annual report 2008 December 2008

The Hon John Della Bosca MP The Hon NSW Minister for Health Parliament House Macquarie Street SYDNEY NSW 2000

Dear Minister

We have pleasure submitting The Children’s Hospital at Westmead 2008 Annual Report, including statements for the fi nancial year ended 30 June 2008 as certifi ed by the Auditor General of NSW.

This report is consistent with the statutory requirements for annual reporting as provided by NSW Health under the Accounts and Audit Determination for Public Health Organisations and the 2007/2008 Directions for Health Service Annual Reporting and is submitted to the Minister for Health.

Yours sincerely

Dr Antonio Penna Chief Executive

Contents

128th Annual Report of The Children’s Hospital at Westmead Contents for the year ending 30 June 2008.

Highlights ...... 2 Our Community ...... 90 Children’s Hospital Advisory Council ...... 90 Chief Executive’s year in review ...... 4 Consumer Feedback ...... 92 Cultural Diversity ...... 93 Profi le, Purpose and Goals ...... 9 Our Volunteers ...... 93 Organisational Chart ...... 11 The Chaplains ...... 94 Benefactors and Donors ...... 94 Performance Summary ...... 12 Roll of Honour ...... 99 Actions and initiatives ...... 17 Freedom of Information Report ...... 101 Corporate Governance Statement ...... 19 Financial Report ...... 108 Clinical Governance ...... 22 Financial Overview ...... 108 Activity Levels ...... 26 Certifi cation of Parent/Consolidated Financial Statements ...... 114 Service Planning ...... 27 Certifi cation of Special Purpose Overview of Operations ...... 28 Independent Audit Report ...... 154 Clinical Programs Special Purpose Service Entity Statements .. 156 Ambulatory and Emergency Program ...... 28 Medical Program ...... 32 Perioperative and Critical Care Program .... 43 Clinical Support Allied Health ...... 50 Diagnostic Services ...... 52 Mental Health Services ...... 59 Corporate and Shared Services ...... 63 Information Management Services ...... 64 Community Relations and Marketing ...... 64 Internal Audit ...... 66

Our People ...... 68 Workforce Development ...... 68 Executive Management ...... 71 Executive Profi les ...... 72 Staff Profi le ...... 73 Disability Action Plan ...... 74 Occupational Health and Safety ...... 74 Equal Employment Opportunity ...... 75 Teaching and Training Initiatives ...... 79 Overseas Travel ...... 83 Research ...... 83

1 Highlights Highlights

• The Emergency Department entered into a • The Children’s Hospital at Westmead has been redevelopment phase, with the fi rst stage being widely praised for remarkable success in the areas the opening of the Emergency Medical Unit of revenue improvement, wastage reduction and (EMU). Additionally, 3.5 additional consultant workforce productivity, exceeding annual targets by medical positions were assigned to the Emergency 33 per cent. The Hospital leads the state in salary Department and performance against key packaging, is exemplary in improvement of private performance indicators (KPIs) was of a patient revenue and has made great improvements high standard. in blood products wastage.

• The Children’s Hospital at Westmead was the fi rst • An Evening Pharmacy Service commenced, along organisation in Australia to receive the globally with a telephone triage system allowing parents recognised International Disability Management and carers to query medications and dosages for Standards Council Certifi cation for Excellence in their sick child. Injury Management, recognising the Hospital’s strong commitment to occupational health and • The story of Demi-Lee Brennan attracted safety and injury management for employees. international media coverage. Demi-Lee received a liver transplant at The Children’s Hospital at • The Animal Assisted Therapies Program was Westmead and miraculously took on the blood launched by the Physiotherapy Department group and immune system of her donor, effectively and the Delta Dog Society. This innovative eliminating the chance of her body rejecting the program involves therapy dogs working alongside precious new organ. physiotherapists to assist and motivate long term physiotherapy patients. • The Long Term Ventilation Unit assisted to return fi ve ventilated children back to their home • The Diabetes Prevention Research Centre was environment. These children were previously launched on World Diabetes Day by Goodwill treated within the Paediatric Intensive Care Unit, Ambassador, Bec Hewitt. This initiative was but this initiative allows them to transition to care made possible by donations from the Diavitiko within the community. Association and the Laki Bank. • A new interventional angiography suite in Radiology • The Kidz Factor Zone was offi cially opened by was installed to allow greater diagnosis and the Minister for Health, Hon Reba Meagher treatment of patients. MP, to provide specialised care to children with haemophilia who require frequent hospital visits.

2 Highlights

• One of Paediatric Intensive Care Unit’s (PICU) • The Book Bunker celebrated ten years as part major achievements has been a steady reduction of The Children’s Hospital at Westmead with a in the mortality rate of critically ill children and birthday party attended by famous children’s infants over the last three years. Following a 20% author, Mem Fox. Established by Scholastic, the reduction in standardised mortality rate between Book Bunker is part of the Hospital’s total healing 2005-06 and 2006-07, there has been a further environment, allowing children and families access 14% reduction between 2006-07 and 2007-08. to books and a library environment staffed by The standardised mortality rate is now only 54% of volunteer librarians. its value ten years ago. • The Pain and Palliative Care Service was awarded • The opening of the Aboriginal Memorial Garden the highly prestigious Institution Award by the was a pinnacle in the Hospital’s commitment to the International Association for Hospice and Aboriginal Community, allowing a place of refl ection Palliative Care. for families and venue to showcase Aboriginal heritage within the history of the Hospital and the • The successful Grace Neonatal Intensive Care local area. Unit Gala Ball raised over $300,000 for the Grace Centre for Newborn Care. • The Annual Memorial Service activities were expanded to include group sessions for bereaved • After staff at The Children’s Hospital at Westmead parents and siblings. Attended by over 450 people, uncovered that the Toy of the Year, Bindeez, the Memorial Service is designed to allow families contained toxic chemical equivalent to an illicit the chance to remember children associated with drug, a major awareness campaign was launched, The Children’s Hospital at Westmead who resulting in an international recall of this have died. dangerous product.

• The inaugural Bandaged Bear Cup was held to • The Occupational Therapy Department celebrated recognise the staff and volunteers of The Children’s 70 years of service, having been an integral part Hospital at Westmead. This is a feature on the of the Hospital’s care for sick children since the NRL schedule and is an initiative of ANZ Stadium, Camperdown days. with the Cup being contested by the Canterbury Bulldogs and the Parramatta Eels. • The Speech Pathology Department received a Service Award from the University of Sydney for continuous contribution to clinical education.

3 Chief Executive’s year in review

Refl ecting upon the last year, my mind fi lls with We welcomed an allocation of an additional 3.5 full- many thoughts of successes, challenges and time equivalent consultant medical positions in our

Chief Executive’s year in review Chief Executive’s highlights. Although one thing stands out in my Emergency Department during the year. This has mind above all else, my strong sense of pride allowed for increased clinical care for patients and smoother transition through the triage system. to be part of such a inspirational organisation, which is underpinned by the talent of dedicated Five children were transitioned back into the staff and volunteers. community from the Long Term Ventilation Unit during the fi nancial year. This is a major achievement as To be at the helm of an organisation such as children with conditions requiring long term ventilation The Children’s Hospital at Westmead is a great were previously patients of the Paediatric Intensive honour. I am part of a team of people who feel Care Unit (PICU). Moving these children to the Long passionately about creating healthier futures for Term Ventilation Unit and working towards their return children and families. to the community has not only been a wonderful result for their families, it has also improved bed availability Our reputation as one of the world’s great children’s in PICU, increasing surgery capacity. hospitals is not based on the equipment we have or the buildings we work in, it has come about because PICU has seen a steady reduction in the mortality rate of our people. Together we all contribute to the of critically ill children. This is a major achievement, positive experience that many families comment upon especially considering that the rate has decreased by when they trust us with the care of their child. 34 per cent since 2005-2006. I have no doubt that this amazing feat is not only as a result of improved The Children’s Hospital at Westmead is built fi rmly treatment options, but is also a refl ection of the upon three platforms – clinical care, research and dedication and talent of staff. education. These three platforms are intertwined and ensure that we are providing the best care today The Minister for Health launched two exciting and are accelerating this standard of care into the initiatives at The Children’s Hospital at Westmead future, through research into the causes and cures during the year. The fi rst was the opening of the of childhood diseases and education across the Kidz Factor Zone, an innovative treatment centre for paediatric discipline to keep skills at the cutting-edge. children with haemophilia. This was offi cially opened in July 2007 and has proven to be an effective venue While there have been challenges over the last year, for care and support of haemophilia patients and I am very pleased to say that our performance across their families. all areas has been very good. With the continued support and dedication of staff across all disciplines, The Minister for Health also offi cially launched the I am sure that we can continue to effectively tackle Animal Assisted Therapies Program, an initiative future challenges and demands. of the Physiotherapy Department and Delta Dogs Association. This is a physiotherapy-based program, Clinical Services using dogs to help facilitate rehabilitation and treatment for sick children. Despite some disruption from renovations, the Emergency Department has managed to meet Key One of the highlights of the year has been the fantastic Performance Indicators (KPIs) set by NSW Health. media coverage of some of the major achievements This is a fantastic achievement which shows the of The Children’s Hospital at Westmead. One of excellent effort of staff. these stories was that of Demi-Lee Brennan, a young liver transplant patient who miraculously took on the We have also met elective surgical KPIs above immune system and blood group of her liver donor. all other Area Health Services, a magnifi cent This was the fi rst time this had happened in the world, achievement in the face of increasing demand allowing this ‘one-in-six-billion miracle girl’ to live a life for services. free of immune suppressant drugs. Her treatment and

4 the handling of this unique phenomenon was a credit The Service Improvement Unit continued to to staff in various departments around the Hospital, coordinate a number of projects to improve patient

including the transplant team and haematology staff. safety and quality of care. One of the key projects is year in review Chief Executive’s the Clean Hands Save Lives initiative, promoting hand Another major story developed in the lead up hygiene practices of staff. We are currently the top to Christmas 2007 when staff from the Poisons performing hospital in NSW for hand hygiene, with Information Centre, based here at The Children’s 85 per cent compliance. Our success in this area has Hospital at Westmead, discovered that the ‘Toy been commended by NSW Health and the Clinical of the Year’, Bindeez Beads, contain a potentially Excellence Commission. lethal chemical which, when ingested, became the equivalent of an illicit drug in a young child’s body. This discovery was made in the Hospital’s laboratory Research and resulted in a world-wide recall of this popular toy, Our Research Division, based at the Kerry Packer which was rapidly fi lling the Christmas stockings of Institute for Child Health Research here at The children of all nationalities. Children’s Hospital at Westmead, continues to go from strength to strength. During the year we installed a new state-of-the-art paediatric interventional radiology operating suite. The ultimate measure of the success of our research This suite is the most advanced of its kind in the activity is improved health for children. As a direct world and allows Interventional Radiologists to operate result of our research, there have been signifi cant on children by inserting small, sophisticated devices advances by the Hospital in treatments, cures through one to two millimetre holes in the skin, and prevention of diseases, and these advances seeing inside the body using the angiography have benefi ted many children. Over the coming machine and ultrasound. This is a major step months and years, we will continue adding to these forward for The Children’s Hospital at Westmead, achievements as we strive to achieve our vision of resulting in minimal scarring, less risk, less pain, being a leading global centre for clinical translational shorter hospitalisation and faster recovery for research in children. children with vascular malformations. Having started with a team of 40 scientists, the Clinical Governance Research Division has now grown to a staff of more than 250 working in 30 research groups. Our work During the year, 165 improvement projects were covers basic, clinical and population health studies lodged with our Service Improvement Unit, all of and is driven by the needs we see in the children which underwent comprehensive ethical review. This who come to the Hospital every day. We take pride in is a true refl ection of the amazing work being done the fact that our research is ‘bench to bedside’ – the by staff in all areas of the Hospital and how they are advances we make at the laboratory bench can be not afraid to challenge the ways things are done and directly applied to the needs of sick patients here at continually improve for the benefi t of children The Children’s Hospital at Westmead. and families. One of the highlights of the year was opening the Development continued on the Hospital’s new Diabetes Prevention Research Centre on World database for improvements, special achievements, Diabetes Day. This was made possible by generous external visits and information sharing. This donations from Diavitiko and the Laki Bank. The database, known as CHARLI, will revolutionise Centre will concentrate on research into the causes, the way we do business, allowing a greater central treatments and cures for Type 1 and Type 2 Diabetes. knowledge of the activities of Departments, something which has previously been a challenge in this complex organisation.

5 Performance Management In addition, three fast track cubicles will be built. These can also be used for assessment in case of and Planning

Chief Executive’s year in review Chief Executive’s a disaster with multiple casualties. Air fl ow will be enhanced in the infectious waiting room facilities to We have now fully implemented our Corporate minimise the spread of air-borne viruses and a waiting Strategic Plan, which is supported by our Healthcare area for children midway through their treatment will Services Plan, Financial Impact Statement and be created to avoid congestion in treatment areas. Clinical Services Plans. Key enabling plans will bring these strategies to fruition in the areas of Finance, During the year we also completed an upgrade of Asset Management, Workforce Development and our Oncology Treatment Centre, an initiative made Information Services. possible through the generosity of our donors. This refurbishment has created a more comfortable One of the major benefi ts of having these plans in environment for patients and families who visit the place is that we have a strong platform to measure Hospital as outpatients for chemotherapy treatment our priorities against and they give us a much clearer for cancer and leukaemia. direction for the future. All proposed new initiatives are now subject to a formal process of prioritisation and are tracked in a central database. Finance

The planning process is ably supported by technology, During this fi nancial year, the Hospital was remarkably allowing for consistent measurement and reporting, successful in improving fi nancial performance in including risk profi ling. those areas within our control, such as revenue improvement, waste reduction and workforce productivity. The Hospital now proudly leads the state Building, Equipment and in salary packaging, is exemplary in our improvement Information Technology of private patient revenue and, in only ten months, achieved the full year revenue improvement target of We have begun to see signifi cant change in our $2 million more than last year. Other examples of the Emergency Department, thanks to $450,000 widespread fi nancial improvement this year include of funding from NSW Health. This has allowed blood wastage and control. Overall, the Hospital completion of two stages of a three stage achieved a pleasing fi nancial result in the face of redevelopment, which has made this area more increased activity and greater pressure on funding. functional and comfortable for families. At a strategic level, the Hospital has developed a Five One of the major features of the Emergency Year Plan consolidating both capital and operating Department redevelopment has been the fi rst stage fi nancial projections for all Programs and Divisions of redevelopment, the opening of the Emergency over the next fi ve years and integrating the annual Medical Unit (EMU). This new overnight-stay budgets and operating plans. The Five Year Plan was eight bed ward allows children and families to be presented to the Minister for Health. Major reviews accommodated for observation periods or other were commenced into the funding model and also extended stays in greater comfort. into Special Purpose and Trust Funds. The results of these reviews will be reported next year. The second stage is based around making the Emergency Department more functional and At a management level, the Hospital transitioned comfortable for families. Major features of this to the new statewide Oracle fi nancial systems, development is making the waiting room more private, involving a new chart of accounts. Improved cost providing a more comfortable setting and making the centre reporting for fi nancial and staffi ng information whole area more safe and secure. was introduced through Corvu. New, online billing systems were rolled out progressively to departments during the year. A review commenced to identify and allocate overhead costs across the Hospital on a more transparent and equitable basis.

6 The Hospital continued to work with HealthSupport This year we celebrated the tenth birthday of the Book Service Centre, Parramatta, to address the challenges Bunker, an initiative of Scholastic which sees trained

of transitioning support services to their new operation volunteer librarians maintaining a wonderful library for year in review Chief Executive’s and location. The Performance Improvement Unit children of all ages. This has been a valued service worked with PricewaterhouseCoopers to identify new for children and families over the years, providing a revenue and cost-saving opportunities. The benefi ts welcome escape from the challenges of illness to the Hospital from these initiatives will be realised in and injury. future years. Our annual Service of Remembrance continues to be an important ongoing aspect of our care for families Workforce and Education of children who have sadly passed away. This Service, We were honoured to be the fi rst organisation attended by around 450 people annually, has been in Australia to receive the globally recognised expanded to include bereavement groups for parents International Disability Management Standards and siblings and is just one way that we can extend Council Certifi cation for Excellence in Injury our care to families and show our compassion and Management. This award recognises our ongoing ongoing support. commitment to occupational health, safety and injury management for all employees, as we continue to be Staff and Volunteers one of the best performing hospitals in this area within the state. I am constantly amazed by the talent and tenacity of staff across all disciplines. Our international reputation We continued the development of the Kim Oates for excellence attracts the best staff from around the Australian Paediatric Simulation Centre, a unique globe and our investment into education and training facility designed to keep staff skilled in the most ensures that their skills remain world-class. cutting-edge treatments for sick children, especially in emergency scenarios. This year we introduced Celebration Week, a chance for us to recognise the signifi cant contribution of staff This Centre will train those who care for our precious and to provide recognition and thanks. There were sick children to intervene in patient care instinctively, several planned activities, a highlight being a display quickly, consistently and appropriately, using in the Hospital’s galleria of hundreds of thank-you techniques that have been proven to save lives. This cards for staff and departments from other staff, will allow for greater learning, educational innovation, patients and families. collaboration and research. I am keen to continue the tradition of Celebration Week annually and I am also looking towards Family-focussed care additional ways we can provide recognition to staff. Our Hospital is well known for our family-focussed approach to paediatric health care. This approach is Roger Corbett, the Chair of our Advisory Council, based around the health and wellbeing of the whole was awarded an Offi cer of the Order of Australia in family and there are many examples of how we strive 2008. This honour is very well-deserved, as Roger has to achieve this. contributed so much to business and the community and we are honoured and grateful that he is part of One of the major contributing factors to family- our Hospital and assists us in so many ways. focussed care is our total healing environment. This incorporates our gardens, playgrounds, our Some of the other major awards given to our staff entertainment program and all of the extra things we during the year include A/Prof Elizabeth Elliot do to bring fun and laughter to the road to recovery. becoming a Member of the Order of Australia for her work with the Australian Paediatric Surveillance Unit.

7 Prof Peter Van Asperen was awarded the prestigious While many of our donors like to choose where John Sands Medal by the Royal Australiasian College their donation is directed, it’s also important that a

Chief Executive’s year in review Chief Executive’s of Physicians and Prof Richard Widmer was awarded signifi cant portion of our donations are untagged, a College Meritorious Service Award from the Council meaning that we can direct this money towards the of Paediatric Dentistry. area of the Hospital in most need. These priorities are continually formally re-assessed. We are very fortunate to have a committed band of 400 Volunteers who dedicate many hours each week I am thoroughly enjoying my role as Chief Executive of towards assisting in various areas of the Hospital The Children’s Hospital at Westmead and feel a strong and fundraising towards special projects. These sense of achievement as I refl ect upon the past year. men and women are one of the cornerstones of our With the immediate support of my Executive and the organisation and their support is a large part of our Children’s Hospital’s Advisory Council, I feel that we ongoing success. will move ahead and achieve even more in the future.

Our vision is ‘Healthy Children for a Healthy Future’ Our Sponsors and I am confi dent that, as a team, we can put an We have many committed donors and supporters in enormous amount of energy toward this vision and the community. Their interest in our work and their change the lives of sick children and their families. unwavering support of our aspirations is one of our greatest strengths.

During the past year we have received close to $25 million in donations. This money is used in a variety of ways, including supporting clinical initiatives, funding research and allowing us to provide extra services for families as part of our total healing environment. Dr Antonio Penna Chief Executive

8 Profi le, Purposes and Goals le, Purposes and Goals The majority of patients treated by The Children’s

Our Vision Profi Hospital at Westmead come from Sydney West (49.84%) and Sydney South West (22.9%) areas. Healthy Children for a Healthy Future Western Sydney is home to over half the children in NSW, with over 90 different cultural groups, including people from non-English speaking backgrounds and Our Mission one of the largest Aboriginal Communities in NSW. The Children’s Hospital at Westmead will strive for Of the 25,754 admissions to The Children’s excellence and build on our strengths as leaders Hospital at Westmead in 2007-2008, 670 (2.6%) in clinical care, research and education with an are Aboriginal or Torres Strait Islanders and 3406 emphasis on: (13.23%) patients do not speak English at home. The largest number of admissions to The Children’s • Balancing our role in providing high quality Hospital at Westmead is in the under one year old tertiary and quaternary care with our primary and category (16.95%) and 54.93% of patients are aged secondary commitments to the community fi ve years and under. • Chronic and complex care A teaching hospital of the University of Sydney and • Building partnerships the University of Western Sydney, The Children’s Hospital at Westmead is a leading institution in children’s clinical research, focusing on turning Values today’s research into tomorrow’s medicine. • Commitment The Children’s Hospital at Westmead is a Statutory • Accountability Health Corporation, established pursuant to the • Respect Health Services Act 1997 (NSW). • Excellence • Service

9 le, Purposes and Goals

Profi Principles Guiding Our Work Purpose and Goals

• Health gain – to ensure that improving • To keep children and young people healthy children’s health and quality of life are the focus - More children adopt healthy lifestyles of our efforts. - Prevention and early detection of • Concern for people – to care for our patients, their health problems families, our staff and our supporters as individual - A healthy start to life people with their own needs. • To provide the health care people need • Doing it better – to provide the best possible patient care by the effective use of resources, recognising - Emergency care without delay the need to continuously review and improve - Shorter waiting times for booked non- procedures and processes. emergency care • A hub of paediatrics – to play a pivotal role in - Fair access to health services cooperating to establish a network to share our • To deliver high quality health services knowledge and skills in paediatrics for the health - Consumers satisfi ed with all aspects of of children. services provided • Making the future better – to invest in and facilitate - High quality clinical treatment research that improves our understanding of how to prevent or treat diseases in children and to - Care in the right setting work with government and community agencies to • To manage health services well promote the health and well-being of all children. - Sound resource and fi nancial management - Skilled, motivated staff working in innovative environments - Strong corporate and clinical governance

10 ORGANISATIONAL STRUCTURE OF THE CHILDREN’S HOSPITAL AT WESTMEAD ce Research Workforce Development Mr Frank Horn Dr Chris Cowell Education HR Medical HR General & Payroll HR Clinical Programs Comp OHS&R/Workers Research Offi Ethics Intellectual Property Infrastructure Support Clinical Trials Clinical Research CHERI Laboratory Research Population Health Research • • • • • • • • • • • • • • MH-Kids & Medicine Dr Stuart Dorney Redesign Unit Medical Profession - MADAC Service Improvement Unit Corporate Governance & Risk Management Clinical Governance • • • • da ciency Emergency - Physical Disabilities Physical - Bifi Spina - - Spinal Injuries and Disease Ward Wade Adolescent Medicine Centre for the Advancement of Adolescent Health Child Development PECAT - DSU - Child Protection CHISM CAPAC Deafness Centre Dentistry Emergency Services: Kidsnet - Mental Health Services Medicine Psychological - Ward Hall - CAPTOS - Outpatients Centre Appliance - Rehabilitation: Injury Brain - Defi Limb - Ambulatory and • • • • • • • • • • • • • Nursing Mental Health Patient Flow Unit - Patient Administration Nursing Profession - Practice Development Volunteers Ms Annette Solman Area Director for • • • Critical Care Academic Surgery Adolph Basser Cardiac Institute Anaesthesia Biomedical Engineering - Inhalation Therapy Burns Burns Plastics Surgical Centre Treatment Clubbe Ward CSSD Edgar Stephen Ward ENT General Surgery - Transplant Trauma Surgery, Facio-maxillary Surgery Grace Centre for Newborn Care - NICU Helen McMillan - PICU Middleton – Day Surgery Ward Operating Theatres Ophthalmology Orthopaedics Plastic Surgery Recovery & Anaesthetics Surgical Unit Theatre Porters Urology Perioperative & • • • • • • • • • • • • • • • • • • • • • • • Clinical Operations Ms Cheryl McCullagh Dr Antonio Penna CHIEF EXECUTIVE Clinical Programs Medical & Marketing Mr Alan Ching Internal Audit Bear Cottage Camperdown Ward Chaplains Clancy Ward Ward Commercial Travellers David Reed Sleep Unit Dermatology Gastroenterology / James Fairfax Institute General Medicine Hepatology Liver Transplant Hunter Baillie Ward Nephrology Renal Transplant Neurology/ Neuro-surgery Oncology Medical Centre Oncology Treatment Pain & Palliative Care Services Poisons Information Centre & Toxicology Unit Renal Treatment Respiratory Medicine Rheumatology Sydney University Dept. of Paediatrics & Child Health Ward Turner Ward Variety Management Weight Ms Gilly Paxton • • • • • • • • • • • • • • • • • • • • • • • • Fundraising Public Relations Radio Bed Rock Starlight Express • • • • Community Relations Finance & Ms Wendy Haigh Ms Wendy Accounting Revenue Reporting Performance Improvement Logistics Property Management Security Child Care Centre Domestic Services Engineering & Maintenance Food Services Accommodation Linen & Sewing Shared Services Corporate Services • • • • • • • • • • • • • • Diagnostics Immunology & Infectious Diseases Institute of Endocrinology & Diabetes Medical Imaging/ Nuclear Medicine Pathology: Biochemistry - Endocrinology - - Haematology: Blood Bank Histopathology - - Laboratory Services Microbiology - - Pathology Collection Services Virology - Pathology Molecular - Sydney Genetics Program: Western - Biochemical Genetics - Clinical Genetics Cytogenetics - - Genetic Metabolic Diseases Service - Molecular Genetics - Newborn Screening • • • • • & Planning Dr Ralph Hanson Allied Health CASU IT Services Management Support & Analysis Unit Medical Records Project & Business Planning Switchboard Services Planning & Population Health Unit Aboriginal Health Audiology Cochlear Implant Kids Health Nutrition & Dietetics - Formula Room Occupational Therapy Orthoptics Orthotics Pharmacy Physiotherapy Play Therapy Psychology Social Work Speech Pathology Information Services • • • • • • • • • • • • • • • • • • • • • 11 Performance Summary

Strategic Baseline Target Result Indicator Direction To keep people healthy A healthy start to life Performance Summary Infants, admitted as inpatients with ‘not up to date’ status, 1 76.4 85 76% receiving documented catch-up immunisation (%)

To provide the health care people need Emergency care without delay Off-Stretcher time <30 minutes (%) 2 90 96 Emergency Department triage times – Cases treated within benchmark times (%):

• Triage 1 (within 2 minutes) 100 100 • Triage 2 (within 10 minutes)2 80 100 • Triage 3 (within 30 minutes) 75 74 • Triage 4 (within 60 minutes) 70 74 • Triage 5 (within 120 minutes) 70 80 Emergency Admission Performance - patients transferred to an inpatient bed within 8 hours of treatment (%): 2 • Overall 74 80 79.1 • Mental Health 70 80 92 Shorter waiting times for non-emergency care Booked medical and surgical patients waiting (number): 2 • Overdues > 30 days 0 0 0 • Long waits >12 months 0 0 0 Planned surgery - cancellations on the day of surgery (%) 2 <2 5 To deliver high quality health services High quality clinical treatment Wrong patient, site, procedures (numbers) 2 0 ▼ 0 Falls in Hospitals (rate per 1,000 bed days) 2 0 ▼ 0 To manage health services well Sound resource and fi nancial management Overall fi nance assessment Net cost of service – General Fund (General) variance against 5 5.79 0 0.71 budget (%)

Creditors > Benchmark as at the end of the year ($’000) 5 1,335 0 0

Major and minor works - Variance against Budget Paper 4 5 95.8 0 100.0 (BP4) total capital allocation (%)

12 To keep people healthy

Health Service Strategic Process Measure Achievements in 2007/08 / Performance Summary Management Direction Further work to be done Accountability

Reduce childhood 1 Identify and manage • Establish the Partially Achieved obesity children and young prevalence of Measures are documented people attending overweight and electronically in Powerchart. CHW who are at risk obesity among Trend showing a steady increase of obesity CHW patients but room for improvement. Further work • Increase the Collaboration continues with percentage of SWAHS & DET on “Crunch and inpatients for whom Sip” program. (Supersedes height and weight previous ‘Stretch and Grow’ measurements are program). Increased number of recorded and charted schools involved in the “Crunch on Powerchart and Sip” program. • Increased number Improvement of the Weight of children recruited Management Services – funding to Stretch and provided by WCHN for Grow Program Obesity project.

Prevention of 1 Collaborate with • Safe physical activity Achievements Sports Injuries in other AHS to and sport for children ‘Physical as Anything’ children enhance health and youth program in Program used in schools. promotion and place (CHISM) (CHW) CHISM conducts Train the prevention efforts for Trainer courses in physical children and young activity. Uses exercise testing people statewide as a predictor in level of risk of injury. Further work CHISM – examining role of exercise interventions in children with chronic illness and disability

Refugee Children 1 Collaborate with • Increased access to Refugee children other AHS to services for Refugee 06/07 = 190 clinic visits. enhance health children (CHW) 07/08 = 190 clinic visits. prevention efforts Safe physical activity for children and Currently being trialled with young people 800 children in Western Sydney

13 To provide the health care people need

• Complete • Steps of clinical Outcome measures – Achievements redesign followed sustainable access : Progressing well in the face Performance Summary ‘Pulling our Wait’ improving the of increased demand: Clinical Redesign emergency • KPIs RSI continuously declining Program patient journey • long wait list DOSA rate on target, Long waits maintained at or • Progress • Continue • DOSA rate near zero for 12 months recommendations to progress Triage waiting times all • triage waiting times remaining improved on previous year. from previous recommendations project ‘Joining • access block Access block improved on from surgical previous year. the Dots’ 2 patient journey • consumer Further work redesign satisfaction The unplanned readmission • Emphasis on rate is: 06/07: 11.8% sustainability of 05/06: 12.2% A decrease of skills in this area 0.4% in readmissions. Further refi ne patient fl ow business rules, isolation practices and transport. Medical ward re-alignment evaluation.

14 To manage health services well

Health Services Strategic Process Measure Achievements in

Management Direction 2007/08 / Further Performance Summary accountabilities work required Progress the Operationalise Demonstrate Partially Achieved implementation of the model of improvement from Approached GP partnership baseline; representatives who did not shared services with between SWAHS • reduce minor wish to follow up children a focus on: and CHW to orthopaedic trauma with minor trauma that had • the introduction manage minor presenting to CHW been treated at CHW of new models trauma in by 10% Further work peripheral centres • reduce non-tertiary Plan to reapproach with new of care and proportion of group at next GP forum. partnerships that orthopaedic work Approaching through facilitate care in done by CHW by the Divisions of General the right setting 10% Practice State Contact, Matt Hanrahan targeting • orthopaedics Operationalise • Appointment of Achieved • diabetes the MOU between Endocrinologist by MOU has been signed by • transitional care Endocrine service Feb 07 SWAHS; we have recruited CHW and SWAHS • Establishment of to the position in July 2007. regular clinics at Education has commenced Nepean by Mar 07 and fi rst clinics booked. • Handover of >50% of endocrinology patients local to Nepean, to Nepean 5 clinic by Jun 07

Transition plans will • Reduce the number Partially Achieved be established for of patients under the Reduced both numbers of all subspecialties care of CHW, aged admitted patients over 19 19 years and over, years from 135 to 87. by 50% by Jun 07 The numbers of outpatients • All remaining over 19 has increased, from patients 19 years 607 in 2006 to 670 in and over will have 2007. Some of the increase transition plan is due to bringing patients in in place to be to fi nalise transition plans, completed within as part of our strategy. 2007 Further work • 50% of patients All specialties will have between 16-18 will a process for transition have documented articulated by the end of transition plan, to be this year. completed within 6 The numbers of outpatients months of their 18th over 19 will be targeted in birthday the year ahead. We expect to see a steady reduction once the backlog of patients has been addressed.

15 To manage health services well

Health Services Strategic Process Measure Achievements in

Performance Summary Management Direction 2007/08 / Further work accountabilities required Introduce a Ongoing Expenditure of Goods Achieved responsible procurement and Services including Goods & services variance and tender drugs and high $1.5M or < 3% considered spending culture at policy complied value categories of small, refl ecting signifi cant CHW targeting and purchases expenditure number of new cost • high cost goods comply with state saving initiatives, eg blood and services contracts. and drugs noted huge improvement. • waste reduction Numerical waste Waste reduction – VHIA and 5 • staff management audit Clinical Redesign Program identifi ed big reductions in waste. Staff management – ERE variance $1.7M or < 1%, very small due to restraint over recruitment, clinical redesign and salary packaging savings $2.9M. Progress the Shared Implementation of Savings achieved with Achieved Corporate Services Shared Services reduction of staff Transitioned: IT – and transition of – estimated to be 10 October 2006. agenda Health Technology, FTE total Purchasing, payables, • Achieve savings IMET & Health general ledger, sundry • Ensure Support debtors – February 2007. appropriate SLAs Payroll – May 2007. Departments Transferred ten staff to • Maintain 5 planned during Health Technology. Four business 06/07 include other staff transferred to new continuity Purchasing, AP, positions in the Performance • Ensure high Sundry Debtors Improvement Unit. and Payroll quality service is provided by external provider

16 Actions and initiatives supporting NSW State Plan

Major actions Major actions for achieved/initiated 2007/08

Healthy Communities Performance Summary

• Improve access to quality healthcare • Sustained improvement in • Appropriate access to all measures of Access for outpatient services patients presenting to ED • Improved access for despite increased activity mental health patients – now meeting targets. • Reduce waiting time for - Enhanmced staffi ng Interventional Radiology - MAU • Improved time - EMU of throughput of • Reduced waiting times for patients attending the outpatients emergency department • Improved all waitlist • Continue to maintain indicators for planned and improve on procedures performance

• Improve survival rates and quality of life for people with • Safe discharge of long • Enhance Cardiac potentially fatal or chronic illness through improvements term ventilated patients services in health care home • Enhance Cerebral Palsy • Management plan for services asthmatics • Lymphoedema Clinic • Increase of immunisation • Improve Liver uptake Transplant services • Strengthening of split liver • Employment of transplantation practices additional Transplant • Introduction of the Surgeon Children’s Home • Continue to improve Ventilation Program timeliness of discharge for Children’s Home Ventilations Program, - aim for stay < 6 months

• Improved health through reduced obesity, smoking, illicit • Safe physical activity • Expansion of weight drug use and risk drinking program management services • Delivery of weight • Development of clinical management clinic for pathways for obese children and adolescents children • Member of SWAHS & DET • Further involvement in Strategy Group – mental the SWAHS and DET health and drug related Strategy Group issues working group • Investment in medical reports to this group staff to sustain obesity • Expansion of CNC hours to service improve access to family obesity clinic • Hospital became smoke free • Smoke cessation education program

Customer friendly services

• Increased customer satisfaction with Government services. • See customer complaint • Survey children, young as opportunity to people and families improve through Public • Involve parents/carers in Accountability planning services • Complaints resolved • Increase committees within 35 days (975) with consumer and GP representation

17 Strengthening Aboriginal communities

• Improved health for Aboriginal people • Updated Aboriginal • Continue to implement Health Plan Aboriginal Health and • “Yarning Circle” cultural Workforce plans training • Launch of Aboriginal Garden – July 2007 Performance Summary

Opportunities and support for the most vulnerable

• Improved outcomes in mental health • Telemedicine outreach – 41 • Plan for expansion of community health services emergency mental health across four rural and services remote areas • Further collaboration with • Mental Health Ward SWAHS and other AHS functioning at full capacity • Increase academic and • Statewide Eating Disorders research profi le Service • Expand Mental Health • Joint assessment with Services such as telemedicine, DADHC for Autism and Developmental Disability networks with community, • Joint collaboration with transcultural services SWAHS and CHW eg • Increase hours and scope of Redbank House Clinic Mental Health CNC • Introduction of Emergency • Potential to increase beds Department Mental available to eating Health CNC disorder patients • Research into Eating • Introduction of Eating Disorder Management Model Disorder CNC

Early intervention to tackle disadvantage

• Embedding the principle of prevention and early • Promotion of immunisation • Increase identifi cation of intervention into Government service delivery • Neonatal Screening potential obesity in children in NSW • Genetic counselling presenting to CHW for parents • Health promotion and health • Regular interviews and prevention activities external media articles on relevant to CHW paediatric health topics • Implement an agreed • Collaborate with other coordinated advocacy plan children’s hospitals as a • Implement brokerage model single voice for child and with support of NSW Health adolescent health • Engage in partnership with • Child protection promotional DET re transition of children program in place to adulthood • Burns injury prevention program in place • Ongoing road safety promotional program in place • Development of a brokerage model for funding of CP patient allied care

• Reduced avoidable hospitalisations • Continue to implement • Evaluate models of care to redesign programs ensure improved outcomes • Improved quality and safety • New model design underway of treatment with reduced for pilot targeting skin unplanned events conditions and Cystic • Identifi cation of changes in Fibrosis paediatric workforce trends and develop appropriate strategies • Community outreach modifi ed service, - addition of Nurse Practitioner

18 Corporate Governance Statement

The Chief Executive is responsible for the Strategic Direction corporate governance practices of The The Chief Executive has in place processes for the Children’s Hospital at Westmead. This effective planning and delivery of health services Corporate Governance Statement statement sets out the main corporate to the communities and patients serviced by The governance practices in operation Children’s Hospital at Westmead. This process includes setting of a strategic direction for both The throughout the fi nancial year. Children’s Hospital at Westmead and for the health services it provides. The Chief Executive Code of Conduct The Chief Executive carries out all functions, responsibilities and obligations in accordance with the The Hospital has adopted the NSW Health Code Health Services Act of 1997. of Conduct (the Code) to guide all employees and contractors in carrying out their duties and The Chief Executive is committed to better responsibilities. The Code covers such matters as practices contained in the Corporate Governance professionalism and competence, confl icts of interest and Accountability Compendium for NSW Health and fairness in decision making. published by the NSW Department of Health. Appropriate communication strategies have been in The Chief Executive has in place practices that ensure place during the year to ensure that all employees that the primary governing responsibilities in relation are aware of the Code. The Code and Statement of to the public health organisation are fulfi lled with Business Ethics are available on the Hospital web site. respect to: Risk Management • setting strategic direction • ensuring compliance with statutory requirements The Chief Executive is responsible for supervising and monitoring risk management by the public • monitoring performance of the organisation health organisation, including the organisation’s system of internal controls. The Chief Executive • monitoring fi nancial performance of has mechanisms for monitoring the operations and the organisation fi nancial performance of the organisation. • monitoring the quality of health services The Chief Executive receives and considers all reports • industrial relations / workforce development of the organisation’s external and internal auditors • monitoring clinical, consumer and and, through the Audit and Risk Management community participation Committee, ensures that internal audit and external audit recommendations are implemented. • ensuring ethical practice.

19 There is in place a risk management plan for the Audit and Risk Management public health organisation. This plan enables the management of key risk areas including: Committee Corporate Governance Statement • clinical The Chief Executive has established an Audit and Risk Management Committee. • workforce • infrastructure / environmental This committee is chaired by Mr Kevin Doyle • fi nance (independent member) and consists of the following • governance members: • reputation • Mr John Dunlop (independent member) • Chief Executive Committee Structure The Audit and Risk Management Committee The Children’s Hospital at Westmead has a meets quarterly. committee structure in place to enhance its corporate governance role and which complies with NSW The objectives of the Audit and Risk Management Department of Health policy regarding mandatory Committee are to: committees – Health Care Quality Committee, Audit and Risk Management Committee, Finance and • maintain an effective internal control framework Performance Committee, and Medical and Dental • review and ensure the reliability and integrity of Appointment Advisory Committee. These committees management and fi nancial information systems meet regularly and have defi ned terms of reference • review and ensure the effectiveness of the internal and responsibilities. and external audit functions Health Care Quality Committee • monitor the management of the key risk areas

The Chief Executive has in place systems and activities for measuring and routinely reporting on the Engagement of External Auditors safety and quality of care provided to the community. The Hospital did not engage external auditors to These systems and activities refl ect the principles, conduct any non-audit assignments. performance and reporting guidelines as detailed in NSW Department of Health core documentation relating to Managing the Quality of Health Services in NSW.

20 Finance and Performance Performance Appraisal

Committee The Chief Executive has ensured that there are processes in place to: Corporate Governance Statement The Chief Executive has established a Finance and Performance Committee. • monitor progress of the matters and achievement of targets contained within the performance This Committee is chaired by the Chief Executive and agreement between the Chief Executive and the consists of the following members: Director-General of the NSW Department of Health • Mr John Dunlop (independent member) • regularly review the performance of the Hospital through the Annual Governance Review process • Mr Kevin Doyle (independent member) • annually review the performance of employees in • Director of Information Services and Planning line with corporate objectives and targets • Director of Clinical Governance and Medicine • annually review the performance of all • Director of Clinical Operations Executives who are employed under the • Director of Finance and Corporate Services Senior Executive Service Award, through • Director of Community Relations and Marketing current performance agreements • Director of Workforce Development • Director of Nursing

The Finance and Performance Committee meets monthly.

The objectives of the Finance and Performance Committee are to:

• examine budget allocations • monitor overall fi nancial performance in accordance with budget targets • develop and maintain an effi cient, cost effective fi nance function and information systems • ensure appropriate fi nancial controls are in place • manage funds effectively

The Chief Executive complies with the provisions of the Accounts and Audit Determination for public health organisations, issued by the NSW Department of Health.

21 Clinical Governance Clinical Governance

Clinical Governance is the term used to describe the rate recorded by any Area Health Service in NSW. systems and processes that ensure that the health This fi gure was the eighth month in a row where we care provided at The Children’s Hospital at Westmead recorded over 80% compliance with hand hygiene is safe and of the highest quality possible. The practice. NSW Health and the Clinical Excellence Clinical Governance Unit is known as the Service Commission have commended the success of our Improvement Unit (SIU) and its major role is to approach and achievements, which were featured in a coordinate improvement, patient safety and consumer recent state-wide HAI newsletter. participation activities for the Hospital as a whole. Development continued on CHARLI Children’s The Health Care Quality Committee (HCQC) meets Hospital Achievements Research Links & once a month to oversight the clinical governance, Improvements) the Hospital’s database for quality improvement, patient safety and accreditation recording improvement activities, special processes at the Hospital which are coordinated achievements, external visits and information and managed by SIU. As well as supporting sharing. Screen designs were documented with HCQC, SIU also supports several other high level programming and testing well underway. CHARLI Hospital committees, such as the Clinical Review is due to be launched in late 2008. Committee, Policy and Procedure Committee, Public Accountability Committee, Clinical Review Committee Major policy and procedure (P&P) processing and the Family Advisory Council. improvements were implemented during 2007-2008, as proven through an evaluation undertaken in Patient safety initiatives have continued to be a focus July 2007 which confi rmed that all of the new P&P for the SIU this past year. We have further developed processes are signifi cant improvements from pre- and embedded incident reporting and management existing processes and that staff are more confi dent in as a cornerstone of improving safety and quality. A using hospital documents. key part of our Safety at Kids Program is the Incident Information Management System (IIMS), where we The Hospital now produces high quality policies, continue to collect incidents with a strong emphasis procedures and guidelines and the improvements on recording ‘near misses’. This information is made in the last 18 months have been so successful analysed and looks for trends and opportunities for that our P&P framework is being recognised improvement. SIU is continuing to help staff view throughout the State. Several meetings have occurred every incident and near miss as an opportunity for with NSW Health, other Area Health Services and improvement to the system. organisations, such as the Western Child Health Network, for them to look at and assess the feasibility The SIU continued to coordinate a number of hospital, of implementing our processes, in particular state-wide and national projects to improve patient ePolicy (our document control database), into their safety and quality of care. As a result, signifi cant organisations. improvements have been made in reducing surgical site infections, central venous related blood stream During 2007-2008, 165 improvement projects infections in the Intensive Care Unit and hospital were logged with the SIU, all of which underwent acquired infections throughout the Hospital. comprehensive ethical review and received support by the SIU. A large number of these improvement One key project which underpins many of the other projects involved consumers, through activities such projects is improving the hand hygiene practices as surveys, focus groups, forums and consumer of staff throughout the Hospital. Our compliance involvement on project teams. rate for June 2008 was 85% and was the highest

22 Clinical Governance

SIU continued to coordinate the benchmarking CHW also had 13 entries in the 2007 NSW Health activities through the Australian Council on Healthcare Awards, with two becoming fi nalists, which were: Standards (ACHS) and submitted over 50 indicators each six month period for comparison with other • The ‘Prioritising Paediatric Care in Disasters’ hospitals. SIU uses the comparative information project submitted by the Emergency Department provided by the ACHS to create user-friendly reports in the ‘New Risks and Opportunities’ category for the information and action of the relevant • The ‘Water Watcher Armband - Keeping Kids Safe’ stakeholders, which includes the HCQC. SIU is also project submitted by Kids Health in the ‘Make taking a lead in coordinating benchmarking with Prevention Everybody’s Business’ category the member hospitals of the Children’s Hospital Australasia (CHA). The Mental Health specifi c interest These two projects plus three of our non-fi nalist group has progressed signifi cantly in the last year to entries were asked to present their project at the compare various clinical and operational indicators NSW Health Expo in October. The three additional with peer hospitals. projects were:

Improvement and Safety Week was held from 15-19 • The ‘Parent and Carer Resource Centre - October 2007 and was a huge success with much A Practical Approach to Caring for Carers’ project, positive feedback received from staff. Around 600 submitted by SIU in the ‘Better Experiences for staff attended events during the week and the profi le People using Health Services’ category of improvement and safety was greatly enhanced. Not • The ‘Communicating Hands Free in the Kids only did a large percentage of staff attend the events ED’ project, submitted by IT Services and the held during the week, the SIU Intranet site had triple Emergency Department in the ‘Smart Choices the number of hits as normal, with almost 900 hits about the Costs and Benefi ts of Health being recorded in October 2007. Services’ category • The ‘Prioritised Clinical Assets Replacement Plan’ project, submitted by the Equipment Committee in 2007 Quality at Kids Awards the ‘Smart Choices about the Costs and Benefi ts of We had another successful Quality at Kids Awards Health Services’ category (QuAKs) in 2007, with the results being announced during the August Staff Forum. There were a total of We also won an award in the Performance Awards 23 entries submitted, comprising involvement from 99 Division, which was Most Improved Performance in staff members. The Judges Choice was awarded for the ‘To Manage Health Services Well’ category. the eight entry categories and a Highly Commended was also awarded in four of these categories. One Special Award, the Caring for Parents and Carers Award, was also awarded. The judging for the QuAKs Awards occurs completely independently of the SIU and the panels of judges are drawn from the Executive and representatives from directorates, programs and divisions. It was great to see so many staff packed into Lorimer Dods to support their colleagues and to celebrate improvement at the Hospital.

