Service Plan No. 6

1 July 2013 – 30 June 2018

This Service Plan sets out the strategic directions of Alpine Health to respond to the health and wellbeing needs of the Alpine Valleys communities

“Keeping local services local”

Health Service: Alpine Health Principal Contact: Lyndon Seys (Chief Executive Officer) Phone: (03) 5751 9344 Email: [email protected]

June 2013

Alpine Health Service Plan – 2013 - 2018

Foreword Alpine Health’s Service model is based on the goal of keeping local services local. The rationale for this philosophy is that people’s health is best served by meeting their needs and providing services where they live and in their homes.

Keeping Local Services Local Alpine Health is the lead health service organisation in Victoria’s Alpine Valleys. We were formed in 1996 from the amalgamation of three hospitals, health and aged care services in Bright, Mount Beauty and Myrtleford. Our purpose is to improve the health and wellbeing of people in the Alpine Shire. Our purpose is underpinned by a strong commitment to local service delivery. We believe that community health is best served through a local, decentralised service delivery model. Our Vision is to striving as far as possible to deliver local services for local people where they live. We also believe strongly that information is power. If we can educate and inform the community about health issues, we effectively empower people to take ownership of and improve their own health. An informed and empowered community is a healthy community – it is core to Alpine Health’s Vision. We are established as a multi-purpose health service under the Victorian Health and Wellbeing Act. We want the level of health and wellbeing of our each of our communities to be among the best in Australia by 2030.

Our Service Philosophy In pursuing our role at Alpine Health, all our actions and decisions are guided by the following principles:  We recognise the rights, dignity and independence of our clients  We recognise that individuals are primarily responsible for improving their own health and well-being  We offer service options and choices to people  Wherever possible, home service delivery options are preferred over institutional delivery options  Local service delivery is preferred over distant service delivery  We talk to our communities where they are, listen to and respect what they have to say  Responsiveness to the needs of individuals is paramount.

These principles provide guidance to all Alpine Health staff, Board members and other service providers.

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Alpine Health Service Plan – 2013 - 2018

Contents 1.0 Introduction ...... 4 1.1 This Service Plan ...... 4 1.2 Alpine Health- a Multi-Purpose Health Service ...... 4 1.3 Our History ...... 4 2.0 Our Current Service Profile ...... 6 2.1 Hospital Services ...... 6 2.2 Community Services- Health Promotion and Primary Intervention ...... 8 2.3 Residential Aged Care – Choices for our Older Residents ...... 8 2.4 Essential and Corporate Support Services ...... 9 3.0 The Past 3 Years: - Our Achievements ...... 10 3.1 Consolidation of the Multi-Service Model ...... 10 4.0 Context: - Our History and Location ...... 12 4.1 Our Location – Alpine Shire ...... 12 4.2 Major Changes from the Current Service Plan ...... 14 5.0 Demographic Profile and Health Indicators: - The Communities We Serve ...... 15 5.1 Demographic Profile and Trends ...... 15 5.2 Alpine Shire - Health Indicators ...... 17 6.0 Community Perceptions and Concerns ...... 23 6.1 Community Engagement Process ...... 23 6.2 Community Advisory Groups...... 23 6.3 Community Consultation- Themes and Outcomes ...... 24 6.4 Internal (Staff) Consultation – Themes and Outcomes ...... 27 7.0 Our Strategic Goals ...... 29 7.1 Process and Structure...... 29 7.2 Key Strategies ...... 30 8.0 Strategic Alignment ...... 34 8.1 Context ...... 34 8.2 Strategic Partnerships and Collaboration ...... 34 9.0 Future Health and Aged Care Service Profiles ...... 36 The Role of Workforce ...... 67 Existing Workforce Profile ...... 68 Workforce Education and Knowledge Acquisition ...... 69 Workforce Positioning ...... 70 Workforce Configuration ...... 71 Workforce Health and Safety ...... 71

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Alpine Health Service Plan – 2013 - 2018

Alpine Health’s Service model is based 1.0 Introduction on the goal of keeping local services local. The rationale for this philosophy is that people’s health is best served by meeting their needs and providing services where they live and in their homes.

1.1 This Service Plan This Service Plan sets out Alpine Health’s strategic directions and priorities for the next 5 years. The Plan covers the period from 1 July 2013 to 30 June 2018. The Service Plan is aimed at a range of key stakeholders who have an interest in what Alpine Health is doing and what we plan to do in the future. The aim is to communicate our strategic directions and priorities to all our key stakeholders. These include the communities for which we work, our State and Federal Government funders and our staff members. It also includes a range of other government, business and community organisations with whom we work, collaborate and partner in serving the community. Our Service Plan also provides a detailed analysis of our communities and the key health indicators for those communities. The Plan also describes, in detail, what we do and our service levels.

1.2 Alpine Health- a Multi-Purpose Health Service Alpine Health is a multi-purpose service constituted under the Health Services Act 1988 (Vic). It is one of 7 multi-purpose health services providing a range of health services to rural communities throughout Victoria. The multi-purpose health service was conceived in 1991. It was set up as a joint Federal –State initiative to find improved ways of meeting the health and aged care needs of people living in rural Australia. Services aim to deliver flexible and integrated community, health and aged care for small rural and remote communities. Alpine Health receives flexible ‘block’ funding jointly from the Federal and State Governments and this is applied flexibly across health and aged care services to respond to and meet local community needs.

1.3 Our History Alpine Health provides services to the communities living within the municipal boundaries of the Alpine Shire. Before the formation of Alpine Health, separate health services existed in each of the 3 main towns within the Shire. These were:  Bright District Hospital (and Hawthorn Village Hostel);  Myrtleford District War memorial Hospital (and Barwidgee Lodge Nursing Home); and  Tawonga District General Hospital (and Kiewa Valley House Nursing Home);  Myrtleford Extended Care Accommodation Centre Inc. Each of these services for many years provided base acute care and day surgery to local people, district nursing services, residential aged care and adult day care services. Each service operated autonomously with its own Board, structure, executive and staff. The joining of these entities to form Alpine Health in 1996 respects the traditions of quality, flexible service provision established by our antecedent organisations. Alpine Health aims to ‘keep the local in local’. Page 4 of 72

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In forming Alpine Health, a fundamental premise of our coming together was to make sure we continue to respect the history of the services that combined to form Alpine Health. We think it is important to honour the community pioneers who built the foundations for what we are today. At the core of what we do is to offer health services to people where they live and where they need them. As far as possible, that means locally. In doing this, Alpine Health is also able to provide a financial sustainable business and financial structure for the delivery, support and management of its services and deliver maximum value for money for our funding agents.

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This Service Plan sets our Alpine Health’s strategic directions and priorities 2.0 Our Current Service Profile for the future. Alpine Health has a long tradition of delivering quality health services to the Alpine Valleys communities that we serve. As a flexible, block-funded multi- purpose service, we serve the rural communities of the Alpine Valleys by keeping local services local.

Integrated Health Service Model Alpine Health currently provides a range of hospital services to the communities we serve. The delivery model for these services is built on the principle of keeping local services local. That means resisting the trend towards centrism, whilst ensuring the efficient, effective and timely delivery of quality services. The ‘stay local principle’ is based on the premise that people’s health is best served by offering service access, as far as reasonably possible, to people where they live. The following illustration shows the Alpine Health service model:

1. Hospital Services 2. Community and 3. Flexible Residential Support Services Aged Care

 In-patient care  Alpine@Home HACC  Bright:  Urgent Care services - Hawthorn Village  Day Surgery  District Nursing Myrtleford:  Maternity Services  Alpine Leisure Groups - Barwidgee Lodge  Palliative Care  Mt Beauty:  Rural Primary Health - Kiewa Valley House Service  Rural Adolescent Program  Allied Health Services  Independent Living - Hawthorn Close  Independent Living –Queen Elizabeth Units  Flexible high level community aged care  Community Aged Care Packages (low level care)

2.1 Hospital Services Alpine Health provides basic hospital services from 3 hospital sites:  Bright District Hospital (9 beds)  Mount Beauty District Hospital (10 beds)  Myrtleford District War Memorial Hospital (15 beds) Inpatient services provide care for medical, obstetric and post-surgical inpatients, low risk birthing services, renal dialysis and minor, low risk procedures.

Urgent Care Services: Alpine Health provides an Urgent Care Service at each of its three core locations (Myrtleford, Bright and Mt Beauty). Services are provided a 24 hour per day 7 days per week. This service is primarily provides treatment for conditions requiring urgent attention. Attendance by a Doctor for all urgent presentations is at the discretion of the on-call Doctor. In other cases, treatment and care is provided by a Nurse or referred to another facility,

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depending on the level of urgency. (Northeast Health Wangaratta or Albury/Wodonga Health in Wodonga). All patients attended to by a Doctor within the Urgent Care Service, are treated as private patients of that Doctor for that occasion of care.

Day Surgery (Peri-operative) Services: Alpine Health provides high quality elective low risk day surgery to the community. Day surgery services are delivered with the highest standard of patient care, customer service and professional competency by our team of staff, the nursing team and visiting medical professions. Day surgery services we provide include minor general surgery such as:  Minor gynaecological surgery  Minor general surgery  Endoscopy procedures  Pain management interventions Surgical procedures are performed by general practitioners and visiting surgeons who are credentialed by the Board of Management. Alpine Health’s day surgery services are delivered from two procedural rooms (one located at each of the Bright and Mt Beauty sites) and two post-anaesthetic care units (also one at each of these sites). There is one central sterilising facility providing services to all of Alpine Health’s peri-operative facilities (located at the Mt Beauty site).

Maternity Services- Safe Birth, Close to Home Alpine Health offers a high quality maternity care service for all women in the Alpine region. We also offer a birthing service for women assessed as low risk. Our maternity service team views uncomplicated pregnancy and childbirth as a normal healthy life event. We encourage women and their families to be actively involved in their pregnancy, birth and post natal care. We respect and treat every birth as a unique event. Throughout the pregnancy, all women receive care that is appropriate to their social, personal and cultural needs. Maternity care at Alpine Health is ‘shared' between GPs and team midwives working together to ensure safe and quality care for women and their babies. The service is provided by obstetric GP's, with additional specialist training in pregnancy, birth and newborn care, and support from specialist obstetricians from Albury Wodonga Health and North East health Wangaratta. Alpine Health midwives team together with client GPs and a visiting specialist obstetrician to provide high quality pregnancy care services. Under this collaborative service model, our team of midwives provide antenatal care for women experiencing normal ‘low risk' pregnancy. Women who choose or are required to birth at a larger hospital can also have their own local (Alpine Health) midwife, who will also see them on a regular basis Alpine Health offers a birthing service for women with term pregnancies (37 - 42 weeks) who have no other complications. Women who develop complications or go into labour less than 37 completed pregnancy weeks, are referred to a specialist located at a larger regional hospital. Alpine Health also provides post-birth care to women who give birth at other hospitals.

Renal Dialysis Services Alpine Health offers a high renal dialysis service for people living within and outside of the Alpine Shire with end stage renal disease. This service is based at Myrtleford District War Memorial Hospital and comprises 4 dialysis chairs that operate over 2 shifts on 3 days per week. It is a satellite service for North West Dialysis Service (Royal Melbourne Hospital) and is funded outside of the Tri-Partite Agreement.

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Activity Levels - Acute Hospital Services: Appendix 2 provides a summary of the caseload for acute hospital-based services across each of Alpine Health’s 3 hospitals.

2.2 Community Services- Health Promotion and Primary Intervention Our community services are delivered to the communities we serve through a range of approaches. Fundamental to our approach is seeking ways to offer services, advice and assistance on an out-reach basis to clients as close to home as possible. Other services, by virtue of their nature are centre-based and offered through our core facilities located at Bright, Myrtleford and Mt Beauty. The core focus of our community services is the prevention of illness through early intervention. We do this by focusing on health lifestyle support, information provision, education and advocacy so we can support people in the community and in their homes.

Alpine Health’s community services are summarised below:  Diabetes education  District Nursing Service (including ‘Hospital in the Home’ post-acute care service)  Community Aged Care Packages  Alpine Leisure Groups for frail aged members of our community  Palliative Care Volunteer Service  Rural Primary Health Services Program (health promotion and primary intervention services for older people and families and young children)  Rural Child Adolescent Program  Youth Services (health promotion and primary intervention)  Support for Volunteer services (Aged Care Advocacy, Cancer Support Groups, Diabetes Support Groups, Dementia Support Group, Autism Support Group, 3 Men’s Sheds, Community Medical Transport Service)

Appendix 2 provides a summary of community service types and levels.

