Adelaide Hills (Mount Barker, Mount Pleasant, Gumeracha, Strathalbyn) 10 Year Local Health Service Plan

2011 – 2020

Mount Pleasant District Hospital Gumeracha District Soldiers’ Memorial Hospital Mount Barker District Soldiers’ Memorial Hospital Strathalbyn and Districts Health Services Adelaide Hills Community Health Service Country Health SA Local Health Network

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10 Year Local Health Service Plan

Adelaide Hills Country Health Services

2011 - 2020

Table of Contents

1. Executive Summary ...... 3 2. Catchment summary...... 8 3. Needs Analysis summary...... 11 4. Local implications of Statewide plans...... 15 5. Planning Principles...... 16 6. Service Delivery Plan...... 17 6.1 Core Services to be Sustained ...... 17 6.2 Strategies for new / expanded services ...... 24 7. Key Requirements for Supporting Services...... 33 7.1 Safety and Quality ...... 33 7.2 Patient Journey ...... 34 7.3 Cultural Respect...... 35 7.4 Engaging with our community...... 36 7.5 Local Clinical Networks ...... 37 8. Resources Strategy ...... 38 8.1 Workforce...... 38 8.2 Infrastructure ...... 40 8.3 Finance ...... 41 8.4 Information Technology...... 42 8.5 Risk Analysis...... 43 9. Appendix ...... 44 9.1 Leadership Structure ...... 44 9.2 Methodology...... 44 9.3 Review Process...... 45 9.4 Glossary...... 46

Date: 8 August 2011

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1. Executive Summary

“We acknowledge this land as the traditional lands for the Peramangk people and that we respect their spiritual relationship with their country. We also acknowledge the Peramangk people as the custodians of the Adelaide Hills region and that their cultural and heritage beliefs are still as important to the living Peramangk people today.”

The Hills Area is east of the capital city of Adelaide in South Australia with Mount Barker 33 kilometres, Strathalbyn 56 kilometres, Mount Pleasant 54 kilometres and Gumeracha 36 kilometres from Adelaide. There are four Hospitals and a Community Health Service in the Hills Area including Mount Barker District Soldiers’ Memorial (DSM) Hospital, Strathalbyn and District Health Service, Gumeracha District Soldiers’ Memorial (DSM) Hospital and Mount Pleasant District Hospital. Adelaide Hills Community Health Service (AHCHS) is a multidisciplinary agency providing a diverse range of community health preventative, early intervention, health promotion, better care in the community and hospital avoidance / GP Plus health service programs.

The Hills catchment area extends to Kersbrook and Springton to the north, Lobethal and Stirling to the west, Callington and Palmer to the east, and Ashbourne and Milang to the south. The resident population for the Hills Area Hospitals is 60, 690 (DPLG, Population Projections 2011). The resident population incorporating the total catchment for Adelaide Hills Community Health Service is 84,548. People from Aboriginal and Torres Strait Islander backgrounds comprise 0.7% of the population catchment, compared with 1.7% of the total South Australian (SA) population. There are 439 people who have identified themselves as Aboriginal in the last ABS Census. The Peramangk people are the original custodians of the land in the Hills Area.

Over the past 10 years the District Council of Mount Barker (DCMB) has been the fastest growing non coastal Council within Australia, averaging 3% growth per annum 1. The Hills Area is one of the fastest growing populations in South Australia with the conservative projected population estimated to increase to 81,639 by the year 2021. The Country Health SA Local Health Network (CHSALHN) projected population for the broader Adelaide Hills Community Health Service catchment is estimated to increase to 105,758 by the year 2021. However the SA Department of Planning and Local Government 2 sets a population growth target of 20,300 by 2024, for the combined population of the townships of Mount Barker, Littlehampton and Nairne, leading to a population of approximately 40,000 people. This is a doubling of the existing population for that area 3. This 10 Year Local Health Service Plan recommends the same approach to planning health services for the Hills Area and the Mount Barker and Strathalbyn districts in particular.

The Hills Area 10 year Health Service Plan reflects consultation between the Adelaide Hills Health Advisory Council, the Adelaide Hills Division of General Practice and the existing Country Health SA health units, namely Adelaide Hills Community Health Service, and Mt Pleasant, Gumeracha, Mt Barker and Strathalbyn Hospitals. The plan is about providing services closer to home for the Hills Area residents and providing better care in the community resulting in hospital avoidance. The overall vision supported within the plan is that in 10 years time (2020) 80% of the hills area population have access to services that meet 80% of their health care needs within the hills area. This will mean in real terms a transition of primary and secondary services across the region. It will require Mt Barker DSM Hospital to provide a new range of services aligned with statewide plans so that only patients requiring highly specialised or complex care will need to access this type of care in Adelaide. These services will be supported by rehabilitation services at Strathalbyn Health Services, integrated closely with statewide rehabilitation directions and an Integrated Health Care Centre at Mt Barker built on the Hospital Grounds and linked to services throughout the hills area. Existing services provided at Mt Pleasant Hospital are to continue and an expanded role in bowel screening program to be investigated. Existing services at Gumeracha Hospital are to continue. Adelaide Hills Community

1 The District Council of Mount Barker (2009). Council Submission to the Draft 30 Year Plan for Greater Adelaide. 2 SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year Plan for Greater Adelaide. 3 SA Department of Planning and Local Government (2009). Planning the Adelaide we all want: Progressing the 30 Year Plan for Greater Adelaide. 3

Health Service is to have an expanded role in collaboration with all key stakeholders within the Integrated Health Care Centre. A GP Plus Super Clinic has been supported by the federal Minister for Health, the Hon. Nicola Roxon who has pledged up to $7 Million seeding funding to the Adelaide Hills Division of General Practice. The Division and Hills Area Health Advisory council support the building of the GP Plus Centre at Mt Barker on the Hospital Grounds.

Through this vision, priority needs identified through the needs analysis process which informed the planning process will be addressed.

ENHANCED PRIMARY HEALTH CARE • Partnerships and collaboration across organisations such as those evidenced within the SA Inner Country Health Network will result in better health outcomes for the population • Increased flexible funding arrangements that support changing models of care and enable greater provision of outpatient, day patient and community based care is enabled through effective partnerships to maximise expertise and funding streams. • Strengthened primary and community based care and transition services to and from hospital via the Better Care in the Community initiative (incorporates self managed care for chronic disease). • Funded early intervention, illness (disease) prevention and health promotion initiatives. • Redesigned aged care support infrastructure to support GP Plus initiatives.

“A high quality and effective acute care system depends, in part on robust primary health care, community care and post acute care services being in place” (SA Health Submission to the National Health and Hospitals Reform Commission)

LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA It is essential to the success of the above vision that an integrated public transport system connecting townships between Mt Pleasant, Gumeracha and Strathalbyn to Mt Barker is developed.

INCREASED CAPACITY TO CARE FOR LOCAL POPULATION Clinical Governance to support the local General Practitioners will be enhanced by the implementation of the Integrated Health Care Centre. This will enable access to both residential and visiting specialist care, recruitment and retention of a skilled health care workforce, training capacity in the areas of obstetrics, anaesthetics and procedures for local GPs. It will also provide opportunity for building links to tertiary health services and utilising e-health technology.

Increased AND redesigned disability support.

Increased access to timely mental health specialist care.

Utilisation of e-health technology.

Ensure that emergency department in each hospital is appropriate to the population health needs of the immediate community

Importance of partnerships with General Practice and future developments in Commonwealth health reform, such as Medical Local networks.

HEALTH PROMOTION Support the provision of opportunities for exercise eg. sporting fields / clubs and healthy lifestyle support.

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Key Recommendations: PROVIDING SERVICES CLOSER TO HOME: 1. Liaise with Adelaide Health Service (formerly Central Northern Adelaide Health Service and Southern Adelaide Health Service) to address opportunities to provide local access to services instead of travelling to metropolitan services. a. Identify the services that are more appropriately accessed throughout the Adelaide Hills Service catchment based on the changing health needs of the population in the catchment and work to repatriate services into the Hills b. Identify the services that will continue to be accessed in metropolitan Adelaide as Mt Barker expands its role in line with statewide plans. c. Explore a medical link between Royal Adelaide Hospital Emergency Department (ED) and Mount Barker DSM Hospital ED in the first instance, building capacity for collaboration regarding more complex inpatient management in the future. 2. Implement an Integrated Health Care Centre at Mount Barker (IHCC). The IHCC will deliver: • Increased opportunities for provision of specialist services • Development of multidisciplinary care models • Enabled early intervention and prevention strategies • Enabled health promotion strategies • Increased mental health workforce • Integrated private and public allied health services • Enhanced midwifery and early childhood intervention services • Development of an aboriginal health strategy • Creation of an ideal environment for medical and allied health education at undergraduate and post graduate level 3. Develop an Orthopaedic Post Acute Rehabilitation service at Strathalbyn and District Health Service based on best practice and with metropolitan rehabilitation services as aligned with the Statewide Rehabilitation Plan. 4. Develop an Arthroplasty Clinic at Mt Barker 5. Resource surgical services across the Hills Area to meet population health demand. 6. Resource the maternity services at Mt Barker Hospital to meet population health demand in the redeveloped Maternity services (allocation announced at CHSALHN HAC in 2010 by Minister Hill. 7. Improve and enhance services to Aboriginal people by working with other service providers to improve accessibility 8. Recruitment and retention of a skilled workforce across disciplines and infrastructure to support best practice service delivery models to ensure future models of care are provided in a quality safety framework.