23 Clinical Governance

Category Results Safety Of Service Judges Choice: Implementing Oral Syringes in ED (submitted by the Emergency Department)

Highly Commended: Reducing CVC Related Bloodstream Infections in PICU (submitted by SIU and PICU) Appropriateness of Service Judges Choice: Push Hard Push Fast (submitted by the Resuscitation Committee) Effectiveness of Service Judges Choice: Policy and Procedure Processing Improvements (submitted by SIU and IT Services)

Highly Commended: Improve Hospital Inpatient Revenue (submitted by Patient Administration) Prevention and Health Promotion Judges Choice: Healthy Food and Drink Provision at CHW (submitted by Nutrition & Dietetics and Food Services) Partnerships with Consumers Judges Choice: Parent and Carer Resource Centre (submitted by SIU)

Highly Commended: Refurbishment of the Clancy Ward Interview Room (submitted by Clancy Ward) Partnerships with External Groups Judges Choice: The George Gregan Foundation Playground (submitted by Fundraising and Allied Health) Education and Training Judges Choice: Physio’s Think Kids (submitted by Physiotherapy) Special Award Results: Parent and Carer Resource Centre (submitted by SIU) Caring For Parents and Carers Award

24 Clinical Governance

Complaints Management, In July 2007, the evaluation report of the Parent and Carer Resource Centre (PCRC)was fi nalised, with Carer Support and initial data confi rming a dramatic increase in average Consumer Participation daily visits to the PCRC from May 2006 to May 2007. We also increased the proportion of male service users and people from ATSI and CALD backgrounds. Complaints management is the responsibility of the SIU and there are two designated complaints In July, the new policy, ‘Supporting Staff who are managers at the Hospital, the Director of Clinical Carers’, was fi nalised and the Carer Support Program Governance and Medicine, Dr Stuart Dorney, and the (CSP) formed a partnership with the Working Carers Patients’ Friend, Betty Radcliffe. Liaison Project, run by Hills Community Care, to offer services and support to our staff who are carers. All complaints are taken seriously and documented The CSP took a lead role in the refurbishment of the very carefully. As much time as is required is spent parent lounges on each of the wards in August 2007. with families in order to ensure that their concerns are addressed fully. Some matters are easily and Carers Week was celebrated and was a very quickly resolved. Others of a more serious or complex successful week. In May 2008, the CSP began the nature may take a number of weeks and numerous fi rst ever hospital-based MyTime group in Australia discussions and meetings to reach a satisfactory and is working in partnership with Playgroups outcome. Australia. The Carers Action Plan was developed, consulted on and fi nalised over the 2007-2008 period Frequently raised issues include diffi culties with and submitted to NSW Health in July 2008. The physical access, access to services, communication Carer Support Program continued to offer a range and hotel services. of events and activities for parents and carers in the Parent and Carer Resource Centre throughout 2007- All complaints and the processes involved in achieving 2008, with almost 4000 occasions of service. resolution are reviewed by a high level committee, the Public Accountability Committee (PAC), which The Family Advisory Council is the peak consumer meets quarterly. The Chief Executive chairs PAC and group at The Children’s Hospital at Westmead and is membership includes most of the senior executive, a dynamic and motivated group of parents who have a representative of the Medical Staff Council and made signifi cant contributions to improvements at the two community representatives. The complaints Hospital. Some of the things they have been involved mechanism is a rich source of improvement activities in this year and have provided feedback from a family and each complaint is regarded as an opportunity to perspective are: review and revise policy and practice. • The redesign of the Emergency Department During 2007-2008, 272 patient complaints were • The CHW Smoking Cessation Committee received, with 16 of these being Ministerials and • Various Clinical Redesign projects seven being referred from the HCCC. NSW Health • The Improvement Action Plan from the 2007 NSW KPIs for complaints management are 100% Patient Health Survey, and acknowledgement within fi ve working days and 85% • Staff Guidelines on Consumer Participation resolution within 35 working days. Our KPIs for the year under review are 92% and 96.5% respectively The FAC have also been Involved in the recruitment and we are consistently the best performer in of several key consumer staff positions, as well as complaints management across NSW Health. looking nationally and internationally at how best practise peak consumer groups operate elsewhere. We participated in the 2007-2008 NSW Health Patient Survey and we were very pleased with our results. Across three categories, paediatric inpatients, emergency patients and outpatients, 89% of families rated our overall care as very good, which was higher than the State average of 88%.

25 Activity Levels

Clinical Governance Notes 2007/08 2006/07 2005/06 Bed Capacity Total Beds at 30 June 339 339 339 Average number of beds available during year 1 266 264 268 June bed Equivalents 2 267 272 271 Patient Details - Inpatients Number in hospital at 1 July 211 194 207 Separations during year 25,731 27,625 26,775 Planned as % of total admissions 53% 45% 48% Same day as % of total admissions 43% 47% 48% Total patients treated 25,965 27,836 26,969 Number in hospital at 30 June 234 211 194 Bed days of inpatients treated 88,080 87,526 86,165 Acute Bed Days 3 88,080 87,526 86,165 Overnight acute bed days 3 77,009 74,627 73,391 Number of operations 14,274 13,537 13,294 Outpatients Total occasions of service 4 732,947 575,147 665,537 Emergency Department attendances 49,630 48,895 45,818 Expenses – All Programs ($1000) 313,777 301,908 275,907 Averages Daily average of inpatients 5 241 240 236 Adjustment for outpatients 200 188.0 182.3 Adjusted daily average (ADA) 6 441 428 418 Average stay of inpatients (days) 7 3.42 3.17 3.22 Bed occupancy rate (%) (after adjustment for weekday beds) 8 86% 83% 90%

Notes:

1. The 2005/06 fi gure is not comparable with other years as it covers only June data instead of full year (due to the introduction of SAP Bed count system). It is calculated as Total Available Beds / No. of days in fi nancial year. 2. 2007/08 and 2006/07 fi gures are not comparable with previous years as they exclude bed types mentioned in Note 1. They are calculated as Total June Beds/30. 3. Acute bed days and acute separations are defi ned by service category of acute or new born. 4. Total occasions of service includes groups, individual and telephone consults excludes some activity performance programs. 5. Daily average of inpatients = Total Bed Days / No. of days in fi nancial year. 6. Adjusted daily average = Daily average of inpatients + Adjustment for outpatients. 7. Acute average length of stay = Acute bed days / Acute separations. 8. 2007/08 and 2006/07 information are not comparable with previous years as bed occupancy calculations now exclude the following bed types: Emergency Departments, Delivery Suites, Operating theatres and Recovery Wards, and include surge beds.

26 Service Planning Service Planning

The Information Services Portfolio has been expanded • The Governance process for setting priorities and to include Planning and Population Health. the approval of business cases has been refi ned and adopted Hospital-wide. All initiatives are now Highlights through the year include: tracked in a central data base. • Our planning and performance framework is • The fi nalisation of key strategies to guide the supported by excellent technology and has Hospital into the future including a Corporate been expanded to include a corporate Strategic Plan, supported by a draft Healthcare scorecard, operational dashboards, Services Plan, Financial Impact Statement and management reporting and risk-profi ling. Clinical Service Plans. Underpinning these are a This will provide the Hospital with the ability range of key enabling plans, including fi nancial, to track performance against strategy asset, workforce and IT, which ensure our planning becomes reality by providing the necessary building blocks. The emphasis has now shifted to marketing the Hospital’s vision of ‘Healthy Children for a Healthy Future’ and building on our strengths as leaders in clinical care, research and education.

27 Overview of Operations Overview of Operations Ambulatory and Emergency Child Development Services Child Development Services are located within the Program Child Development Unit (CDU), the Parramatta Early Childhood Assessment Team (PECAT) and the The Ambulatory and Emergency Program represents Disability Specialist Unit (DSU), Burwood. These a group of clinical departments and wards that services provide a comprehensive range of tertiary provide services to children with a wide range of level assessments of children with developmental medical, developmental and behavioural conditions. delay and complex developmental disorders from The Program includes the Emergency Department across NSW. and inpatient services within the adolescent and mental health wards. The other Departments primarily A major working meeting was convened to enhance provide outpatient services through the Outpatient communication and networking among developmental Clinics, Child Protection Unit, Child Development disability services within NSW. The meeting initiated a Unit and the Departments of Adolescent Medicine, major service mapping exercise that will enable better Deafness Centre, Dentistry, Psychological Medicine, service planning and coordination. Within the CDU, Rehabilitation and the Children’s Hospital Institute of assessments of preschoolers were further refi ned Sports Medicine (CHISM). Where required, outpatient with updated testing tools. There was an increase services are provided through home and school visits. in joint consultations with genetics services and a comprehensive survey was undertaken to obtain During the past year, initiatives have occurred in all feedback from parents and other services on the areas in response to changing needs, demands and assessment process and services provided. new opportunities. The survey confi rmed the high regard for this Adolescent Medicine specialised developmental service and identifi ed Comprehensive multi-disciplinary health care and opportunities to enhance communication and health promotion is provided for young people with information provided. The Developmental Outreach complex medico-psychosocial presentations, nutrition Service to Broken Hill was further consolidated. and eating disorders, chronic illness, disability The School Starters Group, led by Social Worker, transition and gynaecological issues. Janis Mendoza, and Occupational Therapist, Neralie Cocks, was further enhanced with the integration The key highlight over the past year was the highly of successful parenting techniques and received successful International Youth Health Conference, that recognition at the International Conference on Social attracted over 500 participants from across Australia, Work in Health Care. New Zealand and the South Pacifi c. An inaugural Fellowship in Adolescent Addiction Medicine At DSU, new medical specialist appointments provided an excellent training opportunity, increased were made with Dr Anna Ward, Staff Specialist awareness of addiction issues among young people in Developmental Disabilities and Dr Jim Xu, and improved systems of assessment and early Rehabilitation Staff Specialist (adults with intervention. developmental disability), commencing. A Clinical Psychology Student Placement Unit was also The Transition Care Project enabled better planning established at DSU, led by clinical psychologist Louisa and preparation for young people with a wide range of Carroll, in conjunction with the University of Western chronic conditions moving into adult health care. New Sydney and University of NSW. triage procedures were introduced to ensure timely assessment of young people presenting with complex The Unit provides experience in diagnosis and conditions. Planning towards the establishment of assessment of children and adults with developmental a Chair in Adolescent Medicine was undertaken, in disability. A project was undertaken to establish conjunction with Sydney University. and refi ne a key referrer pathway. This initiative has enabled more timely and effective referrals and better support for families through the assessment process when parents often learn about the extent of their child’s disability.

28 Overview of Operations At PECAT, new Visiting Medical Offi cer appointments Children’s Hospital Institute for were made, with Dr Meg Phelps and Dr Robert Sports Medicine (CHISM) Hardwick. A range of initiatives were also introduced CHISM provides a leading service in clinical paediatric to provide more information and support families sports medicine, paediatric sports physiotherapy, through the assessment process. An interagency clinical research, education and training. This year forum was conducted to inform a wide range of early saw a signifi cant increase in the number of patients childhood organisations about services provided referred from clinical departments within the Hospital, through PECAT and to enhance networking and particularly from the Weight Management Service and collaboration among services. Endocrinology, as well as an increase in the number of referrals from external sources. Dr Paul Hutchins, Dr Natalie Silove, Dr Jacqueline Small and Dr Bee Hong Lo made signifi cant Research was initiated into ‘best practice’ models for contributions to the fi eld of developmental paediatrics exercise testing and exercise prescription for children with major contributions to the development of policy with a wide range of illness and disability, such as and practice in areas such as autism intervention, haemophilia, cerebral palsy, insulin resistance and early childhood services, developmental screening, morbid obesity. A major initiative was taken toward the needs of people with intellectual disability and establishment of a national Adopt-a-School Program, management of ADHD. to promote fi tness in schools in partnership with the peak body, Fitness Australia. Child Protection Unit (CPU) The Child Protection Coordination Committee, chaired CHISM received international recognition through by the Chief Executive, brought greater recognition links established with KK Women’s and Children’s of child protection as an important concern for all Hospital in Singapore and Beijing Children’s Hospital, clinicians. and contributed to the establishment of paediatric sports medicine in these hospitals through hosting Clinical services were surveyed in relation to their visiting fellows. A new Human Movement Laboratory support needs when dealing with complex and was opened in the Research Building, which provides challenging child protection situations and in- state-of-the-art exercise equipment and much needed service training programs were further enhanced. additional space for testing. Involvement in World Child Abuse Prevention Day and promotion of The Children’s Hospital at Westmead’s The Deafness Centre Child Protection Awards has increased awareness of Hearing loss is a common and pervasive problem. vulnerable children and the value of early intervention It may invade every aspect of a child’s or adult’s life. and timely support to families experiencing parenting At some time in their lives, one in six Australians stress. will have a problem with hearing loss. To help draw attention to this problem, the Deafness Centre, Dr Anna Stakurska established a new developmental Audiology, Psychological Medicine and the Children’s assessment and screening service for children in out- Cochlear Implant Centre organised an information of-home care, a new clinic was established for review stall in the Hospital for Hearing Awareness Week to of complex sexual assault cases and the Shaken highlight services available to assist deaf and hearing- Baby Prevention Project gained wider international impaired children and their families. recognition through a range of conference presentations. The CPU also received recognition In addition, the Deafness Centre and Educators of at the QUAKS Awards for the Healthy Children’s Deaf Students Association held a conference in July Program, which provides an outreach service to the which was helpful in updating many people regarding Sydney West Addiction Services for young children recent developments in deafness. It also allowed our who have parents enrolled in a methadone program. staff to network with many teachers of the deaf from rural and metropolitan areas. A combined Deafness Centre/ Psychological Medicine Clinic was established to address the emotional and behavioural problems of deaf and hearing impaired children.

29 Overview of Operations Dental families and staff to obtain their feedback and gather A comprehensive dental care service is provided for ideas for improvement. These discussions produced a inpatients and outpatients requiring complex dental range of ideas which were able to be implemented to care, often associated with other medical conditions. streamline the patient journey.

A research project was commenced to evaluate new The Emergency Department received a QUAKS restorative dental materials and better understand awards in 2006 for service improvement projects on saliva fl ow in patients with chronic and disabling safely administering medications via infusions pumps conditions. Oral health education programs were and submitted four projects for the QUAKS awards for introduced into support groups for parents of children 2007. with haemophilia, renal problems and liver disease. Head of Department, Dr Richard Widmer, also made Kidsnet received a total of 17,627 calls over the year signifi cant contributions to oral health education from parents regarding the acute care of their child. through training programs for rural doctors, speech Our experienced nursing staff give advice on common pathologists and nurses. illnesses and direct families to the most appropriate care for their child. Eating Disorders Service Our outreach services are undergoing a major review The Eating Disorders Team, led by Dr Michael Kohn to work towards service delivery which allows for from the Department of Adolescent Medicine and Dr children to be cared for in the home. Sloane Madden from Department of Psychological Medicine, has received recognition of their world Mental Health Services standard service in obtaining a NHMRC grant for $530,000. Mental Health Services have made signifi cant progress through expanding partnerships, new The study is examining the effectiveness of the appointments, improving services, establishing Maudsley Model Family Therapy Service with a internationally recognised research and contributing shorter versus longer admission, and is conducted to statewide planning to address an increase in the in collaboration with the Adolescent Medical Service demand for Mental Health Services in the Emergency at Westmead Hospital. The study has the potential to Department of 300% over the past three years. further advance care by reducing the amount of time young people with eating disorders need to stay in The role of the Mental Health CNC in the Emergency hospital. Department has become an integral part of emergency services, providing more timely and Emergency Department effective assessment of young people with acute mental illness. There has also been a corresponding During the year 48,974 patients were seen and reduction in clinical incidents, including presentations treated in the Emergency Department. There was an of incidents involving self-harm or aggressive increase in the numbers of children presenting with behaviours, through more systemised harm gastroenteritis in spring, asthma at the start of the minimisation training for our Emergency Department school year and bronchiolitis in autumn. The increase staff. in the numbers of acutely ill children presenting to Emergency has continued to put pressure on waiting The leadership of Hall Ward Mental Health Inpatient times. Changes planned for the next fi nancial year Unit has been consolidated with the appointment will improve the overall patient experience for children of Dr Lucy Chapman, who works collaboratively and families. with the Nursing Unit Manager, Mr Earle Durheim, in a nursing/medical co-management model. Hall There was a focus on the journey of emergency Ward is leading the development of standardised patients through the Hospital in a major Clinical clinical indicators throughout the Australasian Child Redesign Project. The Project reviewed the full and Adolescent Mental Health Services to facilitate patient journey through the Emergency Department, benchmarking environments that specialise in this diagnostic tests, admission to wards and discharge area. from Hospital. Focus groups were held with both

30 Overview of Operations As part of the closer collaboration with Sydney West NSW Centre for the Advancement of Adolescent Health AHS, an Outreach Mental Health Service has been The Centre aims to build the confi dence and established through two staff attending community capacity of partner agencies in responding to youth clinics at Castle Hill and Parramatta North. The health issues through research, dissemination of initiative will provide better access to specialist information and resources, delivering professional assessment for children and young people and clinical education and training and contributing to advocacy support for community health professionals providing and policy development. Key highlights have been ongoing care. the organisation of a major youth health forum, ‘Youth Services in Western Sydney’, the launch of an The clinical partnership with the Statewide important report on young people’s access to health Behavioural Intervention Service of the Department care, publication of a youth health better practice of Aging, Disability and Homecare has produced framework and completion of the Spinning the Web important new research initiatives to assist children Project, which will improve the coordination and with developmental disabilities in two areas. The fi rst linkages among services. involves the development of educational curricula to train community professionals treating children with Outpatient Department mental health problems and intellectual disability. The Over the past three years, the number of outpatient second aims to establish and research an Emotion- attendances has doubled. The increase in outpatient Based Social Skills Training Program for young activity has produced new challenges and this people with Autism or Asperger’s Syndrome and mild year has seen a number of exciting changes. The intellectual disability. management structure of the Department was enhanced with the establishment of a new Clerical The Child and Adolescent Psychiatric Telemedicine Manager position and increased administrative Outreach Service was consolidated through research support to the Eye Clinic. Telecommunications have that found a high level of satisfaction with the range been upgraded, resulting in signifi cant reductions and quality of the teaching and supervision provided. in waiting times for parents making appointments A statewide reference group is being developed and more effi cient processes for staff. A monthly to enable further service planning in collaboration newsletter has been created to inform staff of new with the Child and Adolescent Mental Health developments and involve all clinical teams in service Subcommittee of the NSW Mental Health Program improvements. Council. The customer focus has been further enhanced, with Ruth Urwin, molecular biologist was the co- the streamlining of check-in procedures. There is investigator for two signifi cant NHMRC grants for now a smoother fl ow of patients, even on the busiest $422,000 for ‘Relating genetic, biological, and clinic days, with very few complaints regarding delays. behavioural markers of early vulnerability in conduct There have been corresponding improvements in the problem children’ and $472,000 for ‘Healthy Start to accuracy of data collection and billing procedures. Life’. An innovative Clinical Nurse Specialist position was established to support the ENT clinics and assist in In the last year, the Program developed a number identifying children with more urgent problems. of initiatives to assist children and young people with complex needs who are in out-of-home-care. Rehabilitation Department A partnership between The Children’s Hospital at Westmead, Sydney West AHS and the Department of The Rehabilitation Department is a leader in fi ve Community Services was further developed, with the specialist clinical areas, cerebral palsy, spinal cord appointment of an additional part-time staff psychiatry injury and disease, acquired brain injury, spina position. A specialised mental health service for bifi da and limb defi ciency. A tertiary and quaternary children in care of DOCS was also enhanced, with multidisciplinary clinical management service is the appointment of a Clinical Psychologist. This has offered for children and adolescents with physical and enabled a signifi cant number of children who require acquired cognitive disability. intensive support to be able to live in the community.

31 Overview of Operations The Department faces a growing demand for services, to link with their model of care and offer a more after a 20% increase in occasions of service in the last coordinated medical specialist review. 12 months. Inpatients and outpatients from across NSW are treated and a model of transition is in place, Active pursuit and assessment of suitability of whereby children are seen regularly over several years improved treatment options will continue to be and then referred to an adult service for ongoing undertaken. Functional electrical stimulation cycling management. and strengthening for children with spinal cord lesions, or as part of a spasticity treatment program, The Rehabilitation Department is a training centre for has been implemented. consultant Rehabilitation Paediatricians and utilises a multidisciplinary, family-focused model of care. Brain Injury Service Signifi cant input into the Connective Tissue Dysplasia We have been reviewing resources, service delivery Service is provided, which is coordinated through the and staffi ng, to improve service provision to children Clinical Genetics Department. with brain tumours and children following epilepsy surgery. Inpatient and outpatient provision of care is being reviewed by the Rehabilitation Department. This is Spina Bifi da focussing on inpatient and outpatient rehabilitation The Spina Bifi da Team has been succession planning activity. The pivotal role of the Clinical Nurse for the Clinical Nurse Consultant and Consultant Consultants in the relevant areas is also being positions. reviewed. Limb Defi ciency Clinic Growth of clinics, increase demand on clinic and assessment space and increases in staff numbers Fundraising has taken place to fund newer expensive will continue to require consideration for capital technologies. There is now clearer documentation works and/or acquisition of suitable space for clinical of positive outcomes and cost and this practice will practice to take place. infl uence policies in the future through evidence- based best practice. Physical Disability Service A business proposal has been considered by Medical Program Senior Management for a funding package for a multidisciplinary team. The urgent area still to be The Medical Program has continued to work with all addressed is an immediate increase in therapist and medical and nursing teams to improve effi ciency of staff specialist positions. service delivery. Many services have seen increasing workloads during the year, with both increased A priority system for new referrals and follow-up numbers of inpatients and outpatients. With a number reviews has been implemented. Active pursuit and of senior physicians reaching retirement age, work assessment of suitability of improved treatment is taking place on succession planning in many options will continue to be undertaken. The main Departments. focus is on Deep Brain Stimulation (DBS) for children with severe Dystonia and Robot-Assisted-Walking Highlights during the year include: (RAW) for children after intervention. • Successful completion of the Ward Realignment We are exploring greater opportunities to discharge Project through which it was demonstrated that and transition adolescent patients by working with the patients’ journeys through the Hospital was adult specialists shortened by cohorting general medical patients on Hunter Baillie Ward Spinal Cord Injury and Disease We have implemented changes to the clinic system, • The successful establishment of the Medical where children with a spinal cord injury are now seen Assessment Unit in Hunter Baillie Ward, to enable at the same time as the children with Spina Bifi da, children with illnesses requiring short stays to be discharged more rapidly

32 Overview of Operations • Funding for junior medical staff and a Clinical clinical research. The Liver Transplant Unit also Nurse Consultant for the Medical Assessment Unit received a $100,000 donation from the Inner Wheel Club. • The appointment of the fi rst Staff Specialist in Australia dedicated to the management of children Gastroenterology continues to have a large infl ux of with obesity infl ammatory bowel disease (mainly Crohn’s disease) • The appointment of an additional Staff Specialist in with referrals exceeding 40 per annum over the last Neurology fi ve years. In both situations we have been helped considerably by the establishment of a medical Fellow • The appointment of Fellows in Liver Transplant position for Liver/Liver Transplant and a Database and Neurology Manager’s position.

• Additional funding for the Poisons Information Centre Academically, the highlights include the publication of the James Fairfax Institute of Paediatric Nutrition’s Dermatology longitudinal study of energy metabolism in cystic Dermatology is one of the fi rst services to take part in fi brosis, with accompanying editorial comment in the the new Community Acute/Post Acute Care Service. premier international paediatric journal, the Journal of Throughout the year, plans have been developed Paediatrics. to allow a home-based service for wet dressings for illnesses such as eczema. This service, which should Vicki Jermyn, CNC Liver Transplant Unit, received the be fully functional by the end of 2008, will allow many Rotary International Paul Harris Fellow Award Medal children to have their care at home, rather than travel from the Hills Rotary Club for her devoted work to sick frequently to The Children’s Hospital at Westmead. children in the community.

General Medicine Gastroenterology, Hepatology and Liver Transplant Unit General Medicine has seen many changes in the last The Liver Transplant Team has now performed over twelve months. An ambitious Clinical Redesign Project 200 transplants and, during the last eight years, the resulted in signifi cant improvements in the patient vast majority of the patients have received split liver journey, with more co-ordinated discharge processes, grafts in which the child receives the smaller left shorter length of stay and improved team-work lobe of a donor liver, allowing the larger right lobe to amongst the medical and nursing staff. be transplanted into an adult recipient. Despite this being a more diffi cult procedure, the current two year After many years of contribution to the Department survival is 100%. as Heads of Medical Teams, Dr Maurie Gett, Dr Chris Poon and Prof Henry Kilham have stepped down from The Liver Transplant team also reported a world fi rst, these positions. where a young girl transplanted for acute liver failure became completely tolerant of her new liver, enabling General Medicine continues to play a prominent her to stop taking all of her immunosuppressant role in junior medical staff training. There have been medication. Laboratory studies, done in conjunction major improvements to the junior staff roster including with Dr Stephen Alexander’s Renal Laboratory, consistent attachment to one of the medical teams demonstrated that her immune system had changed for both the registrar and resident, improved cover and become that of the donor. This unique event was of the wards and the Emergency Department after reported in the New England Journal of Medicine in hours and a new roster, resulting in improved clinical January 2008, along with an editorial, and received experience and better supervision. A new initiative, widespread international media coverage. in collaboration with the Anaesthetic Department, is for one of the General Medical registrars to attend an Dr Michael Stormon and a group of friends undertook anaesthetic list each week for airway management the arduous Kokoda Track walk over the Anzac Day experience. This has signifi cantly increased the skills period this year, using it as a means of rasing money and confi dence of the registrars in resuscitation for the Liver Transplant Unit. Thus far, nearly $40,000 situations. has been raised, which will be used to help undertake

33 Overview of Operations The annual FRACP clinical examination was organised These improved avenues of communication between by the General Medical Fellow, Dr Jeanette Marchant, physicians, nurses and allied health professionals with the support of Dr Ken Peacock, regional is particularly important in the case management of examiner for the RACP and acting Network Director long-term chronically ill patients and has resulted in of Paediatric Physician training. This year, due to the improved patient and family experiences, improved large number of candidates, the exam was held over communication amongst the multidisciplinary team, two days at The Children’s Hospital at Westmead. This expedited discharges and a smoother transition to was a large and complex task which, to Jeanette and home care. Ken’s credit, ran without mishap with complimentary feedback from the examiners and families involved. Hunter Baillie is involved in the reviewing and rewriting of the intravenous cannulation policy, with Dr Emma McCahon, who is acting as Head of General plans for some nursing staff to become accredited. Medicine during Professor Kilham’s long service leave, Hunter Baillie, in conjunction with Clancy Ward, has continues in her role as State Director of Paediatric coordinated and presented a study day, entitled ‘Pee Training for NSW Institute of Medical Education and and Puff Study Day’ to teach nurses about kidney and Training (IMET) and has recently been appointed to respiratory disorder. This was open to internal and the IMET Management Committee. external participants and was a huge success with great attendance. General Medicine continues to play a key clinical support role in a number of services across the Variety Ward Hospital, including Adolescent Medicine, Eating Variety Ward has had another busy year, with a Disorders, Immunology and Allergy, Haematology, substantial increase in the number of oncology Vascular Malformations and Rheumatology. This is at patients, including bone marrow transplant patients, both a junior staff and senior staff level. In addition, who require isolation. Variety Ward received a General Medicine continues to play a key role in donation of $22,000 from the Oncology Department organising Grand Rounds, the Annual Paediatric to purchase two fi xed monitors, which has given the Update and the Clinical Ethics Discussion Group and ward four high observation rooms. is co-ordinating the writing of a new edition of the Children’s Hospital Handbook. The Variety Ward Staff Recognition Award was introduced at the beginning of the year, with staff Hunter Baillie Ward nominated by their peers. This has certainly increased Hunter Baillie Ward cares for many children admitted moral amongst the staff. Variety Ward has supported under General Medicine. Following on from the four new graduate nurses. They were provided with success of the Ward Realignment Project 2007, a comprehensive orientation program. They have all which aimed for all general medical patients to be had positive experiences and some have requested cohorted in Hunter Baillie Ward and increased bed positions in the ward at the end of their training. numbers to 27, a Medical Assessment Unit (MAU) was set up. The aim of the MAU is to improve patient Variety Ward is currently in the second year of the transfer from the Emergency Department to the TLC Project (Teamwork, Learning and Change), which ward and discharge children within 72 hours, where is facilitated by the Variety Ward Educator and the appropriate. Nursing Research and Practice Development Unit. The workplace culture analysis has taken place and A Senior Registrar has been appointed to the MAU there are currently six projects being worked on with to ensure regular patient review and to facilitate early four to six staff in each group. Projects include ‘How discharge. do we value the contribution of each member of the team?’ ‘How do we provide opportunities and support The Clinical Coordinators or the Team Leader attends for staff’s learning and development?’ ‘How do we give the morning medical handover meeting. This enables and receive feedback?’ and ‘How do we support staff nursing staff to have a more effi cient plan of action in developing leadership skills?’ for patients on the ward, particularly in relation to discharge plans, and also allows them more Variety Ward had two staff members present at the opportunity to provide input into a child’s care. ACPCHN conference in Darwin, which was very well

34 Overview of Operations accepted. The staff are now working on a handbook research interest in nephrotic syndrome and in the and updating the policy for the administration of study of antecedents of renal disease in Aboriginal Ribavirin. children and young adults. The latter study was funded for a further fi ve years by the NHMRC. Dr Variety Ward is one of the wards utilised by UTS as a Stephen Alexander has received research funding Clinical Development Unit for third year students. We from the NHMRC to study regulation of immune cells participated in this program in 2007 and it was very in kidney disease and is involved in an international successful. These students are studying paediatrics as study of processes of rejection in kidney transplants. their sub-major. We are also preparing Team Leader He continues work on the genetics of renal disease Workshops, aimed at staff who are working towards with Dr Fletcher, who is completing his PhD research. the Team Leader role. Several topics will be covered He has also been involved in organising the recent in one hour workshops in the clinical area, facilitated World Transplantation Congress in Sydney. by the Clinical Nurse Educator and Nursing Clinical Co-ordinators. We are aiming to provide support and Prof Jonathan Craig has completed his work as education, as well as sharing experiences from other co-editor for a new book, entitled Evidence-Based senior members of staff. Nephrology, to be published in 2008. Dr Elisabeth Hodson was one of editors for the paediatric section Nephrology and Renal Treatment Centre of this book while she, Prof Jonathan Craig, Dr Patrina The Nephrology Service continues to have between Caldwell and other members of the Centre for Kidney 1500 and 2000 inpatient occasions of service Research contributed chapters. Dr Elisabeth Hodson annually. Outpatient visits have increased to almost and Dr Stephen Alexander, as well as Prof Jonathan 1900 per year. The Renal Treatment Centre continues Craig and Dr Gabrielle Williams, contributed chapters to have a large workload, with over 1000 episodes on the steroid responsive nephrotic syndrome and of peritoneal dialysis, haemodialysis and plasma urinary tract infection respectively in ‘Comprehensive exchange treatments each year. We continue to have Pediatric Nephrology’, a recently published paediatric a strong transplantation program with a recent series nephrology textbook. of young recipients who have all done well. The development by Dr Patrina Caldwell of separate Dr Deborah Lewis is the Paediatric Stream Coordinator clinics for children with incontinence problems for Advanced Training (specialities) at the Institute of has freed up Nephrology Outpatient Clinic time, Medical Education and Training. She continues to play allowing staff to see more patients without delays. a major role in the education of the junior medical During 2007-2008, outreach clinics were provided staff. She has continued her interest in transplantation to Canberra Hospital and to Bathurst and Orange, and lupus nephritis, with a recent period of study time in addition to clinics at John Hunter Hospital in at Guy’s Hospital in London. Newcastle. The expansion of the Bladder and Nocturnal Enuresis Clinics allows an average of 27 Prof Jonathan Craig has received his Professorship, children to be seen each week, with a reduction in in recognition of his many academic activities. He waiting times. This service is the only multidisciplinary has completed the PRIVENT trial, which aimed to service of its kind in NSW and patients from all over determine whether antibiotics prevented recurrence of NSW have found help for their incontinence problems. urinary tract infection, and the results are awaited. He We are increasingly referred complex patients who continues to oversee the FEVER study, which aims to have failed previous treatments, with an excellent develop a decision support system to assist clinicians success rate. in determining whether a child has a serious bacterial infection. He has recently been appointed chair of The team has expanded to include a general the NHMRC Clinical Trials Committee. His clinical paediatrician, two continence nurses, three research effort has continued to expand and attract physiotherapists, a nurse aid and a clinical many students and researchers. psychologist. We also play an important role in educating clinicians in the management of urinary Dr Elisabeth Hodson, in addition to her clinical incontinence and members of the team are frequently nephrology role, has continued as Co-chair of the invited to speak to doctors, continence advisors and Medical Program. She continues her strong clinical the general public on incontinence issues. We have

35 Overview of Operations produced an education resource for clinicians, the Neurology Nocturnal Enuresis Resource Kit, which has proved This has seen a busy year with many landmarks very popular. and new initiatives. We have seen the departure of Dr Elizabeth Fagan as Head of Department, with The ongoing challenge for the Renal Service has Dr Deepak Gill taking on this role. Dr Fagan and Dr been the shortage of renal nurses and, in particular, Jayne Antony have steered the Department through a paediatric renal nurses. Despite continuing period of transition, which will be a major theme over recruitment campaigns, the Renal Treatment Centre the next three years as the Department establishes is now critically short-staffed. Management are subspecialty interests as a major way of increasing its working hard to improve the situation. Despite these focus on specialised neurology services. diffi culties, the service continues to provide a high standard of care to its patients, due to the dedication On a world scale, neurology at The Children’s Hospital of staff, in particular the Nurse Practitioner, Jill at Westmead is represented by Professor Robert Farquhar. We hope to attract more nurses to train in Ouvrier who is in the second year of his tenure this specialty. as President of the International Child Neurology Association. He has been the driving force of the Clancy Ward Association, giving it a wider profi le helping child Clancy Ward commenced team nursing during the neurology advocacy throughout the world and helping year. This has provided better continuity of care for to secure the Asian Congress on Child Neurology, patients and learning/teaching opportunities for staff. which will be held in Australia in 2011. Team nursing is working well to provide support to staff to assist them to rapidly become competent in all basic Dr Russell Dale has been invited to be the co-editor of aspects of care provided on Clancy Ward. In support an international textbook on Infl ammatory Disorders of the Trainee Enrolled Nurse Program, we have of the Brain. This continues to highlight Russell’s increased the number of Endorsed Enrolled Nurses authority, in this fi eld in which he has already on the ward to four. Two of these nurses undertook published widely. Russell, along with Dr Elizabeth their training at The Children’s Hospital at Westmead. Fagan, have continued to build up the complex These new nurses have adapted well to the Team movement disorders clinics and the tic disorders Nursing Model of Care and are effectively delivering clinics; both services are unique to The Children’s high quality care to patients and their families. Hospital at Westmead.

We currently have a number of quality improvement The Institute for Neuromuscular Research (INMR) projects underway. These include labelling and has had a very productive and successful 2007/8 frequency of changing of intravenous fl uids/lines, – the group has published over 60 peer reviewed arrest trolley checking compliance project, admission journal articles and has been awarded nearly $1M in paperwork audit project and knowledge/administration peer reviewed funding for 2008. A number of clinical of oral opioids project. Clancy Ward has undertaken trials are actively underway including studies in the a follow-up parent satisfaction survey. Feedback on evaluation of genetic therapy for Duchenne muscular the physical environment was much more positive, dystrophy (DMD), a multi-centre trial looking at the demonstrating that the redecorating and other drug PTC-124 to treat DMD and the world’s fi rst changes we undertook last year have had a positive paediatric vitamin C trial in Charcot-Marie-Tooth benefi t for families. Feedback on care delivery (CMT) disease. In addition to this exciting work, the remained very positive. The orientation manual for INMR continues to conduct groundbreaking research the ward has had an initial review and more detailed in a number of areas: including the identifi cation and review and restyling will occur this year. Policies role in health and disease of a gene associated with and care plans relating to care of the liver transplant athletic performance and the study of the processes patient have been developed. of muscle membrane repair with an aim to develop therapies for muscular dystrophy. A Diabetes Study Day was organised jointly with the Diabetes Education Service to train staff regarding Dr Richard Webster, with colleagues, has won a grant educating parents about the care of a child with newly to study cognition and cerebellar disorders, which will diagnosed type one diabetes mellitus. be undertaken with the Children’s Hospital Education

36 Overview of Operations Research Institute (CHERI), and he will be a co- annual scientifi c meeting in Adelaide and the visiting investigator looking into the relationship of memory specialist to the International Workshop on Epilepsy in and epilepsy. New Delhi in 2008.

The Comprehensive Epilepsy Program (CEP) has 2007/08 has seen the introduction of a phone triage continued to fl ourish, and is now fi rmly established system for children with epilepsy, which allows their as part of a combined adult and paediatric diffi culties to be dealt with promptly and expertly by Westmead Comprehensive Epilepsy Program. This doctors and nurse clinicians. Fiona Wade and Tony combines specialised children, adolescent and Galea have been driving this new initiative, that is adult services and expertise at one site. The CEP is providing quality care for children with epilepsy and a multidisciplinary program that offers the highest reducing visits to emergency and outpatients. level of care for children with complex epilepsy, bringing together teams from nursing, neurosurgery, The next 12 months will see changes as the neuropsychology, imaging and rehabilitation. Neurology Department enters a transitional phase. One of the major goals will be the establishment of a The last year has seen the 100th surgery performed Neurology Training Program, allowing comprehensive for epilepsy at The Children’s Hospital at Westmead training in all aspects of neurology at a single campus. and, in most of these children, the operation has been Research initiatives are underway in many areas of curative, allowing them to live a life free of seizures. neurology, with targeted areas being critical care, This expertise has allowed us to win the prestigious status epilepticus, neuroinfl ammatory disorders and Asian Oceanian ESA scholarship for Dr Vinayan language and memory. Puthenveetil, a talented Paediatric Neurologist from Cochin, India who will be appointed as an Honorary Neurosurgery Fellow for 2008/09 to allow him to gain expertise in The Neurosurgical Unit has been accredited epilepsy surgery to establish a centre in India. for paediatric neurosurgical training by the Royal Australasian College of Surgeons and the Ms Samantha Soe underwent a clinical attachment Neurosurgical Society of Australasia, until 2011. We in Uppsala, Sweden and has established a high offer an accredited training registrar position and one standard of neurophysiology technology running the non-accredited registrar position. The accredited Video-EEG Service. The Video-EEG Service, as part registrar is appointed by the College of Surgeons. of CEP, has been running effi ciently with very few cancellations and excellent patient fl ow, monitoring The Surgical Epilepsy Service continues to expand. over 150 children per year, in addition to the 2300 A NSW Paediatric Epilepsy Group has been formed, EEGs performed per year. The Service has been with regular meetings at The Children’s Hospital at helped signifi cantly by very generous donations from Westmead, to look at services available in the state the Humpty Dumpty Foundation and the Economus and advise NSW Health about resource allocation. Sisters, who donated new EEG monitoring equipment. This group continues with gaps in service being identifi ed and presented to government. Surgery for The collaboration with the Epilepsy Research Centre spasticity continues as before, with botox clinics, in Melbourne continues into its second year with baclofan pumps and selective dorsal rhizotomy now observations from patients at The Children’s Hospital offering the children of NSW a complete service in the at Westmead, allowing us to make signifi cant management of cerebral palsy. Referrals for selective breakthroughs into the genetic causes of epilepsy dorsal rhizotomy from interstate have been treated. and mental retardation. The collaboration between the CEP at The Children’s Hospital at Westmead Craniofacial work progresses, with the introduction and Sydney Children’s Hospital, as well as the adult and approval by the Therapeutic Goods Administration programs, has allowed epilepsy services to come to of springs for the surgical correction of craniostenosis. the fore and this has resulted in a signifi cant grant There is an increasing workload surgically and from NSW Health to build epilepsy services and through the Outpatients Department. The Unit has increase evaluations for complex epilepsy throughout helped Operation Smile in Hanoi Vietnam over the NSW in 2008-2009. Dr Deepak Gill was invited as past two years, with visits to the Military Hospital 108 a guest speaker to the Epilepsy Society of Australia to do complex craniofacial surgery. A further visit is

37 Overview of Operations planned for October 2008. The ward has continued to receive much appreciated fi nancial support from three of its sponsors. The Shunt Infection Study, with the Clinical Brainwaves are developing a survival kit for parents of Excellence Commission, which commenced in April children who are admitted to Commercial Travellers 2007 and is funded through the Safer Systems- Ward, the Rouse Hill Renegades Rugby Club Saving Lives Initiative from NSW Health, continues have provided funds for the purchase of a Phillips with outstanding results. The shunt infection rate Monitor for the telemetry room and the upgrade of has dropped from 7.5% to 1.4% as a result of the the playroom and ward interview room has recently introduction of a strict shunt insertion protocol and commenced, with funding support from the George excellent compliance. This protocol is now standard Gregan Foundation. practice. Two of the consultant staff has been involved with the Clinical Excellence Commission by doing Oncology, Camperdown Ward and the the Clinical Leadership Program in 2007 and 2008. Oncology Treatment Centre Clinical auditing continues, with surgical data and In 2007, 121 new patients with malignancy were surgical indicators being directly reported to the referred to the Oncology Unit. The Oncology GMCT Neurosurgical Database electronically for state- Treatment Centre provided 6500 occasions of service wide analysis, thus ensuring good clinical governance. and Camperdown Ward cared for 2000 admissions. Service provision and advocating for additional Laboratory research continues into Aquaporins resources was undertaken to continue to provide and CSF circulation disorders. There is continuing excellent care for our patients. development of the Westmead campus, with medical staff all having appointments at Westmead and Throughout 2007 we placed particular emphasis registrars rotating through the campus for training. on the growth of services and provision of There is a sharing of resources with complex vascular adequate support structures in our departmental and base-of-skull cases being treated at Westmead. plan. Consequently, the following positions were established: Commercial Travellers Ward Commercial Travellers Ward has maintained a high • Quality Manager for Oncology Services level of occupancy over the past 12 months, but has • Offi ce Manager, Personal Assistant to Head of seen a signifi cant decrease in the number of booked Department admissions that have been cancelled. The multi- • Permanent Clinical Nurse Specialist position to disciplinary approach to providing holistic care for Oncology Long Term Follow-up patients on Commercial Travellers Ward has been • Clinical Nurse Consultant, Oncology Community upheld during 2008, through strong communication Outreach between medical, nursing and allied health staff. • Lead Clinical Research Associate • Clinical Research Associate – Stem Cell Transplantation The Ward has continued to provide a supported learning environment for new graduate nurses in the The Oncology Department has seen leadership area of paediatric neuroscience nursing, in addition changes also, with the appointment of Amy Walker to extended clinical placements for nursing students to Nurse Manager Oncology Services in mid 2007. from UTS. Seven staff are currently engaged in post During the year, the Department has worked with staff graduate studies, three at master’s level and four to focus on succession planning, on promoting role through the College of Nursing. One staff member will development and on professional development. With shortly complete the CEC Leadership Course for 2008. these plans in place, we envisage creating ongoing The TLC Process (Teamwork, Leadership, Change) has stability in the workplace, focusing on improving continued, with support from the Nursing Research morale, culture and team effectiveness. and Practice Development Unit. Nursing staff have identifi ed fi ve key areas for improvement, which We have also been working on the creation of a include the handover process, medication safety, Team-Based Model of Care. Large amounts of work leadership development, facilitation and retention of have been dedicated to this theme over the years, new graduates and the development of clinical care including the work from Connect 4 Redesign, but we guidelines for the paediatric neuroscience patient. expect to bring it to fruition and transition to this in the

38 Overview of Operations near future. We believe that this will create a stronger (post-operative and procedural) pain management patient-orientated, coordinated care approach, with and chronic pain (complex and intractable). The thorough case management occurring through a Department operates an integrated system of team-based model. paediatric palliative care through the home, hospital and hospice (Bear Cottage, Manly). We continue to collaborate with the Cancer Institute and have commenced a number of collaborative The Department has continued to be extraordinarily approaches with Sydney Children’s Hospital and John busy over the last fi nancial year. The acute pain Hunter Hospital. This is being undertaken through service has had approximately 12,000 occasions of monthly case review presentations and the Nursing service in the 2007-2008 fi nancial year. The Chronic Cancer Collaborative projects. Pain Clinic continues to see record numbers of patients, with 265 occasions of service in the 2007 The Oncology Unit has been well represented at calendar year and 217 occasions of service in the fi rst numerous national and international conferences six months of 2008. 48 new palliative patients were throughout 2007-2008, through oral and written referred to the Department in the 2007 calendar year presentations in areas of Long Term Follow-up, Bone and 21 patients were referred in the fi rst six months of Marrow Transplantation, Adolescents and Young 2008. In the 2007-2008 fi nancial year, Bear Cottage Adults and General Oncology. admitted 268 patients and their families and had 74 new referrals of children with life-limiting illnesses. The Bone Marrow Transplant Service continues to work toward obtaining accreditation by the Foundation The Department has been successful in obtaining for the Accreditation of Cellular Therapy (FACT) in funding for a number of new palliative care initiatives, 2008. The Team, alongside the Quality Manager and including appointment of part-time Play Therapist, a Project Leader for FACT continue to press forward project evaluating provision of volunteers in the home, with implementation of a number of initiatives for this a project evaluating provision of in-home nursing to become successful. Accreditation will ensure the support and a project to recruit a Nurse Educator to Unit’s capacity to participate in frontline clinical trials provide paediatric palliative care education within the and to enable independent review of the quality of the Western Child Health Network. Unit’s activities. The Department has appointed a senior social worker Our Late Effects Clinic underwent a name change from the United States and, as a result, we have in late 2007 to the Long Term Follow-up Clinic. been able to offer increased social work support We felt this better represented the work which is through both the Hospital service and Bear Cottage. undertaken in this specialised area and contributed Innovations at Bear Cottage this fi nancial year have to a more optimistic approach. A number of initiatives included a weekend residential camp for siblings, a are occurring in this area and we look to seeing residential camp for mothers of current patients and advancements in our team approach, through the successful trial appointment of a Senior Nurse to creation of key positions to meet International Best co-ordinate the bookings and admissions process. Practice Standards within the multidisciplinary team. The Department has continued to work toward Importantly, we will focus on Adolescent and Young establishment of an integrated medicine service, Adult Care (AYA) through 2008, with the creation with staff developing skills in hypnosis/hypnotherapy, of a Clinical Nurse Consultant position dedicated remedial massage and acupuncture. to this age group and building relations with other area health services to undertake a multidisciplinary The Program Development and Quality Care Manager approach to care. We will also be facilitating transition has put in place quality programs and policies that of young people to adult services and will strive for have enhanced the functioning and effi ciency of an approach which is consistent with our values of the Department. The Department now has clinical providing high quality care for all. indicators developed for the pain clinic and outcome measures and a review program for palliative care. Pain and Palliative Care Service and Bear Cottage This has contributed to the major goal of providing The Department of Pain Medicine and Palliative Care and maintaining a world-class pain management and is responsible for the management of paediatric acute palliative care service.