2.3 Residential Aged Care – Choices for our Older Residents Alpine Health offers affordable choices for ageing support and service provision for our older residents. Informed choices, made by older people and their families, are central to appropriate care for older people. Choices include independent living units, low care, high care and community care (in the home) packages tailored to individual needs. The provision of residential aged care services is undertaken in an environment in which residents are able to maintain and enjoy independence, with nursing and personal care staff available to assist them in meeting their daily living needs. Our residential and aged care services offer residents an affordable option in either the independent living units at Bright and Myrtleford; or as a resident in a low or high care facility. Residential aged care services are available in each of the 3 major townships in Alpine Shire as follows: Bright:  Bright District Hospital - offers limited ‘high care’ residential aged care services  Hawthorn Village - 40 room residential aged care hostel facility offering low/high care service.  Hawthorn Close – 6 single bedroom independent living units. Mount Beauty: Page 8 of 72

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 Kiewa Valley House - 20 bed ‘high care’ residential facility and community services. Myrtleford:  Barwidgee Lodge - 28 ‘high care’ residential beds and community services.  QE II – 8 single bedroom independent living units.

Residential Aged Care Philosophy: Our philosophy and approach in delivering our residential care is as far as possible to provide residents with a ‘home-like’ facility. Our professional caring staff members meet client needs and expectations, in accordance with the flexible provisions of the Aged Care Act (1997) and Aged Care Nursing Standards. Core components of our service approach and philosophy include:  The Department of Health and Ageing Charter of Residents’ Rights and Responsibilities is observed and implemented in the manner defined in the Resident Agreement.  Every person is treated with respect and the dignity of residents is honoured.  The comfort, safety and well-being of residents are the prime responsibility of all staff.  Every effort is made to ensure that residents feel secure in their tenure of accommodation. We acknowledge and support the ongoing need for family and friends involvement in our endeavour to maintain a quality lifestyle for residents, whilst maximizing independence, and preserving dignity in a safe, happy and homely environment.

Appendix 2 provides a summary of service levels and occupancy rates for residential aged care services.

2.4 Essential and Corporate Support Services Corporate and Business Services: Alpine Health has a corporate and business support structure to ensure the efficient management and of the organisation. Core corporate and business support functions include:  Finance, administration and information management  Compliance and risk management  Human resources and workforce development  Marketing, media, communications and community liaison

Essential Support Services: Alpine Health has a strong team providing the essential support services that underpin our service delivery in the 3 hospital locations. The essential support functions include:  Catering, food services and hospitality  Environmental management (cleaning and hygiene)  Building and asset management and maintenance.

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The past 3 years have been a period of consolidation for Alpine Health. This 3.0 The Past 3 Years: followed a period in our early years of ‘organisation-building’ where we built the - Our Achievements foundations for an entity that could delivery service efficiently but still stay in touch with the people we serve. The past 3 years place us in a good position to reinforce our localized service delivery model.

3.1 Consolidation of the Multi-Service Model The past 3 years at Alpine Health has been a period of consolidation and continual improvement. Alpine Health was focused on building sustainable organisational infrastructure that could build and retain the community’s confidence through difficult economic times. In last Service Plan period, we have been able to capitalise on the hard work through the early years of Alpine Health. This section summarises our key achievements of the past 3 years. Aged Care Services: Our key achievements include:  We developed and implemented new flexible community based aged care service with 15 clients  We expanded the provision of respite, transitional and more flexible residential aged care  We reduced the average length of stay in residential care and provided services to more clients

Acute Hospital Services: Our key achievements include:  We succeeded in transforming our traditional emergency service provision from doctor- led to a nurse-led urgent care service that is now the model promoted by the Hume Medicare Local for all hospitals in the Hume Region  We successfully implemented a common on-call system for medical support of after- hours urgent care across all three hospitals  We expanded our renal dialysis service from 1 shift 3 days per week to 2 shifts 3 days per week  We reduced average length of stay in our hospitals

Community and Allied Health Services: Our key achievements include:  We succeeded in expanding youth services to cover all 3 major communities in the Alpine Shire  We established our second Men’s Shed in Myrtleford and started planning for the third in Mount Beauty  We consolidated new cancer support groups in Bright and Mount Beauty and dementia and diabetes support groups in Mount Beauty  We established a volunteer based aged care advocacy service for the Alpine Shire  We established a community transport service for the Ovens Valley to provide access for people to medical services outside of the Alpine Shire

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 We succeeded in getting a grant from Health Workforce Australia to trial a new anticipatory model of care for the Mount Beauty community in conjunction with Mount Beauty Medical Centre  We developed a new Charter for our Community and Health Advisory Groups that has enabled them to expand their interests in cultural, linguistically diverse and disability issues  We developed a new Disability Plan with the Alpine Shire to ensure a single and fully integrated approach across our local government and health sectors  We developed a Positive Ageing Strategy conjointly with the Alpine Shire to build a single approach to improving the health and well-being of the older residents in the Alpine Shire  We developed a single HACC service conjointly with the Alpine Shire that has a single management structure and common processes and services – Alpine@Home  We secured permanent accommodation in purpose built facilities for our Adult Leisure Group service in Bright with the Uniting Church

Corporate, Business and Essential Services: Our key achievements include:  We succeeded in managing financially across the 3 years in difficult economic times  We successfully implemented a plan to recover from the financial losses arising from the global financial crisis  We developed and implemented a support service for general practice in conjunction with Mount Beauty Medical Centre  We built a single health workforce across Alpine Health and general practice for the Kiewa Valley  We expanded training opportunities for all staff members and in particular, medication endorsement for enrolled nurses, basic and advanced life support for registered nurses, leadership and management training for all senior, middle level and front line managers, workplace training and assessment training for 20 staff members and a Certificate 3 in Health Service Assistance for all essential services staff members  We established the Alpine Institute, obtained funding for the refurbishment of facilities to house it and achieved its accreditation as a Registered Training Organization  We established an IRON/RTP training service and succeeded in getting approval from ANMAC for its expansion to 105 nurses this year  We successfully implemented an e-learning system for the delivery of training, orientation and re-orientation across the organization  We successfully implemented electronic management systems for aged care and staff payroll management  We established a new Code of Corporate Governance  We successfully achieved accreditation of all services with QICSA and DVA

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Alpine Health is nestled in the foothills of Victoria’s magnificent alpine region. It 4.0 Context: has 3 main towns across 2 river valleys, interspersed by a range of rural areas - Our History and Location and communities. Alpine Health services the needs of a diverse range of rural communities. In recent years, the community has responded to the complex challenges presented by floods, drought and fire.

4.1 Our Location – Alpine Shire Alpine Health’s geographic boundaries correspond with the boundaries of the Alpine Shire (see map below). At the core of our business and operating model is recognition of our geographic diversity and dispersal.

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The Alpine Shire straddles several valleys in the foothills of the Victorian Alpine region. Rather than being one single contiguous community, we service what are in effect a range of very different and physically separate communities. Recognising and respecting each of these township-based and rural communities and their different needs and identities is critical in the Alpine Health Service Model. The communities served by Alpine Health are located in Victoria’s beautiful Alpine Valleys in north east of Victoria. Located some 270 kms north east of Melbourne, Alpine Health services an area covering 4,839 square kilometres. A significant part of the Alpine Health catchment includes mountainous terrain of State Forests and Alpine National Park areas. The catchment is focused on the rural communities living in the Mitta and Ovens River valleys. With a total population of 13,049 (2012 ERP), Alpine Shire has 3 main township population centres being Bright, Myrtleford and Mt Beauty. The Shire also includes the following areas and localities:

Town/Locality: Town/Locality: Town/Locality:

Coral Creek Dederang Glen Creek Kancoona Mongans Bridge Running Creek Upper Gundowring Tawonga Tawonga South Bogong Falls Creek Mount Beauty Abbeyard Barwidgee Buffalo Creek Buffalo River Dandongadale Gapsted Havilah Merriang Mudgegonga Myrtleford Nug Nug Rosewhite Ovens Eurobin Brookside Buckland Mount Buffalo Porepunkah Bright Freeburgh Germantown Harrietville Hotham Heights Mt Hotham Smoko Wandiligong Cobungra Dinner Plain

Bright is the main town in the upper Ovens Valley. It is a popular multi-season destination for tourists and holidaymakers and is a gateway to the Mount Hotham alpine areas and ski fields. The Bright economy is substantially focused on the tourism market. Bright has a high proportion of retirees and people who have relocated for the outstanding lifestyle. Mt Beauty and Tawonga too are popular visitor destinations. They are situated at the foot of Victoria’s highest peak, Mt Bogong. Mt Beauty and Tawonga are the gateway to the Falls Creek alpine area and ski fields. Myrtleford is a more traditional rural township that is focused on a rural and farm economy. Located at the foot of Mt Buffalo, Myrtleford offers a strong food and wine based industry and a natural environment in close proximity to Australia’s alpine areas.

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4.2 Major Changes from the Current Service Plan There are several significant issues which have impacted on the Alpine Shire and the delivery of community, health and aged care services since the 2008 Alpine Health Service Plan. Firstly, the Alpine Shire has suffered from two large bushfires (in the summers 2009/2010 and 2012/2013) that were repetitions of the large bushfires of 2003 and 2006. All levels of the community and the Victorian government have realized that wild fires are now a part of the environment, have significant economic, social and health consequences and require complex, coordinated and integrated responses from the community. This is particularly evidenced by the Victorian Royal Commission into the 2009 bushfire. These responses have required Alpine Health and the Alpine Shire to work more closely together and it has led to the development of an alliance for community development, HACC service coordination through Alpine@Home and coordinated social, health and economic planning. The most obvious impacts on our service plan have been the increasing numbers of presentations to our urgent care centres, increasing calls from the community for more local mental health service delivery and more support for the most vulnerable and older members of our community. In this context it is important to note that most urgent care service delivery is not funded under the Tri-Partite Agreement. Secondly, the closure of the tobacco industry in 2008 has led to on-going impacts on service delivery and these too include increasing numbers of presentations to our urgent care centres, increasing calls from the community for more local mental health service delivery and more support for the most vulnerable and older and younger members of our community. Thirdly, the demography of the Alpine Shire is heavily weighted to the older and younger ends of the age spectrum and this trend is continuing. Its impacts have been felt in two ways. The first has been in the decline in demand for residential aged care (particularly low level care) and the rapidly escalating demand for community aged care and other community based services as the baby boomers age. This has, and will continue to require cultural changes to our service delivery and workforce recruitment, retention and training. It has already led to the alliance with the Alpine Shire and the Positive Ageing Strategy. And the Alpine Shire now relies on Alpine Health for most community capacity building for social and health well-being. The second impact has been on the health workforce. The demography demonstrates inadequate numbers of people in the 25 to 55 year age groups to satisfy the workforce demands arising from changing community needs for all services, particularly health services. This impact has already led to the establishment of the IRON/RTP service and the establishment of the Alpine Institute, the work to establish pathways to employment through education and training and pathways to education and training through employment. All of these changes have required a significant shift in priorities for Alpine Health and will continue to impact on our investment, planning and service decisions over the life of the next plan.

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The Shire has a strong tourism/visitor driven economy, focused mainly on the 5.0 Demographic Profile and Health alpine region and the natural beauty of Indicators: the Shire. Alpine Shire’s population is growing - The Communities We Serve steadily. Whilst the growth rate is slower than for Victoria generally, it is higher than for other rural shires. The population is ageing. The age profile is characterised by low proportion of younger working-age groups and higher proportions of older people.

5.1 Demographic Profile and Trends As part of this service planning process, Alpine Health commissioned a detailed analysis of the demographic profile of the community and it health status and indicators. Following is summary ‘snap-shot’ of some of the key characteristic and trends identified in the analysis. Diversity: Approximately 80.5% of the Shire’s population were born in Australia compared to 84.2% for regional Victoria and 68.6% for Victoria overall. With people from the United Kingdom and Italy making up the majority of the other cultures in the Shire, Italian is a commonly spoken language in many households. Alpine Shire has a range of industries including tourism, timber and forestry, agriculture, services and retail. The Shire is a prosperous community and an attractive place in which to live, work and visit. Population Growth: The following table shows the population growth trend of Alpine Shire from 2006 (actual) through to the predicted population in 2016 and 2026:

2006 2016 2026 Predicted Predicted

Population: 12,574 13,406 14,152

% Change 6.6% 5.6%

As is the case in most of Australia’s rural areas, Alpine Shire’s rate of population growth lags behind the growth rate in capital cities and larger regional centres. Whilst Alpine’s population growth is low, it remains relatively steady. In many rural and remote areas, population is in decline, with communities grappling with their very viability. The following graph shows predicted population growth in Alpine Shire (2006 to 2026) compared to Victoria, the Melbourne statistical division and for regional areas generally.

