ALPINE HEALTH www.alpine he alth.org.au 14th Annual Report 2009-2010

STATUTORY REQUIREMENTS

Alpine Health 30 O’Donnell Avenue PO Box 236 Myrtleford Vic 3736 Telephone: 03 5751 9300 Facsimile: 03 5751 9396 Website: www.alpinehealth.org.au

SOLICITORS DLA Phillips Fox 140 William Street Melbourne Vic 3001

Health Legal Level 1, 499 St Kilda Road Melbourne

AUDITORS Victorian Auditor-General Auditor-General’s Agent Mr T Frazer -WHK Albury

BANKER National Australia Bank

Annual Report of Operations 09-10.doc Page 1 of 23 CONTENTS

INTRODUCTION...... 3 DISCLOSURE INDEX...... 7 POLICY STATEMENT...... 9 STATEMENTS OF COMPLIANCE ...... 9 ALPINE HEALTH SERVICES ...... 10 NUMBER OF STAFF...... 10 AVERAGE COLLECTION DAYS ...... 10 DEBTORS OUTSTANDING AS AT 30 JUNE ...... 10 BOARD OF MANAGEMENT ...... 11 MEETINGS ATTENDED BY BOARD OF MANAGEMENT ...... 11 EXECUTIVE STAFF...... 12 VISITING MEDICAL OFFICERS:...... 12 HOSPITAL OPPORTUNITY SHOP REPORTS...... 13 ORGANISATIONAL CHART...... 14 AWARDS...... 15 SCHOLARSHIPS ...... 15 COMMUNITY SUPPORT 2009-2010...... 17 FINANCIAL HIGHLIGHTS 2009-2010 ...... 18 SUMMARY OF FINANCIAL RESULTS...... 19 SUMMARY OF FINANCIAL RESULTS FOR LAST FIVE YEARS ...... 20 BUDGET ANALYSIS FOR YEAR ENDING 30 JUNE 2010...... 20 ADDITIONAL INFORMATION (FRD 22B APPENDIX)...... 21 ACTIVITY...... 21

Alpine Health Annual Report 2009-2010 Page 2 of 23 INTRODUCTION Chair’s Report since 2002. We expect that the financial On behalf of the Board of Management and in pressures will continue, and the Board is accordance with the Financial Management Act considering further strategies to protect the 1994, I am pleased to present the Report of security of Alpine Health’s services into the Operations for Alpine Health for the year ending future. These strategies are outlined in Alpine 30 June 2010. Health’s fifth Service Plan (2010-14), and include the possibility of further mergers and This financial year has been a challenging and amalgamations of existing services, as well as difficult time for Alpine Health. Our revenue implementation of new services that have clear base improved overall during the year with sources of revenue, such as medical and nurse increased income from inpatient and outpatient training. fees. Grants from the State government increased while grants from the Commonwealth During the course of these disruptions, the remained at similar levels to the last financial commitment and dedication of staff members, year. Costs continued to rise in line with the volunteers and Board members have made it previous financial year, and we again possible for Alpine Health to deliver high quality experienced real cost pressures arising from the services to the community while continuing to 2007 Nurses Enterprise Bargaining Agreement. implement our Service Plan. We were also able As a result it became necessary to develop and to review and update all of our disaster planning implement a plan to rebalance our costs with our processes during this period, in preparation for income. A number of cost-cutting measures an uncertain future. were initiated in October and November 2009, and I am pleased to say that these brought the There were a number of other highlights during 2009/10 operating budget and the actual financial the year that I wish to particularly mention. result much closer to our target of zero deficit. New and Improved Services The recovery plan was developed in accordance I am particularly pleased to report that our fifth with Alpine Health’s Service Plan. This was to Service Plan has been endorsed by the Victorian ensure that our front line services would remain Department of Health (formerly the Department secure. The three major components of the plan of Human Services) and the Commonwealth comprised a restructuring of Alpine Health’s Department of Health and Aged Care, with administration and senior management; the approval being extended from three to five years. contracting out of allied health services and the This provides Alpine Health with a longer period establishment of infrastructure relationships with to develop new services with a strong Goulburn Valley Health and North East Health foundation. We look forward to working with in Wangaratta. We are expecting this recovery the two departments on the implementation of plan to return the organization to a surplus our plan, and at an early stage, to discussing new position early in the 2010/2011 financial year, investments consistent with Alpine Health’s fifth although this will be very dependent on how an Service Plan. ongoing issue of the funding formula for the 2010 rounds of enterprise bargaining is resolved. A significant proportion of service development We are currently working with the Department this year was planned, led and delivered by of Health on this matter, and we remain positive volunteers, and it has been gratifying to see such that the problems that Alpine Health has with the strong support of volunteerism re-emerging in funding base and formulae for allocating money our communities. This has enabled the Board to meet increased salary costs can be settled. and staff members to think differently about Alpine Health’s role in the community, and for Our experience of the last two financial years us to have a dual role of provider of needs-based have clearly shown how vulnerable Alpine community services while also supporting Health is to changes in the wider economic, community based service delivery. financial and social environment. The value of planning for the future has been clearly As a consequence of this expanded role we have vindicated: the components of the 2009 financial seen the establishment of an Autism Spectrum recovery plan had its basis in our Service Plans Disorder Support Group in the Alpine Shire, the

