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Providing Quality Care Annual Report 2016/17 Nathalia District Hospital ANNUAL REPORT 2016/17
Mission Values Working collaboratively to provide quality health and Integrity well-being services for our community. We engage others in a respectful, fair and ethical manner, fulfilling our commitments as professionals. We ensure the highest degree of dignity, equity, honesty and kindness.
Vision Accountability Leading our community towards better health. We ensure quality patient care and use resources appropriately in an open and transparent manner.
Collaboration We work as a team in partnership with our staff, our community and other healthcare providers.
Knowledge We create opportunities for education and health promotion.
Excellence We are committed to achieving our goals and improving quality of care by delivering efficient, safe, person-centred, innovative, knowledge-based healthcare.
2 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 INTRODUCTION In accordance with the Financial Management Act 1994, I Contents am pleased to present the Report of Operations for the Nathalia District Hospital for the year ended 30 June 2017.
About Nathalia District Hospital 4
Board Chair Report 6
Sue Logie Director of Medical Services Report 7 Board Chair 4 September 2017 Board & Board Committees 8
Board of Management 11
Leadership Team 12 ANNUAL REPORTING Workforce 14 Nathalia District Hospital reports on its annual performance in one document. This Annual Financial and Performance Organisational Structure 15 Report fulfils the statutory reporting requirements to Government by way of an Annual Report and the Victorian Statutory Requirements 16 Quality Account reports on quality, risk management and performance improvement matters. Both documents are Initiatives and Key Achievements 10 presented to the Annual General Meeting and then distributed to the community. Part A - Statement of Priorities 22
Nathalia District Hospital was established under the Health Part B - Performance Priorities Service Act 1988. Financial Performance 26
Part C - Activity & Funding 28
Disclosure Index 32
RELEVANT MINISTER Financial Report 33 The responsible Ministers during the reporting period were: Victorian Quality Report 105 The Honourable Jill Hennessy MP, Minister for Health, Minister for Ambulance, 1 July 2016 to 30 June 2017. The Honourable Martin Foley MP, Minister for Housing, Disability and Ageing, Minister for Mental Health, 1 July 2016 to 30 June 2017.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 3 About Nathalia Hospital
athalia District Hospital is a Small Rural Health History Service located in the north of the State. It services the residents of Nathalia and district, which In response to an advertisement placed in the Nathalia N Herald on 14 December 1888, on 21 December 1888 encompasses the small townships and districts of Waaia, Barmah, Picola, Kotupna, Bearii and Yalca. about thirty gentlemen gathered to consider the advisableness or otherwise of erecting a hospital in Nathalia District Hospital is governed by a Board of Nathalia. The opinion of this meeting was that ‘the time Management, appointed by the Governor in Council upon has now arrived, when a hospital should be erected in recommendation of the Victorian Minister for Health, the Nathalia’. The meeting did not decide to build a hospital, Hon. Jill Hennessey. Under the Health Services Act 1988, the but only affirmed that it was a necessity, and that if the hospital has flexibility to tailor services to meet the changing promised support warranted, a further meeting would needs of our community. be called. Whilst it would be many years before a public Our Annual Report is best read in conjunction with the hospital would be established in Nathalia, during the early Quality of Care Report. These two documents detail our 1900’s a hospital service was represented by a succession achievements across the clinical, community and operational of midwives who delivered babies in the home and several departments of our health service. lying-in homes and private hospitals. The purpose, function, power and duties of Nathalia District In 1892-93 Dr F. Keyes built a private residence known as Hospital are described in the operation practices and ‘Mayo’ on the corner of Elizabeth and North Streets in by-laws of the organisation. Established under the Health Nathalia. In 1939 the then current owner of the house Dr Services Act 1988, Nathalia District Hospital is the major N. Harbison closed the six bed private hospital he ran at 42 health provider for Nathalia. Fraser Street and converted ‘Mayo’ into a private hospital. In 1951 the Hospital & Charities Commission and the Acknowledgement to Country Hospital Committee of Management purchased ‘Mayo’. The Hospital became known as Nathalia District Hospital We acknowledge the traditional owners of this land and and was officially opened by the Hon. E. P. Cameron MLC pay our respects to their Elders past and present. We Minister of Health in December 1955. acknowledge their living culture and the unique role they play in the life of our region. Today Nathalia District Hospital plays a key role in the provision of health care to Nathalia and district communities operating from a purpose built facility it relocated to in November 2009.
4 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Our Services • Urgent Care Centre provides urgent medical care on a 24 hour basis, seven days a week. • Acute Care Unit of six beds offers general inpatient medical and palliative care. • A twenty bed residential aged care home offering high level nursing care. • Nathalia Medical Clinic. • In addition, various community and primary care services are offered either by the health service or through private providers. These including Radiology, Pathology Collection, Physiotherapy, Podiatry, Diabetes Education, Occupational Therapy, Women’s Health Clinic, Dietetics and Generalist Counselling.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 5 Board Chair Report
t has been a very busy year for the board of management Thanks must go to our Director of Nursing Leigh Giffard, and staff. The introduction of the Department of Health the doctors, hospital and medical centre staff and the Iand Human Services Safer Care Victoria program has volunteers who strive to provide a caring and quality service. seen the Board review its clinical governance systems to The hospital nominated Dr Peter Poon for the Moira Shire eliminate avoidable harm and strengthen the quality of care Australia Day Awards and he was awarded the Nathalia delivered to our community. Citizen of the Year. Our congratulations to Dr Poon. The hospital was successful in obtaining funding to Congratulations also to Dr Drenen who reached a milestone upgrade our nursing home to extend the dining living area by achieving twenty-five years of service to the hospital. and allow more personal space for residents. Thank you to our partner organisation Goulburn Valley Changes to Home and Community Care Services, which Health for their support and expertise: to Trevor include the District Nursing Service and Planned Activities Saunders CEO, Donna Sherringham Executive Director Group, has moved under the control of the Federal Clinical Services, Sam Costanzo Executive Director Government and staff have worked to make the transition of Finance & Business Services and Kate Osmond seamless for the consumer. Governance Officer. The Peter Prentice flats were sold and some of the We welcome our new Board members Peter Limbrick profit was used to install solar panels on the roof of and Maxene Hughes who bring financial and clinical the hospital. This will help to reduce energy costs and governance expertise to the Board. Finally, I would like is a long term investment to making our service more to acknowledge the hard work and commitment of our financially and environmentally sustainable. The balance Board members who strive to make our health service has been invested, to be used for community programs the best it can be. and services. Susan Logie, Our partnership with Barwo Homestead has delivered Board Chair several information sessions which include Advanced Care Planning, Powers of Attorney and Wills and Fees and Charges in Residential Aged Care. The joint committee continues to work together in consultation with the community to deliver sessions which meet their needs. Our Community Advisory Committee has been very active with the refurbishment of the Palliative Care Suite, which was official opened in October 2016 and was well attended by the community. The upgrade was made possible by funds donated by the New Year’s Eve Carnival Committee. Hospital signage has been reviewed and changes made; this has received very positive feedback from consumers. Thank you to the committee for their time and commitment; it is much appreciated by the Board and hospital management.
6 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Director Medical Services Report
athalia’s dedicated GPs provide high calibre family The DMS role in small rural hospitals is one of liaison GP level medical services to patients at Nathalia with health service clinicians as well as the provision of NDistrict Hospital (NDH), its nursing home as well senior medical administrative advice to staff on clinical as at the Nathalia Medical Centre (NMC). governance, medical services, clinical quality and medico- legal matters. As NDH’s visiting Director of Medical This year has seen the retirement of a highly esteemed Services (DMS), my role includes monthly visits to NDH, senior GP, Dr Peter Poon as well as the commencement of during which I meet with NMC doctors, executive staff practice in Nathalia of Dr Hamed Shafaie ably supported and attend Board and NDH related clinical governance by Drs John Drennan and Mogeke Nyorora. Attempts to committee meetings. In so doing I co-operate closely with recruit another GP and or GP registrar are actively on-going. the DON/Manager (Ms Leigh Giffard) and NMC practice It is these doctors, capably assisted by NDH/NMC nurses, manager (Ms Lynne Peterson) as well as the responsible allied health and clerical staff, that allow continuing Senior Executive at Goulburn Valley Health (Ms Donna admissions to the hospital and nursing home, as well as Sherringham), who I would like to thank for their support. attendances at the Urgent Care Centre. Dr Rick Lowen The quality of these services is regularly reviewed at hospital MBBS, FRACGP, AFACHSE, meetings as part of our clinical governance obligations and Sub-Regional Director Medical Services national accreditation requirements. Of the last mentioned, NDH is again to be visited shortly by hospital accreditors. Nathalia doctors also regularly submit to external medical credentialing undertaken by Goulburn Valley Health. This process also ensures that medical services provided by our doctors align closely with the hospital’s clinical capability as well as community expectations. All of these reviews to date, confirm clinical services provided at NDH are of a high standard, compared to other like sized small rural Victorian health services.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 7 Board & Board Committees
BOARD BOARD BOARD DIRECTOR 16 28 July 25 Aug 16 29 Sept 16 31 Oct 16 16 28 Nov 29 Dec 16 19 Jan 17 17 23 Feb 6 April 17 27 April 17 17 25 May 17 29 June % Attendance
Sue Logie P P A P P NM P P P A P P 82%
David Vaughan P P P P P NM P P P P P P 100%
Kerry-anne Rappell P A P A A NM A P A P P P 55%
Diana Baxter P A P P P NM A P A P A P 64%
David McKenzie P P P A P NM A P A P P A 64%
Chris McCallum P P A A P NM A P A P P P 64%
Peter Limbrick P P P P P NM P P P P P P 100%
Maxene Hughes P P P NM P P A A P P 78%
Audit Committee Meeting 2016/17 BOARD DIRECTOR Extraordinary 5 August 25 August 24 November 6 April 29 June % Attendance
Peter Limbrick P P P P 100%
Sue Logie P P P P P 100%
David Vaughan P P P P P 100%
Chris McCallum A P P A P 60%
8 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Medical Appointment Committee Meetings 2016/17 BOARD BOARD DIRECTOR 25 August 25 May % Attendance
Diana Baxter A A 0%
Sue Logie P P 100%
David Vaughan P P 100%
David McKenzie P P 100%
Dr Rick Lowen A P 50%
Patient Care Review Committee 2016/17 BOARD DIRECTOR 16 28 July 29 Sept 16 27 Oct 16 19 Jan 17 6 April 17 17 25 May % Attendance
Sue Logie P A P P P P 83%
David Vaughan P P P P P A 100%
Kerry-anne Rappell P P A A A P 50%
Diana Baxter P P P A A A 50%
David McKenzie P P P A P P 83%
Chris McCallum P P P A A P 67%
Peter Limbrick P P P P P P 100%
Maxene Hughes P P P P A P 83%
P - In Attendance A - Apology NM - No Meeting
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 9 Initiatives and Key Achievements
Nathalia Citizen of the Year Palliative Care Room On Australia Day 2017, Dr Peter Poon received the Citizen The Nathalia Carnival Committee, in partnership with of the Year Award for Nathalia for his services to our our Consumer Advisory Committee, officially opened the community. Dr Poon has served the people of Nathalia redecorated palliative care room on 27 October 2016. for 37 years and there were many of the staff and Board Consumers had worked with interior designers to make of Management at the award ceremony to share this the area more homelike, thus making the end of life journey celebration. for families and their loved ones less stressful. Wall murals were made using photographs from local Installation of Solar Panels photographers Roy Peachey and Estelle Chalker. The project was funded through the generous donation At the end of June the power was cut to the hospital for from the Nathalia Carnival Committee who have been 15 minutes, while the new solar panels were commissioned supporting our hospital for many years through the New and connected to the power grid. This step takes our Year’s Eve raffle. organisation forward in its endeavours to reduce its carbon foot print. As there is very limited funding available to support this type of initiative, the Board of Management made the decision to self-fund the venture, aimed at becoming more environmentally friendly.
10 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Board of Management
Board Chair Diana Baxter Ms Sue Logie Appointment: 1 July 2015 Appointment: 1 November 2004 Term Expires: 30 June 2019 Term Expires: 30 June 2017 Committees: Committees • Patient Care Review Committee • Patient Care Review Committee • Medical Appointments Advisory Committee (Chair) • Moira Healthcare Alliance • Audit Committee Chris McCallum • Medical Appointments Advisory Committee Appointment:1 July 2004 Term Expires 30 June 2017 Deputy Board Chair Committes: Mr David Vaughan • Patient Care Review Committee Appointment: 1 November 2000 Term Expires: 30 June 2017 • Audit Committee
Committees: Peter Limbrick • Patient Care Review Committee Appointment:1 July 2016 • Moira Healthcare Alliance Term Expires 30 June 2019 • Medical Appointments Advisory Committee Committees: • Audit Committee • Patient Care Review Committee
Kerry-anne Rappell • Audit Committee (Chair) Appointment: 19 February 2013 Term Expires: 30 June 2019 Maxene Hughes Appointment:6 September 2016 Committees: Term Expires 30 June 2019 • Patient Care Review Committee (Chair) Committees: • Patient Care Review Committee David McKenzie Appointment:10 September 2007 Term Expires: 30 June 2018
Committees: • Patient Care Review Committee • Audit Committee • Medical Appointments Advisory Committee
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 11 Leadership Team
CHIEF EXECUTIVE OFFICER Interim Chief Executive Officer Positions Mr Trevor Saunders Following the resignation of Dale Fraser in June 2016, Fiona Master Public Sector Executive Management, B.Bus, CPA, Brew was appointed Interim CEO for the period July 2016 Grad Cert Public Sector Management, GAICD. to September 2016 and Dr Max Alexander was appointed Interim CEO for the period October 2016 – February 2017. Trevor was appointed Chief Executive Officer of Goulburn Valley Health in February 2017. EXECUTIVE DIRECTOR CLINICAL Trevor has significant experience at senior executive OPERATIONS level and has held leadership roles at a range of large organisations within the health and education government Ms Donna Sherringham sectors across Australia. RN, Dip App Sci, B Nursing, MHA, FACSHM Prior to working at GV Health, Trevor held senior The Executive Director Clinical Operations has positions at SA Health including: Director Medical Imaging responsibility for the financial management and reporting Operations, Director of Finance and Executive Director requirements to the Board of Management and external Corporate Services. He was also employed as the Chief bodies including the Department of Health and Human Finance Officer at Gold Coast Health and Northern Services. Territory Employment, Education and Training. Trevor’s professional affiliations over recent years DIRECTOR OF NURSING/MANAGER have included membership of the Australian Society of Mrs Leigh Giffard Certified Practicing Accountants. Trevor is a former member of the Institute of Public Administration Australia RN, BN, Grad Dip Advanced Nursing (Management), Master and the Australian Institute of Company Directors. of Health Service Management, MRCNA Trevor prides himself on his work ethic, political acumen, The Director of Nursing/Manager is responsible for the service delivery record, management skills and strong management of all clinical and non-clinical services within communication – demonstrating effective leadership at the organisation. This includes Nursing, Hospitality, both an organisational and community level. Maintenance, Allied Health Services and the Nathalia Medical Clinic. Leigh also oversees the operational Trevor is dedicated to providing excellent services to the management of Quality Improvement, Risk Management, community and is actively involved in the local area. He Occupational Health and Safety and Complaints lives in Shepparton and is a member of the Shepparton Management. Leigh maintains strong links with the Central Rotary Club. community and its representatives to ensure the services provided by our Hospital meet community needs.
12 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 ASSISTANT DIRECTOR OF NURSING DIRECTOR OF MEDICAL SERVICES Mr Grant Hutchins Dr Richard (Rick) Lowen RN, Bachelor of Public Health, BN MBBS, DipObs RCOG, FRACGP, AFCHSE CHE The Assistant Director of Nursing holds a key The Director of Medical Services provides clinical management and leadership role within the Hospital, advice to the health service, contributes to Patient Care coordinating the quality of clinical care delivered to our Review meetings and supports Nathalia’s Visiting Medical residents and patients. Major responsibilities include Officers. He attends the Nathalia District Hospital Clinical Leadership and Standards of Practice, Nursing monthly, during which time he attends Medical Staff Recruitment and Retention, Clinical Risk Management, Group meetings, reviews clinical policies of the Hospital, and Quality Improvement. Grant oversees the placement provides advice and support to the Director of Nursing/ of nursing, allied health and medical students as well as Manager and staff and responds to day to day operational the ongoing professional development of our own clinical issues of medical importance. staff. Where necessary, Grant relieves the Director of Nursing/ Manager to ensure seamless service delivery.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 13 Workforce Data
Ancillary Staff (Allied Health) 2.46% Hospital Medical Officers 0.68%
Hotel & Allied Health Services 11.08%
Nursing 28.71%
Administration & Clerical 5.46%
June June Labour Category Current Month FTE YTD FTE 2016 2017 2016 2017 Nursing 29.29 28.49 29.11 28.71 Administration & Clerical 6.09 4.71 5.53 5.46
Hotel & Allied Health Services 10.40 10.88 11.71 11.08
Hospital Medical Officers 0.95 0.00 0.38 0.68 Ancillary Staff (Allied Health) 2.38 2.30 2.47 2.46 Total 49.11 46.38 49.20 48.39
Merit & Equity Principles Code of Conduct Nathalia District Hospital is committed to applying merit All Nathalia District Hospital staff are required to abide and processes to ensure that applicants are assessed by the Code of Conduct, which is based on the Code of and evaluated against criteria and other accountabilities Conduct for Victorian Public Sector Employees. without discrimination.
14 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Nathalia District Hospital Organisational Chart 2017
Board of Management
Chief Executive Officer Executive Director Clinical Director of Medical Services Operations - CEO Delegate
Visiting Medical Officers Executive Director Finance and Business Services Director of Nursing/Manager Quality & Risk Co-ordinator
Assistant Director of Nursing
NATHALIA HOSPITALITY LOGISTICS NURSE UNIT • District Nurses MEDICAL SERVICES AND MANAGER • Planned Activity CLINIC COORDINATOR PLANNING Group PRACTICE MANAGER • Urgent Care MANAGER • Catering Centre • OHS • Gym and • Cleaning • Acute Care • Practice Nurse Strength Training • Maintenance • Laundry • Palliative Care • Reception and • Allied Health • Gardening Administration • Volunteers • Transition Care • Health Staff • Accounts • Consumer • Residential Aged Promotion Advisory • Procurement Care • Diabetes Clinic Committee • Information • Resident • Counselling Technology Lifestyle Services • Project • ACFI Management Documentation • Visiting Services including Radiology and Pathology
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 15 Statutory Requirements
Consultancies In 2016/17, there were zero consultancies where the total fees payable to the consultants were more than $10,000. In 2016/17, there were zero consultancies where the total The total expenditure incurred during 2016/17 in relation to fees payable to the consultants were less than $10,000. The these consultancies was zero. total expenditure incurred during 2016/17 in relation to these consultancies was zero. The following statistics have been collated for Occupational Violence in the workplace at Nathalia District Hospital:
Occupational violence statistics 2016-17
1. Workcover accepted claims with an occupational violence cause per 100 FTE Nil
2. Number of accepted Workcover claims with lost time injury with an occupational Nil violence cause per 1,000,000 hours worked.
3. Number of occupational violence incidents reported 5
4. Number of occupational violence incidents reported per 100 FTE 10
5. Percentage of occupational violence incidents resulting in a staff injury, illness or condition Nil
For the purposes of the above statistics the following definitions apply. Occupational violence - any incident where an employee is abused, threatened or assaulted in circumstances arising out of, or in the course of their employment. Incident - occupational health and safety incidents reported in the health service incident reporting system. Code Grey reporting is not included. Accepted Workcover claims - Accepted Workcover claims that were lodged in 2015/16. Lost time - is defined as greater than one day.
16 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Occupational Health & Safety A visit from Worksafe in October 2016 found the systems in place managed occupational safety well and NDH was fully Nathalia District Hospital is committed to providing a compliant with legislation. safe environment for staff, patients, residents, visitors and contractors at all times. To achieve this, we engage in regular Occupational safety is monitored through our risk consultation with staff and consumers to identify all potential management framework, with all risks having key workplace hazards and eliminate them where reasonably performance indicators in place to ensure the identified risks practicable. are effectively managed and monitored.
No. of Topic KPIs Results
Fire and Emergency 2 100% of staff completed fire and emergency training in 2016-17.
100% of staff completed competency in manual handling, the same as for the previous year. Manual Handling 2 There were two manual handling incidents in 2016-17 resulting in 16 hours lost.
100% of staff completed the workplace hygiene competency, an increase of 2% on the Infection Control 2 previous year.
Safe Chemical 1 All chemicals had current Material Safety Data Sheets available at point of care. Management
Radiation Safety 1 100% compliance at point prevalence audits.
There were 3 incidents of breaches in security reported, all relating to lock down of the Security 1 building after hours.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 17 Statutory Requirements continued
Details of Information and Communication (ICT) expenditure The total ICT expenditure incurred during 2016/17 is $130,202 (excluding GST) with the details shown below.
ICT Expenditure Total Operational Capital
Business as usual expenditure $130,202 $102,563 $27,639
Non business as usual expenditure $0 $0 $0
Total excluding GST $130,202 $102,563 $27,639
Compliance with Building Act Essential Safety Measures Reports are prepared annually for properties owned by Nathalia District Hospital Nathalia District Hospital remains compliant with the building to confirm that all of the essential safety services are and maintenance provisions of the Building Act 1993 – operating as required. Guidelines issued by the Minister for publicly owned buildings. We ensure works are inspected by independent building Occupancy Permits and Certificate of surveyors and maintain a register of building surveyors, as well as the jobs they have certified and for which Final Inspection occupancy certificates have been issued. Nathalia District Hospital Occupancy Permits and Certificates of Final Inspection are all current. Freedom of Information
Building Works The Victorian Freedom of Information Act 1982 provides individuals with the opportunity for consumers to access No new Occupancy Permits and Certificate of Finance personal documents held by public hospitals and other Inspection were issued. government agencies. The designated Principal Officer who manages applications at Nathalia District Hospital is Chief Essential Safety Measures Executive Officer, Mr Trevor Saunders. We comply with building standards and regulations, with all Under the legislation, all public entities in Victoria must works completed in 2016/17 according to the Building Act submit an annual return to the Department of Justice 1993, the Building Code of Australia, Standard for Publicly regarding Freedom of Information activity. Application Owned Buildings 1994 and relevant statutory regulations. fees and access charges applied in regard to Freedom of Information are done so in accordance with State All essential safety measures have been maintained, so Government regulations. far as is practicable, in accordance with the Building Regulations 2006 as is recorded in the Annual Essential During 2016/17 there was only one request for access to Safety Measures Report. documents under the Victorian Freedom of Information Act 1982. The request related to access to medical records and the request was approved. Information on how to make an application can be found on the Nathalia District Hospital website.
18 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Fire Audit Compliance Competitive Neutrality The Nathalia District Hospital Fire Audit is current. We are committed to ensuring that our services demonstrate both quality and efficiency. Competitive Government Advertising neutrality, which supports the Commonwealth Government’s national competition policy, helps to There was zero expenditure spent on government ensure that net competitive advantages which accrue to advertising during 2016/17. a government business are offset. We understand the requirements of competitive neutrality and act accordingly. Protected Disclosure We support the principles of the Partnerships Victoria policy, We comply with the requirements of the Victorian which relates to responsible expenditure and infrastructure Government’s Protected Disclosure Act 2012. projects and the creation of effective partnerships between Neither improper conduct nor the taking of reprisals private enterprise and the public sector. against anyone who comes forward to disclose such conduct is acceptable to us. We distinguish protected Environmental Performance disclosures from something that would be considered Nathalia District Hospital recognises that the environment a grievance or internal organisational dispute. Zero is one of the most precious resources and the Board and disclosures as per the Protected Disclosure Act 2012 were staff are committed to improving and maximising our made in the year ended 30 June 2017. environmental sustainability whilst minimising any negative impact upon the environment. Carers Recognition The environmental management plan covers reduction in The Carers Recognition Act 2012 formally acknowledges the use of energy and water and the effective management the important contribution that people in a care of waste, chemicals, noise and spills. relationship make to our community and the unique In the 2016-17 year the following measures have been knowledge that carers hold of the person in their care. The initiated: valued role of the carer has been actively integrated in the policies and procedures of Nathalia District Hospital. • Replacement of all light globes to LED, markedly reducing the carbon footprint and the maintenance Victorian Industry Participation Policy requirements on lights. We are committed to ensuring that our participation with • Continuing to increase planting of native vegetation Victorian industry is maximised and delivers the highest to decrease water usage. level of performance for each dollar expended. There were • The installation of an 80kW solar power unit to zero procurements or projects above $1 million for the reduce the use of electricity on the grid and so 2016/17 year, in accordance with the Victorian Industry decrease the energy footprint. Participation Policy Act 2003. • Commenced a recycling of printer cartridges to reduce landfill. Car Parking Nathalia District Hospital complies with the Department of Health and Human Services hospital circular on car parking fees effective 1 February 2016.