ENHANCED PRIMARY HEALTH CARE The area health service will work closely with strategic partners including the Adelaide hills Division of General Practice to enhance Primary Health Care. 9. Increase access to and services for early intervention for children and youth. 10. Develop an Early Childhood and Family Centre integrated closely with other service providers. 11. Increase hospital avoidance by greater integration with the aged care sector to ensure streamlined services, adequate provision of aged care beds, community care packages and health care services for older people at home. 12. Implement the Health Service Framework for Older People 2009 – 2016 as a priority. Establish a Level 4 Older People’s Health Services including inpatient Geriatric Evaluation and Management or ‘GEM’ teams and support across the Hills area. 13. Introduce a flexible suite of ambulatory community and hospital based services with multiple access points to be available to older people, and include day rehabilitation programs and rehabilitation in the home. 14. Consider mobile support teams for aged care and mental health needs. 15. Provide a Level 4 Palliative Care Service as described in the Palliative Care Services Plan 2009-1 16. Source physicians for the Hills, Southern Fleurieu, and Kangaroo Island (HSFKI) cluster; to increase access to specialist care locally. There would be a combination of resident and visiting services. 5

17. Increase models that support changing models of care and enable greater provision of outpatient, day patient, and community based care regardless of age. 18. Ongoing cultural awareness program for all health service providers. Cultural respect will improve with the continuation of a dedicated education program for all staff and community as well as engagement and consultation with culturally and linguistically diverse (CALD) communities. 19. Ongoing engagement with the Aboriginal community and implement a local strategy for Improving Aboriginal health; including breaking down service delineation barriers 20. Implement a men’s health program.

LINKED PUBLIC TRANSPORT SYSTEM FOR THE HILLS AREA 21. The Hills Area Health Advisory Council and Country Health SA seek a review of the current public transport system with a view to increased access to rehabilitation, outpatient departments, ambulatory centres, community and acute services across the Hills Area. 22. Improve access to health care by innovation in transport including a ‘bee-line’ (free scheduled transport) concept for residents over 65 years or who need public transport to access health care. It is acknowledged that health services in Adelaide will continue to be an option for care, recognising personal networks, historic connections and individual choice, particularly for people residing in the North of the catchment.

INCREASED CAPACITY TO CARE FOR LOCAL POPULATION 23. Implement a formal local clinical governance structure that evidences links with the statewide clinical networks. 24. Increase access to diagnostic results.

INCREASED AND REDESIGNED DISABILITY SUPPORT.

INCREASED ACCESS TO TIMELY MENTAL HEALTH SPECIALIST CARE. 25. Establish, strengthen and continue collaborations that are currently happening across the Hills, Southern Fleurieu and Kangaroo Island Cluster. 26. Improve mental health services by clear links to tertiary visiting services, strong governance and implementation of a local 24/7 on call service response capability within the local service networks. 27. Work with DASSA and strengthen links with Divisions of General Practice (Adelaide Hills Division of General Practice (AHDGP)), general practitioners (GPs), and nurse practitioner programs. Implement training of health providers in the use of screening and brief intervention tools; training of GP prescribers; DASSA community pharmacy program links to local pharmacies; partnerships across health, alcohol, tobacco and other drugs (ATOD) and mental health services. 28. Explore local models of care to better manage people, who are affected by alcohol and other drugs, including those experiencing co-morbidity. 29. Implement a Youth Centre.

UTILISATION OF E-HEALTH TECHNOLOGY. 30. The patient journey will be improved by the Implementation of e-health. 31. ICT capacity is built in to all capital works redesign and care modelling: a. Access to e-health is essential to meet current and future models of care. b. ICT connectivity at outreach centres across the Hills Area. c. CHSALHN has equity of access to e-health with metropolitan health services and units within CHSALHN have equity of access. d. Education program for all staff relative to their role to support e-health, including visiting GPs and specialists.

ENSURE THAT EMERGENCY DEPARTMENT IN EACH HOSPITAL IS APPROPRIATE TO THE POPULATION HEALTH NEEDS OF THE IMMEDIATE COMMUNITY 32. Build the Emergency Department capacity at Mount Barker and Strathalbyn – including capital works to redesign the Emergency Departments to meet current Australian Standards.

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HEALTH PROMOTION 33. Ensure that the community is engaged in the ongoing review and implementation of the 10 Year Health Service Plan. 34. Improve aged care with strong health promotion programs, providing opportunity to reduce social isolation, and a workforce development strategy that focuses on the development of aged care specific or blended nurse practitioner roles. 35. Continue effective community engagement to ensure that the Hills Area community is health literate and supports consumer / volunteer / carer programs 36. Advocate for increase funding for the public dental service to meet population demand.

The Hills Area Health Advisory Council acknowledge the importance of reviewing the plans and progress annually as needs change in the future. The Plan provides a framework to move forward in a planned and forward thinking way. It sets out strategic directions over the next 10 years and implementation steps will need to be established annually to describe how they will be achieved – addressing the highest priorities first.

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2. Catchment summary

Introduction

The Hills Area Health Services catchment has a population of approximately 53,200 residents living within four local government areas including Adelaide Hills, Alexandrina, Barossa and Mount Barker. The catchment area encompasses key townships including Gumeracha, Mount Barker, Mount Pleasant, Strathalbyn, Birdwood, Echunga, Kersbrook, Lobethal, Macclesfield, Meadows, Milang, Mount Torrens, Oakbank, Nairne, Springton and Woodside (refer map below). Four hospital and health services provide services to the community situated in the Gumeracha, Mount Barker, Mount Pleasant and Strathalbyn. The Mount Barker and Gumeracha Hospitals and Health Services are located approximately 32-39 kilometres from Adelaide, and the Mount Pleasant and Strathalbyn Hospitals are located approximately 54-56 kilometres from Adelaide.

Source: www.atlas.sa.gov.au

Population

The resident population for the catchment is 60, 690 (DPLG, 2011). People from Aboriginal and Torres Strait Islander backgrounds represent 0.7% of the catchment population compared with 3.1% across country South Australia. The traditional owners of the land throughout the Hills catchment are the Peramangk people. Approximately 2.9% of the population speak a language other than English at home, compared with 3.9% across country South Australia.

The proportion of people aged 0-14 for the catchment area is 20.5%, compared with 18.5% across total SA. The proportion of people aged 15-64 for the catchment area is 65.6% compared with 63.8% across country SA and 66.1% across total SA. The proportion of people aged 65-84 for the catchment area is 12.2% compared with 13.9% across country SA and 13.4% across total SA. The proportion of people aged over 85 years for the catchment area is 1.8% compared with 2.0% across total SA. It is estimated that the total population of the Hills Area Health Services catchment has increased by approximately 7,000 persons in the five year period between 2006 and 2011.

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Based on Planning SA data (high stable projections), the population is expected to increase by approximately 7% over the next 10 years. This prediction is below the growth identified by the Mount Barker District Council and the Greater Adelaide Plan. It is also important to note that from 2004 to 2009, Statistical Local Areas such as Mount Barker Central, Strathalbyn district and the Adelaide Hills North/Balance have grown by 19%, 11% and 3% respectively (2009 ABS Estimated Resident Population). The fertility rate across the catchment ranges between 1.83 in the Adelaide Hills - North Statistical Local Area (SLA) to 2.21 in the Barossa - Barossa SLA (encompassing the Mount Pleasant catchment). This compares with 1.82 for South Australia. The average indirect standardised death rate for the Hills Area Health Services catchment ranges from 4.8 in the Mount Barker - Balance SLA to 7.3 in the Mount Barker – Central SLA. This compares with 6.1 for South Australia.

Information sourced from the South Australian Tourism Commission for 2007 indicates that for the Adelaide Hills (which includes Mount Barker and Gumeracha but excludes Strathalbyn) and Fleurieu Peninsula (which includes Strathalbyn, Yankalilla and Victor Harbor) there is a significantly high number of overnight and same day visitors, most of which are aged between 45-64 years of age. The Tour Down Under attracts more than 7,000 visitors to the area. Other major events include Classic Adelaide and the Bay to Birdwood.

Table 1: Hills Area Health Services Population

Country Cluster* Cluster* SA total No. % SA No. % % % Total Population 60,690 98,235

Males 30,186 49.7% 48,662 49.5% 50.5% 49.4% Females 30,504 50.3% 49,573 50.5% 49.5% 50.6%

0-14 years of age 12,431 20.5% 18,403 18.7% 20.4% 18.5% 15-24 years 7,502 12.4% 10,908 11.1% 11.4% 13.3% 25-44 years 15,052 24.8% 22,183 22.6% 25.1% 26.7% 45-64 years 17,208 28.4% 27,997 28.5% 27.3% 26.1% 65-84 years 7,394 12.2% 16,236 16.5% 13.9% 13.4% 85 years and over 1,102 1.8% 2,507 2.6% 1.8% 2.0%

ATSI** 379 0.7% 681 0.9% 3.1% 1.7% CALD (Speaks a language 1,558 2.9% 2,360 2.8% 3.9% 12.2% other than English at home)** *Adelaide Hills, Fleurieu and KI Cluster total Source: Projected population by age and sex – SLAs in South Australia, 30 June 2011, Department of Planning and Local Government **Source: 2006 ABS Census

Socioeconomic factors

On the basis of Australian Bureau of Statistics’ measures of remoteness, the Hills Area Health Services catchment has been identified as inner regional which indicates reasonable proximity to service centres including Adelaide when compared with other country locations. However transport for health care consumers remains a barrier to better care in the community despite the existing public infrastructure including regular bus services between major centres in the region and between the region and Adelaide. Despite the close proximity to Adelaide, the public transport system across the Hills Area is insufficient to meet the community needs, especially when needing to access health care services.

The socioeconomic status for most of the catchment area is similar to or higher than country SA and total SA averages. A relatively low socioeconomic status is observed in several collection districts 9 within the Mount Pleasant catchment, and Strathalbyn. For most of the catchment area, the median individual, family and household incomes are consistent or higher than the state average. Strathalbyn and parts of the Mount Pleasant catchments are slightly lower than the state average. Aboriginal people living in Strathalbyn have been identified as a special needs population since they have come into the area from elsewhere with little family support.