Alpine Health Annual Report 2009-2010 Page 3 of 23 consolidation of Men’s Sheds in Bright and new management system for aged care, which Myrtleford, the advancement of work to establish will continue over the next year. an Aged Care advocacy service and a commitment to ‘Cancer Connect’ by our Cancer With the support of the Board, Alpine Health Support Groups. New services also include Life took a leadership role in a national approach to Transition Planning (future care planning) and an negotiating the rejuvenation of the Multi-Purpose agreement with the Dinner Plain community to Services program with the Commonwealth establish a community-based first aid service to government, as part of the reform of the meet identified needs. Australian health care system. The Board is monitoring and evaluating the potential impact of A draft discussion paper on the development of this reform process on Alpine Health, and we integrated family violence services in the Alpine will continue our advocacy of the MPS concept Shire was developed, as well as a new plan for for regional and rural communities in 2010-11. securing Adult Leisure Group services in the We were pleased to see an announcement from Bright community and a Sustaining General the Commonwealth in April 2010 about an Practice strategy. Management frameworks for expansion of the MPS program, and in particular, people suffering from cancer, depression and about a new allocation of specific capital funding anxiety were completed, as well an operational for local sub-acute services. Alpine Health has plan for mental health in Early Intervention since started discussions with the Victorian services. Department of Health to secure these local services. We look forward to working with both In the coming year, Alpine Health will progress the State and Commonwealth governments on further with its work in support of carers and the this initiative. consolidation of community and volunteer services, especially in cancer support and autism. In April 2010 Alpine Health again asked QICSA This will be done primarily through our to conduct a formal survey and quality relationship with the Community and Health assessment of its operations and processes, and I Advisory Groups, and we look forward to the am pleased to report that our accreditation was continuing community engagement strategy in reaffirmed following their visit. This is a great coming years. credit to all of our staff members, who continue to show great commitment to the delivery of high Protecting the Future quality services, which they strive to In addition to service development and continuously improve. improvement, Alpine Health completed a number of projects that are important to its Alpine Health again involved the community in future. Improvements in governance processes the Board’s annual corporate planning process, included a revised handbook for Board members, through the Community and Health Advisory and extending the role of the Audit Committee to Groups, and this year we were pleased to have encompass risk management, disaster and more than fifty people providing the Board with bushfire plans. Support for general practice advice on the issues we addressed. This advice registrars, funding to test the feasibility of particularly included the urgent need for medical intern training in the 2011 academic dedicated high level residential aged care beds in year, a strengthened relationship with Tayside Bright, with an allocation for dementia specific NHS Trust (Scotland) through staff exchange services. The Board and the Bright Community and a funded program for educating nurses and Health Advisory Group jointly convened a through the Nurses Board of Victoria are further community meeting in April 2010 to address this examples of our focus on the future. Alpine issue. As a consequence, the community Health also implemented a new Birthing resolved to take the leadership role in Outcomes system for our obstetric service in establishing a community-based working party conjunction with three other hospitals in north convened by the Bright Rotary Club, and the eastern Victoria. Board has fully committed to supporting its work. The Board is particularly pleased to In the administrative area, a new financial support the redevelopment of Bright Hospital as management system was implemented and the a core element of the project, which aims to build final upgrade of our payroll system to eliminate co-located facilities which will provide fully time sheets was completed. Work also began on integrated services in Bright, similar to those

Alpine Health Annual Report 2009-2010 Page 4 of 23 already existing in Myrtleford and Mount disappointed to learn of the decision of the Beauty. Community support for this Department of Housing to sell its assets there. development has been reinforced by our local As a consequence, the Board will redirect this general practitioners and by the Alpine Shire, effort to working with rural housing agencies, in which is most encouraging. A commitment to order to determine whether affordable housing early capital funding from the Commonwealth closer to the Mount Beauty business district and and Victorian Governments is currently being its health services is possible. pursued, with a business case to be developed in coming months. The development of community transport services linking each of the three major towns in Alpine Health received a $93,000 grant from the the Alpine Shire continues to be a major focus Department of Health this year for digital for our communities and for Alpine Health. We medical imaging equipment for Bright and will continue this work with key transport Myrtleford. This grant has enabled Alpine providers, local government and other health Health to have the same X-Ray system in all of service agencies to find a solution to this issue. its hospitals. The new equipment allows darkrooms and film processing chemicals to be We will also continue our work with local removed from our hospitals, improving patient doctors, the Bogong Regional Training Program, and staff safety and providing a much improved the universities and the Department of Health to service to patients and doctors. We look forward support the education of registrars in our health to the installation of this equipment early in the and aged care services, introducing medical next financial year. internships in 2011 and beyond. This work is a crucial part of our support for general practice The Coming Year and their capacity to recruit and retain doctors in In the coming year, Alpine Health will again our rural communities. Much of this work is focus on eliminating the main sources of the now being undertaken in conjunction with other operating deficit experienced in 2008/2009, hospitals in the Hume Region, and this is while actively seeking new government capital becoming an important feature of Alpine funding, particularly for the Bright Hospital re- Health’s future. We look forward to expanding development and for the associated residential our relationships with other agencies and in health services that are needed to support the particular, to establishing future sub –regional increasing number of people requiring high level credentialing of local medical officers. aged care. Our three local Community Health Advisory Alpine Health and Alpine Shire have done a Groups (CHAGs) continued to work tirelessly great deal of work together in the last year, with through the year, and the Board appreciates and the mutual aim of finding new ways to improve supports their active involvement in addressing a local health services for our communities. In wide range of health and well-being issues in our 2010-11 we will further develop the newly communities. This work includes a major focus formed alliance with Alpine Shire, with the aim on aged care with the Bright CHAG, on-going of establishing a single, fully coordinated home support for the Autism Spectrum Disorder and community service for people living in the Support Group with the Myrtleford CHAG and Shire, and an advocacy service for people who pressure for community transport and cancer are accommodated in residential aged care. services with the Mount Beauty CHAG.

Alpine Health will continue its support of the Organizational development has been a strong Men’s Sheds, the three Cancer Support Groups theme of our current Service Plan, and it is in each of our towns, and the new Autism pleasing to report that Alpine Health has Support Group. If resources permit, we will also continued to implement the plan that was restart work on planning for the improvement of developed two years ago. New team-based oral and dental health in our community. performance management systems have been developed for the Board and for all levels of our The work of the Board in lobbying for new staff. This gives us new ways of working with public housing in Mount Beauty, as part of its our staff members and involving them in commitment to health precinct planning, has so improving the services that our communities are far been unsuccessful: the Board was asking us to provide. In order to continue this

