Admitted subacute services 4,481.76 Emergency services 6,657.90 Non-admitted services 4,187.03 Block Funding Non-admitted mental health services - 33,316,972 Teaching, training and research Other non-admitted services Other Funding - 18,645,094 Total 53,998.43 274,116,297

Note:  Estimated National Weighted Activity Unit may be amended by the Department following the finalisation of the 2016–17 reconciliation by the Administrator of the National Health Funding Pool.  Activity loadings are included in the Estimated National Weighted Activity Units (i.e. Paediatric, Indigenous, Remoteness, Intensive Care Unit, Private Patient Service Adjustment, and Private Patient Accommodation Adjustment).  In situations where a change is required to Part D, changes to the agreement will be actioned through an exchange of letters between the Department and the Health Service Chief Executive Officer.

Ambulance Victoria and Dental Health Services Victoria do not receive a Commonwealth funding contribution under the National Health Reform Agreement. Dental Health Services Victoria receives Commonwealth funding through the National Partnership Agreement.

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