Bordertown 10 Year Local Health Service Plan

2011 – 2020

Bordertown and District Health Advisory Council Bordertown Memorial Hospital Country Health SA Local Health Network

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10 Year Local Health Service Plan

Bordertown Memorial Hospital

2011 - 2020

Table of Contents

1. Executive Summary ...... 3 2. Catchment Summary ...... 4 3. Needs Analysis Summary ...... 6 4. Local Implications of Statewide plans...... 10 5. Planning Principles...... 11 6. Service Delivery Plan...... 12 6.1 Core Services to be Sustained ...... 12 6.2 Strategies for new / expanded services ...... 17 7. Key Requirements for Supporting Services...... 21 7.1 Safety & Quality...... 21 7.2 Patient Journey ...... 22 7.3 Cultural Respect...... 23 7.4 Engaging with our community...... 23 7.5 Local Clinical Networks ...... 24 8. Resources Strategy ...... 26 8.1 Workforce...... 26 8.2 Infrastructure ...... 27 8.3 Finance ...... 27 8.4 Information Technology...... 28 8.5 Risk Analysis...... 28 9. Appendix ...... 29 8.6 Leadership Structure ...... 29 8.7 Methodology...... 29 8.8 Review Process...... 29 8.9 Glossary...... 30

Date: 8 August 2011

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1. Executive Summary

Background and context The Bordertown Memorial Hospital (BMH) has taken the lead and determining role in the development of the 10 Year Health Service Plan, with the support of the Country Health SA Local Health Network (CHSALHN) Planning Projects Team. The Bordertown and District Health Advisory Council Inc (HAC) has worked closely with the BMH in the planning and implementation of the community consultation as well as the review and consultation of the Plan. A Local Liaison Planning Officer and South East Planner have worked with the HAC in the planning and implementation phases of the community consultation and needs analysis processes. A workshop was held in August 2009 with the Local Liaison Planning Officer, South East Planner and the Bordertown and District HAC members to identify the priority areas for community consultation. Small groups from the workshop were then selected to progress the consultations through focus groups during the next few months in areas identified including local government, local medical practitioners, youth, aged care, disability, community groups and local staff. Feedback was accepted up until the 15 March 2010.

The needs analysis has included all of the findings from these community consultation processes as well as analysis of the Health Service Profile and other relevant data.

Key components of the Plan

Key evidence which supports the maintenance of these services and the right of people to access safe services as close to home as possible within available resources includes: geographic remoteness/isolation, an increasing and ageing population, diverse levels of socioeconomic disadvantage with some very disadvantaged areas, limited availability of flexible and affordable transport options, and the reliance on volunteer ambulance crews.

The primary focus of the Plan is to sustain and maintain current services including 24/7 emergency and acute inpatient care, nominated elective surgery, community health (including outpatients, GP Plus strategies, allied health), mental health (including drug and alcohol services), in-home and residential aged care, medical specialists, respite and rehabilitation, palliative care, clinical support services and oral/dental health services.

Recommendations

• Maintenance of a 24 hour emergency service. • Maintenance of existing acute care, day surgical and aged care services. • Ongoing review and planning of acute care hospital and community health services to meet the future needs of the area. • Ongoing workforce development, recruitment and retention of community, hospital and medical health professionals. • Improve and coordinate GP Plus strategies and packages of care across the Upper South East cluster. • Development of more comprehensive palliative care services and effective coordination of palliative care for cancer patients. • Improve information and communication technology (ICT) support for clinical requirements. • Improve and coordinate improved mental health services. • Feasibility of building a new Medical Centre on the grounds of the Hospital. • Feasibility of rebuilding a purpose built low level of care facility. • Continued support for the recruitment and retention needs of the local general practice to maintain a minimum of 4 general practitioners.

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2. Catchment Summary

Introduction

The township of Bordertown is located approximately 270 kilometres south-east of and approximately 180 kilometres north of Country General Hospital.

The Bordertown Memorial Hospital is situated within the Tatiara District Council area. The catchment area for the Hospital encompasses the Tatiara Statistical Local Area (SLA) which includes Keith to the north-west, Willalooka to the west, Padthaway to the south-west and Wolseley to the east (see map below). The catchment also extends into , with residents from Serviceton accessing regular health services from the Bordertown Memorial Hospital.

Reference: http://www.atlas.sa.gov.au/

Population

The estimated resident population for the Bordertown catchment is 7,101 (DPLG, ERP, 2011). People from Aboriginal and Torres Strait Islander backgrounds comprise 0.9% of the Bordertown catchment compared with 3.1% of the total country South Australian population. Approximately 2.5% of the population in the Bordertown catchment speak a language other than English at home, compared with 3.9% of the total country South Australian population.

When compared with country South Australian averages, in the Bordertown catchment there is a slightly lower proportion of the population over 45 years, and a higher proportion in the 0-14 and 25-44 year age groups. Approximately one-third of the population is under 24 years of age. The projected population for the catchment area is estimated to decrease by the year 2021. The fertility rate for the broader catchment is approximately 2.34. This is above replacement level and higher than the South Australian rate (1.82). The indirect standardised death rate for the catchment (6.4) is slightly higher than the South Australian average (6.1).

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The South East region had an estimated 589,000 overnight visitors and 1,758,000 day visitors in 2007. There were 13,898 visitors to Bordertown in 2008.