Based on data which monitors the trends of diseases, health related problems, risk factors and other issues across major regional areas, the Hills Mallee Southern region demonstrates similar levels of risk factors for alcohol consumption, obesity, blood pressure, cholesterol, physical inactivity and smoking when compared with country South Australia overall. The prevalence of chronic disease for persons aged 16 years and over in the Hills Mallee Southern region demonstrates a slightly lower prevalence of diabetes and a slightly higher prevalence of existing mental illness when compared to country and total South Australia.

Health care and social assistance makes up 11.9% of total employment across the Hills Area Health Services catchment, with manufacturing making up to 10.5%, retail trade 10.0%, education and training 8.7%, and construction 8.5%. Located just 20 minutes drive east of Adelaide, the Hills Area region offers easy road access to the eastern states and metropolitan Adelaide. The key industry sectors in the Adelaide Hills region are wine production, beef and dairy cattle, vegetable growing, fruit orchards and tourism. Significant extractive mineral operations contribute significantly to the economy of the region and state. The region has the potential to be the site of new mining ventures, for example the Angas Prospect near Strathalbyn has significant diamond, copper, lead and silver deposits.

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3. Needs Analysis summary

Methodology used to identify community needs

Community consultation is fostered through a number of formal and informal stand alone and ongoing forums.

Previous formal community and network engagement in service planning for the Hills Area has included: • Northern Adelaide Hills Health Service (NAHHS) - survey to ascertain the Torrens Valley community’s knowledge, use and perception of the NAHHS sites and its services. • Review of the pressures impacting on delivery of health services in the Mount Barker and surrounding areas. • Gumeracha Community Association Public Survey. • Alexandrina Council Feedback Report ‘Have Your Say’ consultation on the Draft Community Strategic Plan 2009-2013. • Council submission to the draft 30 Year Plan for Greater Adelaide. • Local Liaison Group (Mental Health Memorandum of Understanding). • Local Councils - Population planning projections. • Hills Area Health Advisory Council Annual General Meeting. • Hills Area Positive Aging Taskforce. • Hills Area Palliative Care Strategic Planning Group. • Hills Area Aboriginal Services Forum. • SA Inner Country Network Local Alliance. • Hills Area Better Care in the Community Committee. • Hills Area Pandemic Planning – Influenza (HAPPI). • Mount Barker District Soldiers Memorial Hospital 2009-10 Business Planning Session. • Strathalbyn and District Health Service Emergency Department questionnaire.

Ongoing community engagement and collaboration will occur with a diverse range of stakeholders in the future.

From mid January 2010 a dedicated CHSALHN Planning Officer liaised and consulted with both internal and external stakeholders including staff, clinicians, local government, statewide service providers and other key groups. All information from community, staff and key stakeholder consultations was reviewed and utilised to inform the 10 Year Local Health Service Plan. Leakage data from the Hills Area to metropolitan health units and outpatient clinics was obtained and analysed. The Hills Area Health Advisory Council (HAHAC) has considered the consultation outcomes.

The 10 Year Health Service Plan has been considered by the cluster Director HSFKI, cluster Executives and the local HAHAC for review and endorsement.

Summary of Needs Analysis Key Issues

Community Health Promotion and Prevention Programs • A need to re-orientate care whenever possible to an ambulatory/hospital avoidance/GP Plus model of care. • South Australia’s Strategic Plan 2007–2016 informs the health reform agenda for South Australia and includes goals for the community to stay healthy, with a focus on preventing illness through improving lifestyle.

Community Health and GP Plus Services • The provision of an Integrated Health Care Centre (IHCC) (GP Plus Centre) has community, key stakeholder and health service staff support and would assist to deliver the integrated care required for the growing population in the Hills 4 The Great Expectations report 5 and recent

4 Adelaide Hills Division of General Practice (2009). Mount Barker Integrated Health Care Centre (proposal) 11

operational assessment of paediatrics in the Adelaide Hills 6 identifies the IHCC as an integral part of a service delivery model for the future. • Capital works to enable future models of care are needed at Mount Barker and Strathalbyn Hospital and AHCHS: o 5,857 community health episodes of treatment provided in the metropolitan area (an additional 11% to treatments provided locally). In the last three financial years leakage to metropolitan community health services has increased by 14%. • The GP Plus Health Care Strategy 2007 is the overarching primary health care and out-of- hospital strategy for South Australia. • Increase ambulatory care for chemotherapy, transfusions, orthopaedic follow up, post acute care and rehabilitation. • Transport to and from the metropolitan area is problematic for the ageing and young populations.

Emergency Services • There is a higher than national average rate of car accidents in the Hills Area. • The close proximity to Adelaide, predicted population growth, high community priority on a 24 hour emergency service at Mount Barker and across the Hills, and lack of access to local GPs impact on emergency service capacity at both Mount Barker and increasing demand at Strathalbyn. This highlights the need for strengthening emergency services. • The Mount Barker DSM Hospital ED requires capital works to provide improve the environment for staff and in particular meet mental health care needs and GP after hours medical clinic needs • There is a strong community desire to maintain the EDs at all Hospitals in the Hills area. The emergency departments provide a core service to both people residing in the catchment and also the many tourists who travel through the area.

Acute Inpatient Care • 42% of catchment area acute medical care is being provided locally. • In the last three financial years leakage to metropolitan public hospitals has increased by 14% for medical episodes, 13% ‘other episodes, and 11% for surgical episodes. • 674 chemotherapy treatments are performed in the metropolitan area from catchment. • 468 renal dialysis admissions to metropolitan area from the catchment. • There is a strong community desire to maintain the acute services at all Hospitals in the Hills area.

Elective Surgical • 22% of catchment area surgery is being performed locally. • 100% of local emergency surgery is being performed in the metropolitan area. • There is a need to explore the existing theatre complex capacity at Mount Barker to meet increased elective surgery demand.

Maternal and Birthing Services • 37% of women in the Hills cluster birth at Mount Barker Hospital, which is a decrease from 40% in 2001. The maternity ward was redeveloped in 1990 to accommodate 150 births per annum however the number of births has grown to 350 per annum. The maternity service at Mount Barker DSM Hospital requires capital works and the introduction of contemporary midwifery models of care to meet current and future population birthing and family needs 7 8 9.Capital works funding was committed for this in the last election. • More contemporary models of care (eg. Midwifery Led Care) may contribute to improving recruitment and retention of midwives.

5 Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to Mount Barker and surrounding districts. 6 Country Health SA (2009). Paediatrics in the Adelaide Hills: Operational assessment . 7 Hoorenman and O’Shea (2007). Great Expectations: A Review of the pressures impacting on delivery of health services to Mount Barker and surrounding districts. 8 Wright, D. (2009). Midwife Models Project: Report to the Midwifery Models Project Steering Committee. 9 HASSELL (2009). Mount Barker Maternity Ward Feasibility Update. 12

Medical Specialist Services • Staff and community identified specialist care needs locally, particularly access to respiratory physician, paediatrician, geriatrician, cardiology, chemotherapy, oncology, orthopaedic, general physician and allied health. Access to psychiatrist and other specialist support for mental health is required in the Northern Hills area. This lack of access to specialists limits the capacity to provide care in the local hospitals and contributes to a negative patient journey and increased leakage to metropolitan hospitals.

Mental Health • Clinicians identified the need to explore the opportunity to provide a better environment to meet mental health and associated co-morbidity needs. • Young people identified mental ill-health as a major issue including depression, stress, anxiety associated with bullying and issues at home. • Clinicians and stakeholders recognised delays in transporting patients to approved treatment centres impacts on local health and police services and the need for support to manage violent patients. • The community and clinicians identified the need for greater clarification about how to access the services. • Aboriginal people are accessing mental health services in the cluster at less than optimal level. • The Country Model of Care has been based on recognition of the need to reform the health care system concepts of ‘Right Care, Right Time, Right Place, Right Person/Team’.

Rehabilitation • Clinicians have identified the opportunity for the provision Orthopaedic Post Acute Rehabilitation services at Strathalbyn and District Health Service, integrated with key directions identified in the Framework for Older People 2009-16 and the Statewide Rehabilitation Plan.

Respite Services • There is a strong community desire to maintain respite at Mt Barker, Strathalbyn, Gumeracha and Mount Pleasant Hospitals.

Aged Care • Statewide planning notes that health care, rehabilitation, primary health care providers and aged care residential services integration is essential for the Hospitals and AHCHS to meet the health care needs of the elderly into the future 10 . • As the majority of health care for older people occurs in primary health care settings, the GP Plus Strategy is integral to the SA Health Service Framework for Older People, and provides the context for many of the strategies described in this Health Service Plan. • The Model of Care to meet the needs of the aged is described in the Health Service Framework for Older People 2009-16 11 . • Clinicians identified the need for a pro-active system that enables outreach into the aged care facilities to facilitate early intervention, health promotion, rehabilitation, palliative care, early discharge from acute care and hospital avoidance. • Burden of disease statistics for the HSFKI cluster indicates that dementia is noticeably higher in the cluster than the national average. • Based on current trends and policy it is likely that there will be a shift in demand away from low-level residential care and towards community care over the next 10 to 15 years — in addition to the projected growth resulting from population ageing 12 . • As people live longer and with advances in medicine it is expected that individuals will live longer with disability and will be more likely to benefit from rehabilitation. Evidence indicates

10 SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together 11 SA Health (2009). Health Service Framework for Older People 2009-16: Improving Health and Wellbeing Together 12 The Allen Consulting Group (2007). The Future of Community Care: Report to the Community Care Coalition, Melbourne. 13

that perhaps as much as half of the functional decline associated with ageing is the result of disuse and can be reversed by exercise aimed at increasing the fitness of older people.