Industrial Relations Industrial relations within the health service have been harmonious and there has been no time lost in 2016/17 due to industrial disputes.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 19 Additional Information
Details in respect of the items listed below have been i. Details of assessments and measures undertaken retained by Nathalia District Hospital and are available to improve the occupational health and safety of to the relevant Ministers, Members of Parliament and the employees; public on request (subject to the freedom of information requirements, if applicable): j. A general statement on industrial relations within the Health Service and details of time lost through a. Declarations of pecuniary interests have been duly industrial accidents and disputes, which is not completed by all relevant officers; otherwise detailed in the report of operations;
b. Details of shares held by senior officers as nominee or k. A list of major committees sponsored by the Health held beneficially; Service, the purposes of each committee and the extent to which those purposes have been achieved; c. Details of publications produced by the entity about itself, and how these can be obtained; l. Details of all consultancies and contractors including consultants/contractors engaged, services provided, d. Details of changes in prices, fees, charges, rates and and expenditure committed for each engagement. 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 Health Service and its services;
20 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Part A - Statement of Priorities - Outcomes
Domain Deliverables Achieved
Quality and Develop and distribute an information A booklet has been sourced from Hume Region safety booklet to carers at end of life care of Palliative Care and included in the resource pack their loved one. provided to carers supporting the patient with end of life care. Evaluate the information provided to ensure it is comprehensive and answers Feedback from families who have been provided with the issues they face. the booklet is positive, stating the information improves their understanding of the end of life care needs and the ways they can assist in the patient journey. Incorporate a question on the existence The current mortality/morbidity review document and respecting of Advanced Care Plans has been updated to include a question regarding the (ACP) in the current morbidity/mortality existence of an advance care plan. review documents. Evaluate this data to This data has been implemented as a key performance determine the effectiveness of the ACP indicator to be reported quarterly to the Board of community education program. Management. In partnership with Goulburn Valley With the support of GV Health, a framework has been Health, develop an evaluation methodology developed to support and manage patient presentations framework to manage family violence. where family violence exists. Once completed, evaluate the family Staff have been assessed on the current level of violence initiatives recently implemented at knowledge to manage family violence and an action NDH. plan to improve knowledge and management has been developed. Participate actively in the Enrolled Nurse Nathalia District Hospital was involved initially in the EN (EN) transition to practice collaborative in transition program collaborative but was unfortunately partnership with GVHealth and the Moira unable to attract any interest/applications for positions health services. within the program. This meant that NDH had to withdraw from inclusion in the program in 2017.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 21 Part A - Statement of Priorities - Outcomes continued
Domain Deliverables Achieved
Identify a minimum of two incidents where Two patient care incidents have been reviewed by the recent patient feedback has resulted in Clinical Standards Committee; these have both resulted changes to improve care; changes agreed in changes being made in partnership with the patient/ upon in partnership with the patient and/ carer. or carer. Report on these improvements in This is to be presented in the Annual Quality of Care the Quality of Care Report. Report in July 2017. Identify any restrictive practices in use Currently three residents have requested bed rails for across the health service. mobility assistance. No other restraints are used at any time. Implement strategies to eliminate the identified practices including staff education. Staff have been provided with education aimed at eliminating restraint practices where possible. Access and Build on the current rehabilitation Community rehabilitation centre services have timeliness program delivered through the Moira commenced delivery at NDH through the Moira Community Rehabilitation Centre (CRC) Community Rehabilitation Centre. to provide a post discharge strength These services are continuing to grow through training program. collaboration across Moira health services. Actively participate in the Hume NDH has been an active participant in meetings and Region District Nursing Collaborative workshops for the proposed new collaborative models to enable NDH to respond effectively for HACC and District Nursing within the Hume region. to the emerging changes in Home and The transition to Community Health Service Provider Community Care (HACC) services. Service (CHSPS) and HACC Program for Younger People Develop an action plan to ensure the (PYP) has occurred. transition for National Disability Insurance Scheme (NDIS) and HACC in Nathalia is seamless to the consumer.
22 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Domain Deliverables Achieved
Supporting Work collaboratively with the three other The Moira Health Services meet regularly to identify healthy Moira Health services to deliver programs collaborative programs across the shire. populations which will improve the wellbeing of Moira An example of one program delivered across Moira is residents across the shire. the Smiles for Miles preschool program. Expand on the current support services NDH has worked extensively and collaboratively recently implemented in response to the with a large number of local, regional and government dairy industry crisis. agencies to link the farming community with support and information to assist them following the crisis in the dairy industry. Review the current cultural diversity plan The Cultural Diversity Plan was reviewed in February in partnership with the culturally diverse in 2017 and presented to the Board of Management for our community, to ensure it is inclusive to endorsement. their special needs. Ensure all staff across the organisation NDH has recently completed a gap analysis with are aware of and demonstrate culturally Aboriginal Elders in our community and has developed a appropriate care of Aboriginal and Torres Cultural Competency Action Plan. Strait Islander people. All senior staff have undertaken ATSI cultural care training. Develop a referral pathway for people who The annual Community Health Plan reflects a referral present with mental health issues, so they pathway to assist clinicians to provide appropriate care are assessed and reviewed by appropriately for patients presenting with mental health issues. skilled practitioners in a timely manner which promotes good outcomes. Develop a policy the ensure the adoption A policy has been developed to ensure the adoption of of inclusive practices across both hospital inclusive practices at NDH. and community health programs, ensuring diversity in LBGTI patients is celebrated. Governance Review the Quality Plan to strengthen its The Quality Plan has been reviewed to reflect the and leadership processes toward meeting the goals as set goals as set in the Victorian Clinical Governance Policy in the Victorian Clinical Governance Policy Framework. Framework. The Board of Management has undertaken further Address the gaps identified in the Board of education on Clinical Governance and reporting Management Clinical Governance Survey structures to the Board have been updated. conducted in February 2016 by DHHS.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 23 Part A - Statement of Priorities - Outcomes continued
Domain Deliverables Achieved
Take an active role in the development of Moira Health Services have completed their service the Moira Health Services Service Plan due plans in Cobram and Yarrawonga and have incorporated to be undertaken in 2016-2017. Numurkah and Nathalia data. Educate senior managers on the newly All senior staff have received education on the bullying developed bullying and harassment and harassment investigation program and the program investigation system. is in use within the organisation. Regularly review and update policy, Policies and procedures have been updated to align with procedure and resources to ensure they organisational and legal requirements. align with the requirements stated in the action. Review and update the organisations The risk register review has been completed using the Occupational Health and Safety risk updated Riskman program recommended by our insurer, register and mitigation strategies and VMIA. ensure communication and reporting The internal audit in March 2017 focused on bullying and as appropriate to staff and at Board of harassment, with recommendations made to strengthen Management. current processes.. Evaluate the newly developed bullying and harassment reporting system using a risk management approach to ensure behaviours which may be interpreted as bullying or harassment are effectively addressed and controlled. Develop a workforce succession plan A Workforce Plan was completed in June 2017. to ensure an appropriately skilled and qualified workforce that meets Nathalia’s needs into the future. Promote and grow the recently Several sessions have been held with staff to gain ideas implemented communication processes on how to promote respect and improve communication amongst staff which aim to enhance amongst staff. communication, promote respect for each Items are appearing regularly in the staff newsletter to other and encourage the sharing of ideas promote the outcomes. that will improve the wellbeing of patients and residents.
24 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Domain Deliverables Achieved
Develop a policy and procedure that A Child Safe Policy has been developed and was clearly outlines appropriate behaviour approved by the Board of Management in June 2017. for all staff when working with children. All staff have been educated about their responsibilities The procedure is to include processes for mandatory reporting. to increase awareness and take effective actions to reduce the likelihood of child abuse. Provide ongoing education to all staff on this policy. Review the current policy and procedure The current staff immunisation policy and procedure for staff immunisations to ensure they have been reviewed and meet the DHHS recommended meet DHHS recommended guidelines as a guidelines. minimum standard. Financial Identify current services which are not Review of all current costs has been undertaken; a plan sustainability financially viable and redevelop those to work towards a break even financial position will be services to become cost neutral. in place within the next month. Work toward full implementation of the 80kW solar panels have been installed to reduce energy 2015-17 Environmental Management Plan; costs and our environmental footprint. Recycle bins changing all lighting to LED lighting and have been installed across all departments. building on the current waste recycling Education has been conducted for staff following a program. change of suppliers; aimed at increasing recycling. Provide education to all staff on the waste management program.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 25 Part B - Performance Priorities - 2016-17
Safety and Quality Performance
Key Performance Indicator Target Actual Health Service Accreditation Full compliance Full compliance Overall compliance with cleaning standards Full compliance Achieved Very high risk (Category A) 90 points N/A High risk (Category B) 85 points 96.6% Moderate risk (Category C) 85 points 98.2% VICNISS data compliance Full compliance Full compliance Compliance with the Hand Hygiene Australia Program 80% 89% av 3 audits Percentage of healthcare workers immunised for influenza 75% 87%
Patient Experience and Outcomes Key Performance Indicator Target Actual Victorian Health Experience Survey Full compliance Full compliance – data submission Victorian Healthcare Experience Survey Insufficient number of – patient experience Quarter 1 surveys received Victorian Healthcare Experience Survey 95% positive 98% – patient experience Quarter 2 experience Victorian Healthcare Experience Survey Insufficient number of – patient experience Quarter 3 surveys received Victorian Healthcare Experience Survey Insufficient number of – patient experience Quarter 2 surveys received
26 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Governance, Leadership And Culture Performance Key Performance Indicator Target Actual People Matter Survey patient safety culture 80% 86%
Funded Flexible Aged Care Places Campus Number Occupancy Level High Care 20 96.49%
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 27 Part C - Activity and Funding - 2016-17
Acute Care Actual Activity Service Type of activity 2015/16 Medical inpatients Bed days 1,345 Urgent care Presentations 255 Nursing Home Type Patients Bed days Nil
Primary Health Care Service Actual Activity 2015/16 Community Health Nursing 1,393 District Nursing 2,377 Dietetics 101 Podiatry (Foot Care) 163 Physio 925 Counselling 680 Optometry 37 Occupational Therapy 225
Financial Sustainability Performance Key Performance Indicator Target Actual
Finance Operating Result ($m) 0.00 -0.42 Creditors avg. days 60 38 Debtors avg. days 60 27
Asset Management Asset Management Plan Compliance Achieved Adjusted current asset ratio 0.7 1.34 Days of available cash 14 days 134.4 days
28 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Financial Analysis of Operating Revenues and Expenses
2017 2016 2015 2014 2013
Total Revenue 6,090,596 6,324,755 6,277,035 5,967,892 6,227,662 Total Expenses 7,129,041 6,743,454 7,038,789 6,412,881 6,655,300 Net Result for the year (1,038,445) (418,699) (761,754) (444,989) (427,638) (inc. Capital & Specific Items)
Retained Surplus/ 607,486 1,645,931 2,042,263 2,889,928 3,424,478 (Accumulated Deficit)
Total Assets 21,893,422 23,387,617 22,688,425 22,403,780 18,010,127 Total Liabilities 3,415,193 3,870,943 2,825,219 1,906,008 1,900,102 Net Assets 18,478,229 19,516,674 19,863,206 20,497,772 16,110,025
Total Equity 18,478,229 19,516,674 19,863,206 20,497,772 16,110,025
Significant Changes in Financial Operational & Budgetary Position Objectives & Factors Affecting
There are no significant changes in financial position. Performance
The Board budgeted for a break even result before capital items and depreciation for the 2016/17 year and the final Events Subsequent to Balance Date result was a deficit of $424,925.
There have been no events subsequent to balance date that will have a significant effect on the operations.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 29 Attestations
ATTESTATION FOR COMPLIANCE WITH THE ATTESTATION FOR COMPLIANCE WITH MINISTERIAL STANDING DIRECTION 3.7.1 HEALTH PURCHASING VICTORIA (HPV) – RISK MANAGEMENT FRAMEWORK AND HEALTH PURCHASING POLICIES PROCESSES I, Trevor Saunders certify that Nathalia District Hospital I, Trevor Saunders, certify that the Nathalia District has put in place appropriate internal controls and Hospital has complied with Ministerial Direction processes to ensure that it has complied with all 3.7.1 – Risk Management Framework and Processes. requirements set out in the HPV Health Purchasing The Nathalia District Hospital Audit Committee has Policies including mandatory HPV collective agreements verified this. as required by the Heath Services Act 1988 (Vic) and has critically reviewed these controls and processes during the year.
Trevor Saunders Chief Executive Officer 4 September 2017 Trevor Saunders Chief Executive Officer 4 September 2017
30 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 This page has been left blank intentionally
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 31 Disclosure Index The annual report of the Nathalia District Hospital 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 Ministerial Directions Report of Operations Charter and purpose FRD 22G Manner of establishment and the relevant Ministers 3 FRD 22G Purpose, functions, powers and duties 2 FRD 22G Initiatives and key achievements 10 FRD 22G Nature and range of services provided 5 Management and structure FRD 22G Organisational structure 15 Financial and other information FRD 10A Disclosure index 32 FRD 11A Disclosure of ex‑gratia expenses 92 FRD 21B Responsible person and executive officer disclosures 91 FRD 22G Application and operation of Protected Disclosure 2012 19 FRD 22G Application and operation of Carers Recognition Act 2012 19 FRD 22G Application and operation of Freedom of Information Act 1982 18 FRD 22G Compliance with building and maintenance provisions of Building Act 1993 18 FRD 22G Details of consultancies over $10,000 16 FRD 22G Details of consultancies under $10,000 16 FRD 22G Employment and conduct principles 14 FRD 22G Major changes or factors affecting performance 29 FRD 22G Occupational health and safety 17 FRD 22G Operational and budgetary objectives and performance against objectives 29 FRD 24C Reporting of office-based environmental impacts 19 FRD 22G Significant changes in financial position during the year 29 FRD 22G Statement on National Competition Policy 19 FRD 22G Subsequent events 29 FRD 22G Summary of the financial results for the year 29 FRD 22G Workforce Data Disclosures including a statement on the application of employment and conduct principles 14 FRD 25B Victorian Industry Participation Policy disclosures 13 FRD 29A Workforce Data disclosures 14 SD 4.2(g) Specific information requirements 20 SD 4.2(j) Sign-off requirements 3 SD 3.4.13 Attestation on data integrity 30 SD 4.5.5 Attestation for compliance with the ministerial standing direction 4.5.5 – Risk management 30 framework and processes Financial Statements Financial statements required under Part 7 of the FMA SD 4.2(a) Statement of changes in equity 40 SD 4.2(b) Comprehensive operating statement 38 SD 4.2(b) Balance sheet 39 SD 4.2(b) Cash flow statement 41 Other requirements under Standing Directions 4.2 SD 4.2(a) Compliance with Australian accounting standards and other authoritative pronouncements 43 SD 4.2(c) Accountable officer’s declaration 35 SD 4.2(c) Compliance with Ministerial Directions 43 SD 4.2(d) Rounding of amounts 102 Legislation Freedom of Information Act 1982 18 Protected Disclosure Act 2012 19 Carers Recognition Act 2012 19 Victorian Industry Participation Policy Act 2003 19 Building Act 1993 18 Financial Management Act 1994 43
32 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Nathalia District Hospital FINANCIAL REPORT 2016/17
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 33 Table of Contents Note Page Comprehensive Operating Statement 38 Balance Sheet 39 Statement of Changes in Equity 40 Cash Flow Statement 41 Basis of presentation 42 Note 1: Summary of Significant Accounting Policies 43 Note 2: Funding Delivery of Our Services 44 Note 2.1: Analysis of Revenue by Source 44 Note 3: The Cost of Delivering Services 47 Note 3.1: Analysis of Expenses by Source 47 Note 3.2: Analysis of Expense and Revenue by Internally Managed and Restricted Specific Purpose Funds 50 Note 3.3: Specific Expenses 50 Note 3.4: Finance Costs 50 Note 3.5: Employee Benefits in the Balance Sheet 51 Note 3.6: Superannuation 53 Note 4: Key Assets to Support Service Delivery 54 Note 4.1: Jointly Controlled Entities 54 Note 4.2: Property, Plant & Equipment 56 Note 4.3: Depreciation and Amortisation 65 Note 4.4: Intangible Assets 66 Note 5: Other Assets and Liabilities 67 Note 5.1: Receivables 67 Note 5.2: Other Liabilities 68 Note 5.3: Prepayments and Other Non-Financial Assets 68 Note 5.4: Payables 69 Note 6: How We Finance Our Operations 70 Note 6.1: Borrowings 70 Note 6.2: Cash and Cash Equivalents 72 Note 6.3: Commitments for Expenditure 73 Note 7: Risks, Contingencies & Valuation Uncertainties 74 Note 7.1: Financial Instruments 74 Note 7.2: Net Gain/ (Loss) On Disposal of Non-Financial Assets 85 Note 7.3: Contingent Assets and Contingent Liabilities 85 Note 7.4: Fair Value Determination 86 Note 8: Other Disclosures 87 Note 8.1: Equity 88 Note 8.2: Reconciliation of Net Result for the Year to Net Cash Inflow/ (Outflow) From Operating Activities 89 Note 8.3: Operating Segments 90 Note 8.4: Responsible Persons Disclosures 91 Note 8.5: Executive Officer Disclosures 91 Note 8.6: Related Parties 92 Note 8.7: Payments to Other Personnel (I.E. Contractors with Significant Management Responsibilities) 92 Note 8.8: Remuneration of Auditors 92 Note 8.9: Ex-Gratia Expenses 92 Note 8.10: AASB's Issued That Are Not Yet Effective 93 N ote 8 .11: Events Occurring After the Balance Sheet Date 96 Note 8.12: Economic Dependency 96 Note 8.13 : Alternative Presentation of Comprehensive Operating Statement 97 Note 8.14: Glossary of Terms and Style Conventions 98
34 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Nathalia District Hospital Board Member’s, Accountable Officer’s and Chief Finance & Accounting Officer’s Declaration
The attached financial statements forNathalia District Hospital have been prepared in accordance with Direction 5.2 of the Standing Directions of the Minister for Finance under the Financial Management Act 1994, applicable Financial Reporting Directions, Australian Accounting Standards including Interpretations, and other mandatory professional reporting requirements.
We further state that, in our opinion, the information set out in the comprehensive operating statement, balance sheet, statement of changes in equity, cash flow statement and accompanying notes, presents fairly the financial transactions during the year ended 30 June 2017 and the financial position of Nathalia District Hospital at 30 June 2017.
At the time of signing, we are not aware of any circumstance which would render any particulars included in the financial statements to be misleading or inaccurate.
We authorise the attached financial statements for issue on 31 August 2017.
Sue Logie Trevor Saunders Salvatore Costanzo Board Chair Chief Executive Officer Executive Director Finance and Business Services
Nathalia District Hospital Nathalia District Hospital Nathalia District Hospital 31 August 2017 31 August 2017 31 August 2017
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 35
Independent Auditor’s Report
To the Board of Nathalia District Hospital
Opinion I have audited the financial report of Nathalia District Hospital (the health service) which comprises the:
balance sheet as at 30 June 2017 comprehensive operating statement for the year then ended statement of changes in equity for the year then ended cash flow statement for the year then ended notes to the financial statements, including a summary of significant accounting policies board member's, accountable officer's and chief finance & accounting officer's declaration. In my opinion the financial report presents fairly, in all material respects, the financial position of the health service as at 30 June 2017 and their financial performance and cash flows for the year then ended in accordance with the financial reporting requirements of Part 7 of the Financial Management Act 1994 and applicable Australian Accounting Standards.
Basis for I have conducted my audit in accordance with the Audit Act 1994 which incorporates the Opinion Australian Auditing Standards. My responsibilities under the Act are further described in the Auditor’s Responsibilities for the Audit of the Financial Report section of my report. My independence is established by the Constitution Act 1975. My staff and I are independent of the health service in accordance with the ethical requirements of the Accounting Professional and Ethical Standards Board’s APES 110 Code of Ethics for Professional Accountants (the Code) that are relevant to my audit of the financial report in Australia. My staff and I have also fulfilled our other ethical responsibilities in accordance with the Code. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion.
Board’s The Board of the health service is responsible for the preparation and fair presentation of responsibilities the financial report in accordance with Australian Accounting Standards and the Financial for the Management Act 1994, and for such internal control as the Board determines is necessary financial to enable the preparation and fair presentation of a financial report that is free from report material misstatement, whether due to fraud or error. In preparing the financial report, the Board is responsible for assessing the health service’s ability to continue as a going concern, and using the going concern basis of accounting unless it is inappropriate to do so.
36 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Auditor’s As required by the Audit Act 1994, my responsibility is to express an opinion on the financial responsibilities report based on the audit. My objectives for the audit are to obtain reasonable assurance for the audit about whether the financial report as a whole is free from material misstatement, whether of the financial due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable report assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the Australian Auditing Standards will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of this financial report. As part of an audit in accordance with the Australian Auditing Standards, I exercise professional judgement and maintain professional scepticism throughout the audit. I also:
identify and assess the risks of material misstatement of the financial report, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the health service’s internal control evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the Board conclude on the appropriateness of the Board’s use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the health service’s ability to continue as a going concern. If I conclude that a material uncertainty exists, I am required to draw attention in my auditor’s report to the related disclosures in the financial report or, if such disclosures are inadequate, to modify my opinion. My conclusions are based on the audit evidence obtained up to the date of my auditor’s report. However, future events or conditions may cause the health service to cease to continue as a going concern. evaluate the overall presentation, structure and content of the financial report, including the disclosures, and whether the financial report represents the underlying transactions and events in a manner that achieves fair presentation. I communicate with the Board regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that I identify during my audit.
MELBOURNE Ron Mak 31 August 2017 as delegate for the Auditor-General of Victoria
2
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 37 Nathalia District Hospital Comprehensive Operating Statement For the Financial Year Ended 30 June 2017
Total Total 2017 2016 Note $ $ Revenue from Operating Activities 2.1 5,872,336 5,685,827 Revenue from Non-Operating Activities 2.1 83,664 96,896 Employee Expenses 3.1 (4,353,206) (3,923,101) Non Salary Labour Costs 3.1 (602,964) (586,706) Supplies and Consumables 3.1 (303,676) (253,978) Other Expenses 3.1 (1,121,079) (1,146,554) Net Result before Capital & Specific Items (424,925) (127,616)
Capital Purpose Income 2.1 134,596 542,032 Depreciation and Amortisation 3.1 (773,982) (769,332) Specific Expenses 3.1 (2,017) - Finance Costs 3.1 (12,608) (1,439) Capital Purpose Expenditure/ HRHA Share Adjustment 3.1 294 (62,343) Net Result after Capital & Specific Items (1,078,643) (418,699)
Other Economic Flows Included In Net Result Revaluation of Long Service Leave 3.5 40,197 22,367 Total Other Economic Flows Included In Net Result 40,197 22,367 Net Result for the Year (1,038,446) (396,332)
Other Comprehensive Income Items that will not be Reclassified to Net Result Changes in Physical Asset Revaluation Surplus - 49,800 Total Other Comprehensive Income - 49,800 Comprehensive Result (1,038,446) (346,532)
This statement should be read in conjunction with the accompanying notes.