Table 1: Bordertown catchment population

Country USE Cluster SA total No. % SA Cluster % % % Total Population 7,101 19,806 490,635 1,667,444

Males 3,735 52.6% 10,289 51.9% 50.5% 49.4% Females 3,366 47.4% 9,517 48.1% 49.5% 50.6%

0-14 years 1,422 20.0% 3,764 19.0% 20.4% 18.5% 15-24 years 860 12.1% 2,356 11.9% 11.4% 13.3% 25-44 years 1,919 27.0% 5,133 25.9% 25.1% 26.7% 45-64 years 1,911 26.9% 5,469 27.6% 27.3% 26.1% 65-84 years 860 12.1% 2,670 13.5% 13.9% 13.4% 85 years and over 129 1.8% 414 2.1% 1.8% 2.0%

ATSI* 65 0.9% 208 1.1% 3.1% 1.7% CALD (Speaks a language 177 2.5% 823 4.2% 3.9% 12.2% other than English at home)* Source: Projected population by age and sex – SLAs in , 30 June 2011, Department of Planning and Local Government *Source: 2006 ABS Census

Socioeconomic factors

The catchment region has been identified as outer regional indicating a moderate level of remoteness when compared with other South Australian locations. The catchment reflects a moderate degree of socioeconomic disadvantage.

Based on data which monitors the trends of diseases, health related problems, risk factors and other issues across major regional areas, the South East region demonstrates higher levels of risk factors for overweight, obesity, physical inactivity, and smoking when compared with total South Australia. The prevalence of chronic disease for persons aged 16 years and over in the South East region demonstrates a higher prevalence of diabetes when compared with total South Australia.

The is one of South Australia's highly productive and diverse agricultural regions with a range of products including vegetables, wine grapes, cereal grain, softwood timber, pastures and . Fishing is also a major contributor to the regional economy and aquaculture an emerging industry. Unique natural attractions such as the World Heritage listed Naracoorte Caves and the Blue Lake at Mount Gambier contribute to an active tourism industry. Agriculture, forestry and fishing make up 31% of total employment across the Bordertown catchment, followed by manufacturing (16%) and retail trade (9%). The Upper South East region, along with other major areas of the State, has been identified for exceptional circumstances due to the prevailing drought.

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3. Needs Analysis Summary

The Bordertown and District Health Advisory Council undertook the needs analysis by making inferences about health needs from existing community and stakeholder feedback received through the previous redevelopment, consideration of statewide planning implications, and data presented in the Health Service Profile.

The key elements, identified in the needs analysis process, that impact across all health services include:

• Ongoing recruitment and retention of general practitioners. • Plans to build a purpose built medical centre on the grounds of the Hospital. • Feasibility of upgrade to the hostel accommodation. • Improve patient journey – discharge, pre admission planning and review transport options and support for clients travelling to other centres for health care. • Improve the use of telehealth and ICT. • Increase the number of visiting Specialist Services

The needs analysis process identified a vast range of strengths, weaknesses, opportunities and threats across the individual service categories. The Bordertown and District Health Advisory Council identified priorities for each major service category to clearly focus on the most important areas for the 10 Year Health Service Plan as summarised below:

Radiology services • Patient transfers and prolonged diagnosis were being experienced through the existing radiology service which was unable to support effective remote reporting. This has led to the need for improved digital radiology services which now require further development to provide the ability to remotely report.

Mental Health • Increasing emergency and after hours mental health presentations emphasise the need for improved emergency mental health response. • The need to increase the focus on wellbeing and restorative approaches and dissemination of information on services available and the expanded usage of programs that aim to support people at home. • State and countrywide strategic directions, provisions of the new Mental Health Act from 1st July 2010 and local clinician and community feedback have identified the need for: o Improved capacity for early intervention o Collaboration with appropriate services o Targeting vulnerable and at risk groups in the community o Adequately resourced tele-medicine units will need to be made available • Statewide directions for Country General Hospitals and the rates of mental health emphasised the need for a Limited Treatment Centre and step down beds/Mental Health Intermediate care in future planning. • Increasing rates of mental health needs requires enhanced care in the community and expanded early intervention services.

Security and access • Staff security audits have identified increasing aggression of patients/residents in both the emergency and aged care services noting the need for enhanced security. • Adhere to standards and procedures.

Information Technology • Adequately resourced tele-medicine units need to be available and supported. • Explore introduction of common electronic client records. • Point of Care technology.

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Safety and Quality & Infection Control • Adhere to standards and procedures.

Acute Care • High demand on inpatient admissions and readmissions reiterate the need to maintain acute inpatient care. • Geographic isolation creating a significant social and economic impact on people that are not able to access services locally, emphasising the need to sustain core services such as emergency services, inpatient acute care, telehealth services and other existing services. • Historic and projected growth in demand for same day services, particularly general surgical services and the feasibility for ophthalmology services to support the maintenance and expansion of same day services based on local needs.

Workforce • Support for new approaches to recruitment and retention. • Support for and provision of training and education. • Sustainability of services such as surgery and aged care has been affected by the skill mix and retention of specialised staff. Sustainable recruitment retention models are critical for the future.

Aged Care • Local community and clinician feedback have highlighted the need for the expansion of mental health services for older people. • The demands an ageing population will place on health services has been identified by state and national strategic directions and well supported by local clinician and community feedback it is therefore essential that adequate support, cooperation and development of service strategies are established to meet these demands. • Local community and clinician feedback reinforces the strategic direction to improve coordination of both residential and community care and individualised client centred approaches which maximise privacy and dignity, promote physical and mental function and increase consultation and participation. • Increasing rates of dementia, a lack of existing capacity and statewide planning directions highlight the need to enhance the dementia service model. • The community and clinicians have noted the increasing demand for respite care needs in the home / community. • Increasing number of older people into the future will create demand for home and community care services.

Accident and Emergency • Clinician and community feedback have identified the need to support workforce requirements, both medical and nursing, and the need for ongoing training and education particularly in triage and assessment skills. • Community feedback and clinician feedback identified the need for greater community education regarding accident and emergency service provision and processes.