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10.00% Alpine Shire 9.00% 20 Year Population

8.00% Trends (per ABS data/Lumin Collaborative) 7.00% 6.00% Alpine Shire 5.00% Melbourne SD 3.78% 4.00% 2.74% 2.74% 2.75% Victoria Total 3.00% Regional Victoria %population increase 2.00% 1.00% 0.00% 2006 to 2011 2012 to 2016 2017 to 2021 2022 to 2026 Actual Predicted Predicted Predicted

This graph suggests that the rate of population growth in Alpine Shire, whilst modest in overall terms, will remain stable at about 0.55% annually over the next 15 years. Compared to Alpine Shire, population growth rates across Victorian generally are predicted to be lower than the growth rate experienced in the 5 years from 2006 to 2011. Within the Alpine Shire, population growth is substantially concentrated in the eastern area (SLA) as illustrated below:

6.00% Alpine Shire

Population Growth Trends 5.00% (East-West) (per ABS data/Lumin Collaborative) 4.00% 3.00% Alpine Shire East SLA 2.00% Alpine Shire West SLA

%Polulation Growth 1.00% 0.00% 2006 to 2012 to 2017 to 2022 to 2011 2016 2021 2026 Actual Predicted Predicted Predicted

This charts shows that population growth in Alpine Shire is predicted to continue to be concentrated in the Eastern area of the Shire into the future. The eastern area comprises the townships of Bright, Porepunkah, Mt Beauty and Tawonga. The western area includes the town of Myrtleford. Age Structure: The age structure of our population is a critical determinant in health service planning. The following chart shows the age distribution of the Alpine Shire community as it compares to the age distribution for Victoria.

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100% Alpine Shire - 90% Age Distribution 80% (ABS/Lumin Collaborative) 70% 60% 80 years plus 50% 40% 65-79 years 30% 25-64 years

%of Total Population 20% 10-24 years 10% 0% 0-9 years

This chart shows that in Alpine Shire, there is a significantly higher proportion of older people (65 years +) living in the Alpine Shire compared to Victoria generally and lower proportions in all age groups under 65. It also shows that the proportion of older people in the Shire is predicted to continue grow to 2016 and 2026. The following chart shows the extent of the age profile variance be comparing Alpine Shire to the rest of Victoria.

Age Distribution - 2006 to 2026 (Alpine compared to Vic total) (per ABS data/Lumin Collaborative) 4.80% 80 years plus

9.60% 65-79 years

2026 -8.20% 25-64 years 2016 2006

Age Age Group -4.30% 10-24 years

-1.80% 0-9 years

-10.00% -5.00% 0.00% 5.00% 10.00% 15.00% % of Total Population -Alpine to State +/-

Importantly for our health service planning, the age profile disparity (with a relatively high proportion of older people) is predicted to progressively increase up 2026. The above chart shows that by 2026, the proportion of 65 to 79 year olds in Alpine Shire is predicted to exceed that of the State by 9.6%. Similarly, the proportion of over 80 year olds will exceed the State average by 4.8%. Equally important for health service and community planning generally, the proportion of people of working age (25-64 year olds) in Alpine Shire is predicted to be significantly lower (8.2 %) than the working age proportion State-wide by 2026.

5.2 Alpine Shire - Health Indicators

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This section sets out the broad health-related indicators for Alpine Shire that inform health service planning. Fertility: The following chart shows the fertility rates in Alpine Shire compared to Victoria overall and to regional Victoria:

3.00 Fertility Rate

(births/1000 women) 2.19 (ABS/LUMIN 2.01 Collaborative) 2.00 1.77

1.00 Total Fertility TotalFertility Rate 0.00 Alpine Shire Regional Victoria Victoria

This shows that Alpine Shire has a significantly higher fertility rate (2.17 births/woman) than both regional Victoria and Victoria. This fertility rate is also relatively high compared to other small shires in the Hume Region, as well as Victoria and regional Victoria. Life Expectancy: Life Expectancy at Birth (LEB) at the start of the 20th century was 55 years for men and 59 years for women. Since then, improved health has lead to steadily increasing life expectancy for both men and women. Life expectancy for rural Australians continues to be lower than for other Australians (as illustrated below). Life expectancy for males continues to lag behind that of females, though rural females have made some progress in closing the gap on their metropolitan counterparts:

86 84 Metropolitan 82 females

80 Rural females

Years 78 Metropolitan 76 males 74 Rural males 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

The following chart shows life expectancy for males and females in Alpine Shire, compared to Victoria and regional Victoria:

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86 Life Expectancy (LEB- ABS data/

84 Lumin Collaborative)

82

Alpine Shire

Years

- 80 Rural Victoria

Age Age 78 Total Victoria 76 74 Male Female

The above chart indicates that, compared to all of Victorian and rural Victoria, life expectancy for women in Alpine Shire is relatively good (it exceeds life expectancy for all women State-wide). However, male life expectancy being relatively poor in Alpine Shire compared to both rural Victorian communities and all of Victoria.

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Avoidable Mortality: Avoidable mortality rates provide a useful indicator for health services seeking to prolong quality life and keep resident healthy. Avoidable mortality trend in Alpine Shire has been improving in Alpine Shire over the past decade, compared to the rest of Victoria. Following a period of elevated avoidable mortality rates (from 1998 to 2004), these have significantly improved in more recent years. The following chart shows the top 9 causes of avoidable mortality in Alpine Shire (compared to Victoria and regional Victoria): Top 9 Causes of 1. Ischaemic Heart Disease Avoidable Mortality 2. Lung cancer (DoH data/Lumin Collaborative) * 3. Road traffic injury * 4. Breast Cancer * 5. COPD Victoria 6. Colorectoral cancer Regional Victoria Alpine Shire * 7. Alcohol related * 8. Skin cancers * Elevated Incidence - Alpine Shire 9. Diabetes

0 20 40 Deaths/100,000 pop.

This chart shows that, for Victoria generally and regional Victoria, ischaemic heart disease, lung cancer and colo-rectoral cancer remain the top 3 causes of avoidable death. However, in Alpine Shire, with relatively lower incidence rates of colo-rectoral cancer, road trauma is the 3rd highest cause of avoidable death. Other causes where Alpine Shire has elevated relative incidence levels are breast cancer, COPD (chronic lung disease), alcohol-related causes and skin cancers.

Socio-Economic Advantage/Disadvantage: The following map provides a visual illustration of the distribution of socio-economic disadvantage across the Alpine Shire (2006). 1 The map shows that (based on the SEIFA index published by DPCD) socio-economic disadvantage is the Shire is concentrated in the townships. The highest level of disadvantage exists in the western area of the Shire, with parts of Myrtleford being in the top decile (most disadvantaged).

1 DPCD, SEIFA Index of Socio-Economic Disadvantage, Page 20 of 72

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Indigenous Population: Based on ABS data, the proportion of the total population that are indigenous in Alpine Shire is 0.7% of the total population. This is the same proportion as for the whole of Victoria. However, it is significantly less that the indigenous proportion recorded for regional Victorian communities which is 1.5% on average. There was a considerable increase in indigenous population of Alpine Shire West (including Myrtleford) from 0.5% in 2006 to 1.1% in 2011. In the Alpine East region, the indigenous population has remained stable over the same period. 2

Income Support: The follow table shows the proportion of Alpine Shire residents receiving the following income support/benefits:  Unemployment benefit (long-term)  Aged pensioners  Disability support pensioners  Single parent payments

80% Income Support 70% Recipients (% of eligible population) 60% Source: ABS data & Lumin Collaborative 50% 40% Alpine Shire 30% Regional Victoria 20% Victoria Total 10% 0% Unemployment Aged Disability Single parent Benefit (LT) pensioners support support pensioners

The chart shows that the proportion of income support recipients in Alpine Shire is generally in line with the total for Victoria and slightly lower than for regional Victoria. Other key income support features include:

2 ABS Data and Lumin Collaborative, 2011 Page 21 of 72

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 Unemployment rates are higher in the Alpine West (4.5%) compared to 3.9% across the whole Shire  Aged pension, disability support pension and single parent support are all higher in the Alpine West area than for the Shire generally  The proportion of the eligible population in the Alpine West area holding health care and concession cards is significantly higher than for the whole Shire (31.5% compared to 28.2%) Transport: Access to transport has a significant impact on the ability of residents to access community and health services. Transport for residents of the Alpine Shire is predominantly by private motor vehicles as public transport options are limited. Key transportation features that are relevant to this service plan include the lack of comprehensive public transport services and the relatively high number of households in the Shire that have no access to a motor vehicle (5.1% of total households). The following table provides a summary of the main public transport options available to residents: Service: Service Level: Falls Creek Coach Service Large and small coaches No wheelchair access Charter available Hire and drive Private transfers Mt Beauty Taxi Service 24 hours day/7 days per week Ovens and King Community Health Service 4 days per week Special needs clients Alpine Shire Community station wagon Meals on Wheels, Dederang Upper Hume Community Health Service Special needs clients with general community availability My Beauty-Kiewa-Wodonga V-Line Bus Services Coach services Mt Beauty-Bright-Myrtleford-Beechworth- Wangaratta Mt Beauty Taxi Service 24 hours day/7 days per week Bright Taxi service 24 hours day/7 days per week Myrtleford Taxi service 24 hours day/7 days per week

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Direct engagement with the community is ‘hard-wired’ into the way we do things at 6.0 Community Perceptions and Concerns Alpine Health. We consult with the our communities on an ongoing basis through Community Advisory Groups in each major township. In preparing this Service Plan, we sought community views on needs and directions through a comprehensive engagement process. We asked staff and internal stakeholders for their views.

6.1 Community Engagement Process As part of the process of preparing this Service Plan, we undertook and extensive process of consultation and engagement. This occurred at 2 levels:

Community 1. External -Our Communities: Advisory Groups Perceptions, needs, concerns and Staff aspirations 2. Internal – Staff: Workshops

6.2 Community Advisory Groups At Alpine Health, engagement and consultation is not a one-off process. It is ‘hard-wired’ into the way we do things. With a diverse and dynamic population, set across different townships and rural areas, the need to stay in direct touch with the people we serve – at Board, staff and clinical levels – is crucial. We engage with our various communities through permanent Community and Health Advisory Groups that have been established in each township. The Groups are the Board’s ‘eyes and ears’ into what the community wants and thinks. As part of the process of preparing this Service Plan, we convened the Community and Health Advisory Groups to consult with the community regarding future directions for Alpine Health. The consultation process included:  All populated areas, including rural hamlets and areas as well as townships.  A ‘place-based’ approach – talking to people where they are and where they live.  Utilisation of a range of formats and techniques to conduct a dialogue (including focus groups, ‘Have a Say” sessions, and one-on-one interviews).  Engagement with organisations and institutional stakeholders.  Engagement with community members across a range of age groups and socio- economic backgrounds. The scope of the community consultation process undertaken included 17 two hour sessions with community groups, 9 ‘Have a Say’ sessions and 29 one-on-one interviews. The questions that formed the core of the engagement process were:  What is working well at Alpine Health?  What needs to be improved or changed?  What are the issues relating to health and liveability that need to be resolved now and in the future?  What could be created or expanded?

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 How will you know that changes and improvements have been implemented and are taking effect?

6.3 Community Consultation- Themes and Outcomes A separate detailed report has been prepared on the outcomes of the community consultation process. Following is a summary of the core themes and messages that emerged from the consultation process.

What is working well?  Health Services: The community has “reasonable” access to a variety of health services. Immediate access to specialists is limited within the Shire. There is good support which enables people to determine the most appropriate specialists and book appointments. However many people have to travel. The medical services in Mt Beauty are very well regarded with a good number of GPs, and a hospital that is well staffed.  Resilience Committee: The Alpine Shire Council Community Resilience Committee assists to prepare the local communities for future hazardous events. The Committee advocates for improvement in government emergency management policy and practice. People living in the Alpine Shire recognise the importance of preparedness to a community’s resilience during times of natural disaster and the critical role that the committee plays in assisting the community in the face of adversity.  Home and Community Care (HACC): The home and community care service (provided jointly by Alpine Health and Alpine Shire) is recognised as an effective and respected service. Services are comprehensive and coordinated including general homecare, personal care and meals on wheels. Staff providing the services are recognised as being capable, reliable, and consistent.  The Natural Environment: There is wide recognition that the Alpine region is rich in environmental assets and provides exceptional lifestyle opportunities and recreational facilities. The assets are also recognised for supporting an active and vibrant tourism industry with around 90% of the municipality comprising public land including the Mount Buffalo National Park, the Alpine National Park, State forests and Crown land.  Men’s Sheds: The Men’s Sheds in Bright, Mt Beauty and Myrtleford have proven to be highly successful. The Men’s Sheds provide support to men in need of help arising from mental illness or other debilitating illnesses; help ease the transition of men from full- time employment to other activities in retirement. They provide an additional link between the primary health network and the many men who have no regular contact with the network and establish a place for men that enables social interaction and activities to maintain the health and wellbeing.  U3A U3A groups provide learning and social opportunities and community interaction for seniors. They also provide the opportunity for older people in the region to explore new fields and new ideas in social, creative, or recreational activities.