Palliative Care • 299 palliative care treatments were performed in the metropolitan area (community health). • The SA Palliative Care Services Plan 13 projects a significant increase in demand for end of life care and outlines an expectation that a significant portion of this demand will be managed by GPs, community health, community and residential aged care providers.

Clinical Support Services • Clinicians and stakeholders have identified the need for access to ultrasound equipment for maternity services and increase in hours to radiology services. • Key focus around the implementation of new health technology concepts in line with SA Health ICT direction including e- health, electronic decision support tool and electronic referral tools.

Youth Services • The Youth Advisory Committee (YAC-RAP) has identified young people’s mental health as needing more of a focus by services, particularly in the areas of depression, anxiety, eating disorders, self-harm and suicide prevention. There are gaps in current services for children and youth as identified in AHCHS Child, Youth, and Families Services Development Proposal 14 • Young people have identified mental health as a major issue including depression, stress, anxiety associated with bullying and issues at home.

Drug and Alcohol Services • Clinicians and stakeholders have identified that there remains significant unmet demand for drug dependence treatment, particularly from those who are primarily heroin users, as well as the increasing number of people dependent on prescription opioids. • ATOD and mental illness admissions comprise a significant proportion of hospital A&E or admission episodes and has been identified as an issue previously in needs assessments. People with ATOD and mental illness co-morbidity often have high and complex health issues and may be at high risk of mortality. • Clinicians and stakeholders identified the opportunity for the use of screening tools such as ASSIST to help identify substance use as a cause of the presenting illness. • Clinicians and stakeholders identified the need to increase the capacity of GPs who are permitted to prescribe Suboxone and dispensing pharmacies to meet demand, and for capacity building in the early identification and treatment intervention of ATOD problems among primary health care services 15 .

Early Childhood • Extract from Operational Assessment of Paediatrics in the Adelaide Hills: ‘Given the growth, demographic make up of the population and perceived benefits from a local service, concentration of the population, future facility developments and ability to recruit specialists ….the location of the Adelaide Hills paediatric services is recommended to be at Mount Barker’.

13 SA Health (2009). Palliative Care Services Plan 2009-2016 . 14 Adelaide Hills Community Health Service (2009). Child, Youth, and Families Service Development Proposal 15 DASSA 14

4. Local implications of Statewide plans

Strategy for Planning Country Health Services in SA

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

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

Health services located in areas in close proximity to Adelaide (peri-urban sites) including Mount Barker, Gawler and Victor Harbor are subject to urban growth and have a rural mode of service delivery. These services’ catchment areas extend into designated country areas and services will be jointly planned across both country and metropolitan areas. This approach aims to support the services to expand as their rural catchment grows, with the advantages of being relatively close to metropolitan services.

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

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

• Patient focused care.

• Care as close to home as possible.

• Teaching and research integrated in service models.

• Integrated service model across the continuum of care.

• Streamlining access to specialist consultations.

• Increasing use of telehealth.

• Improving Aboriginal health services.

• Focus on safety and quality.

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

• Engaging closely with consumers and community.

• Developing the infrastructure to meet future service models.

• Clinical networking and leadership.

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

• Reduce progression to chronic disease for at risk populations.

Strategies within the Statewide Clinical Service Plans which support the achievement of local needs have been integrated through the 10 Year Local Health Service Plans.

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5. Planning Principles

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

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

2. Ensuring sustainability of country health service provision.

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

4. Improving Aboriginal health status.

5. Contributing to equity in health outcomes.

6. Strengthening the IT infrastructure.

7. Providing a focus on safety and quality.

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

9. Maximising the best use of resources.

10. Adapting to changing needs.

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6. Service Delivery Plan

6.1 Core Services to be Sustained

Service Category Service Description Target Group Directions over next 10 years Community Health Local Area: • Over 45 All Sites: Promotion and • Access to chronic disease self • Children and youth • Ongoing staff development in the delivery of services that respond to Prevention management programs, • People with diabetes community demand including: Programs Domiciliary Care, Aboriginal • Aboriginal people o Post acute management health, community nursing and • Carers o Palliative care midwifery services, drug and o Expansion of staffing capacity to address ageing workforce issues alcohol services, community • Continue with qualified diabetes resource mental health (adult and child), • HAHAC to work with the community to resource an Aboriginal counselling and allied health Community House services. • HAHAC to source a bus for use by Aboriginal communities for events / District: funerals, medical appointments • Specialised chronic disease • HAHAC to work with Local Council and Housing SA to address the lack practitioners eg. diabetes of public housing for Aboriginal people educators, chemotherapy • Increase resources to meet increasing population demand for early • Diabetes management, women’s intervention strategy implementation including allied health health, Aboriginal health, early • Continue to engage the community and key stakeholders to support learning for families team, youth carers: program, o SA Carers Support Model Carers Support Program: o HACC service agreements • Commonwealth Respite and o Positive Aging Taskforce 10 Year Plan Carelink Centre South and East o Carers support groups Country (Carers SA) • Hills Carer Wellness Centre which Mount Barker is auspiced by Carers Link in the • Work with partners to implement a Youth Centre to respond to youth Barossa mental health needs and a large number of disengaged youth from school, significant youth issues

• See section 6.2 for new services Outpatient Care District: • People with cancer Mount Barker • Chemotherapy • People with a clinical • Establishment of an Outpatient Department Cancer Oncology and • High level provision of post acute need that does not Chemotherapy clinic with specialists who would consult and supervise and hospital avoidance services require a hospital the administration of the more toxic drugs that are not administered at a admission local level currently • Implement a designated ambulatory care centre for chemotherapy, transfusions, post acute assessment and rehabilitation assessment • Develop common approach to packages of care that are criteria driven 17

Strathalbyn, Mount Pleasant and Gumeracha Hospitals • Provide services to clients in the community using existing hospital staff. AHCHS and Hospitals collaborate to provide outreach services in the community using this model Allied Health • Local access to broad range of Clients across the All Sites allied health services (eg. continuum of care • Development of allied health assistant roles eg. reorienting services to physiotherapy, occupational use professional skills appropriately therapy, social work, speech • Re-orienting services to promote independence and early intervention 16 pathology, podiatry, dietician) • Partnerships - shared leadership of a broad range of health and human • services at the local level to deliver on specified impacts and outcomes • Practice standards - agreed minimum standard of service coordination practice Emergency Services • Mount Barker, Strathalbyn, All people All Sites Gumeracha and Mount Pleasant • Nurse led emergency care overnight 24 hour service 7 days a week • Ensure ongoing education program and up skilling for nursing staff in • first line emergency management • Introduce aged care specialist nurses into the ED to facilitate hospital avoidance for the elderly

Mount Barker • Using current facilities, explore alternative models of care in provision of emergency services notably at Mt Barker • Capital works business case to meet service demand, address deficits and control risks at Mount Barker Hospital: o Establish separate space for agitated patients or grieving families Establish physical infrastructure to manage presenting patients and improve facilities for staff to safely manage agitated or violent clients • Work towards capacity for emergency surgery in Mount Barker

Acute Inpatient Care • Local area services at all Hills Area community All Sites: hospitals • Maintain access to acute inpatient care • District services for surgical, birthing, chemotherapy at Mount Mount Barker DSM Hospital: Barker • Increase capacity to admit and treat more complex medical conditions, • Level one surgery at Strathalbyn to improve the patient journey • Day procedural surgery at Mount • Increased capacity is linked to the IHCC initiative Pleasant • Paediatric Step Down Unit linked to increased maternity services and IHCC

16 Chronic Disease Action Plan for South Australia 2009-2018 17 Stepping up Report, Social Inclusion Report 18

• Explore possibility of expanded service for youth and young adults with mental health / drug and alcohol co-morbidities 17 Elective Surgical • Local area services at Mount Hills Area community Mount Barker DSM Hospital: Barker and Strathalbyn • Ensure that infrastructure and resourcing meet the elective surgery • District services including joint demand for the Hills Area replacement at Mount Barker • Explore the possibility of providing all inpatient surgery at Mount Barker, • Procedural and scope services at appropriately funded by the elective surgery strategy; with Strathalbyn a Mount Pleasant (linked to national Centre for Orthopaedic Post Acute Rehabilitation, supporting the bowel screening program) increased surgical demand across the Hills Area • Explore the feasibility of 23 hour day surgery clinic and stand alone day surgery suite into the future • Explore the possibility of a team to support the national bowel screening program across the Hills supported by Mount Barker and Mount Pleasant District Hospitals (high prevalence of cancer in the Hills area) Mount Pleasant District Hospital: • Continue and expand procedural day surgery only; particularly for screening and monitoring for bowel cancer (could service the Hills, some of the Barossa and the near Murray Mallee area eg. Mannum) Strathalbyn and District Health Service: • Utilise existing theatre resources for up to level 1 day surgery until Mount Barker builds capacity to meet demand in the Hills Area Maternal and Local Area Services: Pregnant women, All Sites Birthing Services • Antenatal and postnatal care foetus and infants in the • Resource community midwifery to meet demand – particularly the large • Shared Care Programs Hills Area proportion of women returning to the Hills Area after birthing in • Access to community midwifery metropolitan health units 18 services and parenting programs District Services: Mount Barker DSM Hospital: • Low risk, single birth, theatre and • Build birthing capacity to 600 births each year and enable a step down staffing for caesarean sections 24 nursery for neonates who no longer need to be at the Women’s and hours a day, 7 days a week Children’s Hospital for ongoing care • Service is supported by one • Encourage the introduction of a Midwifery Led Model to compliment the obstetric specialist, 5 GP existing Shared Care Model as it taps into a sustainable workforce in the obstetricians and 4 GP recruitment/employment of direct entry midwives anaesthetists Medical Specialist Local area services • People with cancer All Sites: Services • District Services • People who need Liaise with Adelaide Health Service (formerly Central Northern • There are no resident medical palliation Adelaide Health Service and Southern Adelaide Health Service) to specialists • People with a mental address opportunities to provide local access to medical specialist health issue or services instead of travelling to metropolitan services illness