Rehabilitation • Statewide directions for Country General Hospitals and local community and clinician feedback support the development of a regional rehabilitation service which incorporates inpatient, home-based, centre-based day therapy and outpatient rehabilitation supported by a multidisciplinary team. • The need to increase the focus on wellbeing and restorative approaches has been identified by State and countrywide strategic directions and local clinician and community feedback which will require education and dissemination of information on services available and the expanded usage of programs that aim to support people at home.

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• State and countrywide strategic directions and local community and clinician feedback recognise that increased rehabilitation services locally will require an increase workforce, increase in coordination and collaboration to work across the continuum of care.

Transport and travel options • Work collaboratively in the region to develop increased transport and travel options. • Improve education and information dissemination of transport and travel options.

Culturally appropriate services • Meet the needs of the Indigenous and Culturally and Linguistically Diverse communities. • Extensive education and training for mainstream services. • Adequate use and access to interpreter service

Collaboration – intra and inter agency • Increase focus on working collaboratively. • Processes to support inter and intra agency collaboration.

Aboriginal Health • Local community and clinician feedback reinforced state and national strategic directions to reduce the gap in health outcomes for Indigenous Australians. • Analysis of Aboriginal health needs in the Tatiara has a burden of physical, spiritual, social and emotional illness related to disadvantage across social determinants of health. The Aboriginal communities across the Tatiara health issues include maternal, child and infant, transport and access, drug and alcohol, youth, chronic disease and mental health. The methods identified to assist in improving the wellness of local Indigenous communities are: o Training for mainstreaming services – designated cultural awareness training officer across all of health and human services in the Tatiara o Expand chronic disease self management programs o Expand maternal and infant health programs o Expand women’s and men’s health programs o Explore ability to improve career pathway for Aboriginal health workers – links to further education and training o Establish a new Indigenous reference group o Assist local AHAC and provide education and training to members. • Continue to engage with the Aboriginal communities – by Health Advisory Councils and Upper SE cluster service providers • HACs to engage with Aboriginal Health Team, Aboriginal Health Council, Aboriginal Elders Group, AHAC • Priority towards recruiting Aboriginal people and up-skilling current employees • Ongoing cultural respect and awareness training • Improve the understanding and utilisation of Aboriginal Impact Statements

Leadership • Supportive stable leadership. • Advocating for client centred care. • Prioritise community wellbeing approaches. • Rural based higher education (undergraduate and post graduate) courses. • Collaboration with training and education programs and facilities. • Support with collaborative research and evaluation. Linkage with Flinders University Rural Clinical School and other Universities

Allied Health • An increased focus on wellbeing and population health initiatives such as early intervention and targeting vulnerable and at risk groups, in particular the economically and socially disadvantaged in the community has been identified by state and countrywide strategic directions and local community and clinician feedback.

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• Statewide directions in the chronic diseases and local clinician feedback supports the expansion of self management programs and Out of Hospital Strategies. • The state and national focus well supported by international research and direction in early intervention and childhood development along clinician and community feedback have reiterated the need for expanded early childhood services locally.

Infrastructure . • Prioritise across the cluster for infrastructure and equipment upgrades and redevelopment • Develop business cases for priority needs to pursue funding opportunities • Partnership with other agencies who have a vested interest in health infrastructure and equipment – e.g. general practice, local government • Review of the business case to locate medical practice at hospital and re submission to the Commonwealth for funding. • Feasibility study of rebuilding current hostel facility • Review options to expand the current theatre ‘clean up’ area to be standard compliant

Community Health -Out of Hospital Strategies • Collaboration with appropriate services targeting vulnerable and at risk groups in the community. Adequately resourced tele-medicine units will need to be available. • Statewide directions in the chronic diseases and local clinician feedback supports the expansion of self management programs and Out of Hospital Strategies • Reorientation of services to achieve a greater focus on PHC, early intervention and health promotion, an increase focus on restorative approaches and an increased ability to provide nurse/allied health led clinics that focus on wellness and prevention are all supported by Statewide directions, clinician and community feedback. • The demands our ageing population will place on health services has been identified by state and national strategic directions and well supported by local clinician and community feedback it is therefore essential that adequate support, cooperation and development of service strategies are established to meet these demands. • The state and national focus, well supported by international research and direction in early intervention and childhood development, along with clinician and community feedback have reiterated the need for expanded early childhood services locally. • The need to increase the focus on wellbeing and population health initiatives such as early intervention and targeting vulnerable and at risk groups in the community has been identified by State and countrywide strategic directions and local community and clinician feedback. To achieve this there is a need to: o expand and improve collaborative approaches and links with community based services o have a greater focus on client/family centred care o have a greater focus on Primary Health Care approaches o improve care coordination o expand the Out of Hospital Strategy programs to reduce hospital length of stay, improve discharge planning and reduce unnecessary admissions o provide nurse/allied health led clinics that focus on wellness and prevention o increase early intervention and target vulnerable and at risk groups in particular the economically and socially disadvantaged. • Local community and clinician feedback reinforces the strategic direction to provide services closer to home including chemotherapy and like services. • Statewide directions in the chronic disease management and local clinician feedback supports the expansion of self management programs and Out of Hospital Strategies. • Local community and clinician feedback reinforces the strategic direction to improve coordination of care and individualised client centred approaches which maximise privacy and dignity, promote physical and mental function and increase consultation and participation. • High rates of chronic disease and risk taking behaviour could be improved through enhanced community based service models. • The community and clinicians have noted that the lack of 24 hour and specialist palliative care services restricts people’s capability of staying in the community.