What needs to be improved or changed?  Services for Young People:

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The need for improved transport across the region has been identified as a key priority for Alpine Shire residents. This is a significant issue for the young people within the region and is a barrier to contact, mobility and social interaction. It was suggested that fully funded youth centres in the three main centres to run recreational and educational programs for young people living in different localities in the region would provide places where young people can go to meet their friends, develop interest in new activities and remain or re-engage with education. This would improve their ability to make positive life choices.  Mental Illness: Many Alpine Shire residents report a high to very high level of anxiety and psychological stress. The community raised this as a concern and evidence also reveals the link between poor mental health and physical illness. Mental wellness and rehabilitation, counselling and personal support is a major challenge and a key focus for the Alpine Health.  Awareness of Entitlements and Access to Services Alpine Health offers a range of services including specialized community and support services. However improving better health outcomes by improving and facilitating access to health care services and information remains a challenge. This issue was raised consistently through our consultation. No wrong door policies (ensuring that people presenting for help are given appropriate service or treatment regardless of where they enter the system or which service they go to for help) were seen as desirable.  Changing Demographic Profile and Aged Care: Alpine has a large population of people in the over 55 age group. It presents a key challenge for Alpine Health to provide adequate services for an ageing population with an increased age profile, and proportionately less people of working age categories.  GP Access - Bulk Billing: The reduction of bulk billing and the increases in out of pocket expenses have been impacting on the number of people visiting the GP. In delaying visiting a GP to seek a diagnosis people are not able to access early interventions and preventative health care treatments. Relying on treatment at later stages will result in significant longer- term social and economic costs.  After Hours Doctor Services: Not having ready after-hours/weekend access to a Doctor at a local hospital or clinic is a major issue for people living within the Alpine region. Frustration and confusion exists about access and availability of a GP after hours and the long waiting times experienced to see a Doctor.  Public Transport: The need for improved transport across the region is a key priority for Alpine Shire residents. Limited or no transport at night and weekends, availability not complementing employment or training requirements, and limited availability to participate in sports, social, cultural or entertainment activities is a significant issue, particularly for the young and elderly people in the Shire.

What could be created or expanded?  National Disability Insurance Scheme (NDIS) and Draft State Disability Plan The community has expressed the view that the National Disability Insurance Scheme (NDIS) will enable better information and referral services to all people with disability and their families. The NDIS includes providing funding to individuals and organisations to help people with a disability participate more effectively in economic and social life. The State Disability Plan (currently being prepared) will provide a four year vision for

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Victoria to improve mainstream policies, programs, services and infrastructure and support reform of disability services. Both of these initiatives will change the way that support is provided to people with a disability. Health service providers will need to be well prepared if they are to successfully embrace the scheme including planning across leadership, financial management, systems and people.  Locality-Specific Service Information The risk of fire or other environmental hazards including flood is high within the Alpine region and it impacts significantly upon the wellbeing of many residents. The community has affirmed the importance of the provision of more information to the public that is locality-specific about available activities and programs for community safety in the face of natural hazards and that this would assist people living in the region undertake preparedness activities, formulate plans and choose options that are appropriate for their circumstances and locality.  Volunteer Services: ‘Blaze Aid’ is a volunteer-based organisation that works with farmers and families in rural Australia after natural disasters such as fires and floods. Working alongside the farmers, volunteers help to rebuild fences that have been damaged or destroyed. Equally important, volunteers also help to lift the spirits of farmers and their families who are often facing their second or third flood event after years of drought. New volunteer services (based on the Blaze Aid model) could be created to assist the vulnerable and isolated including elderly farmers that are facing increasing costs and decreasing incomes. Inability to leave the farm is leading to increasing isolation, loss of connections and poorer health. New volunteer services could also be developed to assist the elderly with tasks around the home that they are not capable of doing themselves.  Youth Employment and Training: Youth employment and training and the retention of young people in the Alpine region is a complex challenge. The physical distance to travel to TAFE and higher level institutions and available platforms for further study offering encouragement, laying a foundation and assisting with entry to new and higher level courses is a major issue and concern. These issues need to be addressed by a long-term policy shift addressing structural issues for rural communities. Development of a ‘rural population policy’ for Victoria that is established cooperatively between all levels of Government which sets clear, long-term goals for population growth in small rural communities is required.

How will you know that changes and improvements have been implemented and are taking effect?  Communication and Word of Mouth: Goals, achievements and changes in the community are spoken about at community events, and social gatherings.  Mass Media: Information about goals, achievements and changes in the community will be provided in newsletters, articles media releases and websites.  Actively Engaged Young People: Young people in the region will be more actively engaged in the community. They are supported to reach their full potential and are actively engaged in learning, training, work and community leadership.  Increased Community Resilience: People will have confidence in the resilience of themselves and the community. They will have a greater ability to cope with stress and adversity. Relationships across Page 26 of 72

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sectors and groups within the community will be strong. The community will have developed the ability to adapt to changes in the physical, social and economic environment and will have the potential to learn from experience and improve over time.

6.4 Internal (Staff) Consultation – Themes and Outcomes As stated, a detailed internal consultation process with Alpine Health staff was also undertaken as part of developing this Service Plan. A comprehensive staff engagement process was designed to find what staff think about future directions for Alpine Health. A separate detailed report has been prepared on the outcomes of the internal consultation process. The scope of the internal consultation process included:  Engagement with middle management group and the Service Plan Implementation Group (SPIG).  Delivering training on effective staff engagement methods.  A series of workplace consultation sessions across the whole organization. Over 40 separate sessions with staff were conducted to find out what their vision is for Alpine Health, using the “6 Thinking Hats” Visioning technique. Sessions were attended by 246 staff in total. Following is a summary of the core themes and messages that emerged from the internal consultation process.  Building a Positive Workplace Culture: Staff are dedicated and committed to improving levels of service and care. Staff feel positive and excited about the opportunity to have their views heard and being involved in development of the Service Plan. There is a strong sense of peer support and camaraderie amongst the staff.  Workforce Development - Up-skilling and Training: Alpine Health needs to continue to invest in developing the skills and knowledge of its workforce. The Alpine Health Service workforce profile is typical of many other small rural health services and is multi-disciplinary. We have a high proportion of female and part-time staff. Alpine Health has established a strong focus on training and education as part of its commitment to the professional development of its staff. Alpine Health needs to continue to ensure that all staff members have the opportunity to access education and that the training programs are appropriate to their needs and are set up appropriately for part time staff. Alpine Health needs to continue to focus on training and education and ensure that it is structured, responsive, flexible and appropriate to specific staff needs.  Recruitment, Retention and Succession Planning: Alpine Health needs to:  Ensure that we have workforce retention strategies in place that focus on the needs of individual staff members and divisions of staff.  Implement programs to ensure succession planning.  Ensure that programs incorporate clear goals and objectives including identifying those with the potential to assume greater responsibility in the organization, provision of critical development experiences to those that can move into key roles and engaging higher management in supporting the development of high-potential leaders.  Capacity-building and Partnerships:

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Alpine Health needs to continue to build strong strategic partnerships with other like service providers and community-based institutions, including the Alpine Shire. We need to develop more formalised links to support and enhance service delivery and workforce knowledge and skills. We need to develop a clear written and stated focus on partnerships, that they are important and that this is a powerful means by which outcomes are achieved in public health.  Better Communication: We need to work towards a culture where open and honest communication is the organisational norm. Improving communication between management and staff is a challenge for organisational development. Staff members like to know that the work they do is valued and that they can speak freely about concerns. Frequent and open styles of communication are required to build an open and trust-based work culture. We need to develop systems that are structured to encourage communication and feedback.  Cross-Functional Collaboration: A collaborative cross-functional approach to service delivery within Alpine Health is necessary to achieve a productive culture in the organisation. Clear goals and objectives are required to give new employees a thorough induction including an understanding of all departments and how they fit together. Regular cross-functional briefings throughout the organisation should take place. Goals and objectives should also provide for periods of secondment to other departments and encourage multi-level project teams.  Mental Health and Wellbeing: A significant proportion of Alpine residents report a high to very high level of anxiety and psychological stress. Strong evidence also consistently reveals the link between poor mental health and physical illness. Mental wellness and rehabilitation, counselling and personal support is a major challenge and focus for the organisation.  Promoting Healthier Lifestyles: Healthy lifestyle choices such as a good diet, exercising regularly, managing weight, and not smoking may substantially reduce lifestyle disease such as obesity and diabetes which are in increasing in prevalence within the Alpine region. There are well established relationships between increased education and the reduction in mortality rates due to lifestyle disease.  Patient Relationships and Care: Patient care to include time with patients to discuss anxieties and worries or simply the provision of time to socialise and talk with patients is identified as a challenge and concern for Alpine Health staff. Social contact for the elderly and people with illness plays an important role in improving mental health and alleviating patient anxieties and concerns.  Promotion of Responsibility for Own Wellbeing: Alpine Health needs to continue to support the development of services that enable people to make life choices that improve their health status and prevent lifestyle related disease. We need to establish ongoing sources of evidence about the health and wellbeing needs of the community that could inform lifestyle education programs.

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This Service Plan embodies strategic goals across 4 core priority areas. 7.0 Our Strategic Goals The focus is on maintaining, building and improving our existing services, whilst developing new services and creating new capacity. Workforce development and capital investment are also core strategic priorities.

7.1 Process and Structure The strategic priorities for Alpine Health for the future development of health services in Alpine Shire are the core of this Service Plan. Our strategic priorities have been determined by the Board of Management applying a process that combines community engagement with an evidence-based approach. This process and the structure within which our future priorities are documented is illustrated below:

Process led by Service Plan External: Implementation Group (SPIG): Community Input- ideas, needs and aspirations Health Data and BOARD: Indicators: Strategic Directions Objective research and Priorities and data analysis Internal: Staff and professional Input

OUR 4 SERVICE PLAN PRIORITIES: 1. Improving the quality and focus of our current services

2. Creating capacity and developing new services for the future

Tackling Causes the

Building Partnerships

3. Developing and improving our Preparing future for the workforce Supporting Vulnerable the 4. Capital Investment - developing the buildings and physical infrastructure we use to provide services

Operational Performance Planning/ Monitoring & Implementation Evaluation

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7.2 Key Strategies STRATEGIC PRIORITY 1 Sustaining and improving our current services: Hospital In-Patient  Improve community access to hospital-based renal dialysis services through redesign and capital works  Introduce and evidence-based predictive wait-list management procedures for hospital- based renal dialysis services  Work with local GPs to improve and develop integrated patient data bases to enable more integrated service delivery  Work with regional health services and specialists to improve and support inpatient care Urgent Care  Continue to promote the availability of Alpine Health’s Urgent Care Services  Build stronger relationships with local GPs and other health service providers to ensure community access to a streamlined services 24 hours and 7 days per week  Work with the Department of Health to secure additional specified funding for urgent care services  Work with Medicare Locals to improve access to local health services  Review staffing rosters to ensure available nursing hours are best utilised for optimal service delivery outcomes  Provide education and up-skilling for registered and enrolled nursing staff to improve service delivery Maternity Services  Maintain the current delivery of antenatal and post-natal maternity services  Work with Albury/Wodonga Health and North East Health Wangaratta to fit services into a regional approach to care  Initiate discussions with Alpine Shire regarding future options for the integration of maternal and child health services with maternity services Day Procedural Services  Maintain the current commitment to day procedural services  Improve the standards of customer service for day procedural services to ensure - family-friendly service delivery - person-centred care - improved overall patient experience Community Services  Improve volunteering capacity across all areas of the service  Develop an integrated overall framework for the attraction and management of volunteers  Increase the number of flexible community aged care packages  Implement the Positive Ageing Strategy in conjunction with the Alpine Shire  Seek to increase the flexibility in aged care packages to improve client fit and outcomes  Move towards more client-directed care model of service delivery through community aged care packages  Work with Medicare Locals to improve health promotion and secure funding for local health services  Continue to work with local GPs to improve health promotion for older adults  Develop programs to assist people to make the transition from employment to retirement

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 Work with the Hume Medicare Local to develop and improve services for urgent care and after hours medical services using Alpine Health Urgent Care Service model  Develop a performance management system for primary care and health promotion services jointly with the Hume Medicare Local using Alpine Health’s “What Matters” Framework  Continue to develop relationships with the McGrath Foundation to provide cancer support services  Develop a strategy and framework to recognise and respond to mental health issues  Continue to support the ‘Communities that Care’ program in Myrtleford  Use the ‘Communities that Care’ model to expand into other health service areas  Continue to provide the current District Nursing Service level  Continue to provide HACC services at the current level but investigate alternative service delivery models  Continue to provide the Alpine@Home service and seek funding to expand it  Seek to better engage with our volunteer resource to improve service delivery  Undertake a review of the Alpine Leisure program  Undertake a review of Alpine Health’s role in the provision of palliative care services  Review the scope of the community transport program and identify options to increase use and patronage (including options for expanding the service to areas outside the Shire)  Develop a strategy to increase the focus of GPs on chronic disease management