Alpine Health Annual Report 2009-2010 Page 5 of 23 approach, Alpine Health invested in a second The Board thanks the Bright and Myrtleford leadership training program in 2010, following Hospital Opportunity Shops and their volunteers the highly successful conclusion of the last for their tireless dedication and support of their year’s program. This investment ensures that hospitals during the year. Their fundraising Alpine Health has a significant number of skilled continues to provide improvements to our leaders throughout its organization, with the hospitals that may not otherwise be possible, all capability of managing the many changes that of which add significantly to the well-being of reform of the Australian health care system will our patients and residents. bring. Great credit is due to our Community and Health Education and professional career development Advisory Groups for their efforts to secure have been cornerstone strategies for retaining improving health services in all three of our and recruiting people into our organization, and towns. These Groups contribute a high this will continue in 2010-11. Alpine Health will awareness of community needs and feelings, and be extending the relationship that was established they each have a proactive style that gets things with the Tayside NHS Trust in 2007, and an done. exchange of management staff members will We want to thank our visiting medical officers continue into 2011. This year we welcomed and our team of general practitioners and nurse Sandra Gourlay, who is the Long Term practitioners, who provide the professional, Conditions Manager from the Perth and Kinross flexible, and highly personal service in our Community Health Partnership. Sandra has surgeries, in our hospitals and when needed, in added considerably to the work of the three our homes, that is such a strong feature of our CHAG’s in her role as Executive Officer this small and dispersed rural communities. year. Particular thanks go to all our staff members for In our last Annual Report we highlighted the their dedication and commitment. Their efforts completion of the refurbishment of Doug Lloyd have again enabled Alpine Health to deliver the Cottage at Myrtleford, which provides short term high quality services that our communities have accommodation for our trainee allied health come to expect, but during this last year, in the professionals and doctors. Unfortunately the face of significant change. We also feel deep Cottage was damaged by a fire in its roof this appreciation for the important contributions from year, and this prevented its planned use. We each of those people who left Alpine Health in look forward to the completion of repairs early in 2009 and 2010 as part of our restructuring the next year so that its purpose can be properly program. All of these staff members added fulfilled. significantly to Alpine Health: we miss their Acknowledgements cheery presence and we wish them well. Alpine Health thanks each of our local Members I want to personally thank our Board Members of Parliament for their interest in our affairs and for their individual and team contributions to the for the support they provide as they each go to governance of Alpine Health during the year, and the forthcoming elections with our good wishes. for their work in taking Alpine Health forward in We have also greatly appreciated the consistent what has been a particularly difficult period. support from the officers of the Department of Human Services and of the Department of Health The Board would also like to acknowledge a and Ageing, who assist us in many unseen ways. former member, Mrs Jane Barter, who left the Board in October 2009 following the birth of her We are particularly grateful to all of our first child. Jane spent a short time with the Board volunteers who assist us with so many aspects of before her resignation, and we look forward to the health services that we provide to our the possibility of her re-joining the Board at communities. Our appreciation is particularly some point in the future. extended to our palliative care volunteers and to the generous visitors to our aged care facilities, all of whom continued to give freely of their time and energy during the year. The efforts of these groups over the last year have directly improved and added to our services, and the Board extends its sincere thanks for these outstanding contributions.

Alpine Health Annual Report 2009-2010 Page 6 of 23 DISCLOSURE INDEX

The Annual Report of Alpine Health is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identification of the Department’s compliance with statutory disclosure requirements.

Legislation Requirement Page Reference

Miiniissteerriial Diirreeccttionss

Charter and purpose FRD 22B Manner of establishment and the relevant Ministers RO 9 FRD 22B Objectives, functions, powers and duties RO 9 FRD 22B Nature and range of services provided RO 10

Management and structure FRD 22B Organisational structure RO 14

Financial and other information FRD 10 Disclosure index RO 7 FRD 11 Disclosure of ex-gratia payments NA FRD 21A Responsible person and executive officer disclosures FS 49 FRD 22B Application and operation of Freedom of Information Act 1982 RO 9 FRD 22B Application and operation of the Whistleblowers Protection Act 2001 RO 9 FRD 22B Compliance with building and maintenance provisions of Building RO 9 Act 1993 FRD 22B Details of consultancies over $100,000 RO 9 FRD 22B Details of consultancies under $100,000 RO 9 FRD 22B Major changes or factors affecting performance RO 18 FRD 22B Occupational health and safety RO 9 FRD 22B Operational and budgetary objectives and performance against RO 20 objectives FRD 22B Significant changes in financial position during the year RO 18 FRD 22B Statement of availability of other information RO 21 FRD 22B Statement of merit and equity RO 9 FRD 22B Statement on National Competition Policy RO 9 FRD 22B Subsequent events NA FRD 22B Summary of the financial results for the year RO 19 FRD 22B Workforce Data Disclosures RO 10 FRD 25 Victorian Industry Participation Policy disclosures NA SD 4.2(j) Report of Operations, Responsible Body declaration RO 11 SD 4.5.5 Attestation on Compliance with Australian/New Zealand Risk RO 8 Management Standard

Financial Statements required under Part 7 of the FMA

SD 4.2(a) Compliance with Australian accounting standards and other FS 9 authoritative pronouncements SD 4.2(b) Comprehensive Operating Statement FS 4 SD 4.2(b) Balance Sheet FS 5

Annual Report of Operations 09-10.doc Page 7 of 23 Legislation Requirement Page Reference SD 4.2(b) Statement of Changes in Equity FS 6 SD 4.2(b) Cash Flow Statement FS 7 SD 4.2(c) Accountable officer’s declaration FS 3 SD 4.2(c) Compliance with Ministerial Directions FS 48 SD 4.2(d) Rounding of amounts FS 10

Legislation Freedom of Information Act 1982 RO 9 Whistleblowers Protection Act 2001 RO 9 Victorian Industry Participation Policy Act 2003 NA Building Act 1993 RO 9 Financial Management Act 1994 FS 3

Page Reference RO – Report of Operations FS – Financial Statements NA – Not Applicable

Alpine Health Annual Report 2009-2010 Page 8 of 23 POLICY STATEMENT

Mission: All requests must include the $23.40 application The mission of Alpine Health is to improve the fee. A total of eleven requests were received and health and well-being of people in the Alpine Shire. processed during the 2009/2010 financial year.

Vision: Compliance with Occupational Health & Safety The vision of Alpine Health is to be recognized Act 2004 leaders in the improvement of health and well- Alpine Health complies with the Occupational being. Health & Safety Act 2004 through a Safe Practice and Environment Committee which reports to the Objectives: Board of Management and Quality Care The objectives of Alpine Health are to: Committee.  Improve the flexibility of programs  Provide more cost effective aged care and Purchasing Policy health services Alpine Health is compliant with the Health  Enhance the matching and coordination of Purchasing Victoria (HPV) Purchasing Policy. aged care and health services to community needs. Consultancies Alpine Health commissioned a total of eight Philosophy: Consultants during the 2009/2010 financial year In pursuing our role, all actions and decisions will under $100,000. The total cost of these eight be guided by the following principles: consultancies was $125,555.  Recognition of the rights, dignity and independence of our clients Building Act 1993  Provision of information to clients and Alpine Health has plans in place to ensure communities as part of our annual planning compliance with the building and maintenance and quality assurance cycles provisions of the Building Act 1993.  Management of services in a flexible and Competitive Neutrality responsive fashion based on identified client health needs. Alpine Health complies with the Victorian Government’s policy framework and is presently  Fostering of linkages and cooperative reviewing the timetable for the implementation of relationships with related service providers. competitive neutrality.