18 Standards for Maternal and Neonatal Services in South Australia 2009 19

• People over 65 Mount Barker • People with a • Building and implementing an Integrated Health Care Centre at Mount respiratory condition Barker will increase access to medical and other specialists eg. • Children o Access to a visiting oncologist o Access to a visiting palliative care specialist o Increase access to visiting mental health specialists o Increase access to visiting geriatric specialists o Access to a visiting respiratory physician o Access to a visiting paediatrician Mental Health Local area services People of all ages and All Sites • Community based care across the continuum of • Identify clear links to tertiary visiting services Primary mental health care care who have a mental • Inclusive leadership and governance • Shared care management with health issue or illness • See section 6.2 for new services local GP • Local admissions for mental health 24 hour 7 day/week emergency mental health service by telehealth

District area services • Visiting psychiatrists in Mt Barker • Local private psychologist in Mt Barker Resident mental health nurses in Mt Barker Rehabilitation • Inpatient immediate post • People who have Strathalbyn District Hospital operative rehabilitation for joint orthopaedic • Work in collaboration with the Hills area to develop a Orthopaedic Post replacement and other procedures, Acute Rehabilitation service at Strathalbyn and District Health Service orthopaedic surgery at Mount including based on best practice and with metropolitan rehabilitation services as Barker and Strathalbyn arthroplasty aligned with the Statewide Rehabilitation Plan • Transitional Care Packages are • People over 65 • See section 6.2 for new services available • community and home based rehabilitation support, centre based day therapy, multi- discipline outpatient rehabilitation and aquarobics / tai chi classes

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Respite Services Local area services All people requiring All Sites • Access to domiciliary care respite • Strengthen partnerships with current providers of respite services • Access to residential care • Improved access to day centres to provide support for carers • Volunteer programs • Explore opportunities to increase respite options to avoid hospital • Organised in home respite admission • No access to higher level acuity / • Continue existing links to the community eg. respite in residential care disability care • Strathalbyn Hospital to provide programmed respite care, other health units to provide emergency respite only Aged Care • Mount Barker Hospital is a Over 65 All Sites casemix funded Hospital for acute • Explore infrastructure needs to meet consumer expectations care only • Implement minor capital works to meet the needs of in house • Strathalbyn, Gumeracha and Transitional Care Packages (TCP) Mount Pleasant District Hospitals • Increase EACH and EACH-D packages to meet population health have aged care beds with a mix demand in the Hills Area of commonwealth and state • Undertake more detailed analysis to clarify HACC accessibility and funding priorities to build community confidence in the service • Local Area services for • Redesign care to meet the outcomes as specified in the Health Service community management, Framework for Older People 2009 19 including aged care assessment • Plan to build capacity for people with dementia to access dementia is provided by Adelaide Hills services across the Hills Area 20 Community Health Service Mount Pleasant District Hospital • Regional services including • Develop space for day activities in line with current required standards psycho-geriatric support are • See section 6.2 for new services available • Day Care Dementia Service • Willow Fern Community Respite House (Southern Cross) overnight and day activities

19 Health Services Framework for Older People 2009-2016 20 South Australia’s Dementia Action Plan 2009-2010 21

Palliative Care • Community and inpatient • All people who All Sites palliative care service AHCHS require palliation • Explore options for the provision of outreach hospice beds provides a consultancy service for • All people who pain and symptom management require oncology Mount Barker and work with acute care and • Increase in oncology and chemotherapy services at Mount Barker GPs for home support should be implemented in line with current state commitments • Part time bereavement counsellor • Develop a designated ambulatory day centre to support the above who also works with the palliative models of care care nurses • See section 6.2 for new services • Breast care registered nurse and a cancer care coordinator providing both in house and community services Clinical Support District service: • Maternity and All sites Services • Point of care testing for INR, birthing services • Identify opportunities for and implement e-heatlh: Troponin etc • All consumers of o Telehealth consultations / assessment • Pathology access via State care o Good e-clinical records management Pathology, private service and 24 o Integration of services via shared medical records hours on call o Electronic Decision Support (eg. high level electronics tools for • Access to pharmacy services decision making for risk assessment and early intervention) • Jones and Partners Radiology on o Electronic referral tools that embed the assessment tools site at Mount Barker with o Shared / integrated separation summaries restricted on call after hours • GP initiated x-ray service at Mount Barker Gumeracha and Mount Pleasant • Access to ultrasound equipment for maternity service – for use by • Blood service midwives and GPs • Helipad at Mount Barker; other • Increase out of hours access to x-ray and higher radiology service towns use an oval Oral Health • SA Dental Service on site at • Over 65 • See section 6.2 Mount Barker only • Aged care residents • Waiting list is 2 years for public care • Inpatient low technology specialist services available at Mount Barker and Strathalbyn (eg. extraction of wisdom teeth) Youth Services • Key stakeholders: Youth All Sites o YAC-RAP • Build on the AHCHS Action Plan and ‘Vision for the Future’ to provide a o Centrelink framework for future service development in the Hills Area and define o Families SA (financial the opportunities and future directions for effective service delivery and counselling/support only), support to young people, aged 12-25 years across the region o SAPOL Drug Action Teams • Liaise with Drug and Alcohol Services to enhance local services which

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and Community Programs address the needs of young people in the area o Drug Diversion Program o Church groups who offer assistance to the whole of community including young people o TAFE SA – IVEC and Pre- employment programs as well as training programs for the whole of community Drug and Alcohol • ATOD and mental health Adults and young • See section 6.2 Services: admissions people with ATOD and • Screening tools such as ASSIST mental health issues and ATOD mental health co-morbidity

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6.2 Strategies for new / expanded services

Service objective: Improved integration and coordination of health care across the Hills Area by increasing investment in prevention, early intervention and chronic disease management: eg. deliver the GP Plus strategy for the Hills Area 21 Target group: Hills Area population Critical milestones: Development of an Integrated Health Care Centre at Mount Barker on the Hospital grounds

Outcomes Strategies Time Frames All Sites All Sites TBD • Increased opportunities for provision of specialist services • Streamline patient journey for Hills Area residents • Integrating private and public allied health services • Development of multidisciplinary care models • Creation of an ideal environment for medical and allied • Enabling early intervention and prevention strategies health education • Increasing the mental health workforce Mount Barker Mount Barker • Increased capacity to increase services at the Mount • Progress current discussions regarding the Integrated Health Care Barker DSM Hospital Centre (IHCC) proposal by AHDGP • Fund, with partners, a detailed feasibility study to identify the optimum business modelling for the IHCC

Service objective: Increase community health promotion and prevention programs for youth services Target group: Youth Critical milestones: Implement a Youth Centre / Clinic

Outcomes Strategies Time Frames All Sites All Sites TBD • Increased capacity to provide youth services • Recruitment of allied health staff and specialist nursing staff who • Youth feel welcomed into service provision have specific passion and expertise in the area • Youth are engaged in their own improved models of care • Engage youth in finding solutions to: o Youth mental health needs o Disengaged youth from school / family o Family stress o Transport barrier o Depression and anxiety • Identify ways to involve Aboriginal youth who do not readily identify with mainstream youth initiatives

21 Chronic Disease Action Plan for South Australia 2009-2018 / Strategy for Planning Country Health Services in South Australia 24

Service objective: Increase participation in health promotion and illness prevention programs for Aboriginal and Torres Strait Islander residents 22 Target group: People who have identified themselves as Aboriginal or Torres Strait Islander Critical milestones: Improve and enhance services to Aboriginal people by working with other service providers to improve accessibility

Outcomes Strategies Time Frames All Sites All Sites TBD • Increased access to services for Aboriginal people • Improve and enhance services to Aboriginal people by working with • Improved patient journey for Aboriginal people other service providers to improve accessibility • Better care in the community and hospital avoidance for • Identify Aboriginal heritage from Torres Strait Islander heritage on Aboriginal people health forms • Improve access by Hills Area Aboriginal people to services provided by Brompton / Bowden and Murray Mallee Primary Health Care Centre (eg. no need to duplicate services, use existing resources) • Find ways to celebrate Aboriginal culture across the Hills Area

22 Healthy for Life Action Plan 2009/10 25

Service objective: Increase capacity for and integrate rehabilitation services 23 Target group: All of the population who can increase their functional capacity (eg. not mentally or physically restricted from doing so) Critical milestones: Build/develop physical infrastructure to support the delivery of evidence based care at the service delivery levels identified as required to meet the need

Outcomes Strategies Time Frames All Sites All Sites TBD • Transport issues are not a barrier to effective rehabilitation • Effective relationships between inpatient, outpatient and community • Increased functionality for people who require rehabilitation, services to facilitate rehabilitation hence possibly leading to hospital avoidance or residential • Develop / increase: dependency o Geriatric Evaluation and Management program Mount Barker o TCP type initiatives • Ambulatory Care Centre at Mount Barker o Dementia programs Strathalbyn o Workforce development models for allied health • Orthopaedic Post Acute Rehabilitation services at o Workforce training to improve capacity for the aged and frail Strathalbyn and District Health Service population o Ongoing support for rehabilitation type models aimed at promoting wellness • Link to Integrated Health Care Centre at Mount Barker Strathalbyn • Implement a Orthopaedic Post Acute rehabilitation service at Strathalbyn and Districts Health Service that links to the Statewide Rehabilitation Plan. Services to include: o Orthopaedics including arthroplasty o Neurological o Stroke o Other