39 Overview of Operations Poisons Information Centre Respiratory Medicine, Sleep Unit The NSW Poisons Information Centre currently The Department is responsible for the care of children employs 20 Poison Information Specialists, who admitted with acute respiratory and airway conditions, provide 24-hour advice to the general public and as well as the long-term care of patients with chronic health care providers throughout Australia. There conditions, such as asthma, cystic fi brosis, chronic are approximately 115,000 phone calls for poisoning neonatal lung disease and sleep-related breathing advice taken by the information specialists yearly, with disorders. The Department co-ordinates the 1100-1200 cases referred to the medical consultants. management of asthma within the Hospital and also They provide a service to all states of Australia after provides a comprehensive Asthma Education Service, hours, with about 30% of calls originating outside aimed at health professionals, parents and children. NSW. Call numbers are increasing at about 7% per year. Sixteen medical toxicologists provide back-up There are also two multi-disciplinary clinical services, medical advice to doctors and other health care the Cystic Fibrosis (CF) Service which is involved professionals for serious or complex poisonings. Each in the care of children with CF and the Respiratory toxicologist is affi liated with one of several toxicology Support Service (RSS) which is involved in the care units in Australia, thus providing a diverse range of of patients with sleep related breathing problems or toxicological knowledge to the Centre. requiring respiratory support, including home oxygen, CPAP or ventilation. These multi-disciplinary services The Centre also provides training in medical poisons are supported by other Departments in the Hospital, information for a number of fellows with toxicology including Allied Health, Gastroenterology and training who are considering a career path in clinical Endocrinology (CF Service) and Paediatric Intensive toxicology. The Centre is staffed with a part-time Care and the Long Term Ventilation Unit. Medical Director and Assistant Medical Director who provide medical leadership, perform toxicology The Department also provides lung function and consultations for The Children’s Hospital at Westmead allergy testing and, in co-operation with the Children’s and NETS and co-ordinate teaching, clinical meetings Hospital Institute of Sports Medicine (CHISM), an and research projects in the Poisons Information exercise testing facility. Research on lung disease Centre. within the Department of Respiratory Medicine is carried out under the auspices of the Children’s Chest Advice regarding exposure to paracetamol remains Research Centre, which was established in 1998, the most common reason for calling the Poisons while research relating to sleep-related breathing Information Centre. The most common referrals to disorders is under the auspices of the SIDS and Sleep medical toxicologists are for management of snake Apnoea Research group. envenomation or for paracetamol, antidepressant and anticonvulsant poisoning. The Centre provides Key highlights for 2007/2008 have included: risk assessment to prevent unnecessary hospital referrals for trivial poisonings and to identify potentially • Establishment of regional Cystic Fibrosis Clinics to serious poisonings that may require time critical facilitate optimal co-management of patients with medical intervention. The Poisons Information Centre regional paediatricians can identify trends in poisoning in the community • Revision of Cystic Fibrosis Policy and Procedures associated with new pharmaceutical agents, Manual, with availability on the Intranet recreational substances and other chemical agents. • Establishment and implementation of protocol for blood sugar level monitoring in Cystic Fibrosis The Centre provides teaching on the management patients of poisonings and risk assessment to health care • Establishment and implementation of protocol for professionals and is a focal point for coordination of once daily tobramycin therapy for pseudomonas in clinical toxicology research in Australia. The medical Cystic Fibrosis patients consultants have been closely involved in the revision • Pharmacy support for Cystic Fibrosis clinic and of national paracetamol overdose management service provided through donated funds guidelines recently published in the Medical Journal • Development of Asthma Care Path and of Australia. accreditation of Registered Nurses in Short Stay Ward and selected General Medical Wards to

40 Overview of Operations increase time between inhaled salbutamol doses The Department continues to provide a number of • Revision of Acute Asthma - Management, subspecialty/inter-disciplinary clinics, with combined Education and Discharge Practice Guidelines orthopaedic surgery and dermatology clinics and • Completion of an audit of asthma education regular scleroderma and periodic fever clinics, • Parental satisfaction survey of children presenting that are the only such clinics which exist anywhere to Emergency Department or admitted with asthma in Australia. We are currently working with the • Provision of electronic Reducing Medication Plans Department of Haematology to establish a specifi c and Asthma Action Plans, through Powerchart Paediatric Haemophilia Joint Disease Clinic, which will • Development of E-Learning Package and Tutorials be the fi rst of its type in NSW. for Smoking Cessation Brief Intervention • Continuing Paediatric Asthma Nurse Resource Department members continue to be actively involved Workshops in education and training. We have had the benefi t • Publication of ‘When your child has asthma’, a of two enthusiastic advanced trainees, supervised book for parents of children and young people under the RACP in the 2007-2008 year, which with asthma has allowed us to improve the service provided. • Contribution to the revision of the NAC Information We have also lectured and taught at various levels, Paper on ‘Leukotriene receptor antagonists: their including at patient and parent forums, primary care, therapeutic role in children with asthma’ Diploma in Child Health, FRACP and post-fellowship • Development and submission to Thoracic levels. Through these activities, we have developed Society of Australia and New Zealand (TSANZ) of relationships with many professional and patient accreditation documentation for the accreditation organisations and maintained already established of the Respiratory Function Unit for the provision links, such as those with Arthritis Australia and the of lung function testing and allergen skin tests NSW Arthritis Foundation. The Department is a regular • Completion of an audit of exercise testing results in contributor to Hospital Grand Rounds and Team children presenting with exercise limitation meetings. Both consultants involved in the service are • Establishment of an effective pathway for part of the Rheumatology SAC of the RACP. transitioning and transferring patients requiring chronic respiratory support to community care Innovations for 2007-2008 include the establishment • Updating of equipment for Sleep Laboratory of regular intra-articular steroid injections for children • Lucia Smith awarded PhD for her thesis, entitled with acute arthritis under conscious sedation in Turner ‘The cardiorespiratory consequences of very pre- Ward (in excess of 100 injections were performed term birth’ during the year). This procedure is considered best • Kirstie Moore awarded MScMed for thesis, entitled practice for this painful condition and we expect ‘Factors affecting airway morphometry’ that the demand for this procedure will increase • Paul Robinson awarded NHMRC PhD scholarship progressively. We currently have three children with and TSANZ Allen and Hanbury’s Paediatric severe recalcitrant systemic arthritis treated with Fellowship to undertake his PhD studies on Tocilizumab, an experimental biological therapy with ‘Complex lung function in paediatric respiratory good results thus far and are currently part of an disease’ international trial of this drug. • NHMRC project grant for ‘Multicentre evaluation of a management protocol for chronic cough in The Department has made a strong commitment to children’. research with six papers published in peer reviewed journals in the 2007-2008 year. Furthermore, we are Rheumatology currently involved in three multinational drug trials, The Rheumatology Department provides a tertiary are the national co-ordinating centre for an Australian and quaternary level multidisciplinary referral service. multi-centre study and have two additional single It provides a signifi cant contribution to the Hospital, centre studies underway with ethics approval granted. with around 500 outpatient episodes of service in The Department is an active member of international the 2007/8 year and a large number of related allied and national research consortia. health outpatient visits. The service also provides around 100 inpatient consultations for a wide range of The Department of Rheumatology aims to continue other departments within the Hospital. improving the service we offer to our patients and their

41 Overview of Operations families in the face of steadily increasing demand for Highlights for 2007-2008 include: service, along with increasing complexity of disease and treatment. • Development of parent group programs - adolescent and child programs each conduct three Turner Ward sets of three education sessions per year As the move towards ambulatory care gains more • A shared advanced trainee position was focus within the Organisation, we are anticipating established in 2007 further increases in patient numbers. This trend is • Successful application for funding for an evident with a 9% increase in patient numbers from Administration Offi cer and appointment to position 2007 to 2008. The main specialities seen within the • Successful application for funding and Department are haematology, immunology, neurology, appointment of a part-time Staff Specialist in gastroenterology, cardiology and rheumatology. Weight Management MRI/CT lists under general anaesthetic have also • Further provision of a child-friendly environment increased. Care by Parent is at capacity most days. for Child Weight Management Clinic (eg. use The admissions that come through this area are of eye-toy, other games; sensitive approach to becoming more complex, thus requiring a nurse to co- potentially embarrassing aspects such as ordinate the daily activities/admissions in the unit. weigh-ins) • Improving the links for transition of Child Weight The Endocrine Testing Unit has also had an increase Management Program families to Adolescent in patient numbers, including outpatient admissions. Weight Management Services at 12 years of age The exciting development for the Endocrine Testing • Develop clinical research training opportunities in Unit is the involvement in two new research studies, paediatric weight management for clinicians in the Intranasal Insulin Trial and the Vibration Study. the state These studies have increased the clinical workload, • Part funding has been achieved, through the Child allowing the Unit to be staffed four days per week. Health Network, as a project for the development With effi cient training and education, the aim and evaluation of a state-wide health professional eventually is to have the Unit opened fi ve days per training program (in conjunction with SWAHS and week to optimise the resources within the Unit and NSW Centre for Overweight and Obesity) also cope with the increasing clinical demands. • Regular staff planning days, in both adolescent and child programs, scheduled for at least three The new initiative for Turner Ward is taking an times per year to assess and evaluate program overfl ow of patients from the Emergency Department. • Executive approval to increase the Clinical Nurse The aim of this is to relieve the pressure and assist Consultant Child Weight Management hours with access block by moving appropriate children • Establishment of parent groups out of the Emergency Department to a single room in • Prof Louise Baur was an invited participant at the Turner Ward, where they are then cared for until a bed Australia 2020 summit becomes available. Turner Ward will continue to work to improve this initiative. In the future there will be provision of a dedicated clinical area for Weight Management Services Turner Ward now has a new consultation room and and adequate clinical rooms for the Child Weight treatment room which provide fantastic resources to Management Program. More formal and integrated cope with the increase in clinical demands and also links will be established with services and the Weight ensures patient confi dentiality. Management Service planning will become core business of all programs and divisions, with Weight Management Services Executive sponsorship. Weight Management Services provide clinical care for severely obese children and adolescents at a tertiary A Weight Management Training Program for health and quaternary level of care, health professional training professionals will be established, with the successful programs on the assessment and management of integration of a permanent staff specialist to the paediatric obesity, selected work on advocacy, general service. This will streamline care and improve service community education and health promotion and provision in the multidisciplinary teams. research into aspects of child and adolescent obesity.

42 Overview of Operations Perioperative and Critical Care Program The Operating Theatres performed 14,274 procedures in the 2007-2008 fi nancial year and continues to The Perioperative and Critical Care Program has had a perform well in meeting NSW Health key performance very successful year. The challenges of providing high indicators. This is highlighted in the following graphs. quality patient care, while meeting State and Federal Government performance targets, have been met by all multidisciplinary teams through their dedication Total Cases and commitment within the Program. 14500

Perioperative Services continue to be a leader in 14000 waiting list management, achieving all or most targets on a monthly basis. The Neonatal and Paediatric 13500 Intensive Care Units have continued to improve 13000 patient outcomes and to reduce access block and cancellations for elective surgical procedures. 12500

The marked increase in emergency surgery 12000 presentations has also been a signifi cant resource 11500 concern, with a 15% increase over the last year. This 03-04 04-05 05-06 06-07 07-08 has created signifi cant access block issues for patient Total Cases 12,508 13,561 13,294 13,537 14,274 fl ow, Surgical Unit and operating suite management.

The Perioperative Critical Care Program will continue Over the past four years there has been a signifi cant to strive to provide best practice surgical and acute increase in the number of emergency surgical care services into the future. A priority for the future procedures being performed. To meet the increasing is to defi ne the tertiary services provided by the demands, a second emergency room has been Program, that will enable us to make smart choices opened on a Friday. This initiative has improved the for our future health service delivery. We will also access of the Operating Suite for patients requiring continue to work with the Surgical Taskforce to emergency surgery. develop strategies to reduce infl ows of non-tertiary surgical patients over the age of 12. 3 Year Comparison - Non-Elective Procedures - TYD Total 2008 brings new NSW Health emergency surgery performance targets that will require creative solutions 5600 and management challenges to achieve and sustain benchmark performance. 5400

We will continue to foster and pursue research and 5200 teaching programs and activities within our clinical departments to promote excellence and awareness of 5000 our services. 4800

Operating Theatres 4600 This year has seen the Operating Suite undertake 4400 elective, emergency and additional waiting list 2005 – 2006 2006 – 2007 2007 – 2008 sessions. The Operating Suite’s performance YTD Total 4810 5122 5461 continues to be monitored against NSW key performance indicators. In 2007-2008, we performed very well against the indicators.

43 Overview of Operations Burns Unit - Clubbe Ward and Burns and Plastic with Information Technology Services to develop the Treatment Centre electronic annotation of clinical notes in Powerchart. The Burns Unit is the paediatric arm of the NSW This has allowed instantaneous access to the patient Severe Burns Injury Service and is responsible for record at all times in the various multi-disciplinary the care of all major burns in children in NSW. clinics. Data collection has improved through the The Burns unit staff provide a 24-hour consultative appointment of a data collector who collects data for service for health providers treating children with research and audit purposes. less severe burns. On the technological front, the increasing use of the The majority of paediatric burns are less than 5% ‘Versajet’ debriding instrument has resulted in less body surface area and these children are managed blood loss and the ability to debride burnt tissue more as outpatients in the Burns and Plastic Treatment accurately with better preservation of skin structure Centre, which is part of the Burns Unit. The numbers and less subsequent scarring. The use of Tisseel glue continue to increase and 964 children with minor has improved graft take and prevented the ruckling of burns were referred in 2007. There is a noticeable skin grafts, resulting in a better cosmetic outcome. increase in contact burns, overtaking fl ame burns as the second most common cause of injury. Signifi cant The Children’s Hospital Burns Research Institute work has been done in preventing exercise treadmill (CHBRI) was established in 2004 to foster clinical injuries which present on a steady basis. and laboratory research into burns at The Children’s Hospital at Westmead. In 2006 the Institute was The results of our efforts to accept direct referrals able to appoint Rachel Murray, an NHMRC Fellow, from medical practitioners in general and Hospital to establish the CHBRI Wound Healing Laboratory. practice were also evident during 2006-2007. Rachel is undertaking basic scientifi c research to the Direct referrals now comprise 50% of our biochemical modulation of scar development at a outpatients, the remainder being referred from cellular level. the Emergency Department. Our Research Fellow has established the scientifi c Clubbe Ward burn patient numbers and /or acuity basis for fi rst aid management; work that has been continue to fl uctuate. There has been a noticeable published and presented internationally. Currently, increase in complex combined medical and plastic we are undertaking clinical and experimental studies surgical patients requiring intricate coordination, to establish the relationship of the depth and healing management and care. time of a burn to the development of a hypertrophic scar. Three of the burn residents completed research The Burns Unit and the Western Child Health Network projects whilst at the Unit, of which all will be project, ‘Capacity building in the management of presented at scientifi c meetings. In addition, medical, children with a burn injury’, funded by NSW Health, nursing and allied health staff contributed seven has progressed well. Evidence-based Guidelines papers to the RACS ASM in Hong Kong and are for the management of minor burns have been presenting at the ISBI meeting in Montreal and to the established, A digital photographic consultation ANZBA ASM in Melbourne in September . service has been successfully implemented, which is allowing children to be treated at their local hospital The Unit has, in collaboration with Kids Health, with direct consultation and support from the Burns developed a Burns Prevention Package for primary Unit. Education resources have been developed and schools. The Program is currently being trialled at a Burns workshop undertaken for medical, nursing selected primary schools across Sydney, prior to and allied health staff. An ambulatory care Paediatric evaluation and dissemination across all Primary Burn Care Service has been established at Fairfi eld Schools in NSW. Hospital, with the direct support of our Burns Unit. It is proposed to pilot further clinics at Wyong and The staff of the Unit are dedicated to contributing to Campbelltown in late 2008. the scientifi c advancement of burns management by undertaking clinical and scientifi c research, the Several initiatives have been implemented in the dissemination of knowledge through education Unit in 2008. The Unit’s staff have collaborated and communication and to the process of burns

44 Overview of Operations prevention through intervention in schools and in the general surgeon and assists with the shortening of community. The Burns Service Transitional Nurse operating waiting lists. Practitioner will shortly receive Nurse Practitioner – Burns [Paediatric] status, which will be a unique 3. Minimally Invasive Surgical Laboratory. position to Australia and New Zealand. It is expected The fi rst Minimally Invasive Surgical Laboratory that this position will provide additional support to for Paediatric Surgeons in Australia has opened, outreach clinics, as well as to patients and families. which has the support of the Animal Ethics Committees and the Royal Australasian College Surgical Unit of Surgeons. This year saw the relocation of the four medical short stay beds from the Surgical Unit to Hunter Baillie Plastic surgery Ward. Wait list funding has been utilised to provide The Plastic Surgery Department has increased, with an additional four temporary surgical beds that have two registrars this year to reduce the after-hours been supporting the Hospital in the surgical wait demand on services. list strategy. Prof Michael Poole retired this year after many In addition, the ward was able to increase capacity dedicated years of service in Craniofacial surgery. to 44 beds on occasions to allow elective surgery to Dr Damien Marucci has commenced as Craniofacial continue when the organisation has had an increased Surgeon to ensure that high quality care and services number of emergency surgical cases. are provided into the future. These responses were dependent on a dedicated team of nurses who willingly supporting this initiative The Plastics Team continue to be involved in the through fl exible work practices. Nursing staff are development of vascular anomalies treatment services currently participating in the REACH performance with Dr David Lord. appraisal research project and have continued to demonstrate a strong commitment to continuing Ophthalmics professional development. Dr Stephen Hing has taken over as Department Head and Gillian Green has been appointed as the General surgery Opthalmic Liaison Nurse, replacing Lisa Sugar. The Department of Surgery is proud to have achieved success with three major projects in 2008. An additional Registrar position has increased service provision and also increased the competence of NSW 1. On-call roster and theatre list redesign. Opthalmology trainees in Paediatric Opthalmology. The goal was to achieve a more fair and equitable allocation of operating sessions and to make Clinical activity continues with greater demand being operating time available for two new Consultants. placed on the Department’s resources. Satellite clinics Overall, this has resulted in the Consultants being continue at Campbelltown and Mt Druitt hospitals. provided with their allocation of theatre lists. The New software and electrodiagnostic equipment has current members of the Department who were in enhanced the reliability of electroretinograms and defi cit on theatre lists now have an appropriate other tests. allocation. It is hoped that this rearrangement of operating lists will also have a secondary benefi t by Ear, Nose and Throat (ENT) encouraging people to more effi ciently utilise the The ENT Department continues to be very busy, with operating lists that they now have allocated. referrals to the outpatient clinics and for surgery. Dr John Curotta has been appointed as full-time 2. The expansion of Transplant Team. Staff Specialist and will commence in that role in An additional Transplant/General Surgeon, September 2008. The Federal Waiting List Strategy Transplant Fellow and a full-time Secretary has also meant that the ENT Department has been were appointed, thus expanding the service actively involved in the waiting list initiative this year. considerably. As the new Transplant Surgeon also performs general surgery, this also impacts upon waiting times for appointments to see a

45 Overview of Operations Orthopaedics Education and training The Orthopaedic Department is one of the busiest The Department successfully hosted the second in the Hospital, offering care for a broad range of Australasian Ponseti Conference for health care musculoskeletal conditions. Issues of patient access professionals. The Ponseti Method is an effective and and care were addressed, with the establishment of inexpensive method for the treatment of congenital an additional weekly triage clinic, second monthly talipes equinovarus (clubfoot) which avoids the need multidisciplinary Osteogenesis Imperfecta Clinics, for major surgery. fortnightly Scoliosis Review Clinic conducted by a The latest advancements in clubfoot treatment Clinical Nurse Practitioner and the doubling of the are also disseminated by an ongoing program of number of Fellow lists. To gauge effi ciency and workshops and lectures by senior orthopaedic maintain a high level of service, the Department has physiotherapists at regional NSW hospitals. taken steps to formalise a policy regarding the clinic referral system for elective patients by assigning The Nurses and Midwives Board recognises clinical priority categories. Paediatric Nursing as one of its broad areas of practice. During the year, Corinne Bridge completed Cerebral Palsy and Neuromuscular Disorders her training and is authorised to practice as a Nurse Practitioner, the fi rst paediatric Orthopaedic Nurse During the past year, patients have benefi ted Practitioner in Australia. from the continuation of a waiting list reduction scheme, providing additional theatre lists and the As part of the Department’s commitment to furthering implementation of clinic scheduling changes which medical education in Asia and developing countries, have reduced rescheduling of patients. the Department hosted an honorary fellow from India and observers from Afghanistan, India, Nepal, Israel The Department is working toward transition of care and Saudi Arabia. for older patients with Cerebral Palsy, which will eventually see the transfer of their management Orthopaedic Research and Biotechnology Unit to SWAHS. The Orthopaedic Research Unit continues to expand In conjunction with Sydney Children’s Hospital, the and is a world recognised leader in the development Department is planning to establish a Paediatric of clinically relevant model systems of bone diseases Orthopaedic Fellowship in Neuromuscular Disorders, affecting children. This work is carried out by a which will provide advanced training in the dedicated team of orthopaedic surgeons, research orthopaedic management of this complex scientists, veterinary surgeons, biomechanical and group of disorders. biomedical engineers, experienced technical support staff and students. Spine Paediatric Intensive Care [PICU] The increasing demand for complex spinal surgery and insuffi cient numbers of spinal surgeons will be The PICU has had a very successful year, with strong addressed with the appointment to the Department of clinical service provision, ongoing improvements to another Spinal Surgeon in 2008. A tendering process patient safety and a positive budgetary performance. is also being considered to contain the escalating costs for spinal prosthetics. Just some of the highlights include: A six month Research Fellowship in Spinal Surgery was established to investigate basic and • We have increased our bed numbers to 18 clinical aspects related to the pathophysiology and beds, as a result of a funding enhancement from biomechanics of spinal disorders and diseases. NSW Health. This makes the Unit one of the The Fellow carried out a study on TL Flexion- largest intensive care units (adult or paediatric) distraction injuries. in Australia. As a result of much hard work, the surgical cancellation rate has been very low. • PICU has experienced a steadily increasing workload, with admissions increasing by 10%. The past fi nancial year saw 1205 admissions

46 Overview of Operations to the Unit. Patients stayed a median of 1.71 • The Intensive Care Specialists established an days. There were 24 deaths over the period Education Fund (using funds from their private (absolute mortality rate 2.0%) with a standardised practice trust) to provide funding to members mortality rate of 0.53 (by PIM2), our lowest ever. of the nursing staff so that they could attend One of PICU’s major achievements has been a important conferences and courses, such as the steady reduction in the mortality rate of critically Advanced Paediatric Life Support (APLS) course. ill children and infants over the last three years. Feedback suggests that this initiative has been Following a 20% reduction in standardised appreciated by all members of the nursing staff. mortality rate between 2005-06 and 2006-07, • The Intensive Care Specialists also sponsored a there has been a further 14% reduction between visiting Professor from overseas to spend a week in 2006-07 and 2007-08. The standardised mortality the PICU. Last year our inaugural visiting Professor rate is now only 54% of its value ten years ago. was Professor Vinay Nadkarni of the PICU at the Children’s Hospital of Philadelphia (CHoP). The PICU was also involved a number of His visit was most stimulating and, in addition to initiatives intended to improve quality of service. invigorating our clinical practice, this initiative also These included: built bridges between our unit and CHoP for future collaboration. • A daily PICU/Microbiology round between the • A working group was established which undertook consultant on-call Intensivist and the Hospital’s a rigorous selection process to choose the best Microbiologist to discuss all positive cultures as available CVVH machine, as our current machines well as antibiotic usage within the Unit. Analysis of are no longer supported by the manufacturer and our usage of third-generation cephalosporin has will require replacement very soon. revealed that this initiative has had a very positive • The PICU has almost 100 policies and procedure impact already. guidelines in its internal manual and these are • We have Increased Fellow cover, ensuring a further constantly being revised and updated through a layer of more senior clinical medical cover during formalized process. the day, especially in view of our increased activity. • The PICU hosted a number of students and • The PICU Nurse Practitioner Outreach Service has observers throughout the year. This included allowed Nurse Practitioners to provide education supervising four medical students on three and training to nursing staff on the wards. month electives from Holland, as well as • In addition to assessing patients referred to the supervising observers from Adelaide, Vietnam, PICU, Nurse Practitioners have also been following Kenya, and India. up all patients on the wards following discharge • Once again, the Intensivists sponsored a University from PICU. We are monitoring readmission rates of Sydney summer scholarship student from to assess the impact of this initiative. the Department of Informatics to work on data • We are currently in the process of designing a presentation and utilisation in the Unit. replacement for our ageing (DOS-based) CRS • Members of the staff continue to perform patient database. Funding for the project has signifi cant clinical and laboratory-based research, been secured. both locally and nationally, and make valuable • The Unit is actively participating in the in contributions to the critical care literature. CLAB-ICU Study, sponsored by the Clinical • Several PICU staff members are currently Excellence Commission. involved in organising the upcoming Annual • Extracorporeal membrane oxygenation (ECMO) Scientifi c Meeting, to be held in Sydney in has recently been introduced as our preferred October, as well as the World Paediatric Critical means of cardiac support following cardiac Care Congress in 2011. surgery. Currently, this is still a perfusionist-led service, however, a course was organised to further staff knowledge and experience using this mode of support. A business case is being prepared examining the extra resources that might be required in the future in order to transition the service to one that is nurse-led.

47 Overview of Operations Cardiac Services A grant was sought to commence a research project, This year has seen a redesign of the Cardiac Services titled ‘Heart Beads’. This creative initiative allows the management structure, with the creation of a Head of journey of children who have had heart surgery to be Department for Cardiology and a Head of Department created through a collection of beads. This research for Cardiothoracic Surgery. Dr Gary Sholler remains project will be evaluated and presented at a paediatric the Head of Adolph Basser Cardiac Institute and conference in September 2008. A further ward-based Cardiology Services. Prof David Winlaw is the Head of study on warfarin administration will be presented at Cardiothoracic Surgery. the Children’s Health Conference in November 2008.

There has been considerable work to action The Cardiac Team has also been successful in gaining the priorities outlined in the Cardiac Services a second Clinical Nurse Consultant position to case Enhancement plan, including: manage children through the acute inpatient phase of their treatment plan This position will be advertised • The appointment of a Interventional Cardiologist in the coming months and will certainly enhance the • Development of additional Clinical Nurse current service provided to our patients and their Consultant – Cardiac Services role families and carers. • Refi nement of programmes for surgical care of neonates Long-Term Ventilation Unit The Long Term Ventilation Unit has had a very Cardiac surgery has continued to provide a high level successful year. The Nurse Practitioner led service. A recent restructure of both senior and junior multidisciplinary team has successfully transitioned positions has consolidated the training and service fi ve children to the community, with only two children commitments, with greater out-of-hours support remaining in the Unit. A strategic management team provided in the Hospital. This has been necessary was created to look at the future management of because of the increasing complexity of cases and long-term ventilated children into the community. An utilisation of extra-corporeal life support systems in appropriate management plan has now been created diffi cult cases. A wider range of cases are now being for both the management of new and existing long referred for surgery, including neonates with complex term ventilated patients. left ventricular outfl ow tract obstruction. Grace Centre for Newborn Care The Cardiac Surgery Group has also had a successful The Grace Centre for Newborn Care continued to year in basic and clinical research, with completion have a higher number of admissions. This reached of a series of experiments studying the role of novel 650 babies last year, with a sustained increase in agents in a model of poor cardiac function after heart the survival rate of over 97%, despite earlier and surgery. This work has been presented at international more complex medical and surgical treatment being meetings and is in-press in highly ranked cardiac provided to smaller and sicker babies. The Unit has surgery journals. The expanded work of Kids Heart also embarked on a developmental follow-up program Reseach has also resulted in major international for infants who undergo major surgery early in life. publications. Adolph Basser Cardiac Institute This decision was based on the early fi ndings of a continues to voluntarily participate in international study conducted in the Unit, funded by the March of projects where multidisciplinary surgical teams bring Dimes in the USA, that approximately 40% of these care to developing countries. children have some developmental delay.

Edgar Stephen Ward The staff in Grace have been raising money to build In April 2008, Edgar Stephen Ward updated the a follow-up clinic, research offi ces and an education cardiac monitoring system to the new Phillips room. The highlight of their fundraising effort was monitors. This initiative has allowed the Ward to have the highly successful inaugural Grace Gala Ball, 14 monitored bed spaces and a much improved which was held on 29 February at the Art Gallery of monitoring system. Six staff members will be trained NSW. The MC for the night was Tracey Spicer and as super-users of the monitors to allow expert and over $400,000 was raised towards the cost of the effective patient care to be delivered. construction.

48 Overview of Operations Two Staff Specialists have recenlty been appointed as effi ciency. Technically, it is highly advanced and allows permanent members of staff, Dr Alison Loughran, full- clinicians web-based access to real time patient time, and Dr Kathryn Carmo, half-time, in a shared monitoring, thus reducing the need for urgent call- position with NETS. They are both PhD candidates ins. As the network is relatively new, clinicians are and this brings the number of PhD candidates in just beginning to take advantage of some the more the unit to fi ve. Grace continues to attract newly advanced features. graduated nurses to the workforce as there is an extensive orientation, preceptor and support program. Another major achievement during the year was to develop and produce the most advanced neonatal The Unit prides itself on working successfully as a system known, as well as highly advanced paediatric multidisciplinary team and this also extends to the and paediatric/adult retrieval systems. These systems research program. A/Prof Kaye Spence and A/Prof have given NSW the most advanced neonatal and Nadia Badawi are collaborating with Melbourne paediatric aeromedical and road retrieval University on a grant to study the emotional and service known. social burden of caring for a young child with complex health needs. Dr Peter Barr is continuing his research The Department also provides both internal and on personality predictors of acute and chronic stress external respiratory support services and is currently in NICU parents. managing over 60 home patients. We currently manage eight of these patients under service level There have been ten international peer reviewed agreements to other Area Health Services and publications and many international presentations produce specialised equipment to enable these by the staff of Grace during this year. Dr Barr gave patients to return home. This number of these presentations to the Association for Death Education patients we support is steadily increasing. and Counselling in Montreal and also facilitated a Parent Bereavement Retreat as part of his annual Our Department provides inpatient technical support visit to the USA as a guest of Arizona State University. and manages the point-of-care biochemistry labs Dr Carmo gave two presentations at the Paediatric throughout the Hospital. We source, order and Academic Society in the USA and the European supply much of the specialised non-sterile stock Academy of Paediatrics on targeting the duration throughout the Hospital and actively participate in of Indomethacin treatment to the PDA constrictive clinical research, equipment development and publish response using echocardiography, a randomised research papers. controlled trial. During the year we supervised two international and A/Prof Spence was on the scientifi c committee of two Australian University students for their Industrial the 6th International Neonatal Nursing Conference Placement Program during the year, as well as a Fijian in India and facilitated a workshop. Ms Jenny Elliott post-grad research student. and A/Prof Spence also gave several presentations at the conference, as did A/Prof Badawi at the British The Department is always very busy, completing International Congress on Obstetrics and Gynaecology repairs, testing equipment and providing clinical in London. The Annual Susan Ryan Conference, support. We engage volunteers to help us in which the Unit organises, is becoming increasingly these duties. successful, with nearly 200 local and interstate attendees. We are an ISO 9001 certifi ed Department and produce or help to produce quality systems for other Biomedical Engineering Departments, as required. Biomedical Engineering supports and advances patient care by applying engineering and management skills to healthcare technology. In 2008, we completed installation of an integrated patient monitoring network throughout the Hospital. This has increased patient safety and also enabled streamlined internal patient transfers, improving overall operational

49 Overview of Operations Allied Health Clinic is being developed, so these patients and their parents will have a contact point and a continuity of The Departments within the Clinical Support Program, care. An education day has been held for parents Allied Health, are: and families.

• Clinical Aboriginal Health Services Procedural support is an ever-growing need in the • Audiology Hospital. It presents itself in many ways, such as • Sydney Children’s Cochlear Implant Centre in the Emergency Department, long term patient • Kids Health procedures, PICU, MRI preparation, radiation, • Nutrition and Dietetics, including the palliative care and Turner Ward, to mention a few. Play Formula Room Therapy are actively trying to reduce the numbers • Occupational Therapy, including Music Therapy of children missing out on the vital service through • Orthoptics business case submissions, the use of donated funds, • Orthotics and regular reviews of our service delivery. • Pharmacy • Physiotherapy After over two years of collaboration with colleagues • Play Therapy at Sydney Children’s Hospital, consumer groups • Psychology and interested health professionals, a large, brightly- • Social Work coloured parent resource, ‘Hearing Loss and Your • Speech Pathology Baby’, was printed and distributed throughout NSW to families of infants diagnosed with hearing loss through the SWISH program. Major Goals and Outcomes To add to the Allied Health New Graduate Programs, Orthotics and Physiotherapy presented at the regular sessions have been organised and co- second international Ponseti Talipes Conference in ordinated by Head, Social Work and Deputy Head, Darling Harbour in February 2008. The presentation Occupational Therapy, to support new Allied Health highlighted a newly developed orthoses for the graduates to not only be competent practitioners, treatment of talipes. but also have the ability to work independently and collaboratively within multi-disciplinary teams. Speech Pathology instigated a simple reporting system Hospital retention rates of new graduates remaining to increase the consensus on reporting of modifi ed in Paediatrics are testimony that the programs are barium swallow results between Speech Pathology successful. This addition is proving to add value. and Medical Imaging, and is currently in the process of reviewing the system. Ten professional groups within the Division of Allied Health have moved to a new amalgamated award. The Annual Memorial Service aims to support the The process was made as smooth as possible through families of patients who have died and to promote the support of all concerned, especially those in Staff healthy grief. Parents and staff from many areas of Services who worked on the transition. the Hospital are involved in the planning and running of the Service. A survey in 2006 indicated an interest There has been strong collaboration with NSW Health by parents in meeting and sharing experiences with and Orthoptics to develop and implement the state- other bereaved parents in small groups. A group work wide Eyesight Preschool Screening Program (StEPS). program for parents and siblings was piloted by the Tender for design, implementation and evaluation of a Social Work Department, with assistance from the Train the Trainer Course for StEPS was won for $5000. Chaplains, in 2007. Subsequent evaluations indicated that this new aspect to the Service allowed families Congenital lymphoedema is a growing clinical area. to make closer supportive connections with other The Physiotherapy Department has had a number of bereaved families and help them express grief in an staff trained in the correct physiotherapy treatment understanding and supportive environment. of lymphoedema patients, which includes massage, bandaging and pressure garments. A Lymphoedema

50 Overview of Operations Key Issues and Events Occupational Therapy celebrated its 70th Birthday Kids Health, working with the Respiratory Unit, by organising a one day Seminar ‘Networking for Adolescent Medicine Unit and Pharmacy, have Kids: Building Partnerships in Occupational Therapy produced an eLearning package and tutorial to Practice’, in October 2007. 178 Occupational educate staff on how to conduct evidence-based Therapists from around NSW and a few from further smoking cessation brief interventions. This has been afi eld heard of the varied and challenging work of piloted with two Hospital wards (91 staff accessed Occupational Therapy at the Hospital. eLearning, with 45 having completed the eLearning package). Pre and post tests will be compared to Future Directions assess knowledge of smoking cessation and also Kids Health plans to pilot an online education portal confi dence to conduct brief interventions. for parents and carers to access health and safety fact sheets, audio clips and lectures. Kids Health, working with Fundraising and Allied Health Departments, has begun a project on creating Audiology will see it’s 1000th infant under the SWISH child-friendly waiting rooms. program sometime late 2008/early 2009.A celebration of this achievement, as well as the arrival of new Physiotherapy, in conjunction with Technical Aid for cutting-edge technology, is planned for that time. the Disabled (TAD) is running a bike clinic in the Department twice annually. The TAD group bring Audiology is steering the set-up of a new regional bikes and a large variety of modifi cations that can be Visual Reward Audiometry Clinic at Mount Druitt fi tted so that children with a variety of disabilities are Hospital, as services for the 12-36 month age group able to ride a bike safely, a skill that many of us take are very poor in Western Sydney. Rooms have been for granted. The smiles in the faces of both children allocated and equipment has been purchased. and parents are priceless. Training/commissioning should be completed in the next 12 months. Play Therapy has been establishing themselves as a new stand alone Department and has been worked Speech Pathology will continue to engage in with Palliative Care and Emergency to trial two new, discussion with local community health services limited-hours positions. One is for home-based care to review the provision of services to children with and the other for procedural support. feeding diffi culties and dysphagia.

To encourage increased collaboration, there have The current practice and clinical protocols used for now been two interdepartmental meetings between electrophysiology have been recently reviewed. A The Children’s Hospital at Westmead and the Sydney staff member will be travelling to electrophysiology Children’s Hospital Orthotics Departments. locations in Canada and England in August and September 2008, to increase their electrophysiology The Nutrition and Dietetics and Speech Pathology knowledge and clinical expertise and form links Departments have worked closely with Food Services between these locations and our Hospital. This trip is to establish and implement a standardised hospital- partly sponsored by Designs for Vision, an ophthalmic wide modifi ed diet for patients who present with supply company and LKC, the supplier of the dysphagia and feeding problems. This diet will comply electrophysiology system. with the Australian Standards set by the Dietetics and Speech Pathology professional associations. The Social Work Department is working to develop and implement uniform minimum standards of Prevention of childhood eye injury has been identifi ed care and follow-up for bereaved families across the by Orthoptics as a key health promotion issue. A Hospital and a more comprehensive bereavement project has begun, supported by a retrospective care service. study of the last ten years of eye injury referrals to the Eye Clinic. The aim is to impact on the prevalence Pharmacy is planning to enhance services to the of childhood eye injuries occurring in NSW through Emergency Department and to provide universal improved parental and child education into risk medication reconciliation and pharmaceutical review factors for eye injury. to all patients.

51 Overview of Operations Diagnostic Services the Hospital and continue to serve the children of NSW. The Division of Diagnostic Services is a diverse group of Departments, both diagnostic and clinical. All Department of Allergy and Immunology Departments are run by dedicated staff, whose main The Immunology Laboratory has again had a very priority is to promote a quality and timely service, busy year, with record numbers of investigations both diagnostic and clinical, for the patients of this performed. There has been major investment in a Hospital and NSW. Both the clinical and diagnostic new FLOW cytometer, which is at the forefront of Departments service not only the children of this diagnostic equipment. Mr Mark Hanlon left The region, but also the wider community in NSW, and, in Children’s Hospital at Westmead after almost 30 years the case of many of the Departments, Australia. of service in order to take up a new position as a Senior Scientist and Dr Andrew Williams, a Principal As a testimony to the quality of service offered by Hospital Scientist, has been appointed as the these departments, the Diagnostic Services Division Immunology Laboratory Manager, bringing a wealth of was involved in three of the entries that won the experience to the position. QuAKs award or were highly commended (Clean Hands Save Lives, Platelet Wastage Improvement The clinical service remains in very high demand. In Projection and Reduction in Turnaround Times for order to cope with this we have developed a series of Potassium (K)). allergy fact sheets, which are available to clinicians and patients. The peanut allergy fact sheet has had Prof Bridget Wilcken has this year substantively 6,864 hits from the Hospital alone over the past retired from her position in Newborn Screening and ten months. The Department is lobbying the RACP Biochemical Genetics. Bridget has an international to set up a more formal process for accrediting reputation in her fi eld and is admired by all who paediatricians for post-graduate training in allergy, have worked with her or sought her opinion. We are which we envisage will partly meet the escalating grateful that she continues to give some of her time demand for clinical services. to the Hospital. Professor Martin Silink has played a major advocate role for diabetes in young people Department members continue to play an active role and for those living with diabetes in disadvantaged in development of the specialty by participating in circumstances, in his position as President of the both state and national committee work. Dr Alyson World Diabetes Association. He has had extensive Kakakios has completed eight years as a member of involvement with the United Nations and the World the Australian Drug Evaluation Committee (ADEC), health Organisation. He has recently received the key advisory committee to the Therapeutic Goods the Kellion Award, which is the highest award in Administration (TGA). Australian Diabetes. Dr Melanie Wong is a member of the RACP In the past twelve months, A/Prof Christopher Written Exam Committee and the National Examining Cowell, as well as maintaining his clinical load in Panel, as well as the JSAC in Clinical Immunology/ endocrinology and as Head of Endocrinology, has Allergy and Paediatrics. She is a member of the been Acting Director of Research, doing an amazing NSW Health IVIG Users Advisory Group and is on the job in both areas. Asia Pacifi c Immunoglobulins in Immunology Advisory Board. Prof Andrew Kemp is a member of the ASCIA We have been fortunate with the help of our Chief Anaphylaxis Working Party and the Asia Pacifi c Executive, Dr Antonio Penna, and Chair of the Immunoglobulins in Immunology Advisory Board. Children’s Hospital Advisory Committee, Roger Both Dr Kakakios and Prof Kemp continue Corbett, to have retained pathology here at The as members of the NSW Health Anaphylaxis Children’s Hospital at Westmead, rather than joining Working Party. a Western Cluster. Our major challenge for the laboratory section of the Division is to now form an Education remains a priority, with the Department independent business unit. This is going to create actively involved at all levels of education, both within some diffi culties, but it will enable us to retain the the Hospital and in a wider context. We organised a close contact and relationships with the clinicians of very successful Paediatric Allergy Update for the past

52 Overview of Operations two years and will be holding a third one in 2008. Institute of Endocrinology and Diabetes Dr Preeti Joshi participated in an educational video The Institute of Endocrinology and Diabetes is a developed by Anaphylaxis Australia. centre for excellence in clinical care, education, advocacy and research for children with endocrine We remain an accredited training site for the disorders, diabetes and disorders of bone health. Our combined subspecialties of Clinical Immunology and major achievements over the past 12 months include Allergy (RACP) and Immunopathology (RCPA) and changes in service delivery for children with diabetes have undergone two successful site visits, with the in Western Sydney via a partnership with Sydney next one due in 2011. Dr Sam Mehr was successful in West Area Health, increasing use of insulin pumps the RACP examinations in Immunopathology. to improve diabetes control, leadership nationally in the assessment and management of children with The Department has submitted an expression of secondary osteoporosis and opening of the Diabetes interest in administering the NSW Health Anaphylaxis Prevention Research Centre. Education Program, which is responsible for a statewide education program targeting all NSW Our major challenge is continue to maintain and Schools in the prevention and management of enhance our clinical excellence, despite the growth anaphylaxis. Ms Geraldine Dunne, the Coordinator of in demand and limited resources. As examples, the current program, is based within our Department. there has been a 19.5% growth in outpatient occasions of service over four years and a 61% We continue to be active in both clinical and growth in separations due to the Bisphosphonate laboratory-based research and have been successful program for osteoporosis and focal bone lesions, and in publishing the results in a number of highly investigations for children with complex endocrine regarded peer-reviewed journals. disorders associated with multisystem disease and children with insulin resistance associated with Department of Clinical Biochemistry obesity. Our high and increasing workload is refl ected One of the highlights of this year for the Department by the disparity in staff to patient ratio, compared to of Biochemistry was the awarding of an NHMRC grant other paediatric tertiary centres in NSW. to Dr John Earl, Deputy Head of the Department, for research into the role of tryptophan metabolism The Institute has a proud history of providing in liver transplant tolerance and rejection. This leadership in management of children with diabetes work will be carried out in collaboration with Dr Ian in NSW. This year, a Memorandum of Understanding Alexander of the Gene Therapy Unit and workers at was signed between Sydney West Area Health the Collaborative Transplant Group, the University Service and The Children’s Hospital at Westmead of Sydney and Liverpool Hospital. Dr Earl was also to enhance paediatric diabetes services at Nepean the principal organiser of a successful Australasian Hospital. Dr Ann Maguire has been appointed to Association of Clinical Biochemists Conference, with a joint paediatric endocrinology position with the overseas speakers on chromatography and mass Nepean Hospital. We have coordinated the up-skilling spectrometry. This meeting was held over three days of four paediatricians who provide the 24 hour on-site in Sydney, in July, 2007. services and participate in the weekly clinic with the Paediatric Allied Health Diabetes Team. The transition The work of the Biochemistry Department continues of patients attending our Diabetes Clinic from the to increase, especially in the area of blood gases, Nepean and Windsor areas to the joint Nepean Clinic where there has been a 30% increase in the is progressing well. numbers. There has also been a very gratifying improvement in the turnaround times for results. At Our priority for children with diabetes is to improve the beginning of 2006, 41% of our electrolyte results their metabolic outcomes. This should lead to had a turnaround time of less than 60 minutes during improved quality of life and reduced long-term normal working hours. In the fi rst six months of 2007, diabetes complications in children. There has been this fi gure rose to 85%, well above the average for improved metabolic control, as measured by median other hospital laboratories. HBA1c, decreasing from 8.5% in 2003-2004 to 8.0% in 2007-2008. This has been achieved by staff commitment and increased use of insulin pumps and

53 Overview of Operations multiple daily injections. However, we will require a Centre for children with bone and mineral disorders large investment of resources and increased use of has been developed, in collaboration with the insulin pumps to achieve the global target of median Department of Endocrinology and the Departments of HbA1c < 7.5%. Clinical Genetics, Nuclear Medicine, Rehabilitation, Allied Health and Orthopaedic Surgery . The Bone and Mineral Service is a referral centre for the State and ACT and we are the only paediatric As the awareness of paediatric osteopenia, Hospital nationally to provide the paediatric osteogenesis imperfecta and the medical community with a transiliac bone biopsy service for management of focal orthopaedic increases, so too do early detection and management of osteopenia and the demands placed upon the Bone Service for expert other bone health related issues. Other achievements investigation and management services. include the management program for prevention Our productivity is high, with 30 publications and $2 of secondary osteoporosis and fractures in children million in competitive grant income in the past year. with genetic bone fragility disorders and prevention of secondary rickets caused by Vitamin D defi ciency. Our senior staff are recognised nationally and The bone and endocrine services are supported internationally, not only for their excellence in clinical by the excellent diagnostic services of the NATA medicine and research, but for their contributions to accredited regional NSW referral paediatric advocating for the rights for children with diabetes endocrine laboratory. and endocrine disorders to achieve the best health outcomes. Our continuing education has been strengthened in the past year with meetings each week organised by Prof Martin Silink, President of the International the junior medical staff. We have been enriched by Diabetes Federation (IDF), continues to be at the overseas trainees from Denmark, China and Taiwan. forefront of the international fi ght against diabetes, Our Diabetes Team has provided ongoing clinical with the aim to increase its global awareness and support to health professionals in the Western Child allow for affordable public health strategies for the Health Network and educators in Wagga, Dubbo and prevention of diabetes and its complications. Prof Bathurst were given education and training in insulin Kim Donaghue, a council member of the International pump therapy. The Endocrine Nurse Consultants have Society for Paediatric and Adolescent Diabetes, has led the revision of our patient information pamphlets coordinated the international paediatric diabetes over the past year. evidence-based guidelines.