Residential Aged Care Services  Increase the capacity of Hawthorn Village to provide for high-care service needs  Improve our capacity to identify and respond to dementia in all residential and community-based services  Seek funding to engage specialist gerontology/dementia staff members  Develop a sustainable model of self-managed health care teams that can be responsive to demands of residential aged care clients  Develop a pricing model for residential aged care services in the context of new Federal Government regulations relating to deposit bonds and the associated implications for Alpine Health’s cash flow management  Undertake research into likely long-term demand trends for residential aged care (low care) services to ensure that Alpine Health’s service level offering and mix is optimised  Develop a more flexible aged care service platform that responds to changing patterns of client demand and needs across the residential and community-based service options

STRATEGIC PRIORITY 2 Building capacity and developing new services for the future:  Develop and introduce a new home-based renal health service  Introduce a community learning and transfer service through the Alpine Institute  Investigate a new fee for service model  Develop training services through the Alpine Institute including additional certificates for essential services, clinical and administrative staff members  Implement an anticipatory model of services and service delivery through Health Workforce Australia project and apply this model to all services  Integrate volunteers into Alpine Health’s workforce and create opportunities for expanding and promoting volunteer services  Seek funding to introduce a visiting specialist gerontology service  Develop a collaborative relationship with Alpine Shire for service development for young people

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 Advocate for funding models that accommop0date and promote innovative service development  Investigate alternative fee for service payment models that focus on improvements in population health, service costs and the experience of care

STRATEGIC PRIORITY 3 Developing and improving our workforce: Workforce Education and Knowledge Acquisition: • Require all staff members to have obtained, or be working towards a formal qualification by 2015 • Embed the Alpine Institute as the primary vehicle of staff development and education, and community based learning opportunities • Expand the scope of courses available under the Registered Training Organisation • Seek approval through the Victorian Regulation and Qualification Authority to broaden the registration scope of the Registered Training Organisation to include course delivery to individuals external to Alpine Health • Continue the commitment to provide traineeships, and establish relationships with local secondary colleges to facilitate school based traineeships • Maintain a comprehensive development agenda for existing staff • Develop further capacity to support and deliver training through contemporary technology

Workforce Positioning • Establish employment pathways that foster the movement and up-skilling of existing staff • Explore a selection of certificate and diploma based courses for development within the Alpine Institute to provide opportunities for employment pathways across all domains of Alpine Health’s services • Forge and expand relationships with the community and service sectors across the community including schools, industry, and local government to ensure pathways through education are inclusive, accessible and relevant to the community • Further engage volunteers and voluntary effort for service delivery through a more coordinated approach to the support of volunteers

Workforce Configuration • Progress toward workforce structures and systems that enable staff to work more consistently at the upper limits of their training and expertise • Identify and structure an appropriate skill mix that meets flexible service and individual needs whilst enabling staff to work more consistently to an expanded scope of practice with appropriate supervision • Employ workforce planning methodologies and approaches drawn from consumers and health need, and predictive modelling • Make better and joined-up use of service and workforce data to direct appropriate resource allocation and role design • Initiate collaborative, team based review and analysis that informs workforce configuration and distribution of skill • Test provisions of workforce configuration and flexibility contained within relevant Enterprise Bargaining Agreements • Initiate external workforce partnerships and alignment for service development and review • Commission a review of Alpine Health’s staff establishment

Workforce Health and Safety • Pursue and periodically review established risk management strategies

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• Encourage staff members in making choices that positively impact on their personal health, resilience, wellbeing and quality of life to support a strong and fulfilling contribution to Alpine Health • Build robust systems for promoting and maintaining the health and well-being of our staff members • Continue to develop mechanisms that engage staff in health, safety and wellbeing strategy development • Engage people to the organisation with a commitment to personal health and safety, and to that of their colleagues

STRATEGIC PRIORITY 4: Capital Investment – developing the building and physical infrastructure we use to provide services: • Co-locate Alpine Health services within Alpine Health buildings and land to create service, coordination, integration, flexibility and efficiencies • Co-locate services provided by other organisations with those provided by Alpine Health (either in Alpine Health facilities or adjacent to them) to create “health precincts” as opportunities for improving service coordination and integration, and improving access for the community • Obtain funding for expanded and improved car parking facilities at Mount Beauty • Invest in information and communication technology for the “virtual” co-location of services to improve service coordination and efficiencies in service delivery • Encourage the development of additional independent living units close to Alpine Health acute hospital and residential aged care services • Provide residential acute inpatient and education facilities that meet current standards and the needs of the community with new and innovative services • Develop permanent accommodation for Alpine Community Health Centre • Develop accommodation and infrastructure locally to support training and the recruitment of students, visiting clinicians and newly recruited staff members • Invest in infrastructure to improve work health and safety conditions for staff members and other stakeholders • Invest in energy, water and other environmental efficiency initiatives to address climate change • Advocate for town planning decisions that encompass medium density housing adjacent to Alpine Health’s facilities to form health precincts

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In diverse and physically separated rural communities like those of Alpine Shire, 8.0 Strategic Alignment strategic partnerships and collaboration are crucial.

They are crucial to maintaining links with all the other service providers)public and private) who work along-side Alpine Health and play a pivotal role in the health and well-being of the community. Only through effective collaboration can we ensure efficiency and quality in the delivery of health services.

8.1 Context A key to effective service delivery in the Alpine region is working collaboratively with other organisations and health service providers. Alpine Health, as the lead health agency in the region, sees a core part of its role in ensuring coordination and cooperation across all the different institutions and organisations that have a role to play in quality health service web. Following is an illustration of the network of health service stakeholders in Alpine Shire:

ALPINE SHIRE Ovens & King Community POPULATION: Health Service  General Practitioners

Upper Hume  Visiting Specialists Alpine Other Community  Allied Health Providers Health Service Health Providers  Regional Services/ Hospitals

Alpine Shire

The key to effective strategic alignment and collaboration is through maintaining an ongoing dialogue with our community partners.

8.2 Strategic Partnerships and Collaboration Alpine Health is a leader and member of, and participates and/or actively engages in the following partnerships, collaborations and alliances: • Hume Health Partnership – for the planning and coordinated delivery of all health services across the Hume Region of the Department of Health • Central Hume Primary Care Partnership – for the planning and coordinated delivery of all primary health services across the Central Hume sub- region of the Hume Region of the Department of Health • Hume Alliance of Rural Hospitals – for the planning and delivery of common information and communications technology and services across the Hume Region of the Department of Health • Victorian MPS CEO Group – for the planning and improvement of Multi-Purpose Services in rural Victoria • Alpine Alliance – conjointly with the Alpine Shire for the planning, integration, improvement and coordinated delivery of all health services across the Alpine Shire Page 34 of 72

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• Alpine Health/Lonsdale Institute Partnership – for the development, planning and delivery of health services training for health services in the Alpine Shire • Alpine Resilience Committee – to provide forum for responses to natural disasters • Hume Region Integrated Cancer Service – to link people in the Alpine Shire who are living with cancer to access services in the most relevant ways according to their needs • Alpine Health/Mount Beauty Medical Centre Partnership – for the planning, development and coordinated delivery of anticipatory primary care services in the Kiewa Valley • M2M Alliance – for the planning, development and coordinated delivery of training for medical interns and continuous medical education for medical interns and registrars, general practitioners, nurses and other health professionals in the Alpine and Moira Shires

Alpine Health has formal relationships with Rural Ambulance Victoria, Albury Wodonga Health and North East Health Wangaratta, Bright Medical Centre, Mount Beauty Medical Centre and Standish Street Surgery (Myrtleford) for the coordinated delivery of acute hospital services to people of the Alpine Shire including: • Emergency services • Obstetric Services • Acute inpatient services • Pharmaceutical supply • Education and training for health professionals

Alpine Health also has strong partnerships with local community led and provided health support services including: • Cancer Support Groups Alpine • Aged Care Advocacy • Kiewa Valley Dementia Support Group • Autism Support Group • Men’s Sheds in Bright, Myrtleford and Mount Beauty • Op-Shops in Bright and Myrtleford • Community transport through Transport Connections

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9.0 Future Health and Aged Care Service Profiles

The following service profiles are appended:

Appendix 3: Continuing Services Appendix 4: Revised /New Services (achievable within current funding) Appendix 5: Revised /New Services (dependent on additional funding)

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APPENDIX 1:

Current service profile and activity levels

Acute Care

Service Frequency of Service availability Type of Activity levels service, e.g. provided (where based activity in 2011/12 daily, 24/7, or & catchment) Mon-Fri. Bright, Mount Bed days 8800 24/7 Medical Beauty, inpatients Myrtleford Bright, Mount Presentations 4662 24/7 Urgent Care Beauty, * Myrtleford Nursing Bright, Mount Bed days 784 24/7 home type Beauty, (NHT) Myrtleford patients Non- Bright, Mount Occasions of 333 Mon-Fri admitted Beauty, service patients Myrtleford Bright, Mount Number of 1004 Mon-Fri Radiology * Beauty, clients Myrtleford Bright, Mount Number of 39 24/7 Palliative Beauty, clients care Myrtleford Bright, Mount Occasions of 11643 Daily District Beauty, service nursing Myrtleford Bright, Mount Number of 136 24/7 Maternity Beauty, clients Myrtleford Renal Myrtleford Number of 918 Mon-Fri dialysis* clients

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Current service profile and activity levels

Flexible Aged Care Places

July–Sept Oct–Dec Jan–March April–June 2011 2011 2012 2012 Flexible high 95.30% 91.45% 90.80% 85.00% care occupancy levels Flexible low 89.3% 83.60% 83.30% 79.30% care occupancy levels Flexible 100% 100% 100% 100% community care occupancy levels Respite care 648 532 477 507 bed days

Primary Health Care

Service* Service availability 2011/12 activity levels Community Health 366 days 138 clients/848 occasions Nursing of service Community Aged Care 366 days Packages * Breast Care Nurse 0.4 EFT / 16 hours per 341 client contacts / 30 (McGrath/IGA) * week new referrals Dietitian* 0.8 EFT / 32 hours per 205 client occasions of week service /120 new referrals Inpatients and residents: 109 client contacts / 39 new referrals Rural Adolescent Health 0.6 EFT / 24 hours per Schools based Worker week counselling Bright P12, Myrtleford P12, Marion College Myrtleford, Mount Beauty Secondary College Youth Worker 1.0 EFT / 38 hours per Blue Light Youth Club Mt week Beauty: twice per week Schools based youth work Mount Beauty Secondary

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College, Myrtleford P12, Marion College Myrtleford Alpine Shire Youth Council facilitation once per month Health Promotion Worker 0.8 EFT / 32 hours per Communities that Care Family and Young week Myrtleford: Phase 3 Persons (18 – 49 years) Create a Profile * Health Promotion Worker 0.8 EFT / 32 hours per Physical Activity Older Persons (50+ week Prescriptions: 69 years) * occasions of service / 23 clients Life! Taking control of Diabetes: 52 clients, 4 programs commenced Men’s Shed: 80 members Health Promotion Worker 0.6 EFT / 24 hours per 4 Kids Go For Your Life (5-12 years) week programs - 60% of all Alpine primary schools holding award status, 85% of Alpine primary school students attending a health promoting school, 60% of Alpine primary schools having ‘healthy’ policies and healthy canteens Integrated Chronic 0.6 EFT / 24 hours per Diabetes Management Disease Management week Framework completed Project Officer July 2012

* If including services which are not funded or only part funded by the Tripartite funding, please denote with an *.