23 Statewide Rehabilitation Service Plan 2009-2017 26

Service objective: Mental Health for All Target group: All age groups Critical milestones: • Identify clear links to tertiary visiting services • Implementation of new Mental Health Act from 1st July 2010. • Implementation of new Model of Care for Country MH. • Implementation if comprehensive Telehealth network across CHSALHN by December 2010

Outcomes Strategies Time Frames All Sites All Sites TBD • Equity of access to specialist care • Implement provisions of the new Mental Health Act from 1st July • Equity of outcomes with metropolitan / state services 2010 • Contribute to reduction in suicide rate • Provide access at the local level to expanded and upgraded • Promotion of optimum quality of life for people with mental telehealth network across CHSALHN disorders and / or mental health problems • Implement comprehensive Mental Health Workforce Development Plan to meet the future workforce needs • Implement robust Local Mental Health Service Network as per Country Mental Health Model of Care, linking with metropolitan health services • Establish new service partnerships with NGOs to support Intermediate Care Services • Identify opportunities for and implement e-health including: o Telehealth consultations / assessment o Good e-clinical records management o Integration of services via shared medical records o Electronic Decision Support (eg. high level electronics tool for decision making for risk assessment and early intervention) o Electronic referral tools that embed the assessment tools o Shared / integrated separation summaries • Link to Integrated Health Care Centre at Mount Barker • Work towards an integrated (co-morbidity) system for the local area eg. work up pathways, so that ‘every door is the right door’ • Implement a communications system when the model of care is clear • Ensure consumer, carer and community participation

Aboriginal Mental Health • Build on the Aboriginal Mental Health Team from Rural and Remote Mental Health Service – Aboriginal psychiatry and Aboriginal mental health consultant and workers 27

• Build the Aboriginal mental health workforce within local teams • Build on cultural safety knowledge base within mental health system • Work closely with Aboriginal Health within CHSALHN and Aboriginal controlled enterprises • Transition from crisis management to early intervention

Service objective: Mental health emergency response Target group: All people who are having an acute episode of mental illness and present to the Emergency Department or their local GP Critical milestones: Emergency care – provided in conjunction with the Rural and Remote Mental Health Service Emergency Triage and Liaison Service for 24/7 support and over time to implement a local 24/7 on call service response capability within the local service networks

Outcomes Strategies Time Frames All Sites All Sites TBD • Provide in conjunction with the Rural and Remote Mental • Work with Inner Country Mental Health Team to implement a Health Service Emergency Triage and Liaison Service streamlined response to acute mental health need • Engage youth in planning to ensure that the service is accessible and acceptable to youth Mount Barker • Explore the opportunity for a mental health nurse practitioner role • Redesign the Emergency Department at Mount Barker to provide a better environment for clients and staff

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Service objective: Working in partnership with DASSA to improve health outcomes for adults and young people with alcohol, tobacco, drugs, mental health and associated co-morbidities Target group: All people with ATOD and mental health issues / co-morbidities, particularly focusing on youth Critical milestones: • DASSA links with GP Divisions (Adelaide Hills Division of General Practice), GPs, and nurse practitioner programs • Training of health providers in the use of screening and brief intervention tools • Training of GP prescribers will be minimal - mainly take the form of guidelines issued by Drugs of Dependence Unit

Outcomes Strategies Time Frames All Sites All Sites TBD • DASSA links with GP Divisions (GP Network South), GPs, • Establish good linkages across hospital and community based and nurse practitioner programs specialist services for seamless referral process, community and • Training of health providers in the use of screening and brief hospital based care and follow-up intervention tools • Provision of ongoing in-service education for all clinical employees • Training of GP prescribers will be minimal - mainly take the • Provision of education and support for translation of up skilling around form of guidelines issued by Drugs of Dependence Unit ATOD and mental illness and co-morbidity into practice for hospital, community health services and NGO employees • Utilisation/liaison with nurse practitioners and/or clinicians with Graduate Diploma in Addictions and Mental Health or other relevant qualifications, in the planning, support, educative, assessment, treatment and management roles • Delivery of training and support programs to primary health service providers in the use of alcohol, tobacco and other drug screening tools and associated brief interventions (eg. Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)) • Capacity in the early identification and treatment intervention of ATOD and mental health problems among primary health care services Mount Barker • Explore the establishment of appropriate care for the stabilisation and withdrawal for people with alcohol and other drug issues, including those experiencing co-morbidity at Mount Barker Hospital • Link to IHCC at Mount Barker the clinical policies and procedures and services for the assessment, management and treatment of clients presenting with ATOD issues and co-morbidity which relates to the CHSALHN Mental Health Model of Care and the CAMHS Model of Care • Provision of support for hospital clinicians for the management of people admitted to hospital for ATOD, mental illness and comorbid conditions

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Service objective: Aged Care Hospital Avoidance / Better Care in the Community Target group: Residents over 65 years Critical milestones: Increased investment in, and greater integration with, the aged care sector to ensure streamlined services, adequate provision of aged care beds, community packages and health care services for older people at home

Outcomes Strategies Time Frames All Sites All Sites TBD • People over 65 years who: • Strengthen primary and community based care and transition services o Reside in nursing homes and have an acute illness that to and from hospital can safely be managed in their home are not • Strategies to support residential aged care facilities to ensure access transferred to an acute facility to receive that care to primary health care on site and support ‘dying in place’ o Have a chronic illness are managed as much as • Redesign services at hospitals to facilitate ambulatory care possible in their residential care facility or their own • Ongoing engagement with the recipients of care, support groups, local home GPs and key stakeholders • There is an improved patient journey, better health • A partnership model with government agencies to address mental outcomes and a reduced cost to the health care system health needs for older people including working with the NGO sector • Early discharge and hospital avoidance will be achieved • Research successful models nationally and internationally • Avoidance of ED presentation will be achieved • increased access to ambulatory care for oncology, chemotherapy, rehabilitation and post acute follow up All Sites • All Sites Establish Level 4 Older • Formal partnering relationship with a Level 4 Service to • Build strong links with mental health services, palliative care services, People's Health Services meet the needs of local patients, caregivers and families rehabilitation services, cancer care and stroke care with complex problems • Facilitate the progress of older people through the right care pathways Mount Barker in a timely manner and enable better clinical outcomes, reduced • Establish Level 4 Older People's Health Services functional decline and improved efficiency of inpatient care • Implement specialist programs to help staff understand the special needs of older people who become ill Mount Barker • Establish Geriatric Evaluation and Management (GEM) team to promote a strong focus on minimising loss of function, independence and confidence through multi-disciplinary input, timely access to neuropsychological assessment, diagnostic and imaging services and co-ordinated care • Explore advanced practice nurses and aged care nurse practitioner roles, working in collaboration with gerontologists • Strengthen community based, specialist advice and support, ambulatory and home based, transition care and care awaiting placement

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Service objective: Men’s health Target group: Young and adult men Critical milestones: Resources to implement a men’s health program

Outcomes Strategies Time Frames All Sites All Sites TBD • Reduction in chronic medical condition due to alcohol • Implement programs: intake o Alcohol awareness, impact on health and social structure • Contribute to a reduction in violence o Domestic violence awareness, link to alcohol and impact on social • Contribute to a reduction in motor traffic accidents structure • Increased health and wellbeing for youth and men o Men’s health • Increased health and wellbeing for women and children

Service objective: GP Plus health services strategies Target group: Residents over 45 years Critical milestones: Introduce a multidisciplinary, multi agency Better Care in the Community Committee / working party

Outcomes Strategies Time Frames All Sites All Sites TBD • People with chronic illness will be better managed in the • Chronic disease self management 24 community, and improving the patient journey • Build collaborative working systems with acute care, community care • Reduced presentation to the local and metropolitan hospital and local GPs Emergency Departments • Increased access to specialist counselling • Source a visiting respiratory physician • Source respiratory rehabilitation programs • Flexible resourcing arrangements that support changing models of care and enable greater provision of outpatient, day patient, and community based care • Strengthen primary and community based care and transition services to and from hospital

24 Chronic Disease Action Plan for South Australia 2009-2018 31

Service objective: Increase access to local palliative care services Target group: All people in need of palliation Critical milestones: • Formal links with Level 6 palliative care at Repatriation General Hospital (RGH) / other cluster resources • Recurrent funding to implement the service

Outcomes Strategies Time Frames All Sites All Sites Work within the • Palliative care needs met for the Hills Area population • Implement programs for: timeframes as set out in o Multi-disciplinary teams the Palliative Care o Specialist nurse input Services Plan 2009-16 o Specialist GP input o Recruitment and retention of a skilled workforce

Mount Barker • Implement a Level 4 Palliative Care Hospice 25 • Implement programs for: o Formal links with level 6 palliative care at RGH o Access to chemotherapy and ambulatory care at Mount Barker District Hospital

Service objective: Oral Health Target group: Residents over 65 Critical milestones: Public dental service

Outcomes Strategies Time Frames All Sites All Sites TBD • Improved oral health for older people, leading to improved HAHAC to advocate for public preventative dentistry for aged care general health and possible hospital avoidance residents Mount Barker • HAHAC to advocate for increased resourcing to SA Dental Service on site at Mount Barker

25 Palliative Care Services Plan 2009-2016 32

7. Key Requirements for Supporting Services

7.1 Safety and Quality

Objective: Services are delivered within a quality safety framework Critical milestones: • Recruitment and retention of a skilled workforce across disciplines • Infrastructure supports best practice service delivery models