A highlight for 2007 was the opening of the Diabetes Dr Neville Howard, in his role as President of Prevention Research Centre on World Diabetes Day. Diabetes Australia in NSW, has advocated for This was made possible by generous donations from increased resources for paediatric diabetes and for Diavitiko and the Laki Bank. The Centre will facilitate the up-skilling of school staff in their management of our research activities which have three main themes children with diabetes. Nuala Harkin, Diabetes Nurse in diabetes: Practitioner, is a council member for the Australian Diabetes Educator Association. Dr Maria Craig has • Diabetes epidemiology and aetiology, leading to become the President of the Australasian Paediatric intervention studies to prevent type 1 diabetes Endocrine Society and A/Prof Geoff Ambler was • Diabetes complications, especially pathogenesis appointed as Chair of the National Growth Hormone and role of genetics, with intervention studies Advisory Committee. commencing in 2008 • Pathogenesis of insulin resistance in obesity, with Haematology Department two intervention studies to prevent type 2 diabetes The Haematology Department continues to be very commencing in 2008. busy, with both clinical and laboratory work. The laboratory successfully underwent NATA accreditation Additionally, research activity in the understanding in August 2007. During the year we have purchased of bone development, including randomised trials a second STAGO coagulation analyser and have and clinical endocrine audits, underpin our clinical expanded the number of coagulation tests we perform excellence in these areas. A Diagnostic and Treatment in-house to include protein C and S and anti-Xa

54 Overview of Operations assays. This results in improved turn-around times signifi cance of this result has recently been evidenced for these assays, which no longer need to be sent out by the success of this project in the Quality at Kids for analysis. Our total laboratory workload continues awards for 2008 to increase at about 3% per year, with certain tests (such as sickle preps and malaria testing), increasing On the clinical front, the Haematology Department signifi cantly more than this in the past three to four continues to care for a wide range of children with years as a refl ection of the increased numbers of non-malignant haematological conditions. We have migrants from the African continent. established a weekly clinical review meeting at which all inpatients, day-stay patients, outpatient Since December 2006, we have taken part in attendances and telephone consults are discussed. the statewide Bloodwatch Transfusion Medicine Children with bleeding disorders continue to make Improvement Project, initiated by the Clinical up a large component of our workload, with over 180 Excellence Commission. With this project, we received patients registered on our books. temporary funding for a transfusion nurse, which ran through until March 2008. Following a series of audits The Kids’ Factor Zone was offi cially opened in July of our current practices, we identifi ed a number of 2007 by the Health Minister, Reba Meagher. This areas that required changes in practice. treatment room represents a fantastic collaboration between parents and carers to improve the care of Quality improvement projects were then established to children with bleeding disorders. Over the fi rst year in address these problems. These projects included the operation, we have seen over 500 attendances at the improved and standardised blood giving sets in the Kids’ Factor Zone for assessment and treatment. Hospital and removal of unnecessary leucodepletion The feedback from the patients and families is fi lters, resulting in a saving of $120,000, extremely positive. implementation of a new all-in-one REM neonatal blood set that can be used with syringe drives in Histopathology Department Grace Centre for Newborn Care, development and The vacant Staff Specialist position, created after the implementation of improved blood transport around retirement of Dr Alex Kan in early 2007, was fi lled with the Hospital, development and implementation of Dr Meena Shingde commencing in February 2008. parent blood transfusion fact sheet, development and She had settled extremely well into the Department, implementation of Transfusion of Blood and Blood gaining experience in all aspects of paediatric Components Policy to refl ect current national and pathology, however unfortunately has recently international best practice guidelines, development resigned to take up a full time position in another and implementation of Nursing Blood Competency hospital. Dr Alex Kan continues to offer an opinion as Assessment, improvement of JRMO blood safety an Emeritus Consultant, allowing us to benefi t from his education, implementation of zero tolerance of blood vast knowledge and experience. sampling labelling errors, development of haematology web page and blood transfusion resources online for The Histopathology Unit has continued to be very the intranet and implementation of the Bloodsafe e- busy and stretched with surgical pathology and learning program to Pathlore and e-learning portal. the Perinatal Autopsy Service. The increase in autopsies has been over 350% in a six year period. An important project established as part of our We completed close to 300 autopsies in 2007, with Bloodwatch initiative is the Platelet Wastage numbers remaining at a similar level for 2008 to date. Improvement Project, which was aimed at reducing The Perinatal Autopsy Service continues to provide our wastage of platelets by 50% from an average of 42 services to many major teaching hospitals throughout units per month. This project has been a combined the state, as well as many country hospitals and the effort, with team members from Haematology, majority of private obstetric hospitals in Sydney. We Oncology and Blood Bank working together to develop also continue to process and report surgical placental strategies to reduce platelet wastage. The strategies specimens for the Sydney West Area Health Service, developed have been highly successful and over the which has resulted in an increase surgical caseload of fi rst six months of 2008 our platelet wastage has been approximately 20% over the past two years. Numbers reduced by 65% to an average of 14 units per month, of complex surgical specimens, including muscle with a projected cost saving of $200,000 per year. The biopsies, also continues to increase as a proportion of

55 Overview of Operations the workload. Specialist electron microscopy is The Department has introduced extra US lists to now performed at Concord Hospital Electron decrease the waiting time for Outpatients. We also Microscopy Unit. provide extra lists for non general anaesthetic (GA) MRI patients on a Saturday, when the waiting time The pathologists and scientists within the Department increases to over four weeks. We have been able to continue to serve on numerous hospital, college, state provide these services due to the tireless efforts of our and national committees. These include the Perinatal hard-working radiographers, sonographers, nursing and Maternal State Committee and the Health and clerical staff. Unfortunately our waiting times for Priority Taskforce, as well as the Maternal Deaths in GA MRIs are more diffi cult to decrease, due to lack of Australia Committee and the NPAAC committee on extra anaesthetic lists, however we are trying, together mortuaries. Within the hospital, Histopathology staff with the cooperation of the Anaesthetics Department, provide representations on the Human Research to achieve this. Ethics Committee and the Tumour Bank Committee. Our senior scientist, Tony Henwood, is the Editor of The Medical Imaging Department maintains its close the journal Histograph, and is actively involved with relationship with the clinical units of this Hospital, helping clinical sciences research and in writing with regular interdepartmental conferences. These papers and teaching. Some research work is being form the basis of mutual understanding and are well- performed within the Department also, with a number attended by medical staff, from the Junior Residents of papers accepted for publication over the past year. to Senior Consultants. It is often here that important decisions on clinical management are made. Medical Imaging The Medical Imaging Department continues to We remain an international centre for the training provide a dedicated diagnostic and interventional of Paediatric Radiologists, with Fellowship positions service and remains a tertiary referral base for parts being fi lled by overseas and local candidates. These of NSW. It also provides this service to surrounding positions are highly sought, due to the fact that our GPs. The referral base continues to grow and, despite case mix is so extensive and covers all aspects of being short of senior medical staff during the last 12 paediatric radiology. We also provide the paediatric months, our turnaround time for putting out reports component of the Radiology Registrar Training has decreased. This is due to the very hard work put Program for most of the NSW candidates. in by the available staff. The overtime budget remains a diffi culty for the The Department is in a state of transition – Dr Department, due to the demand of a 24 hour service. Christopher Wong has resigned and Albert Lam has Together with the Emergency Department, we are been made a Professor and continues his teaching always seeking new avenues in terms of rostering role throughout Asia during his attendances at and reassessing to improve this. In the next twelve multiple centres. Dr Vivienne Stockton has retired, her months we are hoping that further improvements will position being fi lled by Dr Susi Bottger. be made.

We have very recently installed a new biplane Department of Infectious Diseases and Microbiology angiography suite. This was made possible by a This is a newly-formed Department, which integrates substantial donation, for which we are most grateful. the areas consisting of the Clinical Infectious Diseases This equipment enables our interventionalists to Consultation Service, the diagnostic laboratories of provide the most advanced and intricate angiography microbiology, virology and molecular pathology, the at the lowest radiation doses and the greatest speed Infection Control Service and, more recently, the for our paediatric population. This, combined with Antimicrobial Stewardship Program. We also provide the 64 slice CT scanner which was acquired in 2006, advice to, and medical oversight of staff health issues, offers state-of-the-art technology. Replacement of including the mandatory Vaccination Program. other radiographic equipment is on the agenda for the next 12 months as this equipment is now nearly 13 The workload in the Department continues to years old. increase, with requests for over 500 clinical consultations per year and an increase in laboratory testing of 8% per annum over ten years. The

56 Overview of Operations introduction of the Antimicrobial Stewardship Service The Program has been staffed by a Senior has considerably increased the workload of the Pharmacist, Ms Lucy Holt and three staff specialists, clinicians involved. Dr David Andresen, Prof David Isaacs and A/ Prof Alison Kesson. The clinicians, pathologists, nurses and scientists within the Department continue to serve on numerous Major goals ahead for the Department are to develop hospital, college, state and national committees. and expand the diagnostic test repertoire to serve the These include the Drug Committee, Infection Control both the clinical and infection control needs of the Committee, Institutional Biohazards Committee, Hospital. Clinical Facilities Planning Committee, Demand and Access Management Committee, Clinical Review Nuclear Medicine Committee, Library Committee, RACP Examinations The Nuclear Medicine Department performed Committee, RCPA Microbiology Committee, NATA, studies on 3988 patients and several therapies on Australian Adverse Drug Reactions Committee and the cancer patients in 2007. Over this period, there Pharmaceutical Benefi ts Committee has been consolidation of services with the PET/CT at Westmead now being a routine service for The The Department is an accredited training site for Children’s Hospital at Westmead on Thursdays and the combined sub-specialties of Clinical Infectious any emergency studies on the other days. Diseases (RACP) and Microbiology (RCPA). The registrar, Dr Brendan McMullan, is commencing PET his infectious diseases training, supervised by A/ For the last fi nancial year, 465 PET/CT studies were Prof Alison Kesson and Prof David Isaacs. There performed by staff on paediatric patients, with the have been several visitors to the Department over majority from The Children’s Hospital at Westmead. the last year for education, Dr Renuka Fernando Our PET service is the only dedicated paediatric (microbiology) from Sri Lanka, Dr Bilal Kamel and service nationally and it also receives requests Dr Ammira AlShummari (molecular biology research) for PET studies from Sydney Children’s Hospital. from Iraq, Dr Tuan Ho (infectious diseases) and Ms The application of PET in paediatric oncology and Sinh Tran (molecular biology), both sponsored by the neurology has continued to rise and be shown to have Hoc Mai Foundation, University of Sydney, as well a signifi cant impact on clinical patient management. as several University of Sydney and overseas Dr Kevin London has commenced a six month medical students. research project, in conjunction with the Oncology Department, to correlate the role of PET/CT with Ms Hanady Elbab has commenced her Masters conventional medical imaging and to determine the of Philosophy studies with A/Prof Kesson into change and impact on patient management. The the role of transcription factors and toll-like funding for PET has been renegotiated by NSW Health receptors in fl avivirus-induced expression of major and the Federal Government. histocompatibility complex-I and intracellular adhesion molecule-1 genes. The Western Sydney Genetics Program A major clinical development in 2008 was the Academic Department of Medical Genetics introduction of the Antimicrobial Stewardship The Department contributed to the new Foundation Program, which is a process to assist and support Block for the Sydney Medical Program in February. clinicians with decisions regarding the optimal This followed a year of detailed planning with other selection, dose and duration of an antimicrobial agent. members of the Discipline of Genetic Medicine, The objectives are to ensure the best clinical outcome demonstrating that our knowledge and skills goals in terms of the treatment or prevention of infection, should address the needs for genetics in clinical with minimal toxicity to the patient and minimal practice of our future graduates. Although we are impact on subsequent resistance development in a small University Discipline, our faculty spanning micro-organisms. Cost-savings are often observed with clinical, counselling and laboratory areas are making a successful stewardship programs, but are not their real contribution to academic genetics in medicine. primary purpose. 2008 witnessed 20 years of teaching and research of genetics here at The Children’s Hospital at Westmead.

57 Overview of Operations In this period we have made an outstanding speaker at the International Prader-Willi contribution to teaching and training, having trained Syndrome Conference. 50 clinical geneticists since 1988. Our fi ftieth trainee, Dr Sunita Bijarnia has just returned to New Delhi with Genetic Metabolic Disorders Service the experience and knowledge to establish a model We farewelled Prof Bridget Wilcken, who has retired service for children with Genetic Metabolic Disorders. after over 30 years of service. A Festschrift in her honour was held in early 2008 and was a fi tting send- Clinical Genetics off. Dr Kaustuv Bhattacharya, a previous fellow from The Clinical Genetics Department continues to the UK who trained with us, has now joined us as provide clinical services to our patients, Westmead Bridget’s replacement. Troy Dalkeith joined the service Hospital and outreach clinics. The services provided as Clinical Nurse Consultant for the Service in to Westmead Hospital are formally recognised under February 2008. the Department of Genetic Medicine (SWAHS). In collaboration with stakeholders at The Children’s We continue to work with the staff and executive of Hospital at Westmead and Westmead Hospital, we the Sydney West Area Health Service to develop an have continued promoting the need for enhanced adult metabolic disorders service. Such a service is provision of adult genetics services. critical for the management of these patients who often have very complex medical needs. We remain a fully accredited training site for clinical genetics, with two permanently funded Molecular Genetics Department advanced training positions. We contribute actively The introduction of MLPA testing for Subtelomeres to undergraduate and postgraduate teaching and and Microdeletion Syndrome by Dr Rachel Smith has participate in a number of statewide and national been a major development. This testing complements committees related to genetics. Several clinicians the CGH microarray and FISH testing provided by the undertake ongoing formal research, as detailed Cytogenetics Department. A number of interesting under the Human Genome Research Program, but cases have been diagnosed. It is also allowing the other staff are also active contributors. Publication detection of aneuploidy in fetal demises, many of highlights for 2007-2008 include an invited book which previously went undetected as they failed in the chapter on Mowat-Wilson Syndrome by Dr Meredith tissue culture step. Wilson for Inborn Errors of Development, second edition, Oxford University Press and Fiona Richards’ With the help of staff within the Department of ongoing contribution to the literature regarding the Cytogenetics, the range of tests has been expanded case against predictive testing for Huntington Disease to include PAX6 and SHOX testing. Mutations in the in minors. PAX6 gene are a major cause for the eye anomaly, aniridia. Mutations or deletions of the short stature Cytogenetics homeobox-containing gene (SHOX) are a cause of The Diagnostic Cytogenetic and Molecular Cytogenetic short stature in children. Service had 6000 referrals in the year. This includes 500 referrals for CGH microarray testing. During this In conjunction with the GOLD Service at Hunter period, we were the only laboratory in Australia or New Genetics, the Department has undertaken a pilot Zealand providing routine testing in CGH arrays and screening study for Fragile X Syndrome, looking at also introduced a second generation, higher-resolution 200 newborn screen cards. The study was able to CGH array test service, using oligomeric probes. develop a semi-automated method for extracting DNA from a portion of the newborn screening cards. The The array data is used in generating research reports FMR1 gene was able to be amplifi ed by PCR in all the on patients and principles of interest, in collaboration specimens though a subset of females who require with our referring clinicians. further development of the assay.

Our prenatal diagnosis service continues, under the NSW Biochemical Genetics Service guidance of Dr Art Daniel. Dr Ellie Smith conducted a NSW Biochemical Genetics Service has continued Cytogenetics Workshop in Vietnam and was an invited its involvement in gene therapy research for OTC

58 Overview of Operations defi ciency through biochemical measurements of which cause childhood blindness. A novel gene, effectiveness of therapy. We have developed a new important in contributing to cataracts and visual assay studying urea synthesis, using stable isotope disability in children, has been identifi ed. This novel techniques which have been applied to the mouse gene, TMEM114, is expressed in the lens and is model for this condition. One highlight of the year was disrupted in several members of a family with cataract the identifi cation of the toxic component in toy beads, formation. Causes of glaucoma in the eye are also which had led to the hospitalisation of several children being investigated. Glaucoma is a condition where around the world. Our discovery resulted in the recall build-up of pressure in the eye is associated with of over eight billion beads worldwide and brought the damage to the nerve of the eye, leading to Hospital great publicity. Sample numbers continue to progressive blindness. grow, up 29% over the last fi ve years. In collaboration with the Department of Cytogenetics, NSW Newborn Screening Program a detailed genomics approach (CGH microarray) is Newborn Screening has had a productive year, with used to identify novel genes in this condition. Luke St seven papers in peer-reviewed journals arising from Heaps, Masters student, has investigated three new the state-wide program. We have begun research families with glaucoma and identifi ed novel candidate on the adequacy of diagnosis of hypothyroidism in disease genes for further investigation. Luke received very low birth weight babies and are fi nalising the a student prize at the recent Discipline of Paediatrics Australia-wide research programme we are leading postgraduate research meeting for this work. Dr on the clinical outcome of early diagnosis by tandem Robyn Jamieson was successful in obtaining grant mass spectrometry newborn screening. Professor funding from the Ophthalmic Research Institute Bridget Wilcken and Associate Professor Veronica of Australia for the project, Ocular developmental Wiley were invited speakers at the International disorders: molecular genetics and gene function. Society for Newborn Screening in Singapore in 2007. Mental Health Services Human Genome Research Program A very generous donation from a private individual This year has been one of some growth in strategic allowed us to continue our research into mitochondrial areas and consolidation of earlier established respiratory chain disorders. This will allow us to build services. We also have been looking to scope our a body of data to make us more competitive when it future developments, given service needs in child and comes to submission of research proposals to funding adolescent mental health and the rate of development agencies in the coming year. since The Children’s Hospital moved to Westmead in 1995. Research performed by Genetic Metabolic Disorders Research Unit, in conjunction with Hall Ward Dutch collaborators, led to the discovery of the The acute mental health ward, Hall Ward is now fully gene responsible for the rare X-linked disorder, staffed, with a growing resource of standby staff. Hall Arts Syndrome. Unexpectedly, it was found that Ward is now the only consistently fully staffed ward in Arts Syndrome was due to an abnormality in purine the Hospital. Another big achievement is the dramatic metabolism and this led to the identifi cation of a new decline by 80% of reportable incidences in the ward. treatment, which at this early stage appears to have This not only refl ects the consolidation of nurse resulted in signifi cant benefi ts for affected individuals. staffi ng and teams, but is a credit to Earl Durheim, Two postgraduate students working in the NSW Hall Ward NUM, and other senior management. Centre for Rett Syndrome Research have successfully completed their studies in 2007, Sarah Williamson We welcomed Dr Lucy Chapman as the new Staff was awarded a PhD and Rose White was awarded a Specialist for the Unit. Hall Ward is an active Masters of Science in Research. contributor to the NSW Forum for Acute Adolescent Psychiatric Inpatient Units, contributing to the Research work in the Eye and Developmental establishment of standards and guidelines across Genetics Research Unit has led to the identifi cation the state. We have also been closely involved in The of novel genes and candidate regions in eye diseases Children’s Hospital Australasia benchmarking of

59 Overview of Operations psychiatric inpatient units in paediatric hospitals. in conjunction with academics from The University of Sydney, The University of Western Sydney Emergency Department and Flinders University in South Australia. The The increase in acute mental health presentations restructuring of the wards around the medical teams in the Emergency Department refl ects the presence has lead to increased problems in providing the of the Acute Mental Health Unit, the collaborative inpatient eating disorder services, particularly for pre- management of complex cases with the intensive adolescent patients. This has been partially addressed support services of DoCS and the continuing growth through the provision of annual funding of $100,000 of the mental health epidemic in young people. We for four years from the Mental Health Drug and received $200,000 enhancement funding to expand Alcohol Offi ce to fund a Clinical Nurse Consultant to our presence of Clinical Nurse Consultants in mental provide, amongst other services, improved liaison for health in the Emergency Department, so that there will eating disorders patients across the Hospital. be presence until eleven o’clock at night on weekdays and a presence for a day shift on weekends. These The Western Paediatric Network also provided funding positions are currently being recruited. There has for a Clinical Nurse Specialist in eating disorders been an improvement in mental health access block to improve the liaison networking and education over the year. of Sydney West. The Eating Disorders Service has also been a benefi ciary of funding from the Butterfl y Addiction Medicine Foundation, which will fund two family admission units and an expansion of offi ce space for the Eating The new project for this year has been the Disorders Program, housed in Adolescent Medicine. establishment of an Addiction Medicine Service, funded by the Consultation Liaison Project of the The Eating Disorders Foundation has also appointed Drug Program, through the Mental Health and Drug a Clinical Psychologist to work across The Children’s and Alcohol Offi ce. This will be run through the Hospital at Westmead, Westmead Hospital, Northside Department of Adolescent Medicine. We received Private Hospital and Prince Alfred Hospital, to assist $100,000 in the initial year and have appointed Dr with the transition of rural patients from hospital Bronwyn Milne as a Staff Specialist in Addiction to home. The Eating Disorders Service has been Medicine and expanded Popi Zappia’s hours as a designated as a separate service and funding Clinical Psychologist. The enhancement of the Mental structure, although it still remains accountable to both Health Clinical Nurse Consultant’s service in the mental health and adolescent medicine. Emergency Department will also benefi t this project, which is currently under development. CAPTOS Eating Disorders The Child and Adolescent Psychiatric Telemedicine Outreach Service (CAPTOS) progresses well. Under Our Department has been coordinating an information Sue Foley’s leadership as Coordinator for CAPTOS, sharing working group between the three children’s there are continuing quality evaluation studies hospitals of NSW. The primary focus has been being done and close linkage with the Area Clinical on eating disorders, where there are discussions Directors of Child and Adolescent Mental Health over establishing a common data set. The Eating that have signifi cant regional populations, through Disorder Service continues to be of high profi le, teleconferencing. with their fi ndings from the national study on pre- pubertal presentations of eating disorder, through This, and the evaluation of the education outreach the Australian Paediatric Surveillance Unit, gaining and regular supervision of one hundred regional signifi cant media coverage. Similar studies have now clinicians a month, was recognised for service been completed in Canada and the UK following the improvement through winning the Quality at Kids lead of our Eating Disorder Service. Award (QUaKS) for Improvement of Service with External Partners. The Eating Disorder Service continues to pursue an active research program, with an ongoing NHMRC CAPTOS remains a highly valued service and its funded randomised controlled trial of inpatient strategic directions will be considered in the context treatment and the submission of a program grant, of a planned review of regional child and adolescent

60 Overview of Operations mental health services being organised by the Mental disability, through the emotion-based social Health and Drug and Alcohol Offi ce. In response to skills training. regional concern, a proposal for a CAPTOS second opinion service, for next day psychiatric consultations, With the statewide Behavioural Intervention Service, was developed and is still due to be considered. we have embarked on training twenty clinicians in Stepping Stones Triple P, to enable access for parents CAPTOS remains a service that has considerable with a child or adolescent with an intellectual disability potential for enhancing the provision of tertiary mental to receive this specialist form of parent training health services for children and adolescents in rural intervention. and remote areas. We have also had quarterly teleconference links with the telemedicine service Lastly Dr David Dossetor is involved in the working at Toronto Children’s Hospital, which is a similarly group to establish fellowships in intellectual disability large telemedicine service. This also led to the Eating for graduating psychiatrists, through the Institute of Disorders Team participating in a teleconference Psychiatry, and in the working group between mental grand round linked with Toronto Children’s Hospital health and DADHC to renew the Memorandum of and the Hospital for Sick Children at Great Ormond Understanding. Street in London, simultaneously presenting on their comparative studies of pre-pubertal eating disorders. Future Concerns With the continuing concerns about the problems of Mental health priority in paediatrics and partnerships rising acuity, more complex co-morbidity and earlier with DCSs and DADHC presentations of children and adolescents with mental In December, a representative of the Department health problems, the Department of Psychological attended the Children’s Hospital of Australasia Mental Medicine at The Children’s Hospital at Westmead can Health Day in Adelaide, where attention was drawn potentially play an important role in working to meet to the mental health needs of children in paediatric these needs of young people in NSW. health settings and there was a consensus view that this was a concern of highest priority. In particular, we have shown a capacity to develop tertiary services, particularly for special need In June, we made a submission to the Garling populations that are not adequately catered for in Enquiry, outlining both the development of the last current services and to provide innovative clinical ten years and our future concerns. In view of the research, collaborative specialty tertiary services and perceived success of our collaborative project with education to enable wider workforce development in Intensive Support Services of the Department of these areas. Community Services for complex cases of abuse and trauma and chronic psychiatric morbidity for children We are evidently involved in some of these areas, with in the care of the Minister, we hope that the outcome the capacity to expand in some others with support of the Wood Enquiry will lead to further investment in and funding where we have clinical champions this area of health provision. with special interest. We already have elements of programs to provide workforce development and Our partnership with DADHC has fl ourished this year. education more broadly through NSW, for example in Building on top of the popularity of the Developmental Autism and Mental Health and Intellectual Disability, Psychiatry Conjoint Clinic, co-hosted with the some specialist parent training, and potentially statewide Behavioural Intervention Service, we have a classroom intervention for Autism. We feel that number of additional projects. collaborative clinical pathways with key agencies that share responsibility for child and adolescent wellbeing Firstly, we are developing, in partnership with the are a critical part of building service capacity for these statewide Behavioural Intervention Service, an complex high-need populations. Education and Training Curriculum for Community Clinicians in child and adolescent mental health One key element that has to be considered for future and intellectual disability and are planning three development is our space needs. This involves a workshops next year. They also kindly host the pilot need to plan for the re-building of Hall Ward, so that study for intervention in Autism with mild intellectual it is purpose-built and could expand its bed numbers

61 Overview of Operations for the same staffi ng. We also need to signifi cantly Table of number of outcome measures collected increase our outpatient capacity, co-locating our service, and plan for an expansion of both tertiary clinical and clinical research and education capacity.

Service Unit Name

Lastly, MH-Kids, which is the Strategic, Policy and Total

Advisory Body on Child and Adolescent Mental Health Reviews Discharges Collections Admissions to the Director of the Mental Health Drug and Alcohol Offi ce, has moved to Gladesville Hospital, but under Psychological the auspices of The Children’s Hospital at Westmead. Medicine Service 210 100 173 483 (Outpatients) Performance Statistics 1 Community Mental Health Care Hours. Hall Ward Mental Statewide expected target for ambulatory client Health Inpatient 93 8 92 193 related provider time is 67% of clinician time spent Service (Inpatients) on client related activities. Suggested target for The Children’s Hospital at Westmead is 50%. We have achieved 44.6% of the expected target in 3 In-patient self suffi ciency. this fi nancial year, (Year 06/07 was 47%) a minor This indicator measures how self-suffi cient each decrease of 3.5%. The main problem is resourcing area is in providing inpatient mental health care to and supporting clinicians to an adequate level of its own residents. compliance with reporting, given their workloads. Clinicians’ workload includes supervision and This measure is not a pure indicator of inpatient training and clinical research. activity, as our mental health service has no defi ned catchment population to provide this 2 Collection of Outcome Measures. data. Instead, service utilisation by the population This indicator measures the number of outcome can be reported. The table below shows the total measures recorded by each area, as a percentage separation and length of stay for SWAHS and other of the expected number of measures for that area health services (n=116), 61 from SWAHS and area. The formula applied to derive the expected 55 from other Area Health Services (including one number of measures is based on total area from overseas) reported for 07/08. Separation from population. As our Hospital has no defi ned both NSCCAHS and SWAHS is 68%. catchment population, this cannot be estimated.

However, the table below shows the total outcome measure collections of outpatient and inpatients at the required standard collection occasions of their episode of care, as per the MHOAT protocol. A signifi cant shift is notable in outcome measure collection in the number of collections at standard review occasions and at discharge, due to feedback mechanism to the clinical teams started in beginning of year 2007. There is a minor increase (11%) reported in the number of admission collection of outpatients this year, 210, compared to 185 last year. Reported number of admission outcome measure collections in the Acute Inpatient Unit (Hall Ward) this year showing an upward trend from 83 in 07/07.

62 Overview of Operations The actual average length of stay was 20.3 days down Corporate and Shared Services from 22 in 06/7. The Division of Corporate and Shared Services Area Health includes the following services: Group Area Code Separations Total LOS Other Area GSAHS 3 76 • Procurement • Engineering and Maintenance GWAHS 5 132 • Facilities Planning and Management HNEAHS 2 26 • Food Services NCAHS 5 111 • Linen Services NSCCAHS 19 674 • Domestic (Cleaning) Services SESIAHS 5 25 • Security and Fire Control • Transport and Stores SSWAHS 15 167 • Mail and Photocopying Own Area SWAHS 61 1,131 • Accommodation OS OS 1 10 • Child Care Centre Grand Total 116 2,352 • Shared Services co-ordination (provided by HealthSupport)

4 Emergency Department Access Block. This indicator measures the percentage of Engineering and Maintenance Departments people with mental health problems seen in the coordinated several major building projects during the emergency department who are admitted to a year, including construction of an Emergency Medical mental health unit within eight hours of active Unit and triage redevelopment. treatment, as captured by the NSW Emergency Department Information System. This is down from Child Care Centre fees increased in January 2008, 28.7% in the previous year. ensuring the cost of these services to the Hospital is minimised. The Parent Hostel was restructured % in Access as the Accommodation Department, to oversee the Total Admissions Total in Access Block Block management of all parent and staff accommodation, while maximising revenue opportunities. 108 16 14.8% The Facilities Planning Committee inaugural meeting occurred in November 2007, bringing together the overall planning and management of the facilities, including design and operational management. The Corporate Services Assets Management Plan was further reviewed to ensure repairs and maintenance of existing facilities minimises any risks.

Food Services major assets were reviewed, with planning for replacement of the assets that had reached their effective life, such as the pot washer and dishwasher.

Engineering and Maintenance is conducting a detailed consultants review of central energy infrastructure and emergency generators.

In future, in-house retail food outlets are moving further towards being privately operated on a phased-in approach. There is ongoing involvement

63 Overview of Operations in operations of HealthSupport to ensure the daily The ongoing deployment of a wireless infrastructure performance meets the operational needs of this and applied technologies is seen as fundamental to Hospital. future initiatives and will continue to progress and expand the benefi ts already being felt in the busy Restructure of Child Care Services, including vacation Emergency Department. This work has been widely and occasional care, will be centralised under the presented and acknowledged as a leading example of Child Care Centre. demonstrated benefi ts.

Waste management strategies to maximise recycling We continue to be recognised as an e-learning Centre and minimise clinical waste costs will be introduced, of Excellence with the development of learning where appropriate. Further review of all facilities modules for many Hospital systems. contracts, including engineering, maintenance, fi re and security, will be undertaken to ensure the services Management reporting continued to be hampered supplied to maintain buildings and grounds are at by a number of factors through the year, including necessary standards. the loss of key personnel and the transition to Health Support. These issues have been resolved and we A detailed review of campus parking is underway, are now making signifi cant progress with the ongoing including the replacement of the visitor parking pay development of accessible management information, stations with a Parking Management System and a using Business Objects and Balanced Scorecard review of staff parking. technology. Despite this progress, there is still much work to be done.

Information Management Services In preparation for episode funding, we have ensured Information Services played a pivotal role over the year that our costing system is stable and the coding of in supporting Directorates and Programs and has led inpatient discharges is well within the NSW Health the implementation of key systems. benchmark, ensuring timely reporting. Clinical documentation continues to improve with the The move to Health Support (Health Technology) has development of documentation guidelines on cards proven to be challenging, with a signifi cant impact which are carried by clinicians on their lanyards. on internal reporting. From a technology perspective, These were developed in consultation with clinicians, there have been no major issues, although the other paediatric hospitals and experienced coders for budgetary pressures continue. each specialty.

The Hospital continues to advance the functionality Community Relations of our Electronic Medical Record (EMR), however the implementation of the statewide program has been and Marketing slow to gain momentum, largely due to functionality The Community Relations and Marketing Division issues in the State Baseline Build. comprises of the Public Relations Department, the Fundraising Department and Radio Bedrock. The expertise of our team will continue to ensure a good outcome for the Hospital. A major focus through The Public Relations Department proactively works the implementation continues to be on the alignment towards positioning The Children’s Hospital at of the strategy for the EMR with the needs of staff and Westmead as a world-class children’s hospital and the Clinical Redesign Program. an advocate for children. Whilst maintaining the Hospital’s high profi le within the community our Regrettably the Cerner Electronic Medication fundraising potential is maximised. Management system has been put on hold, due to the lack of funds. Improving medication safety remains a The Fundraising Department utilises an array of strategic priority and will progress as soon as funding fundraising programs to raise the signifi cant funds becomes available. required to enhance The Children’s Hospital at Westmead each year. Specialist staff work within

64 Overview of Operations areas such as direct marketing, regular giving, trusts • The story of Demi-Lee Brennan, a patient who and foundations, major gifts and bequest fundraising received a liver transplant at The Children’s to ensure sustainable fundraising income and they Hospital at Westmead and her body spontaneously also provide support and advice to individuals and took on the immune system and blood group of groups who wish to support The Children’s Hospital her donor, received extensive media coverage at Westmead. on an international scale. This was the lead story of range of proactive media stories focussing on Income derived from fundraising contributes towards organ donation facilitated by the Public Relations around ten per cent of the Hospital’s running costs, Department. including research, equipment replacement, special • There was an overhaul of the Fundraising programs and staff positions. Department’s direct mail strategy, in line with the overall strategy to increase untagged donations Radio Bedrock is The Children’s Hospital at through regular giving from individuals. Westmead’s in-house radio station, presenting a • A range of special events were held at the Hospital live radio program to patients each weeknight. Sick during the year, including the launch of the children and their families can either listen from the Diabetes Prevention Unit, attended by one of the Hospital wards or come to the studio to join in the Hospital’s Goodwill Ambassadors, Bec Hewitt, fun and activities that Radio Bedrock provides. This and the Book Bunker tenth birthday celebrations, service is run by volunteers and it contributes to the attended by famous author, Mem Fox. Hospital’s philosophy of providing a total healing • The Chairman of the Children’s Hospital Advisory environment for families. Council (CHAC) hosted a dinner for major donors at the Hospital to build closer ties with these A number of signifi cant achievements from the individuals and to further communicate the Community Relations and Marketing Division have Hospital’s challenges ahead and need for contributed to the success of the Hospital overall. further support. These include: • After staff at The Children’s Hospital at Westmead uncovered that the Toy of the Year, Bindeez, • A total of $24.3 million was raised through contained toxic chemical equivalent to an illicit donations, ranging from corporate partnerships, drug, a major awareness campaign was launched community events, bequests, regular individual by the Public Relations Department, resulting in an giving and merchandise. This includes a record international recall of this dangerous product. donation from Woolworths of $1.2 million, bringing • The inaugural Bandaged Bear Cup was held. This their total donated to The Children’s Hospital at was a NRL game between the Bulldogs and the Westmead to almost $14 million over the past Parramatta Eels and recognised the contribution of 14 years. Hospital staff to the community. This annual event • The Minister for Health, Hon Reba Meagher is a result of the Hospital’s ongoing partnership MP, offi cially opened the Kids Factor Zone, with ANZ Stadium. an innovative treatment facility for patients • Two of the major fundraising events to benefi t The with haemophilia, and attended the launch Children’s Hospital at Westmead were the Grace of the Animal Assisted Therapies Program, a Gala Ball, which raised over $300,000 for the physiotherapy-based program using dogs to help Grace Centre for Newborn Care, and the Singapore facilitate rehabilitation and treatment for sick Airlines maiden voyage of the A380, which had a children. Both of these projects are funded by signifi cant fundraising aspect and as one of the donations. benefi ciaries we received $236,000. • Internal communications were improved, with the • A record number of volunteers were recruited to introduction of the weekly Bandaged Bear Bulletin sell merchandise on Bandaged Bear Day, part of and the weekly In the Media newsletter to keep the Hospital’s major fundraising appeal. staff more informed and involved. • A nursing recruitment campaign was launched, • The Volunteer Management Plan was developed targeting nurses to become part of The Children’s to recruit, train and retain an improved bank of Hospital at Westmead’s team. This consisted of volunteers for special events, tours and promotional banners and cards to be used for fundraising events. displays and a series of advertisements.

65 Overview of Operations • The Think Kids Challenge, part of the annual City Internal Audit provides reasonable assurance to to Surf, raised a record amount of $113,000, up executive management and the Chief Executive, from $55,000 the previous year. through the Audit and Risk Management Committee, • The Community Relations and Marketing Division that at the time of review, all reviewed functions managed the presence of the Special Commission are working in a manner that is consistent with of Inquiry into Acute Care Services in NSW at established policies and procedures. The Children’s Hospital at Westmead. Two public hearings were held at the Hospital and a number One of the main functions of the Internal Audit of closed sessions also enabled staff to give is to conduct a broad comprehensive program evidence confi dentially. of evaluating the effectiveness of the Hospital • Over 15,000 people visited the Radio Bedrock management control system. studio during the broadcast hours and over 18,000 song requests were taken from patients. Internal Audit oversights the Hospital corruption prevention function, which includes the development Looking towards the future, each department within and implementation of the Hospital Fraud Control the Community Relations and Marketing Division Strategy, and investigation of potential and suspected has a strategic plan and specifi c strategies in place fraud or other irregularities. to contribute towards the overall success of The Children’s Hospital at Westmead. The Hospital Code of Conduct is issued to all staff members. The Code of Conduct and a Statement of Business Ethics are available on the Hospital website Internal Audit for staff and public awareness. All staff members are expected to read, understand, observe and comply The role of the Internal Audit is an independent, with these documents by demonstrating honest, objective assurance and consulting activity to add ethical and professional behaviour. value and improve the Hospital’s operations. It helps the Hospital accomplish its objectives by bringing Staff and those who deal with the Hospital are a systematic, disciplined approach to evaluate and expected to promptly bring any instance of improve the effectiveness of risk management, suspected internal or external fraud to the attention control, and governance process. of management. This will result in the process of investigation, as set out in the Hospital Fraud Internal Audit is committed to comply with the Reporting Policy and Procedures. Standards for the Professional Practice of Internal Auditing, issued by the Institute of Internal Auditors.

66 Overview of Operations Internal Audit usually conducts investigation on The Audit and Risk Management Committee had fi ve suspected fraud. This may involve investigation in meetings in 2007 / 2008. cooperation with the Police and/or the Independent Commission Against Corruption. Meetings Member Possible Meetings # Attended The Audit and Risk Management Committee Mr Kevin Doyle 44 comprises the Chief Executive and two independent (Chair) persons who are not employees of or contracted to Mr John Dunlop 3 3 provide services to the Hospital. At least one member of the Audit and Risk Management Committee has Dr Antonio Penna 5 5 signifi cant experience with fi nancial matters. The chairperson is one of the independent members # If a member has been granted leave, meetings appointed by the Director-General NSW Department of held during that leave are not considered as possible Health. The Audit and Risk Management Committee meetings. receives and considers all reports of the external and internal auditors and ensures that all audit The Audit and Risk Management Committee attended recommendations are implemented. by the following staff members and external auditor:

The Audit and Risk Management Committee • Director, Information Services and Planning meets four times per year, or more frequently as • Director, Clinical Governance and Medicine circumstances require. A copy of the agenda papers • Director, Clinical Operations and minutes is provided to the Director Corporate • Director, Finance and Corporate Services Governance and Risk Management of NSW • Director, Community Relations and Marketing Department of Health. • Director, Workforce Development • Deputy Director, Finance The key role of the Audit and Risk Management • Manager, Internal Audit Committee is to assist the Chief Executive in carrying • Representatives, the Audit Offi ce of NSW out the corporate governance responsibilities in (External Audit) relation to the fi nancial reporting, internal control, risk management, compliance with laws, regulations and The External Auditor, the Audit Offi ce of NSW, did not ethics and the internal and external audit functions. undertake any non-audit assignments in 2007- 2008. The Audit and Risk Management Committee is separate from the executive management and has no decision-making powers or supervisory functions.

67 Our People Our People

Workforce Development The Hospital has a vision of ‘Healthy Children for a Healthy Future’.

The Hospital’s vision is enabled by focussing on achieving strategic goals and operational excellence consistent with NSW Health and State Government strategies.

The following strategy map expresses the Hospital’s vision and strategic goals from a workforce perspective.

Healthy Children for a Healthy Future

Sustainable Skilled motivated staff, work in safe Paediatric innovative environments Workforce

Employment Education, Learning Performance Workforce & Equity & Research & Recognition Relations Employee Jorney Staff are CHW is the Education, learning and accountable and Staff respect each Paediatric employer research develops recognised for other and work of choice staff capacity meeting service effectively in standards teams

Culture of Workforce Support OHS&IM Wellness

Staff, teams and the Hospital CHW ensures a safe demonstrate CHW values working environment in action

Education & Learning Culture Workforce Leadership Workforce Infrastructure Resources Workforce Planning & Innovation & Systems

Services, teams Service plans reflect Workforce systems facilitate and staff lead future service and service and staff needs and innovate staff needs

68 Our People

Achievements Approximately 100 employees completed traineeships that were supported by State and Federal grants. The 1. Employment and Equity success rate for completion of traineeships is very high and demonstrates the support staff obtain from The Hospital entered into a partnership with the their managers and education staff. Federal Department of Education, Employment and Workplace Relations (DEWR) to facilitate development 3. Performance and Recognition and implementation of an Aboriginal Employment Strategy (Closing the Gap). The Hospital has developed the Performance Development Review System and will enhance its There has been a focus on recruitment of nursing staff reporting capabilities in the subsequent year. and junior medical staff in 2007-2008. A signifi cant change to employment of overseas junior medical There has been a focus on active management of staff has been implemented by the NSW Medical clinician registration. A system was put in place by Board. These changes will support implementation of NSW Health for the capture of registration information a National Registration system for specifi ed and the Hospital has built on this foundation to clinical groups. introduce a credentialing and defi ning scope of practice policy supported by monthly reporting Employment staff participated in a documentary for and follow-up. An external audit of the Hospitals German television which focussed on employment registration system for medical staff was very positive. processes for overseas nurses. 4. Workforce Relations The New Graduate Nursing Support Program was evaluated and changes implemented to support There have been a number of signifi cant changes to employment of a large cohort of nursing graduates. awards, requiring education and consultation with large groups of staff to implement these changes. Employment data demonstrates that the Hospital has These changes have occurred effi ciently and increased the number of nursing, medical and allied effectively with no signifi cant disputation. health staff to support the Hospital’s clinical services. The governance structures for industrial relations were 2. Education Learning and Research reviewed and minor changes implemented to improve communication. There has been no lost time due to The Hospital entered into partnership with the industrial disputes and relationships with industrial University of Sydney to deliver: organisations are healthy. a. A clinical simulation centre, the Kim Oates The majority of employees who were displaced by Australian Paediatric Simulation Centre, which is outsourcing specifi ed services to HealthSupport have the fi rst simulation centre focussed primarily on been placed in other positions. paediatrics in the Southern hemisphere. 5. Workforce Support b. The Diploma of Child Health (DCH) - the DCH is an internationally recognised course for medical The Hospital offers a range of programs to support offi cers who wish to become more confi dent in wellness. These include: treating children and young people. a. An external counselling service available to all Mandatory training for employees has developed staff at any time night or day. The annual report over the preceding 12 months. The system has been demonstrates an increase in service usage with a enhanced and data integrity improved. At present, mixture of personal and work related issues. mandatory training is focussed on Fire Training, Child Protection and Resuscitation.

69 Our People

6. Occupational Health, Safety and The Nursing Clinical Accreditation Program (CAP) is a joint project between The Children’s Hospital at Injury Management Westmead, the Sydney Children’s Hospital and the The Hospital is an extremely good performer in University of Technology, Sydney. Eleven new nursing the Treasury Managed Fund. Performance results graduates commenced the pilot program in 2007, demonstrate that the Hospital is a very safe place with a further fourteen commencing in May 2008. for our staff and visitors. The Hospital’s incident/ accident rate is approximately half that of other 8. Workforce Planning government agencies. The fi ve year Workforce Plan is in place. Individual The Children’s Hospital at Westmead is the fi rst clinical services are ensuring that workforce Australian company, across all industries, to be requirements are included within their service plans. awarded the International Disability Management Standards Council Certifi cation for its injury Outcomes of planning activities are reviewed and management program. The Consensus Based reported annually. Disability Management Audit, based on international best practice, was conducted in November 2007 and 9. Workforce infrastructure and Systems certifi cation was awarded in December 2007 for three years. The Hospital is a benefi ciary of the NSW Health Human Resource Information Systems (HRIS) The Hospital implemented the NSW Health strategy. An updated version of the payroll and roster Vaccination Policy. Vaccination compliance has systems was implemented. Whilst there were some improved from 15% in July 2007 to 62% in June initial implementation issues, these are mostly 2008. The Hospital is aiming for 100% compliance now resolved. by December 2008. A new hazardous substance database was introduced 7. Workforce Leadership and Innovation statewide. The Hospital trained a number of key staff to use the database and all information on hazardous A new workforce governance structure was approved substances is being loaded into the system. Material in 2007-2008 with a Workforce Leadership Group data safety sheets are able to be produced from the established to provide leadership of workforce issues system to aid in safe management, storage and use of across the Hospital. hazardous substances.

The Hospital is participating in the Clinical Excellence New HRIS projects will be implemented in the Commission’s Clinical Leadership Program. This coming years, which will enhance the HRIS and program provides opportunities for clinical leaders ultimately provide tangible improvements for to develop their leadership skills and experience. employees and management. Anecdotal feedback from participants demonstrates the program is a success. A formal evaluation will be 10. Nursing completed in late 2008. Critical social science theory has been used to develop a Nursing Strategic Plan to enhance nursing practice, meet the future workforce needs and to streamline practices and processes and to develop innovation in practice. The approach was shared at an International Conference on Practice Development in Holland, with the Director of Nursing being a key note invited speaker.

70 Our People

The Nursing Research and Practice Development Executive Management Unit continues to support evidence-based clinical practice and a culture for patients, their families and Chief Executive: staff that is person-centred. The Professor of Nursing was co-editor of an international book on Practice Dr Antonio Penna, MD, FRACP, MBA Development for Health Care Professionals, with both the Professor and Director of Nursing contributing Director of Clinical Governance to writing of chapters within this book. This Unit is involved and leads local, state-wide and international and Medicine: research. Dr Stuart Dorney MBBS, FRACP The Children’s Hospital at Westmead is the lead site for the NSW Health Essentials of Care Program for Director of Clinical Operations: Paediatrics across the State. The Professor of Nursing Cheryl McCullagh RN, Dips App Sci Nursing, is the lead researcher on the Essentials of Care Project BN MHSN FACHSE overall within NSW. Director of Finance: A coaching program was offered to the Nurse Managers and Nursing Unit Managers to enhance Wendy Haigh BA (Hons), FCA, MAICD their leadership capabilities and to support them in the implementation of a new performance Director of Community Relations development system. and Marketing: There have been many innovative programs offered, Gillian Paxton, BA including a speciality New Graduate Program (Economics and Industrial Relations) for newly graduated nurses with the Emergency Department and transitional educational support programs to enhance our workforce. Director of Information Services and Planning: Nurses have presented at local, interstate and international conferences and shared their experience Dr Ralph Hanson, BSc(Med), MBBCH, MPH, and expertise with others. There have been numerous MRACMA, FRACP, FACEM publications by nurses and this is an area where we are seeing further growth as the nurses of The Director of Workforce Development: Children’s Hospital at Westmead continue their research and commitment to share this work with Frank Horn, Grad Dip ER, NZTTC, Dip Teach others to inform their practice.

71 Our People

Executive Profi les Commission Statewide Clinical Leadership Programme as the Statewide Coordinator. In addition, Annette Dr Antonio (Tony) Penna worked with Northern Sydney Central Coast Area Health Service, as the Manager responsible for Area Dr Antonio Penna was appointed to the position Organisational Culture and Practice Development of Chief Executive of The Children’s Hospital at Annette is patient, family and staff orientated. She Westmead following Prof Kim Oates’ retirement in has extensive experience in practice development, February 2006. For one year prior to this he was management, change management, leadership Director of Clinical Services - Medical. Before joining development, strategic planning, research and The Children’s Hospital at Westmead, Dr Penna workforce development towards meeting the needs of had been the Director of Medical Services at Royal a contemporary healthcare system. North Shore Hospital, a position he had held since 1997. He is an Adelaide graduate, who did his paediatric training at the Adelaide Children’s Hospital, Cheryl McCullagh followed by time at the University of Melbourne as an NHMRC Postgraduate Fellow, where he completed Cheryl McCullagh moved from the Women’s and his doctorate in pharmacokinetics. In 1992, he Children’s Hospital in Adelaide in 2001 to take up the became Clinical Superintendent in the Department position as Nurse Manager for Oncology Services. She of Paediatrics at Westmead Hospital, where he worked in several roles before accepting the position was subsequently promoted through a range of of Medical Program Chair in April 2004, a new administration positions, while still maintaining a position in the Hospital structure. She began relieving clinical role. in the role of Director of Clinical Operations and Nursing in October 2006 and formally took over the new role Director of Clinical Operations in May 2007. Dr Stuart Dorney Cheryl has worked in adult and paediatric tertiary referral hospitals in Adelaide and Sydney, she has a Dr Stuart Dorney was appointed to the position of Diploma in Applied Science, a Bachelor of Nursing, Director of Clinical Governance and Medicine in May a certifi cate in paediatric palliative care and has just 2007. He had been acting in the position for three completed a Masters in Health Service Management. months prior to this and for the previous fi ve years She is also a Fellow of the Australian College of Health he had been the Hospital’s Clinical Risk Manager. Service Executives. Cheryl is focussed on developing Originally from Townsville, Stuart studied Medicine people and is committed to creating models which at the University of Queensland and came to The address fair resource allocation and inequities of Children’s Hospital in 1978 as a Paediatric resident. access to health services. He did all his Paediatric training at the Hospital, followed by fellowships in Gastroenterology both here and at the University of California Los Angeles (1983- 85). He was appointed to The Children’s Hospital at Wendy Haigh Westmead as a Staff Specialist in Gastroenterology Wendy joined the Hospital in August 2006 as Director and Liver Transplantation in July 1985, to help of Finance and was appointed Director of Finance establish the Pilot National Liver Transplantation and Corporate Services in May 2007. She has a Program which was a joint venture with Royal Prince successful track record in fi nance, having held a Alfred Hospital. He continued in that role full time number of senior management positions across both until November 2001. Stuart continued to see the private and public sectors. After completing an outpatients in the weekly Liver Clinic until honours degree in accounting, Wendy qualifi ed as a January 2006. Chartered Accountant with PricewaterhouseCoopers in the UK before transferring to Sydney in 1984. She Annette Solman is a Fellow of the Institute of Chartered Accountants of England and Wales, an Associate of the Institute of Annette joined The Children’s Hospital at Westmead Chartered Accountants of Australia and a Member of in July 2007 in the position of Director of Nursing. She the Australian Institute of Company Directors. previously worked with the NSW Clinical Excellence

72 Our People

Gilly Paxton in Employment Relations/Industrial Law and was awarded the NSW Industrial Relations Society Prize Gilly Paxton joined The Children’s Hospital at and graduated top of his year. He has worked in Westmead as Public Relations Manager in March the NSW Public Health sector for almost 20 years 1998. After fi ve years in the position she moved into and been employed at The Children’s Hospital at the Fundraising Department and was appointed Westmead for approximately seven years. Frank is Deputy Director Community Relations in 2004. Gilly is dedicated to furthering the professionalism of human now the Director Community Relations and Marketing. resources, improving systems and developing the Hospital’s workforce.