STATEMENTS OF COMPLIANCE Risk Management and Audit Committee Alpine Health’s Risk Management and Audit Minister for Health in the State of Victoria Committee comprises: Mr John Kantor (Chair), Ms Alpine Health is established under the Health Marion Schumejko, Ms Christine Hau, Mr David Services Act 1988. The responsible Minister during Dart, Mrs Wendy Paglia and Dr Jeff Robinson. the reporting period is the Minister for Health the Hon Daniel Andrews MP. Statement of Merit and Equity Alpine Health ensures that the principles of equal Pecuniary Interests opportunity, merit, responsible management, Members of the Board of Management are required professional competence and diversity will to notify the Chairperson of any pecuniary interests constitute the basis of recruitment and appointment which might give rise to a conflict of interest. of all staff members. Whistleblowers Protection Act The Board of Management implemented the Whistleblower Protection Act during 2002 and at 30 June 2010, no notification with respect to improper or corrupt conduct had been received.

Freedom of Information under the Freedom of Information Act 1982 Any requests under this Act are required to be in writing and addressed to the Chief Executive Officer who is the Freedom of Information Officer.

Alpine Health Annual Report 2009-2010 Page 9 of 23 ALPINE HEALTH SERVICES  Nursing Care – low and high level  Acute Medical Inpatient Care  Nursing Education  Alpine Leisure Groups (ALGs)  Occupational Therapy  Central Sterilising Unit  Pain Management  Community Aged Care Packages  Palliative Care Services  Community Health Centre  Palliative Care Volunteers  Day Surgery (minor procedures – including  Pathology endoscopy)  Physiotherapy  Diabetics Support and Education  Podiatry  Dietetics  Post Acute Care  District Nursing (including immediate after-  Primary Care Team hospital discharge care)  Radiology  Emergency Care Services  Regional Health Program  Health Promotion  Renal Dialysis  Home Referral Service (including Home in  Residential Aged Care Services the Home and Post Acute Care)  Respite Care  Hospital in the Home  Rural Adolescent Program  Independent Living Units  Team Midwifery Program (including ante-  Infection Control natal, labour and post-natal care)  Medical Imaging

NUMBER OF STAFF

Labour Category June Current June YTD FTE Month FTE Administration & Clerical 34.6 34.6 Nursing 89.8 89.8 Hotel and Allied Services 61.6 61.6 Allied Health 7.6 7.6 Total 193.6 193.6 NB: Above figures include back-filling of positions for staff on leave

AVERAGE COLLECTION DAYS

Average Collection Days 2010 2009 Private 65 51 Transport Accident Commission 91 73 Victorian WorkCover Authority 273 117 Other Compensable 31 20 Psychiatric - - Residential Aged Care 8 8

DEBTORS OUTSTANDING AS AT 30 JUNE

< 30 days 31-60 days 61-90 days > 90 days Total 2010 Total 2009 Private 110,375 13,661 14,855 24,327 163,218 64,512 Transport Accident Commission 6,300 - - - 6,300 31,550 Victorian WorkCover Authority - - - 2,813 2,813 - Other Compensable 158,801 -3,290 -4,484 8,517 159,544 38,439 Psychiatric ------Residential Aged Care 11,159 - - - 11,159 15,335

Alpine Health Annual Report 2009-2010 Page 10 of 23 BOARD OF MANAGEMENT Mrs Wendy Paglia Project Support Officer Alpine Health is governed by a Board of Business Management Administration Health Management, who are volunteers and are and Retail and Environment selected from nominations within our Term of Appointment: 01.11.2006-30.06.2012 community, and appointed by the Victorian Minister for Health. They have a diverse range Mr Kevin Paynter of skills, experience and interests that contribute B Com, M Tax to Alpine Health, to ensure the efficient, Chartered Accountant effective and accountable governance of the Term of Appointment: 01.07.2009-3.06.2012 organisation through strategic leadership and a direction focussed on defined outcomes. The Mr Red Ramia Board of Management comes together: Self Employed Trader To govern and improve the well-being of the Business Management organisation, Term of Appointment: 01.11.2006-30.06.2011 To protect and improve the health of the community; and Mr Geoffrey Tually, JP Chair – Finance and Planning Committee To improve access to, and delivery of, health  Msc Science, BA Economics, Grad Dip Tax, services. Grad Dip Agric Extension, Diploma in Agriculture The Board of Management for the past year have Term of Appointment: 01.11.2006-30.06.2011 been:

Chair - Mrs Judith Barlee MEETINGS ATTENDED BY BOARD Grad Dip Spec Ed, B Ed, QSA Accred Auditor OF MANAGEMENT Aged Care Consultant – Auditing and Training. Chair, Board of Management and Executive Board of Management meetings Committee Board member % of meetings Term of Appointment: 01.11.2001-30.06.2010 attended BARLEE Judith 100% Deputy Chair - Ms Kitty Knappstein BARTER Jane 0% Background in Commonwealth Government KNAPPSTEIN Kitty 91% (Commercial Policy, Statistics, Government & LESCHEN Zuvele 64% Legal), IT (Microfilm) and Tourism and PAGLIA Wendy 82% Hospitality. Has particular interest in PAYNTER Kevin 64% Emergency Services, Community Welfare and RAMIA Red 91% Aged Care. TUALLY Geoffrey 82% Term of Appointment: 01.11.2002-30.06.2012 Board of Management, Finance and Planning Members Committee and Quality Care Committee Mrs Jane Barter meetings Kindergarten Director Board member % of meetings Term of Appointment: 01.07.2008-(Resigned 19 attended October 2009) BARLEE Judith 92% Mrs Zuvele Leschen BARTER Jane 0% Bachelor of Arts KNAPPSTEIN Kitty 80% Teacher LESCHEN Zuvele 61% Chair, Quality Care Committee PAGLIA Wendy 84% Term of Appointment: 01-07.2009-30.06.2010 PAYNTER Kevin 65% RAMIA Red 88% TUALLY Geoffrey 80%