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APPENDIX 2:

Alpine Health Governance Structure:

Board and Governance: Alpine Health is governed by a 7 member volunteer Board of Management. Board membership is a volunteer role. Board members are selected from nominations within the community and appointed by the Minister for Health. Board members reflect a range of interests across the community and the geographic areas we cover. They have a diverse range of skills and experience to meet the long term governance needs of Alpine Health. The role of the Board is to provide strategic leadership to Alpine Health on behalf of the community. This includes:  Govern Alpine Health and continuously improve the organisation  Protect and improve the health and well-being of the Alpine Valleys communities  To improve access to and delivery of health services to the Alpine Valleys communities.  Undertake long-term strategic planning and policy development in relation to the health and well-being of the community  Directly engage with the communities they represent to ensure health service planning and delivery is aligned with community needs  Oversee the assets of and resources available to Alpine Health to ensure it remains a viable health service provider in the long-term. The structure of Alpine Health is illustrated below:

Alpine Valleys Communities Community Advisory Group: ALPINE HEALTH Myrtleford Board of Management Community Advisory Group: Bright Finance & Planning Committee Community Advisory Group: Quality Care Committee Mt Beauty

Risk and Audit Committee

Executive and Staff

ALPINE HEALTH SERVICES See belo w

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Organisation Structure and Management: Alpine Health’s Organisational structure is illustrated below:

BOARD OF MANAGEMENT

Communications Director of Medical Media Chief Executive Administration Services Officer Community & Service Development

HEALTH SERVICES BUSINESS SERVICES

Health Health Health BUSINESS FINANCE & HUMAN Services: Services: Services: DEVELOPMENT CORPORATE RESOURCES BRIGHT MYRTLEFORD MT BEAUTY  Alpine@Home  Finance  Human Resources  Acute services  Acute services  Acute services Alliance  Information  Workforce  Residential Aged  Residential Aged  Residential Aged  District Nursing Management Planning Care Care Care  Packaged Care  Compliance, Audit  Payroll/  Midwifery  Early Intervention  Peri-Operative  Alpine Leisure and Risk Remuneration  Allied Health Team  CSSD Group  Administration  Learning and Support  Allied Health  Allied Health  Palliative Care Development  Client Services Support Support  Administration  Client Services  Client Services  Fleet

ESSENTIAL SERVICES  Catering and food  Environmental  Building Maintenance

Community Engagement – Community Advisory Groups: Alpine Health’s is committed to engaging with each community in its area in a direct and meaningful way. To achieve this, the Board has established Community Advisory Groups in each of the main townships of Bright, Mount Beauty and Myrtleford. The goal of the engagement process is find out what the community thinks about its health services and what its needs are. The information gleaned from the engagement process is applied to plan and deliver services and deliver the best health outcomes for the Alpine Shire region. Through these Groups, local residents can share information and ideas and contribute to the affairs of Alpine Health. The Groups advise the Board of Management on community concerns, needs and issues. The role of the Community Advisory Groups is to advise the Board of Management (and other agencies) on:  The health needs of the community and how these might be met  How existing services might be changed or improved to meet community needs  What services (current or proposed) people don't need or don't want. In effect, the Community Advisory Groups are the ‘eyes and ears’ of the Board of Management into the community. Appointments to Community Advisory Groups are made by the Board of Management from people living in the Alpine Shire.

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APPENDIX 3: Continuing Service Profiles:

Service – Acute Hospital Inpatient Services o Provision of responsive and flexible hospital based inpatient services in Bright, Mount Beauty and Myrtleford to meet the acute health needs of individuals

Future Objectives o Improve service delivery to each residential care client by focussing on the specific clinical, social, and cultural needs of each individual o Work in partnership with local general medical practitioners, the Alpine Shire and the community (through service and volunteer support groups) to reduce the demand for inpatient care by implementing anticipatory models of care and providing alternative services

Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally and to promote standardisation of service delivery o Provide 9 flexible acute care beds at Bright, 10 flexible acute care beds at Mount Beauty and 15 flexible acute care beds at Myrtleford o Provide inpatient care for general medicine, perinatal care, day and overnight stay procedures, slow stream rehabilitation, palliative care and flexible aged care clients as required o Build an acute care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive acute hospital care services o People visiting the Alpine Shire who need access to acute hospital inpatient care as a result of unanticipated circumstances

Confirmation of Need o The provision of acute hospital care services has been identified by the Alpine Shire communities since the 1920’s. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Health Service Managers 3.0 EFT (Bright, Mount Beauty and Myrtleford) o Myrtleford 12.35EFT; Mount Beauty 10.5EFT; Bright 9.6EFT (comprising registered nurses, enrolled nurses, 0.6 Infection Control Officer, WHS Officers, 0.1EFT Transfusion Trainer, 0.15 clinical support nurses and 0.6 EFT site support staff) Page 42 of 72

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Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for acute inpatient care have been well established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o 2012/13 total budget : $8.417m o Funding source is the Victorian Department of Health

Capital Funding Implications o Alpine Health has made an application for funding the co-location of residential aged care services with all other services at Bright to enable the provision of fully integrated health services for this community in the same way as they are provided in Mount Beauty and Myrtleford. The approved master plan identified a 2015 capital investment need of $42 million.

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Service – Community Aged Care Services o Provision of responsive and flexible community aged care services to meet the support needs of frail older people with complex care needs, who wish to remain living in their own homes

Future Objectives o Increase the provision of flexible community aged care to better meet the needs of individuals by expanding the service with flexible funding models o Increase the provision of community aged care services as demand for these services increases o Improve service delivery to each aged care client by focussing on the specific clinical, social, and cultural needs of each individual o Work in partnership with local general medical practitioners, other service providers, o the Alpine Shire and the community (through service and volunteer support groups) to establish new and alternative services by implementing anticipatory models of care

Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally o Provide 25 community aged care packages and 15 flexible high care packages to clients in the Alpine Shire and surrounding areas to meet their needs o Provide leadership and support in assessment, care planning and service provision of frail aged residents and residents with a disability o Build an aged care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive aged care services

Confirmation of Need o The provision of community aged care services reflects a response to the ageing population of the Alpine. It has been affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Business Development Manager o CC Admin Assistant, CC Admin Assistant, Packaged Care Case Manager, Packaged Care Case Manager, Packaged Care Case Manager

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Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for community aged care have been established with auditing, reporting and measurement systems to ensure compliance obligations for funding and standards of service provision are met, to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o 2012/13 total budget : $658k o Funding source is the Commonwealth Department of Health and Ageing

Capital Funding Implications o There are no significant capital implications for this service at current levels of service provision.

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Service – Day Procedure Services o Provision of responsive and safe day procedure services in Bright and Mount Beauty to meet the day based surgical needs of individuals locally where this is appropriate

Future Objectives o Improve service delivery to each client by focussing on the specific clinical, social, and cultural needs of each individual o Work in partnership with local general medical practitioners, the Alpine Shire and the community (through service and volunteer support groups) to reduce the demand for inpatient care by implementing anticipatory models of care and providing alternative services

Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally o Provide 12 day procedure sessions at Bright and at Mount Beauty each year and ensure the safe delivery of endoscopy and other minor procedures within Alpine Health o Provide inpatient care to support day procedures and overnight stays as required o Build an acute care workforce in conjunction with visiting specialist medical officers and local general practitioners focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training for peri-operative services

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive acute hospital care services o People visiting the Alpine Shire who need access to acute hospital inpatient care as a result of unanticipated circumstances

Confirmation of Need o The provision of surgical procedure services has been identified by the Alpine Shire communities since 1970. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Health Services Manager (Mount Beauty) o Peri-Op Service Manager 0.8EFT; Theatre staff 0.75EFT; CSSD staff 1.0EFT

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Alpine Health Service Plan – 2013 - 2018

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board will establish a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for peri-operative services have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources.

Level of Funding and Funding Source o 2012/13 total budget : $490k o Funding source is the Victorian Department of Health

Capital Funding Implications o Alpine Health has made an application to the Department of Health for funding the replacement of its only sterilizer to support this service at a potential cost of $150k.

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Service – Health Promotion & Primary Intervention Services o Provision of responsive and flexible health promotion and primary care services in Bright, Mount Beauty, and Myrtleford to meet the health improvement needs of individuals and families and to support communities in the prevention ill health and the improvement of health and well-being.

Future Objectives o Work in partnership with local general medical practitioners, the Alpine Shire and the community (through service and volunteer support groups) to increase capacity for self-management of health and wellbeing and personal interventions for health improvement o Improve service delivery by focussing on the specific clinical, social, and cultural needs of each individual and community o Enhance service reach by prompting community led health promotion and primary intervention support service development o Enhance the anticipatory capacity of health promotion services through the development of predictive models of risk assessment and through the establishment of shared client information between primary and secondary care providers o Train staff in the use of predictive models of care and the use of predictive data sets in order to manage health promotion in an anticipatory capacity o Establish an agenda for the development of an integrated planning framework for health and local government service delivery for the purposes of health promotion and primary intervention o Refine measurement frameworks, in conjunction with Hume Medicare Local for the delivery of health promotion and primary intervention inputs, processes, outputs and outcomes.

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Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally and to standardize approaches to care to complement community based health promotion and primary interventions services o Deliver services as close to peoples’ homes as possible and ensure the maintenance of local service delivery where appropriate o Build community capacity for people to take responsibility for their own health and wellbeing by promoting community leadership, increasing health literacy, improving personal health skills and providing health education, information and support o Develop and support community led, managed and delivered volunteer health and community support services in the Alpine Shire including diabetes, dementia, autism and cancer support, community transport, aged care advocacy and Men’s Sheds o In conjunction with the Alpine Shire, provide centre based planned activity services in Bright, Mt Beauty and Myrtleford, to improve and maintain the physical, psychological and social well-being of people who are frail aged, or who have a disability o In conjunction with the Alpine Shire, provide home and community care services with funding from the Department of Health (Victoria) o Provide home nursing services to residents of Alpine Shire and those discharged from acute services who require clinical management in their homes o Provide practical support and comfort to people living in the Alpine Shire with terminal illnesses and their families and carers through the delivery of volunteer services o Provide health promotion activities and early intervention services to improve the mental health and wellbeing of young people aged 12-18 years and their families o Provide a range of health promotion activities within the community relevant to the needs of older people and families and children o Build an acute care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships with the Alpine Shire and frail aged, and disabled persons in their homes along with their carers who need access to responsive services and support.

Confirmation of Need o The provision of responsive health promotion and primary services has been identified by the Alpine Shire communities since the 2002. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes. It is also consistent with state and Commonwealth health priorities.

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Who is Responsible o Business Development Manager o District Nursing 6.35 EFT; Alpine Leisure Group 4.1EFT; Alpine@Home 1.4EFT o Community team 10.8EFT (comprising Early Intervention Manager, Early Intervention Project Officer, Dietitian, Health Promotion (50+ years), Health Promotion (18-49 years), Health Promotion (5-12 years), Youth Worker, Rural Adolescent Program Worker, McGrath IGA Breast Care Nurse, Sustainable Farm Families’ Project Officer

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board will establish a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for all health promotion and primary intervention services are being established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources.

Level of Funding and Funding Source o 2012/13 total budget : $1.393m o Funding source is the Victorian Department of Health ($1.134m) and Commonwealth Department of Health and Ageing ($0.259m)

Capital Funding Implications o Alpine Health has made an application for funding the co-location of residential aged care services with all other services at Bright to enable the provision of fully integrated health services for this community in the same way as they are provided in Mount Beauty and Myrtleford. The approved master plan identified a 2015 capital investment need of $42 million.

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Service – Perinatal Care Services o Provision of responsive and flexible services in Bright, Mount Beauty, and Myrtleford to meet the pregnancy, birth and early parenting health needs of families in the Alpine Shire

Future Objectives o Improve service delivery to each residential care client by focussing on the specific clinical, social, and cultural needs of each individual o Work in partnership with local general medical practitioners, the Alpine Shire and the community to sustain a perinatal and low risk birthing services for all families in the Alpine Shire

Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally o Resource a dedicated team of midwives and obstetric qualified general practitioners to provide a perinatal and low risk birthing services for all families in the Alpine Shire o Provide inpatient, diagnostic x-ray and limited pathology services for obstetric clients and new born babies care as required o Build an obstetric and early parenting workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training o Work in conjunction with the Alpine Shire to develop an integrated perinatal, child and early parenting service for the communities of the Alpine Shire

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive perinatal services

Confirmation of Need o The provision of perinatal care services has been identified by the Alpine Shire communities since the 1920’s. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Health Services Managers (Bright) o Clinical Nurse Consultant 1.0EFT; Caseload midwives 0.2EFT and 15 non caseload midwives working within Alpine Health.

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Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for perinatal have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources.

Level of Funding and Funding Source o 2012/13 total budget : $180k o Funding source is the Victorian Department of Health

Capital Funding Implications o Alpine Health has made an application for funding the co-location of residential aged care services with all other services at Bright to enable the provision of fully integrated health services and the improvement of perinatal services for this community in the same way as they are provided in Mount Beauty and Myrtleford. The approved master plan identified a 2015 capital investment need of $42 million.

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Service – Renal Dialysis Services o Provision of renal dialysis services in Myrtleford as a satellite of the Royal Melbourne Hospital (North West Dialysis Service) to meet the needs of people in the Alpine Shire and surrounding areas with end stage renal disease

Future Objectives o Sustain renal dialysis services at Myrtleford to meet local needs and support additional clients from the Royal Melbourne Hospital o Develop a focus on home based renal dialysis and the necessary services to support its self-management o Build on existing relationship with Royal Melbourne Hospital (North West Dialysis Service) and local specialists to develop anticipatory models of renal dialysis services with a strong focus on renal disease prevention and renal health promotion. o Sustain a dialysis service capacity responsive to the visiting needs of renal dialysis patients from outside the region.

Strategies o Provide and resource 4 chairs (x 2 shifts 3 times per week) for renal dialysis at Myrtleford o Source support for the re-development of the clinical space for dialysis services in order to increase the clinical footprint of clinical work space and treatment space. o Build an acute nursing workforce with renal dialysis skills focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts who need access to responsive renal dialysis services

Confirmation of Need o The provision of residential aged care services has been identified by the Ovens Valley communities since 1970 and has been re-affirmed by these communities in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Health Services Managers (Myrtleford) o Registered Nurse Dialysis staff 0 .6EFT

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Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for renal dialysis have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o 2012/13 total budget : $443k o Funding source is the Victorian Department of Health

Capital Funding Implications o Alpine Health has made an application for funding the redevelopment of its renal dialysis facilities at Myrtleford to meet new standards for these services and support service development for growing demands for home based dialysis. The 2013 capital investment costs are $450,000 for basic infrastructure.