Dr Ralph Hanson Staff Profi le Dr Ralph Hanson joined the Hospital in 1982. After Jun-07 Jun-08 successfully completing his training in paediatrics, he Medical 334 369 was appointed as Staff Specialist and subsequently Head of the Emergency Department and Outpatients. Nursing 819 849 In 1997 he was seconded to the position of Manager, Allied Health 213 221 Clinical Services Network Taskforce and subsequently Other Prof. & Para professionals 30 24 appointed Chair of Information Services in 1998 and Oral Health Practitioners & Therapists 5 5 Director of Information Services in February 2000. He has extensive experience in health informatics Corporate Services 136 131 and information management. He is both a Fellow Scientifi c & technical clinical support staff 296 246 of the Australasian College of Physicians and the Hotel Services 152 149 Australasian College of Emergency Medicine and has a Masters in Public Health. Maintenance & Trades 12 12 Hospital Support Workers 364 432 Frank Horn Other 15 15 Grand Total 2,376 2,453 Frank originally trained as a teacher, eventually tutoring part time and casual at TAFE, the University Notes: of Sydney and Western Sydney University. He 1. There has been a welcome increases in the number of nurses, medical offi cers and allied health staff to support entered the NSW Health system as a Training Offi cer, increased demand. before commencing a career in Human Resources. 2. Scientifi c and technical clinical support staff have decreased Frank completed post graduate university studies due to a re-classifi cation of research staff resulting in an increase in hospital support workers

Staff Excellence

Month Employee of the Month Department Category Jul-07 Cale O’Bryan Information Services Service Delivery Aug-07 John Coakley Biochemistry Across all categories Sep-07 Kanchan Das Brain Injury and Rehabilitation Across all categories Oct-07 Therese Baker Occupational Therapy Service Delivery and Innovation Nov-07 Janette Clarkson Oncology Across all categories Jan-08 Kevin Carpenter Biochemical Genetics Service Delivery, Leadership and Innovation Feb-08 Scott Rowan Camperdown Ward Across all categories Mar-08 Grant Maddaford IT Services Service Delivery and Leadership Apr-08 Sally Markoska Food Services Service Delivery and Leadership May-08 Robyn Lamb Child Protection Unit Leadership and Innovation Jun-08 Marguerite Ogg Haemotology Service Delivery and Innovation

73 Actual and Estimated Staff Numbers by Level Actual Number Weighted Estimate Our People LEVEL Men STAFF TOTAL Groups Women Islanders (Number) Disability Adjustment Respondents Work-related Work-related People with a People with a Ethnic, Ethno- People Whose Language First & Torres Strait & Torres was not English Aboriginal People Spoken as a Child Religious Minority Disability Requiring People from Racial,

< $35,266 45 40 8 37 2 9 12 2 $35,266 - $46,319 721 644 134 587 10 199 256 53 11 $46,320 - $51,783 247 214 23 224 2 44 59 18 3 $51,784 - $65,526 688 594 74 614 5 180 180 43 1 $65,527 - $84,737 632 574 92 540 9 133 126 58 7 $84,738 - $105,923 412 383 148 264 134 125 28 1 > $105,923 (non SES) 224 188 122 102 61 46 25 2 > $105,923 (SES) TOTAL 2,969 2,637 601 2,368 28 760 804 228 26

Disability Action Plan Occupational Health, Safety and Rehabilitation (OHS&IM) The Children’s Hospital at Westmead has an updated Disability Action Plan, with a changed format to For the 2007-2008 fi nance year: assist in assigning tasks and priorities. New terms of reference have also been developed. • 330 incident/accidents were reported • 75 Workers’ Compensation claims were lodged There is now a reviewed membership to ensure - total hours paid: 7,377 hours improved representation from relevant departments • Mean time lost per claim: 98 hours or 2.5 weeks and personnel working with children with disabilities • 36 staff participated in rehabilitation and six of and/or staff members with disabilities. these were for non-work related conditions. Of the 23 fi nalised rehabilitation programs, there has The Hospital reviewed and adapted the relevant NSW been a 100% success rate in returning staff to Health Policy to ensure appropriateness and relevance pre-injury duties. For non-work related programs, to children and young people hospitalised and treated there was an 83% return to pre-injury duties and as outpatients. This led to the development of the the remaining 17% were terminated as they were policy, Disability - Children and Young People with unable to fulfi l their substantive role. 85% of other Disabilities: Responding to their Needs. programs are ongoing and progressing well. 15% remain totally incapacitated with one of the two We conducted a retrospective review of the activities claims being declined and presentations for 2002–2007 for the annual • There were no WorkCover prosecutions during celebration of the International Day of People with a this period DisAbility.

In response to RTA provision of additional disabled parking spaces in Hawkesbury Road, we created Staff Vaccinations posters detailing additional parking spaces with For the 2007-2008 fi nancial year, a total of 3316 illustrative photographs. Families with children with staff vaccinations were given – representing a 235% disabilities were informed about these additional increase on the previous year. Vaccinations included: parking spaces. • Hepatitis B (1157) We facilitated consultation and liaison with relevant • Infl uenza (812) departments regarding access issues, such as lift • Boostrix (872) renovations and complex clinic appointments. • MMR (354) • Varicella zoster (114) • Hepatitis A (3) • Typhoid (4)

74 Equal EmploymentOpportunity Workplace Claims–MainOccupationGroups Distribution ofWorkplace Incidents/Accidents * Total staffdifferencewithActualandEstimatedStaffNumbersbyLevelduetocontractorcasualvariances. Permanent Full-time OA ,1*8%2%8%09 4 6 %0.9% 7% 26% 24% 0.9% 80% 20% 84% 3,310* TOTAL Casual Retained Staff Training Positions Contract -NonSES Contract -SES Temporary Part-time Temporary Full-time Permanent Part-time oa 9 9 9 8 330 4 23 - 381 41 18 27 15 67 - 94 393 42 46 10 40 21 16 70 394 108 - 35 59 14 41 26 24 57 390 139 39 38 50 15 57 30 22 48 100 44 - 55 52 23 57 96 Total Incidents 61 64 Visitors Journey injuries Time lostinjuries No losttimeinjuries Scabies Slip/Fall Manual handling Blood exposure Main OccupationGroups oa 0 89 075 80 21 29 12 10 97 19 33 12 12 98 24 35 13 108 19 27 38 14 15 20 42 19 21 Total General Maintenance LinenHotel Services Medical/Med Support General Admin Nursing 00010 EMPLOYMENT BASIS Benchmark premium (budget allocation) $3,706,875 ye0/40/50/60/707/08 06/07 05/06 04/05 03/04 Type Worker’s Compensationfor2007/2008-Treasury ManagedFund(TMF) ,6 3 5 5 .%2%2%8 0.7% 8% 29% 27% 0.9% 75% 25% 93% 1,260 3 9 6 4 .%1%2%4 0.8% 4% 20% 0.8% 14% 0.4% 7% 1.7% 0.8% 4% 10% 21% 84% 29% 25% 19% 16% 30% 23% 1.2% 39% 1.1% 0.8% 336 89% 73% 11% 91% 27% 79% 9% 86% 309 88% 653 737

17%3%6%2%13% 25% 64% 36% 73% 11 TOTAL 5 75% 25% 4 STAFF (Number) Total Claims premium detail.Claimsdataasat30June2008 03/04 Respondents 64633 (amount paidintofund) Incurred cost:$402,128 Men Deposit premium Claims total:75 Total Claims $1,684,755 04/05

Women

Aboriginal People

Total Claims & Torres Strait

05/06 Islanders

People from Racial, Ethnic, Ethno- Religious Minority Groups Total Claims

06/07 People Whose

$2,022,120 Language First

Surplus Spoken as a Child was not English

People with a

Total Claims Disability 07/08 People with a Disability Requiring Work-related Adjustment

75 Our People 76 Our People • December 2007.Notethattarget2statisticsareasatJune claim activityusingdataextractedfromtheSICorpDataWarehouse asat31March2008,for claimsmadeasat31 The Working Together StrategyReportwasreceivedfromNSWTreasury ManagedFund.The reportmeasures Working Together Targets • • • • • • Strategies employedduringtheyeartoeliminateorreduceworkplaceincidents and staffinjuriesinclude: Risk Minimisation performance. Themostrecentfi gures demonstratethatthetargethasalmostbeenachieved. The baselineyear(2001/2002)wasanexceptionallygood andtheHospital hasmaintainedagood Data source: Standards Council(IDMSC)Certifi cation forExcellenceinInjuryManagement We arethefi rst organisationinAustraliatoachievethegloballyrecognisedInternationalDisabilityManagement safe workingenvironment Ongoing extensiveergonomicsurveys,workplaceandequipmentmodifi cations and/ordesignstopromotea Increased staffvaccinationuptaketocomplywithHealthDepartmentPolicy Developed andimplementedacomprehensiveOHStrainingpackageformanagers Consolidated OHSformstoassistwiththeimplementationofsystem Extensive reviewofexistingOHSsystemwithmajorpolicyandprocedure reviews

Workplace injuries as % of employees TARGET 1–INJURY PREVENTION 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% NSWTreasury ManagedFundWorkers’ Compensation Jun 02 Jun 03

Jun 04 Period enteredontosystem Jun 05 Workplace injuryincidencerate Dec 05 Jun 06 Dec 06 Jun 07 Dec 07 Jun 12 per annum CHW -Actualincidencerate rate perannum All Health-Target incidence per annum CHW -Target incidencerate annum Actual incidencerateper All GovernmentAgencies- rate perannum All Health-Actualincidence • Data source: Data source:

Percentage of claimants (%) Percentage of claimants (%) TARGET 2–INJURY MANAGEMENT 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% NSWTreasury ManagedFundWorkers’ Compensation NSWTreasury ManagedFund Workers’ Compensation Jun Jun 05 05 Percentage ofclaimantsonweeklybenefitsorafter Percentage ofclaimantsonweeklybenefitsorafter Dec Dec 05 05 Measurement Period Measurement Period Jun Jun 06 06 Dec Dec 12 weekssinceinjury 06 06 8 weekssinceinjury Jun Jun 07 07 Dec Dec 07 07 Jun Jun 08 08 weekly benefitsperannum CHW -Actualproportionof weekly benefitsperannum Target Actualproportionof All GovernmentAgencies- per annum proportion ofweeklybenefits All Health-Target Actual of weeklybenefitsperannum CHW -Target Actualproportion benefits perannum Actual proportionofweekly All GovernmentAgencies- of weeklybenefitsperannum All Health-Actualproportion weekly benefitsperannum CHW -Actualproportionof weekly benefitsperannum Target Actualproportionof All GovernmentAgencies- per annum proportion ofweeklybenefits All Health-Target Actual of weeklybenefitsperannum CHW -Target Actualproportion benefits perannum Actual proportionofweekly All GovernmentAgencies- of weeklybenefitsperannum All Health-Actualproportion

77 Our People 78 Our People • Data source: Data source:

Average cost of claims ($) TARGET 3–COSTOFCLAIMS Percentage of claimants (%) 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 10,000 15,000 20,000 25,000 30,000 5,000 NSWTreasury ManagedFundWorkers’ Compensation NSWTreasury ManagedFund Workers’ Compensation 0 Jun 05 040 050 060 2007/08 2006/07 2005/06 2004/05 Percentage ofclaimantsonweeklybenefitsorafter Dec 05 Measurement Period Jun 06 Injury Period Average costofclaims Dec 26 weekssinceinjury 06 Jun 07 - Dec2007 July 2007 Dec 07 Jun 08 weekly benefitsperannum CHW -Actualproportionof weekly benefitsperannum Target Actualproportionof All GovernmentAgencies- per annum proportion ofweeklybenefits All Health-Target Actual of weeklybenefitsperannum CHW -Target Actualproportion benefits perannum Actual proportionofweekly All GovernmentAgencies- of weeklybenefitsperannum All Health-Actualproportion of claims CHW -Actualaveragecost Target average costofclaims All GovernmentAgencies- cost ofclaims All Health-Target average of claims CHW -Target averagecost Actual averagecostofclaims All GovernmentAgencies- cost ofclaims All Health-Actualaverage • Data source: development seminarsonportfolios. and recognitionofthesickchild andprofessional and studydays,preceptorworkshops, assessment of childrenwithcancer, newgraduateorientation dependency paediatricnursing, nursingmanagement 454 nurses,includingorientation fornurses,high Nursing educationprogramswereattendedby staff acrosstheHospitalin2009. It isplannedthatCAPwillbeavailabletoallNursing 14 NewGraduatesareundertakingCAPin2008. of CAP. Graduate Certifi cate for2008followingthecompletion Four CAPparticipantshaveenrolledintheUTS nurses willbeundertakingtheinauguralprogram. certifi cate inChildren’s Nursing.15newgraduate subject (SpecialtyClinicalPractice)inUTSGraduate CAP isgivenadvancedstandingforanequivalent competencies orstandards. development andutilisesrelevantspecialistnursing with children,youngpeopleandfamilies,growth and refl ective practice.Contentfocusesonworking learning. Itdrawsontheoriesofexperientiallearning developed andisderivedfromamodelofworkplace The ClinicalAccreditationProgram(CAP)was Nursing EducationalActivities Teaching andTraining Initiatives

Percentage of S38 Claimants TARGET 4–INJURY MANAGEMENT 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% NSWTreasury ManagedFundWorkers’ Compensation Jun 05 Dec Percentage ofweeklyclaimantsonS38benefits 05 Measurement Period Jun 06 Dec 06 for 2ormoreweeks Jun 07 Dec 07 department tutorials.Atotalof ten from28people in ChildHealth(DCH),journal club andinternal time teachingsessions,FRACP lectures,Diploma Medical Staffisofferedfortnightly. Thisincludeslunch A rangeofpostgraduatemedical educationforJunior Postgraduate MedicalEducation clinical placements. clinical hoursofundergraduatenursingstudent The Hospitalhasprovidedapproximately30,000 four participantscommenceinSeptember2007. completion oftheProgram.TheTENProgramhad at TheChildren’s HospitalatWestmead following these TENsweresuccessfulingainingemployment participants whostartedinSeptember2006,allof The Trainee EnrolledNurse(TEN)programhad12 with fourNGsparticipatingin2008. an EmergencyDepartmentNewGraduateProgram, Program. We have alsodevelopedandimplemented Program and50commencedtheJanuary2008 Four newgraduatescommencedtheAugust2007 following completionoftheProgram. March 2007(20participants).83%wereemployed (ten participants),January2007(30participants)and Intakes ofnewgraduatesoccurredinAugust2006 60 newgraduatenursesoverthelastfi nancial year. The Hospital’s NewGraduateProgramsupported

Jun 08 CHW -Actual%S38benefits Target %S38benefits All GovernmentAgencies- benefits All Health-Actual%S38 CHW -Target %S38benefits Actual %S38benefits All GovernmentAgencies- benefits All Health-Actual%S38

79 Our People 80 Our People range ofinitiatives,includingresuscitation training. 2008. TheCentrehasincreasingly beenusedfora Manager fortheCentrewillcommence inAugust with theUniversityofSydneyClinicalSchool.A Clinical SkillsCentrehascontinued,incooperation Planning fortheKimOatesAustralianPaediatric Kim OatesAustralianPaediatricClinicalSkillsCentre enhance geographicalandculturalrelevance. lectures viaDVDsorinternetwithlocaltutoringto of distanceeducationincorporates111hours Vietnem areunderdevelopmentfor2009.Themodel Plans fordeploymentinMaharashtraandpossibly Cambodia, China,theSolomonIslandsandVanuatu. and isnowconductedinternationallyinHongKong, 1998 asadistanceeducationcoursearoundAustralia Westmead. It has grownsinceitsestablishmentin primary focusforstaffatTheChildren’s Hospitalat Since itscommencement,thisProgramhashada practice. case-based, withimmediaterelevanceinday-to-day work atthefrontlineofchildhealthcare.Teaching is knowledge, confi dence andskillsofdoctorswho the healthofchildrengloballybyenhancing current bestpractice.Itaimstomeasurablyimprove evidence-based overviewofpaediatrics,teaching The DiplomainChildHealthoffersacomprehensive, in 2008. distribution. Therewere352participantsintotal added impetusin2008withcoursedevelopmentand group ofexpertvolunteers,therehasbeensignifi cant and internationally. Withvaluableassistancefroma has provedtobeasuccessfulprogramnationally excellent post-graduatepaediatriceducationand The DiplomainChildHealthcontinuestoprovide go onlineinthenearfuture. various hospitallibraries.We hopeforthelecturesto available totrainees,bothinternallyandexternallyat FRACP lecturesarenowbeingrecordedandmade and usefultrainingforourJuniorMedicalStaff.The with theaimofprovidingmoresuitable,informative and clinicalexampreparationisbeingevaluated, The currentformatoftheFRACPlecturesandwritten people passedtheclinicalexam. passed thewrittenFRACPexamandninefrom15

Merck SharpandDohme. paediatricians viaaCD-ROMdistributedthrough Selected presentationsarealsoavailableto interested Hospitalsviavideoconferencing. Grand Roundspresentationsareofferedtoother Community ChildHealthTraining (VicFEAT), RespiratoryMedicine,BugBreakfastsand Paediatric FurtherEducationandTraining Program the NSWClinicalGeneticsFellows’Training Program, in anumberofeducationprograms.Theseinclude Videoconferencing hasbeenusedforparticipation for NSWHealth. solutions toastatewideplatformfore-learningdelivery Team isassistingintheinvestigationandtestingof Programs arenearingcompletion.TheE-Learning and SmokingCessation:BriefInterventionsE-learning for staffandproductionofthePaediatricResuscitation Technology. ARiskManagementModulewascreated PowerChart andPatientManagementforHealth across thestate,ElectronicMedicalRecord(EMR), Electronic HealthRecord(EHR),whichisaccessible Applications developedine-learningwerethe E-Learning andVideoconferencing Pacifi c GuestFellowship. Putting SiblingsontheAgendaSymposiumandAsia Palliative CareSymposium,PeeandPuffSeminar, Postgraduate Weekend forGeneralPractitioners, Hospital. TheseincludePaediatricUpdate, assistance toanumberofconferencesrunbythe The EducationCentrehasprovidedorganisational • • • • • • Education Centre:KeyStatistics 2895 staffcompletedanonlinecourse 119 ongoingtraineeshipswerecompleted 46 traineeshipswerecompleted 197 staffcompletedorattendednon-clinicaltraining Fire Awareness compliancedroppedto70%buthas (including FireTheory) within theHospital increased steadilyto80%forbothcomponents Protection Training steady atbetween90-95%complianceforChild Mandatory Training compliancehasremained workshop organisedbyCarmel Blayden,Project Clinic Tea wenttoOrangepresent atthetwo-day Diana Barnett,aspartoftheHospital’s Feeding and workofOccupationalTherapy attheHospital. Therapists fromacrossthecountry heardofthevaried Practice, inOctober2007.178Occupational Kids: BuildingPartnershipsinOccupationalTherapy by organisingaonedayseminar, Networkingfor Occupational Therapycelebratedits70thBirthday Occupational Therapy physiotherapy studentsAustraliawide. for consistentgradingoftheclinicaleducation to developanationalassessmenttoolallow Our educatorsrecentlytookpartintheprocess of theBurnsEducationPackage. currently involvedindevelopingthepaediatricportion The physiotherapistsfromtheBurnsUnitare requested byoutsidepaediatricphysiotherapists. conference daysattheHospitalontopicsthatare Department alsocontinuestoprovideworkshopsand education programwasforAuburnHospital.The that arebetterseenclosetohome.Themostrecent metropolitan hospitalssotheycantakereferrals We arealsoproviding paediatriceducationtosmaller well asDADHCandotherNGOs. Wagga andNewcastle. TheypresentforHealth,as including Armidale,Brewarrina,CoffsHarbour, Wagga to presentinmanycentresregionalandruralNSW, The PhysiotherapyDepartmentcontinuestobeinvited Physiotherapy interstate universities. education placementsfromavarietyofNSWand for theirundergraduateandpostgraduateclinical Allied HealthDepartmentscontinuetotakestudents successful. Thisadditionisprovingtoaddvalue. in paediatricsaretestimonythattheprograms Hospital retentionratesofnewgraduatesremaining and collaborativelywithinmulti-disciplinaryteams. but alsohavetheabilitytoworkindependently graduates tonotonlybecompetentpractitioners, Occupational Therapy, tosupportnewAlliedHealth ordinated byHead,SocialWork andDeputyHead, regular sessionshavebeenorganisedandco- To addtotheAlliedHealthNewGraduatePrograms, Allied Health speaker wasTed McNeill,Director ofSocialWork Social Workers fromacrosstheHospital.The invited Seminar washeld,organisedby acommitteeof The IntegratingSocialWork PracticeandResearch Social Work provided lecturesasapartoftheDCHprogram. Kids HealthandNutritionDieteticsDepartments many otherchildhealthandsafetytopics. information availableviatheirwebsite,alongwith the Hospital.KidsHealthnowplanstomakethis starting (pre)school,werepresentedbyexpertsat behaviours, parentingadolescents,bullyingand seminars, addressingtopicssuchasprotective for parents,carersandprofessionalsin2007.The Kids Healthorganisedandcoordinatedfi ve seminars prevention knowledge. 8-12 years),andfoundan18%increaseinburns the programwith89studentsinNSW(agedbetween Physical Education(PDHPE).KidsHealthpiloted the K-6SyllabusPersonalDevelopment,Healthand and stagethreeoutcomesintheSafeLivingStrandof allow studentstoworktowardsachievingthestagetwo assist studentsinexploringthehouse.Theactivities suggested teachingandlearningactivities,which A teachingresourcewasdeveloped,containing can happenandalsohowtheybeprevented. journey throughahousetoseeandlearnhowburns based, animatedhazardhouse,whichallowsusersto “Learn toStopBurns!”programisacomputer- Stop Burns!”programandteachingresource.The an educationconsultanttodevelopthe“Learn and NSWSevereBurnInjuryService,haveengaged Kids Health,workingwiththeBurnsUnit,Kidsafe brief interventions. smoking cessationandconfi dence toconduct Pre andPosttestswillbeusedtoassessknowledgeof with 45havingcompletedtheeLearningpackage). piloted withtwowards(91staffaccessedeLearning, smoking cessationbriefinterventions.Thishasbeen educate staffonhowtoconductevidence-based produced aneLearningpackageandtutorialto Adolescent MedicineUnitandPharmacy, have Kids Health,workingwithRespiratoryUnit, Kids Health Allied HealthProfessionalsWorking withChildren. Offi cer fortheWCHNetwork’s project,Supporting

81 Our People 82 Our People specifi c needsofcliniciansattherural sites. deliver teachingandtrainingworkshops tailoredtothe via videoconferencing,aswell regularsitevisitsto program. Thisprovidessupervision andeducation health professionalsacrossNSWthroughtheCAPTOS Medicine supportarangeofruralandremoteallied University ofSydney. PsychologistsinPsychological and thepostgraduatemedicalstudentprogramat Institute ofPsychiatry, theDiplomaofChildHealth into arangeofoutsideprograms,includingtheNSW contribution toteaching,bothwithinourHospitaland Psychologists intheHospitalmakeasignifi cant NF1LD clinic. Adolescent MedicineUnitandoneinthe four intheDisabilitySpecialistUnit,two Development Unit,seveninPsychologicalMedicine, seven acrosstheRehabilitationDepartmentandChild postgraduate studentsoverthelastfi nancial year, of 21NeuropsychologyandClinicalPsychology The StudentInternProgramsupportedatotal wide rangeofhealthandeducationprofessionals. up-to-date evidence-basedpracticethatattractsa This isasuccessfulongoingprogramwithfocuson psychology seminarsatoverthelastfi nancial year. The PsychologyDepartmenthasrunsixchild childhood dementiaandliteracyremediation. This year, thegroupfocussedontopicssuchas and promotepaediatricresearchclinicalpractice. psychology professionalsworkinginpaediatricsettings Sydney anditsaimistofosterlinkswithother Group. Thisgroupisheldatvariouslocationsaround statewide PaediatricNeuropsychologicalInterest Neuropsychologists intheHospitalco-ordinatea Australia andtheworld. in attendance,alongwith70delegatesfromaround Dr BradDuchaineandProfessorGerryTaylor, were development. Two internationalkeynotespeakers, on theevolutionofcognitiveprocessesinnormal in March2008.Thisyear’s conferencethemecentred Research Unit(DeCog)hosteditsbiennialconference The DevelopmentalCognitiveNeuropsychology Psychology research projects. Social Workers fromwithintheHospitalpresentedon and ChildLife,Toronto HospitalforSickChildren.Six general meeting. electrophysiology toorthopticcolleaguesatanannual Orthoptics havepresentedanupdateon being implementedinNSW2008. StEPS -thenewpreschoolVisionScreeningProgram nurses inSydneyandTamworth, toorientatethem on visionscreeningandTrain theTrainer sessionsfor teaching, offeringaseminartotheCollegeofNursing Orthoptics havealsobeeninvolvedinexternal been addressed. development anddetectionofeyediseasehasalso with limitedresources.Monitoringfornormalvisual and tipsonassessingbabieschildren’s eyes the orthopticsessionhasbeenpracticaladvice sessions runbytheClinicalSchool.Thefocusof Orthoptics haveparticipatedintheSCORPIO Orthoptics This numberincreasedtothreein2008. certifi cation bytheAudiologicalSocietyofAustralia. Clinical Practicum,priortoacceptanceforclinical clinicians werebeingsupervisedfortheir12month In 2007,twoofourpostgraduateMastersinAudiology Audiology paediatric pharmacistcompetencies. and thisgroupisalsodevelopingspecialised a specialisedtrainingcourseinpaediatricmedicines pharmacists arealsoworkingnationallytoconduct prior toregistrationasapharmacist.Several undergoing theirsupervisedpracticeyear, required education programfortwopharmacygraduates The PharmacyDepartmentrunsastructured Pharmacy professional development. is aimedatsupportingcompetenciesandongoing two yearspostgraduateexperience.Thisprogram Psychologists withintheDepartmentwithlessthan a secondarysupervisionprogramforallClinical The DepartmentofPsychologicalMedicineruns with theopeningofnewbuilding in2005 research, indeedthedoubling of researchspace years hasbeeninbasicandpopulation health A largeproportionofthegrowth inthepastten population healthissues. driven byourresearchstaffexposuretoclinicaland health fi elds, with ouractivitiestoalargeextent current researchcoversbasic,clinicalandpopulation to over250researchstaffin25units.Our when theResearchDivisionwasformalisedin1997 over thepasttenyearsfromagroupof60researchers planning forourfuture.We havegrownsubstantially The pastyearhaswitnessedsignifi cant investmentin ultimately aimedathelpingchildreninhospitalbeds. – theadvanceswemakeatlaboratorybenchare in thefactthatourresearchis‘benchtobedside’ directly participateinhealthdelivery. We takepride groups withintheHospitalandhavememberswho groups areassociatedwithclinicaldepartments/ - healthychildrenforafuture.Ourresearch research activityisimprovedhealthforallchildren in careandtreatment.Theprimaryobjectiveofour the Hospitalprovideshighestpossiblestandards Research isoneofthekeymechanismsbywhich Research P ud $7,2.6 529 400 $672,222.76 13 $85,400.26 NoofApplications $25,199.51 11 Funding $18,924.75 250 1,083 $1,104,829.68 Totals $2,709,693.56 385 $753,479.08 Other $803,116.60 $1,906,576.96 General funds-ClinicalTrials $1,956,214.48 SPT funds General funds Staff Specialists(Level1generalfunds&PPT) Bulkeley fund(costcentre9259) $2,709,693.56 Domestic/other travel(allemployees) Overseas travel(allemployees)forperiod Title 1,468 Overseas travel 265 1,203 1,468 • • • making signifi cant investmentsin; a globalleaderintranslationalresearch,wewillbe research centreforchildren.Inorderustobecome Our visionistobecomealeadingglobaltranslational Our vision and ourgovernancestructure. creatively andcollaborativelyonourfuturedirection community, staffinthepastyearhaveworked In broadconsultationwiththeresearchandHospital signifi cantly enhancedourcapacityintheseareas. Medical Research of SydneyandtheOffi ce forScienceand Research Institute,Millennium Institute,University Technology, withpartners Children’s Medical Enhancing theWestmead ResearchHubCore child health. create criticalmassinresearchthemesrelevantto and theUniversityofSydneyotherpartnersto Research InstituteandtheMillennium Research Hubpartners,theChildren’s Medical maximising opportunitieswithourWestmead expertise thatiscurrentlypresent.Thiswillinclude Strategic healthprioritiesbuildingonthecore capacity toconductclinicaltrials Clinical Trials ResearchCentretoenhanceour

83 Our People Our People

Already, the fi rst step in enhancing our clinical trial One of the unique strengths of the Research Hub capacity is underway with a generous donation from is that we are the only campus of the University of a bequest from the University of Sydney. The bequest Sydney that can offer research and clinical trials will support a Clinical Trials Project Coordinator whose across all age groups. One of the main focuses of role will involve an assessment of future infrastructure this campus will be to increase the capacity of our requirements (resources and facilities) and clinical trials initiatives across all age groups where developing models for growth. Broad consultation with there are common issues and expertise, for example researchers, clinicians, other key staff and external cancer, diabetes, infectious disease, novel therapies to stakeholders to achieve these goals and to coordinate promote fracture healing and minimise osteoporosis, the establishment of a paediatric network will be a inherited neuromuscular disorders and asthma. part of the role. Our Research Division and the CMRI share a Research Governance common history, several strong collaborations, The governance structure for the Research Division shared facilities and close geographical proximity, has been reviewed with a clear objective of providing but are independent in their governance and in accountability for research activities and their fi nances most of their research activities. During the year, we through the Research Committee. New terms of have provided background information for a review reference for the Research Committee have been of the two organisations by an external committee, endorsed by the Hospital and are being progressively chaired by Professor Brandon Wainwright from implemented throughout 2008. University of Queensland. The purpose of the review is to determine whether there is a case for some Our Partners form of amalgamation of the research efforts of both institutions, in particular: Research at The Children’s Hospital at Westmead is part of a vibrant research community of over o What benefi ts and synergies might fl ow from a 800 researchers, the Westmead Research Hub. closer organisational alignment? Our major partners in the Hub are the Westmead o If these are substantial, what is the optimal form Millennium Institute, Children’s Medical Research of organisational restructuring to capture Institute (CMRI), University of Sydney and the Offi ce these benefi ts? for Science and Medical Research. Planning has started for a new Hub building on the Westmead The information prepared by our research units campus, which will house an expanded Millennium highlighted the high quality of our research and our Institute and core high technology facilities that will productivity – this is now available on our website, be jointly funded and used by the partners. This is an www.chw.edu.au/research exciting collaborative initiative that will enhance our strong biomedical research base, provide increasing Senior staff changes opportunity to attract leading clinician researchers and postgraduate students and ensure quality and I wish to acknowledge the contributions of two key excellence in clinical care. staff who have taken positions in other institutions. Professor Peter Gunning was the fi rst director of the Research Division being appointed in 1997.

84 Our People

Peter made enormous contributions in his leadership a multidisciplinary approach to improve child health of the Research Division, his enthusiasm and and this has led to over 450 publications in the past expertise in translational research, linking the bench year. Our research activity has resulted in some to bedside, saw a four fold growth in the research extraordinary outcomes for our patients and their community and more than doubling of our laboratory families and a few of these are described below. and offi ce space. The inclusion of the Human Applications Laboratory and the Transgenic Facility • Discovery of a new form of muscle disease and in the new building position us at the forefront of development of mouse models to help develop facilities for translational research and refl ected therapies that may help children with this Peter’s clear vision for research at The Children’s muscle disease Hospital at Westmead. • Identifi cation of a common genetic variant that infl uences muscle performance in elite athletes Peter has a broad perspective on biomedical research and the general population and has been a key individual in developing strong • Discovery of new treatments to promote relationships with our Westmead Hub partners. Peter bone healing was instrumental in promoting the commercialisation • First report of spontaneous bone marrow of biomedical research. He successfully lobbied chimerism following liver transplant in a government to establish a technology transfer offi ce 12 year old girl (Bio-Link) in NSW and was the founding Chairman • Commissioning of the fi rst Australian facility for of the board, Bio-Link Partners Ltd. We wish him well gene therapy applications. This facility will allow for the future leading his research program at the us to harvest and manipulate patient cells prior University of NSW. to their delivery back into the patient and we will also be able to produce our own gene vectors at Professor Raina McIntyre has been a senior member therapeutic levels. The fi rst trial to assist children of the National Centre for Immunisation Research with cancer will commence during the next year. and Surveillance since 2003. Raina has been active • National centre for paediatric clinical trials in immunisation clinical trials and has provided - First large randomised trials of asthma and unique expertise in economic modelling of infectious diabetes prevention from birth disease. Raina will be taking up a position as Head of - First randomised trial of inpatient weight Population Health at the University of NSW. restoration versus brief hospitalisation for management of anorexia nervosa Our Achievements - Large randomised trials for immunisation of The ultimate measure of the success of our children and adults, neurogenetic and respiratory research activity is improved health for children. disorders, diabetes and obesity As a direct result of past research, there have been signifi cant advances by the Hospital in the The past year has also witnessed increasing success development of treatments, cures and prevention of with competitive grant funding of more than $12 diseases, which have benefi ted numerous children million, from a broad array of funding organisations with cancer, obesity, kidney, heart and respiratory including NHMRC/ARC and competitive USA based problems. Our researchers share their knowledge in organisations.

85 Grant Type Chief Investigators Title

NHMRC Project Grant A/Prof David Little Modelling the loss of NF1 heterozygosity in congenital Dr Paul Baldock; pseudarthrosis of the tibia (CPT) Dr Ian Alexander; Our People Dr Aaron Schindeler

NHMRC Project Grant Dr Stephen Alexander Kidney Transplantation; Improving Outcomes Dr G. Alex Bishop; Dr Alexandra Sharland

NHMRC Project Grant A/Prof Jonathon Craig Antecedents of Renal Disease in Aboriginal Children and Young Dr Elisabeth Hodson; Adults - 12 year follow-up Prof David Lyle; Ms Della Yarnold; Prof Paul Roy; Dr Leigh Haysom

NHMRC Project Grant Dr Geraldine O’Neill Understanding Focal Adhesion Dynamics in Cells Migration Prof Peter Gunning

NHMRC Project Grant Prof Kathryn North The infl uence of alpha actinins on human performance in health Dr Edna Hardeman; and disease Prof Peter Gunning; Dr Stewart Head; Dr Nan Yang

NHMRC Project Grant Dr Rachael Murray Integrin intracellular transport, expression and function in macrophages regulates infl ammation during wound healing

NHMRC Project Grant Prof Sandra Eades Ear health, hearing, speech and language development in urban Prof Peter McIntyre; Aboriginal children Prof Kim Oates; Dr John Daniels; Dr Susan Woolfenden

NHMRC Project Grant Prof Tien Wong Prediction of Microvascular Complications in Type 1 Diabetes A/Pr Kim Donaghue; Using Novel Retinal Vascular Imaging Techniques A/Pr Alicia Jenkins; Dr Gabriella Tikellis

NHMRC Project Grant Dr Genevieve McAuthur A randomised control trial of treatments for children with different Prof Max Coltheart; types of reading diffi culty Prof Anne Castles

NHMRC Project Grant A/Prof Maria Kavallaris Targeting the cytoskeleton in cancer Prof Peter Gunning

NHMRC Project Grant Dr Maria Craig Viral triggers of autoimmunity and type 1 diabetes: a prospective study of at risk children

NHMRC Project Grant Prof Anne Simpson Reversal of diabetes in pigs using liver-directed gene therapy Dr Bronwyn O’Brien; Dr Ian Alexander

NHMRC Project Grant Prof Anne Chang Multi-centre evaluation of a clinical pathway for chronic cough in Dr Peter Morris; children – can it’s use improve clinical outcomes Prof Collin Robertson; Prof Peter Van Asperen; Prof Nicholas Glasgow; Dr Ian Masters

ARC Discovery Project A/Prof Cheryl Jones The effect of age on regulatory T cell control of the innate and Prof A Cunningham; adaptive antiviral immune responses Dr S Alexander

ARC Discovery Project Dr James Wood Modelling and estimation techniques for the transmission and Dr P Caley control of Tuberculosis with new and existing vaccines

ARC Discovery Project Prof Kathryn North Molecular dissection of the effects of alpha-actinin-3 defi ciency on Dr G Huttley normal variation in skeletal muscle function

86 Grant Type Chief Investigators Title

ARC Discovery Project Dr Ms Gold Can and should we link data at a national level? Vaccine safety A/Prof AJ Braunack-Mayer; surveillance: A case study A/Prof P Ryan; Prof CA Gericke; Prof JJ McNeil; Our People Dr CJ Freemantle; Prof CJ Thomson; Dr EE Roughead; Dr LK Taylor; Prof E Elliott; Dr DR Filby; Dr JP Buttery

NHMRC Australian Dr Mohamud Sheikh Infection, Immunity and immigration – prevention and control of Based Public Health infectious diseases in refugee children Fellowship

NHMRC Overseas Dr Kate Quinlan The role of growth factors in pluripotency and differentstion of Biomedical Fellowship human embryonic stem cells - towards human therapy

NHMRC Dora Lush Ms Leigh Waddell To apply evidence based practice to the diagnosis of muscular Scholarship dystrophies’

NHMRC Public Health Ms Anita Heywood Travel patterns, traveller behaviour and their relationship to the Scholarship importation of infectious disease into Australia

NHMRC Biomedical Ms Vanessa Shrewsbury Treatment of overweight and obesity in adolescence Scholarship

NHMRC Clinical Dr Paul Robinson The Clinical Utility of Small Airway Function Tests in Paediatric Scholarship Respiratory Disease

NHMRC Public Health Ms Michelle Irving Implementation of evidence into clinical practice in chronic kidney Scholarship disease (CKD)

NHMRC Biomedical Ms Nicole Yu Manipulating the anabolic and catabolic responses for Bone Tissue Scholarship engineering

AOA Research A/Prof David Little Manipulating the anabolic and catabolic Responses for bone tissue Foundation Grant engineering

Apex Foundation Dr Belinda Barton Does the cognitive psychsocial profi le of children with for Research into velocardiofacial syndrome (VCFS) differ from an IQ matched Intellectual Disability Ltd control group?

Cancer Inst. Clinical Dr Loretta Lau Selective targeting of the actin cytoskeleton in cancer therapy Research Fellowship

Coles Community Grant Prof Louise Baur Patterns and predictors of physical activity in young children

Diabetes Australia Dr Sarah Garnett Dietary protein: the effects of insulin resistance in adolescents Research Trust Grant

Muscular Dystrophy Dr Sandra Cooper Dysferlin and defective muscle membrane repair in limb girdle Association Prof Kathryn North muscular dystrophy

Perpetual Foundation Prof Peter Gunning Application of a state of the art intermediate voltage transmission Grant electron microscope to further elucidate the underlying mechanisms of cancer

Pfi zer Endocrine Care Dr Kim Ramjan The effect of whole body vibration training on insulin sensitivity in Dr Sarah Garnett overweight adolescents Dr Craig Munns A/Prof Chris Cowell

Clive and Vera A/Prof Chris Cowell Real-time Amplifi cation System (QPCR) and high resolution Melt Ramaciotti Foundation (HRM) - Gene Expression and analysis Facility Medical Research Grant

Australian Rotary Health Prof John Christodoulou Development of Novel Treatment Strategies for Phenylketonuria Research Fund Dr Ian Alexander

87 Grant Type Chief Investigators Title

March of Dimes Prof Kathryn North The Role of Contactin-1 in serve Childhood Myopathy

MBF Foundation Dr Sarah Garnett The role of dietary protein and exercise in pre-diabetic adolescents

Our People The Financial Markets Prof Lousie Baur Loozit: a community-based healthy, active living program for Foundation for Children overweight and obese young people aged 13-16 year

March of Dimes Prof John Christodoulou The Utility of forced Myogenesis of cells in culture: Unmasking mitochondrial Respiratory Chain (RC) Disorders

Children’s Tumour Dr Aaron Schindeler Modelling the loss of NF1 heterozygosity in congenital Foundation pseudarthrosis of the tibia (CTP)

US Army Grant Prof Kathryn North A randomised placebo controlled study of lovastatin in children with neurofi bromatosis Type 1

ARC Linkage Grant Ms Kaye Spence The emotional and social burden of caring for a young child with Dr Nadia Badawi complex health needs

ARC Linkage Grant Prof Robert Booy Social, Economic, and Health Benefi ts of Vaccinating Children in Dr Julie Leask Day Care Centres against Infl uenza Prof Theodorous Sloots Prof Stephen Lambert

Infrastructure Support for Research Ethical Assessment of Research Projects The Research Offi ce is an administrative unit of 20 All research projects involving human subjects carried staff that supports laboratory management, facilities out within the Hospital are required to conform with including microscopy, transgenic, human movement the principles set out in the Declaration of Helsinki, laboratory, clinical research rooms and the human the National Health and Medical Research Council’s application laboratory, ethics and governance ‘Statement on Human Experimentation’ and the including Intellectual Property and manages an Australian College of Paediatrics Code of Ethics in infrastructure budget of approximately $2.6M. The Regard to Research in Children. unit also administers grants and scholarships in partnership with The University of Sydney and our For research involving animals, projects are required Clinical School (Faculty of Medicine, Discipline of to conform to the National Health and Medical Paediatrics and Child Health). Research Council’s Australian Code of Practice for the care and use of animals for scientifi c purposes Fundraising (7th Edition, 2004) and the Animal Research Trish van Leeuwen has joined the Research Division Regulation 2005. as a dedicated Fundraiser with the objective of building an endowment and recurrent revenue for The Human Research Ethics Committee (HREC) research. Trish’s experience will be instrumental in is one of the principal committees of the Hospital, helping overcome the challenges of developing a and is constituted according to the guidelines for dedicated research fundraising program and strategy Human Research Ethics Committees determined by in fundraising in a highly competitive environment. the National Health and Medical Research Council in its Statement on Human Experimentation. The Salary Structure committee consists of chairperson and secretary, The NSW Health salary structure for research is three laypeople, two members with legal expertise, not linked to enterprise bargaining and, as such, one minister of religion, one representative of the salaries have not increased in three years. We have Hospital Executive, one professional care member and successfully implemented a new salary structure representatives from research including allied health for research which will provide a new framework for and nursing research, basic/laboratory research and performance management and career development of anaesthetic/surgical research. research staff. The HREC meets eight times per year and has two sub-committees, the Form Review Committee (FRC) and the Scientifi c Advisory Committee (SAC).

88 In the fi nancial year there were 95 HREC submissions comprising of:

Project Type Submitted Clinical Drug/Device Trials 17 COG new Clinical Trial/Project 4 Our People Clinical Studies 36 Laboratory Studies 8 Qualitative 14 Questionnaire 6 Other 10 Total Projects 95

The Animal Care and Ethics Committee (ACEC) meets six times a year and is a joint committee with the Children’s Medical Research Institute (CMRI). The committee is constituted as per item 2.2.2 of the Code of Practice. The committee is comprised of two category A people (Veterinarian), four category B people (Researchers with current animal handling experience, two each from the Hospital and the CMRI), two category C people (demonstrable activity and experience in animal welfare) and two category D people (Layperson viewed by the wider community as bringing an independent view to the AEC).

89 Our Community Our Community

Children’s Hospital Children’s Hospital Advisory Advisory Council Council Report The Children’s Hospital Advisory Council (CHAC) met ten times during the 2007/2008 fi nancial year. Chairman’s Year in Review Council members have contributed enormously to the policies, plans and initiatives of the Hospital since the The Children’s Hospital at Westmead is one of this Council’s inception in 2005. State’s most precious assets. The tradition of the Hospital at the highest level goes back to the Royal CHAC continues to provide excellent fi nancial advice Alexandra Hospital for Children at Camperown and support to the Hospital. The Council has been and this institution has now been an icon for many particularly involved in the Hospital’s long term decades – why so? fi nancial planning and asset replacement strategy. An important consideration of CHAC is to ensure that The Hospital literally has the biggest facility clinicians, patients and the community are effectively and, above all, the greatest faculty of clinicians, engaged and consulted on an ongoing basis. researchers and the highest levels of professional

support in NSW. Each year, through the dedication, Members have been selected for their understanding skill, research, innovation and selfl ess application of of health challenges facing NSW communities and these wonderful people, countless children are given bring a unique perspective on the issues facing the another chance in life, despite illnesses or handicaps. provision of paediatric health care.

The Children’s Hospital at Westmead brings together CHAC has been consulted on a range of issues a world-class group of talented and experienced throughout the 2007/2008 fi nancial year and have individuals who have chosen to make their experience made a signifi cant contribution to the Hospital in the and knowledge available to develop and shape the following areas: Hospital for the future.

• Supporting and advising on the Hospital’s fi nancial My own association with the Hospital goes back to position and strategic direction the Camperdown days, along with many of my fellow • Consumer and patient satisfaction initiatives Council members, who I thank for their ongoing • Donor nurturing and support support. I am delighted to serve on the Advisory Council as a small way to support this outstanding The Chairman’s major donor dinner was also held to institution. nurture some of the Hospital’s major supporters. This event was a success, building closer ties with these I also wish to express our appreciation for the individuals and further communicating the Hospital’s countless thousands of individuals and groups challenges ahead and need for further support. It is who support The Children’s Hospital at Westmead anticipated that this will be a regular event. and for the other major opportunities provided to fi nancially support this great work. Thank you for your The role of CHAC will continue to strengthen over commitment and ongoing support to the Hospital. time. Important issues which will be addressed in the future by CHAC include: I look forward to working with you all in the

coming year. • Financial management • Future strategic direction Roger Corbett AO • Positioning and branding Chair, Children’s Hospital Advisory Council

90 Our Community

Member profi les Mr John Conde, AO Mr Conde is Chairman of EnergyAustralia, MBF Mr Roger Corbett, AO (Chair) Australia Limited and PowerTel Limited. He is a Roger Corbett’s esteemed career in the retail sector Director of Excel Coal Limited, the Sydney Symphony spans over 40 years, the pinnacle being his position Orchestra, The Australian Elizabethan Theatre Trust. as Chief Executive and Group Managing Director He is President of the Commonwealth Remuneration of Woolworths Limited. He currently holds various Tribunal. He is also Chairman of the Australian Chairman and Board of Director positions in a variety Olympic Committee (NSW) Fundraising Committee, of organisations, including Fairfax Holdings and the President of the Dermatology Research Foundation Reserve Bank of Australia. Roger is renowned within (University of Sydney), and Member of the President’s the business sector for his intuitive understanding of Council of the Art Gallery of NSW. the changing needs of consumers and his ability to set and maintain high standards. Mrs Renata Kaldor, AO Mrs Kaldor is the Deputy Chancellor of the University Dr Bronwyn Gould, AM of Western Sydney and is involved in business, education and community affairs. She was a director Dr Gould has experience working in a primary care of the Sydney Symphony Orchestra for eight years practice specialising in child and family health for from 1996 to 2004 and was made an Offi cer in the more than a quarter of a century. She has served on Order of Australia in 2002. the Australian Council for Children and Parenting (ACCAP) since 2001 and as Chair since 2005. She Ms Kerry West is a member of the NSW Ombudsman’s Reviewable Child Deaths Advisory Committee. She is an active Ms West is the Deputy Head Physiotherapist at The leader with young people in Guides NSW. Children’s Hospital at Westmead. She is Chair of the Allied Health Quality Improvement Committee and Professor Ralph Nanan is also a member of the Nursing and Allied Health Research Committee. Professor Nanan is the Chair of Paediatrics, Nepean Clinical School, The University of Sydney. As a clinical Mr Bradley Ceely academic at Nepean Hospital, he is responsible for clinical supervision and teaching in paediatrics and is Mr Ceely is a Nurse Practitioner in Paediatric Intensive also involved in research. Care at The Children’s Hospital at Westmead. He has developed a model of care for long-term ventilated Dr Michael Fasher children at the hospital and has presented at state and national conferences on critical care and quality Dr Fasher has worked as a health care provider in improvement. western Sydney for nearly 30 years. He is a member of the management committee of the Blacktown Mr Harry Michaels, OAM (to October 2007) Medical Practitioners Association and is involved in the education of parent groups in the community, Mr Michaels is the owner and Managing Director of a medical students and registrars in Vocational General major innovator of studio and digital outside broadcast Practice Training. facilities. He has created and directed more than 4,000 episodes of the fi tness show, Aerobics Oz Style. Mrs Joanna Capon, OAM Professor Kim Oates, AM Mrs Capon is a member of the Health Care Quality Committee of The Children’s Hospital at Westmead, Professor Oates’ positions at The Children’s Hospital the Operations Art Management Committee and the have included Community Paediatrician; Head of the Australian Centre for Photography. She was awarded a Child Protection Unit; Head of the Child Development Medal of the Order of Australia (OAM) in 2002 for her Unit and Children’s Assessment Centre; Chairman services to The Children’s Hospital at Westmead. and Director of Medical Services and Chief Executive (retired February, 2006) and he was the Foundation Douglas Burrows Professor of Paediatrics and Child Health in the University of Sydney.