Outcomes Existing Strategies Sustained Strategies for the Future • Risks that are foreseeable are controlled • Quality Improvement Program • Recruitment and retention strategy to secure a • Networking and collaborative relationships with key skilled workforce to deliver new models of care as stakeholders described in the Palliative Care Strategic Plan and • Accreditation is maintained Health Service Framework for Older People • Link to Integrated Health Care Centre at Mount • Capital works to ensure physical environment to Barker deliver new and improved models of care and meet • Contribute to a country-wide accreditation framework existing standards • Implement the Australian Charter of Health Care • Enhance clinician involvement in clinical governance Rights leadership and clinical governance framework • Implement strategies to improve the State and • Work toward the implementation of the National National Patient Safety priority areas Open Disclosure Standard in all health facilities • Transition to one accreditation provider from April 2010 which will integrate acute, community health, and mental health in accreditation

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7.2 Patient Journey

Objective: Patient journey is improved Critical milestones: • Implementation of e-health • GP Plus strategy philosophy implemented via an Integrated Health Care Centre at Mount Barker

Outcomes Existing Strategies Sustained Strategies for the Future • Hospital admissions, length of stay and • Midwifery Led Care • Implementation of e-health ED presentations will be reduced at Hills and • Expansion of maternity services • Implementation of expanded services integrated with metropolitan hospitals • Elective surgery strategy Statewide planning • Visiting specialists • Implementation of an ambulatory service • Community services • Implementation of a Orthopaedic Post Acute rehabilitation • Local GP services service at Strathalbyn and District Health Service • A sustainable model for surgical, rehabilitation • Explore reducing the number of avoidable journeys to and birthing services will remain in place metropolitan outpatient departments for country people. • Maintenance of EDs and acute beds at • For those that require attendance in metropolitan area, Gumeracha, Mount Pleasant, Strathalbyn and continue to advocate for a smooth and convenient journey Mount Barker District Hospitals • Promote and further develop integrated care between country health services and regional general practices to assist with the patient journey in the regions • Explore strategies to achieve better integration of mental health care within mainstream health services in country • Integrate the new Aboriginal patient pathway officers, implemented through COAG Closing the Gap funds, with other liaison positions • Continue to seek alternatives to travelling to access health services for people from country SA through strengthening GP Plus strategies, utilising available and emerging IT solutions and increasing capacity of country-based health services • Improved access to health services for children and their families 26 • Explore initiatives to support local community/health transport solutions locally, across the cluster and to Adelaide

26 Recommendations from the Patient Liaison Network Forum 26 February 2010 34

7.3 Cultural Respect

Objective: All people who access hospitals in the Hills Area and AHCHS are treated with dignity and respect regardless of ethnicity or religion Critical milestones: • Dedicated education program for all staff • Education program for the community • Engagement and consultation with CALD

Outcomes Existing Strategies Sustained Strategies for the Future • No person who access the health service will be • Continue current education program for staff • Identify the Aboriginal / CALD population and their disadvantaged due to their ethnicity or religion • Continue Aboriginal community engagement strategy individual needs • Maintain Aboriginal Health Worker position • Increase / improve recruitment of Aboriginal staff • Continue working with the SA Inner Country Health Network Health Alliance

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7.4 Engaging with our community

Objective: Build on the existing collaborative partnerships in place with members of the community, support groups and key stakeholders Critical milestones: Ensure that the community is engaged in the review and implementation of the 10 Year Local Health Service Plan

Outcomes Existing Strategies Sustained Strategies for the Future • Health literacy for the community • As identified in the community engagement • Continue to work with the Hills Area Health Advisory • Consumer focused and led services explanation; section 3 Needs Analysis Summary Council to engage with the community to implement • Client centred care the 10 Year Health Service Plan • Improved key stakeholder relationships • Continue to work with consumers, carers, interested community members and key stakeholders during the transition to: o Level 4 palliative care service o Level 4 aged care service o Ambulatory care o Rehabilitation / restorative care o GP Plus Model o Youth led services for youth • Building sustainability capacity for volunteer and • Continue to engage the community and key • Find new models for volunteer support as the carer support programs stakeholders to support carers eg. population continues to age and people stay in the • ‘Burn out’ due to overburdening of volunteers o SA Carers Support Model workforce longer will be avoided o HACC service agreements • Resolve transport barrier o Hills Area Positive Ageing Taskforce 10 Year • Younger people / others will become engaged in Strategic Plan volunteering o Carers support groups • The current invaluable volunteer workforce will be maintained • Critical programs will be continued eg. cancer / disability support and resource groups

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7.5 Local Clinical Networks

Objective: Link with statewide clinical networks Critical milestones: Formal clinical governance structure that evidences these links

Outcomes Existing Strategies Sustained Strategies for the Future • Equity in health outcomes for Hills Area • Palliative Care Services Plan 2009-16 • Explore formal pathways with metropolitan services population • SA Inner Country Health Network: Local Health for palliative care and specialist geriatric • Increased clinician involvement in the planning Alliance management of health services, to find ways to better • Continue to work closely with General Practice • Explore how state networks can link to services in coordinate delivery of those services supporting initiatives such as the Country Health the Hills Area • Ensure a strong, sustainable, integrated Practice Nurse initiative and workforce development • Engage with other agencies and service providers in workforce • Networks in place: the Hills Area to improve patient journey and health o Cancer outcomes eg. Local Councils, Finding Workable o Cardiology Solutions, DASSA, CAMHS, Disability SA, Regional o Child health Development Board, Stirling District Hospital etc o Maternal and neonatal • Implement a SA Retrieval Service video-link in ED at o Mental health Strathalbyn o Orthopaedics • Clarify that the CHSALHN boundary includes o Rehabilitation Adelaide Hills Ranges and Central for all services o Renal and programs (liaise with DoHA, Adelaide Health o Stroke Service)

Network leadership/coordination: • Clinical networks, statewide clinical network link to the models of care for SA Health – metropolitan and country • Division of General Practice mental health specialist staff • Specialist NGO sector • CAMHS • Finding Workable Solutions • Private psychology • Local specific initiatives: primary, secondary, tertiary • Work with the SA Inner Country Health Network HSFKI Alliance • Participation in the development / implementation of the new Model of Service Delivery for all statewide initiatives

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8. Resources Strategy

8.1 Workforce

Objective: Health Services, clinicians, education providers, rural communities and governments are interdependent and thus form a symbiotic system 27 Critical milestones: Secure packages of care

Outcomes Existing Strategies Sustained Strategies for the Future • Hills Area Hospitals and AHCHS will have • Continued funding for professional development • Formal partnerships with key stakeholders, capacity to deliver the services required in the • Keeping up with CPI and identified needs community and services community • Continue upskilling for staff • Introduce feedback mechanisms to value work done • Increased attraction, recruitment and retention and continual evaluation of services to see if they are of a skilled workforce actually meeting the need / on track with best practice • Frequent contact with services outside of the area to enable benchmarking • Contribute to statewide review of education delivery modes across country eg. e-health, video conferencing • Explore opportunities to support local GP training and upskilling, improve collaboration • Contribute feedback to the new frameworks when in place for the new Model of Service Delivery for all statewide initiatives • Increase local presence from universities including local conduct of research activities in health and aged care fields to provide a greater diversity of professional development and growth opportunities that will significantly compliment the regions capacity to attract and retain quality health professionals • Explore models for medical staff on site for the Mount Barker Hospital ED and oversight of inpatients • Ensure ongoing education program and upskilling for nursing staff in first line emergency management • Introduce aged care specialist nurses into the ED to facilitate hospital avoidance for the elderly • Implement innovative and creative models to attract and retain workforce in the future

27 Prideaus, D. Worley, P., Bligh, J. (2007). Symbiosis: A new model for clinical education. The Clinical Teacher ; 4(4), pp. 209-212. 38

Aged Care Workforce redesign: • Consider realignment or extension of existing workforce roles or scope of practice • Create new assistant roles and reorganising work to minimise duplication of effort 28 • Greater use of the vocational education and training qualified health workers to enable tertiary trained health professionals to work at their optimal level • Residential aged care providers make arrangements with primary health care providers and geriatricians to provide visiting seasonal and on-call medical care to residents of aged care homes 29 • Build health service, clinical and workforce capability through a remote and rural health research program • Increase the focus on ageing research by involving each Regional Older People’s Health Service in research to improve health outcomes for older people in conjunction with universities and research foundations 30

28 National Health Workforce Taskforce (December 2008). Workforce Innovation and Reform: Caring for Older Australians . 29 National Health and Hospitals Reform Commission (June 2009). A Healthier Future for all Australians: Final Report . 30 SA Health, Statewide Service Strategy Division (May, 2009). Health Service Framework for Older People 2009–2016: Improving Health and Wellbeing Together.