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Service - Residential Aged Care Services o Provision of responsive and flexible residential aged care services in Bright (Hawthorn Village), Mount Beauty (Kiewa Valley House) and Myrtleford (Barwidgee Lodge) to meet the needs of individuals when other options for aged care are no longer appropriate

Future Objectives o Increase the provision of respite, transitional and part time residential care as demand for permanent care services declines o Increase the provision of high level care services as demand for low level care services declines o Improve service delivery to each residential care client by focussing on the specific clinical, social, and cultural needs of each individual o Work in partnership with local general medical practitioners, the Alpine Shire and the community (through service and volunteer support groups) to reduce the demand for residential aged care by implementing anticipatory models of care and providing alternative services

Strategies o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally o Provide 40 flexible residential places at Hawthorn Village, 20 flexible residential places at Kiewa Valley House and 30 flexible residential places at Barwidgee Lodge o Build an aged care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive residential aged care services

Confirmation of Need o The provision of residential aged care services has been identified by the Alpine Shire communities since 1970 and has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

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Alpine Health Service Plan – 2013 - 2018

Who is Responsible o Health Services Managers 3.0 EFT (Bright, Mount Beauty and Myrtleford) o Hawthorn Village – 11.4 EFT (comprising NUM 1.0EFT; PCA’s 6.6EFT; Enrolled Nurses 2.2EFT; Trainee PCA 1EFT; Allied Health Assistant 0.8EFT; Diversional Therapist 0.8 EFT) o Kiewa Valley House - 15EFT (comprising Registered Nurse staff 4.2EFT; Enrolled Nurse staff 9.4EFT; Infection Control 0.1EFT; Activities Assistant 0.7EFT; Allied Health Assistant 0.6EFT) o Barwidgee Lodge - 19.2EFT comprising NUM 1.0EFT; Registered Nurses 5.6EFT; Enrolled Nurses 11.2EFT; No-Lift 0.05EFT; Activities Assistant0 .75EFT; Allied Health Assistant 0.6EFT)

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board will establish a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for residential aged care have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o 2012/13 total budget : $5.816m o Funding source is the Victorian Department of Health ($1.516m) and Commonwealth Department of Health and Ageing ($4.3m).

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Service – Urgent Care Services o Provision of responsive services in Bright, Mount Beauty, and Myrtleford to meet the urgent and emergency health care needs of people in the Alpine Shire

Future Objectives o Work in partnership with local general medical practitioners, Hume Medicare Local the Alpine Shire and the community (through service and volunteer support groups) to reduce the demand for urgent and emergency and urgent primary health care by implementing anticipatory models of care and providing alternative services o Work in partnership with referral centres to standardise the management of care coordination and patient referral o Improve service delivery to each residential care client by focussing on the specific clinical, social, and cultural needs of each individual o Secure specified recurrent funding to provide this service

Strategies o Provide 24hour nurse led urgent care services Bright, Mount Beauty and Myrtleford in conjunction with general practitioners available in an on-call capacity o Provide inpatient, diagnostic x-ray and limited pathology services for urgent care and emergency patients as required o Build an acute care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training o Integrate all acute, residential and community care service types in facilities in each town to meet local needs locally o Integrate urgent care Service and general practice based primary care data sets o Develop specific health care promotion strategies in conjunction with general practice to prevent the need for unplanned primary care episodes of service delivery, including for specific groups (e.eg. 40 - 65 year olds)

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships who need access to responsive acute hospital care services o People visiting the Alpine Shire who need access to urgent, emergency and acute hospital inpatient care as a result of unanticipated circumstances

Confirmation of Need o The provision of urgent care services has been identified by the Alpine Shire communities since the 1920’s. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

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Who is Responsible o Health Services Managers (Bright, Mount Beauty and Myrtleford) o Bright 0.4EFT; Mount Beauty 0.4EFT; Myrtleford0 .6EFT Registered Nurses

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for urgent and emergency care have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o 2012/13 total budget : $190k o Funding source is the Victorian Department of Health

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APPENDIX 4:

Revised/New Service Profiles (achievable in current funding):

There are no revised or new service profiles (achievable within current funding) for the 2013 Service Plan.

APPENDIX 5:

Revised/New Service Profiles (dependent on additional funding):

Service - Residential Aged Care Services - Change in service provision in Bright o Provision of responsive and flexible residential aged care services at Hawthorn Village in Bright, to provide low and high residential services to meet the needs of individuals and provide increased high care residential service locally within Bright.

Future Objectives o Increase the provision of flexible respite and transitional care from low to high care within Hawthorn village. o Increase the provision of high level care services as demand for low level care services declines o Improve service delivery to each residential care client by focussing on the specific clinical, social, and cultural needs of each individual within their current community. o Work in partnership with local general medical practitioners, the Alpine Shire and the community (through service and volunteer support groups) to reduce the demand for residential aged care by implementing anticipatory models of care and providing alternative services

Strategies o Integrate low and high residential care within Hawthorn Village to meet local needs locally o Provide 40 flexible residential places at Hawthorn Village which can accommodate all level of residential care requirements. o Build a flexible aged care workforce focussed on the specific clinical, social, cultural, pastoral needs of each individual. The team structure will support a person centred care approach. The organisation will provide appropriate resources ,information education and training

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Target population/group o Persons in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships) who need access to responsive and person centred residential care services

Confirmation of Need o The provision of residential aged care services has been identified by the Alpine Shire communities since 1970 and has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

Who is Responsible o Health Services Manager - Bright o Nurse Unit Manager- 1 EFT o EFT 17.2 including Registered Nurses, Enrolled Nurses, Personal Care Attendants and Diversional Therapists and Allied Health Assistants

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board will establish a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for residential aged care have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care.

Level of Funding and Funding Source o Initial Budget estimate per annum: $1.8m o Funding source is the Commonwealth Department of Health and Ageing from the conversion of the last 10 flexible low care places to flexible high care.

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Capital Funding Implications o Alpine Health has made an application for funding the co-location of residential aged care services with all other services at Bright to enable the provision of fully integrated health services for this community in the same way as they are provided in Mount Beauty and Myrtleford. The approved master plan identified a 2015 capital investment need of $42 million, of which $17 million is needed for residential aged care. o Alpine Health is currently discussing interim capital works funding to upgrade Hawthorn Village to provide high level care with the Department of Health

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Service – Alpine Community Services o Provision of integrated primary intervention social and health promotion services to people living in the Alpine Shire with the triple aim of improving the experience of care (including quality and satisfaction); improving the health of the Alpine population; and reducing the per capita cost of care.

Future Objectives o Development of an Integrated Resource Framework between Alpine Health and local government to plan for the delivery of integrated social and health promotion & primary intervention services in Bright, Mount Beauty, and Myrtleford to meet the health and social improvement needs of individuals and families. o Work in partnership with local government to increase capacity for service development, service efficiency and service measurement in terms of local socio-health priorities o Improve service delivery by focussing on the specific clinical, social, and cultural needs of each individual and community subsets. o Enhance service reach by prompting community led socio-health promotion and primary intervention support service development o Enhance the anticipatory capacity of health promotion services through the development of predictive models of socio-health risk assessment and through the establishment of shared client intelligence between health and local government departments o Establish an agenda for the development of an integrated planning framework for health and local government service delivery for the purposes of health promotion and primary intervention o Refine measurement frameworks, in conjunction with local government for the delivery of socio-health promotion and primary intervention inputs, processes, outputs and outcome.

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Strategies o Deliver services as close to peoples’ homes as possible and ensure the maintenance of local service delivery where appropriate o Provide targeted health and social care by understanding the demographic, population health and social care needs and choice preferences of communities; and o Increase coordination, access to, flexibility of and innovation in the delivery of the health and social care; and o Ensure the health and social care is cost-effective by promoting integrated working, alignment service re-design work, and resolving duplication of effort o Ensure the health and social care is culturally and population appropriate. o Iidentify release of resource / capacity for re-investment to support care models and co-production activity that are evidenced as having the best impact on the care of the locality population o Build community capacity for people to take responsibility for their own health and wellbeing by promoting community leadership, increasing health literacy, improving personal health skills and providing health education, information and support o Develop and support community led, managed and delivered volunteer health and community support services in the Alpine Shire including diabetes, dementia, autism and cancer support, community transport, aged care advocacy and Men’s Sheds o In conjunction with the Alpine Shire, provide centre based planned activity services in Bright, Mt Beauty and Myrtleford, to improve and maintain the physical, psychological and social well-being of people who are frail aged, or who have a disability o In conjunction with the Alpine Shire, provide home and community care services with funding from the Department of Health (Victoria) o Provide home nursing services to residents of Alpine Shire and those discharged from acute services who require clinical management in their homes o Provide practical support and comfort to people living in the Alpine Shire with terminal illnesses and their families and carers through the delivery of volunteer services o Provide health promotion activities and early intervention services to improve the mental health and wellbeing of young people aged 12-18 years and their families o Provide a range of health promotion activities within the community relevant to the needs of older people and families and children o Build an acute care workforce focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information, and education and training

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts have relevant relationships with the Alpine Shire and frail aged, and disabled persons in their homes along with their carers who need access to responsive services and support.

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Confirmation of Need o The provision of responsive health promotion and primary services has been identified by the Alpine Shire communities since the 2002. This need has been re-affirmed by these communities as of the highest priority in Alpine Health’s service planning processes 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes. It is also consistent with state and Commonwealth health priorities. Who is Responsible o Business Development Manager o This service first needs an appropriate governance and planning framework and the staffing requirements have not yet been determined Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board will establish a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met. Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for all health promotion and primary intervention services are being established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources. Level of Funding and Funding Source o Funding sources include Alpine Health, Alpine Shire, Department of Health (Victoria), Department of Health and Ageing, Department of Veteran’s Affairs and clients o This service first needs an appropriate governance and planning framework and the total budget for this service has not yet been fully determined. Initial budget estimate per annum: $500k Capital Funding Implications

Capital funding implications are not clear at this time and will first require the establishment of an appropriate governance model for the service.

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Service – Renal Health Services o As an extension of the existing service, establish an anticipatory model of renal health services in Myrtleford as a satellite of the Royal Melbourne Hospital (North West Dialysis Service) to meet the needs of people in the Alpine Shire and surrounding areas with a demonstrated predictive risk for the development of end stage renal disease

Future Objectives o Sustain renal dialysis services at Myrtleford to meet local needs and support additional clients from the Royal Melbourne Hospital o Develop a focus on home based renal dialysis and the necessary services to support its self-management o Build on existing relationship with Royal Melbourne Hospital (North West Dialysis Service) and local specialists to develop anticipatory models of renal dialysis services with a strong focus on renal disease prevention and renal health promotion. o Sustain a dialysis service capacity responsive to the visiting needs of renal dialysis patients from outside the region.

Strategies o Provide and resource 4 chairs (x 2 shifts 3 times per week) for renal dialysis at Myrtleford o Source support for the re-development of the clinical space for dialysis services in order to increase the clinical footprint of clinical work space and treatment space. o Build an acute nursing workforce with renal dialysis skills focussed on the specific clinical, social, and cultural needs of each individual through team based organization, the provision of appropriate resources and information and education and training o Provide a model of anticipatory care for people with a predictive risk for end stage renal disease incorporating health promotion and primary care interventions for those risks

Target population/group o People in the communities of the Alpine Shire and parts of the Indigo Shire and the Rural City of Wangaratta where surrounding districts who need access to responsive renal dialysis services

Confirmation of Need o The provision of residential aged care services has been identified by the Ovens Valley communities since 1970 and has been re-affirmed by these communities in Alpine Health’s service planning processes in 1999, 2002, 2005, 2008 and 2012 through Alpine Health’s comprehensive community engagement and consultation processes.

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Who is Responsible o Health Services Manager (Myrtleford) o This service first needs an appropriate governance and planning framework and the staffing requirements have not yet been determined

Quality Strategy o Alpine Health’s quality management system is based on the seven principles of the Australian Business Excellence Framework – Leadership; Customer and Stakeholder Focus; Strategy and Planning; Involvement of People; Information and Knowledge; Process Management, Improvement and Innovation; and Results and Sustainable Performance. o These principles also encompass processes for organizational self-assessment, the involvement of staff members, volunteers and contractors in training and the appropriate use of data and measurement. o Leadership of the implementation of these principles will be given by the Board of Management through its five year strategic service plan and its annual business plan processes. o The Board has a Quality Care Committee as a sub-committee of the Board with responsibility for planning, implementing and evaluating quality improvements within Alpine Health. o The quality management system will be established with documented policies, procedures and work practices that reflect best practice and that are necessary to ensure client needs and statutory requirements are met.