38 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Nathalia District Hospital Balance Sheet For the Financial Year Ended 30 June 2017
Total Total 2017 2016 Note $ $ Current Assets Cash and Cash Equivalents 6.2 3,963,748 4,726,525 Receivables 5.1 320,036 164,380 Prepayments and Other Assets 5.3 30,235 36,873 Total Current Assets 4,314,019 4,927,778
Non-Current Assets Receivables 5.1 209,460 154,718 Property, Plant and Equipment 4.2 17,328,818 18,276,444 Intangible Assets 4.4 41,125 28,678 Total Non-Current Assets 17,579,403 18,459,840 TOTAL ASSETS 21,893,422 23,387,618
Current Liabilities Payables 5.4 379,614 492,046 Borrowings 6.1 13,664 16,198 Provisions 3.5 1,056,193 954,972 Other Current Liabilities 5.2 1,731,646 2,211,493 Total Current Liabilities 3,181,117 3,674,709
Non-Current Liabilities Borrowings 6.1 15,487 19,438 Provisions 3.5 218,589 176,796 Total Non-Current Liabilities 234,076 196,234 TOTAL LIABILITIES 3,415,193 3,870,943 NET ASSETS 18,478,229 19,516,674
Equity Property, Plant and Equipment Revaluation Surplus 8.1a 5,122,513 5,122,513 General Purpose Surplus 8.1a 1,354,608 1,354,608 Restricted Specific Purpose Surplus 8.1a 162,466 162,466 Contributed Capital 8.1b 11,231,156 11,231,156 Accumulated Surpluses 8.1c 607,486 1,645,931 Total Equity 18,478,229 19,516,674
Contingent Assets and Contingent Liabilities 7.3 Commitments 6.3
This statement should be read in conjunction with the accompanying notes.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 39 Nathalia District Hospital Statement of Changes in Equity For the Financial Year Ended 30 June 2017
Property, Plant & Restricted Equipment General Specific Accumulated Revaluation Purpose Purpose Contributions Surpluses/ Surplus Surplus Surplus by Owners (Deficits) Total Note $ $ $ $ $ $ Balance at 5,072,713 1,354,608 162,466 11,231,156 2,042,263 19,863,206 1 July 2015
Net Result for 8.1 (c) - - - - (396,332) (396,332) the Year
Other Comprehensive 8.1 (a) 49,800 - - - - 49,800 Income for the Year
Balance at 5,122,513 1,354,608 162,466 11,231,156 1,645,931 19,516,674 30 June 2016
Net Result for 8.1 (c) - - - - (1,038,445) (1,038,445) the Year
Balance at 5,122,513 1,354,608 162,466 11,231,156 607,486 18,478,229 30 June 2017
This statement should be read in conjunction with the accompanying notes.
40 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Nathalia District Hospital Cash Flow Statement For the Financial Year Ended 30 June 2017
Total Total Property, 2017 2016 Plant & Restricted Note $ $ Equipment General Specific Accumulated Revaluation Purpose Purpose Contributions Surpluses/ Cash Flows from Operating Activities Surplus Surplus Surplus by Owners (Deficits) Total Operating Grants from Government 4,020,360 4,110,473 Note $ $ $ $ $ $ Capital Grants from Government 22,500 454,205 Balance at 5,072,713 1,354,608 162,466 11,231,156 2,042,263 19,863,206 Patient and Resident Fees Received 512,232 607,614 1 July 2015 Private Practice Fees Received 842,754 735,957 Net Result for 8.1 (c) - - - - (396,332) (396,332) Donations Received 2,282 19,602 the Year GST Received From ATO 168,277 158,385 Other Interest Received 94,702 95,601 Comprehensive 8.1 (a) 49,800 - - - - 49,800 Other Capital Receipts 6,000 - Income for the Year Other Receipts 420,304 647,243 Total Receipts 6,089,411 6,829,080 Balance at 5,122,513 1,354,608 162,466 11,231,156 1,645,931 19,516,674 30 June 2016 Employee Expenses Paid (4,174,790) (3,984,012) Net Result for 8.1 (c) - - - - (1,038,445) (1,038,445) Non Salary Labour Costs (663,260) (645,377) the Year Payments for Supplies, Consumables and Services (1,700,729) (1,507,616) Balance at 5,122,513 1,354,608 162,466 11,231,156 607,486 18,478,229 Total Payments (6,538,779) (6,137,005) 30 June 2017
Net Cash Flow From/ (Used In) From Operating Activities 8.2 (449,368) 692,075 This statement should be read in conjunction with the accompanying notes.
Cash Flows from Investing Activities Payments for Non-Financial Assets (86,987) (293,204) Proceeds From Sale of Non-Financial Assets 259,910 7,955 Net Cash Inflow/ (Outflow) From Investing Activities 172,923 (285,249)
Cash Flows from Financing Activities Repayment of Finance Leases (6,485) 12,589 Net Cash Flows From/(Used In) Financing Activities (6,485) 12,589
Net Increase/ (Decrease) In Cash and Cash Equivalents Held (282,930) 419,415 Cash & Cash Equivalents at Beginning of Financial Year 2,515,032 2,095,617 Cash & Cash Equivalents at End of Financial Year 6.2 2,232,102 2,515,032
This statement should be read in conjunction with the accompanying notes.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 41 Basis of presentation
These financial statements are presented in Australian dollars and the historical cost convention is used unless a different measurement basis is specifically disclosed in the note associated with the item measured on a different basis. The accrual basis of accounting has been applied in the preparation of these financial statements whereby assets, liabilities, equity, income and expenses are recognised in the reporting period to which they relate, regardless of when cash is received or paid. Consistent with the requirements of AASB 1004 Contributions (that is contributed capital and its repayment) are treated as equity transactions and, therefore, do not form part of the income and expenses of the hospital. Additions to net assets which have been designated as contributions by owners are recognised as contributed capital. Other transfers that are in the nature of contributions to or distributions by owners have also been designated as contributions by owners. Transfers of net assets arising from administrative restructurings are treated as distributions to or contribution by owners. Transfer of net liabilities arising from administrative restructurings are treated as distribution to owners. Judgements, estimates and assumptions are required to be made about financial information being presented. The significant judgements made in the preparation of these financial statements are disclosed in the notes where amounts affected by those judgements are disclosed. Estimates and associated assumptions are based on professional judgements derived from historical experience and various other factors that are believed to be reasonable under the circumstances. Actual results may differ from these estimates. Revisions to accounting estimates are recognised in the period in which the estimate is revised and also future periods that are affected by the revision. Judgements and assumptions made by management in applying the application of AASB that have significant effect on the financial statements and estimates are disclosed in the notes under the heading: 'Significant judgement or estimates'.
42 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 1: SUMMARY OF SIGNIFICANT The going concern basis was used to prepare the financial statements. Refer to Note 8.12 regarding economic ACCOUNTING POLICIES dependency. These annual financial statements represent the audited The financial statements, except for cash flow information, general purpose financial statements for Nathalia District have been prepared using the accrual basis of accounting. Hospital for the period ending 30 June 2017. The report Under the accrual basis, items are recognised as assets, provides users with information about the Health Services’ liabilities, equity, income or expenses when they satisfy the stewardship of resources entrusted to it. definitions and recognition criteria for those items, that is (a) Statement of compliance they are recognised in the reporting period to which they relate, regardless of when cash is received or paid. These financial statements are general purpose financial statements which have been prepared in accordance with These financial statements are presented in Australian the Financial Management Act 1994 and applicable AASBs, dollars, the functional and presentation currency of the which include interpretations issued by the Australian Health Service. Accounting Standards Board (AASB). They are presented The financial statements are prepared in accordance with the in a manner consistent with the requirements of AASB 101 historical cost convention, except for: Presentation of Financial Statements. • non-current physical assets, which subsequent to The financial statements also comply with relevant Financial acquisition, are measured at a revalued amount being Reporting Directions (FRDs) issued by the Department of their fair value at the date of the revaluation less any Treasury & Finance, and relevant Standing Directions (SDs) subsequent accumulated depreciation and subsequent authorised by the Minister for Finance. impairment losses. Revaluations are made and are re- The Health Service is a not-for profit entity and therefore assessed when new indices are published by the Valuer applies the additional Aus. paragraphs applicable to “not-for- General to ensure that the carrying amounts do not profit” Health Services under the AASBs. materially differ from their fair values; and The annual financial statements were authorised for issue by • the fair value of assets other than land is generally based the Board of Nathalia District Hospital on 31st August 2017. on their depreciated replacement value. (b) Reporting entity Judgements, estimates and assumptions are required to be The financial statements include all the controlled activities of made about the carrying amounts of assets and liabilities that the Nathalia District Hospital. are not readily apparent from other sources. The estimates and associated assumptions are based on professional Its principal address is: judgements derived from historical experience and various 34-44 McDonell Street other factors that are believed to be reasonable under the Nathalia Victoria, 3638. circumstances. Actual results may differ from these estimates. A description of the nature of Nathalia District Hospital’s Revisions to accounting estimates are recognised in the operations and its principal activities is included in the report period in which the estimate is revised and also in future of operations, which does not form part of these financial periods that are affected by the revision. Judgements and statements. assumptions made by management in the application of AASBs that have significant effects on the financial Objectives and funding statements and estimates relate to: Nathalia District Hospital’s overall objective is; Healthy Communities, as well as improve the quality of life to • the fair value of land, buildings, infrastructure, plant and Victorians. equipment, (refer to Note 7.1); Nathalia District Hospital is predominantly funded by accrual • superannuation expense (refer to Note 3.6); based grant funding for the provision of outputs. • actuarial assumptions for employee benefit provisions (c) Basis of accounting preparation and based on likely tenure of existing staff, patterns of leave measurement claims, future salary movements and future discount rates (refer to Note 3.5) Accounting policies are selected and applied in a manner which ensures that the resulting financial information satisfies (d) Principles of consolidation the concepts of relevance and reliability, thereby ensuring Intersegment Transactions that the substance of the underlying transactions or other Transactions between segments within the Nathalia District events is reported. Hospital have been eliminated to reflect the extent of the The accounting policies set out below have been applied in Nathalia District Hospital’s operations as a group. preparing the financial statements for the year ended 30 June 2017, and the comparative information presented in these financial statements for the year ended 30 June 2016.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 43 NOTE 2: FUNDING DELIVERY OF OUR SERVICES
The hospital’s overall objective is to deliver programs and services that support and enhance the wellbeing of all Victorians.
To enable the hospital to fulfil its objective it receives income based on parliamentary appropriations. The hospital also receives income from the supply of services. Structure 2.1 Analysis of Revenue by Source
NOTE 2.1: ANALYSIS OF REVENUE BY SOURCE
Admitted Aged Primary Patients RAC Care Health Other Total 2017 2017 2017 2017 2017 2017 $ $ $ $ $ $ Government Grants 1,736,042 1,924,559 268,376 - 54,742 3,983,718 Indirect Contributions by Department of Health and Human 2,229 7,428 753 - - 10,409 Services Patient & Resident Fees 67,530 450,407 28,136 16,340 206 562,619 Other Revenue from Operating 102,509 370 5,044 31,469 202,536 341,927 Activities Transfer Pricing 42,038 142,390 17,881 16,711 (219,021) -
Commercial Activities - - - - 973,663 973,663 Total Revenue from 1,950,347 2,525,154 320,189 64,520 1,012,126 5,872,336 Operating Activities
Interest - - - - 83,664 83,664 Total Revenue from Non- - - - - 83,664 83,664 Operating Activities
Capital Purpose Income (excluding - - - - 128,366 128,366 Interest) Capital Purpose Interest - - - - 6,230 6,230 Total Capital Purpose - - - - 134,596 134,596 Revenue Total Revenue 1,950,347 2,525,154 320,189 64,520 1,230,386 6,090,596
44 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Admitted Aged Primary Patients RAC Care Health Other Total 2016 2016 2016 2016 2016 2016 $ $ $ $ $ $ Government Grants 1,051,044 2,559,819 276,421 - (104,369) 3,782,915 Indirect Contributions by Department of Health and Human 12,783 7,975 808 - - 21,566 Services Patient & Resident Fees 87,662 412,656 26,191 21,502 - 548,012 Other Revenue from Operating 165,209 11,300 3,276 43,122 231,818 454,725 Activities Transfer Pricing 23,734 75,992 8,043 7,313 (115,081) -
Commercial Activities - - - - 878,610 878,610 Total Revenue from 1,340,431 3,067,743 314,739 71,937 890,978 5,685,827 Operating Activities
Interest - - - - 96,896 96,896 Total Revenue from Non- - - - - 96,896 96,896 Operating Activities
Capital Purpose Income (excluding - - - - 537,911 537,911 Interest) Capital Purpose Interest - - - - 4,121 4,121 Total Capital Purpose - - - - 542,032 542,032 Revenue Total Revenue 1,340,431 3,067,743 314,739 71,937 1,529,906 6,324,755
Department of Health and Human Services makes certain payments on behalf of the Health Service for insurance expenses. These amounts have been brought to account in determining the operating result for the year by recording them as revenue and expenses.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 45 Income is recognised in accordance with AASB 118 Revenue Interest Revenue and is recognised as to the extent that it is probable that the Interest revenue is recognised on a time proportionate basis economic benefits will flow to Nathalia District Hospital and that takes in account the effective yield of the financial asset, the income can be reliably measured at fair value. Unearned which allocates interest over the relevant period. income at reporting date is reported as income received in advance. Other Income Amounts disclosed as revenue are where applicable, net of returns, allowances and duties and taxes. Other income includes non-property rental, dividends, forgiveness of liabilities, and bad debt reversal. Government Grants and other transfers of Category groups income (other than contributions by owners) Nathalia District Hospital has used the following category In accordance with AASB 1004 Contributions, government groups for reporting purposes for the current and previous grants and other transfers of income (other than financial years. contributions by owners) are recognised as income when the Health Service gains control of the underlying assets • Admitted Patient Services (Admitted Patients) irrespective of whether conditions are imposed on the comprises all acute and subacute admitted patient Health Service’s use of the contributions. Contributions are services, where services are delivered in public deferred as income in advance when the Health Service has hospitals. a present obligation to repay them and the present obligation • Aged Care comprises a range of in home, specialist can be reliably measured. geriatric, residential care and community based programs and support services, such as Home and Indirect Contributions from the Department of Community Care (HACC) that are targeted to older Health and Human Services people, people with a disability, and their carers. • Insurance is recognised as revenue following advice • Primary and Community Health comprises a range from the Department of Health and Human Services. of home based, community based, community and primary health and including health promotion and Patient and Resident Fees counselling, physiotherapy, speech therapy, podiatry and Patient and resident fees are recognised as revenue at the occupational therapy. time invoices are raised. • Residential Aged Care comprises those Commonwealth-licensed residential aged care services Private Practice Fees funded from the Commonwealth with supplementary funding from Department of Health and Human Private practice fees are recognised as revenue at the time Services, Aged Care Services. invoices are raised. • Other Services not reported elsewhere - (Other) Revenue from commercial activities comprises services not separately classified above, which includes Public Health Services. Health and Revenue from commercial activities is recognised at the time Community Initiatives also falls in this category group. invoices are raised.
Donations and Other Bequests Donations and bequests are recognised as revenue when received. If donations are for a special purpose, they may be appropriated to a surplus, such as the specific restricted purpose surplus.
46 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 3: THE COST OF DELIVERING SERVICES This section provides an account of the expenses incurred by the hospital in delivering services and outputs. In Section 2, the funds that enable the provision of services were disclosed and in this note the cost associated with provision of services are recorded.
Structure 3.1 Analysis of Expenses by Source 3.2 Analysis of Expense and Revenue by Internally Managed and Restricted Specific Purpose Funds 3.3 Specific Expenses 3.4 Finance Costs 3.5 Provisions 3.6 Superannuation
NOTE 3.1: ANALYSIS OF EXPENSES BY SOURCE Admitted Aged Primary Patients RAC Care Health Other Total 2017 2017 2017 2017 2017 2017 $ $ $ $ $ $ Employee Expenses 641,261 1,872,675 146,544 277,475 1,415,253 4,353,206
Other Operating Expenses
Non Salary Labour Costs 102,172 - - - 500,792 602,964
Supplies & Consumables 68,529 85,323 3,059 22,857 123,908 303,676
Other Expenses 69,969 24,887 18,679 10,627 996,917 1,121,079
Transfer Pricing 294,627 1,356,642 117,838 103,278 (1,872,384) - Total Expenditure from 1,176,558 3,339,527 286,120 414,237 1,164,486 6,380,925 Operating Activities
Finance Costs (refer note 3.4) - - - - 12,608 12,608
Other Non-Operating Expenses
Specific Expenses - - - - 2,017 2,017
HRHA Share Adjustment - - - - (294) (294) Depreciation & Amortisation (refer - - - - 773,982 773,982 note 4.3) Total Other Expenses - - - - 788,313 788,313
Total Expenses 1,176,558 3,339,527 286,120 414,237 1,952,799 7,169,238
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 47 NOTE 3.1: ANALYSIS OF EXPENSES BY SOURCE (CONTINUED)
Admitted Aged Primary Patients RAC Care Health Other Total 2016 2016 2016 2016 2016 2016 $ $ $ $ $ $ Employee Expenses 587,707 1,741,396 197,443 196,099 1,200,456 3,923,101
Other Operating Expenses
Non Salary Labour Costs 91,501 - - - 495,206 586,706
Supplies & Consumables 54,417 52,268 3,045 13,196 131,052 253,978
Other Expenses 49,025 28,881 21,281 10,501 1,036,865 1,146,554
Transfer Pricing 282,654 1,290,700 91,279 120,005 (1,784,638) - Total Expenditure from 1,065,305 3,113,245 313,049 339,801 1,078,940 5,910,339 Operating Activities
Finance Costs (refer note 3.4) - - - - 1,439 1,439
Other Non-Operating Expenses
Capital Purpose Expenditure - - - - 62,343 62,343 Depreciation & Amortisation - - - - 769,332 769,332 (refer note 4.3) Total Other Expenses - - - - 833,115 833,115
Total Expenses 1,065,305 3,113,245 313,049 339,801 1,912,055 6,743,454
48 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Expenses are recognised as they are incurred and reported Net gain/ (loss) on non-financial assets in the financial year to which they relate. Net gain/ (loss) on non-financial assets and liabilities includes realised and unrealised gains and losses as follows: Cost of goods sold Costs of goods sold are recognised when the sale of an item Revaluation gains/ (losses) of non-financial occurs by transferring the cost or value of the item/s from physical assets inventories. Refer to Note 4.1 Property plant and equipment.
Employee expenses Net gain/ (loss) on disposal of non-financial • Employee expenses include: assets • wages and salaries; Any gain or loss on the disposal of non-financial assets is recognised at the date of disposal and is the difference • fringe benefits tax; between the proceeds and the carrying amount of the • leave entitlements; asset at the time. • termination payments; Amortisation of non-produced intangible assets • workcover premiums; and Intangible non-produced assets with finite lives are amortised • superannuation expenses which are reported as an ‘other economic flow’ on a systematic basis over differently depending upon whether employees are the asset’s useful life. Amortisation begins when the asset members of defined benefit or defined contribution is available for use that is when it is in the location and plans. condition necessary for it to be capable of operating in the manner intended by management. Other operating expenses Other operating expenses generally represent the day-to-day Impairment of non-financial assets running costs incurred in normal operations and include: Goodwill and intangible assets with indefinite useful lives (and intangible assets not available for use) are tested annually Supplies and consumables for impairment and whenever there is an indication that the asset may be impaired. Supplies and services costs which are recognised as an expense in the reporting period in which they are incurred. The carrying amounts of any inventories held Revaluations of financial instrument at fair value for distribution are expensed when distributed. Refer to Note 7.1 Financial instruments.
Bad and doubtful debts Other gains/(losses) from other economic flows Receivables are assessed for bad and doubtful debts on Other gains/(losses) include: a regular basis. Those bad debts considered as written • the revaluation of the present value of the long off by mutual consent are classified as a transaction service leave liability due to changes in the bond rate expense. movements, inflation rate movements and the impact of changes in probability factors; and Fair value of assets, services and resources provided free of charge or for nominal • transfer of amounts from the reserves to accumulated surplus or net result due to disposal or derecognition consideration or reclassification. Contributions of resources provided free of charge or for nominal consideration are recognised at their fair value Derecognition of financial liabilities when the transferee obtains control over them, irrespective of whether restrictions or conditions are imposed over A financial liability is derecognised when the obligation under the use of the contributions, unless received from another the liability is discharged, cancelled or expires. agency as a consequence of a restructuring of administrative When an existing financial liability is replaced by another arrangements. In the latter case, such a transfer will be from the same lender on substantially different terms, or the recognised at its carrying amount. Contributions in the terms of an existing liability are substantially modified, such form of services are only recognised when a fair value can an exchange or modification is treated as a derecognition of be reliably determined and the services would have been the original liability and the recognition of a new liability. The purchased if not donated. difference in the respective carrying amounts is recognised as an expense in the consolidated comprehensive operating statement.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 49 NOTE 3.2: ANALYSIS OF EXPENSE AND REVENUE BY INTERNALLY MANAGED AND RESTRICTED SPECIFIC PURPOSE FUNDS
Total Total Total Total Expense Expense Revenue Revenue 2017 2016 2017 2016 $ $ $ $ Catering Services 53,234 67,272 22,824 34,254 Medical Clinic 1,028,837 984,296 936,762 819,103 Rental Properties 14,554 27,372 14,077 25,253 Total 1,096,625 1,078,940 973,663 878,610
NOTE 3.3: SPECIFIC EXPENSES
Total Total 2017 2016 $ $ Voluntary Departure Packages 2,017 - 2,017 -
NOTE 3.4: FINANCE COSTS
Total Total 2017 2016 $ $ Finance Charges on Finance Leases 944 - Accomdation Bonds 11,664 1,439 Total Finance Costs 12,608 1,439
Finance costs are recognised as expenses in the period in which they are incurred. Finance costs include: • Finance charges in respect of finance leases recognised in accordance with AASB 117 Leases; and • Interest on RAC Accommodation Deposits.