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4. Local Implications of Statewide Plans

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

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

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

• Multi-disciplinary teams across and external to the public health system. • Patient focused care. • Care as close to home as possible. • Teaching and research integrated in service models. • Integrated service model across the continuum of care. • Streamlining access to specialist consultations. • Increasing use of tele-medicine. • Improving Aboriginal health services. • Focus on safety and quality. • Recruiting and developing a workforce to meet future service models. • Engaging closely with consumers and community. • Developing the infrastructure to meet future service models. • Clinical networking and leadership. • Connecting local patients with pathways to higher level care needs. • Reducing progression to chronic disease for at risk populations.

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

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5. Planning Principles

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

1. Focusing on the needs of patients, carers and their families utilising a holistic care approach. 2. Ensuring sustainability of country health service provision. 3. Ensuring effective engagement with local communities and service providers. 4. Improving Aboriginal health status. 5. Contributing to equity in health outcomes. 6. Strengthening the IT infrastructure. 7. Providing a focus on safety and quality. 8. Recognising that each health service is part of a total health care system. 9. Maximising the best use of resources. 10. Adapting to changing needs.

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6. Service Delivery Plan

6.1 Core Services to be Sustained

Service Category Service Description Target Group Directions over next 10 years Community & • Local primary health care initiatives, chronic disease Residents Tatiara • Reorientate from a visiting allied health service to Allied Health services, community nursing services, Domiciliary community recruit and establish local allied health team Care, day care activities, step down unit and specific including: • Increased chronic disease management systems 1 GP Plus strategies hospital strategies • Children • Improve the waiting time for clients • Access to Aboriginal health, drug and alcohol • Youth • Extend the bi-annual mammogram service to services, community mental health (adult and child). • Disabled Bordertown • Access to visiting allied health services • Frail Aged • Diabetes services recently introduced be maintained • Limestone Coast Division of General Practice have • Aboriginal locally recently commenced a local diabetes service people • Maintain the level of services currently provided • CALD people • Increase the funded and adequately staff a men’s health program and service • Increase the available podiatry services and decrease the waiting times • Promote and communicate to the community all local community health services available • Promote the importance and availability of a men’s health service annually Local General • Inadequate local Medical Centre infrastructure in Tatiara District • Build a new purpose Medical Centre/Hub on the Practitioner Services Bordertown community Hospital grounds in Bordertown • Maintain the current numbers of general practitioners including: • GP Plus model to be investigated in both Bordertown and Keith • Visitors • Increase the level of locum support available to all GPs • General practitioner services are provided to the • Seasonal at both clinics locally communities in Bordertown and Keith from Workers • CHSALHN to support and assist local communities in local clinics (Bordertown Family Medicine and Keith the recruitment process for local communities when Surgery) they are required to recruit new general practitioners Medical Specialist • Access to range of visiting medical specialist services Tatiara District • Increase surgical specialist consultations Services • 9 visiting specialists consult at the Bordertown Community • Implement increased virtual specialist services through Memorial Hospital and 4 undertake procedures at the including: telemedicine Hospital • Visitors • Maintain the current visiting medical specialist services • Seasonal • Improve and extend the number and availability of Workers specialist services locally to include e.g. psychiatry • Improve the availability of local transport for patients/consumers when they are required to access services out of the town and monitor the level of need

1 Chronic Disease Action Plan for South Australia 2009-2018 12

Service Category Service Description Target Group Directions over next 10 years Emergency Service • 24 hour, 7 day/week emergency triage and Tatiara District • Improved specialist mental health emergency and 24 assessment; emergency trauma and resuscitation, community hour, 7 day/week services mental health service through telehealth, minor • Visitors • Improved emergency telemedicine systems emergency surgical procedures • Seasonal • Provision of after hours security support • Appropriately staffed and supported by medical and Workers • Continue to enhance retrieval in conjunction with nursing staff MedSTAR Statewide Retrieval Service, South • Treatment for/management of appropriate (non-life Australian Ambulance Service and the Royal Flying threatening) conditions and minor surgical Doctor Service procedures • Improve current communication and workplace • Inpatient diagnosis, monitoring and treatment of strategies with key stakeholders to provide a more appropriate conditions comprehensive A&E service to the community • Telehealth facility in emergency rooms • Review and seek funding to increase emergency care • MedSTAR communication with A&E access to training opportunities videoconferencing • Introduce an ultrasound service • Improved radiology service with ability to send externally (digitally) for reporting • South Australian Ambulance Services (SAAS) provide and support emergency services to the Tatiara District Acute Inpatient Care • Admissions for management of minor (lower risk) Tatiara District • Improved service to Aboriginal clients assessments and treatments; Intermediate care community • Improved provision and coordination of same day including recuperative care • Visitors services • Admissions for acute medical, same day or overnight • Seasonal • Review and seek funding to increase acute care surgery, mental health, chemotherapy Workers training opportunities • Access to general practitioner practice service to • Broader recruitment and retention strategies across provide both acute illness management cluster to address both ageing workforce and workforce development plus Aboriginal employment strategy Elective Surgical • Minor procedures, day surgical procedures and level Tatiara District • Maintain access to a functional operating theatre to 1 surgery community support appropriate elective surgery • Operating theatre staffed and equipped to support a • Maintain current surgical workforce and skill mix range of lower risk and appropriate surgeries • Investigate opportunities to enhance the general • Maintain the current operating room surgical services surgical services, to include ophthalmology and ensure currently provided that all surgery conducted occurs within budgeted resources meets relevant Australian Standards. • Improved day only service / facilities / systems • Strengthen pathways for patients that are required to travel for surgery in regional centres or Adelaide • Continuous improvement in the rigour or peri-operative assessment and management