91 Our Community

He has been President of the International Society We participated in the 2007-2008 NSW Health for the Prevention of Child Abuse and Neglect (and Patient Survey and we were very pleased with our is currently an Executive Councillor), Inaugural Chair results. Across three categories (paediatric inpatients, of the NSW Child Death Review Team and chaired emergency patients and outpatients) 89% of families the Federal Government’s National Council on the rated our overall care as very good, which was higher Prevention of Child Abuse. Professor Oates was than the State average of 88%. appointed to the Advisory Council in June 2006. In July 2007, the evaluation report of the Parent and Carer Resource Centre (PCRC) was fi nalised, with Consumer Feedback initial data confi rming a dramatic increase in average Complaints management is the responsibility of the daily visits to the PCRC from May 2006 to May 2007. Service Improvement Unit (SIU) and there are two We also increased the proportion of male service designated complaints managers at the Hospital; the users and people from ATSI and CALD backgrounds. Director of Clinical Governance and Medicine (Dr In July the new policy, Supporting Staff who are Stuart Dorney) and the Patients’ Friend Carers, was fi nalised and the Carer Support Program (Betty Radcliffe). (CSP) formed a partnership with the Working Carers Liaison Project, run by Hills Community Care, to offer All complaints are taken seriously and documented services and support to our staff who are carers. very carefully. As much time as is required is spent with families in order to ensure that their concerns The CSP took a lead role in the refurbishment of are addressed fully. Some matters are easily and the parent lounges on each of the wards in August quickly resolved. Others of a more serious or complex 2007. Carers Week was celebrated and was a very nature may take a number of weeks and numerous successful week. In May 2008, the CSP began the discussions and meetings to reach a satisfactory fi rst ever hospital-based MyTime group in Australia outcome. and is working in partnership with Playgroups Australia. Frequently raised issues include diffi culties with physical access, access to services, communication The Carers Action Plan was developed, consulted and hotel services. on and fi nalised over the 2007-2008 period and submitted to NSW Health in July 2008. The Carer All complaints and the processes involved in achieving Support Program continued to offer a range of events resolution are reviewed by a high level committee, and activities for parents and carers in the Parent and the Public Accountability Committee (PAC), which Carer Resource Centre throughout 2007-2008, with meets quarterly. The Chief Executive chairs PAC and almost 4000 occasions of service. membership includes most of the senior executive, a representative of the Medical Staff Council and The Family Advisory Council is the peak consumer two community representatives. The complaints group at The Children’s Hospital at Westmead and is mechanism is a rich source of improvement activities, a dynamic and motivated group of parents who have and each complaint is regarded as an opportunity to made signifi cant contributions to improvements at the review and revise policy and practice. Hospital. Some of the things they have been involved in this year and have provided feedback from a family During 2007-2008, 272 patient complaints were perspective are: received, with 16 of these being Ministerials and seven being referred from the Health Care Complaints • The redesign of the Emergency Department Commission (HCCC). NSW Health KPIs for • The Smoking Cessation Committee complaints management are 100% acknowledgement • Various Clinical Redesign projects within fi ve working days and 85% resolution within 35 • Improvement Action Plan from the 2007 NSW working days. Our KPIs for the year under review are Patient Health Survey, and 92% and 96.5% respectively and we are consistently • Staff Guidelines on Consumer Participation the best performer in complaints management across NSW Health. The FAC have also been Involved in the recruitment of several key consumer staff positions, as well as

92 Our Community

looking nationally and internationally at how best recently arrived migrants, especially refugee families, practise peak consumer groups operate elsewhere. are particularly vulnerable in accessing healthcare because of linguistic barriers and misunderstandings.

Cultural Diversity There is a continuing need for translations of fact The Children’s Hospital at Westmead continues sheets and other health promotion material for to serve a very culturally and linguistically diverse patients and their families. Major translations this year community and is committed to ensuring equity included the Asthma Education Plan and the DVD for of access to all services. The Hospital has been the Shaken Baby Prevention Project. Our bilingual recognised generally as a leader in family centred staff also provided valuable assistance in reviewing and child friendly care. This means addressing not translations to help ensure the quality of translations. only the child’s specifi c illness, but the broader The Hospital’s Cultural Diversity intranet website also developmental, emotional and social needs of the has fact sheets and profi les a range of cultural issues child within the context of their family. with links to other multicultural health websites. The information is available to support staff in working As parents and carers are partners in care, it is across cultures. essential to share information and engage with them in collaborative decision making. In applying Other cultural diversity initiatives included special this approach, it is also important to recognise that educational events within the Pain and Palliative Care hospital staff as well as patients and families come Service to enhance the cultural competence of staff from a wide range of cultural backgrounds. Particular and new teaching modules within the Diploma of challenges arise with variable English language skills, Child Health related to cultural and social infl uences cross generational confl icts and differing practices on child health. The Volunteers Department also around parenting and the health care of children. developed a project to enable mature aged TAFE Moreover, cultures are constantly changing in students from diverse cultural backgrounds to gain response to new circumstances and opportunities. volunteer experience here at the Hospital. This requires staff to be not only skilled, respectful and comfortable in working across cultures but to be Our Volunteers open to new learning from the experiences of families who use our services. The Hospital relies on its volunteers for the strong support they offer in so many different ways. The past year saw the completion of valuable research Volunteers support staff by helping out in ward areas, in relation to how cultural diversity among the Hospital feeding and caring for babies and children who need patients and staff infl uences care. With support assistance, taking kids for walks, reading them stories of an ARC Grant, a research team at the Centre or playing with them, both to assist staff and to allow for Cultural Research at the University of Western parents some time for themselves. Sydney worked in a constructive and rewarding partnership with The Children’s Hospital at Westmead Our ‘Vollies’, as they are affectionately known, also and Sydney Children’s Hospital at Randwick. Other provide a Hospital escort service for those who are partners included the NSW Department of Health, new to the Hospital or need to fi nd a department the Multicultural Health Service of South East Sydney which is some distance from the front entrance. Illawarra Health and Community Paediatrics in Sydney South West. The volunteers continue to operate the Volunteers’ Shop and the Trash and Treasure Stall, which sells A multi-method research approach delivered mostly donated goods. These funds are used to signifi cant fi ndings and recommendations that are provide equipment and services which supplement highly useful in developing future policy, practice, those purchased from the general budget. They not educational programs. The fi ndings highlighted only sell raffl e tickets in-house for the Hospital, but opportunities for improvement, as well as an overall also help raise money in external raffl es. They also sense of commitment and compassion among staff spend many hours giving their service to external caring for children and their families. Communication activities, such as at the Teddy Bears’ Picnic. diffi culties remain a signifi cant challenge and more

93 Another service provided by the volunteers is vacation care for children of staff who cannot take the time Our team of Volunteer Chaplains supplement the off in the school holidays. They also support parents services provided by the chaplaincy team. Their initial in the evenings and on weekends in the Emergency training has been followed up by ongoing mentoring. Department. They offer assistance in caring for the We are currently organising a Volunteers’ Training other children, providing a listening ear, the occasional Course to recruit and accredit new volunteers. cup of tea and generally helping the Department to

Our Community maintain a friendly environment. A 24 hour on-call service is always provided for the Hospital. It has been noted that chaplaincy services Volunteers also work in offi ces, various clinics, the are still not routinely accessed at times of trauma Hydrotherapy Pool and the Medical Library. or death. We are seeking to address the reasons behind this trend. Chaplains are involved in Hospital The weekend opening of the Sibling Care Centre has committees. We keenly support the provision of proved very successful and is appreciated by parents pastoral care at Bear Cottage and would participate in who are able to relax while visiting their sick child, any improvement deemed necessary in the future. knowing their other children are being well looked after. In 2006, the Sibling Care Centre accommodated Resources, memorial services, baptisms, funerals 2050 children. and celebrations of special religious days are frequently requested. The 400 Volunteers who offered their time to the Hospital this year gave a total of over 1800 hours of The Chaplaincy team appreciates the way the Hospital their time each week. Volunteer donations to The openly values and supports the holistic care of its Children’s Hospital at Westmead for 2008 amounted patients, staff and families. to $180,000. Benefactors and Donors Chaplains Each year we turn to the community for additional Providing pastoral care for the patients, families and fi nancial support to allow us to transform The staff of the Hospital remains the core business of the Children’s Hospital at Westmead from a very good Chaplains. Every baby, child and teenage patient has hospital to one which provides excellence in care for access to spiritual support while at the Hospital. Some sick children, equal to the world’s best. families are followed up further by phone, mail, email or home visits. Unique to our Hospital is our program Again we extend a very special thank you to all our of ward-based chaplaincy. This means that support is donors and supporters who have given so generously available to all, beyond the limits of religious affi liation. this year.

Individually packaged pastoral care is designed to Founders meet the expressed need of the patient and family. Visiting in the ward, initial spiritual assessment, Australasian Order of Old Bastards empathic listening and, if requested, spiritual or Bridgestar Pty Ltd religious services are provided in fl exible response to Clubs NSW Eastern Zone Bear Cottage & Other the dynamic nature of the hospital experience. Charities Committee Emerald Ball Committee A network of accredited visitors from many faiths Inghams Enterprises Pty Ltd and cultural communities is maintained to provide a John R Turk Fund prompt and appropriate response to specifi c religious Rett Syndrome Australian Research Fund requests, beyond the expertise of the current team. A Estate Late Edward O Drysdale key development of this network is that an accredited Estate Late Noni Dora Audette part time Muslim pastoral visitor has now been Estate Late Phyllis Lillian Rose providing twice weekly visits to all Muslim patients since August 2007. Benefactors

Meetings initiated by Hospital staff members Canterbury Bulldogs Leagues Club themselves are overseen by the Department. Diavitiko Committee These take the form of public lectures and Integral Energy Australia discussions and regular prayer and study groups. Jardine Lloyd Thompson Kel Geddes Management There has been a constant interest in these groups Shipping Industry Golf Challenge by the Hospital community. Sir Robert & Lady Askin Charities Trust Estate Late Arthur Brown The Department has eight part time Chaplains (4.15 Estate Late Joan Margaret Economus FTE) appointed and funded by their churches with Estate Late John Arthur Fairless Dent some State government assistance in the form Estate Late John Thomas Ryan of grants. Estate Late Marius Joseph Bourke

94 Groups and Corporate Donors over $5000 Fairfi eld RSL Memorial Club Ltd Finity Consulting Pty Limited 11:11 Productions Fire Fighters Calendar 400 in 4 Charity Ride Footwear Leather And Allied Trades Cot Fund A Bear Affair Committee Fred’s Fruit Markets Access Security Pty Ltd Freight Train Music ACCO Australia Friends of Bear Cottage

Allergan Front Row Events Our Community Amyson Pty Ltd GA & SW Commerford Pty Ltd Andrews & Rech Pty Limited GE Capital Finance Australia ANZ Stadium Geberit Associazione S. Sebastiano Martire Gilbert & Roach Auburn RSL Bowling Club Ltd Goodman Fielder Austbrokers RWD Pty Ltd Goodman International Australasian Order of Old Bastards Granville RSL Sub-Branch Ltd Australia Post Gresham Partners Limited Australian Poker League (APL) Greyhound Publications Pty Ltd Australian Reptile Park Gypsy Jokers Balgowlah RSL Memorial Club Heartkids NSW Inc Bandaged Bear Benefi t Night Hornsby RSL Club Limited Bankstown District Sports Club Howards Storage World Bears to Broome IGA Distributions Blue Mountains Home Hardware Inghams Enterprises Pty Ltd BP Inner Wheel Club of Liverpool Combined Inc BREATHE Insurance Australia Group Bridgestar Pty Ltd Integrated Group BT Financial Group International Order of the Rainbow for Girls Bulldogs Rugby League Football Club Intrepid Travelling Troupe Cabramatta Rugby League Club IUS Holdings Pty Ltd Camp Quality Ltd J J Lawson Customs & Freight Brokers Canterbury Bulldogs Leagues Club J.A.C.E.K. Pty Ltd Canterbury-Hurlstone Park RSL Club Jardine Lloyd Thompson Caring for Kids - Bankstown Group Jenolan Caves Reserve Trust Case Fabrication Pty Ltd John Swire & Sons Pty Ltd Central Coast Kids In Need Inc Kandalee Grazing Co Children’s Oncology Group Kandiut Holdings Pty Ltd Citi Australia Kayaking for Kemo Kids City Tattersalls Club Keith Soames Real Estate CLM Excavations Pty Ltd Kel Geddes Management Clubs NSW Eastern Zone Bear Cottage & Other Kindifarm Charities Committee Lill Bayley & Friends Coastal Watch Pty Ltd Lions Club of Carlingford-Dundas Combined Ford Clubs of NSW Lions Club of West Pennant Hills - Cherrybrook Inc Commercial Travellers Cot Fund Lions Clubs International District 201N5 ConnecTeD Committee Liquid Learning Group Pty Ltd Convoy for Kids Sydney Inc Little Wishes Inc Cornucopia Committee Inc Liverpool West Rotary Cranium Hair Loud & Clear Cupcake Creations Luxe Medispa Cure Our Kids Inc Marsupial Landscapes Pty Ltd Delahunty Constructions Massel Pty Ltd Dell Computers Pty Ltd MBF Australia Limited Delta Society Australia McHugh Holdings Diavitiko Committee Medtronic Australasia Pty Ltd Dooleys Lidcombe Catholic Club Ltd Meteora Benevolent Society Dounia’s Dancing World Metromix Pty Ltd Drummoyne Rowing Club Mount Lewis Bowling Club Dulux Australia Mounties Swimming Club Edwin Street Residents Munich Holdings of Australasia Pty Ltd Emerald Ball Committee Mustang Owners Club of Australia (NSW) Inc Era Polymers Pty Ltd National Foods Ethcorp & Associates Pty Ltd Nationwide News Pty Ltd Eventide Homes (NSW) Near East Distributors

95 NeuroFriends Committee The Buchan Group Novartis The Cameron’s Bandaged Bear Blues NSW Fire Brigades - Katoomba The Ettamogah Pub Social Club NSW Fire Brigades - Payroll Contribution Scheme The Independent Liquor Group (Suppliers) Co- NSW Fire Brigades - Training College Operative Ltd NSW Fire Brigades Band The Laugh Garage Comedy Club NSW Food & Allied Trades Golf Assoc The Sound of Music

Our Community NSW Police Hurstville Local Area Command Thomas Hare Investments Ltd NSW Rural Fire Service (Coffee4Kids) Toongabbie Sports & Bowling Club Limited Olex Australia Pty Ltd - Golf Day Total Advertising & Communications Osteogenesis Imperfecta Society of Australia UCB Pharma Pacifi c Hoists Unilever Australasia Panthers Club North Richmond Variety the Children’s Charity Parramatta City Council Vietnamese Australian Welfare Association Parramatta Social Club - DCS Western Earthmoving Pty Ltd Perkin Elmer Wallac Oy Westpac Poseidon Tarama Pty Ltd Whites Wires Australia Pty Ltd Princeton Publishing Pty Ltd Woolworths Supermarkets Print Management Australia Pubfaast Holdings Pty Ltd Private donor gifts over $1000 Pymble Pub Pensioners Qantas Airways Ltd Adams W F & K H Mr & Mrs Rachel Parkinson Hospital Equipment Fund Adams Elizabeth Radiomarathon Adams Rob & Sarah Mr & Mrs Rat Pack Golf Tours Adamsas D Mr & Mrs RBC Dexia Investor Services Ahrens M Mr RED Abrasive Blasting & Protective Coatings Albert AO Robert Mr Reed Elsevier Australia Pty Ltd Alfaro Mario Mr Rellim Holdings No 2 Pty Ltd Ali Avsar Serdar Mr Rett Syndrome Australian Research Fund Allen Gary Roche Products Pty Limited Allen R & M Mr & Mrs Rotary Club of Balgowlah Amata Phillip Mr Rotary Club of Belrose Anderson Garry Mr Rotary Club of Burwood Anderssen Susan Mrs Rotary Club of Frenchs Forest Ball Steve Mr Rotary Club of Glenhaven Barber & Vella Rosemary & Tess Mrs & Mrs Rotary Club of Ku-ring-gai Barker C&R Rotary Club of Manly Sunrise Barnes David Mr Rotary Club of Terrey Hills Barrett Marcia Mrs Rouse Hill “Renegades Rugby” Barter R G Mr & Mrs Russell Investment Group Basha Ken Mr Sargents Pty Limited Basil-Jones Richard Mr Save Our Sons Baur Louise A Professor Scholastic Australia Beattie & Maher Scott & Taryn Mr & Ms Shin-A Pty Ltd Bedwell Esq J B Mr Shipping Industry Golf Challenge Bennett Margaret Mrs Singapore Airlines Bickford E Mr Smartline Blackley Grant Mr Sovereign Order of St John of Jerusalem Blomfi eld C I Mrs Specialized Engineering Services Bloom QC David Mr Sports Outdoor Media Pty Ltd Bolster Sarah Ms Springvale Colliery CFMEU Lodge Bonifacio Michael Mr St George Bank Bovis Darren Mr Starbucks Coffee Company Brasher Richard Mr Sydney Ferries Brown Stewart H M Mr Sydney Invitational Pty Ltd Brown Adam Mr Sydney Water Corporation Brown Jenny Mrs SydneySiders Express Inc Bunting Richard Mr Synovate Aztec Pty Ltd Burgess John Mr T Greenway & J Banks Pty Ltd Burgic Vera Ms Tarkett Australia Butler E G Mrs Tasome Butt K & J Mr & Mrs Techsmart International Pty Ltd Butterfi eld Peter Mr

96 Caldwell Charity Freeman Stuart Mr Callaghan MJ Mr Fuchs Matthias Mr Cameron David Mr Fung & Lee Denis & Doris Mr & Miss Capon OAM Joanna Mrs Furness Des Mr Carpenter Brian Mr Gardner Wayne Mr Carrier Phil Mr Gaskin AO Kevin Prof Carroll Helen Ms Gaudry Alan J Mr

Carroll Noel Mr Gedeon Gilbert Mr Our Community Cary Barbara Ms Gibbs Susan Chalmers Josephine Ms Golby Craig Mr Chan Michael Mr Gollan K Mrs Cheng FY Ms Goodyear Tricia Clark Jim & Angela Mr & Mrs Goodyear Rob Clark Patrick Mr Goodyear & Sattout Neville & Sonie Mr & Ms Clarke AO David Mr Gowen Alison Clarkson Una Ms Gowing BG Mrs Clijsters Mathias Mr Goymer Ray & Margaret Mr & Mrs Coates Peter Mr Grace Michael E Mr Colmer D & K Mr & Mrs Grace Megan Ms Condor Robert Mr Grady Maggie Connell Barry & Helen Mr & Mrs Graham James & Helen Mr & Mrs Connor Jeff Mr Graham Mavis Mrs Conry Melinda Ms Greer Pamela Mrs Cooley Damien Mr Griffi th Danae Ms Corney Kent Mr Griffi th Andrew Mr Cosenza Narelle Mrs Grigg John Dr Cottee Beverley Mrs Grimish Geoff Mr Cottrell Joan Mrs Grove Scott Mr Courtenay Bryce Mr Grzonkowski P Mr Cramond David Mr Gwynne M & C Mr & Mrs Crane Carmel Mrs Hallam Reggie Mr Craven Catherine Harris Pepper Mrs Cutrupi Michael Mr Harris Stephen Mr Da Prato Janelle Ms Hatton Ken & Paddy Mr & Mrs Daft Linda Mrs Hawker RE Dr Darragh Debbie Hawkins Stephen Mr Dascal Evelyn Mrs Hay Jean & David Mr & Mrs Davidson JA Dr Hill M Mr Dawson Jennie Ms Hoggard Peter Mr Day Kerrie Mrs Holland Andrew J Assoc Prof Day Jodie Lee Hornery David & Bronwyn Mr & Mrs De Mestre John Mr Houghton Barbara Mrs De Ravin John Mr Hutchinson H & D Mr & Mrs Dean Simon Mr Ibbotson Terry Mr Desai BK Dr Ireland Mr & Mrs Di Bello Gabriel Isaacs David Professor Dickson JE Ms Jacobs Ken Mr Didio Antonio Dr Jones Michael Mr Dixon Connie Ms Keogh John Dr Dolman Bette Mrs Kerameas C & A Doran Susan Ms Kinghorn Geoffrey Mr Dovico Marc Mr Klimenko Betty Drayton D & S Mr & Mrs Langley Andrew Mr Eabry Michelle Larkin Deborah Ms Economus HM Miss Lavermicocca Rosalinda Ms Edmonds Bill & Joyce Mr & Mrs Lawler Gary Mr Edwards Tim Mr Laws John Mr Eid Elie Mr Lee Judy Ms Farrell Lionel Mr Liljemark Grace Ms Federman Diane and Edward Mr & Mrs Linton Neil Mr Flahvin Tim Mr Littlejohn A Mrs Franchimon Charles Mr Littlejohn Kirsten Ms Freeman Lindsay Mr Loewenthal Lady

97 Lowe Kim Miss Potter Robin Ms Mackisack JM Mrs Pragastis Katrina Ms Maclean Connor & Cheryl Priestley Rob & Alexandra Mr & Mrs Madden Tam Quatroville Mario Madden Greg Quinlan Kate Dr Mailman Greg Quinn Matthew Mr Maini Marco & Mary Mr & Mrs Reoch Andrew Mr

Our Community Mapp AM Grahame Mr Riach Lesley Miss Maroney John Mr Rice Mark Mr Matthews John Mr Richardson Richard Maxwell Roy A Mr Ronayne Barbara Maxwell Marion Ms Ross Ben Mr McClelland Alan Mr Rowe Paul Mr McDougall Peter Mr Sampson Ruth Mrs McEwan Matthew Scobie Carolyn Ms McGregor James Mr Scopelitis George Mr McIntyre Sarah Ms Scott Gordon & Meredith Mr & Mrs McIvor Gus Mr Scott Gregory Mr McLaren Sean Mr Screnci Paula Mrs McNee M & K Mr & Mrs Shields Stephen Mr Mellak Albert Mr Sholler Gary Dr Merchant OAM Dennis & Gay Mr & Mrs Simons Hedley P Mr Metzmacher Susan Mrs Simpson Wayne Mr Millar James Mr Smedley N & D Mr & Mrs Mills Brian & Elaine Mr & Mrs Smith Grahame Dr Miltenyi GP Mr & Mrs Smith Bob & Liddy Mr & Mrs Mitchell David Mr Smith Damian Mr Monaghan Michael Mr Smith David Mr Mong Daniel Solomon Ezekiel Moore Peter Mr & Mrs Standfi eld Shaun Mr Moscato John & Teresa Mr & Mrs Stanley Ian Mr Moulos Konstantina Steel Jodi Dr Mullett Gavin Mr Stephan Armenouhi Mrs Murdocca Nancy Mrs Stephan Said Mr Murray Jason & Danni Mr & Mrs Stephens Malcolm Mr Mustica Carmelo A Mr Stevens Margaret Mrs Myers Lawrence Mr Stevenson OAM Shirley Mrs Nevell David Mr Steward Val Miss Nicholls Brian & Cassandra Mr & Mrs Stewart Shanna Ms North Kathryn N Professor Stewart Greg Mr O Neill Edel Stewart Rhys Mr O’Brien Barry Stinson Anne Ms O’Brien Michael Mr Stinson John Mr O’Connor John R Mr Stone Katherine Ms O’Connor Mary Ms Strange Brian Mr O’Connor John Mr Styles Robert Mr Overton Peter & Lauraine Mr & Mrs Talbot Antony Ovington Derek Mr Taylor Mark & Bronwyn Mr & Mrs Pacey Nathan Thomas Jack Mr Pang Peter Mr Thomson Kirsten Mrs Papadimitriou Peter Mr Threkeld P Parker Benjamin Mr Threlfo Paul Mr Peden AJ & ML Mr & Mrs Tighe Hugh & Colleen Mr & Mrs Perceval EC Mrs Toomeh Elias Mr Perinetto Giulio Mr Topalov Michael Peter Shanks Mr Triguboff Michael Mr Philpotts Graeme & Gayle Mr & Mrs Tuckerman Gregor Mr Pires Francis Anthony Mr Turner Peter Mr Pluss Jeanette Mrs Turner M Mr Podda Efi sio Mr Turton MP Mrs Pollock AM Reg Mr Underwood Dean Mr Pontifex Gary Mr Veitch Margaret Mrs Portlock Gary & Michelle Mr & Mrs Visevic Vera Ms

98 Wales Tony & Gai Mr & Mrs Kenneth Walter Gray Wallace Ben Mr Anastasia Gronski Ward Karen & Mal Mr & Mrs Leila Mary Hamer Warren Kent & Fiona Mr& Mrs Alice Holliday Wechsler Adam Mr Margaret Ellen Hume Welsh RM Miss Neville Vernon Huntington West EHL Mr Kenneth Lee Jones

White Tony Mr Martin Leslie Keating Our Community Whittle David & Catherine Mr & Mrs Barbara Kathleen Kendall Wikramanayake Shemara Ms Allan St Ruth Knights Williams Sarah Mrs Irene Muriel Lawton Haynes Wills David Mr Laurence Charles Lye Wilson GR Mr Doris May Lewsam Wood Craig & Alicia Mr & Mrs Vera Ellaine Marshall Woods Tony Mr Hovsep Mazloumian Yates Peter Mr James Patrick McCann Zavone John Mr Sydney Thomas Metcher Ziade Anthony Mr Sybil May Millington Esme Vera Muir Myrtle Amber Mulvaney Roll of Honour Dorothy Murphy We were again honoured this year by a number of Sami Nicolas very special people who remembered The Children’s Ellen Frances Olsen Hospital at Westmead in their Will. Each bequest is a Josephine Elizabeth Pearson special gift, promising a better future for children now Eileen Margaret Pering and in future generations. We extend our condolences Alma Margaret Puxley to their families and, with gratitude and respect, Marian Florence Rawlinson honour their memories. Margaret Leicester Rhodes Herbert Dean Rose John Thomas Ryan Legacies and Bequests Gary Sellers Gwen Smith James Raymond Ashley Victor Spence Elsie Marie Baddeley Emil Surnicky Robert William Battye John Uhlir Annie Beatrice Bourke Norma May Versperman Marius Joseph Bourke Everene Jean Vidler Arthur Brown Eileen Stella Weidmann Zohry Adele Cameron Ruth Marjorie White Thelma Sophia Louise Campbell Evan Frederick J Williams Norma Campbell Hamilton John Cyril Williams Gwenyth Carpenter Beryl Edna Williamson Zelie Maude H Cole Claudia Mary Willis Kathleen Maud Connelly Georgette Yared Eric Francis Cook Harold Ernest Court Frederick Arthur Crimson Brenda Eunice Davey Trusts and Foundations over $5000 Smoky Dawson Trevor W Dewsbury Adolph Basser Trust Svetomir Djunovic AOA Research Foundation Ltd Edward O Drysdale Australian Allergy Foundation Joan Margaret Economus Baxter Perpetual Trust Patricia Ann Edwards Bluey Day Foundation NSW John Arthur Fairless Dent Bluffpoint Corporation Pty Ltd AL Rigoll Family Trust Vivianne Eleanor Falconer CAF Community Fund Violet Falls Charitable Trusts Bruce and Corrie Fletcher Day of Difference Foundation Mary Fraser Dunn Family Trust Fund Loyal Leslie Gabb Fairbridge Foundation Paul Gauci First Hand Foundation Eileen May Gittoes Fred P Archer Charitable Trust Gustave A Gluck H & R Israel Fund Humpty Dumpty Foundation

99 J & G Bedwell Foundation John R Turk Fund Ken West Family Trust Kids with Cancer Foundation Liangrove Foundation Pty Ltd Macintosh Foundation Macquarie Group Foundation Limited

Our Community Madeline Foundation Maple-Brown Family Charitable Foundation Margaret Pemberton Foundation Oncology Children’s Foundation Owen Miller Foundation Paint a Rainbow Foundation Perpetual Trustees Australia Ltd Rett Syndrome Research Foundation Sherman Foundation Sir Robert & Lady Askin Charities Trust Skipper-Jacobs Family Trust Smile Foundation Limited Starlight Children’s Foundation Australia The Balnaves Foundation The Bernard David Rothbury Trust The Charlotte Dopson Memorial Fund The Corio Foundation The Freedman Foundation The George Gregan Foundation The Humour Foundation The John Bedwell Foundation The McLean Perpetual Children’s Foundation The Petre Foundation The Pratt Family Foundation The Profi eld Foundation Unilever Australasia Foundation Woodend Foundation

100 Freedom of Information Report

NEW FOI APPLICATIONS Freedom of Information Report How many FOI applications were NUMBER OF FOI APPLICATIONS received, discontinued or completed? Personal Other TOTAL

2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008

A1 New 006363 A2 Brought forward 002020 A3 Total to be processed 008383 A4 Completed 006363 A5 Discontinued n/a n/a n/a n/a n/a n/a A6 Total processed 006363 A7 Unfi nished (carried forward) 002020

DISCONTINUED APPLICATIONS

Why were FOI applications NUMBER OF DISCONTINUED FOI APPLICATIONS discontinued? Personal Other TOTAL

2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 B1 Request transferred out to another 000000 agency (s.20) B2 Applicant withdrew request 000000 B3 Applicant failed to pay advance 000000 deposit (s.22) B4 Applicant failed to amend a request that would have been an unreasonable diversion 000000 of resources to complete (s.25(1)(a1)) B5 Total discontinued 000000

101 102 Freedom of Information Report APPLICATIONS GRANTEDOROTHERWISEAVAILABLE INFULL Note: The fi gures in D8 should correspond to those in C1. in those to correspond should D8 in fi gures The Note: COMPLETED APPLICATIONS 5 Lbaymtra / / / / / n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a D7 Subjecttodeferredaccess D6 material Library D5 Available forpurchase D4 available totheapplicant? How werethedocumentsmade applications? What happenedtocompletedFOI 2 D2 D1 All documentsrequestedwere: C1 3 Available forinspection D3 8 D8 2 C2 5 Total completed C5 Nodocumentsheld C4 Refused C3 above of thereasonslistedinD1-D6 Available byacombinationofany medical Practitioner Provided totheapplicant’s Provided totheapplicant in full Granted orotherwiseavailable available infull Total grantedorotherwise in part Granted orotherwiseavailable 001111 Access Patient Under Applications / / / / / n/a n/a n/a n/a n/a n/a Access Patient Under Applications 001111 001111 000000 001111 000101 002121 0620 0720 0620 0720 0620 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 esnlOhrTOTAL Other Personal esnlOhrTOTAL Other Personal Access Patient Under Applications Access Patient Under Applications (GRANTED OROTHERWISEAVAILABLE INFULL) NUMBER OFCOMPLETEDFOIAPPLICATIONS NUMBER OFFOIAPPLICATIONS Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications APPLICATIONS GRANTEDOROTHERWISEAVAILABLE INPART Note: The fi gures in F3 should correspond with those in C3. in those with correspond should F3 in fi gures The Note: Note: The fi gures in E8 should correspond to those in C2. in REFUSED FOIAPPLICATIONS those to correspond should E8 in fi gures The Note: 5 Lbaymtra / / / / / n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a E8 n/a E7 Subjectto deferredaccess E6 Library material E5 Available forpurchase E4 3 Total refused F3 F2 F1 Available forinspection E3 refused? Why wasaccesstothedocuments available totheapplicant? How werethedocumentsmade 2 E2 E1 Documents madeavailablewere: available inpart Total grantedorotherwise above of thereasonslistedinE1-E6 Available byacombinationofany Deemed refused Exempt 002121 medical Practitioner Provided totheapplicant’s Provided totheapplicant / / / / / n/a n/a n/a n/a n/a n/a 000000 002121 Access Patient Under Applications / / / / / n/a n/a n/a n/a Access Patient n/a Under Applications n/a 0620 0720 0620 0720 0620 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 esnlOhrTOTAL Other Personal esnlOhrTOTAL Other Personal Access Patient Under Applications Access Patient Under Applications (GRANTED OROTHERWISEAVAILABLE INPART) NUMBER OFREFUSEDFOIAPPLICATIONS NUMBER OFFOIAPPLICATIONS Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications Access Patient Under Applications

103 Freedom of Information Report EXEMPT DOCUMENTS

Why were the documents classifi ed NUMBER OF FOI APPLICATIONS as exempt? (REFUSED OR ACCESS GRANTED OR OTHERWISE AVAILABLE IN PART ONLY) (identify one reason only) Personal Other TOTAL

2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 Restricted documents:

G1 Cabinet documents (Clause 1) G2 Executive Council documents (Clause 2) G3 Documents affecting law Freedom of Information Report enforcement and public safety (Clause 4) G4 Documents affecting counter terrorism measures (Clause 4A) Documents requiring consultation:

G5 Documents affecting intergovernmental relations (Clause 5) G6 Documents affecting personal 11 affairs (Clause 6) G7 Documents affecting business 22 affairs (Clause 7) G8 Documents affecting the conduct of research (Clause 8) Documents otherwise exempt:

G9 Schedule 2 exempt agency G10 Documents containing information confi dential to Olympic Committees (Clause 22) G11 Documents relating to threatened species, Aboriginal objects or Aboriginal places (Clause 23) G12 Documents relating to threatened species conservation (Clause 24) G13 Plans of management containing information of Aboriginal signifi cance (Clause 25) G14 Private documents in public library collections (Clause 19) G15 Documents relating to judicial functions (Clause 11) G16 Documents subject to contempt (Clause 17) G17 Documents arising out of companies and securities legislation (Clause 18) G18 Exempt documents under interstate FOI Legislation (Clause 21) G19 Documents subject to legal professional privilege (Clause 10) G20 Documents containing confi dential material (Clause 13) G21 Documents subject to secrecy provisions (Clause 12) G22 Documents affecting the economy of the State (Clause 14)

104 G23 Documents affecting fi nancial or property Interests of the State or an agency (Clause 15) G24 Documents concerning operations of agencies (Clause 16) G25 Internal working documents (Clause 9) G26 Other exemptions (eg., Clauses 20, 22A and 26) G27 Total applications including exempt 2121 documents

Note: Where more than one exemption applies to a request select the exemption category fi rst occurring in the

above table. The fi gures in G27 should correspond to the sum of the fi gures in C2 and F1. Freedom of Information Report

MINISTERIAL CERTIFICATES (S.59)

How many Ministerial Certifi cates were issued? NUMBER OF MINISTERIAL CERTIFICATES

2006/2007 2007/2008

H1 Ministerial Certifi cates issued 0 0

FORMAL CONSULTATIONS

How many formal consultations were conducted? NUMBER

2006/2007 2007/2008

I1 Number of applications requiring formal consultation 2 5 I2 Number of persons formally consulted 2 5

AMENDMENT OF PERSONAL RECORDS

How many applications for amendment of personal records were NUMBER OF APPLICATIONS FOR AMENDMENT OF agreed or refused? PERSONAL RECORDS 2006/2007 2007/2008

J1 Agreed in full 0 0 J2 Agreed in part 0 0 J3 Refused 0 0 J4 Total 00

NOTATION OF PERSONAL RECORDS

How many applications for notation of personal records were NUMBER OF APPLICATIONS FOR NOTATION made (s.46)? 2006/2007 2007/2008

K1 Applications for notation 0 0

105 FEES AND COSTS

What fees were assessed and received for FOI applications ASSESSED COSTS FEES RECEIVED processed (excluding applications transferred out)? 2006/2007 2007/2008 2006/2007 2007/2008

L1 All completed applications $532.50 $850.00 $532.50 $850.00

FEE DISCOUNTS

NUMBER OF FOI APPLICATIONS How many fee waivers or discounts (WHERE FEES WERE WAIVED OR DISCOUNTED) Freedom of Information Report were allowed and why? Personal Other TOTAL

2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008

M1 Processing fees waived in full M2 Public interest discount Under Under Under Under Under Under M3 Financial hardship discount Patient Patient Patient Patient Patient Patient – pensioner or child Access Access Access Access Access Access M4 Financial hardship discount – non profi t organisation M5 Total

FEE REFUNDS

How many fee refunds were granted as a result of signifi cant NUMBER OF REFUNDS correction of personal records? 2006/2007 2007/2008 N1 Number of fee refunds granted as a result of signifi cant 00 correction of personal records

DAYS TAKEN TO COMPLETE REQUEST

How long did it take to process NUMBER OF COMPLETED FOI APPLICATIONS completed applications? (Note: calendar days) Personal Other TOTAL 2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008 O1 0-21 days – statutory n/an/a6161 determination period O2 22-35 days – extendedstatutory determination period for consultation or retrieval of archived records (S.59B) O3 Over 21 days – deemed refusal where no extended determination period applies O4 Over 35 days – deemed refusal where extended determination period applies O5 Total 6161

Note: Figures in O5 should correspond to fi gures in A4.

106 PROCESSING TIME: HOURS

How long did it take to process NUMBER OF COMPLETED FOI APPLICATIONS completed applications? Personal Other TOTAL

2006/2007 2007/2008 2006/2007 2007/2008 2006/2007 2007/2008

P1 0-10 hours n/a n/a n/a 1 n/a 1 P2 11-20 hours n/a n/a n/a n/a P3 21-40 hours n/a n/a n/a n/a P4 Over 40 hours n/a n/a n/a n/a P5 Total n/a n/a n/a 1 n/a 1 Freedom of Information Report

Note: Figures in P5 should correspond to fi gures in A4.

NUMBER OF REVIEWS

How many reviews were fi nalised? NUMBER OF COMPLETED REVIEWS

2006/2007 2007/2008

Q1 Internal reviews 1 0 Q2 Ombudsman reviews 1 0 Q3 ADT reviews 0 0

RESULTS OF INTERNAL REVIEWS

What were the results of internal reviews fi nalised?

Grounds on which the internal review NUMBER OF INTERNAL REVIEWS was requested. Personal Other TOTAL Original Original Original Original Original Original Agency Agency Agency Agency Agency Agency Decision Decision Decision Decision Decision Decision

Upheld Varied Upheld Varied Upheld Varied R1 Access refused n/a n/a n/a n/a n/a n/a R2 Access deferred n/a n/a n/a n/a n/a n/a R3 Exempt matter deleted from n/a n/a n/a n/a n/a n/a documents R4 Unreasonable charges n/a n/a n/a n/a n/a n/a R5 Failure to consult with third parties n/a n/a n/a n/a n/a n/a R6 Third parties views disregarded n/a n/a n/a n/a n/a n/a R7 Amendment of personal records n/a n/a n/a n/a n/a n/a refused R8 Total n/a n/a n/a n/a n/a n/a

Note: Figures in R8 should correspond to fi gures in A4.

107 108 Financial Overview orwn ot 3 51 320 - 325 $000 5,648 68,650 31 $000 4,618 Actuals 4,652 14,346 564 63,973 Budget 4,618 $000 2006/07 15,156 5,068 Actuals 2007/08 70,073 204,621 2007/08 15,525 4,913 213,511 218,053 Total Expenses Borrowing Costs Grants andSubsidies Depreciation andAmortisation Maintenance Goods andServices Visiting MedicalOffi cers Employee RelatedExpenses Financial informationissummarisedbelow: frames agreed. of levelsagreedwiththeNSWDepartmentHealthand,further, haseffectedallloanrepaymentswithinthetime of governmentcashpayments.Ithasalsoensuredthatnogeneralcreditors existattheendofmonth inexcess In achievingtheaboveresultRoyalAlexandraHospitalforChildrenissatisfi medical andsurgicalsupplieshaveallincreasedcomparedtobudgetasa result oftheincrease inactivity. 11% fromlastyear. Theincreaseinactivityresultedhigheremployee costs.Inaddition,thecostofblood,drugs, This wasprimarilyduetohigheractivitythanexpected,particularlyfrom Inter AreaPatientFlowswhichincreasedby represents anunfavourablevariationof$2.4millionor2.5%. 2008 provideforaNetCostofServicesbudget$96.3million,againstwhichthe auditedactualof$98.7million The auditedfi Executive Summary Financial Overview rnsadCnrbtos 121 732 34,508 8,069 27,302 1,280 158,411 31,281 (340) 172,777 178,547 7,504 5,489 7,150 Total Revenues Other Grants andContributions Investment Income Revenue Sale ofGoodsandServices te an Lse) 10) 44 (277) (484) (57) (1504) - (402) Net CostofServices(NCOS) Other Gains/(Losses) Gain/(Loss) onDisposalofNonCurrentAssets nancial statementspresentedfortheRoyalAlexandraHospitalChildrenyearended30June

98,691 313,777 216,992 ed thatithasoperatedwithinthelevel

96,287 302,651 206,848

90,484 298,288 208,138 etlHat 977 7 967 ,8 26 8,872 4,385 216 16 5,628 2,628 9,088 6,367 10,013 143 4,754 29,556 35,923 159 3,377 7,382 (11,622) 24,279 9,607 5,432 11,810 22,975 12,657 170 3,772 114,990 15,187 23,172 137,965 3,145 3,737 9,204 25,310 47 9,777 (14,918) 3,845 3,164 48,482 25,667 2,853 13,342 10,749 94 7,582 6,309 128,301 12,882 141,643 15,735 Total 313,777 141 3,783 Teaching andResearch 2,747 Population Health Rehab &ExtendedCare 6,530 Mental Health Same DayAcute Overnight Acute Emergency Care Outpatients 65,207 Aboriginal Health Primary andCommunity 215,086 $000 Exp Program 2007/08 Department ofHealth. care deliveryutilisedacrossNSWHealthandsatisfi12,979 es themethodologyforapportionmentadvisedbyNSW The RoyalAlexandraHospitalforChildrenreportingofprogramsisconsistent with thetenprogramsofhealth 2006/07 Program Reporting 98,691 $000 Rev 52,228 298,288 62,332 $000 NCOS 12,583 207,804 $000 Exp 49,749 90,484 $000 Rev $000 NCOS overallincreaseincostswascontainedtojust5%overthatof2006/07. • • • theperformanceimprovement initiatives helpedachieve$2.7Minrevenueimprovement overlastyear; • • 2006/07. Thefollowingweresignifi cant contributorstothisachievementin 2007/08: The RoyalAlexandraHospitalforChildrenhadNetCostofService,whichwas9%higher thantheNCoSof The Challenges2007/2008 of the2007/08overallrevenuecomparedto0.16%for2006/07; increase inthelossondisposalandotherlossesaccountof impairmentofreceivables hasjumpedto0.88% the lastyear; the InterAreaPatientsFlowsrevenuecontinuedtoincreaseduring2007/08.Thisis 11%overthatof compared tothatofthelastyear; overall growthinrevenueof4%overthat2006/07,despitesignifi cant declineintheinvestmentrevenue

109 Financial Overview Financial Overview

The 2008/2009 Budget

The Royal Alexandra Hospital for Children received its 2008/09 allocation on 27 June 2008. The allocation provides additional funding to address:

• replacement of Plant and Equipment up to $2.5M; • the provision of more elective surgery to tackle existing waiting lists; • the provision of four new beds including Medical Assessment Units; • mental health service improvements- Child & Adolescent Health - $100k; • new nurse educator positions.

Future Direction

The Royal Alexandra Hospital for Children will continue to work with the NSW Department of Health in a major reform program that will focus on ensuring that each child has the best possible journey through the health system. This will ensure that patient care is better coordinated, leading to improved patient outcomes and more effi cient use of resources. Ultimately it will provide better care for more children.