50 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 3.5: EMPLOYEE BENEFITS IN THE BALANCE SHEET
Total Total 2017 2016 $ $ Current Provisions Employee Benefits (i) Annual Leave - Unconditional and expected to be settled wholly within 12 months (ii) 316,058 310,009 - Unconditional and expected to be settled wholly after 12 months (iii) 28,211 -
Long Service Leave - Unconditional and expected to be settled wholly within 12 months (ii) 72,520 55,959 - Unconditional and expected to be settled wholly after 12 months (iii) 422,014 397,562
Accrued Days Off - Unconditional and expected to be settled within 12 months (ii) 4,762 7,772
Accrued Wages and Salaries - Unconditional and expected to be settled within 12 months (ii) 120,306 103,919 963,871 875,221
Provisions related to Employee Benefit On-Costs - Unconditional and expected to be settled within 12 months (ii) 42,081 35,219 - Unconditional and expected to be settled after 12 months (iii) 50,241 44,532 92,322 79,751 Total Current Provisions 1,056,193 954,972
Non-Current Provisions Employee Benefits (i) 196,571 158,988 Provisions related to Employee Benefit On-Costs 22,018 17,808 Total Non Current Provisions 218,589 176,796
Total Provisions 1,274,782 1,131,768
(a) Current Employee Benefits and Related On-Costs Unconditional Long Service Leave Entitlements 549,928 504,321 Annual Leave Entitlements 380,512 338,336 Accrued Wages and Salaries 120,306 103,919 Accrued Days Off 5,447 8,396
Non-Current Employee Benefits and Related On-Costs Conditional Long Service Leave Entitlements (ii) 218,589 176,796 Total Employee Benefits and Related On-Costs 1,274,782 1,131,768
Notes: (i) Provisions for employee benefits consist of amounts for annual leave and long service leave accrued by employees, not including on-costs. (ii) The amounts disclosed are nominal amounts (iii) The amounts disclosed are discounted to present values
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 51 NOTE 3.5: EMPLOYEE BENEFITS IN THE BALANCE SHEET (CONTINUED)
Total Total 2017 2016 Movements in provisions $'000 $'000 Movement in Long Service Leave: Balance at start of year 681,117 770,062 Provision made during the year - Revaluations (40,197) (22,367) - Expense recognising Employee Service 187,930 (21,438) Settlement made during the year (60,333) (45,140) Balance at end of year 768,517 681,117
Provisions service does not expect to settle the liability within 12 Provisions are recognised when the Health Service has a months because it will not have the unconditional right to present obligation, the future sacrifice of economic benefits is defer the settlement of the entitlement should an employee probable, and the amount of the provision can be measured take leave within 12 months. An unconditional right arises reliably. after a qualifying period. The amount recognised as a liability is the best estimate of The components of this current LSL liability are measured at: the consideration required to settle the present obligation at • Undiscounted value – if the health service expects to reporting date, taking into account the risks and uncertainties wholly settle within 12 months; and surrounding the obligation. Where a provision is measured using the cash flows estimated to settle the present • Present value – where the entity does not expect to obligation, its carrying amount is the present value of those settle a component of this current liability within 12 cash flows, using a discount rate that reflects the time value months. of money and risks specific to the provision. Conditional LSL is disclosed as a non-current liability. There When some or all of the economic benefits required to is an unconditional right to defer the settlement of the settle a provision are expected to be received from a third entitlement until the employee has completed the requisite party, the receivable is recognised as an asset if it is virtually years of service. This non-current LSL liability is measured at certain that recovery will be received and the amount of the present value. receivable can be measured reliably. Any gain or loss followed revaluation of the present value Employee benefits of non-current LSL liability is recognised as a transaction, except to the extent that a gain or loss arises due to changes This provision arises for benefits accruing to employees in in estimations e.g. bond rate movements, inflation rate respect of wages and salaries, annual leave and long service movements and changes in probability factors which are then leave for services rendered to the reporting date. recognised as other economic flow. Wages and salaries, annual leave, and accrued days off Termination benefits Liabilities for wages and salaries, including non-monetary Termination benefits are payable when employment is benefits and annual leave are all recognised in the provision terminated before the normal retirement date or when an for employee benefits as ‘current liabilities’, because the employee decides to accept an offer of benefits in exchange health service does not have an unconditional right to defer for the termination of employment. settlements of these liabilities. The health service recognises termination benefits when Depending on the expectation of the timing of settlement, it is demonstrably committed to either terminating the liabilities for wages and salaries and annual leave are measured at: employment of current employees according to a detailed • Undiscounted value – if the health service expects to formal plan without possibility of withdrawal or providing wholly settle within 12 months; or termination benefits as a result of an offer made to encourage voluntary redundancy. • Present value – if the health service does not expect to wholly settle within 12 months. On-costs related to employee expense Long service leave (LSL) Provision for on-costs, such workers compensation and superannuation are recognised together with provisions for Liability for LSL is recognised in the provision for employee employee benefits. benefits. Unconditional LSL is disclosed in the notes to the financial statements as a current liability, even where the health
52 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 3.6: SUPERANNUATION
Total Total 2017 2016 $ $ (i) Defined benefit plans: First State Super 5,955 7,038 Defined contribution plans: First State Super 222,906 214,628 HESTA Superannuation 112,808 105,204 Other 7,151 - Total 348,820 326,870
There were no unpaid contributions at 30th June 2017.
Employees of the Health Service are entitled to receive superannuation benefits and the Health Services contributes to both defined benefit and defined contribution plans. The defined benefit plan(s) provides benefits based on years of service and final average salary. The Health Service does not recognise any defined benefit liability in respect of the plan(s) because the entity has no legal or constructive obligation to pay future benefits relating to its employees; its only obligation is to pay superannuation contributions as they fall due. The Department of Treasury & Finance discloses the State’s defined benefits liabilities in its disclosure for administered items. However, superannuation contributions paid or payable for the reporting period are included as part of employee benefits in the comprehensive operating statement of the Health Service. The name, details and amounts expense in relation to the major employee superannuation funds and contributions made by the Health Services are detailed in the table above. Defined contribution superannuation plans In relation to defined contribution (i.e. accumulation) superannuation plans, the associated expense is simply the employer contributions that are paid or payable in respect of employees who are members of these plans during the reporting period. Contributions to defined contribution superannuation plans are expensed when incurred. Defined benefit superannuation plans The amount charged to the comprehensive operating statement in respect of defined benefit superannuation plans represents the contributions made by the Health Service to the superannuation plans in respect of the services of current Health Service staff during the reporting period. Superannuation contributions are made to the plans based on the relevant rules of each plan, and are based upon actuarial advice. Superannuation liabilities The Nathalia District Hospital does not recognise any unfunded defined benefit liability in respect of the superannuation plans because the Health Service has no legal or constructive obligation to pay future benefits relating to its employees; its only obligation is to pay superannuation contributions as they fall due.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 53 NOTE 4: KEY ASSETS TO SUPPORT SERVICE DELIVERY
The hospital controls infrastructure and other investments that are utilised in fulfilling its objectives and conducting its activities. They represent the key resources that have been entrusted to the hospital to be utilised for delivery of those outputs.
Structure 4.1: Jointly Controlled Entities 4.2 Property, Plant & Equipment 4.2 Depreciation and Amortisation 4.3 Intangible Assets
NOTE 4.1: JOINTLY CONTROLLED ENTITIES
Name of Entity Principle Activity Ownership Interest 2017 2016 Hume Rural Health Alliance Information System 2.10% 2.15%
Nathalia District Hospital interest in assets employed in the above jointly controlled operations and assets is detailed below. The amounts are included in the financial statements and consolidated financial statements under their respective asset categories:
Total Total 2017 2016 $ $ Current Assets Cash and Cash Equivalents 76,040 41,046 Receivables 54,761 20,255 Prepayments 2,882 1,610 Total Current Assets 133,683 62,911
Non Current Assets Property Plant & Equipment 29,438 36,042 Intangible Assets 33,425 18,805 Total Non Current Assets 62,863 54,847 Total Assets 196,546 117,758
Current Liabilities Payables 10,357 11,467 Borrowings 13,664 16,198 Total Current Liabilities 24,021 27,665
Non Current Liabilities Borrowings 15,487 19,438 Total Non Current Liabilities 15,487 19,438 Total Liabilities 39,508 47,103 Net Assets 157,038 70,655
54 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 4.1: JOINTLY CONTROLLED ENTITIES (CONTINUED)
Nathalia District Hospital service's interest in revenues and expenses resulting from jointly controlled operations and assets is detailed below: Total Total 2017 2016 $ $ Operating Revenue 179,576 188,959 Operating Expenses 155,721 172,987 Net Result before Capital and Specific Items 23,855 15,972
Capital Purpose Income 84,000 20,414 Finance Costs 944 1,442 Specific Expense 2,017 - Capital Purpose Expenditure - - Depreciation and Amortisation 18,805 19,072 Net Result After Capital & Specific Items 62,234 100 Net Result for the Year 86,089 15,872
Contingent Liability and Capital Commitments There are no known contingent liabilities or capital commitment for the HRHA as at the date of this report.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 55 NOTE 4.2: PROPERTY, PLANT & EQUIPMENT (a) Gross Carrying Amount and Accumulated Depreciation Total Total 2017 2016 $ $ Land Land at Fair Value 323,336 406,800 Total Land 323,336 406,800
Buildings Buildings at Fair Value 18,900,080 19,067,665 Less Accumulated Depreciation 2,069,447 1,392,482
Buildings Under Construction at cost 13,573 - Total Buildings 16,844,206 17,675,183
Plant and Equipment Plant & Equipment at Fair Value 70,598 70,598 Less Accumulated Depreciation 63,424 60,616 Total Plant & Equipment at Fair Value 7,174 9,982
Vehicles at Fair Value 156,565 156,565 Less Accumulated Depreciation 103,743 89,199 Total Vehicles at Fair Value 52,822 67,366
Computers & Communication at Fair Value 222,062 204,145 Less Accumulated Depreciation 203,994 199,794 Total Computers & Communication at Fair Value 18,068 4,351
Furniture & Fittings at Fair Value 59,303 59,303 Less Accumulated Depreciation 46,632 41,541 Total Furniture & Fittings at Fair Value 12,671 17,762
Non-Medical Equipment at Fair Value 240,067 237,329 Less Accumulated Depreciation 222,020 214,589 Total Non-Medical Equipment at Fair Value 18,047 22,740 Total Plant & Equipment 108,782 122,201
Medical Equipment at Fair Value 520,170 520,170 Less Accumulated Depreciation 497,114 483,952 Total Medical Equipment at Fair Value 23,056 36,218
Hume Rural Health Alliance (HRHA) Plant & Equipment at Fair Value 2,972 3,043 Less Accumulated Depreciation 2,685 2,637 Total HRHA Plant & Equipment at Fair Value 287 406
Leased Assets at Fair Value 60,905 70,095 Less Accumulated Depreciation 31,754 34,459 Total HRHA Leased Assets at Fair Value 29,151 35,636 Total Hume Rural Health Alliance Plant & Equipment 29,438 36,042
Total Property, Plant and Equipment 17,328,818 18,276,444
56 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 $ - - (537) (837) Total 49,800 66,619 287,659 (12,365) (248,184) (763,835) (765,224) 18,715,722 18,276,444 17,328,818 $ - - - - - (523) (837) Rural 30,952 11,975 Hume 23,048 36,042 29,438 Health (17,435) (17,742) Alliance (HRHA) $ ------27,468 (2,251) 27,644 36,218 23,056 (16,643) (13,162) Medical Equipment $ - - - - - (14) 35,438 20,656 (10,114) (32,700) (34,075) 129,591 122,201 108,782 Plant and Equipment $ ------33,988 13,573 193,801 (20,415) (193,801) Work In Work Progress $ ------20,415 193,801 (164,720) (697,057) (700,245) Buildings 18,178,439 17,675,183 16,830,633 $ ------Land 49,800 (83,464) 357,000 406,800 323,336 PROPERTY, PLANT & EQUIPMENT (CONTINUED) PROPERTY, (b) Reconciliations of the Carrying Amounts of Each Class of Asset NOTE 4.2: NOTE Balance at 1 July 2015 HRHA Asset Share Adjustment Additions Disposals Net Transfers between Classes Increments/(Decrements)Revaluation Depreciation (Note 4.3) Balance at 1 July 2016 Additions Disposals HRHA % Share Adjustment Net Transfers between Classes Depreciation (Note 4.3) Balance at 30 June 2017 valuation carried at Land buildings and An independent valuation the of Health Service's land and buildings was performed the by Valuer-General Victoria to determinebuildings. The the valuation, fair value the of which land and conforms to Australian Valuation Standards, was determined reference by to the amounts for whichknowledgeable assets could be exchanged willing parties between in an arm's length transaction. The valuation was based on independent assessments. The effective date the of valuation is 30 June 2014. Further to the independent revaluation above, Nathalia District Hospital performed a Managerial Revaluationconducted on on Land the basis The during Managerial that land 2015/2016. indices revaluation provided the by Valuer-General was Victoria indicated that land values in the Nathalia area hadmateriality increased in value threshold more by than since 10% the previous valuation conducted the by Valuer-General Victoria. The effective date the of Managerial Valuation is 30 June 2016.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 57 NOTE 4.2: PROPERTY, PLANT & EQUIPMENT (CONTINUED) (c) Fair Value Measurement Hierarchy for Assets
Carrying Amount Fair value measurement as at 30 at end of reporting period using: June 2017 Level 1 (i) Level 2 (i) Level 3 (i) Land at Fair Value $ $ $ $ Non-Specialised Land 125,061 - 125,061 - Specialised Land Nathalia District Hospital - McDonell Street, Nathalia 198,275 - - 198,275 Total of Land at Fair Value 323,336 - 125,061 198,275
Buildings at Fair Value Non-Specialised Buildings 204,125 - 204,125 - Specialised Buildings 16,626,508 - - 16,626,508 Total of Buildings at Fair Value 16,830,633 - 204,125 16,626,508
Plant and Equipment at Fair Value Plant & Equipment 7,174 - - 7,174 Vehicles 52,822 - - 52,822 Computers and Communications 18,068 - - 18,068 Furniture and Fittings 12,671 - - 12,671 Non-Medical Equipment 18,047 - - 18,047 Total Plant and Equipment at Fair Value 108,782 - - 108,782
Medical Equipment at Fair Value Medical Equipment 23,056 - - 23,056 Total Medical Equipment at Fair Value 23,056 - - 23,056
Hume Health Alliance at Fair Value Hume Rural Health Alliance 29,438 - - 29,438 Total Hume Health Alliance at Fair Value 29,438 - - 29,438
Assets Under Construction at Fair Value Buildings 13,573 - - 13,573 Total Assets Under Construction at Fair Value 13,573 - - 13,573 17,328,818 - 329,186 16,999,632 (i) Classified in accordance with the fair value hierarchy There have been no transfers between levels during the period.
58 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 4.2: PROPERTY, PLANT & EQUIPMENT (CONTINUED)
Carrying Amount Fair value measurement as at 30 at end of reporting period using: June 2016 Level 1 (i) Level 2 (i) Level 3 (i) Land at Fair Value $ $ $ $ Non-Specialised Land 208,525 - 208,525 - Specialised Land Nathalia District Hospital - McDonell Street, Nathalia 198,275 - - 198,275 Total of Land at Fair Value 406,800 - 208,525 198,275
Buildings at Fair Value Non Specialised Buildings 381,950 - 381,950 - Specialised Buildings 17,293,233 - - 17,293,233 Total of Buildings at Fair Value 17,675,183 - 381,950 17,293,233
Plant and Equipment at Fair Value Plant & Equipment 9,982 - - 9,982 Vehicles 67,366 - - 67,366 Computers and Communication 4,351 - - 4,351 Furniture and Fittings 17,762 - - 17,762 Non-Medical Equipment 22,740 - - 22,740 Total Plant and Equipment at Fair Value 122,201 - - 122,201
Medical Equipment at Fair Value Medical Equipment 36,218 - - 36,218 Total Medical Equipment at Fair Value 36,218 - - 36,218
Hume Health Alliance at Fair Value Hume Rural Health Alliance 36,042 - - 36,042 Total Hume Health Alliance at Fair Value 36,042 - - 36,042 18,276,444 - 590,475 17,685,969
Consistent with AASB 13 Fair Value Measurement, Nathalia District Hospital determines the policies and procedures for both recurring fair value measurements such as property, plant and equipment, investment properties and financial instruments, and for non-recurring fair value measurements such as non-financial physical assets held for sale, in accordance with the requirements of AASB 13 and the relevant FRDs. All assets and liabilities for which fair value is measured or disclosed in the financial statements are categorised within the fair value hierarchy, described as follows, based on the lowest level input that is significant to the fair value measurement as a whole: • Level 1 – Quoted (unadjusted) market prices in active markets for identical assets or liabilities • Level 2 – Valuation techniques for which the lowest level input that is significant to the fair value measurement is directly or indirectly observable • Level 3 – Valuation techniques for which the lowest level input that is significant to the fair value measurement is unobservable. For the purpose of fair value disclosures, Nathalia District Hospital has determined classes of assets and liabilities on the basis of the nature, characteristics and risks of the asset or liability and the level of the fair value hierarchy as explained above.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 59 In addition, Nathalia District Hospital determines whether transfers have occurred between levels in the hierarchy by re- assessing categorisation (based on the lowest level input that is significant to the fair value measurement as a whole) at the end of each reporting period. The Valuer-General Victoria (VGV) is Nathalia District Hospital’s independent valuation agency. Nathalia District Hospital, in conjunction with VGV monitors the changes in the fair value of each asset and liability through relevant data sources to determine whether revaluation is required. The estimates and underlying assumptions are reviewed on an ongoing basis. Fair value measurement Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. The fair value measurement is based on the following assumptions: • that the transaction to sell the asset or transfer the liability takes place either in the principal market (or the most advantageous market, in the absence of the principal market), either of which must be accessible to the Health Service at the measurement date; • that the Health Service uses the same valuation assumptions that market participants would use when pricing the asset or liability, assuming that market participants act in their economic best interest. The fair value measurement of a non-financial asset takes into account a market participant’s ability to generate economic benefits by using the asset in its highest and best use or by selling it to another market participant that would use the asset in its highest and best use. Consideration of highest and best use (HBU) for non-financial physical assets Judgements about highest and best use must take into account the characteristics of the assets concerned, including restrictions on the use and disposal of assets arising from the asset’s physical nature and any applicable legislative/contractual arrangements. In considering the HBU for non-financial physical assets, valuers are probably best placed to determine highest and best use (HBU) in consultation with Health Services. Health Services and their valuers therefore need to have a shared understanding of the circumstances of the assets. A Health Service has to form its own view about a valuer’s determination, as it is ultimately responsible for what is presented in its audited financial statements. In accordance with paragraph AASB 13.29, Health Services can assume the current use of a non-financial physical asset is its HBU unless market or other factors suggest that a different use by market participants would maximise the value of the asset. Therefore, an assessment of the HBU will be required when the indicators are triggered within a reporting period, which suggest the market participants would have perceived an alternative use of an asset that can generate maximum value. Once identified, Health Services are required to engage with VGV or other independent valuers for formal HBU assessment.
60 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 4.2: PROPERTY, PLANT & EQUIPMENT (d) Reconciliation of Level 3 Fair Value
Hume Rural Assets Health Plant and Medical Under Alliance Land Buildings Equipment Equipment Construction (HRHA) 30 June 2017 $ $ $ $ $ $ Opening Balance 198,275 17,293,233 122,201 36,218 - 36,042 Purchases (sales) - - 20,655 - 33,988 11,975 Transfers in (out) of Level - 20,415 - - (20,415) - 3
Gains or losses recognised in net result - Depreciation - (687,140) (34,075) (13,162) - (17,741) - Disposals ------HRHA % share adjustment - - - - - (838) Subtotal - (687,140) (34,075) (13,162) - (18,579)
Items recognised in other comprehensive income - Revaluation ------Subtotal ------Closing Balance 198,275 16,626,508 108,782 23,056 13,573 29,438
Hume Rural Assets Health Plant and Medical Under Alliance Land Buildings Equipment Equipment Construction (HRHA) 30 June 2016 $ $ $ $ $ $ Opening Balance 148,475 17,796,489 129,074 27,644 - 23,565 Purchases (sales) - - 8,635 25,217 193,801 30,954 Transfers in (out) of Level - 193,801 - - (193,801) - 3
Gains or losses recognised in net result - Depreciation - (697,057) (15,508) (16,643) - (18,477) Subtotal - (697,057) (15,508) (16,643) - (18,477)
Items recognised in other comprehensive income - Revaluation 49,800 - - - - - Subtotal 49,800 - - - - - Closing Balance 198,275 17,293,233 122,201 36,218 - 36,042
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 61 Identifying unobservable inputs (level 3) fair value For non-specialised land and non-specialised buildings, an measurements independent valuation was performed by independent valuers, Level 3 fair value inputs are unobservable valuation inputs Victorian Valuer General, to determine the fair value using for an asset or liability. These inputs require significant the market approach. Valuation of the assets was determined judgement and assumptions in deriving fair value for both by analysing comparable sales and allowing for share, size, financial and non-financial assets. topography, location and other relevant factors specific to the asset being valued. An appropriate rate per square metre has Unobservable inputs shall be used to measure fair value to been applied to the subject asset. The effective date of the the extent that relevant observable inputs are not available, valuation is 30 June 2014. thereby allowing for situations in which there is little, if any, market activity for the asset or liability at the measurement To the extent that non-specialised land and non-specialised date. However, the fair value measurement objective remains buildings do not contain significant, unobservable the same, i.e., an exit price at the measurement date from adjustments, these assets are classified as Level 2 under the the perspective of a market participant that holds the asset or market approach. owes the liability. Therefore, unobservable inputs shall reflect Specialised land and specialised buildings the assumptions that market participants would use when The market approach is also used for specialised land and pricing the asset or liability, including assumptions about risk. specialised buildings although is adjusted for the community Assumptions about risk include the inherent risk in a service obligation (CSO) to reflect the specialised nature particular valuation technique used to measure fair value of the assets being valued. Specialised assets contain (such as a pricing risk model) and the risk inherent in the significant, unobservable adjustments; therefore these assets inputs to the valuation technique. A measurement that does are classified as Level 3 under the market based direct not include an adjustment for risk would not represent a fair comparison approach. value measurement if market participants would include one The CSO adjustment is a reflection of the valuer’s when pricing the asset or liability i.e., it might be necessary assessment of the impact of restrictions associated with to include a risk adjustment when there is significant an asset to the extent that is also equally applicable measurement uncertainty. For example, when there has to market participants. This approach is in light of the been a significant decrease in the volume or level of activity highest and best use consideration required for fair value when compared with normal market activity for the asset or measurement, and takes into account the use of the asset liability or similar assets or liabilities, and the Health Service that is physically possible, legally permissible and financially has determined that the transaction price or quoted price feasible. As adjustments of CSO are considered as significant does not represent fair value. unobservable inputs, specialised land would be classified as A Health Service shall develop unobservable inputs using Level 3 assets. the best information available in the circumstances, which For the health services, the depreciated replacement cost might include the Health Service’s own data. In developing method is used for the majority of specialised buildings, unobservable inputs, a Health Service may begin with its adjusting for the associated depreciation. As depreciation own data, but it shall adjust this data if reasonably available adjustments are considered as significant and unobservable information indicates that other market participants would inputs in nature, specialised buildings are classified as Level 3 use different data or there is something particular to for fair value measurements. the Health Service that is not available to other market participants. An independent valuation of the Health Service’s specialised land and specialised buildings was performed by the Valuer- A Health Service need not undertake exhaustive efforts General Victoria. The valuation was performed using the to obtain information about other market participant market approach adjusted for CSO. The effective date of the assumptions. However, a Health Service shall take into valuation is 30 June 2014. account all information about market participant assumptions that is reasonably available. Unobservable inputs developed In accordance with FRD 103F a managerial valuation of in the manner described above are considered market land was performed in June 2016 as compound movement participant assumptions and meet the object of a fair value indicators provided by Valuer General Victoria indicated a measurement. difference between the fair value and the carrying amount value of land held at Nathalia was potentially material. Non-specialised land and non-specialised buildings Non-specialised land and non-specialised buildings are valued Vehicles using the market approach. Under this valuation method, the The Health Service acquires new vehicles and at times assets are compared to recent comparable sales or sales of disposes of them before completion of their economic comparable assets which are considered to have nominal or life. The process of acquisition, use and disposal in the no added improvement value. market is managed by the Health Service who set relevant depreciation rates during use to reflect the consumption of the vehicles. As a result, the fair value of vehicles does not differ materially from the carrying amount (depreciated cost).
62 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Plant and equipment There were no changes in valuation techniques throughout Plant and equipment is held at carrying amount (depreciated the period to 30 June 2017. cost). When plant and equipment is specialised in use, such For all assets measured at fair value, the current use is that it is rarely sold other than as part of a going concern, considered the highest and best use. the depreciated replacement cost is used to estimate the fair value. Unless there is market evidence that current replacement costs are significantly different from the original acquisition cost, it is considered unlikely that depreciated replacement cost will be materially different from the existing carrying amount.