Alpine Health Annual Report 2009-2010 Page 11 of 23 EXECUTIVE STAFF VISITING MEDICAL OFFICERS:

Chief Executive Officer Anaesthetist: Mr Lyndon Seys, BHA (UNSW), MA (Leeds), Dr Andrew Haughton, MBBS, FANZCA, FCHSM ACRM Instructor

Director of Medical Services Consultant Paediatrician Dr Jeff Robinson, MB BS FRACGP FACRRM Dr D Christie, MBBS, FRACP Dip RACOG, Grad Dip Rural GP General Practitioners Dr R Anderson, B Sc BMBS Finance and Corporate Services Manager Dr N Banu, MBBS Mr Craig Thompson, BCom, MBA Dr L M Bennie, B Med, B Ed, FRACGP, DRANZCOG Health Services Manager /Director of Dr D Blanks, MBBS Nursing- Bright District Hospital and Health Dr P Brown, MBBS, FACRRM, Member of Services DRS Mrs Gill Graves, RN, Post Grad Certificate Dr S K Cavini, MBBS Management, Dip Community Health Nursing Dr S Datta, MBBS Dr P C Dawkins, MBBS, DRANZCOG, Health Services Manager/Director of Nursing- FACRRM Mount Beauty District Hospital Dr S N Delaney, B Med Sc (Honors 1), MBBS, Mrs Cheryl Clutterbuck, RN, RM, Dip Bus, Dip FRACGP, DRANZCOG Human Resources Dr D Devereux, MBBS, DCH (SA) Dr D Dong, MB BS Health Services Manager/Director of Dr P Duff, MBBCh, BAO, MRCGP Nursing–Myrtleford District War Memorial Dr C Evill, MBBS, FRACGP, FACRRM Hospital Dr E M Garoni, MBBS, DRANZCOG, Mr Mark Ashcroft, RN, RM, Accident & FACRRM, FRACGP Emergency Certificate, Graduate Dip Nursing, Dr A Hassan, MBBS Grad Diploma Business Administration, Master Dr E Lisik, MBBS, FRACGP of Management. Dr I G McCallum, MBBS, FRCOG, FCRRM Dr A McEniery, MBBS, FRACGP, Dip Obs Primary Care Manager Dr S Marshman, MBBS Mr Trevor Marshall, Master of Social Work- Dr C O’Brien, BMBS, FRACGP, Grad DipRM, Human Service Management (Latrobe) DRANZCOG, FACRRM Dr R Richardson, MBBS, FRACGP, DRACOG, Quality and Accreditation Manager (to Grad Dip RM, FACRRM 21.12.2009) Dr J B Robinson, MBBS FRACGP FACRRM, Miss Sally Rashbrooke, Hon FAOQ DRANZCOG, Grad Dip Rural GP Masters Applied Science - Innovation and Dr S A Shute, MBBS, FRACGP, DRANZCOG Service Management, RMIT; Masters Human B Med Sc Resource Management, Charles Sturt University; Dr G B Taylor, MBBS, FRACGP, FACRRM, Certificate IV - Health Supervision (VU); Grad Dip Ed Certificate IV – Business Management – Small Dr C Urquhart, MB BS, Dip Obst RACOG Business – GOTAFE; Certificate IV Health Dr A M Zagorski, MBBS, DRANZCOG, Supervision, Diploma Vocational Education and FACRRM, FRACGP Training, Diploma of Practice Management, Victoria University; Diploma-Australian Institute General Surgeons of Company Directors and UNE; Diploma Dr S Franzi, MD, FRACS Occupational Health and Safety Management – Dr F J Miller, MBBS, PhD, FRACS NSCA NSW Obstetrician and Gynaecologist: Dr C J Pearse, MBBS (Syd), FRANZCOG

Alpine Health Annual Report 2009-2010 Page 12 of 23 Physicians Dr J B Best, AO, MD, PhD, FAFPHM, Dr L E Bolitho, MBBS (Melb), FRACP, FRACMA FACRRM Radiologists: Dr P G MacLeish, MBBS, FRACP Northeast Health Wangaratta Medical Imaging Border Medical Imaging Medical Administration Consultant

HOSPITAL OPPORTUNITY SHOP REPORTS

Bright Hospital Opportunity Shop Inc Myrtleford Hospital Op Shop Manager The Bright Hospital Opportunity Shop continues to trade successfully in both areas. Myrtleford Hospital Op Shop Financial statement for the Year ended 30 June 2010 We are very grateful to the men and women who man the shop and to the general public who Balance at 30 June 2009 15,630.31 purchase and provide goods for sale so that some Plus income 30,875.00 of the proceeds can go towards providing Less expenses 10,463.67 equipment for Bright Hospital as necessary. *Purchases expenditure 10,136.00 Balance as at 30 June 2010 $25,905.64 This year we have also been able to provide TV equipment for Hawthorn Village and games for *Purchased 2 x SARA Lifters for Residents at the Bright Hospital Alpine Leisure Group which Barwidgee Lodge Nursing Home have been appreciated by staff and clients.

We look forward to another year of service to the hospital and the community.

Betty E Seeley Honorary Secretary

Myrtleford Hospital Op Shop The second full year of trading in the new shop at 86 Standish Street Myrtleford resulted in a slight increase to that of last financial year’s income.

Donations from local and nearby areas continue regularly with any surplus goods passed on to other charities.

The Op Shop would not be able to operate without the dedication of its enthusiastic group of 10 volunteers who work regularly to ensure the goods that are on sale are clean and in good order. We are indebted to each of them for their continued support.

The Customers appear to be pleased with the prices and minor problems with theft are kept under control. Some difficult situations have been referred to the local police who have provided us with valuable assistance over many years.

Jean Ellis

Alpine Health Annual Report 2009-2010 Page 13 of 23 ORGANISATIONAL CHART

Alpine Health Annual Report 2009-2010 Page 14 of 23 AWARDS

Staff Long Service Recipients 2009/2010 (Graduate Certificate in Acute Nursing Trauma- The Board of Management is pleased to Critical Care Nursing). acknowledge the dedicated service of long 2007 - Maureen Ryland serving staff members during the year. These (Graduate Certificate in Health Promotion) are: 2008 - Heather Street (Graduate Diploma in Wound Care) Ten Years 2009 - Faisal Sabih ALLEN Jenny (Masters in Diabetes Education) CLARK Christine FARRINGTON Kay A word from the 2009 Winner MARSHALL Trevor I would like to thank the Otto Schmalz family MORRISON Dorothy and the Alpine Health Board of Management for VILLELLA Margot their kind generosity in awarding me the 2010 Otto Schmalz Memorial Scholarship; and Fifteen Years accordingly enabling me to undertake and BAXTER Veronica continue my studies for a Masters in Science GRAVES Gillian (Diabetes Education). REID Mandy SIMPSON Rosemary This year has seen me undertake some interesting studies to include Health Research Twenty Years Methods, Chronic Illness, Health Project COCKS Joy Preparation and Chronic Diseases Management.