110 Chief Executive’s yearinreview

111 Text goes here 112 113 Financial Statements Financial Statements

For the 128th Annual Report of The Royal Alexandra Hospital for Children (The Children’s Hospital at Westmead) for the year ending 30 June 2008

114 Royal Alexandra Hospital for Children

Operating Statement for the year ended 30 June 2008

PARENT CONSOLIDATION

Actual Budget Actual Notes Actual Budget Actual 2008 2008 2007 2008 2008 2007 $000 $000 $000 $000 $000 $000

Expenses excluding losses Operating Expenses - - - Employee Related 3 218,053 213,511 204,621 218,053 213,511 204,621 Personnel Services 4 - - - 4,913 5,068 4,652 Visiting Medical Offi cers 4,913 5,068 4,652 74,691 68,591 74,298 Other Operating Expenses 5 74,691 68,591 74,298 15,525 15,156 14,346 Depreciation and Amortisation 2(i), 6 15,525 15,156 14,346 564 325 320 Grants and Subsidies 7 564 325 320 ______31 ______- ______51 Finance Costs 8 ______31 ______- ______51 ______313,777 ______302,651 ______298,288 Total Expenses excluding losses ______313,777 ______302,651 ______298,288

Revenue 178,547 172,777 158,411 Sale of Goods and Services 9 178,547 172,777 158,411 (340) 1,280 8,069 Investment Revenue 10 (340) 1,280 8,069 35,225 31,307 37,180 Grants and Contributions 11 31,281 27,302 34,508 ______7,504 ______5,489 ______7,150 Other Revenue 12 ______7,504 ______5,489 ______7,150 ______220,936 ______210,853 ______210,810 Total Revenue ______216,992 ______206,848 ______208,138

(402) - (57) Gain/(Loss) on Disposal 13 (402) - (57) ______(1,504) ______(484) ______(277) Other Gains/(Losses) 14 ______(1,504) ______(484) ______(277) ______94,747 ______92,282 ______87,812 Net Cost of Services 32 ______98,691 ______96,287 ______90,484

Government Contributions NSW Department of Health 73,759 73,759 82,263 Recurrent Allocations 2(d) 73,759 73,759 82,263 NSW Department of Health 1,152 1,000 309 Capital Allocations 2(d) 1,152 1,000 309 Acceptance by the Crown Entity of ______- ______- ______- Employee Benefi ts 2(a)(ii) ______3,944 ______4,005 ______2,672

______74,911 ______74,759 ______82,572 Total Government Contributions ______78,855 ______78,764 ______85,244

______(19,836) ______(17,523) ______(5,240) RESULT FOR THE YEAR 28 ______(19,836) ______(17,523) ______(5,240)

Statement of Recognised Income and Expense for the Year Ended 30 June 2008

PARENT CONSOLIDATION

Actual Budget Actual Notes Actual Budget Actual 2008 2008 2007 2008 2008 2007 $000 $000 $000 $000 $000 $000 Net Increase/(Decrease) in Property, Plant and Equipment Asset Revaluation ______28,867 ______- ______- Reserve 28 ______28,867 ______- ______-

TOTAL INCOME AND EXPENSE RECOGNISED ______28,867 ______- ______- DIRECTLY IN EQUITY ______28,867 ______- ______- ______(19,836) ______(17,523) ______(5,240) Result for the Year ______(19,836) ______(17,523) ______(5,240)

TOTAL INCOME AND EXPENSE ______9,031 ______(17,523) ______(5,240) RECOGNISED FOR THE YEAR ______9,031 ______(17,523) ______(5,240)

The accompanying notes form part of these Financial Statements 115 Royal Alexandra Hospital for Children

Balance Sheet as at 30 June 2008

PARENT CONSOLIDATION

Actual Budget Actual Notes Actual Budget Actual 2008 2008 2007 2008 2008 2007 $000 $000 $000 $000 $000 $000 ASSETS

Current Assets 41,727 39,018 44,435 Cash and Cash Equivalents 17 41,727 39,018 44,435 10,663 8,362 8,090 Receivables 18 10,663 8,362 8,090 ______4,424 ______4,135 ______4,081 Inventories 19 ______4,424 ______4,135 ______4,081 ______56,814 ______51,515 ______56,606 Total Current Assets ______56,814 ______51,515 ______56,606

Non-Current Assets 59 303 303 Receivables 18 59 303 303 33,238 36,625 37,147 Financial Assets at Fair Value 20 33,238 36,625 37,147 Property, Plant and Equipment 303,719 279,565 284,385 - Land and Buildings 21 303,719 279,565 284,385 28,808 24,766 28,565 - Plant and Equipment 21 28,808 24,766 28,565 ______27,760 ______26,040 ______25,768 - Infrastructure Systems 21 ______27,760 ______26,040 ______25,768 360,287 330,371 338,718 Total Property, Plant and Equipment 360,287 330,371 338,718 ______4,783 ______6,163 ______5,433 Intangible Assets 22 ______4,783 ______6,163 ______5,433 ______398,367 ______373,462 ______381,601 Total Non-Current Assets ______398,367 ______373,462 ______381,601 ______455,181 ______424,977 ______438,207 Total Assets ______455,181 ______424,977 ______438,207

LIABILITIES

Current Liabilities 22,655 20,733 19,280 Payables 24 22,655 20,733 19,280 123 - 116 Borrowings 25 123 - 116 67,526 65,091 63,451 Provisions 26 67,526 65,091 63,451 ______108 ______50 ______50 Other 27 ______108 ______50 ______50 ______90,412 ______85,874 ______82,897 Total Current Liabilities ______90,412 ______85,874 ______82,897

Non-Current Liabilities 305 544 428 Borrowings 25 305 544 428 ______4,326 ______4,978 ______3,775 Provisions 26 ______4,326 ______4,978 ______3,775 ______4,631 ______5,522 ______4,203 Total Non-Current Liabilities ______4,631 ______5,522 ______4,203 ______95,043 ______91,396 ______87,100 Total Liabilities ______95,043 ______91,396 ______87,100 ______360,138 ______333,581 ______351,107 Net Assets ______360,138 ______333,581 ______351,107

EQUITY

166,762 137,895 137,895 Reserves 28 166,762 137,895 137,895 ______193,376 ______195,686 ______213,212 Accumulated Funds 28 ______193,376 ______195,686 ______213,212 ______360,138 ______333,581 ______351,107 Total Equity ______360,138 ______333,581 ______351,107

The accompanying notes form part of these Financial Statements 116 Royal Alexandra Hospital for Children

Cash Flow Statement for the year ended 30 June 2008

PARENT CONSOLIDATION

Actual Budget Actual Notes Actual Budget Actual 2008 2008 2007 2008 2008 2007 $000 $000 $000 $000 $000 $000

CASH FLOWS FROM OPERATING ACTIVITIES

Payments (209,147) (205,649) (191,156) Employee Related (209,147) (205,649) (191,156) (564) (325) (320) Grants and Subsidies (564) (325) (320) (31) - (51) Finance Costs (31) - (51) ______(84,909) ______(70,026) ______(89,115) Other ______(84,909) ______(70,026) ______(89,115) ______(294,651) ______(276,000) ______(280,642) Total Payments ______(294,651) ______(276,000) ______(280,642)

Receipts 175,672 168,774 162,501 Sale of Goods and Services 175,672 168,774 162,501 3,569 1,802 2,647 Investment Income 3,569 1,802 2,647 ______44,597 ______32,790 ______48,159 Other ______44,597 ______32,790 ______48,159 ______223,838 ______203,366 ______213,307 Total Receipts ______223,838 ______203,366 ______213,307

Cash Flows From Government 73,759 73,759 82,263 NSW Department of Health Recurrent Allocations 73,759 73,759 82,263 ______659 ______1,000 ______309 NSW Department of Health Capital Allocations ______659 ______1,000 ______309 ______74,418 ______74,759 ______82,572 Net Cash Flows from Government ______74,418 ______74,759 ______82,572

NET CASH FLOWS FROM OPERATING ______3,605 ______2,125 ______15,237 ACTIVITIES 32 ______3,605 ______2,125 ______15,237

CASH FLOWS FROM INVESTING ACTIVITIES

Proceeds from Sale of Land and Buildings, Plant and Equipment 8 - - and Infrastructure Systems 8 - - Purchases of Land and Buildings, Plant and Equipment ______(6,205) ______(7,542) ______(10,163) and Infrastructure Systems ______(6,205) ______(7,542) ______(10,163) ______(6,197) ______(7,542) ______(10,163) NET CASH FLOWS FROM INVESTING ACTIVITIES ______(6,197) ______(7,542) ______(10,163)

CASH FLOWS FROM FINANCING ACTIVITIES

______(116) ______- ______(462) Repayment of Borrowings and Advances ______(116) ______- ______(462)

______(116) ______- ______(462) NET CASH FLOWS FROM FINANCING ACTIVITIES ______(116) ______- ______(462)

(2,708) (5,417) 4,612 NET INCREASE / (DECREASE) IN CASH (2,708) (5,417) 4,612

______44,435 ______44,435 ______39,823 Opening Cash and Cash Equivalents ______44,435 ______44,435 ______39,823 ______41,727 ______39,018 ______44,435 CLOSING CASH AND CASH EQUIVALENTS 17 ______41,727 ______39,018 ______44,435

The accompanying notes form part of these Financial Statements 117 8,138 2,376 3,468 98,691 90,484 (19,836) (5,240) - 218,053 204,621 - 74,691 74,298 Non Attributable TOTAL 78,855 85,244 78,855 85,244 6.1* Program Research Teaching and Teaching on. 3 48,482 35,923 - - 313,777 298,288 uded in the ‘Not Attributable’ column. program. 5.1* Program Services Population Health ------21129 - -3151 4.1* Program Services Extended Care Rehabilitation and 3.1* Program Services Mental Health 2.3* Program Same Day Acute Inpatient Services 2.2* Program Overnight Acute Inpatient Services 2.1* Program Services Emergency Royal Alexandra Hospital for Children 1.3* Program Outpatients Services ------Program Statement - Expenses and Revenues for the year ended 30 June 2008 1.2* Program Services Aboriginal Health 1.1* Program 2008$000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 2008 $000 2007 $000 nity Based Services Primary and Commu- No changes have occurred during the period between 1 January 2008 and 30 June which would materially impact this allocati government contributions must be incl ** Allocations are made on an agency basis and not to individual programs. Consequently, HOSPITAL’S EXPENSES AND HOSPITAL’S REVENUE *The name and purpose of each program is summarised in Note 16. nancial information to each fi The program statement uses statistical data to 31 December 2007 allocate the current period’s Expenses excluding losses Operating Expenses Employee Relatedcers Visiting Medical Offi Other Operating ExpensesDepreciation and Amortisation 4,532 Grants and Subsidies 1,609 90 5,530Finance Costs 287 1,591 Expenses excluding lossesTotal 13 100 440Revenue 32 6,530Sale of Goods and Services 110 2 11 7,582 45,618InterState Patient Flows 7 37 37,563 15,135 141 - 7 11,037 253 19,300 12 1 1,063 12,483 159 3,577 3,277 99,364 2,199 75 65,207 - 2,044 - 3,174 97,860 1 62,332 32,180 269 15,735 7,540 - 824 9 32,124 15,187 - - 8,649 141,643 26 2,445 107 624 137,965 6,859 3 2,429 3,195 10,749 - 7,424 - 10,445 7,991 83 12,657 2,085 2,220 FOR THE YEAR RESULT 5,736 8,986 4,348 9,777 7 12,524 26 184 - 719 562 4,701 9,088 11,238 1,634 125,567 13 6,450 186 6,309 611 110,448 9 - 2,251 7,308 24,984 7,382 168 513 32,205 2,108 2 230 23,336 9,204 22,426 - 2,146 10,01 89 286 138 175 13,751 1 190 10,891 242 - 149 74 17 16 277 406 343 - 12 1,806 14 22 475 2,636 124 155 16 544 1 380 461 5 1,914 3 555 204 2,513 2 479 1,410 11 - 1 380 37 - 10 - - - - - 15 15,525 14,346 - - - - 9 176,171 4,913 154,943 131 4,652 47 - - 564 320 118 Investment IncomeGrants and ContributionsOther Revenue RevenueTotal 3,268Gain / (Loss) on Disposal (72)Other Gains / (Losses) 2,993Net Cost of Services 651 113Government Contributions ** (23) (653) (3) 111 2,796 137 (26) (6) 1,356 3,856 24 3,783 - (24) 1,283 (5) 3,737 - 95 334 5 - (1) 89 143 47 765 - 1,265 13,400 83 12,655 - - 1,621 16 35 (97) 12,978 52,228 447 (324) 140 11,829 (11) 49,749 68 129,166 (61) 406 115,143 2,853 163 (13) 266 25,733 3,377 (83) 1,080 24,297 48 13,342 (2) 455 1,198 (17) 22,975 230 (113) (14,918) 40 (11,622) (752) 259 62 226 (18) 9,607 (135) 46 273 3,217 93 8,872 (9) (57) 4,763 44 3,145 6 3 3,830 (17) 3,764 (1) 2,628 5,640 3,672 18 5,432 (52) 15 25,547 (8) 4,411 4,385 (801) 29,586 (89) (9) 23,172 4,303 (1) 168 17,739 6,367 799 (20) - 21,573 (33) (938) (104) (4) - 197 (5) - - 936 216,992 7,170 (48) 20 (10) (772) - 3,370 - 4,263 (9) (3) 31,281 (141) 34,508 - (96) - (20) (10) - - 7,504 - (340) - 7,150 8,069 - - (1,504) (402) (277) (57) Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

1. The Hospital Reporting Entity

The Royal Alexandra Hospital for Children was established under the provisions of Health Services Act 1997 as a statutory corporation with effect from 1 July 1998.

The Royal Alexandra Hospital for Children, “the Hospital”, trading as The Children’s Hospital at Westmead, comprises all the operating activities of the Hospital facilities under its control. It also encompasses the Special Purposes and Trust Funds which, while containing assets which are restricted for specifi ed uses by the grantor or the donor, are nevertheless controlled by the Hospital. The Hospital is a not for profi t entity.

With effect from 17 March 2006 fundamental changes to the employment arrangements of Health Services were made through amendment to the Public Sector Employment and Management Act 2002 and other Acts including the Health Services Act 1997.

The status of the previous employees of Health Services changed from that date. They are now employees of the Government of New South Wales in the service of the Crown rather than employees of the Hospital. Employees of the Government are employed in Divisions of the Government Service.

In accordance with Accounting Standards these Divisions are regarded as special purpose entities that are consolidated with the fi nancial report of the Hospital. This is because the Divisions were established to provide personnel services to enable the Hospital to exercise its functions.

As a consequence the values in the annual fi nancial statements presented herein consist of the Hospital (as the parent entity), the fi nancial report of the special purpose entity Division and the consolidated fi nancial report of the economic entity. Notes have been extended to capture both the parent and consolidated values with Notes 3, 4, 11, 24, 26 and 32 being especially relevant.

In the process of preparing the consolidated fi nancial statements for the economic entity consisting of the controlling and controlled entities, all inter-entity transactions and balances have been eliminated.

The reporting entity is consolidated as part of the NSW Total State Sector Accounts.

These fi nancial statements have been authorised for issue by the Chief Executive on 8 December 2008

2. Summary of Signifi cant Accounting Policies

The Hospital’s fi nancial report is a general purpose fi nancial report which has been prepared in accordance with applicable Australian Accounting Standards (which include Australian Accounting Interpretations), the requirements of the Health Services Act 1997 and its regulations including observation of the Accounts and Audit Determination for Area Health Services and Public Hospitals.

Property, plant and equipment and fi nancial assets at ‘fair value through profi t and loss’ are measured at fair value. Other fi nancial report items are prepared in accordance with the historical cost convention.

The consolidated entity has a defi ciency of working capital of $33,598,000 (2007 $ 26,291,000). Notwithstanding this defi ciency the fi nancial report has been prepared on a going concern basis because the entity has the support of the New South Wales Department of Health.

All amounts are rounded to the nearest one thousand dollars and are expressed in Australian currency.

Judgements, key assumptions and estimations made by management are disclosed in the relevant notes to the fi nancial report.

Comparative fi gures are, where appropriate, reclassifi ed to give a meaningful comparison with the current year.

No new or revised accounting standards or interpretations are adopted earlier than their prescribed date of application. Set out below are changes to be effected, their date of application and the possible impact on the fi nancial report of the Royal Alexandra Hospital for Children.

119 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

Standards/Interpretations Operative Date Comment AASB3, AASB127 & AASB2008-3, Business 1 July 2009 The changes address business combinations and the Australian Accounting Combinations Standards Board has indicated that it is yet to consider its suitability for combinations among not-for-profi t entities. AASB8 & AASB2007-3, 1 July 2009 The changes do not apply to not-for-profi t entities and have no application within Operating Segments NSW Health. AASB101 & AASB2007-8, 1 July 2009 Health agencies are currently required to present a statement of recognised Presentation of Financial Statements income and expense and no variation is expected. AASB123 & AASB2007-6, 1 July 2009 Borrowing costs that are directly attributable to the acquisition, construction or Borrowing Costs production of a qualifying asset form part of the cost of that asset. As Health Service borrowings are restricted to the Sustainable Energy Development Authority negligible impact is expected. AASB1004, Contributions 1 July 2008 The requirements on contributions from AASB27, 29 and 31 have been relocated, substantially unamended in AASB4. AASB1049, Whole of Government and General 1 July 2008 The standard aims to provide the harmonisation of Government Finance Statistics Government Sector Financial Reporting and Generally Accepted Accounting Principles (GAAP) reporting. The impact of changes will be considered in conjunction with the reporting requirements of the Financial Reporting Code for Budget Dependent General Government Sector Agencies. AASB1050 regarding administered items 1 July 2008 The requirements of AAS29 have been relocated, substantially unamended and are not expected to have material effect on Health entities. AASB1051 regarding land under roads 1 July 2008 The standard will require the disclosure of “accounting policy for land under roads”. It is expected that all such assets will need to be recognised “at fair value”. The standard will have negligible impact on Health entities. AASB1052 regarding disaggregated disclosures 1 July 2008 The standard requires disclosure of fi nancial information about Service costs and achievements. Like other standards not yet effective the requirements have been relocated from AAS29 largely unamended. AASB2007-9 regarding amendments arising from 1 July 2008 The changes made are aimed at removing the uncertainties that previously existed the review of AAS27, AAS29 and AAS31 over cross references to other Australian Accounting Standards and the override provisions in AAS29. AAS2008-1, Share Based Payments 1 July 2009 The standard will not have application to health entities under the control of the NSW Department of Health. AASB2008-2 regarding puttable fi nancial 1 July 2009 The standard introduces an exception to the defi nition of fi nancial liability to instruments classify as equity instruments certain puttable fi nancial instruments and certain instruments that impose on an entity an obligation to deliver to another party a pro-rata share of the net assets of the entity only on liquidation. Nil impact is anticipated.

Other signifi cant accounting policies used in the preparation of these fi nancial statements are as follows:

a) Employee Benefi ts and Other Provisions

i) Salaries & Wages, Annual Leave, Sick Leave and On Costs

At the consolidated level of reporting liabilities for salaries and wages (including non monetary benefi ts), annual leave and paid sick leave that fall wholly within 12 months of the reporting date are recognised and measured in respect of employees’ services up to the reporting date at undiscounted amounts based on the amounts expected to be paid when the liabilities are settled.

All Annual Leave employee benefi ts are reported as “Current” as there is an unconditional right to payment. Current liabilities are then further classifi ed as “Short Term” or “Long Term” based on past trends and known resignations and retirements. Anticipated payments to be made in the next twelve months are reported as “Short Term”. On costs of 17% are applied to the value of leave payable at 30 June 2008, such on costs being consistent with actuarial assessment (Comparable on costs for 30 June 2007 were 21.7% which in addition to the 17% increase also included the impact of awards immediately payable from 1 July 2007). .

Unused non-vesting sick leave does not give rise to a liability as it is not considered probable that sick leave taken in the future will be greater than the benefi ts accrued in the future.

The outstanding amounts of workers’ compensation insurance premiums and fringe benefi ts which are consequential to employment, are recognised as liabilities and expenses where the employee benefi ts to which they relate have been recognised. 120 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

ii) Long Service Leave and Superannuation

At the consolidated level of reporting, Long Service Leave employee leave entitlements are dissected as ”Current” if there is an unconditional right to payment and ”Non Current” if the entitlements are conditional. Current entitlements are further dissected between ”Short Term” and ”Long Term” on the basis of anticipated payments for the next twelve months. This in turn is based on past trends and known resignations and retirements.

Long Service Leave provisions are measured on a short hand basis at an escalated rate of 8.1% (also 8.1% at 30 June 2007) for all employees with fi ve or more years of service. Actuarial assessment has found that this measurement technique produces results not materially different from the estimate determined by using the present value basis of measurement.

The Hospital’s liability for the closed superannuation pool schemes (State Authorities Superannuation Scheme and State Superannuation Scheme) is assumed by the Crown Entity. The Hospital accounts for the liability as having been extinguished resulting in the amount assumed being shown as part of the non-monetary revenue item described as “Acceptance by the Crown Entity of Employee Benefi ts”. Any liability attached to Superannuation Guarantee Charge cover is reported in Note 24, “Payables”.

The superannuation expense for the fi nancial year is determined by using the formulae specifi ed by the NSW Department of Health. The expense for certain superannuation schemes (ie Basic Benefi t and First State Super) is calculated as a percentage of the employees’ salary. For other superannuation schemes (ie State Superannuation Scheme and State Authorities Superannuation Scheme), the expense is calculated as a multiple of the employees’ superannuation contributions.

iii) Other Provisions

Other provisions exist when: the Hospital has a present legal or constructive obligation as a result of a past event; it is probable that an outfl ow of resources will be required to settle the obligation; and a reliable estimate can be made of the amount of the obligation.

These provisions are recognised when it is probable that a future sacrifi ce of economic benefi ts will be required and the amount can be measured reliably. b) Insurance

The Hospital’s insurance activities are conducted through the NSW Treasury Managed Fund Scheme of self insurance for Government Agencies. The expense (premium) is determined by the Fund Manager based on past experience. c) Finance Costs

Finance costs are recognised as expenses in the period in which they are incurred.

121 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

d) Income Recognition

Income is measured at the fair value of the consideration or contribution received or receivable. Additional comments regarding the accounting policies for the recognition of revenue are discussed below.

Sale of Goods and Services Revenue from the sale of goods and services comprises revenue from the provision of products or services, i.e. user charges. User charges are recognised as revenue when the service is provided or by reference to the stage of completion.

Patient Fees Patient Fees are derived from chargeable inpatients and non-inpatients on the basis of rates specifi ed by the NSW Department of Health from time to time.

Investment Revenue Interest revenue is recognised using the effective interest method as set out in AASB139, “Financial Instruments: Recognition and Measurement”. Rental revenue is recognised in accordance with AASB117 “Leases” on a straight line basis over the lease term. Dividend revenue is recognised in accordance with AASB118 “Revenue” when the Hospital’s right to receive payment is established.

Debt Forgiveness Debts are accounted for as extinguished when and only when settlement occurs through repayment or replacement by another liability.

Use of Hospital Facilities Specialist doctors with rights of private practice are subject to an infrastructure charge for the use of hospital facilities at rates determined by the NSW Department of Health. Charges consist of two components:

* a monthly charge raised by the Hospital based on a percentage of receipts generated

* the residue of the Private Practice Trust Fund at the end of each fi nancial year, such sum being credited for the Hospital’s use in the advancement of the Hospital or individuals within it.

Use of Outside Facilities The Hospital uses a number of facilities owned and maintained by the local authorities in the area to deliver community health services for which no charges are raised by the authorities. The Hospital is unable to estimate the value of services provided and as such no amounts have been recognised in the fi nancial report.

Grants and Contributions Grants and Contributions are generally recognised as revenues when the Hospital obtains control over the assets comprising the contributions. Control over contributions is normally obtained upon the receipt of cash.

NSW Department of Health Allocations Payments are made by the NSW Department of Health on the basis of the allocation for the Hospital as adjusted for approved supplementations mostly for salary agreements, patient fl ows between Health Services and approved enhancement projects. This allocation is included in the Operating Statement before arriving at the “Result for the Year” on the basis that the allocation is earned in return for the Hospital’s services provided on behalf of the Department. Allocations are normally recognised upon the receipt of cash.

122 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

e) Accounting for Goods & Services Tax (GST)

Revenues, expenses and assets are recognised net of the amount of GST, except that:

* the amount of GST incurred by the Hospital as a purchaser that is not recoverable from the Australian Taxation Offi ce is recognised as part of the cost of acquisition of an asset or as part of an item of expense;

* receivables and payables are stated with the amount of GST included. f) Inter Area and Interstate Patient Flows

Inter Area Patient Flows

The Hospital recognises patient fl ows for patients it has treated that live outside the Hospital’s regional area. The fl ows recognised are for acute inpatients (other than Mental Health Services), emergency and rehabilitation and extended care.

Patient fl ows have been calculated using benchmarks for the cost of services for each of the categories identifi ed and deducting estimated revenue, based on the payment category of the patient. The fl ow information is based on activity for the last completed calendar year. The NSW Department of Health accepts that category identifi cation for various surgical and medical procedures is impacted by the complexities of the coding process and the interpretation of the coding staff when coding a patient’s medical records. The Department reviews the fl ow information extracted from the Hospital records and once it has accepted it, requires the Hospital to bring to account the value of patient fl ows in accordance with the Department’s assessment.

The adjustments have no effect on equity values as the movement in Net Cost of Services is matched by a corresponding adjustment to the value of the NSW Department of Health Recurrent Allocation.

Inter State Patient Flows

The Hospital recognises the value of infl ows for acute inpatient treatment provided to residents from other States and Territories within Australia. The revenue values reported within the fi nancial statements have been based on 2006/07 activity data using standard cost weighted separation values to refl ect estimated costs in 2007/08 for acute weighted inpatient separations.

The reporting adopted for both inter area and interstate patient fl ows aims to provide a greater accuracy of the cost of service provision to the Area’s resident population and disclose the extent to which service is provided to non residents.

The composition of patient fl ow revenue is disclosed in Note 9.

123 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

g) Acquisition of Assets

The cost method of accounting is used for the initial recording of all acquisitions of assets controlled by the Hospital. Cost is the amount of cash or cash equivalents paid or the fair value of the other consideration given to acquire the asset at the time of its acquisition or construction or, where applicable, the amount attributed to that asset when initially recognised in accordance with the specifi c requirements of other Australian Accounting Standards.

Assets acquired at no cost, or for nominal consideration, are initially recognised as assets and revenues at their fair value at the date of acquisition except for assets transferred as a result of an administrative restructure.

Fair value means the amount for which an asset could be exchanged between knowledgeable, willing parties in an arm’s length transaction.

Where settlement of any part of cash consideration is deferred beyond normal credit terms, its cost is the cash price equivalent, i.e. the deferred payment amount is effectively discounted at an asset-specifi c rate.

Land and Buildings which are owned by the Health Administration Corporation or the State and administered by the Hospital are deemed to be controlled by the Hospital and are refl ected as such in the fi nancial statements.

h) Plant and Equipment and Infrastructure Systems

Individual items of property, plant & equipment are capitalised where their cost is $10,000 or above.

“Infrastructure Systems” means assets that comprise public facilities and which provide essential services and enhance the productive capacity of the economy including roads, bridges, water infrastructure and distribution works, sewage treatment plants, seawalls and water reticulation systems.

i) Depreciation

Depreciation is provided for on a straight line basis for all depreciable assets so as to write off the depreciable amount of each asset as it is consumed over its useful life to the Hospital. Land is not a depreciable asset.

Details of depreciation rates initially applied for major asset categories are as follows:

Buildings 2.5% Electro Medical Equipment - Costing less than $200,000 10.0% - Costing more than or equal to $200,000 12.5% Computer Equipment 20.0% Infrastructure Systems 2.5% Motor Vehicle Sedans 12.5% Motor Vehicles, Trucks & Vans 20.0% Offi ce Equipment 10.0% Plant and Machinery 10.0% Furniture, Fittings and Furnishings 5.0%

Depreciation rates are subsequently varied where changes occur in the assessment of the remaining useful life of the assets reported.

124 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

j) Revaluation of Non Current Assets

Physical non-current assets are valued in accordance with the NSW Department of Health’s “Valuation of Physical Non- Current Assets at Fair Value” policy. This policy adopts fair value in accordance with AASB116, “Property, Plant & Equipment” and AASB140, “Investment Property”.

Property, plant and equipment is measured on an existing use basis, where there are no feasible alternative uses in the existing natural, legal, fi nancial and socio-political environment. However, in the limited circumstances where there are feasible alternative uses, assets are valued at their highest and best use.

Fair value of property, plant and equipment is determined based on the best available market evidence, including current market selling prices for the same or similar assets. Where there is no available market evidence the asset’s fair value is measured at its market buying price, the best indicator of which is depreciated replacement cost.

The Hospital revalues Land and Buildings and Infrastructure at minimum every three years by independent valuation. To ensure that the carrying amount of each asset does not differ materially from its fair value at reporting date, indices provided in expert advice from the Department of Lands are applied. The indices refl ect an assessment of movements in the period between revaluations.

Non-specialised assets with short useful lives are measured at depreciated historical cost, as a surrogate for fair value.

When revaluing non-current assets by reference to current prices for assets newer than those being revalued (adjusted to refl ect the present condition of the assets), the gross amount and the related accumulated depreciation are separately restated.

For other assets, any balances of accumulated depreciation existing at the revaluation date in respect of those assets are credited to the asset accounts to which they relate. The net asset accounts are then increased or decreased by the revaluation increments or decrements.

Revaluation increments are credited directly to the asset revaluation reserve, except that, to the extent that an increment reverses a revaluation decrement in respect of that class of asset previously recognised as an expense in the Result for the Year, the increment is recognised immediately as revenue in the Result for the Year.

Revaluation decrements are recognised immediately as expenses in the Result for the Year, except that, to the extent that a credit balance exists in the asset revaluation reserve in respect of the same class of assets, they are debited directly to the asset revaluation reserve.

As a not-for-profi t entity, revaluation increments and decrements are offset against one another within a class of non-current assets, but not otherwise.

Where an asset that has previously been revalued is disposed of, any balance remaining in the asset revaluation reserve in respect of that asset is transferred to accumulated funds.

125 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

k) Impairment of Property, Plant and Equipment

As a not-for-profi t entity with no cash generating units, the Hospital is effectively exempt from AASB 136” Impairment of Assets” and impairment testing. This is because AASB136 modifi es the recoverable amount test to the higher of fair value less costs to sell and depreciated replacement cost. This means that, for an asset already measured at fair value, impairment can only arise if selling costs are regarded as material. Selling costs are regarded as immaterial.

l) Restoration Costs

The estimated cost of dismantling and removing an asset and restoring the site is included in the cost of an asset, to the extent it is recognised as a liability.

m) Intangible Assets

The Hospital recognises intangible assets only if it is probable that future economic benefi ts will fl ow to the Hospital and the cost of the asset can be measured reliably. Intangible assets are measured initially at cost. Where an asset is acquired at no or nominal cost, the cost is its fair value as at the date of acquisition. All research costs are expensed. Development costs are only capitalised when certain criteria are met.

The useful lives of intangible assets are assessed to be fi nite. Intangible assets are subsequently measured at fair value only if there is an active market. As there is no active market for the Hospital’s intangible assets, the assets are carried at cost less any accumulated amortisation. The Hospital’s intangible assets are amortised using the straight line method based on the useful life of the asset for both internally developed assets and direct acquisitions. In general, intangible assets are tested for impairment where an indicator of impairment exists. However, as a not-for-profi t entity the Hospital is effectively exempt from impairment testing (see Note 2[k]).

n) Maintenance

The costs of maintenance are charged as expenses as incurred, except where they relate to the replacement of a component of an asset in which case the costs are capitalised and depreciated.

o) Leased Assets

A distinction is made between fi nance leases which effectively transfer from the lessor to the lessee substantially all the risks and benefi ts incidental to ownership of the leased assets, and operating leases under which the lessor effectively retains all such risks and benefi ts.

Where a non-current asset is acquired by means of a fi nance lease, the asset is recognised at its fair value at the commencement of the lease term. The corresponding liability is established at the same amount. Lease payments are allocated between the principal component and the interest expense.

Operating lease payments are charged to the Operating Statement in the periods in which they are incurred.

p) Inventories

Inventories are stated at cost. Costs are assigned to individual items of stock mainly on the basis of weighted average costs.

Obsolete items are disposed off in accordance with instructions issued by the NSW Department of Health.

126 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

q) Loans and Receivables

Loans and receivables are non-derivative fi nancial assets with fi xed or determinable payments that are not quoted in an active market. These fi nancial assets are recognised initially at fair value, usually based on the transaction cost or face value. Subsequent measurement is at amortised cost using the effective interest method, less an allowance for any impairment of receivables. Any changes are accounted for in the Operating Statement when impaired, derecognised or through the amortisation process.

Short-term receivables with no stated interest rate are measured at the original invoice amount where the effect of discounting is immaterial. r) Investments

Investments are initially recognised at fair value through profi t or loss. The Hospital determines the classifi cation of its fi nancial assets after initial recognition and, when allowed and appropriate, re-evaluates this at each fi nancial year end.

• Fair value through profi t or loss - The Hospital subsequently measures investments classifi ed as “held for trading” or designated upon initial recognition “at fair value through profi t or loss” at fair value. Financial assets are classifi ed as “held for trading” if they are acquired for the purpose of selling in the near term. Derivatives are also classifi ed as held for trading. Gains or losses on these assets are recognised in the Operating Statement.

The Hour-Glass Investment facilities are designated at fair value through profi t or loss using the second leg of the fair value option i.e. these fi nancial assets are managed and their performance is evaluated on a fair value basis, in accordance with a documented risk management strategy, and information about these assets is provided internally on that basis to the Hospital’s key management personnel.

The risk management strategy of the Hospital has been developed consistent with the investment powers granted under the provision of the Public Authorities (Financial Arrangements) Act. T Corp investments are made in an effort to improve total return on investments through access to equities and fi xed interest products managed professionally by NSW Treasury.

The movement in the fair value of the Hour-Glass Investment facilities incorporates distributions received as well as unrealised movements in fair value and is reported in the line item ‘investment revenue’.

• Held to maturity investments – Non-derivative fi nancial assets with fi xed or determinable payments and fi xed maturity that the Hospital has the positive intention and ability to hold to maturity are classifi ed as “held to maturity”. These investments are measured at amortised cost using the effective interest method. Changes are recognised in the Operating Statement when impaired, derecognised or through the amortisation process.

• Available for sale investments - Any residual investments that do not fall into any other category are accounted for as available for sale investments and measured at fair value directly in equity until disposed or impaired, at which time the cumulative gain or loss previously recognised in equity is recognised in the Operating Statement. However, interest calculated using the effective interest method and dividends are recognised in the Operating Statement.

Purchases or sales of investments under contract that require delivery of the asset within the timeframe established by convention or regulation are recognised on the trade date; i.e. the date the Hospital commits to purchase or sell the asset.

The fair value of investments that are traded at fair value in an active market is determined by reference to quoted current bid prices at the close of business on the balance sheet date.

127 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

s) Impairment of fi nancial assets

All fi nancial assets, except those measured at fair value through profi t and loss, are subject to an annual review for impairment. An allowance for impairment is established when there is objective evidence that the Hospital will not be able to collect all amounts due.

For fi nancial assets carried at amortised cost, the amount of the allowance is the difference between the asset’s carrying amount and the present value of estimated future cash fl ows, discounted at the effective interest rate. The amount of the impairment loss is recognised in the Operating Statement.

When an available for sale fi nancial asset is impaired, the amount of the cumulative loss is removed from equity and recognised in the Operating Statement, based on the difference between the acquisition cost (net of any principal repayment and amortisation) and current fair value, less any impairment loss previously recognised in the Operating Statement.

Any reversals of impairment losses are reversed through the Operating Statement, where there is objective evidence, except reversals of impairment losses on an investment in an equity instrument classifi ed as “available for sale” must be made through the reserve. Reversals of impairment losses of fi nancial assets carried at amortised cost cannot result in a carrying amount that exceeds what the carrying amount would have been had there not been an impairment loss.

t) De-recognition of fi nancial assets and fi nancial liabilities

A fi nancial asset is derecognised when the contractual rights to the cash fl ows from the fi nancial assets expire; or if the Hospital transfers the fi nancial asset:

* where substantially all the risks and rewards have been transferred; or * where the Hospital has not transferred substantially all the risks and rewards, if the Hospital has not retained control.

Where the Hospital has neither transferred nor retained substantially all the risks and rewards or transferred control, the asset is recognised to the extent of the Hospital’s continuing involvement in the asset.

A fi nancial liability is derecognised when the obligation specifi ed in the contract is discharged or cancelled or expires.

u) Payables

These amounts represent liabilities for goods and services provided to the Hospital and other amounts. Payables are recognised initially at fair value, usually based on the transaction cost or face value. Subsequent measurement is at amortised cost using the effective interest method. Short-term payables with no stated interest rate are measured at the original invoice amount where the effect of discounting is immaterial.

Payables are recognised for amounts to be paid in the future for goods and services received, whether or not billed to the Hospital.

v) Borrowings

Loans are not held for trading or designated at fair value through profi t or loss and are recognised at amortised cost using the effective interest rate method. Gains or losses are recognised in the Operating Statement on derecognition.

The fi nance lease liability is determined in accordance with AASB 117 “Leases”.

128 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

w) Trust Funds

The Hospital receives monies in a trustee capacity for various trusts as set out in Note 30. As the Hospital performs only a custodial role in respect of these monies, and because the monies cannot be used for the achievement of the Hospital’s own objectives, they are not brought to account in the fi nancial statements. x) Budgeted Amounts

The budgeted amounts are drawn from the budgets agreed with the NSW Department of Health at the beginning of the fi nancial reporting period and with any adjustments for the effects of additional supplementation provided. y) Summary of Capital Management

With effect from 1 July 2008 project management for all capital projects over $10M will be provided by Health Infrastructure, a division of the Health Administration Corporation created with the purpose of managing and coordinating approved capital works projects within time, budget and quality standards specifi ed by the NSW Department of Health.

129 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

3. Employee Related

Employee related expenses comprise the following:

- - Salaries and Wages 175,836 162,555 - - Superannuation - defi ned benefi t plans 3,944 2,672 - - Superannuation - defi ned contributions 14,005 13,025 - - Long Service Leave 5,599 6,126 - - Annual Leave 16,896 18,386 - - Workers Compensation Insurance 1,704 1,812 ______- ______- Fringe Benefi ts Tax ______69 ______45

______- ______- ______218,053 ______204,621

4. Personnel Services

Personnel Services comprise the purchase of the following:

175,836 162,555 Salaries and Wages - - 3,944 2,672 Superannuation - defi ned benefi t plans - - 14,005 13,025 Superannuation - defi ned contributions - - 5,599 6,126 Long Service Leave - - 16,896 18,386 Annual Leave - - 1,704 1,812 Workers Compensation Insurance - - ______69 ______45 Fringe Benefi ts Tax ______- ______-

______218,053 ______204,621 ______- ______-

5. Other Operating Expenses

9,895 11,785 Blood and Blood Products 9,895 11,785 3,038 2,718 Domestic Supplies and Services 3,038 2,718 12,847 11,263 Drug Supplies 12,847 11,263 2,698 2,243 Food Supplies 2,698 2,243 1,533 1,729 Fuel, Light and Power 1,533 1,729 6,536 5,527 General Expenses (See (a) below) 6,536 5,527 869 723 Hospital Ambulance Transport Costs 869 723 1,770 262 Information Management Expenses 1,770 262 45 88 Insurance 45 88 Maintenance (See (b) below) 4,618 5,648 Maintenance Contracts 4,618 5,648 1,321 4,240 New/Replacement Equipment under $10,000 1,321 4,240 1,882 2,797 Repairs 1,882 2,797 11,215 9,750 Medical and Surgical Supplies 11,215 9,750 1,161 1,055 Postal and Telephone Costs 1,161 1,055 1,368 1,261 Printing and Stationery 1,368 1,261 501 510 Rates and Charges 501 510 139 188 Rental 139 188 8,989 8,266 Special Service Departments 8,989 8,266 1,526 1,865 Staff Related Costs 1,526 1,865 ______2,740 ______2,380 Travel Related Costs ______2,740 ______2,380

______74,691 ______74,298 ______74,691 ______74,298

130 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

(a) General Expenses comprise: 443 399 Advertising 443 399 427 381 Books, Magazines and Journals 427 381 - - Consultancies - - 1,065 1,812 - Operating Activities 1,065 1,791 350 308 Courier and Freight 350 308 153 81 Auditor’s Remuneration - Audit of fi nancial reports 153 102 2 - Auditor’s Remuneration - Other Services 2 - 160 29 Data Recording and Storage 160 29 362 235 Legal Services 362 235 129 138 Membership/Professional Fees 129 138 152 165 Motor Vehicle Operating Lease Expense - minimum lease payments 152 165 358 397 Other Operating Lease Expense - minimum lease payments 358 397 6 2 Payroll Services 6 2 47 - Quality Assurance/Accreditation 47 - 414 231 Translator Services 414 231 ______2,468 ______1,349 Other general operating expenses ______2,468 ______1,349

______6,536 ______5,527 ______6,536 ______5,527

(b) Reconciliation Total Maintenance Maintenance expense - contracted labour and other (non employee ______4,618 ______5,648 related), included in Note 5 ______4,618 ______5,648

______4,618 ______5,648 Total maintenance expenses included in Notes 5 ______4,618 ______5,648

6. Depreciation and Amortisation 8,259 8,248 Depreciation - Buildings 8,259 8,248 5,214 3,954 Depreciation - Plant and Equipment 5,214 3,954 812 813 Depreciation - Infrastructure Systems 812 813 1,221 1,312 Amortisation - Intangible Assets 1,221 1,312 ______19 ______19 Amortisation - Leased Buildings ______19 ______19

______15,525 ______14,346 ______15,525 ______14,346

7. Grants and Subsidies

322 312 Non Government Voluntary Organisations 322 312 ______242 ______8 Other ______242 ______8

______564 ______320 ______564 ______320

8. Finance Costs

______31 ______51 Interest on Loans ______31 ______51

______31 ______51 Total Finance Costs ______31 ______51

131 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

9. Sale of Goods and Services

(a) Sale of Goods comprises the following:

1,753 1,404 Sale of Prostheses 1,753 1,404 730 452 Pharmacy Sales 730 452

(b) Rendering of Services comprises the following:

9,964 7,616 Patient Fees [see note 2(d)] 9,964 7,616 90 469 Staff-Meals and Accommodation 90 469 9,601 8,712 Infrastructure Fees - Monthly Facility Charge [see note 2(d)] 9,601 8,712 506 533 - Annual Charge 506 533 1,757 2,248 Cafeteria/Kiosk 1,757 2,248 1,867 1,808 Car Parking 1,867 1,808 551 427 Child Care Fees 551 427 1,451 1 Clinical Services (excluding Clinical Drug Trials) 1,451 1 1,460 351 Commercial Activities 1,460 351 38 23 Fees for Medical Records 38 23 143,029 128,804 Allocation from Inter Area Patient Infl ows, NSW [see Note 9(c)] 143,029 128,804 104 111 Salary Packaging Fee 104 111 13 12 PADP Patient Copayments 13 12 2,376 3,469 Patient infl ows from Interstate [see Note 9(d)] 2,376 3,469 ______3,257 ______1,971 Other ______3,257 ______1,971

______178,547 ______158,411 ______178,547 ______158,411

(c) Details of the Allocations received for Inter Area Patient Flows, NSW on an Area basis as accepted by the NSW Department of Health are as follows:

33,249 30,582 Sydney South West 33,249 30,582 21,173 18,190 North Sydney/Central Coast 21,173 18,190 62,526 54,728 Sydney West 62,526 54,728 5,383 6,047 Hunter/New England 5,383 6,047 6,397 5,973 South East/Illawarra 6,397 5,973 3,433 3,338 North Coast 3,433 3,338 7,388 5,880 Greater Western 7,388 5,880 ______3,480 ______4,066 Greater Southern ______3,480 ______4,066

______143,029 ______128,804 ______143,029 ______128,804

(d) Revenues from Patient Infl ows from Interstate are as follows:

1,448 2,429 Australian Capital Territory 1,448 2,429 111 159 Northern Territory 111 159 150 478 Queensland 150 478 (29) 82 South Australia (29) 82 103 255 Tasmania 103 255 394 2 Victoria 394 2 ______199 ______64 Western Australia ______199 ______64

______2,376 ______3,469 ______2,376 ______3,469

132 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

10. Investment Revenue

Investment Income - T Corp Hour Glass Investment Facilities designated at Fair Value (1,193) 7,010 through profi t or loss (1,193) 7,010 319 570 Interest - Other 319 570 ______534 ______489 Lease and Rental Income ______534 ______489

______(340) ______8,069 ______(340) ______8,069

11. Grants and Contributions

900 612 Clinical Drug Trials 900 612 2,066 2,723 Commonwealth Government Grants 2,066 2,723 24,027 25,366 Industry Contributions/Donations 24,027 25,366 53 - NSW Government Grants 53 - 3,944 2,672 Personnel Services - Superannuation Defi ned Benefi ts - - 4,204 5,807 Research Grants 4,204 5,807 ______31 ______- Other Grants ______31 ______-

______35,225 ______37,180 ______31,281 ______34,508

12. Other Revenue

Other Revenue comprises the following:

2 3 Bad Debts recovered 2 3 122 70 Commissions 122 70 1,274 1,069 Conference and Training Fees 1,274 1,069 - 8 Discounts - 8 198 136 Sale of Merchandise, Old Wares and Books 198 136 69 - Sponsorship Income 69 - 313 1,189 Treasury Managed Fund Hindsight Adjustment 313 1,189 ______5,526 ______4,675 Other ______5,526 ______4,675

______7,504 ______7,150 ______7,504 ______7,150

13. Gain/(Loss) on Disposal

21,220 9,101 Property, Plant and Equipment 21,220 9,101 ______20,813 ______9,044 Less Accumulated Depreciation ______20,813 ______9,044

407 57 Written Down Value 407 57 ______5 ______- Less Proceeds from Disposal ______5 ______-

______(402) ______(57) Gain/(Loss) on Disposal of Property Plant and Equipment ______(402) ______(57)

3 - Intangible Assets 3 - ______3 ______- Less Proceeds from Disposal ______3 ______- ______- ______- Gain/(Loss) on Disposal of Intangible Assets ______- ______-

______(402) ______(57) Total Gain/(Loss) on Disposal ______(402) ______(57)

14. Other Gains/(Losses)

______(1,504) ______(277) Impairment of Receivables ______(1,504) ______(277)

______(1,504) ______(277) ______(1,504) ______(277)

133 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT AND CONSOLIDATION

15. Conditions on Contributions

Purchase of Health Promotion, Other Total Assets Education and Research

$000 $000 $000 $000

Contributions recognised as revenues during the current reporting period for which expenditure in the manner specifi ed had not occurred as at balance date 539 4,572 507 5,618

Contributions recognised in amalgamated balance as at 30 June 2007 which were not expended in the current reporting period ______0 ______61,147 ______2,103 ______63,250 Total amount of unexpended contributions as at balance date ______539 ______65,719 ______2,610 ______68,868

There is a change in the methodology used to split the unspent contribution between the above categories. The 2006/07 unspent contribution for purchase of assets was based on a percentage of some major cost centres that regularly receive donations and purchase assets. However, as conditional contributions for the purchase of assets are generally spent in the year of receipt, in 2007/08 any unexpended contributions are based on known amounts.

Comment on restricted assets appears in Note 23

134 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

16. Programs/Activities of the Hospital

Program 1.1 - Primary and Community Based Services

Objective: To improve, maintain or restore health through health promotion, early intervention, assessment, therapy and treatment services for children in a home or community setting.

Program 1.2 - Aboriginal Health Services

Objective: To raise the health status of Aborigines and to promote a healthy life style.

Program 1.3 - Outpatient Services

Objective: To improve, maintain or restore health through diagnosis, therapy, education and treatment services for ambulant patients in a hospital setting.

Program 2.1 - Emergency Services

Objective: To reduce the risk of premature death and disability for children suffering injury or acute illness by providing timely emergency diagnostic, treatment and transport services.

Program 2.2 - Overnight Acute Inpatient Services

Objective: To restore or improve health and manage risks of illness, injury and childbirth through diagnosis and treatment for children intended to be admitted to hospital on an overnight basis.

Program 2.3 - Same Day Acute Inpatient Services

Objective: To restore or improve health and manage risks of illness, injury and childbirth through diagnosis and treatment for children intended to be admitted to hospital and discharged on the same day.

Program 3.1 - Mental Health Services

Objective: To improve the health, well being and social functioning of children with disabling mental disorders and to reduce the incidence of suicide, mental health problems and mental disorders in the community.

Program 4.1 - Rehabilitation and Extended Care Services

Objective: To improve or maintain the well being and independent functioning of children with disabilities or chronic conditions, the frail and the terminally ill.

Program 5.1 - Population Health Services

Objective: To promote health and reduce the incidence of preventable disease and disability by improving access to opportunities and prerequisites for good health.

Program 6.1 - Teaching and Research

Objective: To develop the skills and knowledge of the health workforce to support patient care and population health. To extend knowledge through scientifi c enquiry and applied research aimed at improving the health and well being of the children of New South Wales.

135 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

17. Cash and Cash Equivalents

6,032 7,646 Cash at bank and on hand 6,032 7,646 ______35,695 ______36,789 Short Term Deposits ______35,695 ______36,789

______41,727 ______44,435 ______41,727 ______44,435

Cash & cash equivalent assets recognised in the Balance Sheet are reconciled at the end of the fi nancial year to the Cash Flow Statement as follows:

______41,727 ______44,435 Cash and cash equivalents (per Balance Sheet) ______41,727 ______44,435

______41,727 ______44,435 Closing Cash and Cash Equivalents (per Cash Flow Statement) ______41,727 ______44,435

Refer to Note 36 for details regarding credit risk, liquidity risk and market risk arising from fi nancial instruments.

18. Receivables

Current 2,724 5,301 (a) Sale of Goods and Services 2,724 5,301 847 141 Leave Mobility 847 141 827 290 NSW Department of Health 827 290 650 671 Goods and Services Tax 650 671 ______7,001 ______1,971 Other Debtors ______7,001 ______1,971 12,049 8,374 Sub Total 12,049 8,374

______(1,830) ______(737) Less Allowance for impairment ______(1,830) ______(737)

10,219 7,637 Sub Total 10,219 7,637 ______444 ______453 Prepayments ______444 ______453

______10,663 ______8,090 ______10,663 ______8,090

(b) Movement in the allowance for impairment Sale of Goods & Services 701 712 Balance at 1 July 701 712 (233) (266) Amounts written off during the year (233) (266) (2) - Amounts recovered during the year (2) - 52 255 Increase/(decrease) in allowance recognised in profi t or loss 52 255 518 701 Balance at 30 June 518 701

(c) Movement in the allowance for impairment Other Debtors 36 30 Balance at 1 July 36 30 (176) (11) Amounts written off during the year (176) (11) - - Amounts recovered during the year - - 1,452 17 Increase/(decrease) in allowance recognised in profi t or loss 1,452 17 ______1,312 ______36 Balance at 30 June ______1,312 ______36

______1,830 ______737 ______1,830 ______737

136 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

Non Current 59 437 (a) Sale of Goods and Services 59 437 ______- ______- Other Debtors ______- ______- 59 437 Sub Total 59 437

______- ______(134) Less Allowance for impairment ______- ______(134) 59 303 Sub Total 59 303

______- ______- Prepayments ______- ______-

______59 ______303 ______59 ______303

(b) Movement in the allowance for impairment Sale of Goods and Services 134 135 Balance at 1 July 134 135 (134) (1) Amounts written off during the year (134) (1) - - Amounts recovered during the year - - - - Increase/(decrease) in allowance recognised in profi t or loss - - ______- ______134 Balance at 30 June ______- ______134

______- ______134 ______- ______134

(c) Sale of Goods and Services Receivables (Current and Non Current) include: 105 283 Patient Fees - Compensable 105 283 662 - Patient Fees - Ineligible 662 - ______1,286 ______2,236 Patient Fees - Other ______1,286 ______2,236

______2,053 ______2,519 ______2,053 ______2,519

Details regarding credit risk, liquidity risk and market risk, including fi nancial assets that are either past due or impaired are disclosed in Note 36.