NOTE 4.2: PROPERTY, PLANT & EQUIPMENT (e) Description of Significant Unobservable Inputs to Level 3 Valuations: Valuation technique (i) Significant unobservable inputs (i) Specialised land McDonell Street, Nathalia Market approach Community Service Obligation (CSO) adjustment
Specialised buildings McDonell Street, Nathalia Depreciated replacement cost Direct cost per square metre
Plant and equipment at fair value Plant and Equipment Depreciated replacement cost Cost per unit Computers and Communication Furniture and Fittings Useful life of PPE Non Medical Equipment
Vehicles Motor Vehicles Depreciated replacement cost Cost per unit Useful life of Vehicles
Medical equipment at fair value Medical Equipment Depreciated replacement cost Cost per unit Useful life of medical equipment
Assets under construction at fair value Buildings Depreciated replacement cost Cost per unit
(i) CSO adjustments of 20% were applied to reduce the market approach value for the Department’s specialised land. The significant unobservable inputs have remained unchanged from 2016. Refer to Note 7.4 for guidance on fair value measurement indicative expectations.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 63 Property, plant and equipment Revaluations of non-current physical assets All non-current physical assets are measured initially at cost Non-current physical assets are measured at fair value and and subsequently revalued at fair value less accumulated are revalued in accordance with FRD 103F Non-current depreciation and accumulated impairment loss. Where an physical assets. This revaluation process normally occurs at asset is acquired for no or nominal cost, the cost is its fair least every five years, based upon the asset’s Government value at the date of acquisition. Assets transferred as part of Purpose Classification, but may occur more frequently if a merger/machinery of government are transferred at their fair value assessments indicate material changes in values. carrying amount. Independent valuers are used to conduct these scheduled revaluations and any interim revaluations are determined in More details about the valuation techniques and inputs used accordance with the requirements of the FRDs. Revaluation in determining the fair value of non-financial physical assets increments or decrements arise from differences between an are discussed in the table above. asset’s carrying amount and fair value. The initial cost for non-financial physical assets under finance Revaluation increments are recognised in ‘other lease is measured at amounts equal to the fair value of the comprehensive income’ and are credited directly in equity to leased asset or, if lower, the present value of the minimum the asset revaluation surplus, except that, to the extent that lease payments, each determined at the inception of the an increment reverses a revaluation decrement in respect of lease. that same class of asset previously recognised as an expense Crown land is measured at fair value with regard to the in net result, the increment is recognised as income in the net property’s highest and best use after due consideration result. is made for any legal or physical restrictions imposed on Revaluation decrements are recognised in ‘other the asset, public announcements or commitments made comprehensive income’ to the extent that a credit balance in relation to the intended use of the asset. Theoretical exists in the asset revaluation surplus in respect of the same opportunities that may be available in relation to the asset class of property, plant and equipment. are not taken into account until it is virtually certain that any restrictions will no longer apply. Therefore, unless otherwise Revaluation increases and revaluation decreases relating to disclosed, the current use of these non-financial physical individual assets within an asset class are offset against one assets will be their highest and best uses. another within that class but are not offset in respect of assets in different classes. Land and buildings are recognised initially at cost and subsequently measured at fair value less accumulated Revaluation surplus is not normally transferred to depreciation and accumulated impairment loss. accumulated funds on derecognition of the relevant asset. Plant, equipment and vehicles are recognised initially In accordance with FRD 103F, Nathalia District Hospital non- at cost and subsequently measured at fair value less current physical assets were assessed to determine whether accumulated depreciation and accumulated impairment revaluation of the non-current physical assets was required loss. Depreciated historical cost is generally a reasonable and did not identify any significant movement that would proxy for fair value because of the short lives of the assets require a revalution. concerned.
64 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 4.3: DEPRECIATION AND AMORTISATION
Total Total 2017 2016 $ $ Depreciation Buildings 700,245 697,057 Plant & Equipment 2,809 1,902 Computers & Communication 4,201 1,169 Furniture & Fittings 5,091 5,091 Vehicles 14,544 14,651 Non Medical Equipment 7,430 9,341 Medical Equipment 13,162 16,643 Hume Rural Health Alliance 17,742 17,983 765,224 763,837 Amortisation Software 7,694 4,406 Hume Rural Health Alliance 1,064 1,089 Total 8,758 5,495 Total Depreciation and Amortisation 773,982 769,332
All buildings, plant and equipment and other non-financial physical assets that have finite useful lives are depreciated (i.e. excludes land assets held for sale, and investment properties). Depreciation begins when the asset is available for use, which is when it is in the location and condition necessary for it to be capable of operating in a manner intended by management. Depreciation is generally calculated on a straight line basis, at a rate that allocates the asset value, less any estimated residual value over its estimated useful life. Estimates of the remaining useful lives, residual value and depreciation method for all assets are reviewed at least annually, and adjustments made where appropriate. This depreciation charge is not funded by the Department of Health and Human Services. Assets with a cost in excess of $1000 are capitalised and depreciation has been provided on depreciable assets so as to allocate their cost or valuation over their estimated useful lives. The following table indicates the expected useful lives of non-current assets on which the depreciation charges are based. 2017 2016 Buildings Structure Shell Building Fabric 25 to 50 years 25 to 50 years Site Engineering Services and Central Plant 25 to 50 years 25 to 50 years Central Plant Fit Out 25 to 50 years 25 to 50 years Trunk Reticulated Building Systems 25 to 50 years 25 to 50 years Plant & Equipment 2 to 10 years 2 to 10 years Medical Equipment 5 to 10 years 5 to 10 years Computers and Communication 3 years 3 years Furniture and Fitting 10 years 10 years Motor Vehicles 7 years 7 years Non Medical 5 years 5 years As part of the buildings valuation, building values were separated into components and each component assessed for its useful life which is represented above. Refer to Note 4.4 for the useful life of intangible assets.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 65 NOTE 4.4: INTANGIBLE ASSETS
Total Total 2017 2016 $ $ Software 22,854 17,334 Less Accumulated Amortisation 15,154 7,460
Hume Rural Health Alliance - Software 36,440 20,801 Less Accumulated Amortisation 3,015 1,997 Total Intangible Assets 41,125 28,678
Reconciliation of the carrying amounts of intangible assets at the beginning and end of the previous and current financial year:
Software HRHA Total $ $ $ Balance at 1 July 2015 14,280 13,813 28,093 HRHA Asset Share Adjustment - 20 20 Additions - 6,060 6,060 Amortisation (4,406) (1,089) (5,495) Balance at 1 July 2016 9,874 18,804 28,678 Additions 5,520 15,685 21,205 Amortisation (7,694) (1,064) (8,758) Balance at 30 June 2017 7,700 33,425 41,125
(i) The consumption of separately acquired intangible assets is included in the 'amortisation' line item. (ii) Impairment losses are included in the line item 'net gain/(loss) on non-financial assets' in the comprehensive operating statement. Intangible assets Intangible assets represent identifiable non-monetary assets without physical substance such as computer software. Intangible assets are initially recognised at cost. Subsequently, intangible assets with finite useful lives are carried at cost less accumulated amortisation and accumulated impairment losses. Costs incurred subsequent to initial acquisition are capitalised when it is expected that additional future economic benefits will flow to the Health Service. Amortisation Amortisation is allocated to intangible non-produced assets with finite useful lives on a systematic (typically straight-line) basis over the asset’s useful life. Amortisation begins when the asset is available for use, that is, when it is in the location and condition necessary for it to be capable of operating in the manner intended by management. The consumption of intangible non-produced assets with finite useful lives is classified as amortisation. The amortisation period and the amortisation method for an intangible asset with a finite useful life are reviewed at least at the end of each annual reporting period. In addition, an assessment is made at each reporting date to determine whether there are indicators that the intangible asset concerned is impaired. If so, the asset concerned is tested as to whether its carrying amount exceeds its recoverable amount. Intangible assets with indefinite useful lives are not amortised, but are tested for impairment annually or whenever there is an indication that the asset may be impaired. The useful lives of intangible assets that are not being amortised are reviewed each period to determine whether events and circumstances continue to support an indefinite useful life assessment for that asset. In addition, the Health Service tests all intangible assets with indefinite useful lives for impairment by comparing the recoverable amount for each asset with its carrying amount: • annually; and • whenever there is an indication that the intangible asset may be impaired Any excess of the carrying amount over the recoverable amount is recognised as an impairment loss. Intangible assets with finite lives are depreciated as an expense from transactions on a systematic basis over the asset’s useful life. Intangible assets with finite useful lives are amortised over a 2-5 years.
66 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 5: OTHER ASSETS AND LIABILITIES This section sets out those assets and liabilities that arose from the hospital's operations.
Structure 5.1 Receivables 5.2 Other Liabilities 5.3 Prepayments and Other Assets 5.4 Payables
NOTE 5.1: RECEIVABLES Total Total 2017 2016 $ $ Current Contractual Trade Debtors 69,647 23,731 Patient Fees & Resident Fees 131,005 76,478 Accrued Investment Income 608 5,417 Other Accrued Revenue 31,876 17,536 Hume Rural Health Alliance 54,761 20,255 Total Contractual Receivables 287,897 143,416 Statutory GST Receivable 32,139 20,963 Total Statutory Receivables 32,139 20,963 Total Current Receivables 320,036 164,380 Non Current Statutory Long Service Leave - Department of Health 209,460 154,718 Total Non Current Receivables 209,460 154,718 Total Receivables 529,496 319,098 (a) Ageing analysis of receivables Please refer to Note 7.1 for the ageing analysis of contractual receivables (b) Nature and extent of risk arising from receivables Please refer to Note 7.1 for the nature and extent of risk arising from contractual receivables
Receivables consist of: • contractual receivables, which includes mainly debtors in relation to goods and services, loans to third parties, accrued investment income, and finance lease receivables; and • statutory receivables, which includes predominantly amounts owing from the Victorian Government and Goods and Services Tax (“GST”) input tax credits recoverable. Receivables that are contractual are classified as financial instruments and categorised as loans and receivables. Statutory receivables are recognised and measured similarly to contractual receivables (except for impairment), but are not classified as financial instruments because they do not arise from a contract. Receivables are recognised initially at fair value and subsequently measured at amortised cost, using the effective interest method, less any accumulated impairment. Trade debtors are carried at nominal amounts due and are due for settlement within 30 days from the date of recognition. Collectability of debts is reviewed on an ongoing basis, and debts which are known to be uncollectible are written off. A provision for doubtful debts is recognised when there is objective evidence that the debts may not be collected and bad debts are written off when identified.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 67 NOTE 5.2: OTHER LIABILITIES
Total Total 2017 2016 $ $ Current Monies Held in Trust RAC - Refundable Accommodation Deposits/Charges 1,722,681 2,205,148 DHHS Grants for Hume Region Funded Programs 4,145 6,345 Paid Parental Leave Scheme Employee Balances 4,820 - Total Current 1,731,646 2,211,493 Total Other Liabilities 1,731,646 2,211,493
Total Monies Held in Trust Represented by the following assets: Cash Assets (Refer Note 6.2) 1,731,646 2,211,493 Total 1,731,646 2,211,493
NOTE 5.3: PREPAYMENTS AND OTHER NON-FINANCIAL ASSETS
Total Total 2017 2016 $ $ Current Prepayments 27,353 35,263 Hume Rural Health Alliance - Prepayment 2,882 1,610 Total Other Assets 30,235 36,873
Other non-financial assets include prepayments which represent payments in advance of receipt of goods or services or that part of expenditure made in one accounting period covering a term extending beyond that period.
68 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 5.4: PAYABLES
Total Total 2017 2016 $ $ Current Contractual Trade Creditors (i) 214,356 278,857 Accrued Expenses 55,936 124,825 Hume Rural Health Alliance 10,357 11,467 Total Contractual Payables 280,648 415,149
Statutory GST Payable 13,417 2,172 Income In Advance - Commonwealth 1,380 5,656 Income In Advance - Department of Health and Human Services (ii) 84,169 69,069 Total Statutory Payables 98,966 76,897 Total Payables 379,614 492,046 (i) The average credit period is 30 days. (ii) Terms and conditions of amounts payable to the Department of Health and Human Services vary according to the particular agreement with the department
(a) Maturity analysis of payables Please refer to Note 7.1 for ageing analysis of contractual payables
(b) Nature and extent of risk arising from payables Please refer to Note 7.1 for the nature and extent of risks arising from contractual payables
Payables consist of: • contractual payables which consist predominantly of accounts payable representing liabilities for goods and services provided to the Health Service prior to the end of the financial year that are unpaid, and arise when the Health Service becomes obliged to make future payments in respect of the purchase of those goods and services. The normal credit terms for accounts payable are usually Nett 30 days. • statutory payables, such as goods and services tax and fringe benefits tax payables. Contractual payables are classified as financial instruments and are initially recognised at fair value, and then subsequently carried at amortised cost. Statutory payables are recognised and measured similarly to contractual payables, but are not classified as financial instruments and not included in the category of financial liabilities at amortised cost, because they do not arise from a contract.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 69 NOTE 6: HOW WE FINANCE OUR OPERATIONS
This section provides information on the sources of finance utilised by the hospital during its operations, along with interest expenses (the cost of borrowings) and other information related to financing activities of the hospital.
This section includes disclosures of balances that are financial instruments (such as borrowings and cash balances). Note: 7.1 provides additional, specific financial instrument disclosures.
Structure 6.1 Borrowings 6.2 Cash and Cash Equivalents 6.3 Commitments for Expenditure
NOTE 6.1: BORROWINGS
Total Total 2017 2016 $ $ Current Hume Rural Health Alliance (i) 13,664 16,198 Total Current 13,664 16,198
Non Current Hume Rural Health Alliance (i) 15,487 19,438 Total Non-Current 15,487 19,438 Total Borrowings 29,151 35,636
(i) Nathalia District Hospital's share of finance lease liabilities undertaken by the HRHA joint arrangement. These liabilities are effectively secured as the rights to the leased assets revert to the lessor in the event of default.
Finance costs of the Health Service incurred during the year are accounted for as follows: Amount of finance costs and Interest on RAC Accommodation Deposits recognised as 12,608 1,439 expenses
(a) Maturity analysis of borrowings Please refer to note 7.1 for the ageing analysis of borrowings.
(b) Nature and extent of risk arising from borrowings Please refer to Note 7.1 for the nature and extent of risks arising from contractual payables
(c) Defaults and breachs During the year and prior year, there were no defaults and breaches of any of the borrowings
70 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 A lease is a right to use an asset for an agreed period of time in exchange for payment. Leases are classified at their inception as either operating or finance leases based on the economic substance of the agreement so as to reflect the risks and rewards incidental to ownership. Leases of property, plant and equipment are classified as finance leases whenever the terms of the lease transfer substantially all the risks and rewards of ownership to the lessee. For service concession arrangements, the commencement of the lease term is deemed to be the date the asset is commissioned. All other leases are classified as operating leases. Finance leases Entity as lessee Finance leases are recognised as assets and liabilities at amounts equal to the fair value of the lease property or, if lower, the present value of the minimum lease payment, each determined at the inception of the lease. The lease asset is accounted for as a non-financial physical asset and is depreciated over the shorter of the estimated useful life of the asset or the term of the lease. If there is certainty that the health service will obtain the ownership of the lease asset by the end of the lease term, the asset shall be depreciated over the useful life of the asset. If there is no reasonable certainty that the lessee will obtain ownership by the end of the lease term, the asset shall be fully depreciated over the shorter of the lease term and its useful life. Minimum lease payments are apportioned between reduction of the outstanding lease liability, and the periodic finance expense which is calculated using the interest rate implicit in the lease, and charged directly to the comprehensive operating statement. Contingent rentals associated with finance leases are recognised as an expense in the period in which they are incurred.
Borrowings All borrowings are initially recognised at fair value of the consideration received, less directly attributable transaction costs. The measurement basis subsequent to initial recognition depends on whether the Health Service has categorised its borrowings as either, financial liabilities designated at fair value through profit or loss, or financial liabilities at amortised cost. Any difference between the initial recognised amount and the redemption value is recognised in net result over the period of the borrowings using the effective interest method. The classification depends on the nature and purpose of the borrowing. The Health Service determines the classification of its borrowing at initial recognition. Operating leases Entity as lessee Operating lease payments, including any contingent rentals, are recognised as an expense in the comprehensive operating statement on a straight line basis over the lease term, except where another systematic basis is more representative of the time pattern of the benefits derived from the use of the leased asset. The leased asset is not recognised in the balance sheet. Nathalia District Hospital has received such approval prior to 30 June 2016, in a joint letter for all Health Services impacted by Finance Leases either directly of via a Jointly Controlled entity. The specific values approved for Nathalia District Hospital total $134,617.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 71 NOTE 6.2: CASH AND CASH EQUIVALENTS Cash and cash equivalents recognised on the balance sheet comprise cash on hand and cash at bank, deposits at call and highly liquid investments (with an original maturity of three months or less), which are held for the purpose of meeting short term cash commitments rather than for investment purposes, which are readily convertible to known amounts of cash with an insignificant risk of changes in value.
Total Total 2017 2016 $ $ Cash on Hand 500 500 Cash at Bank 1,789,629 1,643,927 Short Term Deposits 2,097,579 3,041,052 Hume Rural Health Alliance 76,040 41,046 Total Cash and Cash Equivalents 3,963,748 4,726,525
Represented by: Cash for Health Service Operations (as per Cash Flow Statement) Cash for Health Service Operations 2,156,062 2,473,986 Hume Rural Health Alliance 76,040 41,046 Total as per Cash Flow Statement 2,232,102 2,515,032
Cash for Monies Held in Trust (Note 5.2) 1,731,646 2,211,493 Total Cash and Cash Equivalents 3,963,748 4,726,525
72 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 6.3: COMMITMENTS FOR EXPENDITURE Nathalia District Hospital does not have any known commitments for expenditure as at the 30th June 2017 (2016 $Nil). Total Total 2017 2016 $ $ Lease Commitments Payable Finance Lease 29,151 35,636 Total Lease Commitments 29,151 35,636
Finance Leases Commitments in relation to finance leases are payable as follows: Current 14,384 16,198 Non-current 16,226 19,438 Minimum Lease Payments Less Future Finance Charges 1,459 - Total Lease Commitments 29,151 35,636 Total Commitments 29,151 35,636
Total Total 2017 2016 $ $ (b) Commitments Finance Lease Commitments Less than 1 year 13,664 16,198 Longer than 1 year and not later than 5 years 15,487 19,438 Total Lease Commitments 29,151 35,636
Commitments for future expenditure include operating and capital commitments arising from contracts. These commitments are disclosed by way of a note at their nominal value and are inclusive of the GST payable. In addition, where it is considered appropriate and provides additional relevant information to users, the net present values of significant individual projects are stated. These future expenditures cease to be disclosed as commitments once the related liabilities are recognised on the balance sheet.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 73 NOTE 7: RISKS, CONTINGENCIES & VALUATION UNCERTAINTIES The hospital is exposed to risk from its activities and outside factors. In addition, it is often necessary to make judgements and estimates associated with recognition and measurement of items in the financial statements. This section sets out financial instrument specific information, (including exposures to financial risks) as well as those items that are contingent in nature or require a higher level of judgement to be applied, which for the hospital is related mainly to fair value determination.
Structure 7.1 Financial Instruments 7.2 Net Gain/ (Loss) On Disposal of Non-Financial Assets 7.3 Contingent Assets and Contingent Liabilities 7.4 Fair Value Determination
NOTE 7.1: FINANCIAL INSTRUMENTS
Financial risk management objectives and policies Nathalia District Hospital's principal financial instruments comprise of: - cash assets - term deposits - receivables (excluding statutory receivables) - payables (excluding statutory payables) - borrowings (finance leases payables) - accommodation bonds and other trust funds Details of the significant accounting policies and methods adopted, including the criteria for recognition, the basis of measurement and the basis on which income and expenses are recognised, with respect to each class of financial asset, financial liability and equity instrument are disclosed throughout the notes to the financial statements. The Health Service's main financial risks include credit risk, liquidity risk, interest rate risk and foreign currency risk. The Health Service manages these financial risks in accordance with its financial risk management policy. The Health Service uses different methods to measure and manage the different risks to which it is exposed. Primary responsibility for the identification and management of financial risks rests with the Finance and Risk Committee of the Health Service. The main purpose in holding financial instruments is to prudentially manage Nathalia District Hospital's financial risks within the government policy parameters.
74 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (a) Categorisation of Financial Instruments
Contractual Financial Contractual Financial Assets - Loans & Liabilities at Amortised Receivables cost 2017 $ $ Contractual Financial Assets Cash and Cash Equivalents 3,963,748 - Receivables - Trade Debtors and Patient & Resident Fees 255,413 - - Other Receivables 32,484 - Total Financial Assets (i) 4,251,645 -
Financial Liabilities Payables - 280,648 Borrowings - Finance Leases - 29,151 Other Financial Liabilities - Accommodation Bonds - 1,722,681 - Other Funds Held in Trust - 8,966 Total Financial Liabilities - 2,041,446
Contractual Financial Contractual Financial Assets - Loans & Liabilities at Amortised Receivables cost 2016 $ $ Contractual Financial Assets Cash and Cash Equivalents 4,726,525 - Receivables - Trade Debtors and Patient & Resident Fees 120,464 - - Other Receivables 22,953 - Total Financial Assets (i) 4,869,942 -
Financial Liabilities Payables - 415,149 Borrowings - Finance Leases - 35,636 Other Financial Liabilities - Accommodation Bonds - 2,205,148 - Other Funds Held in Trust - 6,345 Total Financial Liabilities (ii) - 2,662,278 (i) The total amount of financial assets disclosed here exclude statutory receivables (ii) the total amount of financial liabilities disclosed here excludes statutory payables (i.e. Taxes payable)
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 75 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (b) Net Holding Gain/(Loss) on Financial Instruments by Category
Total interest income / (expense) Total 2017 $ $ Financial Assets Cash and Cash Equivalents (i) 83,664 83,664 Total Financial Assets 83,664 83,664
Financial Liabilities At Amortised Cost (ii) 12,608 12,608 Total Financial Liabilities 12,608 12,608
2016 Financial Assets Cash and Cash Equivalents (i) 96,896 96,896 Total Financial Assets 96,896 96,896
Financial Liabilities At Amortised Cost (ii) 1,439 1,439 Total Financial Liabilities 1,439 1,439 (i) For cash and cash equivalent, loans and receivables, the net gain or loss is calculated by taking the movement in the fair value of the asset, interest revenue and any impairment recognised in the net result. (ii) For financial liabilities measured at amortised cost, the net gain or loss is the interest expense.
76 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (c) Credit Risk Credit risk arises from the contractual financial assets of the Health Service, which comprise cash and deposits and non- statutory receivables. The Health Service's exposure to credit risk arises from the potential default of a counter party on their contractual obligations resulting in financial loss to the Health Service. Credit risk is measured at fair value and is monitored on a regular basis. Credit risk associated with the Health Service's contractual financial assets is minimal because the main debtor is the Victorian Government. For debtors other than the Government, it is the Health Service's policy to only deal with entities with high credit ratings of a minimum Triple-B rating and to obtain sufficient collateral or credit enhancements, where appropriate. In addition, the Health Service does not engage in hedging for its contractual financial assets and mainly obtains contractual financial assets that are on fixed interest, except for cash assets, which are mainly cash at bank. The Health Service's policy is to only deal with banks with high credit ratings. Provision of impairment for contractual financial assets is recognised when there is objective evidence that the Health Service will not be able to collect a receivable. Objective evidence includes financial difficulties of the debtor, default payments, debts which are more than 60 days overdue, and changes in debtor credit ratings. Except as otherwise detailed in the following table, the carrying amount of contractual financial assets recorded in the financial statements, net of any allowances for losses, represents Nathalia District Hospital's maximum exposure to credit risk without taking account of the value of any collateral obtained.
Credit quality of contractual financial assets that are neither past due nor impaired Financial Government Institutions Agencies (min BBB (AAA Credit Credit rating) rating) Other Total 2017 $ $ $ $ Financial Assets Cash and Cash Equivalents 178,000 3,785,248 500 3,963,748 Receivables - Trade Debtors and Patient & Resident Fees - - 255,413 255,413 - Other Receivables (i) - - 32,484 32,484 Total Financial Assets 178,000 3,785,248 288,397 4,251,645
2016 Financial Assets Cash and Cash Equivalents 178,000 4,548,025 500 4,726,525 Receivables - Trade Debtors and Patient & Resident Fees - - 120,464 120,464 - Other Receivables (i) - - 22,953 22,953 Total Financial Assets 178,000 4,548,025 143,916 4,869,942
(i) The total amounts disclosed here exclude statutory amounts (e.g.. amounts owing from the Victorian Government and GST input tax credit recoverable)
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 77 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) Ageing analysis of Financial Assets as at 30 June Past Due But Not Impaired
Not Past Due 1 - 3 3 Months - Carrying and Not Months 1 Year Amount Impaired 2017 $ $ $ $ Financial Assets Cash and Cash Equivalents 3,963,748 3,963,748 - - Receivables - - Trade Debtors and Patient & Resident Fees 255,413 204,330 38,312 12,771 - Other Receivables (i) 32,484 32,484 - - Total Financial Assets 4,251,645 4,200,562 38,312 12,771
2016 Financial Assets Cash and Cash Equivalents 4,726,525 4,726,525 - - Receivables - Trade Debtors and Patient & Resident Fees 120,464 96,371 18,070 6,023 - Other Receivables (i) 22,953 22,953 - - Total Financial Assets 4,869,942 4,845,849 18,070 6,023
(i) Ageing analysis of financial assets exclude the types of statutory financial assets. Contractual financial assets that are either past due or impaired There are no material financial assets which are individually determined to be impaired. Currently Nathalia District Hospital does not hold any collateral as security nor credit enhancements relating to any of its financial assets. There are no financial assets that have had their terms renegotiated so as to prevent them from being past due or impaired, and they are stated at their carrying amounts as indicated. The ageing analysis table above discloses the ageing only of contractual financial assets that are past due but not impaired.