Twenty-five Years In essence, The Otto Schmalz Memorial HINSON Laurene Scholarship has provided me with much needed financial relief to meet university course costs. SCHOLARSHIPS Otto R Schmalz Memorial Scholarship I hope to complete my studies mid next year and The Otto R Schmalz Memorial Scholarship is an to incorporating learnt knowledge and skills into annual Education and Study Award for Alpine the care and management of diabetes and its Health staff members. It was established in 2001 associated chronic illness co morbidities. Also to to commemorate the great contribution of Mr continue in the support and provision of optimal Otto Schmalz to Alpine Health and his nursing care for Alpine Health clientele in the commitment to welfare and development of Aged, Acute and Emergency Health settings and Alpine Health staff. other Alpine Health initiatives across the local and culturally diverse communities. The following staff members have been successful in their application for the Otto R I am optimistic about the future health directions Schmalz Memorial Scholarship. These are: of our unique region and communities; and to being able to provide diabetes specific clinical 2001 - Kerrie Hay-Smith nursing expertise, support, care and education for (Diploma of Counselling and Communication) peers, clients and the community. 2002 - Leanne Boase (Master of Nursing- Nurse Practitioner) Once again, my thanks and appreciation for the 2003 - Vicky Southgate Otto Schmalz Memorial Scholarship and to (Graduate Certificate in Management) honouring the late Otto Schmalz’s memory, 2004 - Jacinta Flood dedication and commitment to championing the (Bachelor of Social Work) Alpine Region’s communities’ health and 2005 - Shane Kirk wellbeing interests. (Graduate Certificate in Aged Care Services Management) Faisal Sabih 2006 - Lisa Lukey

Alpine Health Annual Report 2009-2010 Page 15 of 23 Mark Robinson Scholarship for Rural Health academic capabilities and will increases my The Mark Robinson Scholarship for Rural Health sense of fairness and humanity and my is an annual Education and Study Award. It has awareness of the diversity of health needs. been established by the Alpine Health Board of Management in recognition of the contribution of Around six months ago I was awarded the 2009 Dr J Mark Robinson and his family to the Mark Robinson Scholarship. This Scholarship development of health services in rural Australia has allowed me many things but most and more specifically those in the Kiewa Valley. importantly has reinvigorated my passion for studying Medicine at the University of The Mark Robinson Scholarship for Rural Health Newcastle, it had allowed me to focus whole is an education and study award promoted by the heartedly on my studies and take up some of the Board of Management to encourage local people fantastic opportunities allowed in my course. to take up studies in health related disciplines at either undergraduate or postgraduate levels and This time next year we have an 8 week return to practice in the Alpine Shire. placement focused on health equity. Our objective is to visit a community that experiences The following people have been successful in a heath disadvantage due to a remote location, their application for the Mark Robinson alcohol and substance abuse, low socioeconomic Scholarship for Rural Health. These are: background etc. I plan to spend my placement in the Torres Straight Islands with the outreach 2004 -Alison Gargan program that visits the communities on the (Bachelor of Physiotherapy) remote islands of that area, visiting communities that only receive heath care when a visiting 2005 - Warren Policha (Bachelor of Physiotherapy) doctor arrives with this program. Without this scholarship I would not have had the means to 2006 - Catherine Gargan attend a placement so far away, and I would not (Bachelor of Medicine/Bachelor of Surgery) be able to experience such heath inequity and I 2007 - Rebecca Morrison  that you very much for this opportunity. I am (Bachelor of Physiotherapy) sure this will have a lasting effect on myself and 2008 - Elizabeth Brown  the way in which I provide health care in the (Bachelor of Physiotherapy) future. 2009 - Alice Bellingham (Bachelor of Medicine) I have also been able to purchase many text books and Neurological assessment tools such as The sixth Scholarship was awarded in November reflex hammers and tuning forks without the 2009 to the successful applicant Alice stresses of having to scrimp and save. You have Bellingham. allowed me the freedom to enjoy my time at University and for that I am endlessly grateful. A word from the 2009 Winner I would like to thank Mark Robinson and his Thank You. family, Alpine Health and all those involved with the Mark Robinson Scholarship. You have Alice Bellingham allowed me opportunities that have improved my

Alpine Health Annual Report 2009-2010 Page 16 of 23 COMMUNITY SUPPORT 2009-2010 participated and contributed to the following Thanks to the individual donors, businesses groups or events including contributions, in and community groups who have supported full or part, towards the purchase of specific Alpine Health by donating. Thanks also to items across the three Alpine Health sites at individuals who have made gifts in memory of Bright, Mt Beauty and Myrtleford. loved ones. These are: DONATIONS FOR THE BRIGHT Autism Support Group DISTRICT HOSPITAL AND HEALTH Cancer Support Groups SERVICE WERE RECEIVED FROM: Endoscope Appeal Anderson, A & R (Open Garden) Henny Fisher’s Easter blanket raffle Anderson, Mariel Kiewa Valley Cookbook Anonymous Melbourne Cup Morning Tea at Mt Beauty Bright Autumn Festival Murray to Moyne Bike Ride Bright Bowl’s Club Various Raffles Bright Football Club WAW Latipsoh Fundraiser Bright Hospital Barrell Bright Hospital Op Shop In Memoriam Donations Bright Lions Club Cooper, Poppy Thank you to those who have chosen to Corry, Sheila remember their loved one by making Fekel, Maria memorial donations. Your kindness is greatly Guy, Keith appreciated. Harbrig, Pauline Luscombe, M Bright District Hospital and Health Services Northern Suburbs Streets Rods In Memory of: Rupp, D and E BARNES, Sid White, Bob and Marg BUNN, William JENVEY, Ron DONATIONS FOR THE MOUNT BEAUTY HADDRELL, Victor DISTRICT HOSPITAL WERE RECEIVED FROM: Mount Beauty District Hospital Anonymous In Memory of: Couttes Carol DEANS, Wallace Dederang Picnic Race Day MORPHETT, Margaret Fekel M RYDER, Victor Holroyd Judy SMITH, Dorothy Koetsveld G Mt Beauty Holiday Centre Myrtleford District War Memorial Hospital Mt Beauty Primary School In Memory of: Mt Beauty Supermarket BROWNE Gladys Upper Kiewa Valley Lions Club FRIZZO, Giovanni Walker Mrs LASPINA Rosa NOLAN, Trevor DONATIONS FOR THE MYRTLEFORD PIAZZA, Dino DISTRICT WAR MEMORIAL HOSPITAL ROGERS, Edna WERE RECEIVED FROM SEVERIN, Luigi Myrtleford Community Pharmacy SUPPA Angelina Myrtleford Craft Group TARRANT, Barbara Myrtleford Hospital Op Shop VILLELLA, Pasquale Novak M & N WORDEN, Dorothy Walker Clive & Rae Whorouly CWA Bequests From the Estate of: Special thanks to everyone who supported, McPHERSON Laura Doreen