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Service Category Service Description Target Group Directions over next 10 years Rehabilitation • Admissions for recuperative and maintenance care Tatiara District • Supporting down transfers for patients from the • Community/home based rehabilitation support community catchment area to return for inpatient and community • Centre based day therapy based care • Build on access to Transitional Care Packages and Country Home Link to support restorative care • Seamless links between services across the health system 2 • Investigate the feasibility of a hydrotherapy pool to be built locally in the future Oral Health • Inpatient low technology specialist services Tatiara District • Build capacity / sustainability of current dental service community • Advocate for public dental service Focus on: • Early childhood • Elderly Mental Health • Shared care management in partnership with a Tatiara District • Building a mental health network that is fully integrated general practitioner community across the community • Local admissions for mental health including respite Focus on: • Working in partnership with a range of government and and short stay options • Aboriginal non government agencies across the cluster 3 • 24 hour, 7 day/week emergency mental health people • Implement the key recommendations from the Stepping service • Disadvantaged Up Report 4 and new Mental Health Act (2009) • Access to community mental health services groups • Improving support in the early stages of mental illness • Access to specialist mental health services via • Visitors • Improve the mental health services available and visiting specialist or telehealth • Seasonal investigate the opportunity of access to a visiting workers psychiatrist and other mental health professionals Clinical Support Services • Point of care testing Tatiara District • Implement visiting on site medical imaging service • Access to pharmacy services Community including visiting / virtual radiologist service • Access to general X-ray capabilities including: • Establish local sonography service • Visitors • Improved radiology service with image transfer and • Seasonal remote reporting workers • Multi-disciplinary workforce skilled and licensed to undertake diagnostics investigations • Expand point of care testing • Access to ultrasound service locally • Identify the needs of the multicultural populations and endure their health needs are met

2 Statewide Rehabilitation Service Plan 2009-2017 3 South Australia’s Mental Health and Wellbeing Policy 4 Stepping up Report, Social Inclusion Report 14

Service Category Service Description Target Group Directions over next 10 years Travel • Patient Assisted Transport Scheme (PATS) Tatiara District • PATS Scheme needs reviewing as it does not support • Red Cross car community the need of rural and remote communities including: • Resident catchment area reimbursements are very low • Visitors • Simplify the PATS scheme reimbursement process • Seasonal • Maintain an appropriate level of funding for the workers Bordertown Hospital up transfers • More support and extend the availability of the Red Cross car service Children’s Services and • Child and Youth Health Tatiara District • Visiting paediatrician and speech pathologist Youth community • In partnership with local schools provide a counselling service to children

Respite Services • Access to community, residential and hospital aged Tatiara District • Increased home based respite services care respite community • Increase the respite services available to the Focus on: community • Frail/Aged/ Disabled Aged Care • Domiciliary Care in home and the community Tatiara District • Rebuild the current Hostel facility in Bordertown with a • Inpatient admissions for elderly, including respite community purpose built facility care Focus on: • Continue to provide the level and number of existing • Low and high care residential aged care • Frail aged care services 5 • Independent living units • Elderly, their • Dementia specific services and facility in both • Access to Aged Care Assessment Teams (ACAT) carers and Bordertown and Keith • Broad range of services currently provided including family • Strengthen capacity to meet growth in home and day care, ACAT, home help, community nursing and community care services mental health options for older people • Review of funding levels to meet projected growth of • Large volunteer base who support community required aged care services within the next 10 years programs and in-patient care • Broader recruitment and retention strategies across • Volunteers are now integrated across acute. Aged cluster to address both ageing workforce and workforce care and community settings development • Hostel accommodation to be built and provided in Keith • Extension and improvement of the activity centre services provided to address ageing population needs • Explore opportunities for provision of a men’s shed • Investigate the introduction of a mature maintenance service to assist the ageing population (elderly/disabled/infirm) • Develop a community communication package to promote awareness of services available for those able to remain in their homes

5 Health Services Framework for Older People 2009-2016 15

Service Category Service Description Target Group Directions over next 10 years Palliative Care • Inpatient admissions for palliative care including more Tatiara District • See Strategies for new / expanded services complex medical care community • Review and plan the palliative care services over the • Provide in-patient and community palliative care next 10 years in accordance with the Statewide services Palliative Care Plan 6 (including outpatient oncology services and chemotherapy) • Implement palliative care packages of care across the Upper South East cluster • Broader recruitment and retention strategies across cluster to address both ageing workforce and workforce development plus Aboriginal employment strategy

6 Palliative Care Services Plan 2009-2016 16

6.2 Strategies for new / expanded services

Service objective 1: Increased focus on GP Plus services to maintain health and wellbeing 7 Target Group: Tatiara District, community and visitors Critical milestones: Purpose built medical centre on Hospital grounds integrated with GP Plus model

Outcomes Strategies Time Frames Implement sustainable GP Plus Model • Integrate health service with medical, dental, primary health care, Aboriginal health, aged care and community based resources as well as Accessible for multicultural population within the catchment the inpatient (hospital) facilities area • Establish a single entry point (one-stop-shop) for health needs of the community Build GP Plus clinic • Place the consumer/patient at the centre of the health care team as a participant rather than a recipient • Establish culturally appropriate and improved services • Establish facilities and service models which have the flexible capacity to respond to and meet the changing health and wellbeing needs of its catchment population over the next 20 years

7 Strategy for Planning Country Health Services in South Australia 17

Service objective 2: Expand local Palliative Care Services Target Group: Tatiara District community, seasonal workers and visitors Critical milestones: Obtaining and increasing palliative care services closer to home

Outcomes Strategies Time Frames • After hours home based palliative care services • Establish short term package options • Visiting palliative care specialist services • Advocate for existing specialist palliative care services to increase.