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8.2 Infrastructure

Objective: Redesign physical infrastructure to meet the contemporary service delivery needs for acute and community health care Critical milestones: • Capital works to redesign / expand the Emergency Department at Mount Barker DSM Hospital • Capital works to expand surgical services at Mount Barker DSM Hospital • Build an ambulatory care centre that facilitates outpatients, ambulatory care, chemotherapy, palliation, rehabilitation - link to Integrated Health Care Centre at Mount Barker • Orthopaedic Post Acute Rehabilitation Service at Strathalbyn and District Health Service • Capital works to implement the Palliative Care Services Plan 2009- 2016 • Build the Integrated Health Care Centre at Mount Barker • Capital works to current aged care facilities to meet industry standards

Outcomes Existing Strategies Sustained Strategies for the Future • Physical buildings meet the needs of the service • Build the Integrated Health Care Centre at Mount delivery for acute, aged, rehabilitation and Barker respite care and community health programs • Revisit the capital works business case to redesign / expand the Emergency Department at Mount Barker DSM Hospital • Develop a business case for a Orthopaedic Post Acute Rehabilitation Service at Strathalbyn and District Health Service • Develop a business case for redesign / expansion of surgical services at Mount Barker DSM Hospital • Revisit the AHDGP proposal for an Integrated Health Centre at Mount Barker • Obtain approval for business cases • Build capacity to identify specific needs of the older person on presentation to the ED to avoid hospitalisation

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8.3 Finance

Objective: Budget allocation / streams enable the right staff to deliver the right service to reach the right customer/client at the right time in the most cost effective service model Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future • Budget is appropriate to the service delineation • Reporting to / from Cluster Business Centre • Access expertise in writing grant funding requests model • Hospitals and the Adelaide Hills Community Health • Develop business cases for redesign as described in Service have a dedicated system to manage budgets infrastructure that is informed by accurate data from CHSALHN • HAHAC to liaise with respective Local Councils, Cluster Business Centre aged care sector, Positive Aging Taskforce, Regional Development Board, DASSA, CLASS, Disability SA, and local service clubs so that collaborative construction around physical buildings to support improved accommodation for disability, respite, aged care and mental health can be progressed • Engage the workforce in a ‘money matters’ mentality where their own expertise is utilised on a daily basis to reduce waste in the system • Explore funding models to distribute according to population health need (equity of access to funding) • Financial planning / budgeting is sensitive to enabling an improved patient journey and better care in the community • Service delineation for Hills Area Hospitals and AHCHS is clear • Hills Area Hospitals and AHCHS have engaged other service providers and agencies so that services are delivered in a collaborative model

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8.4 Information Technology

Objective: Information technology supports an improved Patient Journey, Better Care in the Community and a Quality Safety Framework for delivery of services across the continuum of care Critical milestones: Country Health SA has equity of access to e-health with metropolitan health services and units within CHSALHN have equity of access

Outcomes Existing Strategies Sustained Strategies for the Future • Improved patient journey • Telehealth consultations / assessment • Better Care in the Community • Enhanced point of care testing • ICT infrastructure supports e-health • SA Health ICT strategic plans • Effective e-clinical records management • ICT capacity is built in to the capital works redesign • Integration of services via shared medical records • ICT connectivity at outreach centres: Goolwa • Electronic Decision Support (eg. high level • CHSALHN ICT Strategic Plan electronics tools for decision making for risk assessment and early intervention) • Electronic referral tools that embed the assessment tools • Shared / integrated separation summaries • ICT connectivity at outreach centres for community health across the Hills Area • Education program for all staff relative to their role to support e-health, including visiting GPs and specialists

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8.5 Risk Analysis

Objective: The risk of harm to the recipient of care across the continuum of care is controlled and health needs are understood Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future • Successful implementation of the service • The Strategy for Planning Country Health Services in • A formal risk assessment is conducted on the directions identified in the 10 Year Local Health SA set out important principles which have been consequences of not implementing the strategies for Service Plan used to guide the local planning the future as identified in the 10 Year Health Service Plan

• Implement strategies which have the most impact on improved health outcomes for people who reside in the Hills Area • Any strategy that indicates an unacceptable risk to the recipient, or cost burden due to implementation will be reassessed for an alternative model of care • Incorporate the 10 Year Health Service Plan planning principles into the ongoing monitoring and review process when implementing the 10 Year Health Service Plan

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9. Appendix

9.1 Leadership Structure

The Hills Area 10 Year Local Health Service Plan was developed by the Hills, Southern Fleurieu, Kangaroo Island Cluster Executive Team in collaboration with the Hills Area Health Advisory Council. The Plan considered the statewide health initiatives, Health Improvement Plans and the directions identified to improve population health by the SA Inner Country Health Network Alliance.

9.2 Methodology

The Hills Area 10 Year Local Health Service Plan has been developed following consultation with the local community, including key stakeholders. The Plan addresses community health needs considering services already in place, existing infrastructure, capacity to attract workforce to provide services, population profile, geography, burden of disease, health service utilisation, statewide SA Health initiatives, expected population growth and expected tourism development over the next 10 years. It is the intent of the Plan to identify strategic issues which impact on the social determinants of health, so that the Plan may address the cause and not the symptoms of less than optimal health outcomes for the community.

Methodology used to identify community needs

Community consultation is fostered through a number of formal and informal stand alone and ongoing forums.

Previous formal community engagement in service planning for Hills Area has included: • Northern Adelaide Hills Health Service - survey to ascertain the Torrens Valley community’s knowledge, use and perception of the NAHHS sites and its services. • Review of the pressures impacting on delivery of health services in the Mount Barker and surrounding areas. • Gumeracha Community Association public survey. • Alexandrina Council Feedback Report ‘Have Your Say’ consultation on the draft Community Strategic Plan 2009-2013. • Council Submission to the draft 30 Year Plan for Greater Adelaide. • Local Liaison Group (Mental Health Memorandum of Understanding). • Local Councils - Population planning projections. • Hills Area Health Advisory Council Annual General Meeting. • Hills Area Positive Aging Taskforce. • Hills Area Palliative Care Strategic Planning Group. • Hills Area Aboriginal Services Forum. • SA Inner Country Network Local Alliance. • Hills Area Better Care in the Community Committee. • Hills Area Pandemic Planning – Influenza (HAPPI). • Mount Barker District Soldiers Memorial Hospital 2009-10 business planning session. • Strathalbyn and District Health Service Emergency Department questionnaire.

Ongoing community engagement and collaboration includes: • Hills Area Positive Aging Taskforce. • Adelaide Hills Carers Forum. • Adelaide Hills Cancer Support and Resource Group. • AHCHS Youth Advisory Committee (YAC-RAP). • Alexandrina Council, District Council of Mount Barker and the Adelaide Hills Council. • YWCA of Adelaide. • Other government agencies. • Local GPs.

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• Adelaide Hills Division of General Practice (AHDGP). • University expo days to foster health traineeships. • Support for local high school training in first line emergency airway management and CPR (the Annie Elliott First Aid Program now with AHDGP). • Support by service clubs in fundraising drives. • Christmas pageants in all towns. • Infection control nurse education sessions at local TAFE. • Volunteer networks.

Specific methodology for the 10 Year Local Health Service Plan 2009

The Hills Area Health Advisory Council provided questionnaires to the local community. 760 responses were received across the age demographic: <20 = 348, 21-40 = 136, 41-60 = 110, 60+ = 113 and 53 of unknown age. A further 151 people were approached and had dialogue with the HAHAC specifically around the service areas. The outcome of the consultation is described in the Summary of Findings. HAHAC questionnaires were provided to all staff and health service providers for the four hospitals and AHCHS.

HAHAC members consulted various groups to capture their priorities for a 10 Year Health Service Plan. These included church groups, service clubs, recreational groups, residents, Hospital volunteers.

From mid January 2010 a dedicated Local Liaison Planning Officer liaised with and provided questionnaires to the Executive Officer / Director of Nursing and Patient Journey Coordinators at the four local hospitals and the Director AHCHS. Local GPs were invited to participate in the planning process and the Planning Officer visited the private practices at Mount Pleasant, Gumeracha, and one of the Mount Barker practices. An interview was conducted with Dr Michael Taylor, Medical Director, AHDGP and Mr Kevin Wisdom-Hill, Chief Executive, AHDGP. Interviews were conducted with the Regional Manager, CAMHS, Elective Surgery Coordinator, CHSALHN, Director, Clinical Workforce Development and Standards, DASSA and the Medical Director for Emergency Services, CHSALHN. An interview was conducted with the Patient Services Manager, SAAS for the HSFKI cluster, two half day workshops were held with the Program Managers and Director, AHCHS, and two meetings with key staff from the District Council of Mount Barker. All information from community, staff and key stakeholder consultations was reviewed and utilised to inform the 10 Year Local Health Service Plan. Leakage data from the Hills Area to metropolitan health units and outpatient clinics was obtained and analysed. The HAHAC has been briefed on all consultation outcomes during this process and the Planning Officer attended the HAHAC meetings.

The first draft of the 10 Year Local Health Service Plan was then presented to the cluster Director and Executives prior to presentation to the dedicated CHSALHN Review Panel. The final draft Plan was provided to the local HAHAC for review and endorsement.

9.3 Review Process

The Hills Area 10 Year Local Health Service Plan implementation and impact will be reviewed quarterly in the first year and bi-annually for the duration of the Plan.

Committees reviewing the 10 Year Health Service Plan will include: • Hills Area Health Advisory Council. • Hills, Southern Fleurieu, Kangaroo Island Cluster Executive team. • SA Inner Country Health Network Alliance – link to Health Improvement Plans.

The Terms of Reference for the Review (methodology) to be decided collaboratively between these 3 key committees. However the review must include community and other stakeholder engagement and consultation.

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9.4 Glossary

24/7 24 hours / 7 days a week A&E Accident and Emergency ABS Australian Bureau of Statistics AHCHS Adelaide Hills Community Health Service AHDGP Adelaide Hills Division of General Practice ASSIST Alcohol, Smoking and Substance Involvement Screening Test ATOD Alcohol, Tobacco and Other Drugs CALD Culturally and linguistically diverse CAMHS Child and Adolescent Mental Health Service (Statewide Service) CHSALHN Country Health SA Local Health Network COAG Council of Australian Governments DASSA Drug and Alcohol Services SA (Statewide Service) DCMB District Council of Mount Barker DPLG Department of Planning and Local Government DSM District Soldiers’ Memorial (such as Mount Barker DSM Hospital) EACH Extended Aged Care at Home package EACH-D Extended Aged Care at Home Dementia package ED Emergency Department GP General Practitioner HACC Home and Community Care HAHAC Hills Area Health Advisory Council HSFKI Hills, Southern Fleurieu, Kangaroo Island ICT Information and Communication Technology IHCC Integrated Health Care Centre NAHHS Northern Adelaide Hills Health Service NGO Non-government organisation RGH Repatriation General Hospital SA South Australia SAAS SA Ambulance Service SAPOL SA Police SLA Statistical Local Area TCP Transitional Care Package YAC-RAP Youth About Changing Reputations and Adult Perceptions

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