Alpine Health Annual Report 2009-2010 Page 17 of 23 FINANCIAL HIGHLIGHTS 2009-2010

Alpine Health recorded a much improved initiatives increased the donated amounts in the financial operating surplus of $65,000 compared previous financial year. to the previous financial year’s large $591,000 operating deficit, following the implementation The increase in Operating Expenses was of a recovery plan in late 2009. This financial contained to $356,000 (1.8%). Despite average recovery strategy proved to be very effective in wage rises of 3.25% during the year, Employee tackling an expanding deficit, especially as the Entitlements – which at $15,319,000 comprise difficult operating conditions of the Global 76% of Alpine Health’s total $20,154,000 Financial Crisis (GFC) continued to impact the operating expenses – rose by only 2% due to the organisation. During the financial year, Alpine restructure recovery plan implemented in late Health maintained and built revenues and 2009.Most other expenses were restricted to services with a particular focus on containing similar levels to the previous year, except for and reducing costs where possible. The net Visiting Medical Officers’ Fees which rose by result, which is a less indicative measure of $159,000 (12.9%) due to fee increases and Fuel, Alpine Health’s financial performance as it Light & Power which increased by $34,000 includes unfunded depreciation, was a (8.3%). The increases in these expenses at $1,797,000 deficit compared to a $987,000 greater than the inflation rate was expected. deficit for the previous financial year. The major reason for the increase in the net deficit was a Capital expenditure of $410,000 included digital large rise of $1,260,000 in the depreciation X-Ray medical equipment, nurses’ call system charge following the revaluation of assets in and patient beds and chairs partly funded by 2009 by the independent Valuer-General. government capital grants and the $106,000 in donations from the community and Op-Shops. Operating Revenues rose 5.3% to $19,861,000 The final $10,000 capital grant for construction with the main contributors to the increase being of the Bright United Men’s Shed was received Government grants up by $526,000 (3.3%) and from the State Department of Planning & Patient & Resident Fee Income rising by Community Development. $319,000 (13%). State government funding increased by about 4% for funding of service Included in the financial accounts was a small development projects and increased employment deficit from Alpine Health’s proportional share costs. Commonwealth grants increased of the operations of the Hume Rural Health marginally by $81,000 (1.8%). A shorter average Alliance, a joint venture of Hume region health stay and a rise in the total number of acute services which primarily co-ordinates patients treated, combined with substantial Information & Communications Technology increases in pension rates – to which residential initiatives. fee income is tied - were the main factors in the 13% increase in Patient & Resident Fee Income. The cash position of Alpine Health remains Capital Purpose Income fell to $565,000 from sound with Total Financial Assets of $4,487,000, $636,000 last year (11.1% decline) as a result of comprising Cash & Cash Equivalents of a fall in interest income from lower GFC interest $1,456,000 and Other Financial Assets of rates, and Donations & Bequests returning to $3,031,000. average levels after targeted fundraising

Lyndon Seys Alpine Health Accountable Officer

6 September 2010

Alpine Health Annual Report 2009-2010 Page 18 of 23 SUMMARY OF FINANCIAL RESULTS

Financial Analysis of Operating Revenues and Expenses Total 2009/10 Total 2008/09 $000 $000 REVENUES

SERVICES SUPPORTED BY HEALTH SERVICES AGREEMENT Government Grants 16,250 15,730 Indirect Contributions by Department of Health 255 245 Patient & Resident Fees 2,777 2,458 Other Revenue 99 68 19,381 18,501 SERVICES SUPPORTED BY HOSPITAL & COMMUNITY INITIATIVES Private Practice Fees 162 109 Catering 143 150 Property Income 78 80 Other Revenue 455 367 838 706 TOTAL OPERATING REVENUE 20,219 19,207

EXPENSES SERVICES SUPPORTED BY HEALTH SERVICES AGREEMENT Employee Benefits 15,319 15,021 Fee for Service Medical Officers 1,394 1,235 Supplies and Consumables 2,165 2,247 Other Expenses 889 930 19,767 19,433 SERVICES SUPPORTED BY HOSPITAL & COMMUNITY INITIATIVES Supplies and Consumables 158 154 Other Expenses 229 211 387 365

TOTAL OPERATING EXPENSES 20,153 19,798

SURPLUS/(DEFICIT) BEFORE CAPITAL PURPOSE INCOME, 65 (591) DEPRECIATION, AMORTISATION AND SPECIFIC ITEMS

Capital Purpose Income 531 618 Gain/(Loss) on Disposal of Non-Current Assets 34 18 Depreciation and Amortisation (2,426) (1,029) Borrowing Costs (1) (3)

NET SURPLUS/(DEFICIT) FOR THE YEAR (1,797) (987)

OTHER COMPREHENSIVE INCOME Net Fair Value Revaluation on Non-Financial Assets - 6,942

COMPREHENSIVE SURPLUS / (DEFICIT) FOR THE YEAR (1,797) 5,955

Alpine Health Annual Report 2009-2010 Page 19 of 23 SUMMARY OF FINANCIAL RESULTS FOR LAST FIVE YEARS

2009/10 2008/09 2007/08 2006/07 2005/06 $000 $000 $000 $000 Total Revenue 20,784 19,843 19,039 17,557 16,857 Total Expenses 22,581 20,830 19,316 17,832 17,456 Total Surplus / (Deficit) (1,797) (987) (277) (275) (599)