• Support for culturally appropriate grief and palliative care • Implementation of the SA Health Palliative Care Services Plan 2009- 2016 8

8 Palliative Care Services Plan 2009-2016 18

Service objective 3: Mental Health Services and Statewide Services – expanded mental health service with a prevention and early intervention focus 9 Target Group: Tatiara District community, seasonal workers and visitors Critical milestones: Recruitment of visiting psychiatrist

Outcomes Strategies Time Frames Sustainable Mental Health services with a prevention • Increase access to skilled mental health staff – recruit visiting psychiatrist and early intervention focus, responsive to community need • Integration of prevention and early intervention strategies into primary health care programs • Improve care coordination through improved case management • Improve partnerships with other agencies – e.g. GPs and Divisions of General Practice, DASSA, CAMHS, C&YHS • Investigate local and metropolitan accommodation options for patient transition to community episodes

9 South Australia’s Mental Health and Wellbeing Policy 19

Service objective 4: Community Health Services – expand and enhance chronic disease self-management services 10 Target Group: People with a chronic disease Critical milestones: Implementation of an improved model of service delivery for chronic disease self-management

Outcomes Strategies Time Frames Sustainable chronic disease self-management services with a • Reorient services to prevention and early intervention prevention and early intervention focus, responsive to • Develop partnerships between community health services, acute community need services, residential aged care services and non-government organisations • Improve, through up-skilling, utilisation of the workforce • Ongoing training of staff and community in chronic disease self management

10 Chronic Disease Action Plan for South Australia 2009-2018 20

7. Key Requirements for Supporting Services

7.1 Safety & Quality

Objective: Maintenance and ongoing improvement of the quality and safety of our health services within the available resources Critical milestones: Australian Council on Healthcare Standards (ACHS), Aged Care Standards Agency Accreditation and other required accreditations, maintained by all sites

Outcomes Existing Strategies Sustained Strategies for the Future Quality, risk and safety systems across all the • Development of a cluster-wide quality, safety and risk • Ongoing development of a cluster-wide quality, safety Upper SE cluster sites resulting in improved process and risk management system that ensures outcomes for health care consumers • Local quality and safety committees compliance with legislation, codes of practice and • Implementation of the new CHSALHN OHSW&IM accreditation standards Quality, risk and safety systems across all Upper manual • Promote a safety culture SE cluster sites resulting in a physically and • Use of clinical practice guidelines and standards • Ongoing development of the cluster-wide clinical professionally safe working environment for staff • Participate in local and state clinical networks governance framework • Injury prevention and injury management - staff • Continue patient safety programs and initiatives • OH&S/patient safety programs and initiatives – e.g. • Ongoing contribution and participation in the country- Red Dot and Green Box (falls prevention) programs; wide accreditation and policy framework Greensleeve program (Respecting Patient Choices) • Advanced Incident Management Systems (AIMS) reporting and follow-up • Consumer feedback policy and procedures • Australian Council on Healthcare Standards (ACHS), Aged Care Standards, HACC and other relevant accreditation processes • Partnership plans with Workcover Data collection and analysis to support planning • Implementation of shared drive (ICT) across the • Country roll-out of CareConnect electronic health and development to meet community need cluster record project and other ICT initiatives • Using Client Management Engine (CME) and other • Improved data collection and analysis using the prescribed data collection and management systems available to improve safety and quality programs • Improved utilisation of data and information collected to inform best practice

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7.2 Patient Journey

Objective: Access to health services as close to home as possible; where this isn’t possible or practicable, access to affordable, flexible and responsive transport options Critical milestones: Community communication strategy launched/implemented

Outcomes Existing Strategies Sustained Strategies for the Future Access to safe and quality care near home • Ensure that the BMH bus is accessible to support • Improve access to information about what health people to participate in local health services services are available locally, regionally and in • Implement future directions identified in the Plan to Adelaide provide care closer to home • Consider access options as an integral part of • Community cars and volunteer drivers planning any service or activity • SA Ambulance Service (SAAS) for local emergency • Increase the use of telehealth/telemedicine and point- response and retrieval of-care testing to avoid unnecessary patient journeys • HealthDirect • Increase community uptake of HealthDirect • HealthLink (referral service) • Improve information to community, GPs and other service providers about services available locally or within the region • Encourage GPs to refer to visiting specialists – locally and within cluster • Working with other service providers (e.g. SAAS, RFDS) to maximise available services Provide a smooth and supported journey when • Coordination and planning between hospitals to • Work closely with RFDS to enhance the transfer of people do need to travel to access services enhance discharge planning mental health clients, particularly after hours • Advocate for private travel support by the Patient • Explore initiatives to support local community/health Assistance Transport Scheme where appropriate transport solutions • SAAS and Royal Flying Doctor Service (RFDS) for • Coordinate with other health services to support metro emergency response and retrieval people to return to local inpatient or community based care as soon as clinically appropriate. • Improved communication and coordination between service providers for better pre-admission and discharge planning • Ongoing review of transport options to meet changing community needs • Participate in upcoming review of current PATS system.