78 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (d) Liquidity Liquidity risk is the risk that Nathalia District Hospital would be unable to meet its financial obligations as and when they fall due. Nathalia District Hospital operates under the Government's fair payments policy of settling financial obligations within 30 days and in the event of a dispute, making payments within 30 days from the date of resolution. Nathalia District Hospital's maximum exposure to liquidity risk is the carrying amounts of financial liabilities as disclosed in the face of the balance sheet. The Health Service manages its liquidity risk by continuously projecting its forward cash out flow commitments and measures it against projected forward cash inflows and current reserves. The Health Service has received a letter of comfort from the Department of Health and Human Services which states adequate cash flow support will be provided to enable the Health Service to meet its current and future operational obligations. The following table discloses the contractual maturity analysis for Nathalia District Hospital's financial liabilities. For interest rates applicable to each class of liability refer to individual notes to the financial statements. Maturity analysis of Financial Liabilities as at 30 June 1 - 3 3 Months Carrying Nominal Less than Months - 1 Year 1 - 5 Years Amount Amount 1 month 2017 $ $ $ $ $ $ Financial Liabilities (i) At amortised cost Payables 280,648 280,648 280,648 - - - Borrowings - Finance Leases 29,151 29,151 1,139 2,277 10,248 15,487 Other Financial Liabilities - Accommodation Bonds 1,722,681 1,722,681 1,722,681 - - - - Other Funds Held in Trust 8,966 8,966 8,966 - - - Total Financial Liabilities 2,041,446 2,041,446 2,013,434 2,277 10,248 15,487
2016 Financial Liabilities (i) At amortised cost Payables 415,149 415,149 415,149 - - - Borrowings - Finance Leases 35,636 35,636 1,350 2,700 12,148 19,438 Other Financial Liabilities - Accommodation Bonds 2,205,148 2,205,148 2,205,148 - - - - Other Funds Held in Trust 6,345 6,345 6,345 - - - Total Financial Liabilities 2,662,278 2,662,278 2,627,992 2,700 12,148 19,438
(i) Ageing analysis of financial liabilities excludes the types of statutory financial liabilities (i.e. GST Payable)
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 79 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (e) Market Risk Nathalia District Hospital's exposures to market risk are primarily through interest rate risk with only insignificant exposure to foreign currency and other price risks. Objectives, policies and processes used to manage each of these risks are disclosed in the paragraph below. Interest Rate Risk Exposure to interest rate risk might arise primarily through Nathalia District Hospital's interest bearing financial instruments. Minimisation of risk is achieved by mainly undertaking fixed rate or non-interest bearing financial instruments. For financial liabilities, the health service mainly undertake financial liabilities with relatively even maturity profiles. Cash flow interest rate risk is the risk that the future cash flows of a financial instrument will fluctuate because of changes in the market interest rates. The Health Service has minimal exposure to cash flow interest rate risks through its cash and deposits, term deposits and bank overdrafts that are at floating rate. The Health Service manages this risk by mainly undertaking fixed rate or non-interest bearing financial instruments with relatively even maturity profiles, with only insignificant amounts of financial instruments at floating rate. Management has concluded for cash at bank, as financial assets that can be left at floating rate without necessarily exposing the Health Service to significant bad risk, management monitors movement in interest rates on a daily basis. Interest rate exposure of financial assets and liabilities as at 30 June Weighted Average Fixed Variable Non Effective Carrying Interest Interest Interest Interest Amount Rate Rate Bearing 2017 Rate (%) $ $ $ $ Financial Assets Cash and Cash Equivalents 1.94% 3,963,748 2,275,579 1,687,669 500 Receivables (i) - Trade Debtors and Patient & Resident Fees 255,413 - - 255,413 - Other Receivables 32,484 - - 32,484 4,251,645 2,275,579 1,687,669 288,397 Financial Liabilities At amortised cost Payables (i) 280,648 - - 280,648 Borrowings - Finance Leases 3.08% 29,151 29,151 - - Other Financial Liabilities - Accommodation Bonds 1,722,681 - - 1,722,681 - Other Funds Held in Trust 8,966 - - 8,966 2,041,446 29,151 - 2,012,295
80 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (e) Market Risk (continued) 2016 Financial Assets Cash and Cash Equivalents 2.32% 4,726,525 3,219,052 1,506,973 500 Receivables (i) - Trade Debtors and Patient & Resident Fees 120,464 - - 120,464 - Other Receivables 22,953 - - 22,953 4,869,942 3,219,052 3,219,052 1,506,973 143,916 Financial Liabilities At amortised cost Payables (i) 415,149 - - 415,149 Borrowings - Finance Leases 4.10% 35,636 35,636 - - Other Financial Liabilities - Accommodation Bonds 2,205,148 - - 2,205,148 - Other Funds Held in Trust 6,345 - - 6,345 2,662,278 35,636 - 2,626,642
(i) the carrying amount must exclude types of statutory financial assets and liabilities (i.e. GST input tax credit and GST payable)
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 81 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (e) Market Risk (continued) Sensitivity disclosure analysis Taking into account past performance, future expectations, economic forecasts, and management's knowledge and experience of the financial markets, Nathalia District Hospital believes the following movements are 'reasonably possible' over the next 12 months (Base rates are sourced from the Reserve Bank of Australia) - A Shift of +1% and -1% in markets interest rates (AUD) from year-end rates of 1.5% - A parallel shift of +1% and -1% in inflation rate from year-end rates of 2%; The following table discloses the impact on net operating result and equity for each category of financial instrument held by Nathalia District Hospital at year end as presented to key management personnel, if changes in the relevant risk occur.
Interest Rate Risk 2017 -1% `+1% Carrying Amount Profit Equity Profit Equity Financial Assets $ $ $ $ $ Cash & Cash Equivalents 3,963,748 39,632 39,632 (39,632) (39,632) Receivables (i) - Trade Debtors and Patient & Resident Fees 255,413 - - - - - Other Receivables 32,484 - - - -
Financial Liabilities At amortised cost Payables (i) 280,648 - - - - Borrowings - Finance Leases 29,151 292 292 (292) (292) Other Financial Liabilities - Accommodation Bonds 1,722,681 - - - - - Other Funds Held in Trust 8,966 - - - - (2,210,199) 39,924 39,924 (39,924) (39,924) 2016 Financial Assets Cash & Cash Equivalents 4,726,525 47,260 47,260 (47,260) (47,260) Receivables (i) - Trade Debtors and Patient & Resident Fees 120,464 - - - - - Other Receivables 22,953 - - - -
Financial Liabilities At amortised cost Payables (i) 415,149 - - - - Borrowings - Finance Leases 35,636 356 356 (356) (356) Other Financial Liabilities - Accommodation Bonds 2,205,148 - - - - - Other Funds Held in Trust 6,345 - - - - (2,207,663) 47,616 47,616 (47,616) (47,616)
(i) The carrying amount excludes types of statutory financial asserts and liabilities (i.e. GST input tax credit and GST payable)
82 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (f) Fair Value The fair values and net fair values of financial instrument assets and liabilities are determined as follows: • Level 1 - the fair value of financial instrument assets and liabilities with standard terms and conditions and traded in active liquid markets are determined with reference to quoted market prices; • Level 2 - the fair value is determined using inputs other than quoted prices that are observable for the financial asset or liability, either directly or indirectly; and • Level 3 - the fair value is determined in accordance with generally accepted pricing models based on discounted cash flow analysis using unobservable market inputs. The Health Services considers that the carrying amount of financial instrument assets and liabilities recorded in the financial statements to be a fair approximation of their fair values, because of the short-term nature of the financial instruments and the expectation that they will be paid in full. The following table shows that the fair values of most of the contractual financial assets and liabilities are the same as the carrying amounts. Comparison between carrying amount and fair value Carrying Carrying Amount Fair Value Amount Fair Value 2017 2017 2016 2016 Financial Assets $ $ $ $ Cash & Cash Equivalents 3,963,748 3,963,748 4,726,525 4,726,525 Receivables (i) - Trade Debtors and Patient & Resident Fees 255,413 255,413 120,464 120,464 - Other Receivables 32,484 32,484 22,953 22,953 Total Financial Assets 4,251,645 4,251,645 4,869,942 4,869,942
Financial Liabilities At amortised cost Payables (i) 280,648 280,648 415,149 415,149 Borrowings - Finance Leases 29,151 29,151 35,636 35,636 Other Financial Liabilities (i) - Accommodation Bonds 1,722,681 1,722,681 2,205,148 2,205,148 - Other Funds Held in Trust 8,966 8,966 6,345 6,345 Total Financial Liabilities 2,041,445 2,041,445 2,662,278 2,662,278
(i) The carrying amount excludes types of statutory financial assets and liabilities.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 83 NOTE 7.1: FINANCIAL INSTRUMENTS (CONTINUED) (f) Fair Value (continued)
Financial instruments arise out of contractual agreements that give rise to a financial asset of one entity and a financial liability or equity instrument of another entity. Due to the nature of Nathalia District Hospital activities, certain financial assets and financial liabilities arise under statute rather than a contract. Such financial assets and financial liabilities do not meet the definition of financial instruments in AASB 132 Financial Instruments: Presentation. For example, statutory receivables arising from taxes, fines and penalties do not meet the definition of financial instruments as they do not arise under contract. Where relevant, for note disclosure purposes, a distinction is made between those financial assets and financial liabilities that meet the definition of financial instruments in accordance with AASB 132 and those that do not. The following refers to financial instruments unless otherwise stated. Categories of non-derivative financial instruments Receivables Receivables are financial instrument assets with fixed and determinable payments that are not quoted on an active market. These assets are initially recognised at fair value plus any directly attributable transaction costs. Subsequent to initial measurement, loans and receivables are measured at amortised cost using the effective interest method, less any impairment. Receivables category includes cash and deposits (refer to Note 6.2), trade receivables and other receivables, but not statutory receivables. Financial liabilities at amortised cost Financial instrument liabilities are initially recognised on the date they are originated. They are initially measured at fair value plus any directly attributable transaction costs. Subsequent to initial recognition, these financial instruments are measured at amortised cost with any difference between the initial recognised amount and the redemption value being recognised in profit or loss over the period of the interest-bearing liability, using the effective interest rate method. Financial instrument liabilities measured at amortised cost include all of the Health Service’s contractual payables, deposits held and advances received, and interest-bearing arrangements other than those designated at fair value through profit or loss.
84 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 7.2: NET GAIN/ (LOSS) ON DISPOSAL OF NON-FINANCIAL ASSETS
Total Total 2017 2016 Proceeds from Disposals of Non-Financial Assets $ $ Land and Buildings 259,910 - Vehicles - 7,955 Total Proceeds from Disposals of Non-Financial Assets 259,910 7,955
Less: Written Down Value of Non-Financial Assets Disposed Vehicles - 10,114 Land and Buildings 248,184 2,252 Total Written Down Value of Non-Current Assets Disposed (248,184) (12,366) Net Gains/(Loss) on Disposal of Non-Financial Assets 11,726 (4,411)
Disposal of non-financial assets Any gain or loss on the sale of non-financial assets is recognised in the comprehensive operating statement. Impairment of non-financial assets Non-financial assets are assessed annually for indications of impairment. If there is an indication of impairment, the assets concerned are tested as to whether their carrying amount exceeds their possible recoverable amount. Where an asset’s carrying amount exceeds its recoverable amount, the difference is written-off as an expense except to the extent that the write-down can be debited to an asset revaluation surplus amount applicable to that same class of asset. If there is an indication that there has been a reversal in the estimate of an asset’s recoverable amount since the last impairment loss was recognised, the carrying amount shall be increased to its recoverable amount. This reversal of the impairment loss occurs only to the extent that the asset’s carrying amount does not exceed the carrying amount that would have been determined, net of depreciation or amortisation, if no impairment loss had been recognised in prior years. It is deemed that, in the event of the loss or destruction of an asset, the future economic benefits arising from the use of the asset will be replaced unless a specific decision to the contrary has been made. The recoverable amount for most assets is measured at the higher of depreciated replacement cost and fair value less costs of disposal. Recoverable amount for assets held primarily to generate net cash inflows is measured at the higher of the present value of future cash flows expected to be obtained from the asset and fair value less costs of disposal.
NOTE 7.3: CONTINGENT ASSETS AND CONTINGENT LIABILITIES Nathalia District Hospital does not have any known contingent assets or liabilities as at the 30th June 2017 (2016 $Nil). Contingent assets and contingent liabilities are not recognised in the balance sheet, but are disclosed by way of note and, if quantifiable, are measured at nominal value. Contingent assets and contingent liabilities are presented inclusive of GST receivable or payable respectively.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 85 NOTE 7.4: FAIR VALUE DETERMINATION
Expected Likely valuation Significant inputs Asset Class Example of types of assets fair value approach (Level 3 Only) level
Non-specialised land In areas where there is an active Level 2 Market approach N/A market: - vacant land - land not subject to restrictions as to use or sale
Specialised land Land subject to restrictions as to Level 3 Market approach CSO adjustments use and/or sale
Land in areas where there is not an active market
Non-specialised For general/commercial buildings Level 2 Market approach N/A buildings that are just built
Specialised buildings Specialised buildings with limited Level 3 Depreciated Cost per square metre alternative uses and/or substantial replacement cost Useful life customisation e.g. prisons, approach hospitals, and schools
Plant and Equipment Specialised items with limited Level 3 Depreciated Cost per unit alternative uses and/or substantial replacement cost Useful life customisation approach
Vehicles If there is an active resale market Level 2 Market approach N/A available; Depreciated Level 3 replacement cost Cost per unit If there is no active resale market approach Useful life available
86 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8: OTHER DISCLOSURES
This section includes additional material disclosures required by accounting standards or otherwise, for the understanding of this financial report. Structure 8.1 Equity 8.2 Reconciliation of net result for the year to net cash inflow/(outflow) from operating activities 8.3 Operating segments 8.4 Responsible persons disclosures 8.5 Executive officer disclosures 8.6 Related parties 8.7 Payments to other personnel (i.e. contractors with significant management responsibilities) 8.8 Remuneration of auditors 8.9 Ex-gratia expenses 8.10 AASBs issued that are not yet effective 8.11 Events occurring after the balance sheet date 8.12 Controlled entities 8.13 Economic dependency 8.14 Corrections of a prior period error and revision of estimates 8.15 Alternative presentation of comprehensive operating statement 8.16 Glossary of terms and style conventions
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 87 NOTE 8.1: EQUITY
Total Total 2017 2016 $ $ (a) Surpluses Property, Plant and Equipment Revaluation Reserve Balance at the Beginning of the Reporting Period 5,122,513 (5,072,713) Increase in the Value of Land - (49,800) Balance at the end of the reporting period 5,122,513 (5,122,513)
Represented by: Land 4,879,186 4,879,186 Buildings 237,837 237,837 Plant and Equipment 5,490 5,490 Total 5,122,513 5,122,513
General Purpose Surplus Balance at the beginning of the reporting period 1,354,608 1,354,608 Balance at the end of the reporting period 1,354,608 1,354,608
Restricted Specific Purpose Surplus Balance at the beginning of the reporting period 162,466 162,466 Balance at the end of the reporting period 162,466 162,466 Total Surpluses 6,639,587 6,639,587
(b) Contributed Capital Balance at the beginning of the reporting period 11,231,156 11,231,156 Balance at the end of the reporting period 11,231,156 11,231,156
(c) Accumulated (Deficits) Balance at the beginning of the reporting period 1,645,931 2,042,263 Net Result for the Year (1,038,445) (396,332) Balance at the end of the reporting period 607,486 1,645,931 Total Equity at end of financial year 18,478,229 19,516,674
Contributed capital Consistent with Australian Accounting Interpretation 1038 Contributions by Owners Made to Wholly-Owned Public Sector Entities and FRD 119A Contributions by Owners, appropriations for additions to the net asset base have been designated as contributed capital. Other transfers that are in the nature of contributions to or distributions by owners that have been designated as contributed capital are also treated as contributed capital. Transfers of net assets arising from administrative restructurings are treated as contributions by owners. Transfers of net liabilities arising from administrative restructures are to go through the comprehensive operating statement. Property, plant & equipment revaluation surplus The asset revaluation surplus is used to record increments and decrements on the revaluation of non-current physical assets. General purpose surplus These are accumulated funds of surplus revenue over expenditure from fund raising activities and community supoort programs. Specific restricted purpose surplus A specific restricted purpose surplus is established where the Health Service has possession or title to the funds but has no discretion to amend or vary the restriction and/or condition underlying the funds received.
88 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8.2: RECONCILIATION OF NET RESULT FOR THE YEAR TO NET CASH INFLOW/ (OUTFLOW) FROM OPERATING ACTIVITIES
Total Total 2017 2016 $ $ Net Result for the Period (1,038,445) (396,332)
Non-Cash Movements: Depreciation & Amortisation 773,982 769,332
Movements Included in Investing and Financing Activities Net (Gain)/Loss of Disposal of Non-Financial Physical Assets (11,727) 4,411
Movements in Asset and Liabilities; Change in Operating Assets and Liabilities (Increase)/Decrease In Receivables (210,399) 253,064 (Increase)/Decrease In Prepayments 6,640 19,341 Increase/(Decrease) In Payables (112,433) 128,280 Increase/(Decrease) In Provisions 143,014 (86,021) Net Cash Inflow/Outflow from Operating Activities (449,368) 692,075
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 89 NOTE 8.3: OPERATING SEGMENTS Residential Aged Care Services All Other Services Total 2017 2016 2017 2016 2017 2016 $ $ $ $ $ $ REVENUE External Revenue 2,382,762 2,991,751 3,617,939 3,231,987 6,000,701 6,223,738 External Expenses (1,982,884) (1,822,546) (5,186,353) (4,920,908) (7,169,237) (6,743,454) Intersegment Expenses (1,214,252) (1,214,707) 1,214,252 1,214,707 - - Net Result From Ordinary (814,374) (45,502) (354,162) (474,214) (1,168,536) (519,716) Activities
Interest Income 6,230 4,121 83,664 96,896 89,894 101,017 Other Economic Flows - - 40,197 22,367 40,197 22,367 Net Result for Year (808,144) (41,381) (230,301) (354,951) (1,038,445) (396,332)
OTHER INFORMATION Assets 65,754 38,484 21,827,669 23,349,134 21,893,422 23,387,618 Liabilities (1,380) (5,656) (3,413,814) (3,865,287) (3,415,193) (3,870,943)
The major services from which the above segments derive revenue are: Business Segments Services Residential Aged Care Services (RAC) Provider of residential aged care beds Other HSA & H&CI Services - Acute and Community Services
Pricing between inter-segments is at cost
Geographical Segment Nathalia District Hospital operates predominantly in Nathalia, Victoria. More than 90% of revenue, net surplus from ordinary activities and segment assets relate to operations in Nathalia, Victoria.
90 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8.4: RESPONSIBLE PERSONS DISCLOSURES In accordance with the Ministerial Directions issued by the Minister of Finance under the Financial Management Act 1994, the following disclosures are made regarding responsible persons for the reporting period.
Period Responsible Ministers: The Honourable Jill Hennessy, Minister for Health, Minister for Ambulance Services 01-07-16 30-06-17 The Honourable Martin Foley, Minister for Housing, Disability and Ageing, 01-07-16 30-06-17 Minister for Mental Health
Governing Boards Ms S. Logie 01-07-16 30-06-17 Mr D. McKenzie 01-07-16 30-06-17 Mr D. Vaughan 01-07-16 30-06-17 Ms D. Baxter 01-07-16 30-06-17 Ms K. Rappell 01-07-16 30-06-17 Mr C. McCallum 01-07-16 30-06-17 Mr P. Limbrick 01-07-16 30-06-17 Ms M. Hughes 06-09-16 30-06-17
Accountable Officers Ms F. Brew 01-07-16 12-09-16 Mr M. Alexander 12-09-16 31-01-17 Mr T. Saunders 01-02-17 30-06-17
Remuneration No Governing Board members received remuneration in the 2016/2017 financial year (2015/16: $Nil). Refer to Note 8.5 for Remuneration of Executives Officers and Note 8.6 for Related Party Transactions.
NOTE 8.5: EXECUTIVE OFFICER DISCLOSURES Executive Officers' Remuneration
Remuneration of executives The Accountable Officer and other key manangment personnel are employed by Goulburn Valley Health and information to remuneration is disclosed in the financial statements of Goulburn Valley Health. During the year Nathalia District Hospital paid $180,000 (2016: $97,008) to Goulburn Valley Health in relation to service provided by the CEO and other key manangment personnel.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 91 NOTE 8.6: RELATED PARTIES The hospital is a wholly owned and controlled entity of the State of Victoria. Related parties of the hospital include: • all key management personnel and their close family members; • all cabinet ministers and their close family members; and • all hospitals and public sector entities that are controlled and consolidated into the whole of state consolidated financial statements. All related party transactions have been entered into on an arm’s length basis. Key management personnel (KMP) of the hospital include the Portfolio Ministers and Cabinet Ministers and KMP as determined by the hospital. The compensation detailed below excludes the salaries and benefits the Portfolio Ministers receive. The Minister’s remuneration and allowances is set by the Parliamentary Salaries and Superannuation Act 1968, and is reported within the Department of Parliamentary Services’ Financial Report. Significant transactions with government-related entities Nathalia District Hospital received funding from the Department of Health and Human Services of $2,487,427. As explained in Note 8.5, Nathalia District Hospital contract management and other services to Goulburn Valley Health, including the CEO. During the year, the net transactions between Nathalia District Hospital and Goulburn Valley Health totalled $416,879, relating to the executive services provided by Goulburn Valley Health and the purchase of goods and services. All transaction are on an arms length basis under normal terms and conditions as per the agreement between Nathalia District Hospital and Goulburn Valley Health.
NOTE 8.7: PAYMENTS TO OTHER PERSONNEL (I.E. CONTRACTORS WITH SIGNIFICANT MANAGEMENT RESPONSIBILITIES) In accordance with FRD 21C Nathalia District Hospital has made no payments to other personnel in the 2016/2017 financial year. Refer to note 8.5 for tranactions with Goulburn Valley Health whom, are deemed to have significant manangement responsibilities.
NOTE 8.8: REMUNERATION OF AUDITORS
Total Total 2017 2016 $ $ Victorian Auditor-General's Office Audit of financial statements 17,590 12,500 Other Providers Internal Audit Services 834 19,663 Total 18,424 32,163
NOTE 8.9: EX-GRATIA EXPENSES In accordance with FRD 11A Nathalia District Hospital has made no ex-gratia payments in the 2016/2017 financial year.