19. Inventories

Current - at cost 1,324 1,235 Drugs 1,324 1,235 2,066 1,873 Medical and Surgical Supplies 2,066 1,873 31 26 Food and Hotel Supplies 31 26 142 105 Engineering Supplies 142 105 231 286 Fundraising Merchandise 231 286 ______630 ______556 Other ______630 ______556

______4,424 ______4,081 ______4,424 ______4,081

137 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

20. Financial Assets at Fair Value

Non Current ______33,238 ______37,147 Treasury Corporation - Hour Glass Investment Facilities ______33,238 ______37,147

______33,238 ______37,147 ______33,238 ______37,147

Refer to Note 36 for details regarding credit risk, liquidity risk and market risk arising from fi nancial investments.

21. Property, Plant and Equipment

Land and Buildings 387,439 352,324 At Fair Value 387,439 352,324 ______(83,720) ______(67,939) Less Accumulated depreciation ______(83,720) ______(67,939)

______303,719 ______284,385 Net Carrying Amount ______303,719 ______284,385

Plant and Equipment 118,624 133,981 At Fair Value 118,624 133,981 ______(89,816) ______(105,416) Less Accumulated depreciation ______(89,816) ______(105,416)

______28,808 ______28,565 Net Carrying Amount ______28,808 ______28,565

Infrastructure Systems 36,050 32,510 At Fair Value 36,050 32,510 ______(8,290) ______(6,742) Less Accumulated depreciation ______(8,290) ______(6,742)

______25,760 ______25,768 Net Carrying Amount ______27,760 ______25,768

Total Property, Plant and Equipment ______360,287 ______338,718 At Net Carrying Amount ______360,287 ______338,718

138 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT AND C0NSOLIDATION

21. Property, Plant and Equipment - Reconciliations

Land Buildings Leased Plant and Infrastructure Total Buildings Equipment Systems 2008 $000 $000 $000 $000 $000 $000

Carrying amount at start of year 20,720 263,038 627 28,565 25,768 338,718

Additions - 1,341 - 5,920 208 7,469

Reclassifi cation of Intangibles - - - (56) - (56)

Disposals - - - (407) - (407)

Net revaluation increment less revaluation - 26,271 - - 2,596 28,867 decrements recognised in reserves Depreciation expense - (8,259) (19) (5,214) (812) (14,304)

Carrying amount at end of year 20,720 282,391 608 28,808 27,760 360,287

Land Buildings Leased Plant and Infrastructure Total Buildings Equipment Systems 2007 $000 $000 $000 $000 $000 $000

Carrying amount at start of year 20,720 270,067 646 29,005 26,581 347,019

Additions - 1,219 - 3,571 - 4,790

Disposals - - - (57) - (57)

Depreciation expense - (8,248) (19) (3,954) (813) (13,034)

Carrying amount at end of year 20,720 263,038 627 28,565 25,768 338,718

(i) Land and Buildings include land owned by the Health Administration Corporation and administered by the Hospital [see note 2(g)].

(ii) Land and Buildings at Westmead were revalued at fair value by an independent valuer, Mr P. Goldsmith APPI (Certifi ed Practising Valuer) Registered Valuer No 3099 from the Property Valuation Services on 31 March 2006. Indices provided by the Department of Lands have been applied at 30 June 2008 [see note 2(j)].

Buildings were valued at fair value of $329,500,000 (cost $221,275,000) on 31 March 2006. Indices applied at 30 June 2008 have resulted in an increase in the fair value of $26,271,000.

Land was revalued at fair value of $20,720,000 (cost $14,600,000) based on valuation dated 31 March 2006. It did not include the leasehold land at Manly, on which Bear Cottage is located. Indices advised by the Department of Lands at 30 June 2008 showed no movement in the fair value of land.

The term of the lease is 20 years with an option to renew for a further 20 years. The rent payable is $1 per annum.

139 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

22. Intangible Assets

Software 10,879 10,308 Cost (Gross Carrying Amount) 10,879 10,308 ______(6,462) ______(5,398) Less Accumulated Amortisation ______(6,462) ______(5,398)

______4,417 ______4,910 Net Carrying Amount ______4,417 ______4,910

Other 991 991 Cost (Gross Carrying Amount) 991 991 ______(625) ______(468) Less Accumulated Amortisation ______(625) ______(468)

______366 ______523 Net Carrying Amount ______366 ______523

______4,783 ______5,433 Total Intangible Assets at Net Carrying Amount ______4,783 ______5,433

PARENT AND CONSOLIDATION

22. Intangibles - Reconciliation

Software Other Total 2008 $000 $000 $000

Net Carrying amount at start of year 4,910 523 5,433

Additions (from internal development or acquired separately) 518 - 518

Reclassifi cation from Plant & Equipment 56 - 56

Amortisation (recognised in depreciation and amortisation) (1,064) (157) (1,221)

Other Movements - Disposals (3) - (3)

Net Carrying amount at end of year 4,417 366 4,783

Software Other Total 2007 $000 $000 $000

Net Carrying amount at start of year 6,051 554 6,605

Additions (from internal development or acquired separately) - 139 139

Amortisation (recognised in depreciation and amortisation) (1,141) (170) (1,311)

Net Carrying amount at end of year 4,910 523 5,433

140 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

23. Restricted Assets

The Hospital’s fi nancial statements include the following assets which are restricted by externally imposed conditions. e.g. donor requirements. The assets are only available for application in accordance with the terms of the donor restrictions.

Category Brief Details of Externally Imposed conditions including Asset Category affected

613 2,669 Children’s Hospital Funds Donations and Fundraisings held for specifi c 613 2,669 purchases of equipment and / or services.

32,313 32,243 Specifi c Purposes Donations, Contributions and Fundraisings held in 32,313 32,243 trust for the benefi t of specifi c patient, departments and / or staff group.

6,861 6,765 Perpetually Invested Funds Funds invested in perpetuity. The income there from is 6,861 6,765 used in accordance with donors’ or trustees’ instructions for the benefi t of patients and / or in support of Hospital Services.

22,568 24,655 Research Grants Funds to be held for research on child health and 22,568 24,655 other related research carried out by the Hospital.

2,609 2,242 Private Practice Funds Funds to be held for the use of training, education and 2,609 2,242 professional development of staff.

148 212 Bear Cottage Donations, contributions and fund raisings held towards 148 212 the cost of operating Bear Cottage, a home for chronically ill children and their families, to provide them with palliative care in a home environment

3,756 4,381 Research Capital Campaign Donations, contributions and fund raisings held towards 3,756 4,381 the building of the Clinical Research Building, to provide infrastructure and facilities to meet the growing needs of the research on disease and children’s health. ______68,868 ______73,167 ______68,868 ______73,167

141 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

24. Payables

Current - - Accrued Salaries and Wages 7,504 6,871 389 686 Payroll Deductions 389 686 7,504 6,871 Accrued Liability - Purchase of Personnel Services - - 10,288 7,383 Creditors 10,288 7,383 Other Creditors 2,621 839 - Capital Works 2,621 839 300 263 - Intra Health Liability 300 263 ______1,553 ______3,238 - Other ______1,553 ______3,238

______22,655 ______19,280 ______22,655 ______19,280

Details regarding credit risk, liquidity risk and market risk, including a maturity analysis of the above payables are disclosed in Note 36.

25. Borrowings Current ______123 ______116 Other Loans and Deposits ______123 ______116 ______123 ______116 ______123 ______116

Non Current ______305 ______428 Other Loans and Deposits ______305 ______428 ______305 ______428 ______305 ______428

Other loans still to be extinguished represent monies to be repaid to the Sustainable Energy Development Authority Final Repayment is scheduled for 31 December 2011

Repayment of Borrowings (excluding Finance Leases)

123 116 Not later than one year 123 116 ______305 ______428 Between one and fi ve years ______305 ______428

Total Borrowings at face value ______428 ______544 (excluding Finance Leases) ______428 ______544

Details regarding credit risk, liquidity risk and market risk, including a maturity analysis of the above payables are disclosed in Note 36.

142 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

26. Provisions

Current Employee benefi ts and related on-costs - - Annual Leave - Short Term Benefi t 20,127 20,918 - - Annual Leave - Long Term Benefi t 10,623 8,352 - - Long Service Leave -Short term Benefi t 3,677 3,387 - - Long Service Leave - Long Term Benefi t 33,099 30,794 ______67,526 ______63,451 Provision for Personnel Services Liability ______- ______-

______67,526 ______63,451 Total Current Provisions ______67,526 ______63,451

Non Current Employee benefi ts and related on-costs - - Long Service Leave - Conditional 4,326 3,775 ______4,326 ______3,775 Provision for Personnel Services Liability ______- ______-

______4,326 ______3,775 Total Non Current Provisions ______4,326 ______3,775

Aggregate Employee Benefi ts and Related On-costs 67,526 63,451 Provisions - current 67,526 63,451 4,326 3,775 Provisions - non-current 4,326 3,775 - - Accrued Salaries and Wages and on-costs (Note 24) 7,893 7,557 ______7,893 ______7,557 Accrued Liability - Purchase of Personnel Services (Note 24) ______- ______-

______79,745 ______74,783 ______79,745 ______74,783

27. Other Liabilities

Current Income in Advance ______108 ______50 - Patients Fees received in advance ______108 ______50 ______108 ______50 ______108 ______50

PARENT AND CONSOLIDATION

28. Equity Accumulated Funds Asset Revaluation Reserve Total Equity 2008 2007 2008 2007 2008 2007 $000 $000 $000 $000 $000 $000 Balance at the beginning of the fi nancial year 213,212 218,452 137,895 137,895 351,107 356,347

Changes in Equity other than transaction with owners as owners

Result for the year (19,836) (5,240) - - (19,836) (5,240)

Increment/(Decrement) on Revaluation of: Buildings - - 26,271 - 26,271 - Infrastructure Systems - - 2,596 - 2,596 -

Total (19,836) (5,240) 28,867 - 9,031 (5,240)

Balance at the end of the fi nancial year 193,376 213,212 166,762 137,895 360,138 351,107

The asset revaluation reserve is used to record increments and decrements on the revaluation of non current assets. This accords with the Hospital’s policy on the “Revaluation of Physical Non Current Assets” and “Investments”, as discussed in Note 2(j).

143 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

29. Commitments for Expenditure

(a) Capital Commitments Aggregate capital expenditure for the acquisition of land and buildings, plant and equipment, infrastructure and intangible assets, contracted for at balance date and not provided for:

______668 ______103 Not later than one year ______668 ______103

______668 ______103 Total Capital Expenditure Commitments (including GST) ______668 ______103

Of the commitments reported at 30 June 2008 it is expected that $668,000 will be met from locally generated monies.

(b) Other Expenditure Commitments Aggregate other expenditure for operating expenses contracted for at balance date and not provided for:

2,552 629 Not later than one year 2,552 629 ______532 ______- Later than one year and not later than fi ve years ______532 ______-

______3,084 ______629 Total Other Expenditure Commitments (including GST) ______3,084 ______629

(c) Operating Lease Commitments Commitments in relation to non-cancellable operating leases are payable as follows:

178 380 Not later than one year 178 380 ______80 ______198 Later than one year and not later than fi ve years ______80 ______198

______258 ______578 Total Operating Lease Commitments (including GST) ______258 ______578

These Operating Leases are not recognised in the Financial Statements as liabilities until due. The Operating Leases represent rental of medical plant and equipment, computer equipment and vehicles.

(d) Contingent Asset related to Commitments for Expenditure The total of “Commitments for Expenditure” above, i.e. $4.01 million as at 30 June 2008 includes input tax credits of $364,000 (this compares with $119,000 for the previous year) that are expected to be recoverable from the Australian Taxation Offi ce.

144 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT AND CONSOLIDATION

30. Trust Funds

The Hospital holds trust fund moneys of $1.045 million which are used for the safe keeping of patients’ monies, employee related monies, deposits on hired items of equipment and Private Practice Trusts. These monies are excluded from the fi nancial statements as the Hospital cannot use them for the achievement of its objectives. The following is a summary of the transactions in the trust account.

Employee Trust/Refundable Deposits Private Practice Trust Funds

2008 2007 2008 2007 $000 $000 $000 $000 Cash Balance at the beginning of the fi nancial reporting period 29 13 632 270

Receipts 43 41 16,204 15,378

Expenditure (26) (25) (16,461) (15,060)

Movement in Net Assets - - 624 44

Cash Balance at the end of the fi nancial reporting period 46 29 999 632

PARENT AND CONSOLIDATION

31. Contingent Liabilities

a) Claims on Managed Fund

Since 1 July 1989, the Hospital has been a member of the NSW Treasury Managed Fund. The Fund will pay to or on behalf of the Hospital all sums which it shall become legally liable to pay by way of compensation or legal liability if sued except for employment related, discrimination and harassment claims that do not have statewide implications. The costs relating to such exceptions are to be absorbed by the Hospital. As such, since 1 July 1989, apart from the exceptions noted above no contingent liabilities exist in respect of liability claims against the Hospital. A Solvency Fund (now called Pre-Managed Fund Reserve) was established to deal with the insurance matters incurred before 1 July 1989 that were above the limit of insurance held or for matters that were incurred prior to 1 July 1989 that would have become verdicts against the State. That Solvency Fund will likewise respond to all claims against the Hospital.

b) Workers Compensation Hindsight Adjustment

Treasury Managed Fund normally calculates hindsight premiums each year. However, in regards to workers compensation the fi nal hindsight adjustment for the 2001/02 fund year and an interim adjustment for the 2003/04 fund year were not calculated until 2007/08. As a result, the 2002/03 fi nal and 2004/05 interim hindsight calculations will be paid in 2008/09.

145 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

PARENT CONSOLIDATION

2008 2007 2008 2007 $000 $000 $000 $000

32. Reconciliation Of Net Cash Flows from Operating Activities To Net Cost Of Services

3,605 15,237 Net Cash Flows from Operating Activities 3,605 15,237 (15,525) (14,346) Depreciation and Amortisation (15,525) (14,346) (959) 6 Provision for Doubtful Debts (959) 6 - - Acceptance by the Crown Entity of Employee Superannuation Benefi ts (3,944) (2,672) (4,626) (8,155) (Increase)/ Decrease in Provisions (4,626) (8,155) (770) 3,153 Increase / (Decrease) in Prepayments and Other Assets (770) 3,153 (1,651) (1,078) (Increase)/ Decrease in Creditors (1,651) (1,078) (403) (57) Net Gain/ (Loss) on Sale of Property, Plant and Equipment (403) (57) (73,759) (82,263) NSW Department of Health Recurrent Allocations (73,759) (82,263) ______(659) ______(309) NSW Department of Health Capital Allocations ______(659) ______(309)

______(94,747) ______(87,812) Net Cost of Services ______(98,691) ______(90,484)

33. 2007/08 Voluntary Services

It is considered impracticable to quantify the monetary value of voluntary services provided to the Hospital. Services provided include:

• Chaplaincies and Pastoral Care - Patient & Family Support • Patient Support Groups - Practical Support to Patients and Relatives • Community Organisations - Counselling, Health Education, Transport, Book Bunker, Starlight Rooms and Radio Bed Rock, Home Help and Patient Activities • Pink Ladies/Hospital Auxiliaries Patient Services, Fund Raising, Assistance in and Volunteers - Sibling Child Care Centre, relief staff to administration areas.

PARENT AND CONSOLIDATED

34. Unclaimed Moneys

Unclaimed salaries and wages are paid to the credit of the Department of Industrial Relations and Employment in accordance with the provisions of the Industrial Arbitration Act, 1940, as amended.

All money and personal effects of patients which are left in the custody of Hospital by any patient who is discharged or dies in the Hospital and which are not claimed by the person lawfully entitled thereto within a period of twelve months are recognised as the property of Hospital.

All such money and the proceeds of the realisation of any personal effects are lodged to the credit of the Samaritan Fund which is used specifi cally for the benefi t of necessitous patients or necessitous outgoing patients.

146 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

35. Budget Review - Parent and Consolidated

Net Cost of Services

The actual net cost of services is $2.4 million higher than budget.

This was primarily due to higher activity than expected, particularly from Inter Area Patient Flows.

The increase in activity resulted in higher employee costs. In addition, the cost of blood, drugs, medical and surgical supplies have all increased compared to budget as a result of the increase in activity.

Results for the Year

The actual result for the year is $2.3 million higher than budget primarily due to the reasons mentioned under Net Cost of Services above.

Assets and Liabilities

Net assets are $27 million more than budget, due mainly to the revaluation of buildings and infrastructure systems of $28 million, which was not budgeted.

Cash Flows

Net cash fl ows from operating activities are $1.5 million higher than budget due mainly to increased operating receipts partially offset by increased operating payments. In addition, net cash fl ows from investing activities are $1.3 million better than budget, resulting in total net cash fl ows of $2.7 million better than budget.

Movements in the level of the NSW Department of Health Recurrent Allocation that have occurred since the time of the initial allocation on 29 June 2007 are as follows:

$000

Initial Allocations 207,180 Revenue 4,085 Blood & Blood Products 3,832 Paediatric Liver Transplants 1,510 Award Increase 920 Inter-Area Patient Flow Adjustment (143,029) Other Miscellanious Funding Allocations ______(739) Allocation as per Operating Statement ______73,759

147 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

36. Financial Instruments

The Hospital’s principal fi nancial instruments are outlined below. These fi nancial instruments arise directly from the Hospital’s operations or are required to fi nance its operations. The Hospital does not enter into or trade fi nancial instruments, including derivative fi nancial instruments, for speculative purposes.

The Hospital’s main risks arising from fi nancial instruments are outlined below, together with the Hospital’s objectives, policies and processes for measuring and managing risk. Further quantitative and qualitative disclosures are included throughout this fi nancial report.

The Chief Executive has overall responsibility for the establishment and oversight of risk management and reviews and agrees policies for managing each of these risks. Risk management policies are established to identify and analyse the risk faced by the Hospital, to set risk limits and controls and monitor risks. Compliance with policies is reviewed by the Audit Committee and Internal Auditors on a continuous basis.

(a) Financial Instrument Categories

PARENT AND CONSOLIDATION

Note Category Total carrying amounts as per the Balance Sheet

2008 2007 $000 $000 Financial Assets Class: Cash and Cash Equivalents 17 N/A 41,727 44,435 Receivables 1 18 Receivables at amortised cost 9,628 7,269 Financial Assets at Fair Value 20 At fair value through profi t or 33,238 37,147 loss - designated as such upon initial recognition

Total Financial Assets 84,593 88,851

Financial Liabilities Class: Borrowings 25 Financial liabilities measured 428 544 at amortised cost Payables 2 24 Finanical liabilities measured 22,655 19,280 at amortised cost Other 27 108 50

Total Financial Liabilities 23,191 19,874

Notes 1. Excludes statutory receivables and prepayments (ie not within scope of AASB 7) 2. Excludes unearned revenue (ie not within scope of AASB 7)

(b) Credit Risk

Credit risk arises when there is the possibility of the Hospital’s debtors defaulting on their contractual obligations, resulting in a fi nancial loss to the Hospital. The maximum exposure to credit risk is generally represented by the carrying amount of the fi nancial assets (net of any allowance for impairment).

Credit risk arises from fi nancial assets of the Hospital i.e receivables. No collateral is held by the Hospital nor has it granted any fi nancial guarantees.

Credit risk associated with the Hospital’s fi nancial assets, other than receivables, is managed through the selection of counterparties and establishment of minimum credit rating standards. Authority deposits held with NSW TCorp are guaranteed by the State.

148 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

Cash

Cash comprises cash on hand and bank balance deposited in accordance with Public Authorities (Financial Arrangements) Act approvals. Interest is earned on daily bank balances at rates of approximately 6.90% in 2007/08 compared to 6.42% in the previous year. The TCorp Hour Glass Cash Facility is discussed in paragraph (d) below.

Receivables - trade debtors

All trade debtors are recognised at amounts receivable at balance date. Collectibility of trade debtors is reviewed on an ongoing basis. Procedures as established in the NSW Department of Health Accounting Manual and Fee Procedures Manual are followed to recover outstanding amounts, including letters of demand. Debts which are known to be uncollectable are written off. An allowance for impairment is raised when there is objective evidence that the entity will not be able to collect the amounts due. The evidence includes past experience and current and expected changes in economic conditions and debtor credit ratings. No interest is earned on trade debtors.

The Hospital is not materially exposed to concentrations of credit risk to a single trade debtor or group of debtors. Based on past experience, debtors that are not past due (2008:$5,773,000; 2007: $3,178,000) are not considered impaired and these represent 60.6% of the total trade debtors. In addition Patient Fees Compensables are frequently not settled within 6 months of the date of the service provision due to the length of time it takes to settle legal claims. Most of the Hospital’s debtors are health insurance companies or compensation insurers settling claims in respect of inpatient treatments. There are no debtors which are currently not past due or impaired whose terms have not been renegotiated.

The only fi nancial assets that are past due or impaired are ‘sales of goods and services’ in the ‘receivables’ category of the balance sheet. Patient Fees Ineligibles represent a signifi cant portion of fi nancial assets that are past due or impaired.

$000 2008 Total Past due but not impaired Considered impaired <3 months overdue 1,445 659 786 3 months - 6 months overdue 794 794 >6 months overdue 1,518 1,518 2007 <3 months overdue 1,666 1,174 492 3 months - 6 months overdue 1,015 731 284 >6 months overdue 795 414 381

The ageing analysis excludes statutory receivables, as these are not within the scope of AASB 7.

(c) Liquidity risk

Liquidity risk is the risk that the Hospital will be unable to meet its payment obligations when they fall due. The Hospital continuously manages risk through monitoring future cash fl ows and maturities planning to ensure adequate holding of high quality liquid assets. The objective is to maintain a balance between continuity of funding and fl exibility through effective management of cash, investments and liquid assets and liabilities.

The Hospital has negotiated no loan outside of arrangements with the NSW Department of Health or the Sustainable Energy Development Authority.

During the current and prior year, there were no defaults or breaches on any loans or payable. No assets have been pledged as collateral. The Hospital’s exposure to liquidity risk is considered signifi cant. However, the risk is mitigated as the NSW Department of Health has indicated its ongoing fi nancial support for the Hospital (Refer Note 2).

The liabilities are recognised for amounts due to be paid in the future for goods or services received, whether or not invoiced. Amounts owing to suppliers (which are unsecured) are settled in accordance with the policy set by the NSW Department of Health. If trade terms are not specifi ed, payment is generally made no later than the end of the month following the month in which an invoice or a statement is received.

In those instances where settlement cannot be effected in accordance with the above, eg due to short term liquidity constraints, contact is made with creditors and terms of payment are negotiated.

The table below summarises the maturity profi le of the Hospital’s fi nancial liabilities together with the interest rate exposure.

149 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

Maturity Analysis and interest rate exposure of fi nancial liabilities.

Interest Rate Exposure Maturity Dates Weighted Average Non - Interest Effective Interest Fixed Interest Rate Nominal Amount 1 Bearing 1 Year or less Over 1 to 5 Years Rate 2008 % $000 $000 $000 $000 % Payables: Accrued salaries 7,504 Wages and payroll 389 deductions Creditors 14,762 Borrowings: Other Loans and 6.07% 428 123 305 6.07% Deposits 428 22,655 123 305

2007 Payables: Accrued salaries 6,871 Wages and payroll 686 deductions Creditors 11,723 Borrowings: Other Loans and 6.07% 544 116 428 6.07% Deposits 544 19,280 116 428

Notes: 1. The amounts disclosed are the contractual undiscounted cash fl ows of each class of fi nancial liabilities, therefore the amounts disclosed above may not reconcile to the balance sheet in respect of non interest bearing loans negotiated with the NSW Department of Health.

(d) Market risk

Market risk is the risk that the fair value of future cash fl ows of a fi nancial instrument will fl uctuate because of changes in market prices. The Hospital’s exposures to market risk are primarily through interest rate risk on the Hospital’s borrowings and other price risks associated with the movement in the unit price of the Hour Glass Investment facilities. The Hospital has no exposure to foreign currency risk and does not enter into commodity contracts.

The effect on profi t and equity due to a reasonably possible change in risk variable is outlined in the information below, for interest rate risk and other price risk. A reasonably possible change in risk variable has been determined after taking into account the economic environment in which the Hospital operates and the time frame for the assessment (i.e. until the end of the next annual reporting period). The sensitivity analysis is based on risk exposures in existence at the balance sheet date. The analysis is performed on the same basis for 2007. The analysis assumes that all other variables remain constant.

150 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

Interest rate risk

Exposure to interest rate risk arises primarily through the Hospital’s interest bearing liabilities.

However, Health Services are not permitted to borrow external to the NSW Department of Health (Sustainable Energy Development Authority loans which are negotiated through Treasury excepted). Both SEDA and NSW Department of Health loans are set at fi xed rates and therefore are generally not affected by fl uctuations in market rates. For fi nancial instruments a reasonably possible change of +/-1% is consistent with trends in interest. The Hospital’s exposure to interest rate risk is set out below.

$000 -1% +1% Carrying Amount Profi t Profi t 2008 Financial assets

Cash and cash equivalents 41,727 (382) 382 Receivables 10,722 - -

Financial assets at fair value 33,238 3,322 (3,322) Other fi nancial assets

Financial liabilities

Payables 22,655 - - Borrowings 428 - - 2007 Financial assets

Cash and cash equivalents 44,435 (408) 408 Receivables 8,393 - -

Financial assets at fair value 37,147 3,974 (3,974) Other fi nancial assets

Financial liabilities

Payables 19,280 - - Borrowings 544 - -

Other price risk - TCorp Hour Glass facilities

Exposure to ‘other price risk’ primarily arises through the investment in the TCorp Hour Glass Investment facilities, which are held for strategic rather than trading purposes. The Hospital has no direct equity investments. The Hospital holds units in the following Hour-Glass investment trusts:

Facility Investment Sectors Investment horizon 2008 2007 $’000 $’000

Cash facility Cash,money market instruments Up to 2 years 35,695 36,674

Long term growth Cash, money market instruments, 7 years and over 33,238 37,147 facility Australian and International bonds listed property, Australian and International shares

151 Royal Alexandra Hospital for Children

Notes to and forming part of the Financial Statements for the year ended 30 June 2008

The unit price of each facility is equal to the total fair value of net assets held by the facility divided by the total number of units on issue for that facility. Unit prices are calculated and published daily.

NSW TCorp as trustee for each of the above facilities is required to act in the best interest of the unitholders and to administer the trusts in accordance with the trust deeds. As trustee, TCorp has appointed external managers to manage the performance and risk of each facility in accordance with a mandate agreed by the parties. However, TCorp, acts as manager for part of the Cash facility. A signifi cant portion of the administration of the facilities is outsourced to an external custodian.

Investment in the Hour Glass facilities limits the Hospital’s exposure to risk, as it allows diversifi cation across a pool of funds, with different investment horizons and a mix of investments.

NSW TCorp provides sensitivity analysis information for each of the facilities, using historically based volatility information. The TCorp Hour Glass Investment facilities are designated at fair value through profi t or loss and therefore any change in unit price impacts directly on profi t (rather than equity).

Impact on profi t/loss

Change in unit price 2008 2007 $’000 $’000

Hour Glass Investment - Cash facility +/- 1% 357 367

Hour glass Investment - Long Term +/- 15% 4,986 5,572 Growth Facility

A reasonable possible change is based on the percentage change in unit price multiplied by the redemption price as at 30 June each year for each facility ( as advised by TCorp).

(e) Fair Value

Financial instruments are generally recognised at cost, with the exception of the TCorp Hour Glass facilities, which are measured at fair value. As discussed, the value of the Hour Glass Investments is based on the Hospital’s share of the value of the underlying assets of the facility, based on the market value. All of the Hour Glass facilities are valued using ‘redemption’ pricing.

The amortised cost of fi nancial instruments recognised in the balance sheet approximates the fair value because of the short term nature of many of the fi nancial instruments.

37. Post Balance Date Events

The Hospital is not aware of any after balance date events.

END OF AUDITED FINANCIAL STATEMENTS

152 153 154 155 Royal Alexandra Hospital for Children

Special Purpose Service Entity Income Statement for the year ended 30 June 2008

2008 2007 $000 $000 Income

Personnel Services 218,053 204,621

Acceptance by the Crown Entity of Employee Benefi ts ______3,944 ______2,672

Total Income ______221,997 ______207,293

Expenses

Salaries and Wages 175,836 162,555

Defi ned Benefi t Superannuation 3,944 2,672

Defi ned Contributions Superannuation 14,005 13,025

Long Service Leave 5,599 6,126

Annual Leave 16,896 18,386

Workers Compensation Insurance 1,704 1,812

Fringe Benefi ts Tax 69 45

Grants and Subsidies ______3,944 ______2,672

Total Expenses ______221,997 ______207,293

Result For The Year ______- ______-

The accompanying notes form part of these Financial Statements 156 Royal Alexandra Hospital for Children Special Purpose Service Entity Balance Sheet as at 30 June 2008

Notes 2008 2007 $000 $000 ASSETS

Current Assets

Receivables 2 ______75,419 ______71,008

Total Current Assets ______75,419 ______71,008

Non-Current Assets

Receivables 2 ______4,326 ______3,775

Total Non-Current Assets ______4,326 ______3,775

Total Assets ______79,745 ______74,783

LIABILITIES

Current Liabilities

Payables 3 7,893 7,557

Provisions 4 ______67,526 ______63,451

Total Current Liabilities ______75,419 ______71,008

Non-Current Liabilities

Provisions 4 ______4,326 ______3,775

Total Non-Current Liabilities ______4,326 ______3,775

Total Liabilities ______79,745 ______74,783

Net Assets ______- ______-

EQUITY

Accumulated Funds ______- ______-

Total Equity ______- ______-

The accompanying notes form part of these Financial Statements 157 Royal Alexandra Hospital for Children Special Purpose Service Entity Statement of Recognised Income and Expenses for the year ended 30 June 2008

2008 2007 $000 $000

Total Income and Expense Recognised Directly in Equity ______- ______- Result for the Year ______- ______-

Total Income and Expense Recognised for the year ______- ______-

Cash Flow Statement for the Year Ended 30 June 2008

2008 2007 $000 $000

Net Cash Flows from Operating Activities ______- ______- Net Cash Flows from Investing Activities ______- ______- Net Cash Flows from Financing Activities ______- ______- Net Increase/(Decrease) in Cash ______- ______-

Closing Cash and Cash Equivalents ______- ______-

The Royal Alexandra Hospital for Children Special Purpose Service Entity does not hold any cash or cash equivalent assets and therefore there are nil cash fl ows.

The accompanying notes form part of these Financial Statements

158 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

1. Summary of Signifi cant Accounting Policies

a) The Royal Alexandra Hospital for Children Special Purpose Service Entity

The Royal Alexandra Hospital for Children Special Purpose Service Entity “the Entity”, is a Division of the Government Service, established pursuant to Part 2 of Schedule 1 to the Public Sector Employment and Management Act 2002 and amendment of the Health Services Act 1997. It is a not-for-profi t entity as profi t is not its principal objective. It is consolidated as part of the NSW Total State Sector Accounts. It is domiciled in Australia and its principal offi ce is at Westmead, New South Wales.

The Entity’s objective is to provide personnel services to the Royal Alexandra Hospital for Children, “the Hospital”.

The Entity commenced operations on 17 March 2006 when it assumed responsibility for the employees and employee- related liabilities of the Hospital. The assumed liabilities were recognised on 17 March 2006 with an offsetting receivable representing the related funding due from the former employer.

The fi nancial report was authorised for issue by the Chief Executive Offi cer on 8 December 2008.

b) Basis of preparation

This is a general purpose fi nancial report prepared in accordance with the requirements of Australian Accounting Standards (including Australian Accounting Interpretations), the requirements of the Health Services Act 1997 and its regulations including observation of the Accounts and Audit Determination for Area Health Services and Public Hospitals.

Generally, the historical cost basis of accounting has been adopted and the fi nancial report does not take into account changing money values or current valuations. However, certain provisions are measured at fair value. See note (j).

The accrual basis of accounting has been adopted in the preparation of the fi nancial report, except for cash fl ow information.

Management’s judgements, key assumptions and estimates are disclosed in the relevant notes to the fi nancial report.

All amounts are rounded to the nearest one thousand dollars and are expressed in Australian currency.

c) Comparative Information

Comparative fi gures are, where appropriate, reclassifi ed to give meaningful comparison with the current year.

159 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

d) New Australian Accounting Standards Issued But Not Effective

No new or revised accounting standards or interpretations are adopted earlier than their prescribed date of application. Set out below are changes to be effected, their date of application and the possible impact on the fi nancial report of the Royal Alexandra Hospital for Children Special Purpose Service Entity.

Standards/Interpretations Operative Date Comment

AASB3, AASB127 & 1 July 2009 The changes address business combinations and the Australian Accounting AASB2008-3, Business Standards Board has indicated that it is yet to consider its suitability for Combinations combinations among not-for-profi t entities.

AASB8 & AASB2007-3, 1 July 2009 The changes do not apply to not-for-profi t entities and have no application Operating Segments within NSW Health.

AASB101 & AASB2007-8, 1 July 2009 Health agencies are currently required to present a statement of recognised Presentation of Financial income and expense and no variation is expected. Statements

AASB123 & AASB2007-6, 1 July 2009 Borrowing costs that are directly attributable to the acquisition, construction Borrowing Costs or production of a qualifying asset form part of the cost of that asset. As Health Service borrowings are restricted to the Sustainable Energy Development Authority negligible impact is expected.

AASB1004, Contributions 1 July 2008 The requirements on contributions from AASB27, 29 and 31 have been relocated, substantially unamended in AASB4.

AASB1049, Whole of 1 July 2008 The standard aims to provide the harmonisation of Government Finance Government and General Statistics and Generally Accepted Accounting Principles (GAAP) reporting. Government Sector Financial The impact of changes will be considered in conjunction with the reporting Reporting requirements of the Financial Reporting Code for Budget Dependent General Government Sector Agencies.

AASB1050 regarding 1 July 2008 The requirements of AAS29 have been relocated, substantially unamended administered items and are not expected to have material effect on Health entities.

AASB1051 regarding land 1 July 2008 The standard will require the disclosure of “accounting policy for land under under roads roads”. It is expected that all such assets will need to be recognised “at fair value”. The standard will have negligible impact on Health entities.

AASB1052 regarding 1 July 2008 The standard requires disclosure of fi nancial information about Service costs disaggregated disclosures and achievements. Like other standards not yet effective the requirements have been relocated from AAS29 largely unamended.

AASB2007-9 regarding 1 July 2008 The changes made are aimed at removing the uncertainties that previously amendments arising from existed over cross references to other Australian Accounting Standards and the review of AAS27, AAS29 the override provisions in AAS29. and AAS31

AAS2008-1, Share Based 1 July 2009 The standard will not have application to health entities under the control of Payments the NSW Department of Health.

AASB2008-2 regarding 1 July 2009 The standard introduces an exception to the defi nition of fi nancial liability puttable fi nancial to classify as equity instruments certain puttable fi nancial instruments instruments and certain instruments that impose on an entity an obligation to deliver to another party a pro-rata share of the net assets of the entity only on liquidation. Nil impact is anticipated.

Other signifi cant accounting policies used in the preparation of these fi nancial statements are as follows:

e) Income

Income is measured at the fair value of the consideration received or receivable. Revenue from the rendering of personnel services is recognised when the service is provided and only to the extent that the associated recoverable expenses are recognised.

160 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008 f) Receivables

A receivable is recognised when it is probable that the future cash infl ows associated with it will be realised and it has a value that can be measured reliably. It is derecognised when the contractual or other rights to future cash fl ows from it expire or are transferred.

Receivables are non-derivative fi nancial assets with fi xed or deteminable payments that are not quoted in an active market. These fi nancial assets are recognised initially at fair value, usually based on the transaction cost or face value. Subsequent measurement is at amortised cost using the effective interest method, less an allowance for any impairment of receivables. Any changes are accounted for in the operating statement when impaired, derecognised or through the amortisation process.

Short term receivables with no stated interest rate are measured at the original invoice amount where the effect of discounting is immaterial.

If there is objective evidence at year end that a receivable may not be collectable, its carrying amount is reduced by means of an allowance for impairment and the resulting loss is recognised in the income statement. Receivables are monitored during the year and bad debts are written off against the allowance when they are determined to be irrecoverable. Any other loss or gain arising when a receivable is derecognised is also recognised in the income statement. g) Impairment of Financial Assets

As both receivables and payables are measured at fair value through profi t and loss there is no need for annual reviews for impairment. h) De-recognition of Financial Assets and Financial Liabilities

A fi nancial asset is derecognised when the contractual rights to the cash fl ows from the fi nancial assets expire; or if the Entity transfers the fi nancial asset:

• where substantially all the risks and rewards have been transferred; or • where the Entity has not transferred substantially all the risks and rewards, if the Entity has not retained control.

Where the Entity has neither transferred nor retained substantially all the risks and rewards or transferred control, the asset is recognised to the extent of the Entity’s continuing involvement in the asset.

A fi nancial liability is derecognised when the obligation specifi ed in the contract is discharged or cancelled or expires. i) Payables

Payables include accrued wages, salaries and related on-costs (such as payroll deduction liability, payroll tax, fringe benefi ts tax and workers’ compensation insurance) where there is certainty as to the amount and timing of settlement.

A payable is recognised when a present obligation arises under a contract or otherwise. It is derecognised when the obligation expires or is discharged, cancelled or substituted.

Payables are recognised initially at fair value, usually based on the transaction cost or face value. Subsequent measurement is at amortised cost using the effective interest method. Short term payables with no stated interest rate are measured at the original invoice amount where the effect of discounting is immaterial. Payables are recognised for amounts to be paid in the future for goods and services received, whether or not billed to the Entity.

161 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

j) Employee Benefi t Provisions and Expenses

i) Salaries and Wages, Annual Leave, Sick Leave and On-Costs

Liabilities for salaries and wages (including non-monetary benefi ts), annual leave and paid sick leave that fall wholly within 12 months of the reporting date are recognised and measured in respect of employees’ services up to the reporting date at undiscounted amounts based on the amounts expected to be paid when the liabilities are settled.

All Annual Leave employee benefi ts are reported as “Current” as there is an unconditional right to payment. Current liabilities are then classifi ed as “Short Term” and “Long Term” based on past trends and known resignations and retirements. Anticipated payments to be made in the next 12 months are reported as “Short Term”. On-costs of 17% are applied to the value of leave payable at 30 June 2008, such on-costs being consistent with actuarial assessment. (Comparable on-costs for 30 June 2007 were 21.7% which, in addition to the 17% increase, also included the impact of awards immediately payable from 1 July 2007).

Unused non-vesting sick leave does not give rise to a liability, as it is not considered probable that sick leave taken in the future will be greater than the benefi ts accrued in the future.

The outstanding amounts of payroll tax, workers’ compensation insurance premiums and fringe benefi ts tax, which are consequential to employment, are recognised as liabilities and expenses where the employee benefi ts to which they relate have been recognised.

ii) Long Service Leave and Superannuation

Long Service Leave employee leave entitlements are dissected as “Current” if there is an unconditional right to payment and “Non-Current” if the entitlements are conditional. Current entitlements are further dissected between “Short Term” and “Long Term” on the basis of anticipated payments for the next 12 months. This in turn is based on past trends and known resignations and retirements.

Long Service Leave provisions are measured on a short hand basis at an escalated rate of 8.1% above the salary rates immediately payable at 30 June 2008 (comparable on-costs for 30 June 2007 were 8.1%, which included the impact of awards immediately payable from 1 July 2007) for all employees with fi ve or more years of service. Actuarial assessment has found that this measurement technique produces results not materially different from the estimate determined by using the present value basis of measurement.

The Entity’s liability for the closed superannuation pool schemes (State Authorities Superannuation Scheme and State Superannuation Scheme) is assumed by the Crown Entity. The Entity accounts for the liability as having been extinguished resulting in the amount assumed being shown as part of the non-monetary revenue item described as “Acceptance by the Crown Entity of Employee benefi ts”. Any liability attached to Superannuation Guarantee Charge cover is reported in Note 3, “Payables”.

The superannuation expense for the fi nancial year is determined by using the formulae specifi ed in the NSW Health Department Directions. The expense for certain superannuation schemes (i.e. Basic Benefi t and Superannuation Guarantee Charge) is calculated as a percentage of the employees’ salary. For other superannuation schemes (i.e. State Superannuation Scheme and State Authorities Superannuation Scheme), the expense is calculated as a multiple of the employees’ superannuation contributions.

162 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

2008 2007 $000 $000 2. RECEIVABLES Current Accrued Income - Personnel Services Provided 75,419 71,008 Non-Current Accrued Income - Personnel Services Provided 4,326 3,775 Total Receivables 79,745 74,783 Details regarding credit risk, liquidity risk and market risk are disclosed in Note 5 3. PAYABLES Current Accrued Salaries and Wages and On-Costs 7,893 7,557 Total Payables 7,893 7,557 Details regarding credit risk, liquidity risk and market risk are disclosed in Note 5 4. PROVISIONS Current Benefi ts and Related On-Costs Annual Leave - Short Term Benefi t 20,127 20,918 Annual Leave - Long Term Benefi t 10,623 8,352 Long Service Leave - Short Term Benefi t 3,677 3,387 Long Service Leave - Long Term Benefi t 33,099 30,794 Total Current Provisions 67,526 63,451

Non-Current Employee Benefi ts and Related On-Costs Long Service Leave - Conditional 4,326 3,775 Total Non-Current Provisions 4,326 3,775 Aggregate Benefi ts and Related On-Costs Provision - Current 67,526 63,451 Provision - Non-Current 4,326 3,775 Accrued Salaries and Wages and On-Costs 7,893 7,557 Total 79,745 74,783

5. Financial Instruments

The Entity’s fi nancial instruments are outlined below. These fi nancial instruments arise directly from the Entity’s operations or are required to fi nance its operations. The Entity does not enter into or trade in fi nancial instruments, including derivative fi nancial instruments for speculative purposes.

The Chief Executive has overall responsibility for the establishment and oversight of risk management and reviews and agrees policies for managing each of these risks. The Entity carries minimal risks within its operation as it carries only the value of employee provisions and accrued salaries and wages offset in full by accounts receivable from the Parent Entity. Risk management policies are established by the Parent Entity to identify and analyse the risk faced by the Entity, to set risk limits and controls and monitor risks. Compliance with policies is reviewed by the Audit Committee and Internal Auditors of the Parent Entity on a continous basis.

163 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

a) Financial Instruments Categories

Total carrying amounts as per Note Category the Balance Sheet 2008 2007 $000 $000 Financial Assets Class: Receivables at Receivables * 2 79,745 74,783 amortised cost Total Financial Assets 79,745 74,783

Financial Liabilities Class: Financial liabilities Payables ** 3 measured at 7,893 7,557 amortised cost Total Financial Liabilities 7,893 7,557

* Excludes statutory receivables and prepayments (ie not within scope of AASB 7) ** Excludes unearned revenue (ie not within scope of AASB 7)

b) Credit Risk

Credit risk arises when there is the possibility of the Entity’s debtors defaulting on their contractual obligations, resulting in a fi nancial loss to the Entity. The maximum exposure to credit risk is generally represented by the carrying amount of the fi nancial assets (net of any allowance for impairment).

Credit risk arises from fi nancial assets of the Entity i.e receivables. No collateral is held by the Entity nor has it granted any fi nancial guarantees.

Receivables - trade debtors

Receivables are restricted to accrued income for personnel services provided and employee leave provisions and are recognised as amounts receivable at balance date. The parent entity of the Royal Alexandra Hospital for Children Special Purpose Service Entity is the sole debtor of the Entity and it is assessed that there is no risk of default. No accounts receivables are classifi ed as “Past Due but not Impaired” or “Considered Impaired”.

c) Liquidity Risk

Liquidity risk is the risk that the Entity will be unable to meet its payment obligations when they fall due. No such risk exists with the Entity not having any cash fl ows. All movements that occur in Payables are fully offest by an increase in Receivables from the Royal Alexandra Hospital for Children, the parent entity.

d) Market Risk

Market risk is the risk that the fair value or future cash fl ows of a fi nancial instrument will fl uctuate because of changes in market prices. The Entity’s exposures to market risk are considered to be minimal and the Entity has no exposure to foreign currency risk and does not enter into commodity contracts.

Interest rate risk

Exposure to interest rate risk arises primarily through interest bearing liabilities.

However the Entity has no such liabilities and the interest rate risk is assessed as Nil. Similarly it is considered that the Entity is not exposed to other price risks.

164 Royal Alexandra Hospital for Children Special Purpose Service Entity Notes to and forming part of the Financial Statements for the year ended 30 June 2008

e) Fair Value

Financial instruments are generally recognised at cost.

The amortised cost of fi nancial instruments recognised in the balance sheet approximates fair value because of the short term nature of the fi nancial instruments.

6. Related Parties

The Royal Alexandra Hospital for Children is deemed to control the Royal Alexandra Hospital for Children Special Purpose Service Entity in accordance with Australian Accounting Standards. The controlling entity is incorporated under the Health Services Act 1997.

Transactions and balances in this fi nancial report relate only to the Entity’s function as provider of personnel services to the controlling entity. The Entity’s total income is sourced from the Royal Alexandra Hospital for Children. Cash receipts and payments are effected by the Royal Alexandra Hospital for Children on the Entity’s behalf.

7. Post Balance Date Events

No post balance date events have occurred which warrant inclusion in this report.

END OF AUDITED FINANCIAL STATEMENTS

165 Hours of operation • The Emergency Department of The Children’s Hospital at Westmead is open 24 hours a day. • Outpatients Clinics are open from 8am to 5pm, Monday to Friday.

Cnr Hawkesbury Road and Hainsworth Street, Westmead Locked Bag 4001 Westmead NSW 2145

Telephone: (02) 9845 0000 Fax: (02) 9845 3489 Website: www.chw.edu.au

Annual report available: http://www.chw.edu.au/about/corporate/#annual_report

Copyright 2009 The Children’s Hospital at Westmead

150 copies of this report were printed at a total cost of $2776.00

166 Our cover boy is seven-year-old Charlie Munns. Charlie is an intelligent, caring and courageous boy who, when this photo was taken, was suffering from liver failure and was severely jaundiced, desperately needing a liver transplant. In November 2008, Charlie’s Mum, Julie-Anne, donated part of her own liver to Charlie in a risky operation for them both. Today Charlie is a thriving young boy who is feeling much better and has the sparkle back in his blue eyes. Charlie is now enjoying being home and playing with The Children’s Hospital at Westmead his dog and his cat, as well as reading and inventing electronic gadgets. Corner Hawkesbury Road and Hainsworth Street Reflecting on his time at The Children’s Hospital at Locked Bag 4001 Westmead NSW 2145 Westmead, Charlie says, “Thank you for caring for me when Tel: (02) 9845 0000 Visit: www.chw.edu.au I’m sick. I have many friends here who are special to me.”