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7.3 Cultural Respect

Objective: Provide culturally sensitive services for Aboriginal people that meet their health and wellbeing needs – either through mainstream or Aboriginal health services Critical milestones: Ongoing community engagement by HACs; annual mandatory cultural awareness training

Outcomes Existing Strategies Sustained Strategies for the Future Health services provided for Aboriginal people in a • Implementation of culturally respectful policies and • Continue to engage with the Aboriginal communities culturally sensitive and respectful way procedures; position descriptions; contract terms and – by Health Advisory Councils and Upper SE cluster conditions service providers Health services provided for multicultural people in • Provision of a range of culturally sensitive primary • HACs to engage with Aboriginal Health Team, a culturally sensitive and respectful way health care services Aboriginal Health Council, Aboriginal Elders Group, • Aboriginal Workforce Plan - employment Aboriginal Health Advisory Committee (AHAC) opportunities provided for Aboriginal people – e.g. • Priority towards recruiting Aboriginal people and up- nursing cadetships skilling current employees • Staff orientation program includes cultural respect • Ongoing cultural respect and awareness training training • Improve the understanding and utilisation of • Cultural awareness initiatives – e.g. flying the Aboriginal Impact Statements Aboriginal flag at hospitals • Aboriginal Impact Statements

7.4 Engaging with our community

Objective 1: Develop and implement a community engagement and communication strategy Objective 2: Continue recruiting volunteers and building their capacity Critical milestones: Development of a community communication strategy; implementation; evaluation; ongoing development

Outcomes Existing Strategies Sustained Strategies for the Future The community is kept informed and up to date • Some formal and informal adhoc communication with • Development and implementation of a coordinated about health services and provided with health the community about current services and issues – and consistent community communication strategy – information they can understand newsletters, public notices e.g. service directories, newsletters, Internet-based communication; provide non-threatening opportunities for feedback/comment • Link with statewide strategies aimed at improving health literacy The community provides feedback in a structured • Consumer feedback mechanisms – e.g. complaints, • HACs develop an ongoing community engagement manner to assist in the ongoing planning and satisfaction surveys and consultation plan, taking into account minority development of services • Health Advisory Councils groups, the disabled and Aboriginal community (and 23

• Consumer initiated forums and support groups Aboriginal Health Team, Aboriginal Health Council, Aboriginal Elders Group, AHAC

• Relationship building between HACs, Upper SE cluster representatives and other key community organisations and groups • Ongoing contribution to and participation in the country-wide community engagement and consumer participation policy framework Services are supported by a sustainable volunteer • Recruitment and screening of volunteers • Increase targeted recruitment of volunteers – i.e. workforce • Community awareness education volunteers suitable to a particular service, e.g. • Recognition of volunteers and the contribution they drivers, palliative care, mental health make • Raise community awareness through education • Links with statewide organisations – e.g. Volunteering SA&NT • Links with NGOs • Review and standardise policies and procedures for recruiting and screening volunteers • Coordination of volunteers across the cluster

7.5 Local Clinical Networks

Objective: Build coordinated and seamless links between health and related services/providers across the Upper South East cluster and CHSALHN Critical milestones: Upper SE governance structure and operational plan implemented

Outcomes Existing Strategies Sustained Strategies for the Future The residents of the Upper SE cluster have • Upper SE Governance Structure and Operational • Creating an environment where collaboration is the access to quality, client focussed health services Plan norm that are safe, and are provided within the • Good, basic infrastructure for workforce – e.g. team • Consolidation of Upper SE Community Health resources available structure Service Structure • Partnerships and working relationships with other • Consolidation of Upper SE Corporate Services private and NGO agencies (e.g. CHAP, Divisions of Structure General Practice, Country North Services) • Strengthen relationships and networks with Statewide • Partnerships and working relationships with Services to build the local capacity of the service e.g. Statewide Services (DASSA, C&YHS, CAMHS, DASSA, C&YHS, CAMHS, Yarrow Place Yarrow Place) • Continue to build on existing relationships and develop formal partnerships with public/private/NGO agencies; avoid competing for funding; avoid duplication of services • Integrated and enhanced programs that support general practice – e.g. practice nurses, mental

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health, chronic disease management • Seek Commonwealth health promotion programs and initiatives that integrate with local initiatives

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8. Resources Strategy

8.1 Workforce

Objective: Maintain a skilled and experienced workforce equipped to meet the changing health environment Critical milestones: N/A

Outcomes Existing Strategies Sustained Strategies for the Future Sustainable workforce strategy • Upper SE Operational Plan – workforce (one of five • Ongoing development and implementation of the key operational areas) Upper SE Operational Plan • Credentialing of qualified medical staff • Improved succession planning for senior • Accreditation of specialist staff – e.g. diabetes nurse management positions – e.g. ongoing support of educators Clinical Leadership Program, Health LEADS, • Recruitment to existing vacancies improved mentoring opportunities • Recruitment – e.g. relocation assistance, housing • Building relationships/partnerships with tertiary assistance institutions – local and metropolitan • Health LEADS • Targeted recruitment of medical specialists to meet • Aboriginal nursing cadetships identified community need – e.g. visiting paediatrician • Undertake workforce planning – proactive response to ageing workforce and changing models of clinical care; focus on health promotion and prevention/early intervention • Develop a service model for ‘sharing’ staff across the cluster – e.g. midwives, dialysis nurses, casual pool • Focus resources for professional development around core business • Explore nurse practitioners models – A&E, palliative care, chronic disease • Increase opportunities and support for Aboriginal employment within health • Ongoing development of local clinical networks and participation in statewide clinical networks Staff feel supported and valued • Professional development program across • Building relationships/partnerships with general disciplines/work groups; mandatory training practice and GPs

• Retention incentives • Support the development of a staffing methodology • Clinical leadership program for allied health and development of career pathways • Local clinical networks • Develop cluster-wide staff recognition strategy • Performance management process

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8.2 Infrastructure

Objective: A planned approach to maintaining and developing infrastructure and equipment to meet future service requirements, and within the resources available Critical milestones: Medical practice located on Hospital grounds and feasibility study of rebuilding current hostel facility