92 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8.10: AASBS ISSUED THAT ARE NOT YET EFFECTIVE Certain new Australian accounting standards have been published that are not mandatory for the 30 June 2017 reporting period. DTF assesses the impact of all these new standards and advises the Health Service of their applicability and early adoption where applicable. As at 30 June 2017, the following standards and interpretations had been issued by the AASB but were not yet effective. They become effective for the first financial statements for reporting periods commencing after the stated operative dates as detailed in the table below. Nathalia District Hospital has not and does not intend to adopt these standards early. Applicable for annual Standard/ reporting periods Interpretation Summary beginning or ending on Impact on financial statements
AASB 9 Financial The key changes include the 1 Jan 2018 The assessment has identified that Instruments simplified requirements for the the amendments are likely to result classification and measurement in earlier recognition of impairment of financial assets, a new hedging losses and at more regular intervals. accounting model and a revised While there will be no significant impairment loss model to impact arising from AASB 9, there recognise impairment losses will be a change to the way financial earlier, as opposed to the instruments are disclosed. current approach that recognises impairment only when incurred.
AASB 2010- The requirements for classifying 1 Jan 2018 The assessment has identified 7 Amendments and measuring financial liabilities that the financial impact of to Australian were added to AASB 9. The available for sale (AFS) assets will Accounting existing requirements for the now be reported through other Standards arising classification of financial liabilities comprehensive income (OCI) and from AASB 9 and the ability to use the fair no longer recycled to the profit and (December 2010) value option have been retained. loss. However, where the fair value Changes in own credit risk in option is used for financial respect of liabilities designated at liabilities the change in fair value is fair value through profit and loss accounted for as follows: will now be presented within other comprehensive income (OCI). The changes attributable Hedge accounting will be more to changes in credit risk are closely aligned with common risk presented in other comprehensive management practices making it income (OCI). easier to have an effective hedge. The remaining change is presented For entities with significant lending in profit or loss. activities, an overhaul of related systems and processes may be If this approach creates or needed. enlarges an accounting mismatch in the profit or loss, the effect of the changes in credit risk is also presented in profit or loss."
AASB 2014-1 Amends various AASs to reflect 1 Jan 2018 This amending standard will defer Amendments the AASB’s decision to defer the the application period of AASB 9 to Australian mandatory application date of to the 2018-19 reporting period Accounting AASB 9 to annual reporting in accordance with the transition Standards [Part periods beginning on or after 1 requirements. E Financial January 2018 as a consequence Instruments] of Chapter 6 Hedge Accounting, and to amend reduced disclosure requirements.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 93 NOTE 8.10: AASBS ISSUED THAT ARE NOT YET EFFECTIVE (CONTINUED)
Applicable for annual reporting Standard/ periods beginning Impact on financial Interpretation Summary or ending on statements
AASB 2014-7 Amends various AASs to incorporate the 1 Jan 2018 The assessment has indicated that Amendments consequential amendments arising from the there will be no significant impact to Australian issuance of AASB 9 for the public sector. Accounting Standards arising from AASB 9
AASB 15 The core principle of AASB 15 requires 1 Jan 2018 The changes in revenue recognition Revenue from an entity to recognise revenue when the requirements in AASB 15 may Contracts with entity satisfies a performance obligation by result in changes to the timing Customers transferring a promised good or service to a and amount of revenue recorded customer. in the financial statements. The Standard will also require additional disclosures on service revenue and contract modifications.
AASB 2014-5 Amends the measurement of trade receivables 1 Jan 2017, except The assessment has indicated that Amendments and the recognition of dividends. amendments to there will be no significant impact to Australian Trade receivables, that do not have a significant AASB 9 (Dec 2009) for the public sector. Accounting financing component, are to be measured at and AASB 9 (Dec Standards arising their transaction price, at initial recognition. 2010) apply 1 Jan from AASB 15 2018.
AASB 2015-8 This standard defers the mandatory effective 1 Jan 2018 This amending standard will defer Amendments date of AASB 15 from 1 January 2017 to 1 the application period of AASB 15 to Australian January 2018. for for-profit entities to the 2018- Accounting 19 reporting period in accordance Standards – with the transition requirements. Effective Date of AASB 15
AASB 2016-3 This Standard amends AASB 15 to clarify 1 Jan 2018 The assessment has indicated that Amendments requirements on identifying performance there will be no significant impact to Australian obligations, principal versus agent for the public sector, other than Accounting considerations and the timing of recognising the impact identified for AASB 15 Standards – revenue from granting a licence. above. Clarifications to The amendments require: AASB 15 a promise to transfer to a customer a good or service that is ‘distinct’ to be recognised as a separate performance obligation; for items purchased online, the entity is a principal if it obtains control of the good or service prior to transferring to the customer; and for licences identified as being distinct from other goods or services in a contract, entities need to determine whether the licence transfers to the customer over time (right to use) or at a point in time (right to access).
94 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8.10: AASBS ISSUED THAT ARE NOT YET EFFECTIVE (CONTINUED)
Applicable for annual Standard/ Summary reporting periods Impact on financial statements Interpretation beginning or ending on
AASB 2016-7 This standard defers the 1 Jan 2019 This amending standard will defer Amendments mandatory effective date of AASB the application period of AASB 15 to Australian 15 for not-for-profit entities from for not-for-profit entities to the Accounting 1 January 2018 to 1 January 2019. 2019-20 reporting period. Standarwds – Deferral of AASB 15 for Not-for-Profit Entities
AASB 2016-8 This Standard amends AASB 9 and 1 Jan 2019 The assessment has indicated that Amendments AASB 15 to include requirements there will be no significant impact to Australian and implementation guidance to for the public sector, other than the Accounting assist not-for-profit entities in impacts identified for AASB 9 and Standards – applying the respective standards AASB 15 above. Australian to particular transactions and Implementation events. Guidance for Not- for-Profit Entities
AASB 16 Leases The key changes introduced by 1 Jan 2019 The assessment has indicated that AASB 16 include the recognition of as most operating leases will come most operating leases (which are on balance sheet, recognition of current not recognised) on balance the right-of-use assets and lease sheet. liabilities will cause net debt to increase. Rather than expensing the lease payments, depreciation of right- of-use assets and interest on lease liabilities will be recognised in the income statement with marginal impact on the operating surplus. No change for lessors.
AASB 2016-4 The standard amends AASB 136 1 Jan 2017, except The assessment has indicated that Amendments Impairment of Assets to remove amendments to AASB 9 there is minimal impact. Given the to Australian references to using depreciated (Dec 2009) and AASB 9 specialised nature and restrictions Accounting replacement cost (DRC) as a (Dec 2010) apply 1 Jan of public sector assets, the existing Standards – measure of value in use for not- 2018. use is presumed to be the highest Recoverable for-profit entities. and best use (HBU), hence current Amount of Non- replacement cost under AASB 13 Cash-Generating Fair Value Measurement is the same Specialised Assets as the depreciated replacement cost of Not-for-Profit concept under AASB 136. Entities
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 95 NOTE 8.10: AASBS ISSUED THAT ARE NOT YET EFFECTIVE (CONTINUED)
Applicable for annual Standard/ reporting periods Interpretation Summary beginning or ending on Impact on financial statements
AASB 1058 Income This Standard will replace AASB 1 Jan 2019 The assessment has indicated of Not-for-Profit 1004 Contributions and establishes that revenue from capital grants Entities principles for transactions that are that are provided under an not within the scope of AASB 15, enforceable agreement that have where the consideration to acquire sufficiently specific obligations, will an asset is significantly less than now be deferred and recognised fair value to enable not-for-profit as performance obligations are entities to further their objectives. satisfied. As a result, the timing recognition of revenue will change.
Current reporting period The following accounting pronouncements effective from the 2016-17 reporting period are considered to have insignificant impacts on public sector reporting: AASB 1056 Superannuation Entities AASB 1057 Application of Australian Accounting Standards AASB 2014‑1 Amendments to Australian Accounting Standards [Part D – Consequential Amendments arising from AASB 14 Regulatory Deferral Accounts only] AASB 2014‑3 Amendments to Australian Accounting Standards – Accounting for Acquisitions of Interests in Joint Operations [AASB 1 & AASB 11] AASB 2014‑6 Amendments to Australian Accounting Standards – Agriculture: Bearer Plants [AASB 101, AASB 116, AASB 117, AASB 123, AASB 136, AASB 140 & AASB 141] AASB 2015-2 Amendments to Australian Accounting Standards – Disclosure Initiative: Amendments to AASB 101 [AASB 7, AASB 101, AASB 134 & AASB 1049] AASB 2015‑5 Amendments to Australian Accounting Standards – Investment Entities: Applying the Consolidation Exception [AASB 10, AASB 12, AASB 128] AASB 2015‑9 Amendments to Australian Accounting Standards – Scope and Application Paragraphs [AASB 8, AASB 133 & AASB 1057] AASB 2015‑10 Amendments to Australian Accounting Standards – Effective Date of Amendments to AASB 10 and AASB 128 AASB 2016-1 Amendments to Australian Accounting Standards – Recognition of Deferred Tax Assets for Unrealised Losses [AASB 112] AASB 2016-2 Amendments to Australian Accounting Standards – Disclosure Initiative: Amendments to AASB 107
NOTE 8.11: EVENTS OCCURRING AFTER THE BALANCE SHEET DATE No matters or circumstances have arisen since the end of the financial year which significantly affect or may significantly affect the operations of the Nathalia District Hospital the results of its operations or its state of affairs in future years.
NOTE 8.12: ECONOMIC DEPENDENCY The financial performance and position of Nathalia District Hospital has declined since the prior year, with the health service reporting a deficit net result before capital and specific items of $424,926 (2016: $127,616 deficit). As a result of the financial performance and position, Nathalia District Hospital has obtained a letter of support from the State Government and in particular, the Department of Health and Human Services (DHHS), confirming that the department will continue to provide Nathalia District Hospital adequate cash flow to meet its current and future obligations up to 30th September 2018. On that basis, the financial statements have been prepared on a going concern basis.
96 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 NOTE 8.13: ALTERNATIVE PRESENTATION OF COMPREHENSIVE OPERATING STATEMENT
Total Total 2017 2016 Note $ $ Grants Operating 2.1 3,994,127 3,804,481 Capital 2.1 22,500 454,205 Interest 2.1 83,664 96,896 Sales of Goods and Services 2.1 1,405,373 1,348,384 Other Income 2.1 472,836 617,791 Other Capital Income 112,097 2,998 Revenue from Transactions 6,090,596 6,324,755
Employee Expenses 3.1 (4,353,207) (3,923,101) Operating Expenses Supplies and Consumables 3.1 (303,676) (253,978) Non Salary Labour Costs 3.1 (602,964) (586,706) Other 3.1 (1,121,079) (1,141,576) Non-Operating Expenses Specific Expenses 3.1 (2,017) - Finance Costs - Other 3.1 (12,608) (1,439) HRHA Share Adjustment 294 - Expenditure for Capital Purpose 3.1 - (67,321) Depreciation and Amortisation 4.3 (773,982) (769,332) Expenses from Transactions (7,169,238) (6,743,453) Net Result from Transactions (1,078,642) (418,698)
Other Economic Flows Included in Net Result Other Gains/(Losses) From Other Economic Flows - LSL Revaluation 40,197 22,367 Total Other Economic Flows Included in Net Result 40,197 22,367 NET RESULT FOR THE YEAR (1,038,445) (396,332)
Other Comprehensive Income Items that will not be Reclassified to Net Result Changes in Physical Asset Revaluation Surplus - 49,800 Total Other Comprehensive Income - 49,800 Comprehensive Result (1,038,445) (346,532)
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 97 NOTE 8.14: GLOSSARY OF TERMS AND STYLE CONVENTIONS
Actuarial gains or losses on superannuation defined benefit plans Actuarial gains or losses are changes in the present value of the superannuation defined benefit liability resulting from (a) experience adjustments (the effects of differences between the previous actuarial assumptions and what has actually occurred); and (b) the effects of changes in actuarial assumptions.
Amortisation Amortisation is the expense which results from the consumption, extraction or use over time of a non-produced physical or intangible asset.
Associates Associates are all entities over which an entity has significant influence but not control, generally accompanying a shareholding and voting rights of between 20 per cent and 50 per cent.
Comprehensive result The net result of all items of income and expense recognised for the period. It is the aggregate of operating result and other comprehensive income.
Commitments Commitments include those operating, capital and other outsourcing commitments arising from non-cancellable contractual or statutory sources.
Current grants Amounts payable or receivable for current purposes for which no economic benefits of equal value are receivable or payable in return.
Depreciation Depreciation is an expense that arises from the consumption through wear or time of a produced physical or intangible asset. This expense reduces the ‘net result for the year’.
Effective interest method The effective interest method is used to calculate the amortised cost of a financial asset or liability and of allocating interest income over the relevant period. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial instrument, or, where appropriate, a shorter period.
Employee benefits expenses Employee benefits expenses include all costs related to employment including wages and salaries, fringe benefits tax, leave entitlements, redundancy payments, defined benefits superannuation plans, and defined contribution superannuation plans.
Ex gratia expenses Ex-gratia expenses mean the voluntary payment of money or other non-monetary benefit (e.g. a write off) that is not made either to acquire goods, services or other benefits for the entity or to meet a legal liability, or to settle or resolve a possible legal liability, or claim against the entity.
98 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Financial asset A financial asset is any asset that is: (a) cash; (b) an equity instrument of another entity; (c) a contractual or statutory right: • to receive cash or another financial asset from another entity; or • to exchange financial assets or financial liabilities with another entity under conditions that are potentially favourable to the entity; or (d) a contract that will or may be settled in the entity’s own equity instruments and is: • a non-derivative for which the entity is or may be obliged to receive a variable number of the entity’s own equity instruments; or • a derivative that will or may be settled other than by the exchange of a fixed amount of cash or another financial asset for a fixed number of the entity’s own equity instruments
Financial instrument A financial instrument is any contract that gives rise to a financial asset of one entity and a financial liability or equity instrument of another entity. Financial assets or liabilities that are not contractual (such as statutory receivables or payables that arise as a result of statutory requirements imposed by governments) are not financial instruments.
Financial liability A financial liability is any liability that is: (a) A contractual obligation: • to deliver cash or another financial asset to another entity; or • to exchange financial assets or financial liabilities with another entity under conditions that are potentially unfavourable to the entity; or (b) A contract that will or may be settled in the entity’s own equity instruments and is: • a non-derivative for which the entity is or may be obliged to deliver a variable number of the entity’s own equity instruments; or • a derivative that will or may be settled other than by the exchange of a fixed amount of cash or another financial asset for a fixed number of the entity’s own equity instruments. For this purpose the entity’s own equity instruments do not include instruments that are themselves contracts for the future receipt or delivery of the entity’s own equity instruments.
Financial statements A complete set of financial statements comprises: a. Balance sheet as at the end of the period; b. Comprehensive operating statement for the period; c. A statement of changes in equity for the period; d. Cash flow statement for the period; e. Notes, comprising a summary of significant accounting policies and other explanatory information; f. Comparative information in respect of the preceding period as specified in paragraph 38 of AASB 101 Presentation of Financial Statements; and g. A statement of financial position at the beginning of the preceding period when an entity applies an accounting policy retrospectively or makes a retrospective restatement of items in its financial statements, or when it reclassifies items in its financial statements in accordance with paragraphs 41 of AASB 101.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 99 Grants and other transfers Transactions in which one unit provides goods, services, assets (or extinguishes a liability) or labour to another unit without receiving approximately equal value in return. Grants can either be operating or capital in nature. While grants to governments may result in the provision of some goods or services to the transferor, they do not give the transferor a claim to receive directly benefits of approximately equal value. For this reason, grants are referred to by the AASB as involuntary transfers and are termed non-reciprocal transfers. Receipt and sacrifice of approximately equal value may occur, but only by coincidence. For example, governments are not obliged to provide commensurate benefits, in the form of goods or services, to particular taxpayers in return for their taxes. Grants can be paid as general purpose grants which refer to grants that are not subject to conditions regarding their use. Alternatively, they may be paid as specific purpose grants which are paid for a particular purpose and/or have conditions attached regarding their use.
General government sector The general government sector comprises all government departments, offices and other bodies engaged in providing services free of charge or at prices significantly below their cost of production. General government services include those which are mainly non-market in nature, those which are largely for collective consumption by the community and those which involve the transfer or redistribution of income. These services are financed mainly through taxes, or other compulsory levies and user charges.
Intangible produced assets Refer to produced assets in this glossary.
Intangible non-produced assets Refer to non-produced asset in this glossary.
Interest expense Costs incurred in connection with the borrowing of funds includes interest on bank overdrafts and short-term and long- term liabilities, amortisation of discounts or premiums relating to liabilities, interest component of finance leases repayments, and the increase in financial liabilities and non-employee provisions due to the unwinding of discounts to reflect the passage of time.
Interest income Interest income includes unwinding over time of discounts on financial assets and interest received on bank term deposits and other investments.
Investment properties Investment properties represent properties held to earn rentals or for capital appreciation or both. Investment properties exclude properties held to meet service delivery objectives of the State of Victoria.
Joint Arrangements A joint arrangement is an arrangement of which two or more parties have joint control. A joint arrangement has the following characteristics: (a) The parties are bound by a contractual arrangement. (b) The contractual arrangement gives two or more of those parties joint control of the arrangement A joint arrangement is either a joint operation or a joint venture.
Liabilities Liabilities refers to interest-bearing liabilities mainly raised from public liabilities raised through the Treasury Corporation of Victoria, finance leases and other interest-bearing arrangements. Liabilities also include non-interest-bearing advances from government that are acquired for policy purposes.
100 N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 Net acquisition of non-financial assets (from transactions) Purchases (and other acquisitions) of non-financial assets less sales (or disposals) of non-financial assets less depreciation plus changes in inventories and other movements in non-financial assets. It includes only those increases or decreases in non- financial assets resulting from transactions and therefore excludes write-offs, impairment write-downs and revaluations.
Net result Net result is a measure of financial performance of the operations for the period. It is the net result of items of income, gains and expenses (including losses) recognised for the period, excluding those that are classified as ‘other comprehensive income’. Net result from transactions/net operating balance Net result from transactions or net operating balance is a key fiscal aggregate and is income from transactions minus expenses from transactions. It is a summary measure of the ongoing sustainability of operations. It excludes gains and losses resulting from changes in price levels and other changes in the volume of assets.
Net worth Assets less liabilities, which is an economic measure of wealth.
Non-financial assets Non-financial assets are all assets that are not ‘financial assets’. It includes inventories, land, buildings, infrastructure, road networks, land under roads, plant and equipment, investment properties, cultural and heritage assets, intangible and biological assets.
Non-produced assets Non-produced assets are assets needed for production that have not themselves been produced. They include land, subsoil assets, and certain intangible assets. Non-produced intangibles are intangible assets needed for production that have not themselves been produced. They include constructs of society such as patents.
Non-profit institution A legal or social entity that is created for the purpose of producing or distributing goods and services but is not permitted to be a source of income, profit or other financial gain for the units that establish, control or finance it.
Payables Includes short and long term trade debt and accounts payable, grants, taxes and interest payable.
Produced assets Produced assets include buildings, plant and equipment, inventories, cultivated assets and certain intangible assets. Intangible produced assets may include computer software, motion picture films, and research and development costs (which does not include the start-up costs associated with capital projects).
Public financial corporation sector Public financial corporations (PFCs) are bodies primarily engaged in the provision of financial intermediation services or auxiliary financial services. They are able to incur financial liabilities on their own account (e.g. taking deposits, issuing securities or providing insurance services). Estimates are not published for the public financial corporation sector.
Public non-financial corporation sector The public non-financial corporation (PNFC) sector comprises bodies mainly engaged in the production of goods and services (of a non-financial nature) for sale in the market place at prices that aim to recover most of the costs involved (e.g. water and port authorities). In general, PNFCs are legally distinguishable from the governments which own them.
Receivables Includes amounts owing from government through appropriation receivable, short and long term trade credit and accounts receivable, accrued investment income, grants, taxes and interest receivable.
N a t h a l i a D i s t r i c t H o s p i t a l - A nn u a l R e p o r t 2 0 1 6 / 1 7 101 Sales of goods and services Refers to income from the direct provision of goods and services and includes fees and charges for services rendered, sales of goods and services, fees from regulatory services and work done as an agent for private enterprises. It also includes rental income under operating leases and on produced assets such as buildings and entertainment, but excludes rent income from the use of non-produced assets such as land. User charges includes sale of goods and services income.
Supplies and services Supplies and services generally represent cost of goods sold and the day-to-day running costs, including maintenance costs, incurred in the normal operations of the Department.
Taxation income Taxation income represents income received from the State’s taxpayers and includes: • payroll tax; land tax; duties levied principally on conveyances and land transfers; • gambling taxes levied mainly on private lotteries, electronic gaming machines, casino operations and racing; • insurance duty relating to compulsory third party, life and non-life policies; • insurance company contributions to fire brigades; • motor vehicle taxes, including registration fees and duty on registrations and transfers; • levies (including the environmental levy) on statutory corporations in other sectors of government; and • other taxes, including landfill levies, license and concession fees.
Transactions Revised Transactions are those economic flows that are considered to arise as a result of policy decisions, usually an interaction between two entities by mutual agreement. They also include flows in an entity such as depreciation where the owner is simultaneously acting as the owner of the depreciating asset and as the consumer of the service provided by the asset. Taxation is regarded as mutually agreed interactions between the government and taxpayers. Transactions can be in kind (e.g. assets provided/given free of charge or for nominal consideration) or where the final consideration is cash.
Style conventions Figures in the tables and in the text have been rounded. Discrepancies in tables between totals and sums of components reflect rounding. Percentage variations in all tables are based on the underlying unrounded amounts. The notation used in the tables is as follows: zero, or rounded to zero (xxx.x) negative numbers 201x year period 201x-1x year period
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104 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Nathalia District Hospital VICTORIAN QUALITY ACCOUNT
2016/17
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 105 Nathalia District Hospital VICTORIAN QUALITY ACCOUNT 2016/17
his report will undertake to give you some idea of The audit identified further areas in which the service what a patient might experience when they seek could improve its performance. An Aboriginal Cultural Tmedical advice or treatment at Nathalia District Competence Action Plan was developed in partnership with Hospital. members of the Aboriginal community, addressing the eight standards in the framework. This plan was endorsed by the In a population of just over 3000, a typical consumer of our Hospital Board of Management and in the future will be services is over 60 or under 15 years of age. People over the made publically available via the hospital website. age of 65 make up 24.5% of our community, compared to the Australian average of 15.0%. 17.5% of children were under the age of 15 compared to the Australian average of 18.8%. Lesbian, Gay, Bisexual, Transgender and Intersex Communities. Access to Our (LGBTI) Nathalia District Health values diversity and supports equality, fairness and decency for LGBTI members of the Service community, as inclusive practice is an essential part of the Aboriginal Health delivery of health and human services. In 2016/17, Nathalia District Hospital with the assistance In the 2016 census 3.13% of our community has identified of the Victorian Government Rainbow eQuality guide as being Aboriginal and/or Torres Strait Islander. With this in adopted a number of inclusive practices to become more mind, Nathalia District Hospital has taken steps to improve responsive to the health and wellbeing needs of the (LGBTI) the health of the local Aboriginal community by increasing community. LGBTI inclusive practices were included into our cultural responsiveness to Aboriginal staff, patients and organisational procedures, policies and protocols (where families. relevant), including position descriptions polices and service All senior staff within the organisation completed cultural intake forms. Staff completed LGBTI inclusive practice competence training in 2016/17. The organisation reviewed education, LGBTI information factsheets and resources were its performance regarding Aboriginal cultural competency, disseminated throughout the organisation. LGBTI symbols completing the Koolin Balit Aboriginal Health Cultural are displayed in the urgent care centre, ward and medical Competence Audit in partnership with members of the clinic to indicate an inclusive approach and safe environment Aboriginal community. for members of the LGBTI community.