Retained Surplus / (Accumulated (3,408) (1,611) (624) (347) (72) Deficit)

Total Assets 38,482 40,644 33,866 28,290 27,556 Total Liabilities 8,579 8,944 8,121 7,634 7,025 Net Assets 29,903 31,700 25,745 20,656 20,531

Total Equity 29,903 31,700 25,745 20,656 20,531

BUDGET ANALYSIS FOR YEAR ENDING 30 JUNE 2010

Operating Revenues - Actual exceeded Budget by 2.5% Total Revenues - Actual exceeded Budget by 3.5% Operating Expenses - Actual exceeded Budget by 1.7% Total Expenses - Actual exceeded Budget by 7.8% Actual Operating Surplus of $65,000 was $169,000 favourable compared to Budgeted Deficit of $104,000, primarily resulting from: higher than expected Patient & Resident Fee Income - due to a rise in acute patients treated, shorter average patient stays and an increase in pension rates to which residential fees are linked additional State Grants – successful funding submissions for various projects which weren’t budgeted favourable variance was partially offset by an increase in Fee for Service charges (higher rates charged by Visiting Medical Officers) , Fuel, Light & Power (rise in utilities’ rates) and Administration costs

Actual Total Deficit of $1,797,000 was $913,000 unfavourable compared to Budgeted Total Deficit of $884,000 mainly due to the increased depreciation charge of $1,260,000 from the Valuer-General’s assets revaluation which wasn’t incorporated into the budget.

Alpine Health Annual Report 2009-2010 Page 20 of 23 ADDITIONAL INFORMATION (FRD 22B APPENDIX) The following information, where it relates to Alpine Health is relevant to the financial year 2009-10 is available upon request by relevant Ministers, members of Parliament and the public: (a) A statement of pecuniary interest has been completed. (b) Details of shares held by senior officers as nominee or held beneficially. (c) Details of publications produced by the Department about the activities of the Health Service and where they can be obtained. (d) Details of changes in prices, fees, charges, rates and levies charged by the Health Service. (e) Details of any major external reviews carried out on the Health Service. (f) Details of major research and development activities undertaken by the Health Service that are not otherwise covered either in the Report of Operations or in a document that contains the financial statements and Report of Operations. (g) Details of overseas visits undertaken including a summary of the objectives and outcomes of each visit. (h) Details of major promotional, public relations and marketing activities undertaken by the Health Service to develop community awareness of the entity and its services. (i) Details of assessments and measures undertaken to improve the occupational health and safety of employees. (j) General statement on industrial relations within the Health Service and details of time lost through industrial accidents and disputes, which is not otherwise detailed in the Report of Operations. (k) A list of major committees sponsored by the Health Service, the purposes of each committee and the extent to which the purposes have been achieved.

ACTIVITY

Admitted Patient – Note (a) Acute Sub-Acute Mental Other Total Health Separations Same Day 996 - - - 996 Multi Day 980 - - - 980 Total Separations 1,976 - - - 1,976 Emergency 545 - - - 545 Elective 246 - - - 246 Other including Maternity 1,185 - - - 1,185 Total Separations 1,976 - - - 1,976

Total WIES 1,196.22

Total Bed Days 9,413 - - - 9,413

Non Admitted Patients Acute Sub-Acute Mental Other Total Health Emergency Department 4,388 - - - 4,388 presentations Outpatient Services – - - - - - occasions of services (VACS and Non VACS clinics) Other Services – occasions of - - - - - service Total occasions of service - - - - - VACS– No of encounters - - - - - (applicable to Health Service/hospital allocated with VACS throughout targets

Alpine Health Annual Report 2009-2010 Page 21 of 23 PLEASE SUPPORT ALPINE HEALTH

Not withstanding the amount of Government subsidy received during the year, Alpine Health is still dependent upon the financial support of the public to enable us to continue and develop its services. Alpine Health has a continuing need for facilities and equipment of the highest modern standards, to serve the needs of the communities of the Alpine Shire and surrounding districts. The range of quality of services provided by Alpine Health is a tribute to the excellent support of the communities of the many years.

To ensure this high standard of care can continue, we seek your financial support to purchase new and improved equipment, and to assist in the improvement of facilities.

YOU CAN ASSIST BY

 A donation towards a special item  Defraying the cost of much needed equipment  Remembering Alpine Health in your will  Assisting as a volunteer.

YOUR HELP IS MUCH NEEDED AND WILL BE APPRECIATED 

The Chief Executive Officer Alpine Health PO Box 236 Myrtleford Vic 3736

I am pleased to donate the enclosed sum of $…………………………...which should be used towards the purchase of

*…………………………………………………………………………………………… for the ………………………………………site of Alpine Health.

Mr/Mrs/Miss/Ms……………………………………………………………………………

Address……………………………………………………………………………………

Signature……………………………………………………………………………………

(*insert equipment or area preferred or write “equipment for general use).

Alpine Health Annual Report 2009-2010 Page 22 of 23 ALPINE HEALTH Multi Purpose Service

www.alpinehealth.org.au

Corporate office Myrtleford District War Memorial Hospital Tel: 03 5751 9300 30 O’Donnell Avenue (PO Box 236) Myrtleford Victoria 3737 Fax: 03 5751 9395 (reception) 03 5751 9396 (administration)

Bright District Hospital and Health Service Tel: 03 5755 0100 Cobden Street Bright Victoria 3741 Fax: 03 5755 2110

Mount Beauty District Hospital Tel: 03 5754 3500 Hollonds Street (PO Box 322) Mount Beauty Victoria 3699 Fax: 03 5754 3555

Aged Care Facilities

Barwidgee Lodge Nursing Home Tel: 03 5751 9335 Myrtleford

Kiewa Valley House Tel: 03 5754 3521 Mount Beauty

Hawthorn Village Tel: 03 5755 0150 Bright

Adult Leisure Groups (ALG’s)

Myrtleford ALG Tel: 03 5751 9326 30 O’Donnell Avenue Myrtleford Victoria 3736

Bright ALG Tel: 03 5755 5123 Cobden Street Bright Victoria 3741

Mount Beauty ALG Tel: 03 5754 3526 Lakeside Avenue Mount Beauty Victoria 3699

Alpine Health Annual Report 2009-2010 Page 23 of 23