Outcomes Existing Strategies Sustained Strategies for the Future Infrastructure and equipment that meets standards • Preventative maintenance programs • Prioritise across the cluster for infrastructure and and supports existing and future service delivery • Minor works planning equipment upgrades and redevelopment • Capital works planning • Develop business cases for priority needs to pursue • Clinical Networks and other CHSALHN programs funding opportunities have provided equipment – e.g. point-of-care testing • Partnership with other agencies who have a vested (iCCnet); ECG machines (CHSALHN A&E Project) interest in health infrastructure and equipment – e.g. • Funding infrastructure from operating budget general practice, local government • Using local capital funds to upgrade equipment and • Development of business case to locate medical develop infrastructure (i.e. donations, bequests, practice at hospital community fund raising) • Feasibility study of rebuilding current hostel facility • Aged care capital funds • Expand the current theatre ‘clean up’ area to be • Other funding sources – i.e. one-off funding for standard compliant specific infrastructure of equipment

8.3 Finance

Objective: Increase the efficiency and effectiveness in the allocation of resources, balanced with the provision of services as close to home as possible Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Sustainable resources for the Bordertown • Funding agreements with the State and • Workforce strategy integrated with service planning Memorial Hospital to provide the services Commonwealth – e.g. RPHS, HACC and development identified by community need • Annual budget process – cluster-wide • Improved use of data and information to determine • Country staffing methodology changes in level of need so appropriate responses • CHSALHN budget saving strategy can be made • Explore new and alternate funding options e.g. partnering with other organisations in funding applications • Partnership with other agencies who have a vested interest in health infrastructure and equipment – e.g. general practice, local government

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8.4 Information Technology

Objective: Improve ICT connectivity to enhance telehealth/telemedicine and communication opportunities Critical milestones: Telehealth model established

Outcomes Existing Strategies Sustained Strategies for the Future Patient journeys reduced • Telehealth and telemedicine – e.g. Rural and Remote • CareConnect Strategy – country rollout Mental Health • Reduce patient journey by providing greater • ICT that supports point-of-care testing telehealth opportunities – e.g. specialist consultations • Pathology and radiology results available via the via videoconference Internet • Improve staff skills and confidence in using ICT modalities in daily practice • Explore opportunities/options for tele-radiology • Expand point-of-care options Safer practice • ICT connectivity across the cluster via a shared drive • Improve ICT connectivity with general practice • Data collection and analysis – e.g. CME • Improve data collection and analysis to assist with • Professional development – e-based interactive skills ongoing planning development programs • Improve range and opportunities for on-line staff professional development

8.5 Risk Analysis

Objective: Identify and manage the risks associated with implementation of the planned strategies Critical milestones: NA

Outcomes Existing Strategies Sustained Strategies for the Future Successful implementation of the service • Upper SE quality, risk and safety key objectives and • Develop an implementation, monitoring and review directions identified in the 10 Year Health Service programs 2009-2011 strategy for the 10 Year Health Service Plans across Plan for the Bordertown Memorial Hospital • Risk register Upper SE cluster – early identification of risks • Hospital and health service accreditation • Ongoing contribution and participation in the CHSALHN Risk Management policy framework and activities • Greater uptake and utilisation of data collection and monitoring tool • Form an Upper SE Quality Risk and Safety Unit and Quality Risk and Safety Committee

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9. Appendix

9.1 Leadership Structure The Bordertown Memorial Hospital has led the planning process, guided the development of the Plan, liaised with the Health Advisory Council, and will oversee the ongoing monitoring and review of the Plan.

9.2 Methodology August 2009 Planning structure established; Local Liaison Planning Officer appointed; HAC engaged in the planning process. November 2009 Senior Design Consultant session on the consultation plan process and progress February 2010 Community, staff and stakeholder engagement strategy planned in partnership with HAC. March 2010 Community, staff and stakeholder engagement strategy implemented; local plans and past consultations reviewed by Local Liaison Planning Officer The community and stakeholder engagement strategy for the Tatiara District involved: • Community focus group discussions and public meetings facilitated by all the HAC members that included the Tatiara District Council area. • A letter and survey to visiting specialists and private/visiting allied health provided information and an opportunity for written feedback. • A survey was distributed to all staff via the payroll system and was collated. April 2010 Findings consolidated in needs analysis May 2010 Draft health service plan ready for CHSALHN steering committee, HAC and community consultation June 2010 Community consultation on draft Health Service Plan for the Tatiara District June 2010 Re-draft Plan to include community feedback; plan to HAC for endorsement 30 June 2010 Final Plan submitted to CHSALHN for sign off by the Minister ###

9.3 Review Process The Bordertown Memorial Hospital Executive Team will develop a review process in direct response to CHSALHN policy and direction. Generally, community respondents indicated community discussion forums (at least annually) would provide an opportunity for ongoing community engagement and consultation. Active HAC involvement and leadership in this process was seen as important. Utilisation of Internet based communication alternatives were recommended to keep communities up to date.

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9.4 Glossary

A&E Accident and Emergency ABS Australian Bureau of Statistics ACAT Aged Care Assessment Team AHAC Aboriginal Health Advisory Council BMH Bordertown Memorial Hospital CALD Culturally and linguistically diverse CAMHS Child & Adolescent Mental Health Service (Statewide Service) CHAP Country Home Advocacy Program CHSALHN Country Health SA Local Health Network CME Client Management Engine C&YHS Child & Youth Health Services (Statewide Service) DASSA Drug & Alcohol Services SA (Statewide Service) ECG Electrocardiography GP General Practitioner or Rural Doctor HAC Health Advisory Council HACC Home and Community Care iCCnet Integrated Cardiovascular Clinical Network ICT Information and Communication Technology OH&S Occupational Health and Safety OHSW&IM Occupational Health, Safety, Welfare and Injury Management NGO Non-government organisation PATS Patient Assisted Transport Scheme RFDS Royal Flying Doctor Service RPHS Rural Primary Health Service Program SAAS SA Ambulance Service SLA Statistical Local Area

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