106 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Child Safe Standards Nathalia Medical Clinic A typical consumer of the Nathalia District Health service At Nathalia Medical Clinic staff work together to ensure could be under the age of 15 years, as approximately 17.5% that patients will receive prompt, high quality health care, of our community falls within this age demographic. As with a strong focus on health promotion through health a result, the organisation has taken a number of steps to checks, recalls and disease prevention information. If a promote the safety of children both within the organisation patient presents with an acute need, he/she will be seen by and within the community. Child safe standards were a GP at the soonest appointment available and any medical introduced which is a set of compulsory minimum standards emergency that may arise will be managed. The service is for organisations who provide services for children, to help proactive and contacts patients on a regular basis to assist in protect children from abuse. managing a chronic disease. As a part of these standards the organisation has; There are currently three doctors working in the clinic. In March 2017 Dr John Drenen celebrated 25 years of service • Reviewed and updated existing child safe policies and at Nathalia District Hospital and Medical Clinic. Dr Mogeke processes for responding to and reporting suspected Nyorora has now been with the clinic for over five years and child abuse. Dr Hamed Shafaie is into his second year. After completing • Developed a statement of commitment to child his first year through the MCCC General Practice Training safety and raised community awareness by promoting program, Dr Abdul Shaik resigned from his position as children’s rights and empowerment within our registrar GP in February to take up a position at another community. clinic as part of the requirements of the program. • Updated position descriptions to build responsibility for embedding an organisational culture of safety for all staff of the organisation. • Reviewed recruitment and selection processes, to reduce the risk of child abuse by new and existing personnel. • Delivered education to all staff of the organisation on protecting vulnerable children, and; • Updated the code of conduct to establish clear expectations for appropriate behaviour with children. When a patient arrives at Nathalia District Hospital, the first point of contact may be the Nathalia Medical Clinic or the Urgent Care Centre.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 107 Urgent Care for Urgent Care One evening I presented to the Nathalia Hospital with one In an urgent situation, patients may present to our Urgent of my young children who was sick. The front doors of the Care Centre. The Centre provides urgent care twenty-four building opened and I proceeded into the building as I was hours per day, seven days per week. Patients presenting at wishing to see a Nurse or Doctor in the Urgent Care facility. the Urgent Care Centre are assessed by nursing staff from Once inside the building I headed towards the Urgent Care the ward and are triaged according to the severity of their Centre but found there was no way to alert medical staff of presenting problem, with the most urgent cases always my arrival or my need for care. At this time of the evening attended to first. The nurse will then contact the doctor on the medical clinic reception desk was closed and in my call for advice and management for ongoing cases. panicked state with a sick child I was unsure of what to do. If a patient’s condition requires more specialist investigation So what changes did we make? or care than can be provided at Nathalia District Hospital, a transfer to Goulburn Valley Health in Shepparton is arranged. After consultation with the young mum and our Consumer Advisory Committee, a call bell system In 2016 – 17, 13% of presentations to Urgent Care Centre linked to the nurse in-charge phone and signage have were triaged as a Triage Category 1 or 2, requiring urgent been installed in the foyer of the facility, to better treatment. These patients were either admitted to NDH or guide those presenting to Urgent Care after hours, transferred to GV Health in Shepparton. and alert staff to the presence of those presenting to urgent care.
Percentage of UCC Presentation Admitted 2016-17
35 To NDH Transfer 30
25
20
15
10
5
0 JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN
108 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Person Centred Care Approach Person-centred care is about treating a person receiving Give Us Great healthcare with dignity and respect and involving them in all decisions about their health. A key part of person-centred Feedback care is getting the patient to become involved in their healthcare. This means choosing to be included in all decision Victorian Health Experience Survey making, healthcare planning and goal setting. Doing this can actually improve healthcare. For person centred care The health service uses the Victorian Health Experience to work, the patient must understand what the healthcare Surveys to collect feedback from consumers. Each month, professional says. eligible participants are randomly selected to receive a questionnaire. Survey participation is by invitation only. If the patient prefers a language other than English, the Nathalia District Health then uses the results to identify areas patient’s care may include using a professional interpreter. that may require improvement. As a small rural health service, NDH has an interpreter service available to consumers if this the number of surveys received back are small, and results is required. In 2016-17, no interpreter services were required. are not collated unless there are 40 or more returns. This is So how else can our patients be involved in the care provided? so the responses from individual patients remain anonymous. Nursing staff inform the patient about the survey during Bedside Handovers their stay in hospital. On discharge, the patient is reminded that they will receive an invitation in the mail in the next At an individual level, bedside handovers offer patients the few weeks. A follow up phone call from our reception staff opportunity to tell staff what is and is not working about encourages the patient to complete the survey. These actions their care and treatment. It allows the nurses to talk to the have resulted in NDH getting great feedback with a return patient about planning their discharge to ensure they are rate of 69% safe once back at home. Bedside handovers occur at 2.30pm every day. The overall patient experience rating was 98%, with 62% of the scores rating higher than the peer group average.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 109 Where NDH Is doing well:
Score Issue
NDH Score100% Were hand wash gels available for patients and visitors to use? Peer Group 99% Our Score100% Overall, how would you rate the care and treatment you received from the nurses? Peer Group 98% NDH Score100% Before any procedure, did staff explain what would be done in a way that you could understand? Peer Group 94% Our Score100% How would you rate the politeness and courtesy of admission staff? Peer Group 99%
Where NDH needs to improve:
Score Issue Action Taken
NDH Score 61% If you had any worries or fears about your Reviewed the bedside handover processes condition, did the health care professional to ensure the patient is given the option for Peer group 82% discuss this with you? further consultation.
NDH Score 83% When you left hospital, did doctors and nurses Reviewed the current discharge plan being sent give you sufficient information about managing home with the patient to ensure it provides Peer Group 88% your health and care at home? sufficient information. At care plan sign off each morning, ask the NDH Score 76% Were you involved as much as you wanted to be patient if any further assistance or information in decisions about your care and treatment? Peer Group 83% is required.
110 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Join the NDH Consumer Advisory Committee Well known Nathalia resident Bob Barton has been in the Acute Ward at Nathalia NDH recognises the important role consumers and carers District Hospital since May 1st after play in ensuring the health service continues to provide safe, spending just over a month in the Alfred quality healthcare. Partnering with consumers and carers Hospital in Melbourne and 2 weeks at is an essential component of patient centred care. The GV Health. NDH Consumer Advisory Committee was established to assist in improving ways the patient can be more involved in “I like it here, I’m putting weight back on decisions about their own health care. In addition, this group and exercising”. Bob was admitted as a of dedicated consumers assist in health service planning and Transition Care Patient to help him build policy development. up his strength to be able to manage The Consumer Advisory Committee achievements for independently once he goes home. Bob 2016-17 include: describes the TCP program as: • the review of hospital signage, which resulted in “It’s a program funded by Goulburn Valley improved directional signage; Health but run locally in our own hospital. The aim of the program is to help me • the official opening of the refurbished palliative care get well enough to go home. They give room; me a coordinator, a physiotherapist, an • development of an urgent care patient discharge occupational therapist and a therapy information form; assistant. The Dietitian also came and visited me. I’m happy to be here in Nathalia • design of a staff prompt sheet for bedside handover. because I get to go home for a couple of hours every now and then, and see the kids.”
Bob was finally discharged home on 30 June and enjoyed his first night’s sleep in his own bed in many weeks.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 111 Safety First - Infection Control
Staphlococcus aureus Bacteraemia Hand Hygiene Compliance When a blood sample is taken from a patient, it is sent to The Department of Health and Human Services requires pathology at GVHealth for examination and diagnosis. If the NDH hand hygiene audits to reach a minimum score of 80%. Blood Culture results identify the organism Staphlococcus During 2016-17 NDH results surpassed targets at internal aureus, this result is reported to Victorian Healthcare and external audits. When the score in March was lower Associated Infection Surveillance (VICNISS) to be included in than expected, the student education was reviewed as this state wide figures. In 2016-17 136 Blood Cultures were sent was the area identified as needing improvement. Once to pathology and on no occasion was this bacteria present. completed, the compliance increased.
Staff Vaccinations for Influenza Internal and External Hand The Department of Health and Human Services set a target Hygiene Audits 2016-17 of 75% of all staff to be vaccinated for Influenza. In 2016 Internal NDS achieved 91.1% compliance, receiving a Certificate of External Excellence from VICNISS. NDH results for 2017 have been 100 recently lodged and returned a compliance rate slightly 80 lower at 87%. 60
40
20
0 AUG OCT JAN MAR MAY JUN
112 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Cleaning Good Food A dedicated team of hospitality staff ensure all functional NDH is required to participate in an external Food Safety areas of the hospital are cleaned to the highest standard Audit each year as a Class A food premises which measures ensuring it presents as a clean, safe environment for patients, compliance with food safety standards. The audit was staff and the general public. conducted by an approved Food Safety Auditor in July 2016. The audit demonstrated a dedicated and positive approach The results of monthly internal cleaning audits by qualified to food safety with an excellent level of compliance. staff in all functional areas has been consistently above the acceptable quality level (AQL) of 85% set by the Department of Health and Human Services. The food was really good, sorry I ate so much but I’m not used to such good food. Internal Cleaning Audit Scores Inpatient August 2016 100 Advanced Care Planning 80 Thought should be given about what will happen when, 60 because of age or illness, a patient can no longer make decisions about care and treatment.
40 All residents over 75 years of age, whether in Banawah, in the acute ward, or doing a 75+ health check in Nathalia Medical Clinic, are encouraged to start the conversation 20 about Advanced Care Planning. In 90% of the deaths in Banawah, the residents had 0 developed an Advanced Care Plan to guide staff on their wishes, but only 30% of deaths in the acute ward had ACP completed. In response to this, NDS has conducted JUL 16 FEB 17 JAN 17 JUN 17 APR 17 MAY 17 MAY DEC 16 MAR 17 SEPT 16 AUG 16 AUG OCT 16 NOV 16 NOV community education on both Powers of Attorney and Wills, and Advanced Care Planning. Both sessions had more than twenty people attend. To keep our patients safe during their stay in hospital, staff monitor different things which might threaten safety.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 113 Medication Safety Improvements made include: Medicines are the most commonly used treatments in • Development of guidelines to monitor the health care. As a result, they are associated with a higher effectiveness of pain medications incidence of errors and adverse events than other health • Securing medication patches with adhesive to ensure care interventions. Medication incidents are the second they stay in place most frequently reported clinical incidents in public hospitals • Ceasing to use nebulisers for asthma inhalation, rather (after falls), accounting for about 25% of reported incidents choosing to use spacers as recommended by the (Australian Institute of Health and Welfare, 2014). Asthma Foundation Individual health care professionals have a critical role to play in medication safety and in reducing the occurrence of such errors. The NDH Medication Safety Program has been implemented to ensure all staff involved in prescribing, dispensing and administering medicines do so in a way that minimises the risk of medication errors to their patients and carers.
Medication Incidents 2015 and 2016 2015 8 2016 7
6
5
4
3
2
1
0 Prescribing Wrong time Wrong Wrong drug Wrong Wrong dose Wrong Patient error Wrong method Wrong Pharmacy error Communication Wrong frequency Wrong Meds not available Count discrepancy Ceased meds given Administration process
114 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Preventing Pressure Injuries Most pressure injuries in the acute care unit were present when the patient was admitted to NDH care. Pressure It is well known that skin thins with age and can become injuries come in four stages, with Stage 4 being the most very weak. Older skin may injure more easily and take serious. Over 2016-2017, no pressure injuries at NDH were longer to heal, and those in NDH care are especially greater than Stage 2 in our acute unit. vulnerable if they do not eat and drink enough, or they become inactive due to pain, progressive illnesses and Improvements made include an update of our pressure incontinence. Pressure injuries (sometimes called bed sores injury care plan, and the purchase of several new Roho or pressure ulcers) can be caused by lying or sitting in one cushions. These are special cushions designed to reduce the position for too long and are most likely to occur on the likelihood of patients developing pressure injuries. bony parts of the body, such as elbows, hips, ankles and the tailbone (sacrum, at the base of the spine). They can quickly develop in only two hours in unwell patients.
Pressure Injuries January 2016 - June 2017
2 On Admission Post Admission
1.5
1
0.5
0 JUL 16 FEB 16 FEB 17 JAN 16 JAN 17 JUN 16 JUN 17 APR 16 APR 17 MAY 16 MAY MAY 17 MAY DEC 16 MAR 16 MAR 17 SEPT 16 AUG 16 AUG OCT 16 NOV 16 NOV
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 115 Preventing Falls and Harm from Falls risk identifiers are used, for example coloured signs or traffic light symbols, to communicate the level of falls risk. Falls Staff are immediately alerted to the need to assist patients if Falls are a complex problem with multiple causes and risk necessary. An explanation of what the identifiers mean to the factors. Preventing falls in hospital is not easy but there are patient is provided. many things that can be done to help reduce the risk. Every effort is made to avoid harm, however 5% of the falls Staff start by assessing a patient’s risk of falls using a check resulted in fractures; four residents had fractures to the arm list. If it is known a patient is a high risk, extra strategies are or wrist and one resident fractured her hip. used to ensure a patient’s safety. Staff check patients every hour to see if they need assistance to go to the toilet, or maybe some pain relief. Both these actions will reduce the risk of harm.
Falls in Acute and Nursing Home 2015-2017
12 2015-16 2016-17 10
8
6
4
2
0 JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN
116 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Safe and Appropriate Use of Blood and Blood Products If Patients and Treatment with the use of blood and blood products can be a lifesaving measure, however, their use is not without risk. Consumers Are As such, the use of blood and blood products at Nathalia District Hospital remains a major focus of quality and safety in 2016/17. Not Happy with The organisation continually reviews its systems and processes to ensure alignment with National Safety and the Service Quality Health Service Standard 7 – Blood and Blood Comments, suggestions, and complaints provide valuable Products, which is aimed at the safe, appropriate, efficient feedback from which Nathalia District Hospital can and effective use of blood and blood products. continually monitor and improve the quality and safety of its Processes and systems reviewed in 2016-17 include; services and ensure provision of high standards of care. • Staff education - All registered and enrolled nurses The organisation seeks feedback regarding quality and safety involved in the administration of blood and blood from both consumers and staff via a number of mechanisms, products have completed the biennial competency including a robust comments and complaints system, using the blood safe e-learning education package. participation in the People Matter Survey, and the Victorian • Consumer information review - Information Healthcare Experience Survey (VHES) given to consumers regarding use of blood products All feedback is taken very seriously, and all complaints was reviewed to ensure it remained best practice, up are managed in an accountable, timely, transparent and to date, and appropriate for consumers. meaningful way. • Blood product administration audits - All use of In 2016/17, Nathalia District Hospital received 18 complaints blood products at Nathalia District Hospital is audited regarding service provision, a decrease of 6% from the to ensure compliance to correct procedure and the safe, previous year. Over the same period the organisation received appropriate, efficient use of blood and blood products. 28 positive comments and three suggestions for service improvement. As a result of feedback received in 2016-17, the organisation has made improvements to its service where able, examples include; • Education to nursing staff re pain management • Development of a communication strategy for the family of a consumer in our care. • A numbering system implemented to address wait times in Pathology.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 117 Comments, Suggestions, Complaints 2016/17
Suggestions 6%
Complaints 37%
Postive Comments 57%
People Matters Safety Scores Staff are surveyed annually to see if they feel the health service is providing quality care to consumers. The survey is called the People Matters Survey and this is run externally by an independent provider. People Matter Survey Results:
2016 2017 Question Asked % agreed % agreed Patient care errors are handled appropriately in my work area 95% 89% I am encouraged by my colleagues to report any patient safety concerns I may have 95% 94% My suggestions about patient safety would be acted upon if I expressed them to my manager 86% 92% Management is driving us to be a safety-centred organisation 97% 92%
118 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 When Things Don’t Go Right Part of the VHIMS program is a standardised rating scale called an Incident Severity Rating, with 1 being severe harm, Nathalia District Hospital records all incidents and adverse ISR 2 causing serious harm and requiring in depth reviews and events on a statewide online reporting system called VHIMS ISR 3 and 4 ratings requiring department manager reviews. (Victorian Health Incident Management System). An incident is defined as something happening which is not consistent There were 242 incidents reported in 2016-17. with the routine operation of the Hospital or the routine care of a particular patient/resident, client or person and includes a situation which has the potential to result in harm or an adverse outcome.
Number Type of Incident in 2016-17 This Includes: Medication incidents 46 One ISR Includes wrong patient, wrong drug, frequency or dose, adverse 2 rating reaction, etc
Skin tears 31 Pressure Injuries 12 Four pressure injuries occurred prior to admission Falls 65 Four ISR Four falls resulted in fractures to our residents; three wrist fractures 2 ratings and one hip fracture Hazards 23 This category includes Incorrect patient identification, breach of (or potential) confidentiality, allergies not recorded and occupational violence against staff (five incidents) Corrective Actions 16 One ISR This may include unlocked doors, security alarms going off, suspicious 2 rating persons (all risks to safety are reported to Police),unsafe equipment, failure of essential equipment Other 42 Many of these are near misses which would have resulted in an incident but for early intervention eg sensor mats for falls management not turned on, resident unstable on their feet or tending to lose balance Work Injuries 7 Two days lost in total
Plans to improve: All individual patient incidents such as falls, pressure injuries and medication incidents are reviewed by a special clinical governance committee called the Clinical Standards Committee. This group includes the Director of Medical Services, all our medical officers and senior nurses and an allied health professional and a pharmacist. They look at each individual incident and make recommendations for improvement.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 119 ISR 2 Corrective Action Preparing For Discharge In September 2016 a patient was transferred from a bigger To prepare patients to be able to manage when they go hospital to NDH for ongoing medical care. The patient was home from hospital, NDH staff work with the patient accepted for transfer and it was only two days later it was towards planning their discharge. This starts on admission, identified that she had been transferred from a ward where with an expected discharge date estimated so the patient there was a gastroenteritis outbreak. can plan their discharge with support from their doctor and the health care team. Following discharge, all patients are The patient developed gastronteritis which was passed on followed up with a phone call the next day. to some of our patients, residents and staff. This was not as a result of poor hand hygiene, as the hand gel is proven ineffective against the Norovirus which caused the illness. As a result, the hospital was closed for several weeks, accepting no admissions at all over that time. A simple check list of requirements before our staff can accept a patient transfer has been implemented. It is anticipated this will stop any possibility of this event reoccurring.
Discharge Quality Audit Evaluation Post Discharge - Follow up Phone Call
Questions Asked 2014-15 2015-16 2016-17 Number of patients who received a follow up phone call post discharge 65% 90% 100% Number of patients provided with a discharge summary 100% 43% 76% Number of patients who required further information about their condition 0% 14% 0% Number of patients coping with the support systems put in place post discharge. 100% 100% 100%
100% of patients were provided with information to assist them to manage at home, but not all patients identified this as a ‘discharge summary’. This question has been reworded to ask about “discharge information”.
120 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 Your May Transfer to Banawah The quality of services extends across all NDH services and Nursing Home patients will receive the same quality care in Banawah. Banawah reports a set of five Quality Indicators to the If patients are no longer able to cope at home, they may Department of Health and Human Services. require admission to the NDH nursing home.
2016-17 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Number of Pressure Injuries 4 1 4 0 Objective is to monitor prevalence of pressure injuries and identify its frequency. A pressure injury is defined as any lesion caused by unrelieved pressure. There was one pressure injury greater than Stage 2 identified in the 2016-17 year. Total Number of Falls 12 15 10 11 Falls resulting in fractures 2 1 0 1 Objective is to monitor falls and the frequency of falls related fractures. Incidence of Physical Restraint: A: Intention to Restrain 5 3 0 6 Incidence of Physical Restraint: B: Physical Restraint Devices 15 13 18 18 List A is to determine the intention to restrain. Two of our residents wear seat belts when in their wheelchairs for fear of falling; this is considered an ‘intention to restrain’. List B related to devices used to physically restrain. Three of our residents have severe physical disabilities and have had the occupational therapist and the physiotherapist approve bed rails to assist them with mobility. Bed rails are considered a restraint device, so Banawah does not rate well in this category. All forms of restraint used in Banawah are at the request of the resident. Incidence of 9 or more medications 6 6 6 8 Objective is to monitor residents using nine or more medications and trends in this incidence. Number of residents who experienced significant unplanned 1 1 1 0 weight loss during the quarter Number of residents who experienced unplanned weight loss 2 2 0 0 over three consecutive months Prevalence of unplanned weight loss in two categories: List A: significant weight loss is defined as equal to or greater than 3kg over three months List B: unplanned weight loss is weight loss where there is no strategy and ongoing record relating to planned weight loss.
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 121 After Discharge Patients Might Other Programs Which Will Help Need Other Services to Keep You Well
District Nursing Community health have a team who work together conducting activities promoting healthy lifestyle and The District Nursing Service provides person centred wellbeing for all community members. Some activities that nursing care and support to clients and/or their carers have taken place through the year include: within the community. It assists clients to remain as
independent as possible in their home and continues to • Smiles 4 Miles This is an ongoing dental health initiative from Dental provide a direct link for the successful transition from a Health Services Victoria (DHSV). hospital stay to home. The local Preschools and Nathalia Early Learning There are also several programs directly linked to the Centre. The centres work closely with the Moira District Nursing Service. consortium promoting healthy dental care. The Planned Activity Group provides twice weekly outings • Act-Belong-Commit for clients whom are in need of social interaction and/ or Keeping mentally healthy is as important as maintaining our physical health. The team worked alongside carers requiring respite. The outings are client focused and Murray Dairy to aid local community members with are directed at the needs and preferences of the clients. support, emotional and financial assistance. The home based planned activity program is directed for • Healthy Eating clients who do not wish to join a group, but are in need of This has been an ongoing project working in one to one social interaction. partnership with the schools and Community House Music Therapy in the home with a qualified Music Therapist • Women’s Wellbeing Session Was carried out at a local school for staff, delivering Monthly shopping trips are also available for isolated persons education and information enabling choices for who are not able to travel locally or to larger regional cities optimal healthy and emotional wellbeing. to purchase general lifestyle necessities. • COPD Program The chronic obstructive disease program ran for consumers living within the community with I would like to thank you all for getting me through a dark respiratory disease. The team worked in partnership period of my life. Thanks for your expertise and care for the with medical clinic staff promoting further past four months. I thank you all most sincerely; you are all a independence for the consumers. This enabled credit to your profession. consumers to carry out basic daily tasks at home as well as further information and education relating to District Nursing Client May 2017 respiratory disease. • Bowel Cancer Screening The team and medical clinic worked in partnership with Murray PHN to increase awareness and encourage participation in National Bowel Cancer Screening.
122 N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 All NDH Services Are Fully Each accreditation body has its own separate requirements which must be complied with for the health service to meet Accredited full compliance. However they are all driven by the same principles of good care set out in the Australian Safety and NDH is required to achieve and maintain accreditation Quality Framework for Health Care. with a number of accreditation bodies as part of its health service agreement. Acute services are accredited under the Australian Council on Health Care Standards EQuIP National Program, residential aged care under Australian Aged Care Quality Agency, District Nursing Service and Planned Activities Group through Home and Community Care and the Nathalia Medical Clinic under the Australian General Practice Accreditation Limited.
Service NSQHC Residential Nathalia District Nursing and Aged Care Medical Clinic Planned Activities Accreditation Agency ACHS EQuIP Australian Aged Care Australian General Home and Community National Quality Agency Practice Accreditation Care Last Visit September 2015 June 2015 November 2015 September 2013 Results Full Compliance and Met all 44 Standards Full Compliance Full Compliance five met with Merit Next Review September 2017 June 2018 November 2018 To be advised One support visit per year
N a t h a l i a D i s t r i c t H o s p i t a l - V i c t o r i a n Q u a l i t y A c c o u n t 2 0 1 6 / 1 7 123 Tell Us What You Think
This Annual Report and Quality of Care Report has been written to inform our community, patients and consumers about the recent achievements by NDH in ensuring a safety, quality service is provided at NDH. Your feedback is valued and NDH invites you to comment on this report so the health service can continue to improve and meet your needs. This report is available for review on-line via the Hospital website. Thank you.
Feedback on the Quality of Care Report 2015 2016 100%
95%
90%
85%
80%
75% Does the QoC Does the QoC Is there evidence Is there evidence of Report contain Report contain of consumer improvement over enough information enough information involvement? the past 12 months? about what we do? about what needs to improve?
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Providing Quality Care
Nathalia District Hospital & Banawah Nursing Home 36-44 McDonell St, Nathalia, VIC 3638 Phone: (03) 5866 9444 Fax: (03) 5866 2042 E-mail: [email protected]
www.nathaliahospital.org.au
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