Performance Monitoring o Alpine Health will participate in the Australian Health Service Safety and Quality Accreditation Scheme for the implementation of the National Safety and Quality Health Service Standards as they apply to the state of Victoria and strategic performance improvements monitored through these accreditation processes. o Performance measures for renal dialysis have been established with auditing, reporting and measurement systems to ensure standards are met and to identify opportunities for continually improving performance and practices and minimising waste of resources in all aspects of aged care and will need to be extended to capture health promotion and primary intervention for renal disease.

Level of Funding and Funding Source o Funding source is the Victorian Department of Health o This service first needs an appropriate governance and planning framework and the total budget for this service has not yet been fully determined. Initial Budget estimate per annum: $800k

Capital Funding Implications o Alpine Health has made an application for funding the redevelopment of its renal dialysis facilities at Myrtleford to meet new standards for these services and support service development for growing demands for home based dialysis. The 2013 capital investment costs are $450k for basic infrastructure.

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APPENDIX 6:

Workforce Development Plan:

The Role of Workforce

Through successive Service Plans, Alpine Health has identified the importance of integrated workforce planning and service planning to the successful implementation of the strategic development of the organisation.

The provision of safe, reliable and flexible health, residential aged care and community services in the Alpine Shire continues to be dependent on Alpine Health’s capacity to support and improve its existing workforce, and attract a skilled prospective workforce.

As the health profile of the Alpine community continues to be influenced by burdens of chronic disease, long term care and support needs of an ageing community, and primary health care need, the response of Alpine Health through Service Plan 6 is the further development of health services characterised by preventative, anticipatory, primary health care. This requires a shift in Alpine Health’s workforce that balances aspects of current health service with the growing demand that consumer driven preventative, anticipatory and primary health care service presents.

The focus on workforce within Service Plan 6 therefore is to test the traditional assumptions regarding workforce planning and workforce sustainability to maintain a skilled, engaged, flexible, and diverse workforce capable of meeting established and emerging health needs of the Alpine community.

Testing traditional workforce assumptions will require Alpine Health to transition to a workforce model that:  is sensitive and responsive to emerging and predictable Alpine community health needs that result in new Alpine Health service priorities;  refocuses staff members toward preventative and anticipatory health services;  prioritises cross functional teams of people around individual and community health needs rather than industrial frameworks;  creates organisational capacity to supervise, manage and improve organisational performance; enables staff members to work more often at the upper limits of their training and expertise;  and places importance on workforce education and training

Alpine Health’s investment in workforce is built from the basis that:  our people are Alpine Health’s most important asset , have obligations to the workplace and have expectations for reasonable support  workforce composition emerges from community and individual health needs and priorities  education, training and knowledge is critical to a high functioning workforce  systems that provide knowledge of and give knowledge to our workforce, are essential to well informed workforce design and productivity knowledge  collective workforce effort and integrated workforce approaches best facilitate positive outcomes to community and individual health need  mechanisms of workforce accountability progress service strategy and direction

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Alpine Health’s workforce planning will be guided by these beliefs. Additionally, it will reflect the current health environment with an attention to both the National and State health workforce agenda, and most importantly, the Alpine community’s health needs and aspirations. In doing so, the role of workforce within Service Plan 6 will focus on:

 Workforce Education and Knowledge Acquisition  Workforce Positioning  Workforce Configuration  Workforce Health and Safety

Existing Workforce Profile The Alpine Health workforce profile is typical of most small rural health services, with a high proportion of female staff members and part-time staff, a high percentage of the workforce aged over 45 years old, and a moderate annual staff turnover.

Alpine Health employs 373 people against 180.8 equivalent full time (EFT) positions. This total EFT number has remained stable over the past four years, with females employed against 86.8% of the EFT positions.

Staff: Gender Analysis by EFT 2001/2002 2004/2005 2007/2008 2012 / 2013 Females 144.7 140.6 151.6 157 Males 20.8 21.5 29.0 23.8 Total 165.5 162.1 180.6 180.8

Of the total staff members, 88.7% are female; however, this varies by employment status, with 69.2% of full-time staff members being female, and 93.8% for part-time employment status.

Male Female Employment Status: Male Female Total % % Full-time 16 36 52 30.8% 69.2% Part-time 13 198 211 6.2% 93.8% Casual 13 97 110 11.8% 88.2% Total Staff members 42 331 373 11.3% 88.7%

Nursing represents the largest workforce group, occupying 47.2% of EFT positions, with Community and Preventative Health care EFT representing 18% of the workforce. Overall, 65.2% of the workforce is employed in direct clinical care. The Community and preventative Care workforce group continue to be the major employment growth area for Alpine Health’s clinical care service.

Staff Category: 2012 / 2013

by Employment Group EFT: % Management/Administration 27.9 15.4% Nursing 85.3 47.2% Essential Services 35.1 19.4% Allied Health and Primary Care 32.5 18% Total 180.8 100%

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The average age of staff members at Alpine Health is 50.4 years. This is higher than the national and state health workforce average age. The average age varies slightly between employment status groups – full-time staff members average age is 49.2 years, part-time is 50.7 years, with casual staff members averaging 47.3 years.

Approximately 82% of staff members are aged over 40 years, with 56% aged over 50 years old.

Number of Age Group staff: % of Total Over 60 years 48 13% 50-59 years 162 43% 40-49 years 96 26% 30-39 39 10% Under 30 28 8% Total 373 100%

Supplementing Alpine Health’s workforce is a significant annual student cohort. Alpine Health is both a provider of education through its status as a Registered Training Organisation and through Australian Nursing and Midwifery Accreditation Council accreditation to provide registered nurse bridging programs for international nursing students, and provider of student placement for students within both the secondary and tertiary domains.

Alpine Health will continue to experience significant numbers of University and TAFE student placements throughout the life of Service Plan 6 as workplace training maintains prominence amongst training and education providers. Alpine Health will host students across all clinical environments, community and preventative health service, essential services, and administration during the lifespan of Service Plan 6, providing a valuable resource to the organisations service structure and driving additional knowledge and exposure of contemporary practices within Alpine Health.

2013 Student placement days 2010 2011 2012 Projected University students 376 312 280 222 TAFE students 355 35 493 360 420 480 1080 3060 International Nursing students (7 students) (8 students) (18 Students) (60 students) Total 1151 827 1853 3642

2013 Traineeships 2010 2011 2012 Projected Internal staff 3 8 9 9 School based traineeships 1 3

Workforce Education and Knowledge Acquisition Alpine Health has acknowledged education and knowledge are key prerequisites to the achievement of the organisations purpose as they are essential elements in sustaining a workforce capable of responding to existing, predicted and known health needs and priorities. More so, workforce education, knowledge acquisition and knowledge management are critical in giving effect to service strategies articulated through the Service Plan, and in ensuring that public confidence in Alpine Health is maintained, through a skilled, knowledgeable, responsive, accountable contemporary workforce.

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Alpine Health has made significant investment in developing a capacity to provide education and training more recently, primarily through the establishment of the Alpine Institute (encompassing Alpine Health’s Registered Training Organisation and expanded Initial Registration of Overseas Nurses program) and the continuation of an expansive workforce development agenda, and Service Plan 6 will focus attention on further developing and sustaining a comprehensive education and knowledge program.

In giving this effect, Alpine Health will: • Require all staff to have obtained, or be working towards a formal qualification by 2015 • Embed the Alpine Institute as the primary vehicle of staff development and education, and community based learning opportunities • Expand the scope of courses available under the Registered Training Organisation • Seek approval through the Victorian Regulation and Qualification Authority to broaden the registration scope of the Registered Training Organisation to include course delivery to individuals external to Alpine Health • Progress toward workforce structures and systems that enable staff to work more consistently at the upper limits of their training and expertise • Equip our workforce with the skills and capacity to deliver customer focussed care • Continue the commitment to provide traineeships, and establish relationships with local secondary colleges to facilitate school based traineeships • Maintain a comprehensive development agenda for existing staff • Develop further capacity to support and deliver training through contemporary technology • Establish the capacity and mechanisms for the professional supervision of all staff members and the supervision of workforce performance

Workforce Positioning The medium to long-term security of Alpine Health’s workforce will require a concerted effort on positioning both the current and prospective workforce to meet the health needs of the Alpine community. As a consequence, Alpine Health will employ a risk management approach to the management of its workforce to support both strategic and operational workforce development objectives.

Alpine Health will take a deliberate approach to the establishment of employment pathways that foster the movement and up-skilling of existing staff into both established and emerging areas of work need, whilst a significant focus will be drawn on ensuring critical workforce skills exist within the community from which a skilled and ready workforce can be accessed to sustain Alpine Health’s commitments to service provision.

The role of Alpine Institute is critical in this regard. A selection of certificate and diploma based courses will be explored for development and established within the Institutes scope providing opportunity for employment pathways across all domains of Alpine Health’s workforce – clinical services, essential services, community health service, and administration.

Relationships will be forged and expanded with the community and service sectors across the community including schools, industry, and local government to ensure pathways through education are inclusive, accessible and relevant to the broad Alpine demographic.

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Alpine Health’s workforce and service capacity is greatly advanced by the engagement of volunteers and voluntary efforts. Voluntary effort has a long history within our organisation and has manifested primarily within formal group structures including the CHAGS, Aged Care Advocates, health and community support groups, Op Shops and the Men’s Sheds. A more coordinated approach to the support of volunteers acting in an individual capacity across Alpine Health’s service structure will form a focus of Service Plan 6, and together with the ongoing work of advisory committees, charitable foundations, auxiliaries and fundraising originations voluntary effort will form a large and important part of the broader “workforce” providing care and improving the health and well-being of others.

The notion of local services for local people will guide Alpine Health’s strategy of workforce positioning, providing a focus for workforce development activity and the placement and expansion of workforce opportunities. This focus will include the long term positioning of our workforce into primary health care to ensure that the needs of our community are met locally.

Workforce Configuration Workforce configuration is pivotal to the success of Alpine Health’s service strategies, and is primarily concerned with the adoption of workforce planning strategies capable of influencing the configuration of a workforce that places staff with the right skills, in the right jobs, at the right time.

Workforce planning strategies to influence the appropriate configuration of workforce shall include:  Identifying and structuring an appropriate skill mix that meets flexible service and individual needs whilst enabling staff to work more consistently to an expanded scope of practice with appropriate supervision  Employing workforce planning methodologies and approaches drawn from consumers and health need, and predictive modelling  Making better and joined-up use of service and workforce data to direct appropriate resource allocation and role design  Initiating collaborative, team based review and analysis that informs workforce configuration and distribution of skill  Testing provisions of workforce configuration and flexibility contained within relevant Enterprise Bargaining Agreements  Initiating external workforce partnerships and alignment for service development and review  Commissioning a review of Alpine Health’s staff establishment

Alpine Health will continue to investigate strategies that assist in managing complex change initiatives that influence workforce configuration. The importance of process, principles of engagement and accountability are central to maintaining transparency in determining workforce configuration.

Alpine Health will pursue the notion of a fair and just workforce for all in defining and configuring a workforce capable of meeting our service objectives. The configuration of workforce will provide for opportunity based on merit, prioritise consumer and health need, expose and stretch the workforce to operational models that improve productivity and health outcomes, and foster a flexible and adaptable approach to work need.

Workforce Health and Safety Workforce health and safety is fundamental to our workforce strategy. Alpine Health’s ability to meet its Service Plan is enhanced by a commitment to improvements in health and safety.

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Alpine Health has made great strides in this regard over the life of the previous Service Plan. Testament to this is the: • Successful implementation of a risk management and incident reporting framework, applied to all areas of Alpine Health • Establishment of a risk register and mitigation strategies to promote the health, safety, and wellbeing of staff and volunteers • Investment in staff health through a range of initiatives focusing on informing and equipping staff to better manage their health • Decline in sick leave taken by staff • A reduction in WorkCover claims • The maintenance of WorkCover premiums below industry standards

Alpine Health is committed to building work environments and practices that promote health, safety and wellbeing. The challenges remain the protection and improvement of staff health, safety and wellbeing (inclusive of volunteers and contractors), preventing illness and injury, implementing return to work and rehabilitation programs for those who are injured at work, and importantly engaging staff in direct decision making and action that influences the health and safety of our work environment.

Alpine Health will meet this commitment by: • The pursuit and periodic review of established risk management strategies • Encouraging staff in choices that positively impact on their personal health, wellbeing and quality of life to support a strong and fulfilling contribution to Alpine Health • Building robust systems for promoting and maintaining the health and well-being of our staff members • Continuing to develop mechanisms that engage staff in health, safety and wellbeing strategy development • Engaging people to the organisation with a commitment to personal health and safety, and to that of their colleagues

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